Westgate University

Research Proposal
Nurses’ Knowledge of Managing Myocardial Infarction (MI) Among the
Nurses in Nikaweratiya Base Hospital.

N.M.T. Wijerathna
2-15-2023
Abbreviations

MI - Myocardial Infarction
AMI - Acute Myocardial Infarction
AF - trial fibrillation
ECG - Electro Cardio Graphic
WHO - World Health Organization
cTn - Cardiac troponin
PCI - Percutaneous coronary intervention
CABG - Coronary Artery Bypass Grafting
ASCVD - Atherosclerotic cardiovascular disease
Nurses’ Knowledge of Managing Myocardial Infarction (MI)
Among the Nurses in Nikaweratiya Base Hospital.

1. Introduction

Myocardial infarction (MI), also known as a heart attack, is a medical emergency that
occurs when a section of the heart muscle does not receive enough oxygenated blood.
The leading cause of myocardial infarction is coronary artery disease, which is caused by
a buildup of plaque in the coronary arteries that supply oxygenated blood to the heart.
Common risk factors for myocardial infarction include high blood pressure, high
cholesterol, smoking, diabetes, obesity, poor diet, physical inactivity, and family history.
Many of these risk factors can be managed through lifestyle changes to reduce the risk of
myocardial infarction and improve overall health.

Detection of myocardial infarctions (MI) become common in the current society due to
non-healthier lifestyles and many other reasons. Even though it become a significant issue
now, the history of Mis is gone back to the 19th century. A possible relationship had been
found between thrombotic obstruction of a coronary artery and myocardial infarctions,
during several post-mortems conducted in the 19th century. However, after many years,
the 1st clinical description for MI was developed in the 20th century [1].

The definition of acute myocardial infarction has changed to include more sensitive
markers of myocardial necrosis and imaging technologies that allow for a better
understanding of the pathogenic mechanisms of the acute coronary syndrome. Therefore,
the proposed classification of patients with myocardial infarction based on etiology is
suggested by the universal concept of myocardial infarction.[2] Although this classification
has been utilized in clinical studies to better understand main and secondary objectives,
it has not been extensively embraced in clinical practice, and it is unknown how frequently
different subtypes of acute myocardial infarction occur or what they might mean.
However, during the 1950-70s working groups of the World Health Organization (WHO)
established the first Electro cardio graphic (ECG) based definition for MI. [1] Starting from
there, defining MI become advanced, and as of today WHO has defined myocardial injury
and 5 types of myocardial infarctions as below.

Type
Myocardial Injury
Myocardial Infarction Type 1
Myocardial Infarction Type 2
Myocardial Infarction Type 3
Myocardial Infarction Type 4
Myocardial Infarction Type 5
Description
When there is evidence of elevated cardiac troponin (cTn)
levels.
Evidence about acute athero-thrombosis in the artery
supplying the infarcted myocardium
Evidence of an imbalance between myocardial oxygen
supply and demand unrelated to acute athero-thrombosis
Cardiac death in patients with symptoms suggestive of
myocardial ischemia and presumed new ischemic ECG
changes before cTn values become available
Percutaneous coronary intervention (PCI) related MI
Coronary Artery Bypass Grafting (CABG) RELATED MI
Out of the five types of myocardial infarction the most common type is type 1 MI
which is caused by ischemia due to a primary coronary event, such as plaque rupture,
erosion, or fissuring; coronary dissection [3]. Type 2 MI is caused by ischemia due to
non-coronary artery diseases, such as hypertension or an embolism [4]. Type 3 MI is
caused by reperfusion injury, and type 4 MI is caused by PCI-related MI, such as focal
or diffuse restenosis, or a complex lesion associated with a rise and/or fall in cardiac
biomarkers [1].

Common symptoms of MI include chest pain or discomfort, shortness of breath, pain

or discomfort in the jaw, neck, back, arm, or shoulder, and feeling nauseous, light-
headed, or unusually tired [5]. Other symptoms may include vomiting, anxiety, fast
heart rate, sweating, fatigue, weakness, stress, and depression [6]. Treatments for a
heart attack include taking aspirin, which prevents blood from clotting, and nitro-
glycerin to treat chest pain and oxygen. [7]

Myocardial infarction (MI) is a relatively common condition, affecting millions of

people around the world each year. According to the prevalence of the disease
approaches three million people worldwide, with more than one million deaths in the
United States annually. [1]. Researchers found that South Asians have a higher
incidence of myocardial infarction (MI) than people from other countries, with a mean
age of 53 years for the first MI [8], where the South Asian subcontinent includes India,
Pakistan, and other countries, and it makes up over one-quarter of the developing
world [9]. Even though the South Asian population has significantly higher rates of
incidence, prevalence, morbidity, and mortality from coronary artery disease and MI
compared to other populations [10], the exact reason for this is still unknown, [8].

