Role of the nurse in myocardial infarction resuscitation
This paper will essentially present an in-depth factual experience on the role of the nurse in myocardial infarction resuscitation in the Medical Assessment processes using John’s (1995) Structured Reflective Cycle Model. It will further critically analyze the influencing factors and the strategies used to deal with the situation above. This reflective experience will embed a brief description of the incident that amounted to the practical applicability of the model. It will also comprise of categorized sections defined by Johns (1995) as Aesthetics; Personal; Ethics, Empirics and Reflexivity. The model will be applied to analyze the actions, sequences and feelings of the writer during this care delivery process. This framework offers a series of reflective experience to the writer to begin to understand the practice in relation to the fundamental ways of knowing.
In accordance with the Nursing and Midwifery Council (NMC) (2004) Code of Professional Conduct, confidentiality will be maintained throughout this reflection. In this situation my patient will be referred as Mike. The patient case is a 61 year old gentleman admitted with left side chest pain, neck pain and sharp throbbing in the shoulder.On assessment by the medical team he was diagnosed with a throbbing chest and leg ulcer. On further investigation by me, mike kept complaining of chest pain. I knew this situation required immediate remedial action. I thus started him on 2 litres of oxygen therapy, checked his vital signs and realized his blood pressure was too low given the 60/45 pulse rate, 48 pulse rate and the respiration rate 10. I then instantaneously performed an electrocardiogram (ESG) and informed my fellow nurse mentor who was not very far from me at once for a collective consultative medical remedial action. It was during this consultative process that Mike’s wife came in to ascertain the medical condition of her husband. I must say she was perturbed as to why there was no change in mike’s condition given the remedial action. The wife called me, about his condition and went to call the mentor. After that, we found out that he was having a cardiac arrest because of the shortness of breath, very low blood and respiration rate. My mentor then called for an immediate cardiac arrest. We called the doctors responsible who came immediately and performed the cardio pulmonary resuscitation. Since Mike’s blood pressure was also as low as 60/45, the doctors asked for gelofusine to be started, which I complied in strong accordance with the trust policy. The doctors then asked for another ECG, which I again performed.
Given my personal experience, Mike was a case that manifested special interaction with the patient. Clearly, the nurse patient interaction was manifest, during this incidence. This section will dwell on the nurse patient interaction and gradually expound on the nurse’s part in the resuscitation process focusing on aethetics. This essentially looks at what you are trying to achieve, how one knows the situation of the patient and the consequences of actions towards your collegue and yourself. When Mike was in pain complaining of his chest aches, I made sure he was consoled. I encouraged him and assured him that all would be ok. This is supported by Johns (1995) as he notes that it’s important to maintain an atmosphere of personal positive engagement with the patient. This interaction is also affirmed by (Morse, 1991) who views this as vital relationship that should be binding. It can be avowed that when Mike complained of chest aches, I made sure that these symptoms were monitored to ensure he received prompt treatment. This is also supported by (Alexander et al, 2000) who stress that observation entails clinical assessment which enables the nurse to identity the patient’s current problems, prioritise care and recognize changes. The Department of Health (2000) also notes that chest aches that are extreme are a serious symptom that may indicate an immediate myocardial infarction. Also, Observation of vital signs is used to gain baseline physiological information on admission for early identification of deterioration and diagnosis.
Provided the given indicators of Mike’s problem, it’s very vital to record vital signs of the patient, which I did in this case. Further more, I made sure that the ECG was performed in order to assess the condition and establish the cause of the pain. I also made sure that Mike was immediately placed on a cardiac monitor so that his vital observations could be recorded. As one method of establishing the cause of Mike’s impediment i applied PQRST. This stands for P which means palliative, Q for quality for pain, R for region or radiation of pain, S for subjective descriptions of pain and T for temporal nature of pain. In this case I investigated the precipitative factors through cross examination of the patient to ascertain the causes of the pain, especially what makes it better or worse. Further more, i established quality of the pain in respect to its sharpness or dullness. I also looked at its Radiation, essentially determining whether it was in one area or all over the body. I finally considered the severity of the pain using the scale of 1-10 putting into consideration the time it started and how long it had lasted. After this quick assessment, I believed that this methodology would provide me a solid basis for pain assessment and determining what was the real problem with the patient. The patient had stressed that he had a central pounding ache of the chest, which I affirmed.
