Nursing Care Model for Safety in STEMI Patients Receiving Percutaneous Coronary Intervention, PCI, at Roi Et Hospital

Abstract

This action research aimed to develop a nursing care model for STEMI patients receiving percutaneous coronary intervention (PCI) at Roi Et Hospital to ensure their safety. The participants were 88 nurses and other multidisciplinary professionals in the care teams, 92 STEMI patients, and 28 caregivers. The study was divided into three phases: 1) problem analysis, 2) model development, and 3) evaluation. The research instruments included in-depth interviews, group discussion questions, a satisfaction with practice guidelines assessment form, Post-PCI complication record forms, and nursing competency assessment forms. The percentage of patients with access to an EKG within 10 minutes upon arrival and the incidence of complications were also studied. The satisfaction scores were analyzed using averages and standard deviations, paired sample t-tests were employed to describe the differences in nurse competency scores, and content analysis was used for qualitative data analysis.

            The results revealed that there were six weak points which needed to be improved, including 1) the occurrence of complications after percutaneous coronary interventions, 2) the caregivers’ limited role in caring for patients, 3) some nurse competences did not meet standard criteria, 4) the lack of a nursing care model for patient safety, 5) the patient unit environment not being suitable to promote rest and relaxation, and 6) a need for hospital discharge plans to ensure preparedness for post discharge care. Based on these findings, the development process was implemented and included raising awareness among the care teams; building team and clinical nursing practice guidelines, and providing training to increase the nurses’ competency; and expanding the care team alliance. Consequently, the 3Cs model for patient safety

composed of clinical nursing practice guidelines, competency guidelines, and clinical supervision was developed. The results showed that patient access to an EKG test within 10 minutes improved from 87.5% to 93.8% and the reductions of complication rates, for example, a decrease in bleeding issues from 12.6% to 6.2% and a decrease in the hematoma rate from 9.4% to 3.1%. The initial use of the MEWs assessment form for active surveillance was 95.3%. Nursing satisfaction with the practice guideline was relatively high.  When comparing nursing competency scores before and after the nursing care model’s implementation, there was a statistically significant increase after participating in the program, at p < .05. As a result, we can conclude that, upon completion of the program, nurses had gained more knowledge and  greater satisfaction while nursing care quality improved leading to an increase in patient safety.