The Research and Development of Nursing Service Perioperative Patient Focused Model for Arthroscopic Anterior Cruciate Ligament Reconstruction in Buri Ram Hospital.

Abstract

Background: Anterior cruciate ligament tear can cause the knee to lose stability.resulting in various activities in daily life. Surgery is a transition period from normal to critical. Patients and their families have to adjust and face those conditions on their own, together with the care of a surgical team with expertise.Perioperative Patient Focused Model shows the results of care for all elements of the nursing process. Covering personnel providing nursing care must have knowledge Assessment ability to lead a nursing diagnosis and select appropriate nursing practice for each patient to provide the patient with a level of comfort equal to or greater than before surgery.From the review of nursing guidelines for Arthroscopic Anterior Cruciate Ligament Reconstruction surgery (ACLR) in Buriram Hospital jointly between the multidisciplinary.It was found that the traditional nursing model focused on assisting and delivering surgical instruments. There is no synchronization of patient information between wards and operating room. Causing effects on patients such as surgical wound infection, Postponed surgery due to inadequate surgical tools, The presence of pressure scars from prolonged surgery, Patient loses weight without crutches after surgery resulting in having to return for repeat surgery and Lengthening surgery time.
Objective: To develop a nursing service perioperative patient focused model for ACLRin Buriram Hospital.
Methods: It is a research and development conducted between May 1^st, 2019 - October 31^st, 2021. There are 4 steps: 1) Analysis of situations and problems. The population consisted of 2 surgeons, 2 wards nurses, 1 physical therapist, 337 anterior cruciate ligament surgery patient profiles. 2) Design and development of nursing models 3) Trial of nursing model The population is 50 professional operating room nurses. Patients who undergo ACLR surgery in Buriram Hospital Between April 1^st, 2021 – July 31^st, 2021, divided into 2 groups:The control group consisted of patients undergoing ACLR surgery who received regular nursing care. and the experimental group, including Patients undergoing ACLR surgery who received Nursing Service Perioperative Patient Focused Model. The sample size was calculated using the G* Power package program, 25 subjects per group, randomized by a specific method, alternately selecting 1 person at a time between 2 groups. 4) Assessment of outcomes and improvement of nursing model. Data were collected in step 1, situational analysis using participant observation. Analysis of the existing nursing service model by Focus Group meeting, multidisciplinary team.The third step is to experiment with the pattern. Using quasi-experimental research methods Quasi-experimental data were collected using questionnaires and skill observation forms. Data were analyzed by using SPSS. Infer statistic was used Paired Samples t-test, Independent t-test, chi square test. Descriptive statistic used frequency, percentage, mean, standard deviation.
Results: The Nursing Service Perioperative Patient Focused Model for ACLR should consist of:Pre operative, Intra operative and post operative. There is support for safe surgery in all 3 phases: arranging personnel with specific expertise by providing knowledge and training. preparation of patient, nursing manuals Educating patients about the practice before and after surgery especially the rehabilitation after surgery. Outcomes of the Nursing Service Perioperative Patient Focused Model for ACLR. it was found that 1) the patients who received Nursing Service Perioperative Patient Focused Model for ACLR had knowledge in Performance was statistically significantly higher than that of patients receiving conventional nursing (p˂0.001) and statistically significantly more satisfied with nursing services than those receiving conventional nursing (p˂0.001). 2) Nurses had a statistically significantly higher level of knowledge in received Nursing Service Perioperative Patient Focused Model for ACLR after using the model than before using the model (p˂0.001). The skill in giving nursing care to patients undergoing received Nursing Service Perioperative Patient Focused Model for ACLR after using the model was significantly increased from before using the model (p˂0.001).4) Nurses had a high level of 60.0% of the satisfaction of the patient-centered anterior cruciate ligament surgery patient with a mean score of satisfaction on benefits. Overall, the most nursing model (Mean 4.1). 5) Patients who Nursing Service Perioperative Patient Focused Model for ACLR had safety from 4 aspects of surgery, injuries from surgical positioning, injuries from pneumatic tourniquet, and surgical wound infections. and postponement of surgery was not different from that of patients receiving conventional nursing (p˂0.05). The surgical time was significantly lower than the normal nursing patients (p˂0.001).
Conclusion: The Nursing Service Perioperative Patient Focused Model for ACLR was developed to reduce the time of surgery. The patient's knowledge of surgery practice and satisfaction increased. Operating room nurses have increased knowledge and skills.