Development of nursing practice guidelines for patients with acute coronary syndrome at Chaokhunpaiboon Phanomthuan Hospital, Kanchanaburi Province

Abstract

This research and development study aimed to achieve three objectives divided into three phases. Phase 1 aimed to study the situational context and problems in caring for patients with Acute Coronary Syndrome (ACS) through a focus group discussion with 10 multidisciplinary team members and medical record reviews. Phase 2 involved the development of nursing practice guidelines and the " Tri-Link Innovation for Heart Safety " (Alert Card, Quick Guide, and SBAR Form) by a working group of 5 internal experts. Phase 3 focused on the implementation and evaluation of the outcomes, with a sample of 16 registered nurses. The research instruments included knowledge and skill assessment forms, yielding Content Validity Indices of .90 and .95, respectively. The reliability of the knowledge assessment was .77 (KR-20), and the skill assessment was .82 (Cronbach’s alpha). Data were analyzed using descriptive statistics and paired t-tests.

            The results revealed that: In the situational study phase, delays in screening for non-specific symptoms, personnel limitations, and complexities in the referral system were identified. In the development phase, the "Nursing Practice Guidelines for Patients with Acute Coronary Syndrome (ACS) Integrating the Tri-Link Innovation for Heart Safety at Chao Khun Paiboon Phanom Thuan Hospital, Kanchanaburi Province" was successfully developed. In the evaluation phase, the registered nurses demonstrated significantly higher knowledge and skill scores than before the implementation (t = 6.35, p < .001 and t = 18.19, p < .001, respectively) and expressed the highest level of satisfaction (  = 4.78, SD = 0.41). Regarding clinical outcomes, the rate of performing an EKG within 10 minutes increased to 88.89% (the median Door-to-EKG time decreased to 2 minutes). The median EKG Diagnosis-to-Needle time was 21 minutes, and the median Diagnosis-to-Refer time decreased to 22 minutes, both of which achieved the 100% standard criteria. Furthermore, no adverse events were observed during the referral process.