Optimal treatment of patients with Acute Coronary Syndrome and the evolutionary role of nurses and allied health professionals.

McLean, Scott (2011) Optimal treatment of patients with Acute Coronary Syndrome and the evolutionary role of nurses and allied health professionals. PhD thesis, Edinburgh Napier University.

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    Heart disease is a serious problem for both the individual and society at large. It
    takes many lives. As an acute cardiac nurse I have spent the bulk of my clinical
    and research career striving to provide acute cardiac care outwith the historical
    boundaries of the doctor-led, specialty-based, inpatient setting. The barometer
    of this work however must be the additive knowledge and consequent impact
    on practice it has provided to the cardiovascular community through peerreviewed
    publications. This thesis presents an analysis of the evidence base for
    contemporary developments in acute cardiac care, including 6 core peerreviewed
    publications, and 11 supporting publications where I am either
    primary or secondary author. These publications demonstrate the feasibility,
    safety and efficacy of programmes of cardiac care which depend on complex
    clinical decision-making and teamwork by nurses, paramedics and doctors.
    Critical appraisal of the publications is conducted and the research
    methodologies and theoretical underpinnings analysed. Strengths and
    limitations are identified and the implications and impact on clinical practice
    debated. One of the primary aims of this work is to identify a logical and
    programmatic approach to the body of work, concordant with and focussing in
    detail on the patient journey. Potential areas, and plans, for future research are detailed.
    Key themes such as moving the site of thrombolytic treatment to the
    Emergency Department (ED), streamlining care for patients presenting to the
    ED with Acute Coronary Syndromes (ACS), establishing and evolving
    communication networks between Coronary Care Unit nurses and ambulance
    paramedics, moving the site of thrombolytic treatment to the ambulance,
    developing an optimal reperfusion programme including pre-hospital
    thrombolysis, primary percutaneous coronary intervention and in-hospital
    thrombolysis, analysis and synthesis of treatment timelines as they are
    distributed across treatment groups are presented.
    In totality this work supports the direction of travel towards pre-hospital
    treatment of ACS. Although this may sound somewhat straightforward it is, and
    has been, a significant paradigm shift for multidisciplinary clinicians in the
    United Kingdom. These works in their totality have contributed to defining the
    optimal contribution of multidisciplinary experts to ACS treatment in the United
    Kingdom, and in a Scottish context have contributed to national policy and
    service provision.
    Finally this thesis does not sit specifically within the confines of “nursing
    research.” Rather it is defined by healthcare research by a nurse with
    multidisciplinary colleagues. The practice and research described herein is not
    confined within artificial boundaries within one discipline. Rather the study is of
    patient outcomes, systems of care and the contribution of nurses and
    paramedics to the care of patients with ACS.

    Item Type: Thesis (PhD)
    Uncontrolled Keywords: Heart disease; acute cardiac care; clinical practice; pre-hospital treatment; nurses; patient outcomes; allied health professional;
    University Divisions/Research Centres: Faculty of Health, Life & Social Sciences > School of Nursing, Midwifery and Social Care
    Dewey Decimal Subjects: 600 Technology > 610 Medicine & health > 610.7 Medical education, research & nursing > 610.73 Nursing
    Library of Congress Subjects: R Medicine > RT Nursing
    Item ID: 4415
    Depositing User: Mrs Lyn Gibson
    Date Deposited: 20 May 2011 09:11
    Last Modified: 20 May 2011 09:11

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    Edinburgh Napier University is a registered Scottish charity. Registration number SC018373