What is the evidence tosupport nurse led thrombolysis?

Is nurse-led thrombolysis clinically safe, beneficial and acceptable?

This study examined the sensitivity and specificity of coronary care unit (CCU) nurses' ability to diagnose acute myocardial infarction (AMI) and to make an independent clinical decision about thrombolysis. The effectiveness of this simulated nurse-led thrombolysis was compared with the sensitivity and specificity of subsequent senior house officer diagnosis and actual treatment. A blinded, retrospective gold standard was provided by consultant cardiologists. Predictions were that: nurse-led thrombolysis would be no worse than current practice; it would lead to a significant time-saving in CCU door-to-needle times; CCU nurses would accept this potential development in their role. The first and second predictions were upheld. Regarding the third prediction, most nurses felt confident about diagnosing AMI and administering thrombolytics, but only half of those who completed an anonymous questionnaire said that nurse-led thrombolysis should be part of the nursing role. The comments against nurse-led thrombolysis related to extra responsibility, legal cover, professional and organisational support and backup, and financial reward. The results of this simulation study suggest that, providing these concerns are addressed, nurse-led thrombolysis may be clinically safe, beneficial and acceptable to nurses.

Attitudes and Perceptions of Nurses and Doctors to Nurse-Led and Nurse-Initiated Thrombolysis—An Irish Perspective

Nurse-led and nurse-initiated thrombolysis are strategies utilised within the United Kingdom to reduce delays for patients with acute myocardial infarction (AMI) requiring thrombolytic therapy. Both strategies have been found to reduce delays significantly. A Reduction in the delays experienced by patients can increase an individual's long-term survival rate. To date, there appears to be no documented research pertaining to nurse-led and nurse-initiated thrombolysis within the Irish arena.

AIM

To investigate if the attitudes and perceptions of nurses and doctors are positive to nurse-led and nurse-initiated thrombolysis.

METHODS

A quantitative approach employing a comparative descriptive survey design was utilised. A convenience sample of 75 nurses and 28 doctors was obtained.

FINDINGS

Highlighted that nurse-led and nurse-initiated thrombolysis are potential roles for coronary care nurses. There was a significant difference of opinion between the two professional groups regarding this initiative, with nurses having higher levels of agreement. Nurses were more willing to undertake nurse-led thrombolysis (91%) as compared to nurse-initiated (74%), with years of experience and education appearing to influence this decision.

CONCLUSION

It is suggested nurse-led thrombolysis is the more favourable role to Irish nurses and doctors.

Preparing nurses to initiate thrombolytic therapy for patients with an acute myocardial infarction - is there a consensus?

Within cardiac practice, one area that has seen much development involves the nurse assessing, diagnosing, and prescribing thrombolytic therapy for patients with a myocardial infarction. Alongside this, a variety of titles aimed at defining these new roles have emerged, but instead of clarifying the situation they have created more confusion about the actual characteristics and functions of nurses engaged in these innovative posts. In addition advice regarding the nature of preparation and training required to ensure the competency of nurses for these specific roles has been sparse and inconspicuous. As posts such as 'acute chest pain nurse', 'thrombolysis nurse', 'nurse-initiated thrombolysis' or 'nurse-led thrombolysis' increase and National Health Service targets tighten, it is timely to critically review the educational preparation for these roles for evidence of coherence. In particular, this paper analyses the literature in order to examine the content of educational programmes, teaching methods and assessment strategies in relation to preparing nurses to initiate thrombolytic therapy. The implications for those managing practice and the higher education sector are discussed. Finally, it is stressed that there is a need for national consultation relating to guidelines, standards and accreditation of practice schemes in this area of patient care.

An exploration of the ethical dimensions pertinent to gaining consent for thrombolysis

--This paper explores some of the pertinent ethical principles involved in gaining consent in thrombolysis, relevant to both nurses and paramedics. --It describes ethical concerns regarding this practice. --Two key themes that have been explored are around the issue of autonomy and paternalism. --With nurse-initiated thrombolysis gaining momentum, an awareness of key ethical dimensions is fundamental.

The introduction of nurse-initiated thrombolysis in coronary care

Nurse-initiated thrombolysis has emerged as an organizational strategy to improve the delivery of thrombolytic agents to patients suspected of having an acute myocardial infarction. This article will outline the evolution of nurse-initiated thrombolysis on the coronary care unit in the authors' trust and present data on the critical decision-making skills of those nurses who have expanded their practice. Patients who were assessed, and whose thrombolysis was initiated by a nurse designated to deliver this treatment, had "door-to-needle" times consistent with the current targets of the National Service Framework for Coronary Heart Disease (Department of Health (DoH), 2000). A cardiologist acting as a "gold standard" reviewed the assessments of the first 50 patients seen by nurses able to deliver thrombolysis, finding each treatment decision appropriate. This gives support to the notion that appropriately trained and experienced nurses can assess and make treatment decisions in this acute care situation.

Nurse-initiated thrombolysis: a systematic review of the literature

This article aims to review, in a systematic manner, the current published evidence base for nurse-initiated thrombolysis. Reasons for this evolution in nursing practice are outlined. Themes emerging from the review are identified. Methodological issues are discussed. This article outlines a conceptual framework for practice evolution. Further research is needed to improve the strength of the evidence base by studies with improved design.

Are manual gestures, verbal descriptors and pain radiation as reported by patients reliable indicators of myocardial infarction? Preliminary findings and implications

Patients experiencing an episode of acute chest pain need to be assessed promptly and effectively to ensure optimal management. The aim of this study was to investigate whether there were specific aspects of patients' symptom reports which could be viewed as additional indicators of myocardial infarction (MI) and contribute to the assessment process. The sample consisted of 267 patients who presented with an episode of acute chest pain. Methods of data collection were based on, or modified from, previous studies which had investigated the use of manual gestures, choice of verbal descriptors and extent of pain radiation in patients with and without MI. To determine whether these variables were of significance in the diagnosis, the responses of those with (n = 118) and without MI (n = 149) were compared. The results suggest that it is currently impossible to draw any conclusions as to whether the variables studied can be judged as reliable indicators of MI. The findings indicate that there are some differences between the groups particularly in the language used. Moreover, women with MI characterized their symptoms through stronger emotive words such as 'worrying' (P = 0.014) 'frightening' and 'intolerable' and also differed from their male counterparts in their reports regarding pain radiation. Implications for practice and for research are discussed.