Aligning the planets: The role of nurses in the care of patients with non-ST elevation myocardial infarction.

Christi Deaton,Jacqueline Hughes,Harry Hemingway,Justin Zaman,Gene Feder,Rachel Johnson,Helen Cramer,Maggie Evans,Adam Timmis

doi:10.1002/nop2.69

Abstract

BackgroundStudies have shown variation in care for patients with non‐ST elevation myocardial infarction (NSTEMI), including in the roles of specialist and advanced practice nurses in diagnosis, treatment and coordination of care.AimThe aim of this study was to describe the roles and responsibilities of specialist and advanced practice nurses in providing care for patients with NSTEMI.MethodsSecondary analysis of observational field notes and interviews from an ethnographic study of variation in care for NSTEMI patients in 10 UK hospitals conducted 2011–2012. Data were thematically analysed to identify key concepts and themes related to the roles of specialist nurses.ResultsSeven of 10 hospitals had roles for specialist nurses in NSTEMI care. The major theme related to high demand and the complexity of patients and organizations (‘Aligning the planets’). In this theme, nurses contributed to improving services or compensating for deficiencies (‘Making the system work versus making up for the system’). Data collection for audit could take precedence over time with patients (‘Paying worship to the paper’). Nurses expressed a sense of ownership of cardiovascular patients that drove their desire to provide quality of care (‘They are our patients’).

Highlights

Studies have shown variation in care for patients with non-ST elevation myocardial infarction (NSTEMI), including in the roles of specialist and advanced practice nurses in diagnosis, treatment and coordination of care
The secondary analysis reported in this paper focused on specialist nurses and advanced practice nurses (APNs) who had responsibilities in identifying and managing patients with NSTEMI and who worked across different departments in the organization
For seven of the 10 hospitals studied, these nurses were central to ensuring patients with NSTEMI were identified, transferred as appropriate, managed, educated, often followed up as out-patients and that care was documented for audit

Summary

Introduction

Studies have shown variation in care for patients with non-ST elevation myocardial infarction (NSTEMI), including in the roles of specialist and advanced practice nurses in diagnosis, treatment and coordination of care. Aim: The aim of this study was to describe the roles and responsibilities of specialist and advanced practice nurses in providing care for patients with NSTEMI. Data were thematically analysed to identify key concepts and themes related to the roles of specialist nurses. The major theme related to high demand and the complexity of patients and organizations (‘Aligning the planets’). In this theme, nurses contributed to improving services or compensating for deficiencies (‘Making the system work versus making up for the system’). Nurses expressed a sense of ownership of cardiovascular patients that drove their desire to provide quality of care (‘They are our patients’)

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