Introduction
This essay explores the critical topic of ST Elevated Myocardial Infarction (STEMI), focusing on the patient experience and the essential role of nursing care within the context of adult nursing. STEMI, a severe form of heart attack caused by a complete blockage of a coronary artery, requires urgent medical intervention and comprehensive care to improve patient outcomes (Ibanez et al., 2018). The purpose of this essay is to examine the lived experience of patients diagnosed with STEMI, alongside an evaluation of nursing interventions that support physical, emotional, and psychological recovery. Key points include an overview of STEMI and its impact on patients, the patient experience during diagnosis and treatment, and the pivotal role of nurses in delivering person-centred care. By drawing on academic literature and clinical guidelines, this essay aims to provide a sound understanding of these interconnected aspects, with some consideration of the limitations of current knowledge and practice.
Understanding ST Elevated Myocardial Infarction
ST Elevated Myocardial Infarction is a life-threatening condition resulting from prolonged ischemia due to a complete obstruction of a coronary artery, often by a blood clot (Ibanez et al., 2018). It is identified on an electrocardiogram (ECG) by characteristic ST-segment elevation, indicating significant myocardial damage. According to the National Institute for Health and Care Excellence (NICE) guidelines, timely reperfusion therapy—either through primary percutaneous coronary intervention (PCI) or thrombolysis—is crucial to restoring blood flow and minimising irreversible damage (NICE, 2014). Despite advancements in treatment, STEMI remains a leading cause of morbidity and mortality in the UK, with data from the British Heart Foundation (2021) estimating that heart and circulatory diseases account for approximately 27% of all deaths annually.
The impact of STEMI on patients extends beyond the acute phase, often leading to long-term physical limitations such as reduced cardiac function and psychological challenges including anxiety or depression (Edmondson et al., 2012). Therefore, an awareness of both the clinical presentation and the broader consequences of STEMI is essential for nurses, who play a central role in managing acute care and supporting recovery. While much of the literature focuses on medical interventions, there is arguably less emphasis on the holistic needs of the patient—a gap that nursing care seeks to address.
The Patient Experience of STEMI
The experience of a STEMI is often sudden and distressing for patients, marked by intense chest pain, fear, and uncertainty about survival. Research highlights that the acute phase of STEMI is particularly traumatic, with many patients describing feelings of vulnerability and loss of control (Edmondson et al., 2012). A qualitative study by Sampson et al. (2010) found that patients frequently report a lack of understanding about their condition during the initial stages, which exacerbates anxiety. This underscores the importance of clear communication and reassurance from healthcare professionals, particularly nurses, who are often the first point of contact in emergency settings.
Furthermore, the transition from acute care to rehabilitation can be equally challenging. Patients may struggle with the fear of recurrence, lifestyle adjustments, and the psychological burden of a life-threatening event. For instance, adhering to medication regimes or adopting heart-healthy behaviours such as smoking cessation or dietary changes can be daunting without adequate support (Smith et al., 2011). These findings suggest that the patient experience is multifaceted, encompassing not only physical symptoms but also emotional and social dimensions. However, there is limited research on how cultural or socioeconomic factors influence these experiences, indicating a potential area for further study.
Nursing Care in STEMI Management
Nursing care is integral to the management of STEMI, spanning from the acute phase to long-term recovery. In the emergency setting, nurses are responsible for rapid assessment, monitoring vital signs, administering medications such as aspirin or nitroglycerin under medical direction, and preparing patients for reperfusion therapy (Ibanez et al., 2018). Their role in recognising symptoms and facilitating timely intervention is critical, as delays in treatment can significantly worsen outcomes. The NICE guidelines (2014) recommend a ‘door-to-balloon’ time of under 90 minutes for PCI, a target that relies heavily on efficient nursing coordination.
