Nurses' perceptions and experiences of initiating thrombolysis: a qualitative study

Nurse-initiated thrombolysis has become established in some trusts for patients presenting to the accident and emergency department or coronary care unit with an acute myocardial infarction. A limited approach to the exploration of this multidimensional expansion in nursing practice is noted in the literature. The aims of this study were to explore the experiential dimensions of nurses who have initiated thrombolysis, if nurses perceive themselves prepared for the role, and whether they consider role expansion a positive or negative experience. A qualitative approach was used. The sample included 12 nurses organizationally sanctioned to autonomously administer a thrombolytic agent, who completed a self-administered, predominantly open-ended questionnaire. Data were analysed using the method described by Giorgi (1997). Two major themes emerged: 'perceived pressure to deliver best practice' and 'developing patient care within a holistic framework', these themes are discussed and underpinned with supporting narratives. Nurses initiating thrombolysis have a desire to engage with delivery of a treatment proven to have a positive impact on individual patient outcomes; they express an overwhelming desire 'to do good' for their patient. Despite struggling with the possibility of adverse patient outcomes, all the nurses felt that their experiences overall were positive and all supported this with examples of practice.