Development and Evaluation of Nursing Practice Guideline in Patients with Severe Traumatic Brain Injury in the Resuscitation Room at an Accident and Emergency Department
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Abstract: This research and development aimed to 1) develop nursing practice guidelines to prevent hypoxia and increase in intracranial pressure condition, 2) evaluate the feasibility and satisfaction of using nursing guidelines, and 3) evaluate patient outcomes. This study used Soukup’s evidence framework as a guide. The sample group consisted of 37 nurses and 63 patients with severe traumatic brain injuries. The research tools were the nursing practice guidelines, patient outcome record form, and a questionnaire on feasibility and satisfaction of use form. Data were analyzed using descriptive statistics and paired t-test. Results showed that the nursing guideline to prevent hypoxia and increase in intracranial pressure was developed from 14 items of evidence-based medicine, comprising 4 categories: (1) ventilator care, (2) patient positioning, (3) airway management, and (4) monitoring and used in patient care. After implementing, the guideline was highly feasible to use (M = 2.9, SD = 0.3) and nurses reported the highest level of satisfaction (M = 4.7, SD = 0.5). Patient outcomes were shown that average fingertip oxygen saturation and the carbon dioxide concentration in the end-exhaled breath before discharge were significantly increased than those at admission (p < .05), while the level of consciousness and blood pressure values at admission and before discharge were not different. So, clinical nursing practices should be used in patients with severe traumatic brain injury in the resuscitation room for preventing hypoxia and reducing the increase in intracranial pressure.
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