Nursing Practice Guideline Development for Surveillance of Compartment Syndrome in Orthopeadic Department Udonthani Hospital

Abstract

The action research was conducted with the objectives to developed nursing practice guideline for surveillance of compartment syndrome in orthopeadic department Udonthani hospital and study the results of nursing practices guideline. The samples consists of 2 group: I) Forty nurses registered who work in 3 ordinary and 1 special orthopedic wards, orthopedic department Udonthani Hospital. II) Seventy patients with injuries to the arms or legs at risk for compartment syndrome who admitted in orthpeadic wards during July to December 2017 by   purposive sampling. The tools are 2 groups which consists of; First Group 1) Compartment Syndrome assessment form 2) The diagram (Flow chart) of nursing practice for surveillance compartment syndrome orthopedic  department Udonthani hospital. Tools of data  collecting in second group consisted of: 1) Nurse satisfaction     questionnaire for the compartment syndrome assessment tool, 2) Nursing satisfaction assessment form for using nursing practice guideline, 3) Evaluation of Practice by evaluating the nursing practice following the nursing practice guidelines. The alpha cronbach’s coefficient was 0.87, 0.87 and 0.84 respectively. The content validity evaluation by 5 experts, IOC 0.84. The content analysis was used descriptive analysis percentage (%), mean (x̄) and standard   deviation (S.D.).

The Clinical Nursing Practice Guideline for compartment syndrome surveillance consists of: 1) The compartment syndrome assessment form that specific for assess the upper (arms) and lower limbs (legs). And 2) The      diagram of nursing practice for surveillance compartment syndrome. The results showed that: I) The nurse aspect: The  guidelines provide same direction of systematic surveillance guidelines for the compartment syndrome  with the same practice. The nurses were satisfied with the guidelines, that helps to monitor risk of compartment syndrome with average mean score is high level (x̄=4.17, S.D. 0.75). The practice guideline helps nurses to make decisions about reporting symptoms to the doctor in time, average mean score is high level  (x̄=4.13, S.D. 0.78). The compartment syndrome evaluation form that is easy to use for complete data collection, average mean score is high level  (x̄=4.10, S.D. 0.71). It allowed nurses to identify patients' abnormal symptoms and report symptoms correctly, average mean score is high level (x̄=4.07, S.D. 0.69). II) The nurse practicing aspect: The top three mean scores for practice items were 1) They asks and assessments  diagnosis of  fracture arm or leg/surgery implants/cast for every new patient. 2) They adjust nursing plans when found that patients whose had identified at risk correctly. 3) They applied a cold compress on the legs or arms fractures when receiving the patient and they can assess the abnormal symptoms. The average mean score is high level (x̄=2.67 (S.D. 0.57) and x̄=2.57 (S.D. 0.41) respectively). III) The quality of  service found that incidence of fasciotomy and amputation was zero. At-risk samples resolved by splitting cast in 8 cases (11.43 %).

The recommendations that the nursing guidelines useful for patient’s limb bones injured before and after surgery or procedures. It is used to monitor the risk of compartment syndrome. Which is an orthopedic emergency. It help to comply information comprehensive, planning nursing, helps to report patients' symptoms accurately and quickly to received timely treatment. Monitoring should be repeated continuously, especially in the first 24 hours after admission with accurate and complete recording was important, eventhough busy due to heavy workloads, assignment system and supervision is therefore helpful.