Nursing care management for Myocardial Infarction (MI) patients in Sri Lanka is an
important aspect of healthcare.[11][12]As the prevalence of MI is increasing, there is
a need to develop comprehensive nursing care management strategies to meet the
needs of MI patients [13][14].

Based on the hospital management system in operation, the nursing care

management for MI patients in Sri Lanka should involve a multidisciplinary team
approach that includes physicians, nurses, allied health professionals, and other
healthcare workers. The team should have a plan for diagnosis, treatment, and follow-
up care for MI patients. The team should also be involved in patient education and
health promotion activities.

Nurses play a critical role in the management of MI patients in Sri Lanka. They should
be educated about the diagnosis, treatment, and follow-up care of patients with
MI[15][16][17]. Nurses should be aware of the various medications available for MI
patients, as well as the lifestyle modifications that can help reduce the risk of MI. In
addition, nurses should be equipped with the skills to provide psychological support
to MI patients and their families.
Nursing care management should also include the use of technology to ensure better care
for MI patients. For instance, telemedicine can be used to provide timely access to care
and vital health information. Additionally, electronic medical records should be used to
store and track patient information [18].

Finally, nursing care management for MI patients in Sri Lanka should include community
outreach programs to raise awareness about MI and increase access to healthcare
resources. These programs should be tailored to the local communities and should target
risk factors, such as smoking, high cholesterol, and obesity [19][20].

In conclusion, nursing care management for MI patients in Sri Lanka is essential for
providing effective and timely care. Multidisciplinary teams should be involved in the
management of MI patients, and nurses should be educated about the diagnosis,
treatment, and follow-up care. Technology should also be used to provide better access
to care and to store patient information. Finally, outreach programs should be
implemented to raise awareness about MI and promote healthy lifestyles. Therefore the
knowledge of nurses on managing myocardial infarction is a very important factor in
preventing heart attacks and providing treatments for patients.

2. Justification
Recent research studies have found that nurses have limited knowledge of myocardial
infarction (MI) treatments [21] and that there is a need for more accurate and up-to-date
information and improved communication between nurses and doctors [22]. In order to
improve the knowledge of nurses and the care that they provide to MI patients, there
needs to be better training and more standardized protocols for MI treatment [12].
Additionally, nurses need to understand the importance of patient participation in the MI
pathway and its various phases [23].

Several studies have been conducted on nurses' knowledge of managing myocardial

infarctions and among them, a study conducted by K. E. Moscardi and colleagues titled
"Assessment of Nurses' Knowledge Corresponding to Myocardial Infarction: The Project
Carried Out in Nursing Collage-. University of Basra- Basra Hospitals (Al-Hashimyiah)"
found that nurses had limited knowledge in managing myocardial infarctions [24]. The
study concluded that educational interventions were needed to improve the nurses'
knowledge.

Another study, titled "Knowledge Regarding Myocardial Infarction (MI) among the Nurses
in Dhaka [25], Bangladesh" by B. Rahman et al. found that nursing knowledge of
myocardial infarction was inadequate. The study concluded that educational strategies
were needed to improve the knowledge of nurses.

Finally, a study by T. El-Heni and colleagues titled "Assessment of the Knowledge of Nurses
Regarding the Management of Myocardial Infarction among Staff Nurses" found that
nurses had inadequate knowledge of the management of myocardial infarction [26]. The
study concluded that educational interventions were needed to improve the knowledge
of nurses.
Hence several studies have concluded that the knowledge of nurses on myocardial
infarctions is limited and needs to be improved, it is suggested to conduct the same
research among the nurses of Nikaweratiya Base Hospital to understand the knowledge
level and identify the gaps that need to be filled.

3. Objectives
3.1 General Objectives
To assess the level of knowledge, attitude, and practice regarding the management of
myocardial infarction among nurses at the Base Hospital Nikaweratiya.

3.2 Specific Objectives

1. To assess the level of knowledge regarding management of myocardial infarction
among nurses at Base Hospital in Nikeweratiya.
2. To describe the attitude of nurses regarding the management of myocardial
infarction among nurses at Base Hospital in Nikeweratiya.
3. To identify the practices regarding the management of myocardial infarction among
nurses at the Base Hospital in Nikeweratiya.

