The Development of Nursing Practice Guideline for Patient with Acute ST Elevated Myocardial Infarction, Mukdahan Hospital

Abstract

Background: Acute ST elevated myocardial infarction (STEMI) is associated with high mortality rate. However, prompt and effective management can reduce mortality rate. According to the patient care indicators in fiscal year 2012, outcome of patient care was not reach the goal of treatment.
Objective: To improve nursing practice guideline for patients with acute STEMI at Mukdahan Hospital and to evaluate the effectiveness of the practice guideline.
Study Design: The action research was conducted from January 2013 to June 2014. The study has been divided into three phases: Phase 1 was patient’s characteristic study, Phase 2 was development process of practices guideline, Phase 3 was the effectiveness evaluation of the practice guideline. The sample was specifically selected for sample size of 30 and there were 73 nurses participated in this study. Research instrument was validated by experts for content validation (p = 0.88). Descriptive statistics using percentage mean, standard deviation, and inferential statistics were Chi Square test, Fisher’s Exact Test and Independent t-test.
Result: The developed practice guideline was applied to target therefore optimal time to reach the medical care and provision of standardized practice were significantly increased. Percentage of door to EKG increased from 46.7% to 100% (p C.01). Rate of history investigation and initial assessment were significantly increased from 40 % and 66.7% to 100% respectively. Whereas the monitoring rate during streptokinase infusion increased from 6.7% to 80 (p c.01) and observation rate for complications increased from 26.7 % of 100%. Most of patient had intermediate level of self-care management (74.1 %). Nurses had high to highest level of attitude for practice guideline adoption. Nurse’s opinion to the practice guideline were convenient for practice (57.6%), easy implemen tation (61.7%) and had high level of satisfaction (46.6%).
Conclusion: Development of the practice guideline requires the participation of practitioners for appropriateness to the hospital context and effective patient care in which resulted in standardized, safe and prompt medical service provision.