Skill to manage perioperative patients following surgical and percutaneous valvular heart disease procedures. Know the symptoms, physical findings, ECG patterns, and biomarker findings in patients with STEMI. Skills to recognize and manage abnormalities in remote monitoring of implanted cardiac devices. These core competencies apply to all nurse practitioners, regardless their medical specialty or patient population focus. Skill to utilize vasoactive and inotropic medications in the treatment of hypotension, heart failure, and shock. Know the postprocedure complications of catheter ablation in patients with atrial fibrillation, atrial flutter, supraventricular tachycardia, and ventricular tachycardia. Solicit and incorporate feedback from patients, colleagues, and healthcare professionals to improve clinical performance. Develop the practice of lifelong learning, including regular review of journals and practice guidelines, appropriate use criteria, consensus statements, and participation in scientific and continuing professional education meetings. Know the effects of heart failure on perfusion, organ function, nutrition, and energy metabolism. Know the principles of exercise physiology and guidelines for physical activity in patients with cardiovascular disease. Know the differential diagnosis and clinical features of patients with typical angina, variant angina, and noncardiac chest discomfort. Know normal arterial blood gas values and clinical implications of abnormal findings. This table represents relationships of committee members with industry and other entities that were determined to be relevant to this document. Skill to integrate history and physical findings to develop a differential diagnosis in adults with congenital heart disease. Know the indications, risks and benefits, and optimal timing for pharmacological and electrical cardioversion. Skills to interrogate, troubleshoot, program, and monitor performance of implanted cardiac devices. Since 1990, the National Organization of Nurse Practitioner Faculties (NONPF) has identified core competencies for all nurse practitioners (NPs). Practice within the scope of personal expertise, training, and technical skills. Skills to recognize and manage prosthetic valve complications. Skills to develop, implement, manage, and evaluate an evidence-based, age-appropriate plan of care for patients with lipid disorders. Skills to recognize and manage musculoskeletal limitations during cardiac rehabilitation sessions. Skill to recognize ECG changes suggestive of myocardial ischemia and/or infarction. Know the causes, physical findings, and treatment of lymphedema. Skill to perform clinical assessments for patients in all forms of shock. Skill to educate patients with cardiovascular disease on a heart healthy diet regimen. Know the clinical manifestations, differential diagnosis, evaluation, and treatment for common venous disorders. In 2016, the ACC’s Cardiovascular Team Council approached the Competency Management Committee to develop a competency statement for members of the cardiovascular care team. ACHD = adult congenital heart disease; BACH = Boston Adult Congenital Heart; UPMC = University of Pittsburgh Medical Center. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> The document was reviewed by 4 official representatives from the ACC and 25 reviewers representing the following organizations: the Accreditation Review Commission on Education for the Physician Assistant, American Academy of Physician Assistants, American Association of Heart Failure Nurses, American Association of Nurse Practitioners, American Heart Association, American Nurses Credentialing Center, Association of Physician Assistants in Cardiology, Heart Failure Society of America, Heart Rhythm Society, National Organization of Nurse Practitioner Faculties, Physician Assistant Education Association, Preventive Cardiovascular Nurses Association, and the Society for Cardiovascular Angiography and Interventions. Skills to identify, evaluate, and participate in the management of cyanosis and associated end-organ hyperviscosity issues associated with congenital heart disease shunting and pulmonary hypertension. Know the clinical presentation and diagnostic findings of statin-induced myopathies. Skills to evaluate and manage patients with venous thromboembolism. stream Skill to obtain point-of-care echocardiographic images, including those for assessment of left ventricular function, pericardial effusion, central venous pressure estimation, aortic dimensions, and significant valvular dysfunction. Skills to utilize and titrate medical therapy for patients with heart failure in both the hospital and outpatient care settings. These relationships were reviewed and updated in conjunction with all meetings and/or conference calls of the writing committee during the document development process. Skill to manage patients following