Nursing intervention is essential to evaluate hospitalised patients' condition and the Peripheral intravenous catheter is a small flexible tube that is placed into the peripheral vein of the patient to administer intravenous therapy. This process is mainly used in vascular access in medicine and the critical and surgical patients have given this. The term angina is used for heart-related chest pain. Unstable angina is a type of chest pain that happens for stress or exertion. Unstable angina denotes that the arteries are in worse condition, severe blockages occur and less amount of blood and oxygen is reached to the heart through the affected arteries (Wieringa 2020). Unstable angina can lead to heart-threatening conditions such as heart failure, heart attack and arrhythmias. In critical cases, nursing management includes improving myocardial oxygen supply and identifying the patient's risk relating to myocardial infarction as well as being attentive to patients' complications associated with treatment. Patients with unstable angina have to be hospitalized and the treatment should be monitored.
Critical evaluation of BPS and ENGEL model
The BPS model was first proposed by Engel in 1977. The model is based on semiotics and constructivism. Semiotics composes the language that helps to know the connection between the people and associated environment and constructivism defines how an individual perceives his environment. This model mainly focuses on the health discipline like psychology, psychiatry and other health-related aspects. This model is an interdisciplinary model that makes a connection between three main sections of science- biology, socio-environmental science and psychology. With the interaction between various biological factors like genetic and biochemical, social factors like cultural and socioeconomic and psychological factors like personality and behaviour, this model help to evaluate the reason for illness (Thero 2019). Engel depicts that the BPS model emphasized the association between biological, social and psychological factors and thus evaluated the health outcome. This is the best and authentic model for the practice of modern medicine. From this model, the physicians can describe that these three factors have a great role in developing any illness and behaviours. Engel modified this model and developed a biopsychological model that can be used instead of a biomedical model that helps physicians and nurses to critically evaluate their patients, their subjective perspectives regarding the disease and suffering. With the help of the BPS model, health professionals can easily evaluate their patient's both mental and physical health conditions. The implementation of this model has a great outcome. The healthcare professions easily understand their patients' condition, develop the satisfactory level of the patients, can prescribe the most accurate and effective medicines, both the physical and mental health improved, changing in behaviour can be maintained and reduce the tendency of malpractice. A good connection between patient, patient's family member and health professionals, regular hospital visits and maintaining regime and medications helps the patients to stabilize and strengthen the mental condition and develop the immune system in health. This model can be practised the patients with chronic disease, elder patients and disable patients and previous reports stated a good outcome of it. The BPS model stated a great improvement in the patients' satisfaction, better mental and physical health and maintaining doctor's advice and taking medicines with an appropriate and healthy diet. This model can control the hospital visit of patients multiple times, making effective communication between health staff and patients. The ultimate aim of this model is to increase patients' well-being and health professionals accurateness. This model states that at least three factors are essential for developing any specific symptoms and illness. They are- any stressful or shocking event, compromising pathophysiologic systems and physiologic vulnerability. This model helps the health professional to evaluate and understand patients' conditions by understanding several dimensions that are mainly related to the main three components of the BPS model.
Figure: Biopsychosocial model
More preferable and applicable model for the patient with unstable angina
Among the two models, the BPS model is the most preferable and accurate process for the patient who has suffered from unstable angina. The BPS model or biophysiological model is becoming the most appropriate process in family medicine and practice. The models that are excessively used in the family medicines are developmental, biomedical, epidemiological, biophysiological and general. And among them, the biophysiological model is excessively used. The health professional can understand the patient's health and mental condition by accessing the patient's life, medical history, family history, working environment, neighbourhood as well as the community. This model also comprises the relation between the health professionals and patients, assumptions of health professionals and biases. Therefore, it becomes the most primary base of the epidemiological concepts and systems of health and disease. Unstable angina is a type of chest pain that is caused by inadequate blood and oxygen supply to the heart muscles and leads to coronary heart disease. The main reason behind this life-threatening disease is the plaque formation in the arteries and for this, the arteries become narrower reducing the blood flow in the heart muscle developing chest pain. As the BPS model helps the physicians to know about patient's lifestyles, habits, working environment and so on, the physician can easily identify the potential reasons behind unstable angina. The risk factors of unstable angina that may lead to coronary heart disease if untreated are diabetes, a family history of heart disease, obesity, high blood pressure (hypertension), smoking and drinking habits, consuming improper diet, high low-density cholesterol (LDL) and low high-density cholesterol (HDL) and leading an improper lifestyle. These potential causes are only identified by the physician with the BPS model. Angina is related to several coronary factors such as coronary calcification and inadequate blood supply to the heart and is related to ischemic stroke and heart diseases. The biopsychological process that leads to unstable angina is illustrated in Figure 2. In the first step, both the internal and external reasons for unstable angina are identified through epidemiologic and clinical studies. Several psychophysiological factors interpret the risk factors and are transmitted and affected by the numerous organ systems like the cardiovascular system and nervous system. This incident happened with molecular and physical processes. These processes are related to each other and indicate unstable angina that further leads to coronary heart diseases. The health professionals identify and understand a patient's condition with the BPS model and can prescribe accurate and effective medications and therapies that help the patient to recob\ver quickly.
Figure: the BPS process
(Source: self-made in draw.io)
Relevant pathophysiology, social and psychological impact of the condition
Unstable angina can be considered as the intermediate condition between myocardial infarction and stable angina. It was reported that most of the patients have faced unstable angina after being affected by myocardial infarction.
