Outcomes of nursing practice guidelines for patients presenting with chest pain and suspected acute myocardial infarction in the emergency outpatient unit
Keywords:
nursing practice guidelines, acute myocardial infarction, chest painAbstract
This quasi-experimental study aimed to compare the mean duration of each step in the care process for patients with suspected acute myocardial infarction. This comparison resulted from the implementation of a nursing practice guideline for patients presenting with chest pain and suspected acute myocardial infarction in the emergency department. The guideline emphasized every step of patient care process, including: (1) a focused chest pain assessment, (2) attaching “chest pain” tag, (3) immediate transfer to the resuscitation room, (4) electrocardiogram (ECG) acquisition and interpretation within 10 minutes, (5) prompt cardiac enzyme testing per physician orders, (6) using a zip-lock bag with an “alert chest pain” tag to transport specimen, (7) providing complementary nursing care while awaiting cardiac enzyme results, (8) prompt cardiac enzyme test reporting, (9) final diagnosis by a physician, and (10) disposition from the emergency department. A purposive sample of 50 participants was selected and equally divided into two groups of 25people each. The experimental group received nursing care according to the nursing practice guidelines. The control group received conventional nursing care before using the nursing practice guidelines, which data were collected retrospectively from medical records. Independent t-test was used for data analysis in comparing the experimental and control groups.
The study showed that the control and experimental groups had an average time to ECG acquisition and interpretation of 16.60 and 2.40 minutes, respectively. The average time to cardiac enzyme reporting were 81.36 and 56.52 minutes, respectively. Comparison between the groups revealed that the differences were statistically significant (p<.005). Additionally, a higher proportion of participants in the experimental group were discharged from the emergency department within 3 hours compared to the control group. Patients receiving care according to this practice guideline had faster access to ECG acquisition and interpretation as well as cardiac enzyme reporting. This enables physicians to diagnose and initiate treatment immediately, ensuring timely care, lowering the risk of serious complications, and improving survival outcomes. Furthermore, patients can be discharged from the emergency department more quickly, which helps reduce waiting times and alleviate emergency department overcrowding.
In conclusion, the implementation of this nursing practice guideline directly benefits service recipients; enabling systematic, rapid, and safe care for patients with chest pain; while also being consistent with international standards.
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