Do nurses have a role in "educating" physicians in new treatments? Consider the story - page 2

below which details four established drugs, that when used together SEEM to cut the risk of death by up to 90% after a heart attack. For instance if you worked in a Cardiac unit and noticed that NONE... Read More

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    Roland - you are still advocating a system running by negative feedback whereas an EBP system runs by positive input. We are finding out here the real cost of litigation and our approach is to cut out the lawyers as much as possible by having good systems in place in the first place.

    This sounds like a nice system but there are at least 3 major flaws which will prevent implimentation.

    1) Who decides?? Research outcomes even when systematically reviewed are not cut and dried

    2)Pt individuality - you might decide that the pt should be on beta blockers but the pt might be asthmatic - conraindicated!!! OR and I have seen this the cardiologist choose not to prescribe because the patient is known to be non-compliant in the extreme and will ignore tablets for days only to take 5 at once - not good with Beta blockers - and this was a Pt we had TRIED to educate

    3) Cost - your system is costly

    4) You are assuming the nurse IS as knowledgable as the MO what if the latest research proves what is now suspected - that statins can interfere with memory - it is still a recommendation by the heart association but MO are now reluctant to prescribe because it becomes a matter of which system is most important - mind or heart??? Comes back to the saying - if you want entertainment watch a neurosurgeon and a cardiologist argue over a patients' BP
    Last edit by gwenith on Feb 20, '04

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  2. 0
    There is evidence to indicate that many of the complications from long term statin therapy can be ameliorated by the concurrent administration of coenzyme Q-10 (available OTC see references below about coenzyme Q10). In addition, there is mounting scientific evidence that alpha lipoic acid in combination with acetyl-l-carnitine can have a powerful effect in counteracting non dementia related memory loss. Of course there will always be situations where a particular drug is not appropriate for a given patient. However, my scenario goes to a situation where the four drug combination is CONSISTENTLY not being utilized (as the study indicates that it is not).

    While I don't believe nurses to be nearly as knowledable as M.D.'s it doesn't change the fact that they often have valuble, relevent, input that can be germaine to optimal patient care and outcomes. My concern is that currently there exists no formal system by which nurses can consistently share this input (indeed, nursing schools do not often stress the role of nurses as "guardians of patient care"). My approach to emphasizing a permanent record that might aid future litigation exists because I believe it to be the ONLY way that M.D.'s and administration will be persuaded to consistently consider such input (there must be a potential monetary cost to NOT doing so or a potential economic benefit for DOING so).

    My model emphasizes an interconnected, integrated "health care team" where each segment nurses, doctors, and allied health care personnel act as a "check and balence" upon the other with the goal of providing the best patient care possible. I believe that this can only occur in an environment with recognized, formal channels of communication for the exchange of pertinent information. I would be willing to consider other mechanisms that might accomplish the same objective.

    Coenzyme Q-10 References (note references 1, 22, and 23 are especially relevent)
    1. Ellis CJ, Scott R. Statins and coenzyme Q10. Lancet. 2003 Mar 29;361(9363):1134-5.

    2. Singh RB, Neki NS, Kartikey K, et al. Effect of coenzyme Q10 on risk of athero- sclerosis in patients with recent myocardial infarction. Mol Cell Biochem. 2003 Apr;246(1-2):75-82.

    3. Ohmoto N, Fujiwara Y, Kibira S, Kobayashi M, Saito T, Miura M. Cardiomyopathy showing progression from diffuse left ventricular hypertrophy to dilated phase associated with mitochondrial DNA point mutation A3243G: A case report. J Cardiol. 2003 Jan;41(1):21-7.

    4. Fosslien E. Review: Mitochondrial medicine--cardiomyopathy caused by defective oxidative phosphorylation. Ann Clin Lab Sci. 2003 Fall;33(4):371-95.

    5. Engelsen J, Nielsen JD, Hansen KF. Effect of coenzyme Q10 and ginkgo biloba on war- farin dosage in patients on long-term war- farin treatment. A randomized, double- blind, placebo-controlled cross-over trial. Ugeskr Laeger. 2003 Apr 28;165(18):1868-71.

    6. Singh RB, Kartik C, Otsuka K, Pella D, Pella J. Brain-heart connection and the risk of heart attack. Biomed Pharmacother. 2002;56 Suppl 2:257s-265s.

    7. Sarter B. Coenzyme Q10 and cardiovascu- lar disease: a review. J Cardiovasc Nurs. 2002 Jul;16(4):9-20.

    8. Piotrowska D, Dlugosz A, Pajak J. Antioxidative properties of coenzyme Q10 and vitamin E in exposure to xylene and gasoline and their mixture with methanol. Acta Pol Pharm. 2002 Nov-Dec;59(6):427-32.

    9. Tran MT, Mitchell TM, Kennedy DT, Giles JT. Role of coenzyme Q10 in chronic heart failure, angina, and hypertension. Pharmacotherapy. 2001 Jul;21(7):797-806.

    10. Shults CW, Oakes D, Kieburtz K, et al. Effects of coenzyme Q10 in early Parkinson disease: evidence of slowing of the function al decline. Arch Neurol. 2002 Oct;59(10):1541-50.