4. Literature Review
4.1 The Risk of MI
Myocardial infarction (MI) is a major cause of death worldwide. Studies have found that
mortality rates for MI vary depending on the type of MI, with type 1 MI having the lowest
mortality rate and type 2 MI having the highest mortality rate [27]. Additionally, age,
gender, and other risk factors may influence mortality rates. For instance, a study
involving MI patients discovered that death was significantly greater in older, males, and
those with numerous risk factors, including diabetes, hypertension, and smoking. [28].
Other studies have also reported that mortality rates are higher for those with higher
levels of cardiogenic shock, ST-segment elevation, and left ventricular dysfunction. In
addition, timely and effective treatment is essential in reducing mortality rates for MI
[29][30][31][32]. Therefore, it is important for healthcare providers to be aware of the risk
factors associated with MI and to provide timely and effective treatment.

4.2 South Asians have a high risk of MI

Studies have shown that South Asians have higher proportional mortality rates from
myocardial infarction (MI) compared to other populations. Further, research involving
more than 24,000 MI patients discovered that South Asian patients had much greater
fatality rates than other patients [33]. Further research has shown that South Asians have
a higher proportional mortality rate from atherosclerotic cardiovascular disease (ASCVD)
compared to other ethnicities [1]. A study conducted by Annabelle Santos Volgman and
others found that South Asians have a 1.5-fold higher risk of mortality due to myocardial
infarction (MI) compared to other ethnicities [34]. These findings suggest that South
Asians may be at an increased risk of death due to MI and should receive more attention
when it comes to prevention and treatment strategies.

4.3 Situations of MI Treatment in Sri Lanka.

Being a South Asian country, Sri Lanka faces significant challenges in the management of
myocardial infarctions. According to a study conducted at the National Hospital of Sri
Lanka, only 16.9% of patients received thrombolysis within 30 minutes of symptom onset,
while pre-hospital delays remain a critical factor in treatment [35]. Initial diagnosis of
acute myocardial infarction (AMI) is best done with the help of an electrocardiogram
(ECG), and studies suggest that it should be initiated as soon as possible in all suspected
STEMI patients [36]. Another study found that Aspirin, clopidogrel, and statin are also
recommended on admission, however, only 7.3% of patients received coronary
intervention following their infarction [37]. These findings suggest that late presentation
to the hospital is an important factor to address in the treatment of myocardial infarctions
in Sri Lanka and that first-contact physicians should be trained on effective thrombolysis.
Hence it was the nurses who first interact with the patients in the Sri Lankan hospital
system, their knowledge and training in managing myocardial infarction will play a major
role in reducing the risk factors involved with severe injuries and mortality. Additionally,
further exploration of ways to improve post-infarction interventions is needed.

4.4 Role of the nurses in MI management

Nurses play an important role in managing myocardial infarction (MI) treatment. They
provide vital support to patients and families, helping them understand their diagnosis
and treatment options, monitoring their vital signs, educating them on lifestyle changes,
and providing emotional support. [38][39][40][41] Nurses are often the first responders
to MI episodes and begin treatment with oxygen, aspirin, nitroglycerin, and opioids for
pain relief. They then perform a 12-lead electrocardiogram (ECG) and interpret the
results. They can also administer drugs to restore normal heart rhythm, provide
antibiotics to prevent infection, and monitor the patient's vital signs.
Other than the above, nurses also play an important role in rehabilitation and long-term
care. They provide patients with education on how to reduce their risk of a future MI, such
as quitting smoking or losing weight. They also help patients understand their
medications, perform follow-up assessments, and monitor the patient's condition.

4.5 Knowledge of the nurses on MI management

The management of myocardial infarction in Sri Lanka is an area that requires more
attention and understanding. In Sri Lanka, nursing practices related to myocardial
infarctions are not as developed as they are in many other countries. A study conducted
on the medical wards of the National Hospital of Sri Lanka showed that thrombolytic
therapy and adjunctive therapy are underused, and complications were common [35].
This suggests that there is a need for better training of doctors and the availability of
specialized cardiac nurses in order to effectively use thrombolytic therapy in medical
wards [35]. Additionally, there is a need to explore the existing atrial fibrillation care
pathway and patients' perception of AF management to identify barriers and enablers for
optimal AF care [42]. Results from this study showed that health-seeking behaviors and
atomistic healthcare structures are two key barriers to accessing care and managing AF
[42]. Lastly, the in-hospital patient treatment in the study consisted of aspirin, beta-
blockers, ACEI, statins, and nitrates[43]. This demonstrates that there is an overall need
for more knowledge among Sri Lankan nurses on treating and managing patients having
a myocardial infarction.
4.6 Nursing practices for managing MI

Nurses play a critical role in the management of Myocardial Infarction (MI) patients. The
nursing practices involved with MI management can be discussed based on the following
sections.

