CHAPTER 1

The Evolution of Vascular Nursing

Jeanne Doyle

Introduction

As the specialties of peripheral vascular surgery, and more recently, vascular medicine, have emerged in the last half-century, so has the specialized body of knowledge that defines vascular nursing practice. With rapid advancements in the diagnosis and management of a wide array of vascular diseases, nurses in nearly all health care settings are now caring for patients with unique needs, in an ever-expanding practice environment.

In the early 1980s, in concert with these advancements, and under the leadership of a core group of self-proclaimed “vascular nurses,” a new nursing specialty began to emerge. The founding officers and Board of Trustees members (see Table 1-1) recognized the need for nursing to define the scope and standards of our specialty practice. Originally incorporated as the Society for Peripheral Vascular Nursing (SPVN, 1982), and re-named the Society for Vascular Nursing (SVN, 1990), the formal establishment of this organization served to solidly validate vascular nursing as a unique specialty.

The charter members, and the many leaders that followed, have fostered the Society’s vision to be the premier vascular nursing organization whose members are improving outcomes for persons living with vascular disease. Our mission is to provide a professional community for vascular nurses focused on advancing the care of persons living with vascular disease through excellence in clinical practice, education, and research. With its focus on the Core Values of Excellence, Respect and Advocacy, SVN has continued to positively influence the quality of care delivery for vascular patients for the past three decades. In addition, and importantly, the Society continues to play a vital role in the multidisciplinary vascular specialty arena. An example of this collaborative work is evidenced in SVN’s endorsement of the ACC/AHA 2005 Practice Guidelines for the Management of Patients with Peripheral Artery Disease (Hirsch et al., 2006) and the 2012 ACCF/AHA/ACR/SCAI/SIR/STS/SVM/SVN/SVS Key Data Elements and Definitions for Peripheral Atherosclerotic Vascular Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Peripheral Atherosclerotic Vascular Disease) (Creager et al., 2012).

As a key component of its first 5-year strategic plan in 1983, the Society recognized the significance of and need for a specialty certification process, to help ensure the competency of nurses caring for vascular patients. This commitment evolved into the establishment of Certified Vascular Nurse (CVN) credentialing for nurses successfully completing a certification examination developed by the Vascular Nursing Certification Board, a self-governed entity within the Society as a whole. More recently, the administration of the credentialing process was adopted by the American Nurses Credentialing Center via the Cardiac/Vascular Nurse examination, in collaboration with SVN. The certification process provided the driving force behind the publication of this Core Curriculum.

TABLE 1-1 The Following Vascular Nurses Served as Charter Members of the Society for Peripheral Vascular Nursing, Incorporated in 1982

Vascular Nursing Practice

Nurses caring for patients and families with vascular disease practice in a wide variety of settings, from acute care to the community. SVN offers all nurses a network for sharing best practices, with an emphasis on evidence-based practice. The Scope and Standards of Vascular Nursing Practice (2004, update anticipated in 2014), written by nurse expert members of SVN in collaboration with the American Nurses Association, provides the framework for defining our patient population, and outlining the behavior, responsibilities, functions, and skills of both the vascular nurse generalist and the advanced practice vascular nurse. The practice of every vascular nurse should be guided by this document.

In its effort to continually improve clinical outcomes and enhance continuity of care in specified patient populations as we go forward, the Society’s Practice and Research Committee has been charged with developing guidance documents to meet this goal. The first such guideline, entitled the Clinical Practice Guideline for Patients Undergoing Endovascular Repair of Abdominal Aortic Aneurysms (AAA), was published in the June 2009 issue of the Journal of Vascular Nursing. Practice Guidelines for care of patients undergoing carotid endarterectomy and carotid artery stenting have been published subsequently, and are available to the membership of the Society’s website.

Vascular Nursing Education

Vascular nursing is ever-evolving. Advances in diagnostic and interventional technology will continue to influence the care we provide to vascular patients. It is incumbent upon each vascular nurse to actively participate in continuing education activities to assure that his/her knowledge remains current. One vital way that SVN helps to educate vascular nurses is through its national convention. What began as a half-day program of didactic content (San Francisco, 1983) has evolved into an annual 2- to 3-day comprehensive educational program covering state-of-the-art topics pertinent to the specialty, presented by internationally recognized vascular experts from all disciplines. The convention also provides an important forum for networking with vascular nurses from around the country, and indeed, around the globe.

In addition, the Society’s early publication of a newsletter, which served primarily as a communication tool for the membership, gradually evolved into the peer-reviewed Journal of Vascular Nursing, a prestigious quarterly periodical with an Editorial Board of expert vascular nurses. The Journal is recognized as a key resource for nurses in all practice areas. Also, the use of varied electronic media, along with continued enhancements of the Society’s website, www.svnnet.org, help to maintain effective communication with the membership.

And as previously mentioned, SVN strongly supports and promotes specialty certification in cardiac/vascular nursing as a tool to promote excellence in practice. It is with this latter focus in mind that this Vascular Nursing Core Curriculum was developed.

