The Development of the Nursing Service System for Patients with Off-Pump Coronary Artery Bypass Grafting: OPCAB, Udon Thani Hospital

Abstract

The OPCAB is a complicated surgery and may lead to life-threatening conditions.  The primary objectives of this research and development are to examine the conditions, to create and to assess a nursing care system for patients undergoing Off-Pump Coronary Artery Bypass Grafting: OPCAB at Udon Thani Hospital.  The samples in this study consisted of 30 patients, 30 nurses, and 30 relatives of the OPCAB patients, and there were three steps in the research process which were 1) Situation analysis; 2) Nursing service system development; and 3) Outcome evaluation. Additionally, experimental instruments such as surgical process protocols, equipment lists, nursing guidelines for surgical patients, knowledge providing, and timekeeping devices were employed as research tools. In order to support the validity and reliability of the study, three experts verified satisfaction assessment forms, which were used as collecting data tools. The item-objective congruence index ranged from 0.67 to 1.00. In addition, acceptable values of 0.88, 0.97, and 0.92 were obtained for the Cronbach alpha reliability of nurses, patients, and relative satisfaction forms, respectively. Furthermore, the assessment and data recording forms were used to collect data. For the data analysis, the quantitative data was examined using frequency, percentage, mean, standard deviation, and Wilcoxon matched-pairs signed-rank test, while qualitative data was analyzed using content analysis.

Results: Based on the findings, the mortality rates for the years 2018–2022 were 4.62%, 9.35%, 5.08%, 5.00%, and 8.44%, respectively, and the infection and re-admission rates were post-operative complications.  Aside from this, two primary reasons for the postponement of the scheduled surgery were a lack of intensive care beds and the inadequate supply of blood components. Following the implementation of the nursing service system, surgical queue postponements decreased and the amount of time needed for equipment preparation was significantly reduced (p < .001).  Moreover, the results also showed that among nurses, patients, and their families, satisfaction was rather high. For further studies in this field, the recommendations included a nursing service system focusing on pre-surgical preparation, collaboration amongst multidisciplinary specialists, and the critical utilization of nursing procedures prior to, during, and following OPCAB surgery.