Effect of nursing process-based nursing decision implementation on emergency patients with acute ST-segment elevation myocardial infarction

Acute ST-segment elevation myocardial infarction (ASTEMI) is a severe cardiovascular disease, characterized primarily by obvious ST-segment elevation on electrocardiogram (ECG), reflecting myocardial injury during acute ischemia [1]. STEMI is often caused by complete occlusion of the coronary arteries, leading to interruption of myocardial blood supply and subsequent myocardial necrosis [2]. This condition is characterized by rapid onset and rapid progression, and if not treated promptly, it can lead to severe HF, arrhythmias, and even life-threatening conditions [3]. Therefore, rapid diagnosis and treatment of STEMI are crucial for improving patient survival rates and outcomes.

In the emergency medical system, nursing is a critical component of overall patient care, extending beyond basic nursing tasks to encompass the monitoring, assessment, and dynamic adjustment of patient conditions. The timeliness and accuracy of nursing decision-making directly affect the treatment outcomes and prognosis of patients with STEMI [4]. Thus, the implementation of nursing decision-making based on the nursing process is particularly important. The systematic and standardized nature of the nursing process enables nurses to make scientific and rational nursing decisions based on the actual conditions of patients, thereby enhancing the quality of care and the overall health level of patients [5]. The nursing process refers to a systematic series of activities designed to ensure optimal care outcomes for patients. This process includes assessment, diagnosis, planning, implementation, and [6‐8]. Initially, the nursing assessment phase involves a comprehensive evaluation of the patient, including medical history collection, physical examination, laboratory tests, and electrocardiogram monitoring, to accurately grasp the patient’s condition. Subsequently, during the nursing diagnosis phase, nurses identify nursing issues based on assessment data and formulate corresponding nursing plans [9, 10]. In the nursing planning phase, nurses establish specific goals and implementation strategies, adjusting them based on the patient’s individual needs and condition. During the implementation phase, nurses carry out the planned interventions while closely monitoring the patient’s response [11]. Finally, in the nursing evaluation phase, nurses assess the effectiveness of nursing measures to determine whether adjustments to the nursing plan are needed [12].

Currently, although clinical emergency measures for patients with ASTEMI are relatively mature, how to effectively implement nursing decision-making in nursing practice and improve the quality of care remains an issue that needs to be addressed [13]. Existing studies have shown that nursing decision-making based on the nursing process can visibly improve the prognosis of patients with acute myocardial infarction. However, in the nursing practice of emergency ASTEMI patients, research in this field still needs further exploration. By further investigating and validating the specific impact of nursing decision-making based on the nursing process on STEMI patients, scientific evidence can be provided to support clinical nursing practice, thereby promoting the continuous improvement of nursing quality. This article aimed to explore the specific impact of the implementation of nursing decision-making based on the nursing process on emergency patients with ASTEMI. By comparing and analyzing patient outcome data and nursing quality indicators before and after the implementation of nursing decision-making, this study assessed its role in improving patient treatment outcomes. It is hoped that this article will provide strong support for nursing practices in the care of emergency patients with ASTEMI and lay the groundwork for further research in related fields.

The primary research question of this study was whether nursing decision-making interventions can play a role in the care of patients with acute STEMI, improving treatment outcomes, shortening hospital stay, reducing complications, and enhancing patients’ quality of life (QoL). This study hypothesized that nursing process-based decision-making interventions can significantly improve the clinical prognosis of acute STEMI patients, particularly in terms of reducing emergency response time, lowering the incidence of adverse cardiac events, and enhancing patients’ QoL.

ASTEMI is a severe cardiac disease, often caused by complete occlusion of the coronary arteries leading to myocardial ischemia or necrosis [14]. As an acute condition, patients require rapid treatment within the “golden time” after the onset of symptoms to reduce myocardial damage [15]. Additionally, STEMI may trigger complications such as HF and arrhythmias, increasing the complexity of treatment, and long-term medication management and lifestyle adjustments are necessary after treatment to prevent recurrence and to facilitate cardiac rehabilitation and regular monitoring [16]. Therefore, timely and accurate diagnosis and comprehensive management are crucial for improving therapeutic outcomes. Emergency nursing refers to nursing services provided in the emergency department or urgent care settings, aimed at quickly assessing, managing, and treating various acute or urgent health issues, with the core goal of stabilizing the patient’s condition, alleviating symptoms, preventing complications, and preparing for further treatment or referral [17]. This article retrospectively included 205 patients with ASTEMI. They were grouped: IG (125 cases) and CG (80 cases) based on the different emergency measures they received. The CG received conventional emergency nursing measures, while the IG received improved nursing decision interventions based on the nursing process. The subjects were clinically balanced in terms of disease, providing an effective basis for subsequent comparative studies on the effects of different emergency measures in the two groups.

