Before you go on a placement where you could be caring for children with cardiovascular problems, it will be helpful for you to:

• Revise anatomy and physiology of the cardio-pulmonary system, including structure of the heart and the conduction system.
• Revise foetal circulation.

Things to familiarise yourself with when you arrive:

• Crash trolley contents.
• Chest opening kit.
• Other emergency equipment and telephone/bleep numbers.
• What procedure to follow in case of cardiac arrest.
• Where the Unit protocols and guidelines are stored.

You could try to take part in the following learning opportunities\visits:

• Observe open-heart surgery.
• Observe cardiac catheter procedure.
• Attend pre-admission clinic.
• Attend surgical clinic.
• Attend foetal scan clinic.
• Spend day with a cardiac liaison nurse.
• Spend a day with the play specialist.
• Spend the day with the nurse in charge.
• Attend medical/specialist ward rounds.
• Research nurses’ input.
• Find out about link nurses and what they do.
• Use handover sheet to make a list of all conditions and revise these.
• Syndromes.

The following is placement advice from Carys Whitby, a third-year children’s nursing student:

‘I was really excited when I found out that I had been placed on the cardiac ward. I had developed an interest in cardiac nursing during a previous placement (PICU) and was eager to learn more about paediatric heart conditions. I knew this placement would nurture my interest and allow me to absorb as much knowledge as possible first-hand. At the same time, I was aware of how quickly children with cardiac conditions can deteriorate, which made me slightly apprehensive. To prepare for my placement, I reviewed lecture notes on common paediatric cardiac conditions and I also borrowed a library book on paediatric cardiology and took this with me (the newly qualified nurse on the ward also found my library book useful, which shows you don’t need to know everything!). The main thing that surprised me whilst on this placement was a three-year-old child who needed high dependency care; he had a heart function of 12% and was awaiting a heart transplant. I expected a very unwell child on a lot of medications, but he was a lively, chatty, happy boy who only had one inotropic drug supporting his heart function. His ability to compensate was fascinating. I learnt so much from the placement, about both palliative and curative treatment options for so many cardiac conditions. I was fortunate enough to observe a cardiac catheter procedure and open-heart surgery to get an insight into what so many of these children experience. I gained a greater understanding of fluid balance, diet and blood gases and their importance in monitoring and improving an unwell child’s condition.  I also gained so much confidence in my nursing ability and myself. I learnt to trust my instinct and was empowered to take the lead in care for groups of patients, both on the cardiac ward and in the high dependency unit, interacting with the multidisciplinary team and making decisions for my “patients”. I will definitely be entering the field of cardiac nursing in the future.’

Carys’ top tips for students about to undertake a cardiac placement are:

• Gain a basic understanding of foetal, neonatal and paediatric cardiac anatomy and circulation. Even if you don’t know the altered physiology of any cardiac conditions, it is easier to develop an understanding of altered anatomy if you are able to compare it to how the heart should ideally function.
• Learn how to find a Pedal pulse (dorsalis pedis). It is commonly used to assess circulation following cardiac catheter procedures that have utilised the groin for access into femoral veins or arteries. However, its location is not commonly taught!
• Know what normal sinus rhythm looks like so that you can identify abnormal rhythms and alert nursing and medical staff to potentially deteriorating children.
• Cardiac surgery can have neural implications for children – know how to recognise the warning signs of a stroke, i.e., uneven pupils, weakness unilaterally.
• Most importantly, don’t be scared! Cardiac nursing can sound terrifying, but the majority of children will compensate well prior to intervention, and recover quickly afterwards. Be aware of what the warning signs could be if a child begins to deteriorate, and then enjoy the family-centred care experience that cardiac nursing gives you.