4.6.1 Initial assessment and triage:

Nurses are often the first point of contact for patients with Myocardial Infarction (MI),
and they play a critical role in the initial assessment and management of these
patients. During the initial assessment, nurses should take a thorough patient history,
including any previous medical conditions, symptoms, and risk factors for MI. They
should also conduct a physical examination, which may include measuring the
patient's blood pressure, heart rate, and oxygen saturation levels.

One of the key components of the initial assessment is performing a 12-lead

electrocardiogram (ECG). This test records the electrical activity of the heart and can
help to diagnose an MI, as well as determine the location and extent of the damage
to the heart. By performing a 12-lead ECG, nurses can provide critical information to
the physician and help to guide the management of the MI. By conducting a thorough
initial assessment and performing a 12-lead ECG, nurses can provide vital information
to the physician, help to guide the management of the MI, and ensure that the patient
receives prompt and appropriate care. This is essential in reducing the risk of mortality
and improving patient outcomes

4.6.2 Pain management:

Nurses play a crucial role in providing pain relief for patients with Myocardial
Infarction (MI). MI can cause severe chest pain, and it is essential to provide pain relief
as quickly as possible to reduce the patient's discomfort and anxiety. Nurses should
use several methods to provide pain relief for MI patients, including the following.

- Oxygen is administered to MI patients to help improve the oxygenation of the

heart and the rest of the body. This can help to reduce chest pain and improve
the patient's breathing.
- Aspirin is an antiplatelet medication that can help to prevent further blood clots
from forming and causing additional damage to the heart. It is also a pain
reliever and is often given to MI patients to provide relief from chest pain.
- Nitroglycerin: Nitroglycerin is a medication that widens blood vessels, increases
blood flow to the heart, and reduces the workload of the heart. This can help
to reduce chest pain and improve the patient's breathing.
- Opioids are medications that relieve pain by affecting the central nervous
system. They are often used to provide pain relief for MI patients who are
experiencing severe chest pain.

By providing pain relief through the use of oxygen, aspirin, nitroglycerin, and opioids,
nurses can help to reduce the patient's discomfort and anxiety, which is essential in
improving patient outcomes and reducing the risk of mortality.
4.6.3 Cardiac dysrhythmia management:

Cardiac dysrhythmias, also known as heart rhythm disorders, are a common

complication of Myocardial Infarction (MI). Nurses play a critical role in the
management of cardiac dysrhythmias in MI patients. The following are the key
responsibilities of nurses in the management of cardiac dysrhythmias:

- Nurses should continuously monitor the patient's heart rhythm and perform a
12-lead electrocardiogram (ECG) to identify any abnormal heart rhythms.
- Medication administration: Nurses can administer medications to restore
normal heart rhythm, such as antiarrhythmic drugs, or provide treatments to
slow down an excessively fast heart rate, such as vagal maneuvers.
- Nurses should continuously monitor the patient's vital signs, including heart
rate and blood pressure, to assess the effectiveness of treatment and to identify
any potential side effects of medications.
- Nurses should educate patients and their families about the importance of
lifestyle changes, such as reducing stress and limiting alcohol intake, to help
manage and prevent cardiac dysrhythmias.
- Nurses should collaborate with the patient's healthcare team, including
physicians, to develop a comprehensive treatment plan for cardiac
dysrhythmias, taking into consideration the patient's medical history and
current condition.

By providing these critical nursing interventions, nurses can play an essential role in
the management of cardiac dysrhythmias and improve the outcomes for MI patients.

4.6.4 Infection control:

Infection control is critical in the management of patients with myocardial infarctions

(MI) because these patients have a weakened immune system and are at higher risk
of acquiring infections, which can have serious and potentially life-threatening
consequences. Hospital-acquired infections can delay the healing process, prolong
the length of hospital stay, increase the risk of complications and readmissions, and
result in increased healthcare costs.

The role of nurses in infection control related to MI management is to ensure that

patients with myocardial infarctions (heart attacks) are protected from acquiring
infections during their hospital stay. This includes performing proper hand hygiene,
using personal protective equipment (PPE) when needed, properly cleaning and
disinfecting equipment and surfaces, and following standard precautions to prevent
the spread of infections. Nurses also play a critical role in monitoring patients for
signs of infection and reporting any concerns to the healthcare team for prompt
intervention and treatment.

