Development of Emergency Nursing System in STEMI Patients. Emergency Department, Phra Nakhon Si Ayutthaya Hospital

Abstract

     This was a participatory action research which aimed to analyze situations, problems and obstacles in the Emergency Nursing System, to improve and to evaluate the development of such system for STEMI patients in the Accident and Emergency department (A&E) of Phra Nakhon Si Ayutthaya Hospital. The research was conducted during January-October 2018 and divided into 3 phases. The first phase started by thoroughly examining the situations, problems and obstacles of the system for patients in A&E. Then, series of development in the Emergency Nursing System for STEMI patients took place in the second phase followed by the evaluation of such developed system in the third phase. The samples consisted of 29 professional nurses working in the A&E, the medical records of 107 and 92 STEMI patients before and after the development of Emergency Nursing System, respectively. The research tools were 1) the personal record of professional nurses, 2) the guideline for group discussion, 3) the STEMI patient information form, 4) the STEMI nursing care competency assessment form of professional nurses in A&E, 5) the guideline for STEMI patient care during emergencies, and 6) the data collection form for STEMI patient care practices during emergencies. The qualitative analysis was done by analyzing the contents and deriving conclusions. As for the quantitative data, descriptive statistics, frequency distribution, number, percentage, mean, standard deviation, and Mann Whitney u test were used.

     During the first phase of this research, problems were discovered in all areas including the service providers, the users, and the healthcare system. The service providers showed lack of knowledge and confidence in nursing STEMI patient. Moreover, there were not enough necessary medical supplies and equipment. As for the user side, it was found that patients and families were not given enough opportunities to get involved in care planning and lacked of knowledge and understanding about the disease. On the healthcare system, the existing STEMI patient care guidelines were difficult to implement. The second phase were series of professional nursing competency enhancement in nursing STEMI patient, the improvement of hospital STEMI care practices both in general and during the emergency. Lastly, the third phase indicated that, after series of competency enhancement, the performance of professional nurses improved with statistical significance (p<.001). Besides, incidences screening error, incidences of non-compliance with emergency care practices, average duration from STEMI patient admission till receiving ECG taking more than 10 minutes, and incidences of lacking adequate equipment or not available were all significantly reduced (P<.05). However, incidences of STEMI patients not receiving thrombolytics within 30 minutes, incidences of unwanted occurrences while transmitting or relocating patients, and the STEMI patient’s mortality rate at Adverse Event were not significantly different.