Background: Current research suggests that nurses can influence the outcome for patients with acute coronary\nsyndrome (ACS). The aim of this study has been to evaluate whether a course in cardiovascular nursing (CVN) can\nimprove ambulance nurses� (ANs�) prehospital care of patients experiencing suspected ACS, related to pain intensity.\nMethods: This is a cluster randomised controlled trial that was conducted in the ambulance services. Patients were\nallocated to one of two groups: in the first group, patients were treated by ANs who had attended the CVN course\nand in the second group patients were treated by ANs without this qualification. Inclusion criteria were: 1/pain\nraising suspicion of ACS, and 2/pain score �4 on a visual analogue scale (VAS). The primary outcome was the\nestimated intensity of pain or discomfort according to VAS 15 min after randomisation. Secondary outcomes were\nestimated intensity of pain or discomfort on admission to hospital and further requirement of pain treatment, as\nwell as symptoms such as paleness and/or cold sweat; nausea and/or vomiting; anxiety, dyspnea, degree of\nalertness, respiratory depression and aggressiveness. A further secondary outcome measured was survival to\n30 days. Lastly, a final diagnosis was made. A total of 38 ANs attended the CVN course. There were 1,747 patients\nwho fulfilled the inclusion criteria.\nResults: The pain score did not differ significantly between the two groups fifteen minutes after randomisation\n(median value of VAS was 4.0 in both groups). On admission to hospital the pain score was significantly lower for\npatients treated by an AN who had attended the CVN course (n = 332) compared with those treated by an AN who\nhad not attended the course (n = 1,415) (median 2.5 and 3.0 respectively, p = 0.001). The ANs who had attended the\ncourse used higher doses of morphine.\nConclusions: An educational intervention with a CVN course did not relate significantly to more efficient pain relief\nin suspected ACS during the first 15 min. However, this intervention was associated with more effective pain relief\nlater on in the prehospital setting. Thus, a CVN course for ANs appears to be associated with reduced pain intensity\namong patients experiencing suspected ACS. This result needs however to be confirmed in further tria
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