الفهرس 
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Abstract
Summary
Coronary artery bypass graft surgery (CABG) is one of the common treatments for cardiac diseases, despite the numerous complications of CABG. The most serious adverse events are bleeding requiring further surgery, cardiac arrhythmias, deep sternal wound infection and death.
Standardization of care is essential for improving cardiac surgery outcome and it is beneficial for patients, professionals andhospitals. Clinical pathway is a standardized protocol for management of patients who undergo cardiac surgery.
A clinical pathway is a treatment or nursing mode formulated by medical workers according to a disease or surgery process, by which the activities involving the patients, such as admission, diagnosis, treatment and nursing, are carried out according to a standardized process, formulated in advance according to a clinical pathway form.
The study was conducted at Cardiothoracic Critical Care Unit in Heart Assuit University Hospital. A convenience sample of 60 adult patients undergoing to CABG surgery was included to the study. The subjects were classified into two groups: control group (30) patients who received the routine hospital care. Study group who received clinical pathway guidelines in addition to top of routine hospital care.
Cardiac surgical patient assessment tool utilized to collect socio-demographic and medical data, predictors of mortality, hymodynamics, and arterial blood gases. clinical pathway outcomes assessment sheet was the second tool used in assessing pain management, duration of invasive devices, degree of limb edema, length of hospital stay, postoperative complications, and patients’ satisfaction. Clinical pathway patient progress variances checklist, aimed to assess the variation of pathway.The study field of work was carried out through three phases: assessment phase, establishing clinical pathway, and outcome evaluation.
After completion of the data collection for intervention group, the researcher made statistical analysis for 60 patients (30 study +30control).Data were collected and analysed by computer programmed SPSS (version 20.0) software.Data were presented using descriptive statistics in the form of frequencies and percentage (N, %) used for describing and summarizing qualitative variables.Mean and standard deviation used for describing and summarizing quantitative variables. Cronbach’s alpha reliability test was used to measure the reliability of the developed test. T- test: was used to test the association between two quantitative variables or to detect difference between two or more proportions. Quantitative continuous data were compared using ANOVA test for comparisons between two groups. Qualitative variables were compared using chi-square(x2) test to determine significance for non-parametric variables. ”P” value was considered statistically significant when ”P ”less than 0.05.
Main findings of the present study:
The distributions of patients’ socio-demographic data between the study and control groups were comparable and no significant differences were noted in age, gender, marital status, and occupation (P˃0.05).
No differences were noted in clinical data and past medical history. Also no differences were noted regarding to risk assessment scale for development of skin injuries.
Comparison between study group and control group related to predictors of mortality rate shows no differences in EURO Score, SOFA Score, and APCHI score.
The comparison between study group and control group related to hemodynamic parameters at the day three shifts (morning shift, afternoon shift, and night shift). There was no statistically significant difference between the study groups at 1st day. Statistically significant differences were noted between study and control group at 3rd and 6th day. The study group had more stability than control group.
The comparison of patients’ arterial blood gases between the study group and control group shows statistically significant differences in [PH, PaO2, PaCo2, HCO3] during four days, significant level at P value ˂0.05.
Mean score and standard deviation regarding to length of ICU stay in study group was 3.27±0.52 and in Control group was 5.33±0.60, therefore, there was highly significant difference and P value <0.001. In relation to length of hospital stay mean score and standard deviation in study group was 7.63±0.89, and mean score and standard deviation in Control group was 8.93±0.94, with also highly significant difference in which hypothesis was supported.
Mean of postoperative invasive devices durations was less in study group than in control group with P value <0.001, except duration of endotracheal tube there was no differences.
There was a decrease in mean of pain scores in study group rather than control group with statistically significant differences were noted (P<0.001), and achieving hypothesis of the study.
Comparison between study group and Control group as regards to limb edema for surgical sites with no significant difference in first day (P=0.126), but there was statistically significant difference from 2nd day to 6th day (P˂0.001).
The study results compare postoperative complications with significant differences noted in postoperative atrial fibrillation, atelectasis, gastrointestinal complications and acute kidney injury stage I, Significant level at P value ˂0.05. No differences noted in ventricular tachycardia, ventricular ectopic, cardiac tamponade, late stages of acute kidney injury, wound infection, and death.
Distribution of patient satisfaction level about caring process for study and control group revealed that there was significant differences with (P=0.003).
In relation to variances, most of variances frequency occurred regarding to nursing assessment. Uncontrolled vomiting is one of the most common causes of patient dissatisfaction (26.6%), increased limb edema (10%), presence of medstinal tubes (6.6%), inadequate output (3.3%) and delayed incision healing (3.3%). Regarding to activity patients not dangled (16.6%).Variations regarding to laboratory tests were delayed in making cultures (6.6%) and abnormal CXR (3.3%). Other variations regarding to nutrition, discharge planning, weaned off inotropes were (3.3%) for each variable.