The Nursing and Heart Care Pioneer

May 2012Martha Ross

When Kathleen Dracup graduated from high school in 1960, there were few career options for a young woman. She toyed with the idea of becoming a lawyer like her father, but the prefeminist bar was not known for welcoming women, and most other careers for women simply didn’t appeal to her.

Then there was nursing.

In Dracup’s mind, it had several things going for it. “It provided intellectual stimulation and an opportunity for service,” she says. “I saw nurses as very independent, and able to combine their jobs with having families.”

So nursing it was. Bright, poised and eager for challenges, the Santa Monica-reared Dracup moved to Chicago to study nursing at Saint Xavier University. She then returned to California, obtained a master’s degree at UCLA and a doctorate at UCSF and rose to a number of high-level clinical and administrative roles in the University of California system: clinical nurse specialist, professor and dean of UCSF School of Nursing for the first decade of the 21st century.

Dracup’s career to date has exceeded her expectations. She has become one of nursing’s most important pioneers, transforming the profession and, in the process, making contributions that have changed and improved all of health care.

When she stepped down as dean in 2010, fulfilling a promise to serve no more than 10 years, Dracup did not see this as an end to her career, but rather a new beginning. She has returned to teaching and research and is in the process of figuring out to what extent she’ll return to patient care. “I’m in an interesting place in my career,” she says.

A Lifetime Achievement

That place includes receiving the 2011 Heart Failure Society of America’s Lifetime Achievement Award – the first nurse ever to be so honored – in recognition of her clinical and research work with patients recovering from heart attacks and living with heart failure.

Dracup’s extensive scholarship, related to the emotional needs of patients and families struggling with heart problems, has led to counseling and education interventions that improve these patients’ quality of life. Her research has also set a standard for nurses’ growing role in developing effective and scientifically validated strategies for improving patient care – strategies that extend far beyond heart patients.

“At the end of the day, scientists are always moving things forward an inch but there are very few breakthrough discoveries,” Dracup said. “I think I’ve improved our knowledge of how heart disease affects patients and their families and how we can best improve their recovery process.”

Adapting to Changing Times

Dracup in the early 1970s. Times were different when Dracup pursued her undergraduate nursing degree in the mid-1960s. Nurses still wore freshly starched dresses and caps and deferred major decisions about patient care and hospital operations to doctors.

As a new nurse rotating among departments at a Chicago-area hospital, Dracup gravitated towards critical and emergency care. She admits to being a “little bit of an adrenaline junkie” but also liked the intellectual challenge that comes from the feeling that “you were on the front line.”

That desire for challenge and independence soon drew her to a new generation of hospital units dedicated to people recovering from heart attacks and other heart-related conditions.

Prior to the 1960s, these patients convalesced in wards or standard hospital rooms with little or no monitoring by staff trained to respond immediately to cardiac arrest, according to a 2011 article, “Historical Perspectives in Cardiology,” published in the journal Circulation.

The invention of ECG machines, external defibrillators and cardiopulmonary resuscitation (CPR) gave doctors and nurses tools to set up coronary care units (CCUs), where staff could employ lifesaving measures within minutes.

“Staff” essentially meant nurses like Dracup. Because doctors couldn’t stand guard on the units, nurses had to identify life-threatening arrhythmias and take action without waiting for doctors’ orders. To keep patients alive, “doctors had to abandon traditional notions of a nurse’s limited role in clinical decision making,” the Circulation article said. The result was a major shift in the hospital hierarchy.

This shift galvanized Dracup’s career as she moved back to California and entered graduate school. While studying and teaching at UCLA, she continued her clinical duties in cardiac intensive care.

An Instinct for Leadership and Compassion

Having those life-and-death responsibilities appealed to Dracup’s instinct for leadership. She also relished the chance to have close contact with patients and their families. “Unlike patients in the ER or those coming out of surgery, these patients had life-threatening illnesses but they were alert and talking,” Dracup says. “There was an emotional component to their recovery that was interesting to me.”

The growing body of research in the 1970s and 1980s confirmed Dracup’s firsthand observations that a cardiac diagnosis can be traumatic and life-changing for patients and their spouses.

