Vol. XXX No. 4 JOURNAL OF VASCULAR NURSING PAGE 135www.jvascnurs.net

Position

Paper

Society for Vascular Nursing position statementon incorporation of vascular disease into nursingeducationPhyllis Gordon, MSN, ACNS-BC, Diane Treat-Jacobson, RN, PhD, and Leslie Beth Sossoman, RN, MSN, ACNP-BC, CVN

PURPOSE

The purpose of this position statement is to articulate theimportance of the incorporation of in-depth education about vas-cular disease in schools of nursing, including the undergraduateand graduate programs. In addition to disease-specific education,such education should include pertinent assessment techniques,diagnostic studies and treatment options.

RATIONALE AND SUPPORTING INFORMATION

Peripheral vascular disease is a major health issue in theUnited States and is associated with a significant level of disabil-ity, increased hospital cost, morbidity and mortality.1-4 Peripheralvascular diseases include arterial, venous and lymphaticdisorders, specifically the disorders of:

� Carotid artery disease and ischemic stroke� Peripheral arterial disease, both upper and lower extremities� Renal and mesenteric arterial insufficiency� Aneurysmal diseases (aortic and peripheral aneurysms)� Deep vein thrombosis (DVT) and venous thromboembolism(VTE)

� Chronic venous insufficiency and venous stasis ulcers� Lymphedema, an under-recognized disorder.

Arterial disease

Peripheral artery disease (PAD) is documented to affect 8-12million Americans.1,2 Risk factors in the development of PAD

From the Division of Vascular Surgery, University of Texas HealthScience Center at San Antonio, San Antonio, Texas; Universityof Minnesota School of Nursing, Minnesota, Minneapolis;Cardiovascular Institute, Presbyterian Hospital, Charlotte,North Carolina.

Corresponding author: Phyllis Gordon, MSN, ACNS-BC, Univer-sity of Texas Health Science Center, Vascular Surgery Division,School of Nursing,United States (E-mail: gordonp@uthscsa.edu).www.svnnet.org/

1062-0303/$36.00Copyright � 2012 by the Society for Vascular Nursing, Inc.

http://dx.doi.org/10.1016/j.jvn.2012.09.005

include age older than 65 (14.5%), diabetes (10.8%), obesity,sedentary lifestyle and smoking (6.8% currently; 4.4% priorsmokers).4 Diabetes and smoking are significant risks for PAD.Individuals with PAD are also very likely to have at least oneof the risk factors associated with atherosclerotic cardiovasculardisease: hyperlipidemia (60%) or hypertension (74%).4 The prev-alence of vascular disease, especially PAD, increases in personswith diabetes, obesity, aging and history of smoking.

� 13.1% of the population (1 in 8 persons) is over 65 yearsof age.5

� 8.3% of the population has diabetes (18.8 million diagnosed;7.0 million undiagnosed).6,7

� One-third of adults and 17% of youth are obese.8

� 45.3 million people, or 19.3% of all adults smoke (18 years orolder).9

� Stroke: 795,000 strokes occur annually, it is the 4th cause ofdeath, and leading cause of disability.10,11

� PAD – 12-20% of persons 65 or older have PAD, affecting atleast 8-12 million Americans.1,11

� PAD treatment is estimated at $4.37 billion with 88% beinginpatient care.3

� Non-traumatic amputations, secondary to severe PAD leadingto critical limb ischemia and ischemic ulcers.

� Diabetics are at greater risk of PAD, and amputation is fivetimes more likely (60%).7

� Risk of amputation due to PAD increases with age; those 65and older are 2-3 times more likely to have an amputation.7

� Abdominal aortic aneurysm (AAA) – 200,000 are diagnosedannually.11

These statistics demonstrate the magnitude of PAD in theUnited States.

VENOUS AND LYMPHATIC DISEASE

Risk factors for venous disease share some of those of PAD,and include history of DVT, older age, gender (risk for womenis twice the rate of men until age 70, when men exceed women),obesity, pregnancy with risk increasing with each pregnancy, in-activity, prolonged sitting or standing, injury to legs, cigarettesmoking and family history.12 Below are statistics relevant to ve-nous and lymphatic disease and the U.S. population:

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� Chronic venous insufficiency is 10 times more prevalent thanPAD; 24 million have varicose veins and 500,000 suffer fromvenous stasis ulcers.11

� Venous stasis ulcer treatment is estimated to cost $1-5 billionannually.13

� DVT/VTE occurs in 1 in 20 persons over a lifetime and morethan 600,000 individuals are hospitalized for this condition an-nually; post-thrombotic syndrome develops in two-thirds ofthose affected with a DVT.11

� Estimated total annual cost of VTE is $3.2 to $15.5 billion.14

� Lymphedema of the lower extremity is an under-recognizeddisorder and is a significant cause of disability. The incidencedata is not readily available and lymphedema is usually docu-mented during inpatient treatment. One group reporting the in-cidence between 1% and 47%, whereas another literaturereview estimated 6.8millionwith any type of lymphedema.15,16

These figures impress on practitioners the impact of vasculardisease on healthcare and the U.S. population. Nurses play keyroles in the assessment, care and education of person’s with vas-cular disease. Advanced Practice Registered Nurses (APRNs) areprominent care providers and disease managers for persons withvascular disease. Nurses are noted to play a major role in educat-ing patients about risk factors and disease. A recent call to actionby the American Heart Association recognizes that we need moreinformation and research on PAD in women, as with heartdisease, so that lifestyle modifications can be implemented early.2

