The Development Nursing Practice Guideline for 72 Hours Post Open Heart Surgery Patients in Uttaradit Hospital

Abstract

This research and development project aims to develop nursing practice guidelines for patients undergoing open-heart surgery within 72 hours at Uttaradit Hospital. And to study the effectiveness of nursing care practices for patients undergoing open-heart surgery 72 hours prior, conducted in 3 steps. Step 1: Study the situation, problems, and nursing needs in caring for patients 72 hours after cardiac surgery. A qualitative method was used, employing in-depth focus group discussions with 10 registered nurses working in the surgical trauma intensive care unit and 27 patient medical records. Data was analyzed using content analysis. Step 2 involves developing a nursing care guideline for patients undergoing open-heart surgery within 72 hours and pilot-testing the guideline through expert review by three individuals. Step 3 involves studying the effectiveness of the proposed practices, divided into two parts: 1) a quasi-experimental research design with one group, measuring outcomes before and after the experiment. The sample group consisted of 10 registered nurses. The research instrument used was a 72-hour post-open heart surgery nursing guideline, Knowledge assessment questionnaire for nursing care of cardiac surgery patients; Nurse satisfaction evaluation form regarding the use of nursing practice guidelines. 2) A retrospective descriptive study was conducted. The sample consisted of 54 patients who underwent open-heart surgery and were treated in the surgical trauma intensive care unit at Uttaradit Hospital. They were divided into an experimental group of 27 patients and a control group of 27 patients. The research instruments included patient data records (general and clinical information). Data were analyzed using descriptive statistics, independent t-test, and paired t-test.

Results: 1) A comprehensive nursing practice guideline for 72-hour post-open heart surgery care was developed, comprising 10 domains with 72 items: preparation for patient admission from the operating room, patient reception, initial and ongoing patient assessment, airway management, medication/fluid/blood administration, circulation management, bleeding management and blood transfusion, prevention of acute renal failure, ischemic stroke surveillance, and pain management.

2) Regarding guideline effectiveness, clinical incidents decreased significantly, including cardiac arrhythmia from 66.7% to 33.3% and acute renal failure from 29.6% to 0% (p = .002). Nursing-related incidents decreased from 22.2% to 3.7%, particularly incidents of unreported/delayed reporting of abnormal ECG findings beyond 30 minutes and inappropriate medication adjustments. Satisfaction with the practice guideline ranged from high to very high levels. Post-implementation, nurses demonstrated statistically significant improvements in knowledge scores from 22.10 ± 1.85 เป็น 26.30 ± 3.65 (t = 3.84, p = .004).

Recommendations: The nursing practice guideline facilitates comprehensive patient care and enables timely surveillance for complications. However, consistent supervision and monitoring are essential to ensure sustained implementation of the guideline, with recommended supervision frequency of once weekly during the first month and once monthly thereafter.