Clinical Observation: Oxygen Therapy for Acute Myocardial Infarction - Essay Example

?Clinical Observation and Literature Review: Oxygen Therapy for Acute Myocardial Infarction Introduction Oxygen therapy has been used to manage myocardial infarction for many years now. Oxygen therapy has been used as a strong and effective option because it seems to have the ability to deliver oxygen to the myocardium, helping to decrease the size of the infarct and also improving the clinical health outcomes. Myocardium infarction primarily involves the lack of oxygen in the myocardium and with increased oxygen deprivation, the infarct can cover a more significant portion of the myocardium. It is therefore important to immediately initiate oxygen therapy in order to deliver oxygen to the myocardium and reduce the infarct. Oxygen therapy is relevant to contemporary nursing practice because myocardium infarcts have now become common occurrences for humans. With increasing rates of obesity, heart diseases have become common health issues. Specifically, myocardium infarcts are some of these issues which have emerged in recent years. It is therefore important for nurses to immediately initiate oxygen therapy for patients having myocardium infarction. For transitional registered nurses, it is also important for them to know how and when to initiate oxygen therapies for their patients. Although these transitional nurses would not have much experience in oxygen therapy, these nurses have to make the necessary adaptations in their knowledge and skills in order to efficiently carry out these therapies. Critical Review In the paper by Nicholson (2004), the author carried out a systematic review seeking to establish the efficacy of oxygen in decreasing acute myocardial ischaemia. The author acknowledged how patients experiencing acute chest pains can effectively be relieved through oxygen therapy, as this type of therapy is known to establish balance in defects seen in ischaemia. Her study was carried out as a systematic review, as such is a secondary research compiling data from other peer-reviewed studies. Studies included in this review were mostly primary studies, including randomized controlled trials and non-randomized controlled trials on acute coronary syndrome. The study was able to establish through its coverage of nine trials, that the efficacy of the oxygen in decreasing myocardial ischaemia was not clear. Based on data, oxygen was also known to reduce the ischaemia, however, some studies also indicated that it also increased ischaemia. In effect, no definite or clear results were apparent from the review. This study is effective in terms of providing systematic sources of information which can be utilized to support the current issue. The methods applied by the author were appropriate and were fully supported by randomized controlled trials. Nevertheless, this study is not considered primary research as the author utilized clinical research by other authors in order to establish a pattern in the clinical practice. There is a need therefore to seek more evidence on the impact of oxygen therapy on myocardial infarction. Moradkan and Sinoway (2010) also carried out their study in order to review data assessing the impact of supplemental oxygen in normoxic patients presenting with coronary artery disease. The authors were also seeking to establish the point that oxygen therapy may have negative effects which must be evaluated before it is utilised. This is another review of data and therefore a secondary research. Nevertheless, it provides critical information on oxygen therapy. In fact, their review was able to establish that supplemental oxygen is being used excessively among cardiac patients, often unintentionally subjecting them to hyperoxia. This study was also able to establish that many medical professionals do not realize that oxygen is vasoactive and when oxygen saturation reaches 100%, increase in blood and oxygen tension may become apparent. The results of this study are however not based on randomised controlled trials and as a result may not have as much credibility as other reviews. Its results and recommendations cannot be considered as fact, unless more evidence and randomised controlled trials are carried out using clinical parameters. The research methods used in this case do not present adequate and repeatable methods of study which can help support a strong and evidence-based result. Burls, et.al., (201) also carried out a systematic review covering the topic of oxygen therapy and myocardial infarction. As a secondary research, a database search was carried out in order to ensure the use of peer-reviewed studies. The authors were able to utilize and cover randomised controlled trials for their review and the quality of these studies was based on the Cochrane Collaboration guidance. Based on evidence established through the studies covered, harm is seen in oxygen use, however excess in deaths seems to also be attributed to chance. Once again, this review also suggests more studies which have to be carried out in order to establish clearer and more comprehensive results. The studies utilised in this review are randomised controlled trials which help provide strong support for the review. Randomised controlled studies provide the highest level of evidence for any clinical research, however, the authors are not the primary researchers of such trials as they derived work from these trials into their review. In effect, the reliability and generalizability of their review is considered lower. In the study by McNulty, et.al., (2005), the authors set out to study whether supplemental oxygen therapy impacts on coronary blood flow in the clinical setting for patients having had coronary artery disease. The authors were basically able to establish that breathing of 100% oxygen increased coronary resistance and did not impact on large conduit arteries. This study was carried out under actual clinical settings with observations and recordings made by the researchers on actual respondents. This is a primary research and has a higher level of evidence as compared to other studies. The methods applied are very much replicable and valid in terms of applied variables and related future applications. The topic is not however in the exact topic which is being studied in this paper. Nevertheless, the results establish sufficient basis for future recommended researches. In a similar systematic review, authors, Wijesinghe, et.al., (2009) sought to review randomised controlled trials, evaluating