Development of a Nursing Care Model for Critically-Ill Patients Based on the FAST HUG Concept in a Medical and Surgical Intensive Care Unit at Chiang Rai Prachanukroh Hospital
Keywords:
Nursing care model development, Critically-ill patients, FAST HUG concept, Proctor conceptAbstract
Critically ill patients admitted to intensive care units have serious conditions which can be life-threatening. They also experience symptoms which change rapidly, and severe complications can occur in all bodily systems. The researcher aimed to develop a nursing care model using the FAST HUG concept (Kemmis & McTaggart, 1988). FAST HUG-based care (Vincent, 2005) enables critically-ill patients to receive holistic care that encompasses all critical issues and is proven to be effective in preventing adverse outcomes. This participatory action research included two (2) cycles. Proctor’s conceptual clinical supervision (Proctor, 2010) was used to foster positive attitudes towards supervision performance. It was intended to develop knowledge and skills in caring for critically-ill patients as a team. The study subjects were 8 head nurses, 48 nurses, and 451 medical and surgical critically-ill patients. The study used 5 research instruments which passed content validity and reliability. Qualitative data were analyzed using content analysis while the quantitative data were analyzed using descriptive statistics, paired t-test, independent t-test, and exact probability test. Results: The study revealed the following results: 1. The nursing care model developed for critically-ill patients based on the FAST HUG concept had 7 bundles of care: 1) F: Fluid and Feeding within 24-72 hours; 2) G: Glycemic control (maintaining DTX at 80-180 mg %); 3) S: Sedation (GCS and RASS score); 4) A: Analgesia (CPOT score within 24-48 hours); 5) H: Head of bed (300 position of the patient’s head); 6) T: Thromboprophylaxis (for patients aged > 60 and BPH); and 7) S: Stress ulcer prophylaxis (PPI within 6-12 hours). 2. The mean score of nurses’ level of knowledge after applying the model yielded a statistically significantly higher result than the mean score before the application (p < 0.001). The level of nurses’ satisfaction was high at 31%, with the highest at 69%. The supervisors’ level of satisfaction was high, at 62.5%, and with the highest score at 37.5%. 3. Outcomes for patients showed that the mortality rate decreased from 14.23% to 12.04%, VAP decreased from 5.77% to 1.57%, weaning failure rate decreased from 13.5% to 6.28%, LOS decreased from 14.23% to 12.04%. and the cost incurred for hospitalization decreased from 123,075 Baht to 92,109 Baht. Based on the results, the nursing care model developed is effective in increasing the quality of nursing care rendered to critically-ill patients.
References
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