Development of a Nursing Care Model for Prevention of Complications in Patients Receiving Heparin Using the Heparin Modified Early Warning Signs (HMEWS) Assessment in the Cardiac Care Unit, Mahasarakham Hospital

Abstract

This action research aimed to: 1) examine the situation and problems in caring for patients receiving Heparin in a cardiac intensive care unit (CCU), and 2) develop a nursing care model to prevent complications using the Heparin Modified Early Warning Signs (HMEWS). The participants included a multidisciplinary team of 10 members, professional nurses working in the CCU (n =18), and 20 cardiac patients receiving Heparin. The research instruments consisted of a demographic and clinical data record form, the HMEWS assessment tool, a practice compliance checklist, a satisfaction questionnaire, and semi-structured interview and focus group guidelines. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed using content analysis.

The results revealed that, prior to the development, there was no standardized nursing guideline for patients receiving Heparin. Monitoring of complications was inconsistent, and communication among the multidisciplinary team was limited. After the development, the nursing care model consisted of three main components: systematic risk assessment using HMEWS, risk-based nursing interventions, and continuous monitoring and evaluation. Following implementation, compliance with the guideline was at a very high level, with most items achieving 100% adherence. Nurses reported the highest level of satisfaction with the developed model. In addition, focus group findings indicated that HMEWS enhanced systematic patient assessment, supported clinical decision-making, and improved communication among the multidisciplinary team.

In conclusion, the nursing care model using HMEWS effectively improved the quality of nursing care, enhanced patient safety, and was feasible for implementation in the cardiac intensive care unit.