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 08:11
Last Modified: 20 May 2011 08:11

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