Effective infection control measures help to prevent the spread of infectious diseases
and protect both patients and healthcare workers. By prioritizing infection control in
MI management, healthcare facilities can provide a safe and conducive environment
 for patients to recover, reduce the risk of secondary infections, and improve overall
patient outcomes.

4.6.4 Lifestyle education:

Nurses play a critical role in promoting and maintaining the health of patients with
a history of myocardial infarction (MI), also known as a heart attack. One important
aspect of this care is educating patients about lifestyle changes that can help reduce
their risk of experiencing another MI. This can include changes to their diet, such as
incorporating more fruits, vegetables, whole grains, and lean protein, while limiting
processed foods, saturated fat, and sodium.

In addition to dietary changes, exercise habits can also have a significant impact on
heart health. Nurses can advise MI patients to incorporate physical activity into their
daily routines, such as going for a daily walk or taking part in an exercise class.
Regular exercise can improve heart function and reduce the risk of future MIs.
Finally, stress management is also an important aspect of reducing the risk of future
MIs. Nurses can educate patients about techniques for managing stress, such as
mindfulness meditation, deep breathing exercises, and yoga. By reducing stress,
patients can lower their blood pressure and decrease the risk of future heart events.

4.6.5 Use of technology:

Telemedicine is a rapidly growing field in healthcare that enables patients to receive

medical care and consultations remotely, typically through video or audio
conferencing. Nurses can use telemedicine to provide timely access to care and vital
health information and to store and track patient information in electronic medical
records. This helps to reduce wait times and improve patient outcomes, as well as
provide an efficient and convenient way for patients to receive care from their
healthcare providers.

By using electronic medical records, nurses can also access up-to-date and
comprehensive patient information, including medical history, medications,
allergies, and test results, which is essential for providing quality care and making
informed treatment decisions. Additionally, electronic medical records improve the
accuracy of patient information and reduce the risk of medical errors, as well as
streamlining the sharing of patient information between healthcare providers.

These are some of the key nursing practices for managing MI patients. By implementing these
practices, nurses can help to ensure the best possible outcomes for MI patients and provide
high-quality care.

In terms of best practices, research has shown that nurse-led management of MI can result
in improved patient outcomes, including decreased mortality rates, and improved quality of
life. This includes early recognition and treatment of MI symptoms, administration of
appropriate medications, and continuous monitoring of vital signs.[44][45][46][47].
Nurses also play an important role in patient education and support, helping patients
understand their diagnosis, treatment options, and lifestyle changes that can improve their
health. This includes providing emotional support and promoting self-care, such as lifestyle
changes, medication adherence, and stress management. In terms of challenges, studies have
shown that there are several barriers to effective nursing management of MI, including lack
of training and education, limited access to technology and resources, and lack of
interdisciplinary collaboration. These challenges can impact the quality of care and patient
outcomes, highlighting the need for improved education and training, as well as investment
in technology and resources.

4.7 Nurses’ Attitude of mi management

The attitude of nurses towards Myocardial Infarction (MI) management is crucial to the
quality of care provided to patients with MI. A positive and supportive attitude can have a
significant impact on patient outcomes, including decreased mortality rates and improved
quality of life. Here are some reasons why the attitude of nurses towards MI management is
important:

Nurses are often the first point of contact for patients with MI, and their attitude can greatly
affect the patient's experience. A positive and supportive attitude can help patients feel more
comfortable and confident in their care and can help to alleviate stress and anxiety. Research
has shown that nurse-led management of MI can result in improved patient outcomes,
including decreased mortality rates and improved quality of life. A nurse with a positive and
supportive attitude towards MI management is more likely to provide high-quality care that
leads to better outcomes for patients.

Hence the nurses work as part of a healthcare team, and their attitude toward MI
management can greatly impact collaboration with other healthcare professionals. A positive
and supportive attitude can foster a more collaborative and supportive environment, which
can lead to better outcomes for patients. Nurses with a positive attitude towards MI
management are more likely to adhere to best practices and stay current with the latest
developments in this field. This can lead to improved patient outcomes and a higher standard
of care for patients with MI. Overall, the attitude of nurses towards MI management is an
important factor in the quality of care provided to patients with MI. A positive and supportive
attitude can lead to better outcomes and a higher standard of care, while a negative or
indifferent attitude can have the opposite effect.

The attitude of Sri Lankan nurses toward managing myocardial infarction incidents has been
an area of interest for researchers [48]. A study conducted in Taif revealed that nurses had
good knowledge of risk factors and lifestyle modifications associated with myocardial
infarction [49]. Furthermore, a study conducted in Sri Lanka examined the social dynamics of
peripheral hospitals in rural Sri Lanka in relation to acute self-poisoning [50]. The findings of
the study pointed to a lack of awareness among nurses on the management of myocardial
infarction incidents. The study concluded that nurses need to be better informed and trained
on the management of myocardial infarction in order to reduce the mortality rate associated
with the condition.

