The Development of a Clinical Nursing Practice Guideline for Care of Hypertension Patients with Atrial Fibrillation in the Community, Loei Province

Abstract

Caring  for  hypertensive  patients  with atrial  fibrillation  needs  a  clinical  nursing  practice guideline  to  minimize harm  to  patients. This  study was  conducted  to:  1) study  the  problems  and needs of hypertensive patients with atrial fibrillation; 2) develop a clinical nursing practice guideline ( CNPG) for the care of hypertensive patients with atrial fibrillation in the sample community; and 3) examine the  effectiveness  of  CNPG. This clinical  nursing  practice  guideline ( CNPG) was developed according to Soukup’ s concept. The participants were purposively selected based on the process of the study, which was divided into three steps: 1) Evidence- triggered phase: the sample consisted of 12 patients and 12 registered nurses; 2) Evidence-support phase: the sample consisted of 11 textbooks and research papers, 12 registered nurses, and 5 experts; and 3) Evidence-observed phase: the sample group consisted of 15 patients and 15 registered nurses. Research tools included: 1) a focus group guideline; 2) a brainstorming guideline; 3) the Appraisal of Guidelines Research and Evolution II; 4) questionnaires assessing knowledge, self- care behavior, and clinical data; and 5) a satisfaction questionnaire. Data were analyzed by descriptive statistics, content analysis, and the Wilcoxon signed rank test. The results illustrated the problems and needs of patients, including 1)the physical problems of heart palpitations, dyspnea, dizziness, fatigue, and bleeding tendency; 2) a lack of self-care knowledge; and 3) a fear of communicating with personnel and society. It was also revealed that the quality assessments of the CNPG by AGREE II were 92.86% overall and 90.00–97. 78% for each item. In addition, it was found that after CNPG testing, the knowledge and self-care behaviors of patients significantly improved, and the nurses’ satisfaction with using the CNPG was at its highest level. However, the clinical outcomes were not statistically significantly different. his may result from the time limitations of implementing the guideline.