Development of a Care Model for Preventing Complications in Stroke Patients During Rehabilitation Phase at Thung Khao Luang Hospital, Roi Et Province

Abstract

Introduction Stroke is a major global public health problem with substantial impacts on families and health service systems. These challenges are particularly evident during the rehabilitation phase, when stroke patients are vulnerable to developing complications. Therefore, the development of a care model aimed at preventing complications in stroke patients during rehabilitation is crucial for preventing such complications, maintaining a good quality of life for stroke patients, and enhancing the overall quality of hospital services. 

Objectives This study aims to 1) develop a care model for preventing complications in stroke patients during the rehabilitation phase at Thung Khao Luang Hospital, Roi Et Province, and 2) test the effects of a care model for preventing complications in stroke patients during the rehabilitation phase by comparing nursing competencies and the incidence of complications before and after the implementation of the model. 

Design This study employs Research and Development (R & D), applying systems theory which includes input, process, and output, as well as feedback mechanisms to facilitate continuous improvement.

Methodology This R & D consists of 4 phases. Phase 1 involved an in-depth exploration of the current situation, identifying existing problems and assessing the needs for model development. Phase 2 focused on the design and development of the care model, which was carried out through three sub-stages to ensure a comprehensive and contextually appropriate framework. Phase 3 entailed the implementation of the developed model in a clinical setting to assess its effectiveness in real-world practice. Phase 4 consisted of a thorough evaluation of the model, including refinement and validation to confirm its quality and applicability. To test the effectiveness of the model, purposive sampling was employed to select the study participants. The sample included two groups of stroke patients in the rehabilitation phase: 40 patients who received standard care prior to the implementation of the model, and 40 patients who received care under the newly developed model. Additionally, seven professional nurses working in the inpatient ward at Thung Khao Luang Hospital participated in the study. Research instruments include 1) a stroke rehabilitation data recording form with a content validity index (CVI) = .95, 2) semi-structured interview guidelines for focus group discussions, 3) a structural evaluation form for the care model, 4) a care documentation form for stroke rehabilitation (CVI = .98), 5) an adherence assessment form for the care model (CVI = .96), 6) a nursing competency evaluation form specific to stroke rehabilitation care (CVI = .95; Cronbach’s alpha coefficient = .80), and 7) a questionnaire assessing opinions toward the care model (CVI = .98; Cronbach’s alpha coefficient = .82). The implementation and data collection were conducted from December 2023 and May 2024. Quantitative data were analyzed using descriptive and inferential statistics, including frequency, percentage, mean, standard deviation, multiple logistic regression, Chi-square test, and Wilcoxon signed-rank test. Qualitative data were analyzed using content analysis.

Results The care model for preventing complications in stroke patients during the rehabilitation phase at Thung Khao Luang Hospital, Roi-Et Province, consists of 3 main components: (1) Key inputs, including multidisciplinary team implementation, institutional policies, and care plans, the defined roles and responsibilities of nurses, nursing competencies, and supportive systems that facilitate effective care delivery, (2) Process, which is guided by the T-K-L-H framework: T: Team and objectives for care implementation, K: Knowledge and clinical practice training in stroke care, L: Long term care and multidisciplinary support, and H: Health status monitoring and evaluation continuity, and (3) Outcomes, which are measured using quality indicators to assess the structure, process, and results in accordance with standards for stroke rehabilitation care. After implementing the model, significant improvements were observed. The incidence of pneumonia decreased markedly (from 23.07 to 5.76 episodes per 1,000 hospital days; p < .001). Similarly, the incidence of urinary tract infections declined (from 9.61 to 1.92 episodes per 1,000 uninary catheter days; p < .001), and the occurrence of pressure ulcers was reduced (from 17.30 to 3.84 episodes per 1,000 hospital days; p < .001). Overall, the total number of complications among stroke patients in the rehabilitation phase significantly decreased (from 26 to 6 episodes; p < .001). In addition, professional nurses demonstrated significantly higher average scores in nursing competency related to stroke rehabilitation care after the model was implemented (p < .001). All participating nurses adhered to the care model, and 71.42% rated the quality of the model as good. The average satisfaction for the care model was high (M = 4.43, SD = 0.48).

Recommendation Thung Khao Luang Hospital should adopt this care model as a primary guideline for managing stroke patients during the rehabilitation phase. Furthermore, a monitoring system should be established to evaluate the long-term sustainability of the outcomes. The effectiveness of the model should be tested through an experimental research with full-scale implementation. Hospitals with similar contextual settings are encouraged to implement this model in their stroke rehabilitation care practices. It is also recommended that care goals for stroke patients be aligned with the broader healthcare system to ensure consistency and integration across services.