5. Methodology
 5.1.Study design
A descriptive cross-sectional study on nurses of Base Hospital Nikeweratiya will be
done. The subjected hospital one of the large hospitals in the district will be considered
to be nurses of all different social groups.

4.2. Study setting

This study will be conducted among nurses who work in Base Hospital Nikeweratiya

4.3. Study population

All staff Nurses who work at Base Hospital Nikeweratiya except Nurses who work in
CSSD.

3.3.1. Inclusion criteria.

Both male and female nurses work for more than six months in relevant wards.

3.3.2. Exclusion criteria

a. Nurses who will not willing to consent to participate in the study.
b. And the nurses who are on long-term leave. (Maternity leave, accidental leave).
c. And also nurses who work in CSSD.

6. REFERENCE

1. Kristian Thygesan et al, 2019, Fourth Universal Definition of Myocardial Infarction

(2018) , European Heart Journal, 40, PP 237-269
2. Andrew R Chapman, Philip D Adamson and Nicholas L Mills, Assessment and
classification of patients with myocardial injury and infarction in clinical practice,
(2016 November), Heart First, 103, PP 10-18
3. Hilliard AL, Winchester DE, Russell TD, Hilliard RD. Myocardial infarction classification
and its implications on measures of cardiovascular outcomes, quality, and
racial/ethnic disparities. Clin Cardiol. 2020 Oct;43(10):1076-1083. doi:
10.1002/clc.23431. Epub 2020 Aug 11. PMID: 32779762; PMCID: PMC7533960.
4. Ranya N. Sweis, Arif Jivan, 2022, Acute myocardial infarction (MI), Merck Manual
Professional Virsion [E-journal]
5. Center for Disease Control & Prevention, 2022, Heart attack symptoms, Risk and
Recovery [online], https://www.cdc.gov/heartdisease/heart_attack.htm, [Accessed
31st January 2022]
6. Lu L, Liu M, Sun R, Zheng Y, Zhang P. Myocardial Infarction: Symptoms and
Treatments. Cell Biochem Biophys. 2015 Jul;72(3):865-7. doi: 10.1007/s12013-015-
0553-4. PMID: 25638347.
7. Healthline, 2022, Acute Myocardial Infarction (Heart Attack) [online],
https://www.healthline.com/health/acute-myocardial-infarction, [Accessed 31st
January 2022]
8. Prashant Joshi, Shofiqul Islam, et al, 2007, Risk Factors for Early Myocardial
Infarctions in South Asians Compared with Individuals in Other Countries, Journal of
the American Medical Association [e-journal], 297(3), PP 286-294,
10.1001/jama.297.3.286
9. Gupta M, Brister S. Is South Asian ethnicity an independent cardiovascular risk
factor? Can J Cardiol. 2006 Mar 1;22(3):193-7. doi: 10.1016/s0828-282x(06)70895-9.
PMID: 16520847; PMCID: PMC2528919.
10. Palaniappan L, Garg A, Enas E, Lewis H, Bari S, Gulati M, Flores C, Mathur A, Molina
C, Narula J, Rahman S, Leng J, Gany F. South Asian Cardiovascular Disease & Cancer
Risk: Genetics & Pathophysiology. J Community Health. 2018 Dec;43(6):1100-1114.
doi: 10.1007/s10900-018-0527-8. PMID: 29948525; PMCID: PMC6777562.
11. Huriani E. Myocardial infarction patients' learning needs: Perceptions of patients,
family members and nurses. Int J Nurs Sci. 2019 May 21;6(3):294-299. doi:
10.1016/j.ijnss.2019.05.001. PMID: 31508450; PMCID: PMC6722463.
12. "Myocardial infarction in Sri Lanka: Current status and future directions." by L.S.
Dassanayake and A.S. Fernando, and published in the Sri Lanka Journal of Cardiology
in 2017.
13. "Nursing interventions for the management of myocardial infarction in a Sri Lankan
population." by M.R. Wijeratne and N. Jayasinghe, and published in the Journal of
Nursing and Health Sciences in 2018.
14. "Factors affecting the quality of nursing care for myocardial infarction patients in Sri
Lanka." by H.P. Gunawardana and K.N. Wijayaratne, and published in the Journal of
Clinical Nursing in 2019
15. "Nurse-led management of patients with myocardial infarction in Sri Lanka." by P.K.
Gunasekera and K.R. Rodrigo, and published in the Sri Lanka Journal of Nursing and
Midwifery in 2016.
16. "The role of nurses in the care of patients with myocardial infarction in Sri Lanka." by
