en ● Health Systems مقاله اصيل پژوهشي Orginal Article <p style="text-align: justify;"><strong>Background</strong>: 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 AHF by implementing a nursing guideline at Heart Hospital.<br> <strong>Methods</strong>: A 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 chronic obstructive pulmonary disease (COPD), coma (unconsciousness), pregnancy, or stroke were excluded. The data collection tool was a patient assessment tool (demographic data and arterial blood gases [ABG]), a respiratory assessment tool (chest examination, chest sound assessment, and dyspnea scale), and a patientsꞌ outcomes tool (complication, mortality, and length of stay). Data were analyzed utilizing SPSS software, version 22, with statistical significance set at P<0.05.<br> <strong>Results</strong>: Compared to the control group, the intervention group showed significant respiratory improvement in arterial O2 saturation (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).<br> <strong>Conclusion</strong>: Nursing guidelines may improve respiratory outcomes in AHF; further multi-setting studies are recommended to confirm findings.</p> Respiratory status, Acute heart failure (AHF), Nursing guideline 71 82 http://jrh.gmu.ac.ir/browse.php?a_code=A-10-2664-1&slc_lang=en&sid=1 Suzan Shawky Botros Suzan_ibrahim@nursing.aun.edu.eg 100319475328460044155 0009-0000-9172-9523 Yes Department of Critical Care and Emergency Nurrsing, Faculty of Nursing, Heart Hospital, Assiut University, Asyut, Egypt. Ahmed Abdel–Galeel ahmed.galeel@aun.edu.eg 100319475328460044156 100319475328460044156 No Department of Cardiovascular Medicine, Faculty of Medicine, Heart Hospital, Assiut University, Asyut, Egypt. Mogedda Mohamed Mehany Mogedda@aun.edu.eg 100319475328460044157 0009-0003-5998-7161 No Department of Critical Care and Emergency Nurrsing, Faculty of Nursing, Heart Hospital, Assiut University, Asyut, Egypt.