Sandra Dunbar, Nursing and Cardiovascular Health

 


Sandra Dunbar How many of us have purchased an exercise bike or treadmill that now sits abandoned? Started a healthy eating plan but only stayed true for a few days? Or begun a new medication regimen and kept to it sporadically? Maintaining healthy self-care is hard enough when you're well and feeling good. It's even harder when you have been diagnosed with heart disease.

Sandra Dunbar, Charles Howard Candler Professor of Cardiovascular Nursing at the Nell Hodgson Woodruff School of Nursing, is devising new ways of educating and counseling "heart patients" and their relatives to achieve and maintain health through better lifestyle and self-care skills. Dunbar, who trained as a critical care nurse before earning her doctorate of science in nursing from the University of Alabama in Birmingham, became interested in the psychosocial and socio-cultural dimensions of cardiovascular illness after watching her patients struggle to maintain the lifestyle changes so critical to improving their health. She soon realized that family dynamics play a significant role in a patient's recovery. "I've grown from focusing only on the individual patient to developing a family-focused approach," she says.

To this end, Dunbar develops and tests interventions that teach self-care techniques to patients with heart failure and arrhythmias, and to their families. She conducts these interventions in partnership with nutritionists, psychologists, clinical advanced practice nurses, and cardiologists at Emory-Crawford Long Hospital, Grady Hospital, and the Atlanta VA Medical Center, and collaborators in the School of Nursing of Georgia State University. In a current project, the Family Partnership Intervention, Dunbar and her colleagues are teaching family members how to support a loved one's recovery from cardiovascular illness without taking away that person's independence. "We are teaching family members how to provide motivational messages for behavior change that go beyond ‘nagging' or ‘reminding' to reach a new level of collaborative communication," Dunbar says. When these interventions succeed, they have the added benefit of helping reduce anxiety and depression in cardiovascular patients. Dunbar hopes to begin translating these findings into the clinical sphere following the completion of her studies.

On the prevention side, Dunbar is collaborating with Emory University School of Medicine and the Morehouse School of Medicine to treat patients with Metabolic Syndrome who are at high risk of developing cardiovascular disease. Her interest in prevention stems from a 2004-2005 sabbatical as a Visiting Scientist at the Centers for Disease Control and Prevention, where she studied the policy dimensions of heart disease. Since then, she has devised and is testing training programs that enable at-risk patients to initiate and sustain a healthy diet and exercise. Says Dunbar: "Most of these individuals already know what they need to do. That's not the issue. They need practical skills in order to maintain these changes and confidence to incorporate them into their daily lives." Her work with at-risk patients aims to help them sustain a healthy lifestyle for months and even years into the future.

As a Fellow of the American Academy of Nursing and the incoming Chair of the Council of Cardiovascular Nursing for the American Heart Association, Dunbar credits Emory's unique collaborative atmosphere with helping her flourish not only as a clinician and scholar, but also as a national leader in cardiovascular care. She is especially thankful for her students—ranging from undergraduates to postdoctoral fellows—who support her research projects, conduct independent research, and raise new questions. In coming years, Dunbar plans to partner with her students and with faculty colleagues to develop a patient teaching model for "co-morbidity," bringing better self-care to patients who suffer from two or more serious diagnoses, such as diabetes and heart disease. Doing so will be a challenge, but Dunbar maintains she and her colleagues as well as the patients are for it. "Emory has allowed me to embrace and use my expertise in everything I do," she says. "Where else could I find such an opportunity?"