Free Nursing Dissertations - This Paper Will Discuss The Nursing Care Of A Patient Attending The Accident
This paper will discuss the nursing care of a patient attending the Accident and Emergency department (A&E) with a myocardial infarction. At the time of his admission, a nursing-led health promotion programme was in place in the A&E department, and cardiac care unit, where all adult smokers presenting with symptoms of cardiovascular disease were provided with a brief nurse-led smoking cessation intervention. The research evidence and theoretical basis for this intervention will be reviewed and followed by a discussion of how this was applied to the nursing care of one patient.
Smoking is a contributory factor in approximately 30% of ischaemic deaths per year, and about half of smokers will eventually be killed by their habit (Richmond, 1999). Smoking is associated with increased heart rate, increased blood cholesterol, fibrinogen and increased platelet production which are all risk factors for the onset of atherosclerosis and myocardial infarction. Carbon monoxide inhibits the circulation of oxygen by the heart, reducing the availability of oxygen to bodily tissues (ASH, 2005). An emergency event such as a myocardial infarction offers a window of opportunity for the health profession to persuade their patients to quit smoking, particularly where the symptoms of cardiovascular disease are severe (Richmond, 1999). Research has shown that smoking cessation rates amongst patients with confirmed coronary artery disease to be between 30% and 75%, and long term abstinence amongst hospitalised cardiac patients is as much as 50% (Richmond, 1999). Furthermore, there is a 50% reduction in the risk of a further myocardial infarction and sudden death in smokers who quit after the first myocardial infarction (Richmond, 1999). Increasingly research has shown that A&E is an appropriate venue for smoking cessation work because it is the only source of primary health care for some people, and their visit may involve treatment for distressing medical conditions, such as cardiovascular disease, that provide an opportunity for the patient to re-evaluate the role of their lifestyle in their health (Boudreaux, Kim, Hohrmann, Clark et al, 2005). Bernstein and Becker (2002) conducted a systematic review showing that routine medical counselling in A&E increases quit rates from 3% (standard care) to between 8% and 11% over a 12 month period. However, research studies yield mixed results. Richman, Dinowitz, Nashed et al (2000) found that brief standardised A&E counselling was ineffective at promoting out-patient clinic attendance, reducing cigarette intake or increasing abstinence rates. However, Quist-Paulsen and Gallefoss (2003) observed a significant reduction in smoking amongst cardiac patients admitted to hospital that were subject a nursing led health promotion intervention.
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