Development of Nursing Practice Guidelines in Caring for Hypertensive Patients at an Emergency Department

Abstract

Hypertension is harmful to patients’ vital organs, so implementing effective nursing practice guidelines with them at their first admission to an emergency department may help reduce disability or death. This implementation research aimed to develop nursing practice guidelines for the care of hypertensive patients at an emergency department. The participants consisted of 3 groups: 1) the guideline developers, including 10 nurses, 5 doctors, 2 pharmacists, and 2 laboratory staff; 2) 19 nurses using the guideline; and 3) 33 hypertensive patients receiving treatment at the emergency department in a medical centre. The research tool consisted of a personal record form, an implementation assessment form (CVI = .75), meeting questions, the Appraisal of Guidelines for Research and Evaluation II (AGREEII), and an evidence extraction form. Data collection followed the steps in the CURN Model. Data were analyzed using descriptive statistics.

The research results provided the guidelines, consisting of five sections. Section 1 included protection of patient rights and ethics; Section 2 was about managing high blood pressure; Section 3 concerned discharge or transfer and follow-up after discharge; Section 4 covered educating patients to control their blood pressure; and Section 5 involved the continuous monitoring of practice and improvement of the quality of the guidelines. The quality of the guideline was assessed using AGREEII, resulting in a total score of 85.02%. After using the guidelines, 17 of the 33 patients (51.52%) experienced a blood pressure level decrease over two hours. All nurses reported that this guideline was easy for screening, giving medicine to decrease blood pressure, referring patients to another hospital, and providing information to patients and relatives. However, some participants (31.58%) found it difficult to send patients to the intensive care unit because of the limited number of beds in the hospital at the research site.

The results of this research included systematically developed nursing guidelines which are suitable for practical application. Further research should study the effectiveness of the guideline implementation and evaluate clinical and procedural outcomes.