The Development of a Nursing Care Model for Patients with Septic Shock
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Abstract
Background: Septic shock is a severe health problem with a high mortality rate. It is a critical medical emergency, with reported mortality rates as high as 30–50%, and is a major cause of admission to intensive care units (ICUs) worldwide. Even a delay of only a few hours in diagnosis and treatment can lead to multiple organ failure and significantly increase the risk of death.
Objective: To study the current nursing care situation of patients with septic shock, to develop a nursing care model for patients with septic shock, and to evaluate the effectiveness of the nursing care model for patients with septic shock in the medical intensive care unit of Surin Hospital.
Methods: This study was a Research and Development (R&D) study conducted from January to December 2025. The participants in the research process included five internists, sixteen registered nurses working in the medical intensive care unit, and forty-five patients with septic shock. The study was conducted in four phases: Phase 1: Analysis of problems and needs, which consisted of 1) retrospective review of medical records of 45 patients with septic shock, 2) in-depth interviews with five physicians, and 3) focus group discussions with 16 registered nurses who were involved in the development and implementation of the nursing care model. Phase 2: Review of model, drafting of the model, and two rounds of focus group discussions with 16 registered nurses who developed and used the model. The model was refined through consensus until agreement was reached among the users. Phase 3: Pilot implementation of the nursing care model. Phase 4: Evaluation and refinement of the model. The effectiveness of the model was evaluated by comparing patient care outcomes before and after implementation of the model. Quantitative data were analyzed using frequency, mean, and percentage, while qualitative data were analyzed using content analysis. Statistical analysis was performed using Fisher’s Exact Test.
Results: Phase 1: All physicians agreed that nurses should strictly adhere to the prescribed treatment plans. Registered nurses expressed the need for a clear nursing care model with systematic supervision and monitoring to ensure complete compliance with the nursing care practices. Phase 2: A nursing care model for patients with septic shock was developed Phases 3–4: After three months of implementation of the nursing care model, it was found that 100% of nurses used the MEWS score for patient assessment. Comparison of outcomes before and after the development using Fisher’s Exact Test revealed that, after implementation, administration of intravenous fluids according to the treatment plan was significantly higher than before implementation (p = 0.03), administration of antibiotics according to the treatment plan was significantly higher than before implementation (p = 0.01), the incidence of extravasation was significantly lower than before implementation (p = 0.01), and the incidence of gangrene was significantly lower than before implementation (p = 0.03), all at a significance level of 0.05. The level of satisfaction among registered nurses regarding the use of the nursing care model was 92.6%, which was rated as high.
Conclusion: The findings of this study indicate that the nursing care model for patients with septic shock is an effective model. Nurses providing patient care demonstrated increased confidence and delivered high-quality nursing practice, which resulted in improved patient outcomes
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