Cardiology Nurses Research Articles

Nurse initiated thrombolysis in the accident and emergency department: safe, accurate, and faster than fast track

Objective: To reduce the time between arrival at hospital of a patient with acute myocardial infarction and administration of thrombolytic therapy (door to needle time) by the introduction of nurse...

Improving Door-to-Drug time and ST segment resolution in AMI by moving thrombolysis administration to the Emergency Department

Background. We describe a combination of measures to reduce Door-to-Drug (DTD) time and improve the Emergency Department (ED) management of ST elevation MI (STEMI): appointment of a Cardiology Nurse Specialist, application of the American College of Cardiology and the American Heart Association (ACC/AHA) guidelines, changing the site of thrombolysis from the CCU to the ED, the introduction of a single bolus thrombolytic agent. Methods. The 12-month period before and after the introduction of the measures were retrospectively reviewed. One hundred and sixty patients were discharged from the CCU with the diagnosis of myocardial infarction confirmed by ECG and enzyme criteria. Eighty patients had STEMI and fulfilled criteria for thrombolytic therapy at the time of presentation to hospital. A full data set was available on 35/38 of patients in the 12 months prior to the measures (Year 1), and 39/42 in the 12 months subsequent (Year 2). Results. Median DTD time fell from 80 to 22 min after institution of the measures. Median Pain-to-Drug time also fell from 270 to 140 min. Thrombolytic agent given in the ED rose from 3% in Year 1, to 72% in Year 2. IV β-blocker administered in the ED rose from 12% to 79%, resulting in median time to receiving IV β-blocker falling from 63 to 19 min. Elevated ST segments resolved by ⩾70% in <2 h in 53% of Year 2 patients, compared with 23% of Year 1 patients. Combined major in-hospital adverse clinical events were reduced from 49% to 15%. Conclusion. This combination of measures reduces DTD time, improves speed to delivery of important concomitant medications, and significantly improves the time to ST segment resolution and outcome in STEMI.

Optimizing treatment of dyslipidemia in patients with coronary artery disease in the managed-care environment (the Rocky Mountain Kaiser Permanente Experience)

Rocky Mountain Kaiser Permanente has taken aggressive steps to ensure optimal treatment of all modifiable cardiac risk factors, especially low-density lipoprotein (LDL) cholesterol, in patients with coronary artery disease. In this article, we are presenting (1) the basic rationale for our approach, (2) the critical steps translating philosophy into practice, and (3) justification for all health plans to pursue a similar course. The continuum of physician-directed disease management systems that have evolved in our region—one administered by cardiology nurses in the perihospitalization period and the other by pharmacists in the long-term, outpatient setting—is then detailed. Although the relatively short duration that our comprehensive systems have been in place precludes any assessment of their impact on cardiac death, coronary artery disease events, or coronary artery disease procedure rates, the improvements in intermediate surrogate outcomes are promising. Virtually all surveyed patients participating in our management systems have been “very” or “extremely” satisfied with their experience. The LDL-cholesterol screening rate in the approximately 2,500 participants in the programs to date has reached 97%. Of these patients, 84% have LDL cholesterol <130 mg/dL and 48% <100 mg/dL, and only 15% of those few with LDL cholesterol >130 mg/dL (2.5% overall) are currently not receiving lipid-lowering therapy. The proportions of patients on aspirin/antiplatelet and β-blocker therapy after myocardial infarction are 97% and 92%, respectively. The lipid-screening and treatment rates, especially, represent significant improvement from our own baseline, and compare favorably with outcomes from other practice settings. In conclusion, health maintenance organizations have tremendous incentive and the unique opportunity and ability to develop systems to better manage large numbers of individuals with coronary artery disease.

Radiology nursing: legal issues surrounding the expanded role.

The annual conference for the Royal College of Nursing's Forum of Nurses in Radiology and Cardiology took place in Birmingham last year. Participants were asked to consider the ways in which their professional practice could develop within The Scope of Professional Practice (UKCC, 1992a) guidelines and the possible problems they feared could arise. The legal issues which arose from their answers were then analysed. The aim of this article is to examine, in the light of the legal issues, the chosen areas of expansion within the nurse's role and the concerns felt by the participants in order to draw up lessons for nursing generally.

Principles of consent: issues for the radiology nurse.

This article considers the law relating to consent to treatment, raised by delegates at an RCN forum for radiology and cardiology nurses. The author outlines general principles of consent to treatment which apply to all specialties, and discusses the specific issues raised by nurses' questions about consent for radiological investigations.

Cardiac Counselling: Birth of a Speciality

The Cardiology Nurse Counsellor is a valuable resource. Jenny Foren explains what the role entails.

Cardiology update. Radiation protection.

Cardiology nurses receive some of the highest occupational radiation doses and good protective practice is essential to cut the associated hazards to safe levels

Cardiac nurses: coping with stress

This paper describes issues relating to coping with stress as expressed by nurses in cardiology. The data were collected at a 1-day workshop on 'Coping with Stress', sponsored by the Israel Cardiac Nursing Association in response to repeated requests from nurses in cardiology. The programme included theoretical presentations. Group work focused on the nurses' self-evaluation of coping with stress, rather than on patients' needs. Twenty-two groups of 15 nurses each worked with pre-trained group leaders on the following issues: causes and origins of stress; coping strategies and mechanisms; feelings and emotions accompanying the different coping strategies; suggestions and alternatives for improving coping skills. The group process also included experiential exercises. Analysis of the nurses' coping strategies in relation to staff, patients and their families, and work-related issues suggests four distinct coping modes. Nurses' overall responses were positive and emphasized practical benefits for future work.

Managers at fault over grading.

RADIOLOGY NURSES may have missed out during the clinical grading review because their managers misunderstood their complex roles, a new survey shows. The survey, which was carried out by Connie Wakley, Chair of the RCN Radiology Nursing Forum, looked at the grades awarded to radiology and cardiology nurses in 170 departments around Britain.

Angiography talks.

'Angiography what follows' was the title of the inaugural meeting of the South West and Wessex Radiology and Cardiology Nurses Special Interest Group.