Thammasat University Hospital Journal Online

The Effects of a Practice Guideline of Chest Pain Triage on Accuracy and Nurses’ Satisfaction at The Out-Patient Department

Sutasinee Pimsung — 2024-08-23

Background: Chest pain is a prevalent condition worldwide. A review of current data at Thammasat University Hospital revealed a 0.02 percent error rate in symptom-based screening, resulting in incorrect department assignments. Notably, misdirected chest pain cases often lead to severe outcomes, accounting for 6.6 percent of these errors.

Objective: This study aims to assess the impact of implementing chest pain screening guidelines for outpatient nurses at Thammasat University Hospital.

Material and methods: The sample group consisted of 5 professional nurses who screened patients with chest pain symptoms 65 persons. The tools used in this study consisted of 1) clinical practice guideline for the screening of chest pain symptoms in outpatients developed according to the Iowa Seven-Step Clinical Guideline Development Guidelines, 2) an outpatient chest pain symptoms screening form that passed the verification from 3 qualified experts by using the Index of Item-Objective Congruence method equal to 0.9. This study evaluates the use of practice guidelines for pain syndrome screening. The data were analyzed using descriptive statistics, and the results obtained through guideline usage were compared using chi-square statistics.

Result: The study found that the accuracy of chest pain syndrome screening significantly improved after implementing the guidelines. The accuracy rate increased from 75.38% before guideline implementation to 90.77% afterward (p<0.05). Additionally, the rate of rejected referrals decreased from 24.62% to 9.23% following guideline implementation, also with statistical significance (p< 0.05).

Conclusion: The improved accuracy of screening is likely attributed to comprehensive history-taking practices, guideline-based decision-making support, and screening symptoms. This positively impacted patient referrals, reducing under-triage and complications while awaiting evaluation.

Development of clinical nursing practice guidelines in the role of nurse-led clinic for multidisciplinary integrated care in atrial fibrillation

chantana charoensin — 2024-08-23

Background: Atrial fibrillation (AF) is the most common arrhythmia in medical practice. It is an increasing trend in the elderly, causing high disease burden and disability. Therefore, nurses need practice guidelines for nurse-led outpatient clinics to care for AF patients under multidisciplinary integration for efficient care outcomes.

Objective: To develop nursing practice guidelines for nurse-led outpatient clinic roles to care for AF patients under multidisciplinary integration.

Material and methods: Analysis and synthesis of research from searching electronic databases such as CINAHL, Science Direct, and PUBMED. The main keywords for the search include nurse-led clinic, atrial fibrillation, nursing practice guidelines for AF patient care, and outpatient. Additional keywords for more specific information include management, administration, care program, comorbidities, cardiac risk factors, stroke prevention, warfarin, and anticoagulants. 13 related papers were found and used for content analysis synthesis.

Result: Nursing practice guidelines summarized important roles of nurse-led AF clinic: 1) Education 2) Assessment 3) Management and finding comorbidities that are modifiable risk factors for AF 4) Treatment 5) Coordination 6) Follow-up, and 7) Counseling.

Conclusion: The developed nursing practice guidelines incorporate six roles of nurse-led outpatient clinics for AF patients. Guidelines focus on two phases of nursing: before and after seeing a doctor. Aiming to achieve good clinical outcomes, patients receive standard professional care, reduce disease progression, prevent complications, improve patient quality of life, and reduce disease burden.

Application of Roy’s Adaptation Model in Nursing care for Non-ST Elevation Myocardial Infarction Patients with Congestive Heart Failure: Case Study

Pongsak Dharmakulsakti — 2024-08-23

Non-ST elevation myocardial infarction (non-STEMI) is one of the common causes of death among Thai elderly. Once the condition has stabilized, if the patient cannot adapt to the changed lifestyle, they often return to the hospital with more serious complications. Roy's adaptation model is directly related to the nursing process. Therefore, it could be applied to the nursing of non-ST elevation myocardial infarction patients with congestive heart failure. The patient could adapt it to this critical illness. The purpose of this article is to describe nursing care for non-ST elevation myocardial infarction patients with congestive heart failure according to Roy’s adaptation concept and to provide guidance for nurses in planning patient care.

A case study of a 68-year-old female patient was discussed. When the doctor diagnosed her with non-ST elevation myocardial infarction and congestive heart failure, there was an assessment of adjustment in a total of 4 areas (physical, self-concept, role and duty, and interdependence) and identified care problems that could be resolved by nursing. From stimuli analysis within the theoretical framework, they may be a stimulus that limits the patient's ability to adapt. Each care problem uses NANDA-I nursing diagnosis and patient nursing planning according to the nursing process. Roy's adaptation model could be used as a guideline for nurses in planning care for non-ST elevation myocardial infarction patients with congestive heart failure. This helps the patient adjust appropriately. The good health and quality of life could be achieved with this disease.

Workload Analysis for Workforce Management through FTE Dashboard

Siraphan Boonrung — 2024-08-23

Background: According to the situation of healthcare workforce shortages and the challenges of managing manpower, which is based on patient numbers, consider sufficiency not only in terms of staff numbers but also ensuring patient and personnel safety. Bangkok Phuket Hospital recognizes the importance of personnel care, which is the most valuable resource of the organization.

Objective: To develop the tools that assist decision-making by utilizing technology and statistical data for workload forecasting. This objective aims to: 1) prevent and resolve staff insufficiency issues 2) enhance the safety of both patients and personnel through medical service readiness and promote positive patient care outcomes, and also 3) increase employee engagement through designing various workforce management processes and plans, ultimately increasing work efficiency.

Methodology: Systematically improve work processes to address staff insufficiency issues through the development of various tools.

Results: The hospital's Full-Time Equivalent (FTE) per Adjusted Average Daily Census (AADC) trend correlated positively with patient numbers, reaching a value of 5.52. This was achieved alongside the improvement of healthcare service quality through the development and measurement of safety-related standards as well as staff retention efforts, which are within the set criteria. Employee engagement with the organization, while not fully meeting goals, showed a continuous upward trend, reaching as high as 77.28% in the year 2022.

Conclusion: Effective workforce management, encompassing sufficiency and efficiency, heavily relies on data from actual historical, current, and forecasted operational activities. This involves cooperation from all parties to ensure workplace safety, along with the continuous development of employees' quality of life. These ongoing efforts strive to create a sustainable state of medical service readiness and the delivery of quality patient care in the future.