Activity 25.2: Reflective practice
Earlier on in this chapter you met Euan. You may wish to take time to reflect and write down some ideas, of how you would help ensure that Euan has an effective, person centred discharge from hospital, specific to his condition, which will enable him to live an independent and fulfilling life.
Here are some suggestions/hints to get you started:
- Does he require a discharge letter/summary sheet?
- Does he have a specific discharge time?
- Does he require an outpatient appointment?
- Does he require to visit his GP practice or hospital/community clinic?
- Does he require to attend cardiac rehabilitation services?
- Does he require screening/follow up in regard to depression?
- Does he require specific advice in regard to resuming driving?
- Does he require specific advice in regard to resuming sexual intercourse?
The suggestions/hints supplied within the chapter include aspects, which are specifically relevant to cardiac conditions. Specific advice is usually given in regard to cardiac rehabilitation services, depression, resuming driving and resuming sexual intercourse. The other suggestions/hints are more generic in that all patients should receive a discharge letter/summary sheet, are likely to require an outpatient appointment and are advised to visit their GP or hospital/community clinic following discharge. Regional practice variations should however be taken into consideration.
Cardiac rehabilitation consists of a programme of exercise and information sessions to help individuals recover from an MI, heart surgery or procedure. It is likely that Euan will be advised to participate in such a programme in order to help him to understand his condition, promote his recovery, encourage him to make changes to his lifestyle in order to improve his heart health and to reduce the risk of future heart problems.
The psychological impact of an MI is considered important because it can be very stressful and it is therefore important to understand how Euan is coping with this in order to offer him the necessary support to meet his needs.
High levels of depressive symptoms are likely to lead to recurrent cardiac problems.
Research produced by the BHF has also shown that around 15% of people who survive an MI become depressed within the first few weeks following this. Furthermore, for some individuals depression can become persistent.
Another 25% of individuals who survive an MI can experience milder levels of depressive or anxiety symptoms. There are also differences in the way that men cope when compared to women. Women tend to use social support more by sharing their feelings. It is therefore imperative that Euan is assessed appropriately and at varying points post MI. Ideally this should occur at follow up visits both at the hospital and GP surgery.
The DVLA do not expect to be informed about drivers who have sustained an MI unless they drive a large goods vehicle (LGV) or passenger carrying vehicle (PCV). This usually involves a temporary suspension for a minimum of six weeks. GP assessment is then required to recommend that the individual is fit to drive. Their driving license would then be re-issued following a basic fitness test. However, the DVLA also strongly recommend that driving of cars or motorcycles should be avoided for at least four weeks after an MI and that the individual should only restart driving when their doctor tells them that they are safe to do so. Euan’s job may involve driving, therefore he should not drive for a minimum period of four weeks.
Euan will require specific advice in regard to resuming sexual intercourse. Sex is considered safe if walking briskly up and down two flights of stairs does not cause pain or undue breathlessness. However, following an MI anxiety is fairly common in relation to becoming sexually active for fear of triggering another MI.