    11. Kishimoto C, Tomioka N, Nakayama Y, Miyamoto M. Anti-oxidant effects of coen- zyme Q10 on experimental viral myocarditis in mice. J Cardiovasc Pharmacol. 2003 Nov;42(5):588-92.

    12. Sandhu JK, Pandey S, Ribecco-Lutkiewicz M, et al. Molecular mechanisms of gluta- mate neurotoxicity in mixed cultures of NT2-derived neurons and astrocytes: pro- tective effects of coenzyme Q10. J Neurosci Res. 2003 Jun 15;72(6):691-703.

    13. Chuang YC, Chan JY, Chang AY, et al. Neuroprotective effects of coenzyme Q10 at rostral ventrolateral medulla against fatality during experimental endotoxemia in the rat. Shock. 2003 May;19(5):427-32.

    14. Shults CW. Coenzyme Q10 in neurodegen- erative diseases. Curr Med Chem. 2003 Oct;10(19):1917-21.

    15. Kishimoto C, Tamaki S, Matsumori A, Tomioka N, Kawai C. The protection of coenzyme Q10 against experimental viral myocarditis in mice. Jpn Circ J. 1984 Dec;48(12):1358-61.

    16. Lamperti C, Naini A, Hirano M, et al. Cerebellar ataxia and coenzyme Q10 defi- ciency. Neurology. 2003 Apr 8;60(7):1206-8.

    17. Langsjoen PH, Langsjoen A, Willis R, Folkers K. Treatment of hypertrophic car- diomyopathy with coenzyme Q10. Mol Aspects Med. 1997;18 Suppl:S145-51.

    18. Langsjoen P, Langsjoen P, Willis R, Folkers K. Treatment of essential hypertension with coenzyme Q10. Mol Aspects Med. 1994;15 Suppl:S265-72.

    19. Langsjoen H, Langsjoen P, Langsjoen P, Willis R, Folkers K. Usefulness of coen- zyme Q10 in clinical cardiology: a long-term study. Mol Aspects Med. 1994;15 Suppl:s165-75.

    20. Langsjoen PH, Langsjoen PH, Folkers K. Isolated diastolic dysfunction of the myocardium and its response to CoQ10 treatment. Clin Investig. 1993;71(8 Suppl):S140-4.

    21. Folkers K, Langsjoen P, Langsjoen PH. Therapy with coenzyme Q10 of patients in heart failure who are eligible or ineligible for a transplant. Biochem Biophys Res Commun. 1992 Jan 15;182(1):247-53.

    22. Folkers K, Langsjoen P, Willis R, et al. Lovastatin decreases coenzyme Q levels in humans. Proc Natl Acad Sci U S A. 1990 Nov;87(22):8931-4.

    23. Langsjoen PH, Langsjoen PH, Folkers K. A six-year clinical study of therapy of car- diomyopathy with coenzyme Q10. Int J Tissue React. 1990;12(3):169-71
    Last edit by Roland on Feb 21, '04
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    Roland please do a search about Evidence based Practice models of care. If you google Joanna Briggs Institute and read the outlines you will start to see what I mean. Now - have ANY of these studies you have quoted been peer reviewed or better yet subjected to a systematic review???
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    Roland ... have you considered going to law school after you graduate with your RN? You can certainly make an arugement and that would be highly beneficial as a nurse-lawyer.
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    I strongly agree that Nursing and medicine should have a collaborative relationship. As I become more experienced with health care I have realized that the definition of "collaborative" is (to say the least) ambiguous. Also, the role of nursing has and continues to change rapidly.

    There was a time when nurses were just people off the street that carried out doctor's orders. Nursing education and role has changed rapidly and now in may cases nurses are more involved then the doctors in directing inpatient care.

    Because of these changes it becomes hard to always know what is within the scope of nursing. Questions like the one in the OP are valid and good. Where exactly does the nurse fall in the hierarchy of healthcare? It's a good question with uncertain answers. It depends largely upon the skill level of the nurse, doctor and the attitudes that both of them have toward the subject. Also nursing is a broad field encompassing many other fields where as medicine is much narrower.

    The argument could be made, that nursing encompasses medicine as one of the disciplines we draw from to provide care to patients. If one takes that view then physicians can be viewed as specialists in a discipline where a nurse has a lesser knowledge base. However if one does take that view then nurses would be seen as caring for the whole patients and using doctors as a resource rather then the authority.

    So if you take that view then it is completely appropriate for the nurse to suggest treatment to a physician. However, I can promise you that (no matter how open minded a physician is) they are not going to share this view of nurses.

    That being the case I would suggest that recommendations on treatment be done in a casual and conversational way. You could say something like "Dr. Smith, what do you think about this new research I read about?" if they have seen it then they will tell you what they think. If they haven't then they will ask you about it. You could then say; "do you think something like that would benefit Mr. Jones?"

    If you do things gently you can accomplish your goal without ruffling feathers or raising questions about your scope of practice.
  6. 0
    Quote from gwenith
    Comes back to the saying - if you want entertainment watch a neurosurgeon and a cardiologist argue over a patients' BP
    I just read this thread!

    OMG this is so true!

    Back to the original topic. Sorry for the hijack!

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