Development of Nursing Practice Guidelines for Patients with Postoperative Open-Heart Valve Surgery

Abstract

Background: Open-heart surgery is a treatment option for patients with valvular heart disease; however, it is associated with postoperative complications, prolonged stays in Cardio-vascular-thoracic Intensive care unit (CVT ICU), and high healthcare costs. This study focused on developing and evaluating a nursing practice guideline for patients following open-heart valve surgery, considering perspectives of healthcare providers, patients, service quality, and organizational outcomes.

Objective: To develop and examine the outcomes of implementing a nursing practice guideline for patients after open-heart valve surgery.

Methods: This research employed a research and development design. Purposive sampling was used to recruit participants, including 10 registered nurses and 30 postoperative open-heart valve surgery patients admitted to CVT ICU. Research instruments consisted of the developed nursing practice guideline and accompanying manual, along with outcome assessment tools. Registered nurse data were collected using a nursing practice checklist, a nursing competency evaluation form, a test, and a perception survey. Patient-and service-related outcomes were assessed using clinical outcome records and patient satisfaction questionnaires. Data were analyzed using descriptive statistics.

Results: The developed nursing practice guideline for patients with postoperative open-heart valve surgery comprised three phases: (1) the critical phase within the first 2 hours after surgery, (2) the critical phase from 2-24 hours postoperatively, and (3) the postoperative phase from 24 hours until CVT ICU discharge. Outcomes after implementation showed that: (1) Registered nurses demonstrated increased knowledge and competency scores; adherence to the guideline was 96.73%, and nurses agreed with its application (mean = 4.20, SD = 0.53). (2) patients with postoperative open-heart valve surgery reported high satisfaction (mean = 4.77, SD = 0.44).     (3) Service quality outcomes indicated no incidence of bloodstream infection, pneumonia, atelectasis post-estuation, surgical site infection, or mortality. (4) Organizational outcomes revealed a reduction in average CVT ICU length of stay and decreased treatment costs, with an average saving of 35,301.4 THB per patient.

Conclusion: Implementation of the nursing practice guideline for patients following open-heart valve surgery yielded positive outcomes across providers, patients, service quality, and organizational levels. Therefore, the guideline should be applied in similar clinical settings and continuously updated to enhance the efficiency of postoperative valve surgery care.