Given the assessment and further investigation, this was a possible indicator of myocardial infarction. In fact, the Resuscitation Council of United Kingdom (2005) states that chest aches relating to a myocardial infarction are ‘usually’ a central crushing pain or discomfort in the chest which often wraps around the body like a tight band. They further stress that it may spread to other parts of the body, or just affect the arms, throat, neck, jaw, back or stomach and doesn’t go away with rest. Mike stated that his pain was crushing and appeared short of breath. According to Thompson (2000) when a patient complains of crushing central chest pain an electrocardiogram (ECG) should be taken at the same time. Since an ECG gives a complete picture of the electrical activity of the heart; it is possible to locate an emerging myocardial infarction (MI) also known as heart attack. Having discussed and affirmed the problem behind the chest pain with my mentor during the shift I was confident that I was acting in Mike’s best interest.
In my interaction with this patient, I had been personally caring for him and inspiring him all morning under the supervision of my mentor. In support of this assertion, (Herth, 1990) notes that nurses play a significant role in handling patients and are an important instrument in encouraging and creating a feeling of optimism to the patient.
At the point when Mike’s condition continued to deteriorate and went in to cardiac arrest, I quickly responded by putting out a cardiac arrest call to the staff concerned. It’s thus very important for the nurse to be alert and act responsively in such circumstances when patients’ conditions deteriorate.
In this case, I quickly responded by putting out a call for a cardiac arrest to staff concerned. After calling the staff, I also took the initiative to bring the Cardiac arrest trolley in preparation for Cardio-Pulmonary Resuscitation (CPR). All these actions are in line with (Carper, 1978) who notes that in such situations the nurse response should be appropriate and skillful.
This also followed with the application of Basic Life Support (BLS) to establish a clear airway which also entailed assisted ventilation and circulation support; which I must say was done without the aid of specialized equipment. However the process was simplified when I arrived with a resuscitation trolley. It’s also during this discourse, that I provided backstopping support to my mentor with CPR 30:2. This was deferred when the supporting nurse connected the defibrillator and monitor to the patient. This was essentially done to assess Mike rhythm to determine if it was shockable or non shockable.
Personal is concerned with knowing the self and how this relates on the nurse patient’s interaction in any therapeutic relationship. On reflection of this incident, I was relieved because I responded appropriately when Mike’s showed signs of deterioration. This is because I was able to execute good clinical skills by monitoring Mike’s critical status regularly and informing other members in the multidisciplinary team who were able to prescribe treatment. Kenworthy et al (2002) agrees with such an approach and states that optimal management requires multidisciplinary teamwork and also enhances the discussion of care for the patient. In addition being a third year student, it had been identified as one of the competencies as expected of m. It’s in this discourse that I was able to utilise interpersonal knowledge and skills acquired for theory and practice. I personally felt sad for Mike’s family after his prognosis and made sure I offered them support with my mentor. . In critical analysis when Mike complained of chest aches, I felt confident in identifying his needs and was able to meet them myself with the guidance and support of my mentor during handover. I can also stress that, the role of the nurse in myocardial infarction resuscitation is a paramount importance. The need I felt to help relieve Mike’s chest discomfort as soon as possible and also provided the patient care and support in a way that would benefit him by safeguarding and promoting his interest and well-being (NMC, 2004).
According to Hinchliff et al (2003) ethics is defined as a systemic approach based on moral principles which can underpin practice and assist the practitioner to act in a manner that fulfils the obligation to their patients. Johns (1995) also notes that ethics looks out how the nurse’s actions match with her beliefs while handling patients. Similarly, Davis (1995) states that ethics is associated with moral decision-making which focuses on what ought to be done in the given situation.
In my actions with the patient during the MIR, I essentially cultivated optimism and showed care to the patient with the aim of improving his welfare and solving the problem that was at hand. I must say the emphasis of care, personal engagement and communication of the nurse during a myocardial infarction resuscitation is paramount. In relation to this due supplementary support was given in the provision of Cardiopulmonary resuscitation(CPR). This is stressed by (Johns, 1995) who notes that the response of the nurse in the latter situation, should consist of responsiveness that embeds skillfulness and appropriateness in delivery of care.
