การพัฒนาแนวปฏิบัติการพยาบาลการเตรียมผ่าตัดเปิดกะโหลกศีรษะสำหรับ ผู้ป่วยเลือดออกในสมอง ห้องผ่าตัด โรงพยาบาลตติยภูมิ

Nongyao hiangthong; Yupaporn Phunuch; Sawitree Limkamontip

Authors

Nongyao hiangthong Phichit Hospital
Yupaporn Phunuch Phichit Hospital
Sawitree Limkamontip Boromarajonani College of Nursing, Buddhachinaraj

Keywords:

Nursing Practice Guidelines, Craniotomy, Intracerebral Hemorrhage Patients, Operating Room

Abstract

Introduction: Craniotomy in patients with intracranial hemorrhage is a complex and high-risk procedure. The operating room of a tertiary care hospital encountered problems with delays and unreadiness in instrument preparation, and still lacked a clearly defined practice guideline.

Research Objectives: To study problems, develop, and test the effectiveness of a nursing practice guideline for craniotomy preparation in patients with intracranial hemorrhage in the operating room of a tertiary care hospital.

Research Methodology: This research and development study was divided into three phases. The sample in the testing phase consisted of 50 patients (25 in the control group and 25 in the experimental group) and 25 operating room nurses. Research instruments consisted of the practice guideline, an efficiency assessment form, and a satisfaction assessment form, all of which were validated for content validity (IOC = 0.67–1.00). Data were analyzed using descriptive statistics and compared using Chi-square test, Mann-Whitney U test, and Wilcoxon Signed Ranks Test.

Results: 1) The main problems were delays in instrument preparation (10–15 minutes) and the need to retrieve additional instruments (80%). 2) An electronic practice guideline in QR code format was developed. 3) After implementing the guideline, preparation efficiency increased significantly (p < 0.01), instrument preparation time decreased from 18.12 to 11.32 minutes, safety incidents were reduced to zero, and nurses reported the highest level of satisfaction with the guideline (Mean = 4.76, S.D. = 0.44).

Conclusion: The developed practice guideline significantly improved efficiency and reduced instrument preparation time, promoting safety and standardization.

Implications: The guideline should be incorporated into orientation programs for rotating nurses and developed as a standard operating procedure for the operating room.

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