Determination Of Nurses’ Practice In Assessment And Initial Management Of Cardiac Related Chest Pain Among Adult Patients At A&e, KNH

Abstract

Background: Coronary artery disease (CAD) is the leading cause of global morbidity and mortality. CAD accounts for 15.9% of all deaths worldwide. Chest pain is the most common complaint and leading cause of emergency department visits in patients with CAD. Cardiac related chest pain is associated with fatal outcomes. Therefore, prompt identification and treatment of a CAD related chest pain is critical to the treatment outcomes. Failure to perform timely assessment and manage has been reported and often associated with adverse patients’ outcome such as death. The aim of this study was to determine the nurses’ practice in the assessment of patients with cardiac related chest pain and its initial management in the accident and emergency department, KNH Material and Methods: A descriptive cross sectional study designs and mixed method of data collection was adopted. Target population consisted of nurses working in the emergency department. Using simple random sample size of 62 nurses was selected for quantitive study. A purposive sampling method was employed to select 4 in Key informants. Informed consent was obtained from the eligible participants after a verbal explanation. Approval for carrying out the study was obtained from KNH-UoN Research Ethics Committee. Quantitative data was collected using self-administered questionnaires and semi-structured observational check list. Qualitative data was collected using in-depth interview guide. Quantitive analyzed using SPSS version 21. Descriptive statistics was analyzed using frequency distribution and chi squire. Measurement of association was measures using logistical regression modeling and correlation Qualitative data was analyzed by use of Nvivo software version 11 into themes and verbatim reporting. Result: Majority of participants were female (69%), with a mean age of 41.1 years. Majority were KRCHN (78%) ,62% trained A&E and CCN. 54% were not aware that there was a chest pain protocol in the department. 57% not trained on assessment and initial care of cardiac chest pain. An average of 47% of nurses always obtained all the relevant information, 27% very often, 18% sometimes. By acquiring higher qualification or specialisation, nurses are likely to perform better in obtaining relevant information and performing nursing role BScN (P< 0.000) A&E nursing 71 %(< 0.001 Critical 52 %( p<0.048) Conclusion: Nurses had varied approach to role performance both in assessment and initial management of cardiac related chest pain which is attributable to lack of training, lack policy guidelines and administrative support Recommendations: Nurses should be trained on assessment and immediate care of cardiac related chest pain and electrocardiogram interpretation. They should also be encouraged to pursue an advanced or specialised training in order to improve their performance. There should also be administration support in care of chest pain patients in terms of provision of a policy guideline on care of chest pain patients in the department and availing working ECG machine throughout the year.