Development of a Nursing Care Model for ST- Segment Elevation Myocardial Infarction Patients Who Had Received Percutaneous Coronary Intervention in Buriram Hospital

Abstract

Background: Nursing for ST-segment elevation myocardial infarction (STEMI) patients who had received percutaneous coronary intervention (PCI), a high-risk procedure. According to the findings of the study of the phenomenon, before the development, previous nursing models were found to lack clarity. Consequently, they were unable to achieve goals of caring for patients based on standards.
Methods: This study is research and development. The objective of this study aims to develop and evaluate the outcome of nursing care model, comparing pre and post-development outcomes, the quality of life satisfaction of patients and The satisfaction of registered nurses who has been using a nursing care model for STEMI patients who had received PCI. This research has been researching and developing with the data collections between October 2015 to December 2020 of Buriram Hospital. The sample was 52 registered nurses; a multidisciplinary team composed of 3 doctors, 1 pharmacist, 1 physical therapist and 2 nutritionists; and 992 STEMI patients who had received PCI. The study was conducted in the following 3 phases: Phase 1-Preparations with analysis of the situation and main factors involved in the care of STEMI patients receiving PCI; Phase 2-Development of a nursing care model for STEMI patients receiving PCI and implementing the model in practice and Phase 3-Evaluation the development of the nursing care model for STEMI patients receiving PCI. The instrumentation employed in the research was divided into the following two groups: 1) the nursing care model for STEMI patients receiving PCI and 2) data collection instruments:2.1) record of information on STEMI patients receiving PCI from patient history files and from the Buriram STEMI data collection form; 2.2) quality of life questionnaire and 2.3) registered nurse satisfaction questionnaire. Data were analyzed by using frequency, percentage, mean, standard deviation and content analysis.
Results: The development of a nursing care model for STEMI patients receiving PCI and outcomes were compared pre-development and post development of the nursing care model for STEMI patients receiving PCI. The findings were as follows: 1) Onset to balloon time in primary PCI took a mean of 241 minutes increase to 275 minutes; 2)the rate of Door to EKG within 10 minutes was 75.9% increased to 84.9%; 3) Door to balloon time in primary PCI took a mean of 45 minutes increase to 55 minutes ; 4) the rate of post-PCI complications was 3.6% decrease to 1.3%; 5) the re-admission rate for the same disease within 28 days was 2.4% pre-development with no cases of hospital re-admission post-development; 6) the length of hospital stay was 5.5 days decrease to 4.3 days and 7) the mortality rate in hospital was 13.2% decrease to 6.8%. Patients were very satisfied with their quality of life ( = 3.5, S.D. = 0.7) and registered nurses were very satisfied with the care model ( = 4.1, S.D. = 0.6).
Conclusion: The development of the nursing care model for STEMI patients receiving PCI provided a standardized service system. Patients had accelerated access to PCI, safety from complications, shorter lengths of hospital stays, lower re-admission rates and lower mortality rates.
Keywords: Nursing model development, ST-Elevation Myocardial Infarction, Percutaneous Coronary Intervention