Teamwork is an integral part of Accident and Emergency care and if it is jeopardized problems tends to occur. Looking at communication, consent and teamwork I will explore and reflect the ways in which the patient I observed was treated.

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Introduction

Teamwork is an integral part of Accident and Emergency care and if it is jeopardized problems tends to occur. Looking at communication, consent and teamwork I will explore and reflect the ways in which the patient I observed was treated and what could be done in the future care and practice of others in order to reach maximum potential with further clients.

First Part

An emergency call went out for a Chest pain in resuss one, Chest Pain Team required. As I was the student nurse in resuss for that particular shift. I was urged to join the medical team to see what was happening with this patient. As I stood and observed what I was witnessing was Myocardial Infarction.

As I was observing the situation, I was surprised to see how calm everybody was. The Resuss room is a room which consists of six bays which have specialist equipment in, if an emergency with a patient was to happen. The patient I was observing was put into the first bay, as this bay has much more space so the team of medics and nurses can work around the patient quite easily. As I was watching I noticed that the nursing staff used the ECG machine. As I was watching the patient’s relative seemed concerned with what was happening to the patient. I took it upon myself to reassure the relative by explaining what was happening and why the medics where doing this procedure.

The ECG showed that the patient had ST elevation and was having a Heart Attack. I felt apprehension for the relatives and patient when this information was told to them. I observed that the patient remained calm and collected. The patient seemed to accept the diagnosis quite well. I felt sad for the patient’s relatives.

The Nursing staff then followed with the baseline observations of the patient. For example the blood pressure, respirations, pulse and oxygen saturations were measured every five minutes to monitor any changes. Everything seemed to becoming a bit clearer as I watched and I started to understand what was happening. The relative still appeared to be very apprehensive. I explained to the relatives with the knowledge that I had in order to help the situation and make them understand why the professionals where doing certain procedures. I felt almost helpless, although I did offer support to the family that needed it at the time.

It was determined that the patient needed to have a thrombolysis treatment. The patient was told by the doctor what was going to happen although I did not know what this treatment was. As this was my first experience of observing a Heart Attack as a professional. The relative asked what this treatment was and I felt helpless as I was unsure. So I took it upon myself to ask the professionals when they had time to talk. This frustrated me; as if I would have known what the treatment was I could have helped. I feel as a Student Nurse I tended to get treated as a non entity by doctors and some nurses because you are unaware of the events unfolding in front of you. When I asked I got a comment back that was rude. This really quite shocked me to see that in a society which people are all trying to be equal and non judgmental that a Doctor could treat a fellow colleague in such a way. This really upset me, but I moved on. I explained to the relatives what the ‘clot busting’ drug was. This made me feel good once I had done this, as I got the satisfaction that I helped the family.

My role in the critical event was observer; I did ring for a chest x ray and so that made me feel like I was contributing in a small way.

My whole perception of a heat attack is somebody gasping for breath and holding their chest. I suppose the media may have glamorized the whole episode of having a Myocardial Infraction. I was really surprised to see how controlled the situation was. Nobody was panicking everybody appeared to be calm and surprisingly the patient was calm and responding. I expected the patient to be in so much pain, and unable to communicate. The patient did not appear to be in pain, but looks can be deceiving, as when I asked whether he was still in pain, he said that he was, but he was handling it very well. As people deal with pain in different ways. I was very interested to see post event the way the Doctors and Nurses reacted. When I asked how they felt whilst the event was occurring, the professionals were panicking inside, but they did not show it to the relatives or patient. I was panicking for the patient and the relatives. Also, the patient that I was witnessing having this episode of cardiac problems was still very young which made me feel sad, for the patient.

After speaking to the patient I felt sad for what had happened but good for what I had done to help, i.e. offering a cup of tea. I felt that I could have got more involved with the clinical aspect of the event, although I did not want to get in the way as I tend to feel like I am. I feel because it was at the beginning of my placement and I had not done much critical care I did not know what to do. As I am further into the placement I feel I could have handled it better. I felt also that I should have spoken more to the patient, but again I may have been in the way of what needed to be done. I should have asked if the team needed any more assistance. If the situation happened now I would get more involved in the critical aspect of care.

I am glad I observed the Heart Attack it has helped me to grow and be a stronger person when dealing with critical illness. I did feel empathy for this family so I could not leave it at the Accident and Emergency stage. I rang the Coronary Care Unit to see how the patient was, which the patient was extremely pleased and grateful for. This patient made an impact on my life and I am glad I went through this with him and his family.

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Second Part

A person has an acute myocardial infarction when the flow of blood through their coronary arteries is reduced to such an extent that part of the heart muscle dies.  Approximately 300,000 people in the United Kingdom suffer a heart attack each year and about 140,000 die (Peterson et al, 1999). Many of these deaths are avoidable. Between two thirds of heart attack deaths take place outside hospital, many within the first few minutes of the onset of symptoms. Helping people avoid a heart attack altogether is the prime aim. (National Service Framework for Coronary Heart Disease, 2000)

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