Table 4.
Acute myocardial infarction: clinical tasks undertaken by percentage of physicians and nurses, by countries’ SoP, 2015/2016
| % Physicians performing tasks | % Nurses performing tasks (all nurses and APN/SN) | |||||
|---|---|---|---|---|---|---|
| Countries with SoP expansion [1] | Countries with no/limited SoP expansion [2] | Countries with SoP expansion [1] | Countries with no/limited SoP expansion [2] | Countries with SoP expansion [1] | Countries with no/limited SoP expansion [2] | |
| AMI | % Physicians, N = 30 | % Physicians, N = 160 | % All nurses, N = 153 | % All nurses, N = 348 | % APN/SN, N = 68 | % APN/SN N = 58 |
| Tasks related to diagnosis/physical examination | ||||||
| Patient arrival/admission: stabilisation on arrival[ii] | 53.3* | 34.3* | 33.9 | 31.3 | 27.9 | 41.3 |
| Patient arrival/admission: preparing patient for heart catheterization[ii] | 60.0** | 31.2** | 43.1 | 45.9 | 27.9** | 53.4** |
| Assessment: evaluating which protocol to apply (STEMI)[i] | 46.6 | 40.0 | 29.4*** | 6.3*** | 20.5* | 6.9* |
| Assessment: conducting coronary angiography[i] | 60.0*** | 22.5*** | 3.9 | 4.0 | 2.9 | 3.4 |
| Tasks related to treatment/therapy | ||||||
| Surgery: performing the catheterisation/ angioplasty[i] | 53.3** | 14.3** | 2.6 | 3.1 | 2.9 | 1.7 |
| Surgery: conducting percutaneous coronary intervention/angioplasty[i] | 40.0** | 13.7** | 1.9 | 3.1 | 2.9 | 1.7 |
| Surgery: putting in stent[i] | 40.0** | 14.3** | 1.3 | 3.1 | 2.9 | 1.7 |
| Surgery: coronary artery bypass graft (CABG)[i] | 0.0 | 3.7 | 0.6 | 0.5 | 1.4 | 0.0 |
| Managing complications: resuscitation[ii] | 83.3** | 57.5** | 63.4 | 70.1 | 51.4 | 67.2 |
| Managing complications: pericarditis[ii] | 80.0** | 46.8** | 39.2 | 31.6 | 27.9 | 32.7 |
| Managing complications: acute heart failure[ii] | 83.3** | 55.0** | 55.5 | 50.5 | 45.5 | 53.4 |
| Managing complications: arrhythmias[ii] | 86.6** | 58.1** | 59.4 | 55.1 | 45.5 | 60.3 |
| Managing complications: ventricular fibrillation[ii] | 76.6* | 53.7* | 56.8 | 50.5 | 44.1 | 55.1 |
| Managing complications: deep vein thrombosis[ii] | 60.0 | 46.25 | 33.9 | 35.9 | 17.6* | 36.2* |
| Managing complications: mechanical complications, e.g. septum rupture [i] | 70.0*** | 29.3*** | 13.7 | 16.6 | 19.1 | 22.4 |
| Care post discharge (hospital-based): Managing co-morbidities/complications: vascular[i] | 46.6 | 43.7 | 27.4*** | 10.0*** | 44.1*** | 28.5*** |
| Care post discharge (hospital-based): Managing co-morbidities/complications: respiratory[i] | 20.0* | 38.7* | 15.6* | 8.9* | 22.0* | 6.9* |
| Tasks related to prescribing medications (AMI) | ||||||
| Patient arrival/admission: prescribing medication[i,ii] | 73.3* | 50.6* | 10.4 | 7.7 | 16.1 | 6.9 |
| Patient arrival/admission: administering medication [i] | 40.0 | 21.2 | 54.9 | 63.2 | 35.2** | 62.0** |
| Prescribing medication according to protocol[i,ii] | 70.0 | 55.6 | 13.0 | 12.3 | 27.9* | 10.3* |
| Adjusting medication based on initial effects[i,ii] | 76.6*** | 56.8*** | 20.2** | 9.7** | 33.8** | 12.0** |
| Administering medication[i] | 43.3 | 29.3 | 54.9 | 61.4 | 41.1 | 56.9 |
| Care post discharge (hospital-based): continued prescribing as per discharge letter[i] | 26.6 | 45.6 | 13.7*** | 2.8*** | 25.0** | 3.4** |
| Care post discharge (hospital-based): prescribing medication review[i,ii] | 56.6 | 49.3 | 31.3*** | 5.7*** | 52.9*** | 5.1*** |
| Care post discharge (hospital-based): prescribing medication change as necessary[i,ii] | 60.0 | 48.7 | 25.4*** | 2.3*** | 44.1*** | 3.4*** |
| Tasks related to providing information to patients/coordination and follow-up | ||||||
| Handover to rehabilitation/primary care: Writing discharge letter to GP/other professional [ii] | 73.3** | 43.1** | 11.7*** | 2.3*** | 13.2** | 0.0** |
| Handover: referral to heart rehabilitation[i] | 36.6 | 31.8 | 50.9*** | 4.8*** | 36.7*** | 5.1*** |
| Handover: plan for outpatient follow-up[ii] | 83.3*** | 32.5*** | 30.7*** | 4.8*** | 35.2*** | 5.1*** |
| Follow-up care: lifestyle support[i] | 36.6 | 35.6 | 41.1*** | 15.5*** | 61.7*** | 17.2*** |
Source: MUNROS 2015/2016. Rationale for inclusion of tasks: [i] = suggested clinical activities as Advanced Nursing Practice: diagnosis/advanced health assessment, treatment/therapy, prescribing medications, by International Council of Nurses (ICN), [ii] = common medical tasks, reported by the majority of physicians as being part of normal duties (≥ 50% of physicians in ≥ 50% of countries). [1] England, Scotland, Netherlands, [2] Czech Republic, Germany, Italy, Norway, Poland, Turkey
SoP Scope-of-Practice, APN Advanced Practice Nurses, SN Specialist Nurses
***p value < .001; ** = p value < .01, * = p value < .05