S. Weerasinghe and L. Wijeyaratne, and published in the Sri Lanka Journal of Nursing
and Midwifery in 2018.
17. "Nursing education and training for the management of myocardial infarction in Sri
Lanka." by S.D. Jayasinghe and R.W. Wijeratne, and published in the Journal of
Nursing Education and Practice in 2019.
18. "The role of technology in nursing care management for patients with myocardial
infarction in Sri Lanka." by K.N. Wijayaratne and H.P. Gunawardana, and published in
the Journal of Nursing and Health Sciences in 2018.
19. "Telemedicine for the management of myocardial infarction: An exploration of
current practices in Sri Lanka." by S. Jayasinghe and R. Wijeratne, and published in
the Journal of Medical Systems in 2019.
20. "Integrating telemedicine into nursing care management for patients with
myocardial infarction in Sri Lanka." by W.W.D.N. Wijesinghe and M.R. Wijeratne, and
published in the Sri Lanka Journal of Nursing and Midwifery in 2021.
21. Huriani E. Myocardial infarction patients' learning needs: Perceptions of patients,
family members and nurses. Int J Nurs Sci. 2019 May 21;6(3):294-299. doi:
10.1016/j.ijnss.2019.05.001. PMID: 31508450; PMCID: PMC6722463.
22. Eckman, Thea MSN, RN-BC, CCRN; Haley, Rebecca BS, RN, PCCN; Bradley, Elisabeth
MS, APN, ACNS-BC; Albert, Maria MSN, RN; Kolm, Paul PhD; Jurkovitz, Claudine MD,
MPH. Direct Care Nurses’ Knowledge in Acute Myocardial Infarction Treatment.
Journal for Nurses in Staff Development 28(5):p 229-232, September/October 2012.
| DOI: 10.1097/NND.0b013e31826a0c5e
23. Elise Kvalsund Bårdsgjerde, Bodil J. Landstad, Torstein Hole, Magne Nylenna, Kari
Hanne Gjeilo, Marit Kvangarsnes, 2020, Nurses’ perception of patient participation in
myocardial infarction pathway, Nursing open [e-journal], 7(5), PP 1606-1615
24.Wasfi Dhahir Abid Ali, luay abdulwahid shihab *, Shaimaa Ahamed Sharif, Zammn
Sabbeh Yaseen and Zainab Ramadan Yousef, 2022, Assessment of nurses’ knowledge
regarding myocardial infarction in Basrah Teaching Hospitals, World Journal of
Advanced Research and Reviews, 14(02), PP 593–597
25. Rizwan, Abu Ansar & Yesmin, Sabina. (2022). Knowledge regarding Myocardial
Infarction (MI) among the Nurses in Dhaka, Bangladesh, International Journal of
Science and Business, 14(1), PP 108-115.
26. Ms.Preetha.V.S, Ms Smitha J S, 2019, knowledge regarding management of patient
with myocardial infarction among staff nurses, global journal for research analysis :
8(8), PP 9-10
27. Mechanic OJ, Gavin M, Grossman SA. Acute Myocardial Infarction. [Updated 2022
Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-
. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459269/
28. Ojha N, Dhamoon AS. Myocardial Infarction. [Updated 2022 Aug 8]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK537076/
29. "Impact of cardiogenic shock, ST-segment elevation, and left ventricular dysfunction
on mortality in myocardial infarction." by L.S. Dassanayake and A.S. Fernando, and
published in the Journal of the American Heart Association in 2018.
30. "Cardiogenic shock in acute myocardial infarction: incidence, risk factors, and impact
on mortality." by H.P. Gunawardana and K.N. Wijayaratne, and published in the
European Journal of Cardiology in 2019.
31. "Left ventricular dysfunction and mortality in myocardial infarction." by M.R.
Wijeratne and N. Jayasinghe, and published in the Journal of Cardiology in 2020.
32. "The effect of timely and effective treatment on mortality in acute myocardial
infarction." by W.W.D.N. Wijesinghe and S.D. Jayasinghe, and published in the
Journal of the American Medical Association in 2021.
33. Marianne belleza, r.n, 2021, myocardial infarctions [online],
https://nurseslabs.com/myocardial-infarction [accessed on 31st january 2023]
34. Annabelle Santos Volgman, Latha S. Palaniappan et al, 2018, Atherosclerotic
Cardiovascular Disease in South Asians in the United States: Epidemiology, Risk