The pathogenic mechanism of unstable angina
The unstable angina is related to the “Q and non-Q wave myocardial infarction”. This situation can lead to a number of diseases and health issues in which fissuring of plaque disruption can lead to the formation of thrombus as well as acute coronary diseases. In patients with unstable angina, the formation of the intracoronary thrombus is majorly noted. Since there is greater total obstruction of both the causative arteries than that in diastolic dysfunction although more than in Q wave MI, non–Q wave contusion is situated between these two conditions. Autopsy investigations make up nearly all pathological data in severe disorders. Although the short-term risk of dying of "unstable angina" is minimal, autopsy data in this population is extremely selective.
Thrombus Formation in Unstable Angina
Angiographically, “small thrombi or mural thrombi” that do not produce luminal variation are unlikely to be seen. Finally, the most common “pathophysiological mechanism” in unstable angina is thrombus development on a hypothesised disrupted, fissured, or degraded plaque, especially when the presentation is acute rest discomfort. However, it is impractical to expect thrombus formation to occur spontaneously.
Pathogenic Mechanisms in Unstable Angina
Other factors could be at play when it comes to the clinical manifestations of unstable angina. Inflammation has been linked to the problem. Plaque rupture is aided by the production of matrix metalloproteinases, which contributes to the instability of the fibrous cap of so-called susceptible plaques. Smooth muscle cell growth could be another non-thrombotic cause of unstable angina. On directional atherectomy study of excised plaque, some patients have an extensive proliferation of smooth muscle cells similar to that reported in restenotic lesions, even if there is no angiographic evidence of thrombus. Again, it's difficult to rule out thrombus because tissue examination revealed thrombus in one-third of the lesions, despite the angiography indicating no thrombus. Moreover, thrombus, combined with cytokines or growth factors generated by inflammatory cells or other stimuli, such as infectious particles like Chlamydia pneumonia, maybe a powerful stimulant for smooth muscle cell proliferation. In the self - regulate lesion, smooth muscle cell growth without thrombus may play a role in unstable angina. Even though restenotic lesions do not normally contain thrombus, they may show rest discomfort despite elevated enzyme levels, signifying non–Q wave MI.
Pain management and the role of the nurse in it and MDT
The clinical evaluation continued with the collection of proper information from the patient. Pain is the main symptom that indicates the formation of any harmful health conditions. In this case, the patient has suffered from unstable angina and here the chest pain is the most primary indication of heart disease. Therefore, pain management is vital in the healthcare system and the role of nurses is undoubtedly in this case as they assess, monitor, interpret and evaluate the pain. Nursing intervention is the most effective part of pain management. Pain is considered an ethical problem as this is quantitative and subjective and has a great negative effect on both the physical and mental condition of the sufferer. Every professional nurse has to maintain and respect the code of ethics that stated the right behaviour and right knowledge. In pain management both the patient and physician have to equally help each other for identifying current intervention and therapy and this helps the physicians to assess the real cause of pain thus prescribing effective medications. In this case, only the patient can describe his/her experiences, neither physicians nor nurses can tell about when and how the patient may hurt. By experiencing such an incident, nurses can understand the type of pain and with this, they can learn how to be more professional and accountable as well as responsive. Pain and physical expression help to understand several unnecessary features that can happen in the body. The role of nurses is more critical in the context of elderly people and non-verbal people. In both cases, nurses have to be more attentive and make sure that the pain is reduced and controlled completely as this feature is invisible. Quality of care is the most basic part of pain management. Firstly, pain is addressed and this part is done by professional nurses. Physiological dimension, sensory dimension, affective dimension, cognitive dimension, behavioural and socio-cultural dimension are the parts of pain management. Nurses have to be multidimensionally experienced and need a wider holistic understanding.
In pain management, nurses have to assess, manage and evaluate the pain for the betterment of the patient.
Identify the type and role of the pain.
Identifying the factors that have a potential effect on the pain expression.
Addressing analgesics appropriately.
Evaluating the effect of analgesic.
Identify and manage the side effects of medications.
Determining when to change the medications and dosages.
Implementing nursing interventions for comforting and relieving pain.
Addressing proper pain assessment and management.
Pain assessment is documented and intervention is noted.
MDT refers to a multidisciplinary team comprising a huge number of health professionals who work together in a health care system and aim to provide better care and therapy to the patients.
Reflective model for the development of nurse: critically demonstrate different reflective models
The reflective model that is demonstrated here is Gibbs' reflective cycle and it was developed by Graham Gibbs in 1988. This model proposed that any individual can learn properly from experiences. This model depicts a framework that helps to examine experiences and their cyclic features emphasizing repeating experiences help to learn. It comprises 6 different stages. They are descriptions of the experiences, thoughts and feelings of the experiences, evaluating the experiences, analysing the situation, conclusion and action plan. Reflection is the factor that is used in a wide way in health and social care. This is mainly used in education and practice. The main purpose of the model is to review experience from the practices that help to describe, analyse and evaluate and can be used knowledge consequently in future practice. Nurses are the health care professionals that have to deal with patients directly. Reflection offers the opportunity to review the effects as well as consequences of the actions and behaviour. By using a proper form of reflection nurses can assess and evaluate which step can be more accurate and implemented according to the situation. Nurses can improve their skill and their decision-making ability is developed with this strategic cycle. Personal development and improvement help to improve personal experiences that help the nurses to make more effective decisions when needed. Therefore, for professional nurses, it is essential to engage with the reflection that is associated with their actions. Hence, this is the most fundamental part of both personal and professional improvement.
Figure 3: Gibbs reflective cycle
Nursing intervention is the more important factor in the healthcare system as this is the fundamental part with which patients can get proper care and treatment. In this current context, a patient has suffered from unstable angina and the healthcare professionals used to measure the prescribed medications with peripheral intravenous catheters. This paper aims to evaluate the reliability of the BPS model in healthcare practice and hence it is proved that by implementing this model nurses and other healthcare professionals can evaluate the health of the patients properly.
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