Development of a Nursing Model for Patients with Acute Myocardial Infarction (STEMI) at Yasothon Hospital

Abstract

This study was a research and development investigation aimed at formulating a nursing model for patients with acute myocardial infarction (STEMI) at Yasothon Hospital and assessing the impact of the developed model on the quality of nursing care for STEMI patients and nursing providers. The purposive sample comprised 51 STEMI patients and 20 professional nurses. The study was executed in four phases: (1) situation analysis utilizing the Six Building Blocks Model alongside a medical record review; (2) development of the nursing model; (3) implementation of the model; and (4) evaluation. The research instruments included STEMI patient nursing standards, a nursing competency development program, a nursing knowledge test, a nursing standards compliance assessment form, and a nurse satisfaction assessment form. All instruments were subjected to content validity testing by experts (CVI = 0.93–1.00, IOC ≥ 0.50) and reliability testing (Cronbach’s alpha = 0.81). Data analysis employed descriptive statistics to characterize data, Chi-square tests to compare clinical outcome proportions, and t-tests to compare nurses' knowledge and time indicators before and after development.

Results: A retrospective analysis identified significant delays within the healthcare system, notably an extended diagnosis-to-fibrinolysis interval exceeding standard benchmarks. Nurses exhibited a lack of confidence in interpreting electrocardiograms (ECGs), and the coordination systems were found to be disorganized, highlighting deficiencies in the service framework. The implementation of a nursing model, which integrates nursing standards and a nurse competency development program, markedly enhanced the quality of care for STEMI patients (p < .05). Improvements included achieving door-to-EKG within 10 minutes, administering Streptokinase, and reducing the diagnosis-to-fibrinolysis time to within 30 minutes. This led to a reduction in complications and an increase in survival rates. Post-development, healthcare providers demonstrated significantly higher knowledge and skills compared to pre-development levels (Mean pre = 12.47, S.D. = 2.03; post-development: 17.53, S.D. = 0.92). Satisfaction levels were notably high (Mean 4.73, S.D. = 0.15), and adherence to standards ranged from 88.24% to 92.16%. In conclusion, the developed nursing model enhances care efficiency, reduces treatment delays, and is appropriate for implementation in a general hospital setting.