Impact of Giving

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Catherine Murks 

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Patient's Dilemma Leads to Doctoral Study

The young man, dying of heart failure, could offer only one- or two-word replies to his caregiver's questions. Then surgeons implanted a high-tech pump called a ventricular assist device (VAD) in his chest. The devise boosted his circulation, and he became "quite vibrant and quite talkative" his caregiver, advanced nurse practitioner Catherine Murks, recalls. "It was only then that we discovered that he couldn't read," she says. "At all."

The unforeseen turn of events forced Murks and her colleagues in the University of Chicago Medical Center (UCMC) Heart Failure Clinic to modify its standard patient education and management protocol for this patient, who couldn’t perform some of the important self-care tasks normally required of VAD patients, such as responding to an alarm indicating that it’s time to replace the device’s batteries.

And it raised a larger question. “It also made me think about the brain and how it’s affected by advanced heart failure,” Murks says.

INspired research
As it often does at UCMC, a clinical experience, combined with curiosity, inspired research. Murks, winner of the Constance E. Staffileno Award for Excellence in Transplant Nursing, is conducting a study to determine how cognitive decline, a common consequence of heart failure, affects a patient’s ability to perform self-care.

In doctoral studies at Loyola University, she is assessing the self-care abilities of patient enrollees using an instrument called the Self-Care Heart Failure Index. She’s correlating those findings with those of a neuropsychological test, the Repeatable Battery for Assessment of Neurological Status that measures cognitive decline.

“My hope is that we would determine that self-care either is or is not impacted by cognitive dysfunction,” she says. “And if it is, ‘What we can do to improve self-care practices for those affected?’”

Murks’ nomination for the Staffileno Award—endowed by the late Harry Staffileno, MD, (see sidebar) in honor of his late wife—praises her for “raising the bar and exemplifying the finest in nursing” over more than two decades in transplant care. During that time, Murks has played important roles in the growth of both the VAD and heart transplant programs at UCMC.

a leading heart transplant program
In the mid-1990s, the Medical Center was performing only five or so heart transplants a year when it decided to invest in expanding the program, hiring Allen Anderson, MD, as medical director for cardiac transplant and assigning Murks, the transplant coordinator, to assist with the application for Medicare funding eligibility. Today, with the recruitment of Valluvan Jeevanandam, MD, Chief, Section of Cardiac and Thoracic Surgery, the Center performs four times as many transplants and is one of Chicago’s leading heart transplant programs.

At the same time she was helping to expand heart transplant services at UCMC, Murks was also coordinator for the hospital’s new VAD program. She wrote the program’s first nursing care protocols for routine, intensive, and emergency care as well its patient education guidelines. This was 13 years ago, she recalls, the “ancient history’’ of VAD technology. Back then, patients were tethered to a cart that contained a large battery and a pneumatic pump. They could not leave the hospital.

“Today, they wear battery packs and a little controller on their belt and they’re out the door,” Murks says.

The advances in VAD technology and its growing role in treatment of heart failure are the biggest changes she’s seen so far in her career at UCMC. Use of the device now equals or exceeds transplantation, which is limited by the availability of organs. There are 3,200 people currently waiting for hearts compared with 1,800 transplants performed in 2010, according to the federal Organ Procurement and Transplantation Network. VAD implants often serve as a lifeline for patients on the waiting list, but not always.

“They can be destination therapy where the patient will have it until the end of their life, or a stop gap until a heart arrives,” she says. “For example, VAD may be used as destination therapy for someone who’s too old for a transplant or has another problem, such as a malignancy.”

Murk’s own research is ultimately aimed at reducing problems for congestive heart failure patients that result in unnecessary sickness and hospitalization. She hopes, for example, to discover how some patients manage to perform self-care tasks despite having cognitive decline.

“What coping mechanisms do they build into their routines that make it easier for them?” Murks wonders. “And how can we teach those to patients who haven’t discovered those kinds of practices?”

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