Edinburgh Napier University

  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.