catheter ablation of atrial fibrillation and atrial flutter, supraventricular tachycardias, and ventricular arrhythmias. View Article Google Scholar; 2. For the purpose of transparency, disclosure information for the Lifelong Learning Oversight Committee is available at http://www.acc.org/guidelines/about-guidelines-and-clinical-documents/clinical-document-approval. Skill to obtain a history and physical examination as clinically indicated in patients with suspected acute coronary syndromes. Know the primary prevention application of various cardiovascular risk assessment tools (e.g., atherosclerotic cardiovascular disease risk). Stable Ischemic Heart Disease Competencies for Cardiovascular Nurse Practitioners and Physician Assistants 2506, Table 13. The ACC Competency Management Committee oversees development of competency statements for cardiovascular specialists covering the entire career spectrum. 5. Skill to manage patients with heart failure with implantable hemodynamic monitoring (e.g., pulmonary artery pressure monitoring systems), including changes in volume status. Skill to manage patients with acute myocardial infarction and associated complications. Know the indications and contraindications of primary percutaneous coronary intervention as initial reperfusion strategies. Accessed July 18, 2019. Tables 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, and 14 encompass the medical knowledge and patient care and procedural skill competencies related to the 11 clinical areas identified in Table 1. Skill to recognize common cardiovascular findings on chest x-ray. The list of peer reviewers, employment information, and affiliations for the review process is included in Appendix 2. Accessed July 18, 2019. Know the causes, pathophysiology, and natural history of aortic, carotid, renal, mesenteric, and extremity peripheral artery diseases. Skills to recognize and manage patients with right ventricular infarction and/or right ventricular dysfunction. Skills to develop, implement, manage, and evaluate a plan of care for patients with elevated blood pressure and hypertension. The competencies are organized in seven content domains: Management of Patient Health/Illness Status, The Nurse Practitioner-Patient Relationship, The Teaching-Coaching Function, Professional Role, Managing and Negotiating Health Care Delivery Systems, Monitoring and Ensuring the Quality of Health Care Practices and Culturally-Sensitive Care (NONPF, 2006). Skills to prevent, identify, and initiate therapies in a bleeding emergency or a vascular access site complication. Know the indications, contraindications, and risks for P2Y. Identify, disclose, and manage relationships with industry and other entities to minimize bias and undue influence on clinical decision-making. Know the differential diagnoses of chest pain, palpitations, fatigue, lightheadedness, syncope, dyspnea, and peripheral edema. 7. Skills to interpret exercise and pharmacological stress test reports with or without imaging and apply results to clinical decision making. Skill to recognize cardiac device system infection. Know the definition, characteristics, prognosis, diagnostic recommendations, and evidence-based treatment options for management of hypertension. J Am Coll Cardiol2015; 65:1721-1723. Know the indications, contraindications, and appropriate use for vascular closure devices for patients with acute coronary syndromes. Know the treatment of hypertension in special populations (e.g., patients with ischemic heart disease, heart failure, diabetes, chronic kidney disease, cerebral vascular disease; minorities, elderly). Professionalism as manifested by a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. 1 0 obj Capstack T.M., Segujja C., Vollono L.M., Moser J.D., Meisenberg B.R., Michtalik H.J. Know the common cardiovascular complications of noncardiac surgery. Skill to recognize cardiac biomarker abnormalities to aid in the diagnosis of acute coronary syndromes. Many hospital systems also now use the 6-domain structure as part of medical staff privileging and peer-review professional competence assessments. Curriculum Survey on Master’s Level Nurse Practitioner Programs (2001) Interprofessional Oral Health Faculty Tool Kit for Primary Care Nurse Practitioner and Midwifery Programs. Know the normal physiological function of the autonomic nervous system. All rights reserved. Know secondary prevention strategies for patients with acute coronary syndromes. The writing committees reflect the diversity of cardiovascular medicine, including content experts, general cardiology and sub-subspecialty practitioners in both academic and private practice settings, and early, mid-, and later-career representatives. Skill to identify genetic syndromes associated with inherited thoracic aortic syndromes, including Marfan Syndrome and Loeys-Dietz. Skill to develop a plan for lifestyle interventions