NATIONAL EDUCATIONAL SUPPORTINGINFORMATION

In the 2010 report, The Future of Nursing: Leading Change,Advancing Health, the Institute of Medicine (IOM) calls forradical transformation in how nurses are educated to meet con-temporary practice needs. Some of the key recommendations ad-dress educating nurses to advance our patients0 health by beingthe leaders of change and this change must reflect the increasingcomplexity of care. The IOM report notes that nursing is in a keyposition to be the coordinator of this care across a large popula-tion of multiple health care needs. The large population ofpersons with devastating peripheral vascular disease should ap-propriately be considered. The IOM recommendations addressboth undergraduate, master’s and doctoral roles as essential in ad-vancing the healthcare of our nation’s population.17

The education of the generalist nurse and the APRN isdirected through documents from the American Association ofColleges of Nursing (AACN). These documents, the Essentialsof Baccalaureate Education for Professional Nursing and Essen-tials ofMaster’s Education in Nursing also recommend a prepara-tion of the generalist nurse and APRN to have the knowledge andskills to appropriately and skillfully assess for health problems inorder to provide protective care and to assess for factors that arepredictive of future health care issues and, thus, be able to inter-vene on their care early and positively influence the health’’ ofindividuals and whole populations. Competencies are recommen-ded that include the acquisition of knowledge related to healthpromotion, illness and disease management. The APRN educa-tion must include courses on advanced physiology, pathophysiol-ogy, health assessment and pharmacology.18,19

SVN’S POSITION AND SUMMARY STATEMENT

GIVEN the large population of individuals with uncontrolledrisk factors for vascular disease

AND, the estimated number of undiagnosed individuals withvascular disease

AND, those diagnosedwith at least one of thevascular diseasesAND, the association of vascular disease to significant disabil-

ity without early interventionAND, the escalating cost of care for most individuals with

vascular disease.The Society for Vascular Nursing believes that it is essential

for the preparation of the generalist nurse and APRN, who bothhave direct roles in caring for patients, to recognize the risk fac-tors and early disease in their patients so that early interventioncan be initiated.

The Society for Vascular Nursing believes that it is essentialthat the education of nurses at the undergraduate, masters, anddoctoral level include appropriate and adequate knowledge ofall vascular diseases and the risk factors associated with vasculardisease.

REFERENCES

1. Centers for Disease Control and Prevention. Peripheralartery disease (PAD) fact sheet. 2012. Available from: http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_pad.htm.

2. Hirsch AT, Allison MA, Gomes AS, et al. A call to action:women and peripheral artery disease. A scientific statementfrom the American Heart Association. Circulation. Avail-able from: http://circ.ahajournals.org.

3. HirschAT,Hartman L, TownRJ, et al. National health care costsof peripheral arterial disease in the Medicare population. VascMed 2008;13:3. Available from: http://vmj.sagepub.com/content/13/3/209.abstract.

4. Selvin E, Erlinger T. Prevalence of and risk factors for periph-eral arterial disease in the United States: results from the Na-tional Health and Nutrition Examination Survey, 1999-2000.Circulation 2004;110:738-43. Available from: http://circ.ahajournals.org/content/110/6/738.full.

5. Administration on Aging. A profile of older Americans.Department of Health and Human Services; Available from:http://www.aoa.gov/aoaroot/aging_statistics/Profile/2011/3.aspx.

6. Data from the 2011 National Diabetes Fact Sheet. AmericanDiabetes Association; Available from: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf.

7. American Diabetes Association & American Heart Associa-tion. National Limb Loss Fact Sheet: Peripheral arterialdisease (PAD) and limb loss. National Limb Loss InformationCenter, Amputee Coalition of America 2006.

8. Centers for Disease Control and Prevention. Prevalence ofobesity in the United States, 2009-2010. NCHS Data Brief,No.82. 2012. Available from: http://www.cdc.gov/nchs/data/databriefs/db82.pdf.

9. Centers for Disease Control and Prevention. Adult cigarettesmoking in the United States: Current estimate. 2010.Available from: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/index.htm#core1.

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10. Roger VL, Go AS, Lloyd-Jones DM, et al. WritingGroup Members Executive Summary: Heart disease andstroke statistics-2012 update. American Heart Associa-tion 2012.

11. Vascular Disease Foundation. Vascular Disease Statistics.2012. Available from: http://vasculardisease.org/education-prevention/knowledge-is-power/vascular-disease-statistics/http://vasculardisease.org/.

12. Criqui MH, Denenberg JO, Bergan J, et al. Risk factors forchronic venous disease: The San Diego Population Study. JVasc Surg 2007;46(2):331-7; Available from: http://www.jvascsurg.org/article/S0741-5214(07)00585-X/fulltext.

13. Swezey L. Causes and treatment of venous stasis ulcers.2011. Available from: http://www.woundsource.com/blog/causes-and-treatment-venous-stasis-ulcers.

14. Passman M. Current statistics from American Venous ForumScreening Program: If we find more disease can society pay

for it? J Vasc Surg; Available from: http://veithsymposium.org/pdf/vei/4043.pdf.

15. Horning KM, Guhde J. Lymphedema: an under-treated prob-lem. Medsurg Nurs 2007;16:221-7.

16. Weiss,R.Howmanypeoplehave lymphedema?2007.Availablefrom: http://www.lymphnotes.com/article.php/id/401/.

17. Institute of Medicine. The future of nursing: leading change,advancing health. National Academy of Science; Availablefrom: http://www.nap.edu/catalog/12956.html.

18. The essentials of baccalaureate education for professionalnursing practice. Washington, DC: American Associationof Colleges of Nursing; Available from: http://www.aacn.nche.edu/education-resources/BaccEssentials08.pdf.

19. The essentials of master’s education in nursing. Washington,DC: American Association of Colleges of Nursing; Availablefrom: http://www.aacn.nche.edu/education-resources/MastersEssentials11.pdf. Accessed September 3, 2012.