Development of Nursing Care Model for Post-Operative Head Injury Patients at Kamphaeng Phet Hospital
Keywords:
nursing care model, head injury patients, post-operativeAbstract
Abstract:
Objectives: To develop a nursing care model and study the outcomes of its implementation on head injury patients have undergone surgery.
Design: Research and development.
Methodology: This study was conducted in four phases: 1) situation analysis; 2) care model development; 3) implementation; and 4) outcome evaluation. The study participants were 28 registered nurses, 28 caregivers, and 56 post-operative head injury patients selected by means of purposive sampling. The patients were equally divided into two groups, one receiving standard care and the other treated with the researcher-designed nursing care model. The data were analysed using descriptive statistics, Chi-square, and t-test.
Results: The designed nursing care model for post-operative head injury patients was composed of three components: 1) the Head Injury Clinical Pathway KPH: SIMPLE +C guidelines; 2) nursing competency development; and 3) monitoring and follow-ups. The study of the model implementation outcomes showed the following. Firstly, the registered nurses displayed signifcantly higher knowledge, competency, and satisfaction concerning the model than before the implementation (p = .000, p = .000, p = .000, respectively). Secondly, the patients treated with the researcher-designed nursing care model experienced signifcantly less deterioration, whether caused by improper care, accidental loosening or disengagement of endotracheal tubes, or pressure sores, than did those receiving standard care (p = .016, p = .000, p = .044, respectively). Finally, the caregivers for the patients treated with the researcher-designed nursing care model displayed signifcantly higher satisfaction with the care quality than did the caregivers looking after the patients given standard care (p = .000).
Recommendations: The nursing care model for traumatic brain injury patients having undergone surgery effectively enhanced the registered nurses’ competency, improved the post-operative head injury patients’ conditions, and increased the nurses’ and caregivers’ satisfaction. It is, therefore, recommended that this model be more widely implemented in order to heighten the quality and effcacy of brain injury patient care.
Downloads
References
National Center for Injury Prevention and Control. Report to congress on mild traumatic brain injury in
the United States: steps to prevent a serious public health problem. Atlanta, GA: Centers for Disease Control and Prevention; 2003
World Health Organization. Global status report on road safety 2018. Geneva: World Health Organization
[Internet]. 2018 [cited 2019 Mar 20]. Available from: https://apps.who.int/iris/bitstream/handle/ 10665/277370/WHO-NMH-NVI-18.20-eng.pdf
Khajavikhan J, Vasigh A, Khani A, Jafarpour M, Kokhazade T. Outcome and predicting factor following
severe traumatic brain injury: aretrospective cross-sectional study. J Clin Diagn Res 2016;10(2):16–9.
Maas AI, Lingsma HF, Roozenbeek B. Predicting outcome after traumatic brain injury. HandbClinNeurol
;128:455-74.
KamphaengPhet Hospital. [Hospital Database: Hos XP]. 2558 - 2560 [cited 2019 Mar 20].
Bradbury CL, Wodchis WP, Mikulis DJ, Pano EG, Hitzig SL, McGillivray CF, et al. Traumatic brain
injury in patients with traumatic spinal cord injury: clinical and economic consequences. Arch Phys Med
Rehabil 2008;89(12):77-84.
Shah MK, Al-Adawi S, Burke DT. Age as a predictor of functional outcome in anoxic brain injury. Journal
of Applied Research 2004;4(3):380-4.
Hadjibashi AA., Berry C, Ley EJ,BukurM, MirochaJ,Stolpner D, et al. Alcohol is associated with a lower pneumonia rate after traumatic brain injury. J Surg Res 2012;173(2):212-5.
Keyser-Marcus LA,BricoutJC,Wehman P, Campbell LR,Cifu DX, Englander J, et al. Acute predictors of
return to employment after traumatic brain injury: a longitudinal follow-up. Arch Phys Med Rehabil
;83(5):635-41.
Sandhaug M, Andelic N, Berntsen SA, Seiler S. Functional level during the frst year after moderate
and severe traumatic brain: course and predictors of outcome. J Neurol Res 2011;1(2):48-58.
Mohamed WRA, Leach MJ, Reda NA, Abd-Ellatif MM, Mohammed MA, Abd-Elaziz MA. The effectiveness of clinical pathway-directed care on hospitalisation-related outcomes in patients with severe traumatic brain injury: A quasi-experimental study. J ClinNurs 2018;27(5-6): e820-32.
Khiewchaum R, Wattana C. Holistic nursing for traumatic brain injury patient. Journal of Phropokklao
Nursing College. Col 2007;28(1):129-39. (in Thai)
Nopparat R, S.Monaiyapong P. The development of supervision program for head nurses in empowering
professional nurses at a tertiary level hospital in the medical service department under Bangkok Metropolitan
Administration. Journal of Nursing, Siam University 2017;8(35):95-105. (in Thai)
Donabedian A. An introduction to quality assurance in health care. New York: Oxford University Press;
Suwanpitak W, Vipavakarn S, Prakeetavatin B. Development of clinical nursing practice guideline
for patients with mild traumatic brain Injury in Krabi Hospital. The Southern College Network Journal of Nursing and Public Health2017;(7):140-56. (in Thai)
Phunawakul S, Reungsri N, Montarak O, Kongros J. The development of clinical nursing practice
guideline for patients with surgery from traumatic brain injury in Phichit Hospital . Journal of the
Department of Medical Services 2017;42(6):102-7. (in Thai)
LincharearnA. Qualitative Data Analysis Techniques. Journal of Educational Measurement Mahasarakham
University2012;17(1):17-29. (in Thai)
Phothisita C. Science and art of qualitative research. Bangkok: Amarin Printing & Publishing Public;2013.
(in Thai)
Thiantong M. Statistics and research methodology for information technology. Bangkok: King Mongkut’s
University of Technology North Bangkok; 2005. (in Thai)
Varghese R, Chakrabarty J, Menon G. Nursing management of adults with severe traumatic brain
injury: a narrative review. Indian J Crit Care Med 2017;21(10):684–97.
Tantisuk W. Development of clinical supervision pattern/participatory clinical nursing supervision
[Dissertation]. Bangkok: Christein University; 2013. (in Thai)
Wangkeeratikarn Y, Sarnsuvarn A, Lertsuphawong P. Effcacy of severe head injury nursing care plan
development. Medical Journal of Srisaket Surin Buriram Hospital 2014;29(1):1-12. (in Thai)
Haddad HS, Arabi MY. Critical care management of severe traumatic brain injury in adults. SJTREM
;20(12):1-15.
Tantivisut S, Namvongprom A, Sirikul S. Effectiveness of nursing system development in using evidence-based protocol on quality of care in patients with severe traumatic brain injury. Journal of Nurses Association
of Thailand, North-Eastern Division 2011;29(3):5-14.(in Thai)
Pearkao C, Pothipong R, Tansura S, Bussamongkon N, Tupsai P. Development of nursing practice guidelines
for pain management in severe traumatic brain injury and multiple injury patients. Nursing Journal of The
Ministry of Public Health 2018;28(2):41-52. (in Thai)
The Healthcare Accreditation Institute (Public Organization). Hospital and healthcare standards.
thed. Bangkok: D one books Press; 2019. p. 65-9.
