Development of A Nursing Care Model for Patients with Acute Myocardial Infarction in the Emergency Phase

Abstract

Background: ST-elevation myocardial infarction (STEMI) represents a critical condition with increasing mortality rates. Statistical data indicate a progressive rise in cases from 2022 to 2024, with recorded figures of 144, 192, and 214, respectively, positioning it as the third leading cause of death within the Thai population. Despite the existence of nursing practice guidelines for acute myocardial infarction patients in emergency departments, these guidelines do not fully encompass all phases of care. This deficiency underscores the need for the development of a comprehensive nursing care model. The objectives of this study were to develop a nursing care model for acute myocardial infarction patients during the emergency phase and to compare patient outcomes before and after its implementation.

Methods: A research and development design was utilized in this study. The sample comprised two distinct groups: 30 registered nurses and 152 patients experiencing acute myocardial infarction during the emergency phase. The study was executed in three phases: situational analysis and model development, pilot implementation and model refinement, and outcome evaluation post-model implementation. Data were analyzed using descriptive statistics, employing clinical outcome records and family satisfaction assessment forms, to compare outcomes before and after the model's implementation.

Results: The situational analysis revealed significant deficiencies in patient screening, the efficiency of electrocardiogram equipment, and referral systems. To address these issues, a comprehensive care model was formulated, which includes guidelines for pre-hospital, in-hospital, and intra-hospital care nursing, a clinical care flowchart, and an emergency-phase nursing knowledge base for patients with acute myocardial infarction. The implementation of this nursing care model resulted in statistically significant enhancements in the competency and knowledge of registered nurses (p < .001). Compliance with the model reached 100%. Following implementation, nurses reported high feasibility and satisfaction with the model's use. In terms of patient-related outcomes, care delivery efficiency improved significantly; the screening error rate was eliminated; the percentage of patients receiving an electrocardiogram within 10 minutes of arrival increased from 82.90% to 94.70%; and the 24-hour mortality rate decreased by 5.30%. Furthermore, family caregivers expressed a very high level of satisfaction with the model (M = 4.58, SD = 0.09).

Conclusion: The nursing model that has been developed provides effective support for the care of patients experiencing acute myocardial infarction during the emergency phase. Additionally, it enhances the knowledge and competence of nurses.