การพัฒนาคุณภาพระบบบริการพยาบาลจากการใช้หลักฐานเชิงประจักษ์ในการดูแลผู้ป่วย โรคกล้ามเนื้อหัวใจขาดเลือดเฉียบพลันชนิด STEMI ของเครือข่ายจังหวัดเชียงใหม่

Chonokporn Uttama; Nareeporn Kaewvijit; Thamonwan khanabkaew; Parichat Khantarak; Utthawit  Jansiri

Authors

Chonokporn Uttama Critical Care Nursing Unit, Nakornping Hospital
Nareeporn Kaewvijit Critical Care Nursing Unit, Nakornping Hospital
Thamonwan khanabkaew Critical Care Nursing Unit, Nakornping Hospital
Parichat Khantarak Critical Care Nursing Unit, Nakornping Hospital
Utthawit Jansiri McCormick Faculty of Nursing, Payap University

Keywords:

nursing care system, relationship-based care theory, ST-elevation myocardial infarction, critical phase

Abstract

Background: The critical care of patients with ST-elevation myocardial infarction (STEMI) requires prompt, precise, and evidence-based services to reduce complications and improve survival outcomes.

Objectives: To develop and evaluate the outcomes of an evidence-based nursing service system integrated with relationship-based care for critically ill STEMI patients.

Methods: This research and development study was conducted at Nakornping Hospital from February 2022 to January 2023, comprising four phases: situational analysis through focus group discussions; system development through a participatory process involving CCU nurses, patient, family and a multidisciplinary team; system implementation in the cardiac intensive care unit using a quasi-experimental pre–post comparative design with professional nurses and STEMI patients as samples; and quality evaluation through reflective focus group discussions. Data were analyzed using descriptive statistics, Chi-square, independent t-test, and paired t-test, while qualitative data were analyzed using content analysis.

Results: The developed system comprised four core components: a service access management and referral network system for Chiang Mai Province; a nurse competency development system; evidence-based nursing practice guidelines for the CCU; and a cardiac rehabilitation system integrated with discharge planning and continuity of care. Following implementation, nurses demonstrated statistically significant improvements in competency and knowledge, and reported the highest level of satisfaction with the system. The rate of streptokinase administration within 30 minutes increased to 30 cases (96.77%), and the rate of primary PCI completion within 120 minutes increased to 22 cases (70.96%). Mortality rate declined significantly to 1 case (3.23%) (p = 0.047). Patients also demonstrated improved self-care knowledge and reported a high level of quality of life.

Conclusion: The developed nursing service system effectively enhanced nurse competency, reduced time to service access, decreased complications and mortality, and contributed to improved patient quality of life.

References

Ministry of Public Health, Office of the Permanent Secretary. Public health statistics A.D. 2021 [Internet]. Nonthaburi: Ministry of Public Health; c2022. Available from: https://spd.moph.go.th/wp-content/uploads/2022/11/Hstatistic64.pdf [In Thai]

Nakornping Hospital, Cardiovascular Care Unit. Statistical report and nursing quality indicators, 2019–2021. Chiang Mai: Nakornping Hospital; 2021. [In Thai]

Benner P. From novice to expert: Excellence and power in clinical nursing practice. AJN. 1984;84(12):1479.

Koloroutis M, editor. Relationship-based care: A model for transforming practice. Minneapolis: Creative Health Care Management; 2004.

Donabedian A. The quality of care. How can it be assessed?. JAMA. 1988;260(12):1743-8. doi: 10.1001/jama.260.12.1743.

Soukup SM. The Center for Advanced Nursing Practice evidence-based practice model: promoting the scholarship of practice. Nurs Clin North Am. 2000;35(2):301-9.

Proctor B. Training for the supervision alliance: attitude, skills and intention. In: Cutcliffe JR, Butterworth T, Proctor B, editors. Fundamental themes in clinical supervision. London: Routledge; 2001. p. 25-46.

Powell SK, Tahan HA. Case management: A practical guide for education and practice. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2010.

Johns Hopkins Hospital; Johns Hopkins University School of Nursing. Johns Hopkins evidence-based practice evidence level and quality guide [Internet]. Baltimore: Johns Hopkins University; 2017 [cited 2022 Mar 9]. Available from: https://www.hopkinsmedicine.org/evidence-based-practice

Sengsiri A, Wattradul D, Kangchanakul S, Natthumrongkul S, Nopplub S, Wonganunnont S. The factors influencing the self-care agency and quality of life of patients with coronary artery disease. Thai Journal of Cardio-Thoracic Nursing. 2015;26(1):104-18. [In Thai]

Akkanit P, Pochana P. Development of STEMI Fast Track in Accidental and Emergency Department, Waritchaphum Hospital, Sakonnakhon Province. Journal of Sakon Nakhon Hospital. 2018;21(1):99-112. [In Thai]

Kositchayawathan J. Guidelines for acute coronary syndrome care at community hospitals. Chanthaburi: Original Press;2011. [In Thai]

Kanhadilok S, Malai C, Punsumreang T. A Design of Case Based Learning for Promoting LearningOutcomes in Practicum. Songklanagarind Journal of Nursing. 2019;39(4):129-37. [In Thai]

Zeng X, Chen L, Chandra A, Zhao L, Ma G, Roldan FJ, et al. Narrative review: updates and strategies for reducing door-to-balloon time in ST-elevation myocardial infarction care. Front Cardiovasc Med. 2025;12:1509365. doi: 10.3389/fcvm.2025.1509365.

Bouchlarhem A, Bazid Z, Ismaili N, El Ouafi N. Cardiac intensive care unit: where we are in 2023. Front Cardiovasc Med. 2023;10:1201414. doi: 10.3389/fcvm.2023.1201414.

Liu X, Zou Y, Huang D, Lu H. Effect of evidence-based nursing combined with exercise rehabilitation in patients with acute myocardial infarction after percutaneous coronary intervention. Am J Transl Res. 2022;14(10):7424-33.

Khanabkaew T, Tasiti W, Jankaew K, Singsai P, Kuntiya N, Khanabkaew C. Effect of tele nursing on the self-efficacy of patients with acute myocardial infarction (ST-segment elevation myocardial infarction, STEMI) in Cardiac Care Unit, Nakornping hospital, Chiang Mai province. Journal of Nakornping Hospital. 2025;16(2):410–23. [In Thai]

Jansiri U, Ponpinij P, Chantamit-O-Pas C. Effect of a Transitional Health Management Program on Readiness for Discharge among Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. The Journal of Faculty of NursingBurapha University. 2023;31(4):24-34. [In Thai]

Prasertsri N, Jirapapa M, Charoennukool A. The Effect of Evidence-based Practice (EBP) Teaching Program on the EBP Competence of Nursing Students. Jounal of Nursing and Health Research. 2016;17(3):145–55. [In Thai]

Tokarewicz J, Jankowiak B, Klimaszewska K, Swieczkowski M, Matlak K, Dobrzycki S. Acceptance of Illness and Health-Related Quality of Life in Patients After Myocardial Infarction-Narrative Review. J Clin Med. 2025;14(3):729. doi: 10.3390/jcm14030729.

Soyprasert J, Rattanaprom A. Development of Caring System for ST Segment Elevation Myocardial Infarction (STEMI) Patients undergoing Thrombolytic agents in Cardiac Network Suratthani Province. Region 11 Medical Journal. 2017;31(3):495-506. [In Thai]