Dr Simone Inkrot is a heart failure nurse with a long-standing interest in how empathy influences people’s ability to look after themselves.

In 2015 the Waikato District Health Board clinical nurse specialist received a Heart Foundation research grant to undertake a study alongside co-investigator Debbie Chappell on the link between health professional empathy and patient self-care.

In June she leaves the Coromandel, where she works as part of Waikato DHB’s nurse-led integrated heart failure service, to present the findings at the EuroHeartCare congress in Dublin.

The Wintec-trained nurse, who has a Master of Science and a PhD from Berlin’s Charité University Hospital, says heart failure care is about supporting people’s self-care skills.

“People need to know what to do to keep themselves well,” Inkrot says. “When a patient becomes unwell, education and support are key [to] getting well again.

“We know that in combination with medical treatment self-care can play a major role in preventing deterioration and hospitalisation for people with a chronic condition such as heart failure. What we’re not sure on is what ingredient it is that makes or breaks a person’s ability to self-care.”

Inkrot’s research examines the levels of empathy perceived during consultations between health professionals and their patients. “Is there a correlation? My hypothesis was that higher perceived empathy leads to higher self-care ability.”

Patients were asked to rank their ability to self-care, as well as whether they thought their health practitioner was empathetic towards them. She also asked practitioners to complete the survey to see if a patient’s perceived ability to self-care matched the practitioner’s thoughts.

Data on Māori patients was also analysed during the cross-sectional study. “We know that, statistically speaking, Māori patients generally have lower healthcare outcomes, so that part of the research was very important,” she says.

Inkrot believes her research has the potential to benefit many New Zealanders, not just those living with heart failure.

“Every New Zealander is likely to have encounters with healthcare providers at some point in their lives. I’m hoping to encourage clinicians to use the power of interpersonal connections in their interactions with patients.”

NZ’s only nurse-led community heart failure service

Inkrot has also recently heard that she has been nominated by European Society of Cardiology (ECS) as a finalist for the ESC Nursing and Allied Professions Investigator Award and in August will get to present some of her results at the ESC congress in Munich – one of the largest of its kind in the world.

The research that she’s sharing on the world stage was carried out while doing her day job as a CNS offering heart failure clinics across the Coromandel Peninsula.
She is one of six CNS working for the Waikato Integrated Heart Failure Service’s nurse-led service, established in 2009, which aims to increase access to heart failure services in the community.

Inkrot first worked in cardiology and internal medicine at Waikato Hospital after graduating from Wintec in 2002. The bilingual nurse grew up in Germany and in 2004 went to Germany to work as a district nurse and then on to agency nursing in London – mainly in cardiology, oncology and A&E.

She moved to Berlin in 2007 to take up a Charité University Hospital research position in cardiology as lead nurse trial coordinator, during which she completed her Master of Science in Nursing and started her PhD (which she completed when back in New Zealand). In 2012 she returned to help develop the Waikato heart failure service, including setting up the service on the Coromandel Peninsula.

Inkrot says the service is the only one of its kind in the country. “While most DHBs have heart failure services, we’re the only one out there in the community, where the people are.”

The nurse-led service’s home is Waikato Hospital’s cardiology department but offers CNS services – including expert care, support and education – in the wider Waikato community. Only the three CNS serving the Hamilton city area are based at Waikato Hospital with the other three based in Tokoroa, Te Kuiti Hospital and Inkrot at Thames Hospital.

“We want to improve outcomes for patients. GPs can refer to us, and we work with patients that have already been admitted too.”

While Inkrot is unable to prescribe medication, she says she works in collaboration with the patient’s doctors and specialists and makes suggestions to help with diagnoses and management plans.

Self-care skills important

Teaching self-care skills is an important part of the nurse specialists’ clinical monitoring and management role, as is working with families and whānau.
“We want to reduce hospitalisation and teach people how to recognise the warning signs of a bad day,” says Inkrot.

Self-care for patients includes following a healthy diet, managing their weight, getting rest as well as regular exercise and taking their medication as prescribed.

Inkrot says there is no “typical patient” that she works with. “Generally though, those that we see are in their late 60s to early 70s. Patients’ experiences of heart failure can differ vastly too.

“Heart failure isn’t just one thing. There are symptoms in common though; fatigue, breathlessness, swollen legs. It can be tricky to do everyday things.”

She says heart failure is complicated and there is no single trajectory. “It can be something of a rollercoaster. You can have bad days and good days.”

Inkrot’s aim is to reduce hospitalisation by teaching patients how to recognise the warning signs of a bad day. “We want to prevent and avoid hospitalisation. It’s about empowering patients to look after themselves.”

While there is no cure for heart failure, there is plenty that can be done to help. “It is true that there is no cure. But we can improve both heart function and quality of life. Early treatment and support is so important.”

Inkrot says patients using the service are generally discharged within six months, once they have the support and tools needed. “We do have a small number who need palliative care, and we support them and their families with that too.”

The prevalence of heart failure is rising. “We have an aging population so it is becoming more common. Better health care also means the numbers are increasing.”

The importance of collaborative education

Education is also an important part of Inkrot’s collaborative work with both primary and secondary health professionals and community teams.

“The service is not possible without the support of the cardiologists, the general practitioners, the nurses. They are integral to this. It’s a multi-disciplinary effort where we
work together.”

She is also excited about the future of the sector.

“Five to 10 years ago, heart failure was in the too-hard basket. It wasn’t sexy, it was super-complicated and hard.”

Having a patient with heart failure was a challenge when she first trained as a nurse. “But now, we’ve worked out how to improve things significantly for the patient. We’ve worked out how to reduce costs and how to decrease mortality.

“I’m so passionate about this work because I can make a difference.”

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