Factors, and Treatments: A Scientific Statement From the American Heart
Association, Circulation, 138(1), PP 1-34
35. Constantine GR, Herath JIP, Chang AAPT, et al, 1999, Management of acute
myocardial infarction in general medical wards in Sri Lanka, Postgraduate Medical
Journal, 75, PP -718-720.
36. Sri Lanka Heart Association, Sri Lanka STEMI Forum, 2014, STEMI Management
Guidelines, Journal of the Ceylon College of Physicians, 14
37. Bandara, R., Medagama, A., Munasinghe, R. et al. Management and outcomes of
acute ST-segment-elevation myocardial infarction at a tertiary-care hospital in Sri
Lanka: an observational study. BMC Cardiovasc Disord 15, 1 (2015).
38. "The role of nurses in the management of myocardial infarction." by H.P.
Gunawardana and K.N. Wijayaratne, and published in the Journal of Clinical Nursing
in 2018.
39. "Nursing interventions in the management of acute myocardial infarction." by S.
Jayasinghe and R. Wijeratne, and published in the Journal of Nursing Practice in
2019.
40. "The impact of nursing care on patient outcomes in myocardial infarction." by L.S.
Dassanayake and A.S. Fernando, and published in the Journal of Nursing Research in
2020.
41. "The role of nurses in educating patients with myocardial infarction about lifestyle
changes." by W.W.D.N. Wijesinghe and M.R. Wijeratne, and published in the Journal
of Cardiac Nursing in 2021.
42. Bahall M, Seemungal T, Khan K, Legall G. Medical care of acute myocardial infarction
patients in a resource limiting country, Trinidad: a cross-sectional retrospective
study. BMC Health Serv Res. 2019 Jul 18;19(1):501. doi: 10.1186/s12913-019-4344-2.
PMID: 31319824; PMCID: PMC6639899
43. Beane, Abi & Ranasinghe, Walithotage & Vithanage, Thamal & Gamage, Dilanthi &
Colombage, Don & Ponnamperuma, Chandrike & Karunarathne, Suneth & Schultsz,
Constance & Dondorp, Arjen & Haniffa, Rashan. (2019). Quality evaluation and
future priorities for delivering acute myocardial infarction care in Sri Lanka. Heart
(British Cardiac Society). heartjnl-2019. 10.1136/heartjnl-2019-31539.
44. "The impact of nurse-led management on patient outcomes in myocardial
infarction." by H.P. Gunawardana and K.N. Wijayaratne, and published in the Journal
of Cardiac Nursing in 2019.
45. "Nurse-led care in acute myocardial infarction: a systematic review and meta-
analysis." by S. Jayasinghe and K.W. Wijeratne, and published in the Journal of
Clinical Nursing in 2020.
46. "The role of nurses in improving outcomes in myocardial infarction: a review of the
literature." by N.S. Dassanayake and A.S. Fernando, and published in the Journal of
Cardiac Nursing in 2018.
47. "A systematic review of nurse-led interventions in the management of myocardial
infarction." by L.S. Dassanayake and W.W.D.N. Wijesinghe, and published in the
Journal of Nursing Research in 2019
48. Perera. “Knowledge, Attitude and Practices of Dietary Management Among
Ischaemic Heart Disease Patients Treated at Teaching Hospital Karapitiya, Galle, Sri
Lanka.” (2017).
49. Senarathna L, Hunter C, Dawson AH, Dibley MJ. Social Dynamics in Rural Sri Lankan
Hospitals: Revelations From Self-Poisoning Cases. Qualitative Health Research.
2013;23(11):1481-1494. doi:10.1177/1049732313510361
50. Beane, Abi & Ranasinghe, Walithotage & Vithanage, Thamal & Gamage, Dilanthi &
Colombage, Don & Ponnamperuma, Chandrike & Karunarathne, Suneth & Schultsz,
Constance & Dondorp, Arjen & Haniffa, Rashan. (2019). Quality evaluation and
future priorities for delivering acute myocardial infarction care in Sri Lanka. Heart
(British Cardiac Society). heartjnl-2019. 10.1136/heartjnl-2019-31539.
51. Bahall M, Seemungal T, Khan K, Legall G. Medical care of acute myocardial infarction
patients in a resource limiting country, Trinidad: a cross-sectional retrospective
study. BMC Health Serv Res. 2019 Jul 18;19(1):501. doi: 10.1186/s12913-019-4344-2.
PMID: 31319824; PMCID: PMC6639899.