“People’s recovery was not predicated on their heart function but on whether they returned to work, to a normal functional status,” Dracup says. “It didn’t have much to do with heart damage; it had to do with emotional damage.”

She became keenly interested in finding ways to help patients get well and stay out of the hospital. “I wanted to understand why patients continued to return to the hospital: what barriers there were to them being able to manage their own illnesses,” she says.

Her early clinical research – which led to her first data-based article, published in Nursing Research in 1978 – focused on providing counseling and education to patients and spouses. “One of the things that came up in those discussions was the fear experienced by spouses that they wouldn’t know how to respond to a cardiac emergency in the home,” says Dracup.

That information led to another study, on teaching CPR to spouses of high-risk cardiac patients so they would feel confident about handling emergencies.

Dracup notes that this research led to the American Heart Association creating new guidelines for CPR, as well as the now common practice of making automatic external defibrillators (AEDs) available in public places. “At the end of the day, we learned that the most important thing is to provide defibrillation as soon as possible after a cardiac arrest,” she says.

Creating the Balance

In 1971, Dracup met her husband, John Dracup, an assistant professor of environmental engineering at UCLA. Balancing busy careers with their five children has had its challenges, but as she hoped when she left high school, a nursing career allowed her the flexibility to have work and family.

“One of the things faculty appreciated about me is that I’ve struggled with that balance. They saw that I somehow managed my career with all the family responsibilities,” she says.

Dean Dracup

Dracup continued to publish, teach and mentor students when she became dean of UCSF School of Nursing in 2000. At the start of the 21st century, she led the School to embrace educational changes nursing students needed in order to work in today’s health care environment.

“The complexity of care in many diverse settings, the role of advanced practice nurses as independent providers, and the growing recognition of the important role of scientific evidence upon which to base nursing practice have changed the way nurses are viewed by the public and the way they should be educated,” Dracup wrote in a paper that was part of the Institute of Medicine’s 2011 report The Future of Nursing: Leading Change, Advancing Health. As dean, Dracup tripled the School’s research dollars and made it the No. 1 recipient of National Institutes of Health funding. She helped the School recruit new faculty, administrators and master’s degree students, increase student and faculty diversity and win a $10 million grant to provide financial support to doctoral students. In keeping with her view that nurses are key players in health care, she promoted cooperation among UCSF’s professional schools and expanded students’ opportunities for interdisciplinary learning.

Dracup stepped down as dean in 2010 so she could focus on research and teaching. On the day she did, Sally Rankin, who became interim dean, noted: “Kathy has embodied the qualities of professional competence as a scholar, she has imparted dignity to her office and through it to the entire School, and she has at every moment been a gracious presence to everyone.”

The Work Continues

Having refocused on the teaching and research that characterize the bulk of her career, Dracup recognizes new challenges, as medical advances have shifted the focus of care from people dying of heart attacks to people learning to live with a chronic condition.

Today, some 5 million Americans live with heart failure. As people live longer, the number of cases will grow. Heart failure costs $37 billion a year. Over the years, research by Dracup and others has shown that good follow-up care in outpatient settings contributes to decreased symptoms, improved quality of life, reduced rates of hospital admission and decreased health care costs. Some of that work made its way into a successful program that recently reduced readmissions at UCSF Medical Center.

Dracup is doing some follow-up work in that program, collaborating with the UCSF Medical Center’s Palliative Care Services to investigate the best social support services for hospice patients dying of heart failure. She also supervises students in the PhD program at the University of Technology, Sydney, where she is an adjunct professor.

But a primary focus for her is working with a team of researchers from California, Nevada and Kentucky to analyze data from a five-year study on improving heart failure symptom identification and management among some 600 patients living in rural areas.

Back in her early years at UCLA, Dracup realized that the combination of teaching, research and clinical work gave her the intellectual challenge and opportunities for service she had wanted when she first started out in nursing. Today she’s assessing how she’ll incorporate these roles into the next phase of her professional life.

“This is the perfect career,” she says.