Background: Patients with Acute Heart Failure (AHF) often experience pulmonary congestion, leading to tachypnea, orthopnea, and hypoxia. Nursing guidelines play a crucial role in relieving pulmonary congestion and improving respiratory function. Thus, this study aimed to improve respiratory status among patients with Acute Heart Failure by implementing nursing guideline at heart hospital.
Methods: Quasi - experimental research design was utilized in this study. This study (August 2023 – September 2024) included 100 patients randomly assigned to intervention (n=50) and control (n=50) groups. The control group received routine care, while the intervention group received nursing guidelines focused on respiratory support, active range of motion, early mobilization and 6-minute walk test. Patients with comorbid COPD, coma (unconsciousness), pregnancy, or stroke were excluded. The data collection tool was patient assessment tool (demographic data and Arterial Blood Gases ABG); respiratory assessment tool (chest examination, chest sound assessment and dyspnea scale) and patientsꞌ outcomes tool (complication, mortality, and length of stay). Analysis of the data was conducted utilizing SPSS, software, version 22, with statistical significance set at P<0.05. 
Results: Compared to the control group, the intervention group showed significant respiratory improvement in sao₂, accessory muscle use, crepitation, and chest infection (p = 0.041, 0.004, 0.008, 0.026), as well as in complications, mortality, and length of stay (p = 0.026, 0.023, 0.009).
Conclusion: Nursing guidelines may improve respiratory outcomes in AHF; further multi-setting studies are recommended to confirm findings.