1. What were your primary concerns related to patient care? What were you primary concerns as a senior nursing student preparing for your final simulation?
My primary concern about this patient is that he has chest pain related to acute coronary syndrome, and the pain is unstable. If we dont intervene, he might go into cardiac arrest.
As a senior nursing student, Im anticipated what could be the worse situation that can happen to my patient in simulation. I try to gather more information as I could to figure out what was the caused that brought the patient to the hospital, and how can I alleviate his symptoms so that he can get better and not worse.
2. Did you miss anything in getting report on these patients? If so why? Were you distracted? Did you receive too little information? Did you receive not enough or incomplete information? Were there environmental distractors?? What actions could you have taken to improve your patient report? What systems are in place that would assist you? (SBAR, etc.) Describe them.
During report with the last shifts nurse, I was pretty thorough and asked what I need to know about my patient. I was focus and listen to what the two nurses have to say. The information I receive was good but it wasnt enough tell me much about the patient and especially his current condition. We were inside the patients room while doing our turn over report. If I was to utilize the PASSMESAFELY report, it could have been better.
3. Did you have the required clinical knowledge and skills to manage the patient illness? If not, what concepts were you missing? Support your reflection with an evidence based reference from a peer reviewed journal (not greater than 5 years old). This information needs to be relevant to your patient, the clinical scenario and your knowledge deficit.
I have the skills and clinical knowledge to manage this patient and prevent him from dropping blood pressure and going into heart attack. Treatment such as: (article) and I can based of hospital protocol and call ask the doctor.
4. How did you prioritize the patient information/data? On what did you base choice of intervention?
I prioritize the information/data based on the severity of his illness and the present symptoms. The patient has chest pain, but no shortness of breath, crackles on the bilateral lungs, hypotensive, tachycardia, unstable O2 saturation. Airway, breathing, circulation are my top priorities. The patient airway wasnt compromised, his breathing is normal (24 breath per minute). His circulation is diminished due to low blood pressure.
So I called the doctor to report about my patient dropping blood pressure and ask him for some treatment orders. The doctor ordered bolus normal saline (NS), and dopamine running at 5mcg/kg/min, maximum 20mcg/kg/min. Titrate it to keep the systolic blood pressure above 90.
5. What were your strengths during the clinical scenario? What areas do you think you could improve upon? How did you utilize the nursing process to enhance your clinical reasoning?
My strength during simulation was teamwork, assessment skill, recognize the severity of symptoms/condition, pick up on the necessary information from the patient and follow orders from the doctors chart.
I still need to work on my communication skills including verifying the doctor order by repeat or verbalize what the doctor just order to make sure I got the verbal orders correctly. My medication calculation was taken a long time before I decided to ask for help. I took a long time on setting up the pump to run the dopamine after I got the calculation. I didnt check the monitor and set the 15 minutes cycle for vital signs to be taken. I was solely depend on what the monitor to tell me what happen to my patient. No wonder his condition didnt get better. I assess my patient before I administered the dopamine drip but I didnt reassess him 15 minutes after to see if his condition improve.
6. How would you approach this clinical scenario if you had to do it over again? Which objectives were you unable to achieve?
I will have to practice on my pump setting skill, drug calculation for drip, and re-verbalize the doctor order when I communicate so that if I have to do it again, I wont make the same mistake like I did in simulation.
o Incorporate assessment and critical/clinical reasoning skills, to create priority interventions for patients who have complex multi-system health care needs
o Utilize effective communication skills in providing care to diverse patient populations and in collaborating with the interprofessional team.
o Integrate patient care technologies, information systems, and communication devices that support nursing practice.
7. How would you summarize this experience?
My experience in simulation allow me to begin to think critically overall the big picture about my patient.
Australian Critical Care 27 (2014) 111118
Contents lists available at
Australian Critical Care
Timely treatment for acute myocardial infarction and health
outcomes: An integrative review of the literature
Lorelle Martin RN, MNSc
Maria Murphy PhD
Andrew Scanlon DNP
Carolyn Naismith MN
David Clark MBBS (Hons), FRACP
Omar Farouque MBBS (Hons), PhD, FRACP
Department of Cardiology, Austin Health, Australia
LaTrobe University School of Nursing, Australia
Department of Neurosurgery, Austin Health, Australia
Received 28 August 2012
Received in revised form
24 November 2013
Accepted 26 November 2013
Percutaneous coronary intervention
Door to balloon time
Coronary heart disease is the most common condition affecting Australians. The time sen-
sitive nature of treating ST-segment elevation myocardial infarction (STEMI) has been the subject of
extensive research for several years. Despite important advances in strategies to reduce time to treat-
ment, time continues to represent a major determinant of mortality and morbidity. Door to balloon time
(DTBT) is a key indicator of quality of care for STEMI. Nurses play a pivotal role in streamlining the care
processes to influence timely management of STEMI.
The aim of this paper is to review the evidence on the time to treat STEMI, the associated factors
impacting upon health outcomes and explore systems of care that reduce time to treatment, using an
integrative review approach.
Established databases were searched from 2000 to 2012. The search terms myocardial
infarction, emergency medicine, angioplasty balloon, time factors, treatment outcome, mortality,
prognosis, female, age factors, and readmission, were used in various combinations. Research studies
that addressed the aims of this paper were examined.
Twenty-nine papers were included in this integrative review. The literature demonstrates a
strong relationship between shorter DTBT and reduced in-hospital mortality. Factors such as age, gen-
der, time of presentation and co-morbid condition were associated with increased in-hospital mortality.
There is sparse literature examining the effect timely reperfusion has on longer-term mortality and other
longer-term outcomes such as readmission rates and occurrence of heart failure. Additionally, strategies
that effectively reduced DTBT were identified, yet little has been reported on the impact reduced DTBT
has had upon health outcomes and whether these improvements were sustained.
Whilst the importance of timely reperfusion is now well recognised, additional efforts to
streamline the process of care and demonstrate sustained improvement for STEMI patients is required.
Nurses in the areas of emergency medicine and cardiac care, play an essential role in facilitating this.
Crown Copyright © 2013 Published by Elsevier Australia (a division of Reed International Books
Australia Pty Ltd) on behalf of Australian College of Critical Care Nurses Ltd. All rights reserved.
Corresponding author at: Department of Cardiology, Austin Health, Australia.
Tel.: +61 0421106296.
Cardiovascular disease (CVD) refers to all diseases of the heart
and blood vessels.
Coronary heart disease (CHD) is the largest
subset of CVD accounting for 14.6% of all deaths in Australia in
In terms of burden of disease, CVD was responsible for
18% of the total burden of disease and injury in Australia in 2003,
second only to cancer.
The Australian expenditure on CVD for
20042005 was recorded as $5.94 billion, more than any other
1036-7314/$ see front matter. Crown Copyright © 2013 Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd) on b
ehalf of Australian College of Critical Care Nurses Ltd. All rights reserved.
L. Martin et al. / Australian Critical Care 27 (2014) 111118
disease group, and accounted for 11% of the total health care
Whilst mortality from CHD is decreasing, it remains the single
largest cause of mortality in Australia for both men and women.
Further, almost half of these deaths were attributed to acute