the application of oxygen therapy in myocardial infarctions. Two studies met the inclusion criteria and one study established that in uncomplicated MI, high-flow oxygen indicated non-significant increased risk of death and higher serum aspartate aminotransferase level as compared to room air (Wijesinghe, et.al., 2009). Once again, the results in this review are not conclusive as more evidence is needed in order to support the indication that oxygen therapy can bring a greater risk to the MI patient. No sufficient evidence was drawn from this review because of limited studies included. Primary research is needed in order to provide support for evidence-based practice. This study reviews other studies and does not provide primary evidence which other practitioners can utilise for their practice. Moreover, the results established were not conclusive and in fact gave further rise to the need to establish more evidence on oxygen therapy and myocardial infarction. In the Kones (2011) study, the authors acknowledged how inhaled oxygen has been issues to all patients often suspected of acute MI. This is based on the fact that there is oxygen deprivation causing infarct for patients. Such a belief is however not supported by evidence. Oxygen may decrease lower capillary density and then redistribute blood in the circulation. This study also acknowledged that there are not significant and randomised trials which evaluate the clinical effects after oxygenation. Hence, there is a need to reevaluate this practice. Current guidelines seem to support the use of oxygen in hypoxemic patients, and then applying more caution in individual oxygen tensions (Kones, 2011). This study provides a progression of the trends in oxygen and myocardial infarction. The results drawn from this study are relevant as they provide a marginal basis for future studies. Moreover, gaps in the methodology are apparent in terms of general applicability and validity. The study is not based on results observed by authors on respondents under the clinical setting. Hence, it also supports the need for more randomised controlled trials to be carried out reviewing the specific variables and elements applicable to this research study. Leadership characteristics Leadership qualities that have been used and can be used by nurses within the clinical practice to help facilitate change include qualities of initiative and teamwork (Kelly, 2011). Initiative includes the process of nurses making the necessary initiatives or moves in order to implement the essential nursing interventions. It is basically about not standing around when it is time to care for a patient, instead, it is about taking immediate actions as soon as a patient is encountered in the clinical setting. Taking the initiative can also motivate other practitioners, also prompting them to act and carry out their own expected functions (Kelly, 2011). Teamwork is also an essential quality of a leader. Teamwork refers to the ability of a person to work in coordination with other members of the team. It is about communicating and listening to others in order to implement the most effective intervention for the patient (Kelly, 2011). Leadership can impact on this clinical issue by prompting the nurse to be more discerning in her actions, initiating discussions with other health professionals in order to determine the efficacy of oxygen therapies for MI patients. Leadership can impact on the clinical issue by prompting discussions and evaluations of usual and established nursing interventions (Hickey and Kritek, 2011). As leaders, nurses have to be willing to initiate discussions in the clinical setting. Initiating discussions with doctors and other nurses can help clarify the purpose and the impact of interventions. It can also prompt discussions among the health professionals on the actual applicability and logic of nursing interventions (Hickey and Kritek, 2011). Without these discussions, nursing interventions will continue to be followed and applied even when their logic or applicability may already be flawed or obsolete. For nurses, being a leader is an important clinical function, one which can initiate change and improve patient outcomes (Hickey and Kritek, 2011). Conclusion The different studies cited above indicate how there are major gaps in the knowledge on oxygen therapy and myocardial infarction. For one, most of the studies carried out are systematic reviews which are secondary researches and are not clinical studies carried out by the authors. Nevertheless, majority of the studies cited by the reviews are randomised controlled trials. These studies are still however very much limited in terms of results and coverage. They cover an insufficient number of studies and do not establish clear results for the current issue being discussed. Leadership is an important element of the nursing practice and it is up to the nurses to initiate discussions with their colleagues and fellow health professionals. These discussions must probe and question the current practices, especially if these are flawed or obsolete. The nurses must be open and must communicate with each other and with other health professionals in order to establish an effective practice and support improved patient outcomes. References Burls, A., Cabello, J., Emparanza, J., Bayliss, S., and Quinn, T., 2010. Oxygen therapy for acute myocardial infarction: a systematic review and meta-analysis. Emerg Med J., 28:917e923. Hickey, M. and Kritek, P., 2011. Change leadership in nursing: how change occurs in a complex hospital system. London: Springer Publishing Company. Kelly, P., 2011. Nursing leadership & management. London: Cengage Learning. Kones, R., 2011. Oxygen therapy for acute myocardial infarction-then and now. A century of uncertainty. Am J Med., 124(11):1000-5. McNulty, P., King, N., Scott, S., Hartman, G., McCann, J., et.al., 2005. Effects of supplemental oxygen administration on coronary blood flow in patients undergoing cardiac catheterization. Am J Physiol Heart Circ Physiol., 288(3):H1057-62. Moradkhan, R. and Sinoway, L., 2010. Revisiting the role of oxygen therapy in cardiac patients. J Am Coll Cardiol, 56(13): 1013–1016. Nicholson, C., 2010. A systematic review of the effectiveness of oxygen in reducing acute myocardial ischaemia. Journal of Clinical Nursing, 13, 996–1007 Wijesinghe, M., Perrin, K., Ranchord, A., Simmonds, M., Weatherall, M., and Beasley, R., 2009. Routine use of oxygen in the treatment of myocardial infarction: systematic review. Heart, 95, 198-202. Read More