This article first compared the differences in various time metrics and found that the rescue time, vein opening time, intervention procedure time, and hospital stay in the IG were all markedly less as against the CG (P < 0.05). The reduction in rescue time improved the nursing decision-making intervention, optimizing the emergency process and response mechanism, enabling emergency personnel to carry out necessary rescue operations more quickly. The advantage of vein opening time may reflect effective management and coordination in the improved nursing process, ensuring rapid and accurate establishment of venous access. This facilitates the timely administration of drugs and other necessary treatments, enhancing treatment efficiency. The reduction in intervention procedure time implies that the improved nursing intervention may have enhanced the timeliness of interventional treatment by optimizing patient transfer, preoperative preparation, and surgical procedures, which is particularly important for patients with ASTEMI. Rapid interventional treatment can effectively reduce myocardial damage and avoid the risks of complications associated with delays. A shorter hospital stay not only reduces the cost of hospitalization for patients but also decreases the risk of hospital-acquired infections and other complications, improving the overall treatment experience for patients [18]. Thus, the improved nursing decision-making intervention markedly outperformed conventional emergency nursing measures in the emergency treatment of patients with ASTEMI. In terms of cardiac adverse events, the IG had a markedly lower probability of HF, cardiac arrest, and death than the CG (P < 0.05), which is similar to the findings [19], indicating that the improved nursing decision-making intervention not only suggested advantages in time management but also achieved visible effects in reducing serious cardiac adverse events.

The improvement in QoL means that patients not only recover better physiologically but also experience a higher sense of well-being and satisfaction on psychological and social levels. This comprehensive improvement helps to enhance the overall life experience of patients, enabling them to better adapt to life after illness, and strengthens their ability to self-care and cope with future challenges [20]. Following intervention, the physical health, psychological health, social relationships, and environmental scores of both the IG and the CG were markedly higher, and the scores were markedly higher in the IG as against the CG (P < 0.05). This result suggests that the improved nursing decision-making intervention can markedly enhance the physical health, psychological health, social relationships, and environmental scores of patients with ASTEMI, thereby comprehensively improving the patients’ daily QoL. Additionally, further comparison of post-intervention outcomes between the IG and CG showed no statistically significant differences in serum BNP and cTnI levels (P > 0.05), with the CIs indicating that the changes between the two groups were similar. This result contrasts with the findings of Yu and Zhang (2022), who observed reductions in levels of aspartate aminotransferase, creatine kinase-MB, cardiac troponin T, and BNP in myocardial infarction patients after treatment [21]. It was believed that the possible reasons for this discrepancy include the following ones. First, the nursing interventions in this study primarily focused on improving patient care processes. Although such improvements can enhance overall treatment outcomes, their direct impact on biomarkers of myocardial injury may be more indirect. In contrast, Yu and Zhang implemented additional therapeutic measures (e.g., pharmacological treatments), which may have had a more direct effect on biomarkers such as BNP. Second, changes in biomarkers like BNP and cTnI often require longer durations of sustained treatment to become evident, while the intervention period in this study was relatively short and may not have fully captured these changes. Additionally, individual patient differences may have influenced the variation in these biomarkers. Nevertheless, the IG’s advantages in time management and care processes still contributed to improvements in cardiac function and QoL, suggesting that improvements in nursing decision-making have a positive impact on clinical outcomes, even though no significant differences were observed at the biomarker level. This result also indicates that the improved nursing decision-making may mainly stand out in improving QoL and time management but has a limited impact on serum marker levels, and further optimization is necessary. Comparing cardiac indicators, it was found that further comparison of post-intervention LVEF between the IG and CG showed that the IG had significantly higher LVEF than the CG, with a statistically significant difference (P < 0.05) and a CI of (P = 0.03, 95% CI [0.05, 0.18]).This suggests that the improved nursing decision-making has a visible positive impact on the recovery of cardiac function in patients with ASTEMI, especially in improving the LVEF, outperforming conventional nursing. This further supports the necessity and effectiveness of applying improved nursing processes in emergency nursing to enhance cardiac function and improve the overall therapeutic outcomes for patients.

This study explored the impact of nursing process-based improved decision-making interventions on the treatment outcomes of patients with acute ASTEMI. The results demonstrated that the improved nursing interventions were significantly more effective than conventional emergency care measures in several key aspects. First, the improved nursing intervention significantly shortened critical time points in emergency management, including time to resuscitation, time to intravenous access, time to intervention, and hospital stay. This improvement in treatment efficiency reduced both patient hospitalization costs and the risk of complications. Second, the IG showed clear advantages in the incidence of adverse cardiac events, with a significantly lower likelihood of heart failure, cardiac arrest, and death compared to the conventional care group, further confirming the effectiveness of the improved nursing intervention in reducing severe cardiac adverse events. In terms of QoL, the improved nursing decision-making not only enhanced physiological health but also comprehensively improved patients’ psychological well-being and social adaptability, significantly enhancing overall QoL.

However, this study has several limitations. First, a retrospective design was employed, which may introduce selection bias and incomplete data, potentially affecting the accuracy and reliability of the results. Second, since the study was based on data from a single hospital, the representativeness and generalizability of the sample may be limited, and therefore, the applicability of the findings to other hospitals and regions needs further validation. Third, although some known variables were controlled for in the study design, potential confounding factors (such as comorbidities and age) may still have influenced the effectiveness of the nursing intervention. For instance, factors like patient age, underlying conditions (e.g., diabetes, hypertension), and the severity of heart disease may have impacted the outcomes of the nursing intervention to some extent. Therefore, future research should take these factors into account more comprehensively. Additionally, the sample size was relatively small, particularly with an unequal distribution of patients in the IG and CG, which may affect the statistical significance of the results and the broader applicability of the conclusions.