การพัฒนาระบบการพยาบาลผู้ป่วยช็อกเหตุจากหัวใจในหออภิบาลผู้ป่วยวิกฤติในโรงพยาบาลศูนย์สวรรค์ประชารักษ์ จังหวัดนครสวรรค์

Orawan   Roubroum; Prakobporn  Timtong; Wannapa  Tungtang; Rungrat  Wanichapichat; Nittaya  Sansiri

Authors

Orawan Roubroum Sawanpracharak Hospital
Prakobporn Timtong Sawanpracharak Hospital
Wannapa Tungtang Sawanpracharak Hospital
Rungrat Wanichapichat Sawanpracharak Hospital
Nittaya Sansiri Sawanpracharak Hospital

Keywords:

cardiogenic shock, critical care nursing, system development

Abstract

Objective: To evaluate the efficacy of the developed Cardiogenic Shock (CS) nursing system, and to compare between the pre-developed and the post-developed mortality rates, including professional nurses' satisfaction with the developed system.

Methods: This research and development study is grounded in Donabedian's systems theory framework. This comprises three phases. Phase 1: An analysis of the situation and a cross-sectional study of retrospective records from 69 CS patients. Phase 2: Developing the CS nursing system by analyzing Phase 1 results, reviewing current literature, brainstorming with an interdisciplinary team, and creating research tools, and Phase 3: evaluating the efficacy of CS nursing system for 26 cardiogenic shock patients and 32 professional nurses, and using test statistics such as the Student's t-test, Chi-square test, or Mann-Whitney U test at a significance threshold of p-value < 0.05.

Results: Between August 10, 2024, and October 31, 2025, the implementation of the clinical pathway resulted in a significant reduction in treatment times. The duration until patients received inotropic or vasopressor agents decreased from 22.51 minutes to 6.42 minutes (p-value < 0.001). The time to initiate Mechanical Circulatory Support (MCS) was reduced from 169.53 minutes to 44.31 minutes (p-value < 0.001), while the time to achieve shock reversal (MAP > 60 mmHg) fell from 212.26 minutes to 58.54 minutes (p-value = 0.004). Furthermore, the overall complication rate associated with Cardiogenic Shock (CS) significantly decreased from 8.27% to 3.18% (p-value=0.026). The in-hospital mortality rate for CS patients declined from 42.01% to 38.40%, though this change did not reach statistical significance (p-value = 0.112). Additionally, there was a significant improvement in the knowledge and clinical skills of nurses, who reported a very high level of satisfaction with the system.

Conclusion: The nursing care system for patients with cardiogenic shock (CS) has improved the efficiency of the nursing process. It significantly reduced the time required to correct hypotension and related factors, although in-hospital mortality rates for CS patients did not decrease in the short term

Keywords: cardiogenic shock, critical care nursing, system development

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