The Development of Case Management Guideline on Homehealth Care for New Stroke Patients, Kosumpisai Hospital, Mahasarakham

Abstract

Abstract

          This action research aimed to study situation and develop case management guideline on home health care for new stroke patients. The research was proceeded from January 2015 to March 2016  and was divided into 3 phases including 1) analyzing situation and preparing, 2) managing case using  nursing process that focused on interaction, and 3)evaluating, exchanging knowledge, and summarizing case management guideline. Purposive sample in total was 72 which consisted of multidisciplinary teams, public health volunteers, 10 new stroke patients who had Barthel activities of daily living index score less than 50, main caregivers, and community network. Data were collected from focus groups, in-depth interviews of main caregivers, health assessment form and nursing care plans, assessment forms of Barthel activities of daily living index, quality of life, and satisfaction, and using patient and caregiver teaching handbooks. Validity of content was checked by 5 experts.Data were analyzed using descriptive statistics and content analysis.

          The study found that care management of stroke patients at home lacked of continuation. Main problems of patients were hemiplegia, not able to use squat toilet and lacking of knowledge and skills for self-care, so patients needed healthcare staff as their consultants. Therefore, nurse was the case manager who took care of new stroke patients in the first 6 months by discharge planning, home visiting, accessing multidisciplinary care and community network, and appropriately adjusting caring plans. Case management increased average score of patients’ Barthel activities of daily living index from 24.5 to 83.0 and quality of life from 87 to 105. Average percentage of clients and community network’s satisfaction was 93.56 (S.D. 3.85). Risk factors and patients’ problems that health care providers and caregivers should be aware of were found. This led to conclusion of case management guideline which was suggested to be used with new stroke patients.