Quality of nursing care for patients with myocardial infarction in accident and emergency Kenyatta National Hospital.

Abstract

Background: Every year around the world, 32.4 million cases of myocardial infarctions occurs, most of these occur in lower- and middle-income countries. (WHO, 2013). Additionally, a report by WHO in 2017 showed that 25% of hospital admissions and 13% of deaths in Kenya are due to Myocardial infarctions (MI). Nurse’s knowledge concerning the signs and symptoms of MI may help them in quickly assessing and determining whether the patient has a life-threatening condition and provide appropriate and possible lifesaving care. Nurse’s competence in obtaining vital signs help them to assess the hemodynamic status, determine the clinical severity of the patient’s health status and prioritizing medical attention to the victim. This study, therefore, sought to determine the quality of nursing care for patients with MI in A and E at KNH whereby: the study assessed the nurse’s competences in provision of care to MI patients in A and E at KNH Methods: A cross sectional study research design was used. A random sample of 118 nurses were selected. The Fisher formula was utilized for sample size determination (n=70). Systematic sampling was used to choose the caregivers who were to undertake the study. Ethical considerations was observed. The data collection tool used was a questionnaires and an observation checklist. The data was coded and entered in Epi Data, a data entry software and analyzed using SPSS (Statistical Software Package for Social Sciences) version 25 for both inferential and descriptive statistics. Analytic tests like chi-square and t-test were used to depict relationships between variables. Data was presented in tables. Result: Most of the respondents were females (53.6%) aged between 31 to 40 years (44.9%). No respondent had a certificate a PhD qualification in nursing. 98.6% of the nurses had a formal training on MI and 100% had not trained in the past three months. 94.2% had taken a life support course and all respondents adhere to the MONA protocol. 94.2% had been training on Basic Life Support (BLS), 31.9% had trained on Advanced Trauma Life Support (ATLS) and 17.4% had been trained on GRASPIT. 46.4% often encountered patients with MI with 94.2% never had any training on assessment and immediate care of MI patients in the last one year with 5.8 stating otherwise. Conclusion: Nurses had an assorted approach to task execution both in initial assessment and in management of MI patients that was ascribed to lack of proper and relevant training and lack of administrative support. Recommendations: Nurses require more training/ specifically on performing a 12 lead ECG on a patient without the directive from the doctor and proper interpretation of the ECG. Due to the effect of COVID-19, this training could be delivered virtually. The nurses also required immense administrative support to boost productivity and eventually quality of care to MI patients. Nurses working in the accident and emergency department need clinical rotation to other units.