Development of Comprehensive Care Model for One Day Surgery of Phaholpolpayuhasaena Hospital , Thailand

Abstract

Objectives:  This research and developmental (R&D) study  was undertaken for three purposes: 1) to address problems and needs in improving comprehensive care model; 2) to develop a comprehensive care model for One Day Surgery, Paholpolpayuhasena Hospital and 3) to examine the effect of the developed comprehensive care model for One Day Surgery on nursing outcomes.

Methods:  Ninehealth care providers were recruited for assessing the problems and needs and 67 ODS clients who met the inclusion criteria were recruited to this study for the effectiveness test.  Semi-structured interview guide was used for the focus group in Phase I. Additionally, the experts’ records were used for Phase II and Phase III, the developed models and nursing outcomes’ questionnaires in terms of anxiety, satisfaction, infection, complications, re-admissions within 28 days ,and rehabilitation time were collected from the clients. Data collection was undertaken during January –March 2019. Later, telephone calls for follow-ups at post ODS were used. Frequencies and percentages were used for data analyses.

Results: Phase I revealed that ODS clients felt stressed and anxious because of a lack of knowledge for pre and post-operative self care, uncertainty of a care process and operative schedules. Moreover, missing appointments took place over than 60% and there were many operative risks.

Phase II, the researchers brought data from phase I and developed the comprehensive care model. Then the quality of the developed care model was appropriate and could  be used in practice.

Phase III, the results showed that amongst 67 participants, 92.5% were treated by a new way of hernioplasty with mesh graft, 4.5% by the hernioplasty without mesh graft and 3.0% was hydrocelectomy. After applying the model to ODS, there were no anxieties, good satisfactions, no post-operative infections, swelling,  pain ,and no re-admissions. About the rehabilitation factor, all clients could maintain their daily activities  2 hours after operations but they might  need to avoid lifting heavy weight things because of leading to abdominal high pressure. The effectiveness result showed that using this model provided care safely.

Conclusion:  Applying the model to ODS can provide care safely and good patients’ satisfactions and is  recommended in the other areas; however, randomized controlled studies should be further done to confirm the effectiveness.