I was also able to recognize from Mike’s early warning signs that he needed urgent medical intervention and was able to act first and timely in order to ensure that adequate support was given during the (MI).These actions truly matched my personal beliefs. It is thus paramount for the nurse to be able to recognize the emerging early warning signs and provide the necessary support during MI. This is an important empirical issue of ‘ethical-knowing’, that is inclined to the nurse’s belief in doing good in a clinical condition. Caper, (1978), notes that it’s of paramount importance to understand the clinical situation, act timely and appropriately for the good of the patient.
I can also note that the nurse should be able to document and map any observations of the patient’s clinical performance during the MI in order to ensure effective monitoring and planned calculated action in order to devise valuable remedies for the patient. It can be stated that when monitoring a critically ill patient, it is important to ensure proper documentation, because it helps to explain changes and confirms observations and actions when needed. Also, from the legal point of view (Chapelhow, 2005: NMC, 2004), suggests that if something has not been recorded, it has not been done.
As a student I believe I was acting in Mike’s best interest and in accordance to the NMC (2004)..
This is because the principles of maleficence(to do good) and non-maleficence(to don’t harm) were reflected in my practice. This was affirmed by continuous observations, monitoring and accurately recording Mike’s vital signs, as well as maintaining good effective communication skills and interpersonal relationships within the Multi Disciplinary Team (MDT), Mike and his relatives.
Knowledge derived from relevant literature and practical training about myocardial infarction resuscitation, and MI,. Should be applied by the nurse in finding remedies to the clinical condition .In relation to the above, during my interaction with the patient I ensured hope to the patient in order to enable him handle the situation well and reduce the level of anxiety during the MI. . This is also affirmed by the Department of Health (DOH) (2000) that stipulates that, student nurses must be able to apply knowledge and understanding as well as skills when performing to the standards required by them.
The nurse should be able to utilize ECG and understand how myocardial infarction resuscitation is applied and how MI progresses. In this case, I was able to determine early warning signs that were possibly indicating a myocardial infarction. In my response to the myocardial infarction my actions were governed by the clinical practice and Resuscitation Council guidelines on Advance Life Support (ALS). According to the Resuscitation Council (UK) (2005) the ALS treatment algorithm provides a standardised approach to the management of adult patients with myocardial infarction. Since the patient had a shockable rhythm, (VF/VT) defibrillation was attempted. Subsequent actions including chest compression, airway management and ventilation, venous access, administration of adrenaline, the identification and correction of reversible factors. Mike unfortunately died after an hours attempt at resuscitation.
During this placement I have taken quite a few ECG‘s and come across several myocardial infarctions, of which I have observed more than participated because I did not feel confident enough to carry out any task. But during Mike’s care I felt more confident and was able to participate at that stage. I now feel relieved that I am coming towards the end of my placement and most of my goals have been achieved. However, I’m still looking forward to learning new skills daily, since each care setting brings new challenges.
In future, I will read more literature review, about the anatomy and physiology of the body, as this will enable me gain more insight about how the body works and what happens when there are abnormalities. I would also like to learn more about drugs used during resuscitation, and how they work. To help me achieve this goal my mentor has provided me with some literature regarding resuscitation, chest pain and ECG readings, which enlightened me about what to do and when to do it in times Like this. This knowledge gained will be used to transfer to future practices and will be shared with others to help them understand more about myocardial infarction and treatment plan for the patients. In the future I will be fully equipped with knowledge, in that in cases where I am consulted by my patients, practitioner or employers, I will be able to give them the answers needed, as well as the rationale for such actions taken.
In summary to analyse and explore my feeling and action, I used John’s (1995) 10th edition structured framework as it enabled me to focus and critically appraise my feelings, and to gain a deeper understanding of this experience. Reflecting on one’s practice is self-empowering as it provides an insight into personal understanding and control (Teekman 2000). Reflective practice can enable personal and professional development as well as clinical practice.
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