Beyond the immediate clinical response, nurses provide essential emotional support. This includes addressing patient and family anxiety through empathetic communication and education about the condition and treatment process. A study by Rolley et al. (2010) found that patients who received consistent information and reassurance from nurses reported lower levels of stress during hospitalisation. Indeed, person-centred care—a core principle of nursing—ensures that interventions are tailored to individual needs, fostering trust and engagement in recovery plans.
In the rehabilitation phase, nurses contribute to secondary prevention by delivering education on lifestyle modifications and medication adherence. Cardiac rehabilitation programmes, often nurse-led, have been shown to reduce readmission rates and improve quality of life (Smith et al., 2011). However, challenges remain, such as inconsistent access to these programmes across the UK, particularly in rural or deprived areas (British Heart Foundation, 2021). This highlights a limitation in current healthcare delivery, where nurses must often advocate for equitable resources while managing heavy caseloads.
Critical Reflection on Nursing Challenges and Limitations
While nurses are pivotal in STEMI care, several barriers can impede optimal practice. Staffing shortages and time constraints, for example, may limit the ability to provide comprehensive emotional support or patient education (Rolley et al., 2010). Furthermore, the emotional toll on nurses themselves—often termed ‘compassion fatigue’—can affect care quality if not addressed through institutional support or training (Smith et al., 2011). These issues reflect broader systemic challenges within the NHS, where resource allocation and workforce wellbeing are ongoing concerns.
Additionally, while evidence supports the efficacy of nurse-led interventions in improving patient outcomes, there is a lack of consensus on the best models of care for long-term follow-up. Different studies propose varying approaches, from community-based nursing to telehealth monitoring, but conclusive data on the most effective strategy remains elusive (Ibanez et al., 2018). This uncertainty suggests that while nursing care is generally effective, it must evolve alongside emerging research and technological advancements to meet diverse patient needs.
Conclusion
In conclusion, this essay has examined the complex interplay between ST Elevated Myocardial Infarction, patient experience, and nursing care within the context of adult nursing. It is evident that STEMI profoundly impacts patients, not only through acute physical symptoms but also via lasting psychological and social challenges. Nurses play a vital role at every stage, from emergency response to rehabilitation, delivering clinical expertise and compassionate, person-centred care. Despite these strengths, limitations such as staffing issues and inconsistent access to rehabilitation services highlight areas for improvement. The implications of this analysis are twofold: firstly, it reinforces the need for ongoing training and support for nurses to manage the demands of STEMI care effectively; secondly, it calls for further research into optimising long-term care models to ensure equitable outcomes for all patients. Ultimately, addressing these challenges will enhance the patient experience and uphold the standards of nursing practice in this critical area of healthcare.
References
- British Heart Foundation. (2021) Heart & Circulatory Disease Statistics 2021. British Heart Foundation.
- Edmondson, D., Richardson, S., Falzon, L., Davidson, K. W., Mills, M. A., and Neria, Y. (2012) Posttraumatic stress disorder prevalence and risk of recurrence in acute coronary syndrome patients: A meta-analytic review. PLoS ONE, 7(6), e38915.
- Ibanez, B., James, S., Agewall, S., Antunes, M. J., Bucciarelli-Ducci, C., Bueno, H., … and Widimský, P. (2018) 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal, 39(2), 119-177.
- National Institute for Health and Care Excellence (NICE). (2014) Acute coronary syndromes in adults. NICE Guideline CG167.
- Rolley, J. X., Smith, J., DiGiacomo, M., Salamonson, Y., and Davidson, P. (2010) The caregiving role following percutaneous coronary intervention. Journal of Clinical Nursing, 20(1-2), 227-235.
- Sampson, F., O’Cathain, A., and Goodacre, S. (2010) Feeling fixed and its contribution to patient satisfaction with primary angioplasty: A qualitative study. European Journal of Cardiovascular Nursing, 9(3), 192-199.
- Smith, S. C., Benjamin, E. J., Bonow, R. O., Braun, L. T., Creager, M. A., Franklin, B. A., … and Taubert, K. A. (2011) AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update. Circulation, 124(22), 2458-2473.
