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.

Thrombolysis Nurses: Time for Review

Thrombolysis remains the most popular means of reperfusion following an acute ST-elevation myocardial infarction in the United Kingdom today. There is a wealth of evidence to support the early provision of thrombolysis care and a number of models of care delivery have been proposed to reduce the time delay from admission to hospital to administration of thrombolytic therapy. The movement of this treatment from the coronary care unit to the emergency department in association with the employment of specialist cardiac nurses has been associated with some time reductions. However the quality of evidence to support the employment of specialist cardiac nurses working outside the coronary care unit is limited. The author provides an overview of the main literature in this area outlining the models of care in operation and argues that there are lessons to be learned for future nursing research.

Can Australian Nurses Safely Assess for Thrombolysis on EKG Criteria?

INTRODUCTION

According to the Australian Institute of Health & Welfare, 48,700 ischemic heart disease events occurred in Australia in 2001-2002; around half of these were fatal. The National Heart Foundation of Australia recommends that eligible patients presenting with acute myocardial infarction should receive thrombolysis within 30 minutes of presentation if primary angioplasty is not available. In Australia, fewer than 80% of eligible patients were treated within 1 hour in the first half of the year 2000. Literature reveals that a number of hospitals in the United Kingdom use a model of acute myocardial infarction management whereby suitably qualified cardiac nurses initiate thrombolysis where appropriate, prior to the patient being evaluated by medical staff. This practice is safe and effective in reducing the door-to-needle time to below 20 minutes. The questions are threefold: Are Victorian cardiac nurses similarly capable? What are the existing abilities of emergency nurses? What do they think about initiating thrombolysis?

METHOD

Mixed methodology (descriptive comparative and thematic analysis) was used. The survey instrument included EKG vignettes and a questionnaire. Participants were Victorian nurses practicing in a coronary care unit or an emergency department.

RESULTS

Seniority was the only apparent predictor of increased accuracy.

DISCUSSION

Nurses are very accurate and safe in their ability to recognize patients warranting immediate thrombolysis. Nurses' decision making is underpinned by 3 of 4 fundamental patterns of knowing identified by Carper-aesthetic, empirical, and ethical. In view of these findings, a number of recommendations are made for research, education, and benchmarking of quality patient management.

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.

Myocardial infarction: nursing responsibilities in the first hour

The aim of this article is to provide a comprehensive review of the physiological processes that occur during the first hour following a myocardial infarction (MI). It will identify the general principles and the physiological processes that occur in response to a MI, outlining the consequences of cellular hypoxia to the heart. The implications for clinical practice and how they link to the physiological processes are detailed. Understanding the physiological principles involved in a MI is important for identification and to ensure patient management is initiated. This, together with prompt diagnosis and interventions, will assist in reducing mortality within the first hour following a MI.