in patients with heart failure. Know palliative care management strategies in patients with refractory heart failure. Know the epidemiology of cardiovascular disease. Know the indications for noninvasive ventilation, endotracheal intubation, and mechanical ventilatory support for patients with hypoxia and/or respiratory failure. Collaborate with all team members to reduce preventable hospitalizations for patients with cardiovascular disease. Skill to perform pre-pregnancy risk assessment and peripartum coordination with obstetric colleagues for women with congenital heart disease. Skills to assess and participate in the management of adults with infective endocarditis associated with congenital heart disease. Brush J.E., Handberg E.M., Biga C., et al. Valvular Heart Disease Competencies for Cardiovascular Nurse Practitioners and Physician Assistants 2508, Table 14. The basic assumption of CBE is that the student will demonstrate acquisition of the identified essential knowledge, skills, and attitudes expected for the designated educational process before leaving the learning environment. Skill to identify physical findings of pericardial effusion, tamponade, and chronic constrictive pericarditis. Please be sure to address all 10 competencies and give specific examples. Know the indications for ambulatory blood pressure monitoring. Utilize the concepts of motivational interviewing when counseling patients. "Expanding the role of advanced nurse practitioners—risks and rewards" endobj Know the noninvasive diagnostic studies and indications to assess for subclinical atherosclerosis (e.g., exercise testing, coronary calcium scoring). Know the findings associated with mechanical complications of myocardial infarction. In addition to the NP and PA members of the committee, 3 cardiologists with expertise in team model care and competency development participated in the writing, review, and revision of the document. Former Competency Management Committee chair, chair during this writing effort. Know management strategies for patients with arterial compression devices and arterial sheaths. Know the indications for and contraindications to computed tomographic angiography, magnetic resonance angiography, and invasive angiography in patients with known or suspected venous and arterial disease. Develop, implement, and evaluate individualized, patient-centered educational strategies. Know revascularization strategies for patients with acute coronary syndromes. Skills to develop, implement, and evaluate lifestyle interventions for prevention and treatment of patients with cardiovascular risk and/or comorbidities. Know the role of local and systemic inflammation on the development and progression of atherosclerotic disease. Know the management interventions for patients experiencing complications of arterial catheterization. Promote the nurse practitioner or physician assistant profession by participation in interprofessional education and research. Renew your Annual Practising Certificate read more. Know the interventions and surgeries performed for complex congenital heart disease. Skill to assist with or remove central venous or arterial catheters and hemodynamic monitoring systems. Know the pathophysiology and clinical findings of heart failure in adults with complex congenital heart disease. Skill to refine the therapeutic plan of care of patients with valvular heart disease based on laboratory and diagnostic test results. Know the supplemental ECG leads to obtain in patients suspected of having right ventricular dysfunction. The American Academy of Physician Assistants, American Association of Nurse Practitioners, American Heart Association, Physician Assistant Education Association, and The National Organization of Nurse Practitioner Faculties endorsed the document in March 2020. Skill to participate in the insertion of temporary transvenous pacemakers, measure pacing and sensing device thresholds, and monitor pacemaker function. Know the clinical implications of ventricular systolic and diastolic function in the management of patients with stable ischemic heart disease. Skills to perform zero referencing and troubleshoot hemodynamic monitoring systems. Know the differential diagnosis, clinical presentation, ECG changes, and imaging and biomarker features for diagnosis and risk stratification of patients with NSTE-ACS and other nonischemic causes of myocardial injury. Chair, ACC Competency Management Committee, Co-Chair, ACC Competency Management Committee. Refer patients who are facing advanced and end-stage cardiovascular disease to appropriate specialists. Know the risk factors, signs, and symptoms associated with access site bleeding in patients with acute coronary syndromes. Assume responsibility and follow through on professional commitments and obligations in a timely fashion. Skill to obtain a history and physical examination for patients