title: Education and practice gaps on atrial fibrillation and anticoagulation: a survey of cardiovascular nurses.
abstract: BACKGROUND
  Patients' knowledge of their atrial fibrillation (AF) and anticoagulation therapy are determinants of the efficacy of thromboprophylaxis. Nurses may be well placed to provide counselling and education to patients on all aspects of anticoagulation, including self-management. It is important that nurses are well informed to provide optimal education to patients. Current practice and knowledge of cardiovascular nurses on AF and anticoagulation in the Australian and New Zealand (ANZ) context is not well reported. This study aimed to; 1) Explore the nurse's role in clinical decision making in anticoagulation in the setting of AF; 2) Describe perceived barriers and enablers to anticoagulation in AF; 3) Investigate practice patterns in the management of anticoagulation in the ANZ setting; 4) Assess cardiovascular nurses' knowledge of anticoagulation.
  
  
  METHODS
  A paper-based survey on current practices and knowledge of AF and anticoagulation was distributed during the Australian Cardiovascular Nursing College (ACNC) Annual Scientific Meeting, February 2014. This survey was also emailed to Cardiovascular Trials Nurses throughout New South Wales, Australia and nursing members of the Cardiac Society of Australia and New Zealand (CSANZ).
  
  
  RESULTS
  There were 41/73 (56%) respondents to the paper-based survey. A further 14 surveys were completed online via nurse members of the CSANZ, and via an investigator developed NSW cardiovascular trials nurse email distribution list. A total of 55 surveys were completed and included in analyses. Prior education levels on AF, stroke risk, anticoagulation and health behaviour modification were mixed. The CHA2DS2VASc and HAS-BLED risk stratification tools were reported to be underused by this group of clinicians. Reported key barriers to anticoagulation included; fears of patients falling, fears of poor adherence to medication taking and routine monitoring. Patient self-monitoring and self-management were reported as underutilised. ANZ cardiovascular nurses reported their key role to be counselling and advising patients on therapy regimens. Anticoagulant-drug interaction knowledge was generally poor.
  
  
  CONCLUSIONS
  This study identified poor knowledge and practice in the areas of AF and anticoagulation. There is scope for improvement for cardiovascular nurses in ANZ in relation to AF and anticoagulation knowledge and practice.
authors.affiliation: Faculty of Health, University of Technology Sydney, Sydney, Australia. caleb.ferguson@uts.edu.au.
authors.forename: Caleb
authors.initials: C
authors.lastname: Ferguson
authors.affiliation: Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Sydney, Australia. sally.inglis@uts.edu.au.
authors.forename: Sally C
authors.initials: SC
authors.lastname: Inglis
authors.affiliation: Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Sydney, Australia. phillip.newton@uts.edu.au.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Newton
authors.affiliation: St Vincent's Health Australia (Sydney), Sydney, Australia. sandy.middleton@acu.edu.au.|Australian Catholic University, Sydney, Australia. sandy.middleton@acu.edu.au.
authors.forename: Sandy
authors.initials: S
authors.lastname: Middleton
authors.affiliation: Heart Transplant Program, Sydney and Victor Chang Cardiac Research Institute, St Vincent's Hospital, Sydney, Australia. peter.macdonald@svha.org.au.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Macdonald
authors.affiliation: Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Sydney, Australia. pdavidson@jhu.edu.|School of Nursing, Johns Hopkins University, Baltimore, USA. pdavidson@jhu.edu.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Davidson
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000451:nursing*; D001315:Australia; D064646:Cardiovascular Nursing / Q000193:education* / Q000379:methods; D002983:Clinical Competence; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D020380:Needs Assessment; D009520:New Zealand; D024802:Nurse's Role; D010353:Patient Education as Topic / Q000379:methods; D057184:Practice Patterns, Nurses' / Q000458:organization & administration*; D011795:Surveys and Questionnaires
chemical_list: D000925:Anticoagulants