Construction Of STEMI Emergency Nursing Process Optimization Scheme Based On The Construction Of Chest Pain Center

PurposesThrough a retrospective analysis of the first regional collaborative chest pain center in China over the past seven years' first aid nursing process,and combining with the literature review,we evaluated whether the STEMI first aid nursing process optimization program gradually optimized over the past seven years is worth promoting.On this basis,from the perspective of time nodes of each link of the treatment process,qualitative interviews were conducted on the medical skills involved in the STEMI patient treatment process to find out the optimized process links.In addition,from the perspective of humanistic needs of STEMI patients,qualitative interviews were conducted for STEMI patients to find out the optimal measures in the treatment process.On this basis,a research group was set up to conduct two rounds of action research,and a nursing process optimization plan based on time nodes and the main line of nursing humanities was formed.The optimization scheme of STEMI patient emergency care process was constructed by Delphi expert consultation method.Methods1.On the basis of literature review,the selection on March 1,2011-December 30,2017,in the center of the first domestic regional synergy chest pain clinic of 1574(male 1320,female 254)in patients with STEMI as the research object,through the chest pain center cloud platform to extract the patients' medical exposure to the delivery time for the first time,the first electrocardiogram,blood time,international activation time,emergency time metrics such as residence time;The annual D2 B compliance rate under the regional cooperative mode and the proportion of the time spent in the emergency department in the whole process to the total emergency time;Length of stay and total cost.To retrospectively analyze and evaluate the current emergency care program of STEMI patients in the first chest pain center in China.2.Semi-structured interviews were conducted with a total of 26 medical technicians participating in the STEMI emergency treatment process to understand their opinions and Suggestions on the existing STEMI treatment process,and the collected data were summarized and analyzed.3.A semi-structured interview was conducted to conduct a qualitative interview with 20 STEMI patients after emergency PCI,to deeply analyze the psychological needs of patients in each link of the treatment process,and to summarize and analyze the collected data.4.In this study,Delphi method was adopted to set the humanistic content in the STEMI patient emergency care process optimization scheme.After two rounds of expert consultation,the STEMI emergency care process optimization scheme was finally established.Results(1)Through to the domestic first regional synergy STEMI process in seven years gradually formed in the center of the chest pain were retrospectively analyzed,found that each node index significantly shorten the time in the existing process,including the first medical contact-delivery time reduced from 68 min to 24 ecg time reduced from 30 min min,first to 6 min,blood time reduced from 35 min to 15 min,international activation time reduced from 40 min to 16 70 min min,emergency stop time shortened to 34 min;D2B compliance rate increased from 59% to 94%,all P < 0.05,and summarized into STEMI emergency care flow plan.Combined with domestic and foreign literature reports,it is found that the target value of time node index of each link in the existing STEMI emergency care process scheme is superior to other hospitals,which is advanced,practical and worth promoting.(2)Through qualitative interviews with medical technical patients,most of them believe that the current first-aid nursing process optimization scheme is more reasonable.The views and Suggestions on the medical skills involved in the STEMI emergency care process are summarized into four aspects,including:(2)information platform construction needs;(3)delay in medical decisions of patients and their families;(4)the need for close multidisciplinary cooperation.Analyze the STEMI nurses' staffing needs and delay of medical decisions,especially those related to nursing,and formulate corresponding measures and incorporate them into the nursing process optimization plan.The humanistic needs of STEMI patients are summarized as follows:Psychological and emotional needs;(3)lack of knowledge about pain;(4)maintain self-image needs;Nursing team construction needs;Nursing technology to improve;7 poor communication between doctors and patients,analysis of each aspect,the development of the corresponding humanistic measures,all into the STEMI emergency care process optimization program.(3)According to the method of admission,the finally established STEMI emergency nursing process optimization scheme is to formulate two optimization schemes of self-admission and detour admission.In the first round of expert consultation,the optimized plan of self-admission to the hospital included four first-level processes,including pretest triage process,emergency room process and transfer transfer process.These include the sense of security,humanistic care of each nursing operation,sense of security,comfort,pain relief,and informed consent.In the detour emergency department and CCU optimization program,there are 5 first-level processes,including pre-hospital discharge process,on-site first aid process,safety transfer process,first aid vehicle transfer process and handover process.It includes the process of emergency house call,personnel requirements,vehicle requirements,telephone guidance,on-site evaluation,humanistic care,sense of security,comfort,pain relief and informed consent in various nursing operations,forming 105 items of the first round of expert consultation questionnaire.On the basis of the first round of expert consultation,11 items were modified according to the coefficient of variation.In the revision of expert opinions,16 items were modified for inappropriate language expression,2 items were reserved according to clinical practicality,and 2 items were deleted according to clinical practice experience,forming a total of 103 items in the second round of expert consultation questionnaire(appendix 6).At the same time,this study compared and analyzed the importance of the content of the optimized program and the current degree of achievement.It was found that the current degree of achievement of 31 nursing measures in the optimized program of the hospital was consistent with the importance,and there were 11 items with significant differences in the importance and the current degree of achievement(P < 0.05).Around in 52 measures to do better,there are nine items importance degree and currently there is a big difference(P < 0.05),mainly focus on patients with gratitude,chest pain team,emergency standby state,the operation is gentle,informed consent,privacy,comfort and pain,rapid response mechanism and guide the visit a self-help,fear and so on,provide direction to future research in this field.ConclusionsIn this study,a retrospective study was conducted to evaluate the STEMI emergency care program gradually developed by the first regional collaborative chest pain center in China.On this basis,qualitative interview method was adopted to understand the views and Suggestions of medical technology in STEMI emergency care process,and the different psychological experience of patients in each link of STEMI emergency care process was analyzed in depth,and the preliminary optimization scheme of STEMI emergency care process was constructed based on the analysis of the original process.Delphi expert consultation was applied to establish STEM emergency nursing process optimization scheme based on medical time node and with humanistic needs of patients as the main line,standardize humanistic nursing measures of STEMI emergency nursing process,improve nursing quality of STEMI patients in the process of first aid,and provide theoretical basis for further optimization of STEMI patients' first aid nursing process.