การพัฒนารูปแบบการดูแลผู้ป่วยไตวายเฉียบพลันที่บำบัดทดแทนไตต่อเนื่อง หอผู้ป่วยหนักอายุรกรรมและศัลยกรรม โรงพยาบาลมหาราชนครราชสีมา

Kamonwan  Ruaysungnoen; Benjamas  Tumcharoentrakul; Rattana  Klaemkrathok; Nuchkanda  Phetmadan; Orawan  Donghong; aukrit plangklang; Monthicha  Khongchana

Authors

Kamonwan Ruaysungnoen Maharat Nakhon Ratchasima Hospital
Benjamas Tumcharoentrakul Boromarajonani College of Nursing Nakhon Ratchasima, Faculty of Nursing, Praboromarajchanok Institute
Rattana Klaemkrathok Maharat Nakhon Ratchasima Hospital
Nuchkanda Phetmadan Maharat Nakhon Ratchasima Hospital
Orawan Donghong Maharat Nakhon Ratchasima Hospital
aukrit plangklang Maharat Nakhon Ratchasima Hospital
Monthicha Khongchana Boromarajonani College of Nursing Nakhon Ratchasima, Faculty of Nursing, Praboromarajchanok Institute

Keywords:

acute kidney injury, continuous renal replacement therapy, care models, intensive care unit, research and development

Abstract

Acute Kidney Injury (AKI) in critically ill patients requiring Continuous Renal Replacement Therapy (CRRT) is complex, carrying a high filter clotting rate of 89.96% and a 46.67% mortality rate due to a lack of clear guidelines. Utilizing Soukup's (2000) framework, this research and development study aimed to develop and evaluate an evidence-based care model. The process involved four phases: problem identification, model development, implementation, and evaluation. The sample included 129 registered nurses and 60 AKI patients undergoing CRRT, equally divided into experimental and control groups. Data were analyzed using descriptive statistics, Chi-square tests, Fisher's exact tests, and Mann-Whitney U tests. Results showed 100% nurse adherence to the clinical practice guidelines. The experimental group demonstrated favorable clinical trends compared to the control group, featuring a lower mortality rate (26.67% versus 43.33%, p=.176), no 72-hour ICU readmission (0% versus 6.67%, p=.492), and a shorter median hospital stay (5.5 days versus 7.0 days, p=.294). Although these outcomes lacked statistical significance (p>.05), the positive trends highlight the potential for establishing this model as standard nursing practice. Further research with larger sample sizes is recommended to validate these finding, improve patient survival rates, and overall clinical recovery metrics effectively.

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