THE DEVELOPMENT OF CLINICAL NURSING PRACTICE GUIDELINES FOR THE GENERAL ANESTHESIA OF PATIENTS WITH CORONARY ARTERY DISEASE UNDERGOING CORONARY ARTERY BYPASS GRAFTING SURGERY AT CHIANG RAI PRACHANUKROH HOSPITAL
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Abstract
BACKGROUND: Nurse anesthetists play an essential role in general anesthesia for coronary artery bypass grafting surgery in patients with coronary artery disease is a complex procedure.
OBJECTIVE: To develop and evaluate the outcomes of clinical nursing practice guidelines (CPGs) for the general anesthesia of patients with coronary artery disease undergoing coronary artery bypass grafting surgery at Chiangrai Prachanukroh Hospital.
METHODS: This study was a research and development of the clinical nursing practice guidelines for the general anesthesia of patients with coronary artery disease undergoing coronary artery bypass grafting surgery. The study was divided into three stages: 1) situation analysis, 2) practice guideline development, and 3) following the guideline and evaluating the results of implementing the guideline. Data were analyzed using descriptive statistics. Inferential statistics were used, such as independent t-test, dependent t-test, Rank-sum test and Fisher exact probability test as appropriate. The level of statistical significance was set at p<0.05.
RESULTS: The clinical nursing practice guidelines for the general anesthesia of patients with coronary artery disease undergoing coronary artery bypass grafting surgery consisted of 1) assessment of patients before anesthesia, 2) monitoring of patients receiving anesthesia, and 3) Nursing care of patients after receiving anesthesia. Outcomes of using CPGs were 1) service providers: increase in knowledge score (p<0.001) and an increase in anesthesia competence score of nurse anesthetists (p<0.001) 2) The service user: decrease in anxiety scores of patients in pre-anesthesia (p<0.001) 3) Service quality: decreased the incidence of hypothermia after anesthesia before ICU CVT (41.67% vs. 0.00%, p=0.008) and when referred to ICU CVT (84.00% vs. 19.23%, p<0.001), reduce the incidence of worsening symptoms from patients transferring, and there was no difference in coagulopathy and AKI in both groups.
CONCLUSIONS AND RECOMMENDATIONS: The clinical nursing practice guidelines for the general anesthesia of patients with coronary artery disease undergoing coronary artery bypass grafting surgery increased the knowledge and competence of nurse anesthetists, reduced patient anxiety and improved the quality of anesthesia services. practices should be followed up to ensure consistent use of the guidelines to achieve consistently good results
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