with elevated blood pressure and hypertension. Know the pathophysiology, differential diagnosis, and management of atrial fibrillation, atrial flutter, and atrial tachycardias. Know the risks, benefits, indications, and timing for diagnostic coronary angiography. Know the anatomy, pathophysiology, and presenting symptoms of adults with complex congenital heart disease. Know the New York Heart Association functional classes (I, II, III, and IV) and stages (A, B, C, and D) of heart failure. Approved March 20, 2020 ACNM Core Competencies for Basic Midwifery Practice The Core Competencies for Basic Midwifery Practice include the fundamental knowledge, skills, and abilities expected of new midwives certified by the American Midwifery Certification Board (AMCB). Skill to participate in the management of sedation and hemodynamics during procedures in the critical care setting. "A comparison of conventional and expanded physician assistant hospitalist staffing models at a community hospital" The statement emphasized the important collaboration between cardiologists, nurse practitioners (NPs), physician assistants (PAs), and other cardiovascular team members in the care of patients. Skill to participate in diagnostic and interventional procedures. Know the indications and recommendations for initial testing for known or suspected simple congenital heart disease in adults. Know the indications for genetic testing and counseling in patients with inherited cardiomyopathy syndromes. Know the arrhythmias common in complex congenital heart disease and indications for referral to electrophysiologists with expertise in congenital heart disease. Know the epidemiology, etiology, pathogenesis, and natural history of acute coronary syndromes, including the roles of plaque rupture, erosion, platelet activation, vasospasm, and thrombosis. Skill to participate in invasive electrophysiology procedures, including catheter ablation. Know the nutritional needs of patients on mechanical ventilation and appropriate nutritional supplementation in conjunction with the nutritional support team. All ACC competence and training statements, therefore, include examples of tools that can be used to assess achievement of the individual components of competency (see Section 1.2.2.). Skills to obtain and interpret a problem-focused history and physical examination for patients entering cardiac rehabilitation. There are several ways cardiovascular NPs and PAs can maintain competency and expand lifelong learning in practice (ensuring currency with the evolving art and science of the field) and assess their own professional needs for education and performance improvement. Such efforts will promote and enhance collaborative, high-quality, patient-centered care teams. Know the pharmacology, classes, indications, contraindications, risks, and interactions of medications commonly used for hypertension management. Know the diagnostic testing for patients with heart failure. CNS Competencies CNS Competencies. 3. Know blood pressure thresholds and goals for nonpharmacological and pharmacological therapies. Know the cardiovascular benefits of aerobic and resistance exercise. American Academy of PAs Research Department. . Nurse Practitioner Core Competencies Content (2014) Know the basic anatomy, pathophysiology, presenting symptoms, and differential diagnosis of simple congenital heart disease in adults. 4. %PDF-1.7 Skills to determine nutritional needs of patients receiving ventilatory support and order appropriate nutritional supplementation. Know the pharmacology of commonly used cardiovascular medications in diverse patient populations. Know the pathophysiology and clinical findings of pulmonary arterial hypertension. Skills to recognize and manage signs and symptoms that indicate an adverse response to exercise during cardiac rehabilitation sessions. Know the indications for referral of patients with advanced or complex valvular heart disease to a multidisciplinary heart team. Know the indications, contraindications, and monitoring implications of medications used in adults with complex congenital heart disease. Skill to use an evidence-based, shared decision-making tool to counsel patients at risk for sudden cardiac death who are undergoing primary prevention implantable cardioverter-defibrillator implantation. Know the clinical, imaging, and hemodynamic characteristics that are useful in distinguishing restrictive cardiomyopathy from constrictive pericarditis. . 2nd edition. Know the pathophysiology and risks of thrombosis and thromboembolism in adults with congenital heart disease. Know the principles of adult learning theories to plan and deliver education for atherosclerotic cardiovascular disease risk reduction. Know the indications for antibiotics for infective endocarditis prophylaxis in patients with valvular heart disease. 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