Patient/Community Education

As we better understand underlying disease processes and their associated risk factors, vascular nurses will play an even greater role in promoting arterial, venous, and lymphatic disease awareness and prevention. One notable example of the Society’s commitment in this regard was the launch of the “A Step Ahead” program at the national convention in Washington, DC, in 1993, as well as at a press conference on Capitol Hill that same year. This nurse-managed peripheral artery disease (PAD) public screening and education program served as the framework for a large scale community-based research study designed to measure PAD awareness, physician recognition, and treatment intensity (Hirsch et al., 2001). The results of this study pointed to the under-diagnosis of PAD in primary care, and led to the convening of a 2-day PAD Public Education Strategy meeting at the National Heart Lung and Blood Institute (NHLBI)/National Institutes of Health (NIH) in 2003 (Hirsch, Gloviczki, Drooz, Lovell, & Creager, 2004). SVN was one of 17 professional societies and public health associations participating in this forum.

Vascular Nursing Research

Nursing research, the foundation for evidence-based practice, is critical to the advancement of nursing, and the key to professional accountability (Kraus, 2000). In its Position Statement on Vascular Nursing Research, SVN submits that “all registered professional nurses need to clarify problems relevant to their vascular nursing practice setting, ask critical questions about the applicability of research findings to the vascular patient population, participate in data collection, and understand the value and relevance of vascular nursing research (2002).”

The Society conducted its own Vascular Nursing Research Priorities Delphi Study in the early 1990s (Hatton & Nunnelee, 1995) and replicated it in 2001 (Wipke-Tevis, 2001). This effort was designed to gain consensus and stimulate vascular nursing research by clinicians and expert researchers. In addition, the Society’s commitment to research is evidenced by its grant support of proposals reviewed and approved for grant funding by the SVN Research Committee.

Summary

In its 32-year history, the Society for Vascular Nursing has continued to outline the scope and define the standards of vascular nursing practice. Working collaboratively, SVN’s members have contributed immeasurably to promoting excellence in quality care for persons with vascular disease. As the recognized experts in vascular nursing, we must continue to chart the course. Efforts aimed at fostering collaborative educational and research initiatives with other vascular specialty societies will be key to optimizing clinical outcomes for our patients, and should be a focus of the Society in the years to come.

The Society’s core purpose and values continue to serve us well as we approach the future. Through 2015, our Society remains focused on three strategic priorities:

• SVN will be the premier resource for vascular nursing, encouraging innovation in vascular nursing practice, education, and research.

• SVN will advance the science of vascular nursing, translate evidence into practice, and improve outcomes for persons living with vascular disease.

• SVN will position its members as advocates for nurses and persons living with vascular disease.

Goals and objectives designed to meet the specific outcomes outlined in this plan are clearly articulated and measurable. Ongoing assessment will help to guide our continued evolution.

Despite our many notable achievements, we will (hopefully) always remain a work in progress, constantly striving to enhance our professional development while remaining focused on the ever-changing needs of our patients.

The evolution of our specialty and our Society is a dynamic journey, and future challenges are both daunting and exciting. I urge you to keep pace with current clinical practice as a means of optimizing quality patient care. This comprehensive Core Curriculum provides a springboard for attaining your certification as a cardiac/vascular nurse, a tangible indicator of your expertise in our specialty, and an important component of your professional development. Our patients deserve to be cared for by the most competent vascular nurses . . . wouldn’t you agree?

Jeanne Doyle, BS, RN-BC
Founding President, Society for Vascular Nursing

REFERENCES

Creager, M. A., Belkin, M., Bluth, E. I., Casey, D. E., Jr., Chaturvedi, S., Dake, M. D., . . . Ziffer, J. A. (2012) 2012 ACCF/AHA/ACR/SCAI/SIR/STS/SVM/SVN/SVS key data elements and definitions for peripheral atherosclerotic vascular disease: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Data Standards (Writing Committee to develop clinical data standards for peripheral atherosclerotic vascular disease). Circulation, 125, 395–467.

Hatton, J. M., & Nunnelee, J. D. (1995). Research priorities in vascular nursing. Journal of Vascular Nursing, 13(1), 1–7.

Hirsch, A. T., Criqui, M. H., Treat-Jacobson, D., Regensteiner, J. G., Creager, M., Olin, J. W., . . . Hiatt, W. R. (2001). Peripheral arterial disease detection, awareness, and treatment in primary care. Journal of the American Medical Association, 286(11), 1317–1324.

Hirsch, A. T., Gloviczki, P., Drooz, A., Lovell, M., & Creager, M. A. (2004). Mandate for creation of a national peripheral arterial disease public awareness program: An opportunity to improve cardiovascular health. Journal of Vascular Nursing, 22(1), 24–31.

Hirsch, A. T., Haskal, Z. J., Hertzer, N. R., Bakal, C. W., Creager, M. A., Halperin, J. L., . . . White, R. A. (2006). ACC/AHA 2005 Practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): A collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines. Circulation, 113, e463–e465.

Kraus, V. L. (2000). The research basis for practice: The foundation if evidence-based practice. In J. V. Hickey, R. M. Oiumette, & S. L. Venegoni (Eds.), Advanced practice nursing: Changing roles and clinical applications (2nd ed., pp. 317–329). Philadelphia, PA: Lippincott.

Society for Vascular Nursing. (2009). 2009 clinical practice guideline for patients undergoing endovascular repair of abdominal aortic aneurysms (AAA). Journal of Vascular Nursing, 27, 48–63.

Society for Vascular Nursing, & American Nurses Association. (2004). Scope and standards of vascular nursing practice. Washington, DC: Nursesbooks.org

Wipke-Tevis, D. D. (2001). The vascular research priorities survey: An update. Journal of Vascular Nursing, 19(3), 101–102.

SUGGESTED READING

Society for Vascular Nursing. (2000). Position statement on vascular nursing research. Pensacola, FL.