The Development of Participatory Clinical Supervision Model of Critically Emergency Nursing Care, Accident and Emergency Department, UdonThani Hospital

Abstract

Nursing supervision should have a clear format, understand and be able to measure results especially the emergency clinical supervision that urgently needed, to reduce life-threatening.  The objective of this research and development was to develop and study the effectiveness of the development of       a clinical supervision model in critical nursing care at accident and emergency (AE) Department, Udon Thani hospital. The sample was 24 professional nurses acted as in charge. The research instrument was a model of clinical supervision model of critically emergency nursing care was developed, divided into  2 parts: 1) a participatory model of clinical supervision in critically emergency nursing care by using the coaching and mentoring process, and 2) guidelines for implementation and assessment. The effectiveness of the supervision model was assessed from the E-I clinical risk level , the supervisor's competency in supervision skills and professional skills from work. The tools used in data collection were 4 parts:         1) general information 2) competency in clinical supervision skills in nursing team leaders 3) competence in professional skills according to the standards of accident and emergency patient services and 4) small group discussion with the in charge nurses in the role of clinical supervisor. The tool's validity by IOC in the competency of clinical supervision skills in nursing team, nursing and the professional skills competence in the AE Patient Service Standards were 0.88 and 0.90, and the reliability was 0.92 and 0.95 respectively. Data were analyzed by descriptive statistics of frequency, percentage, mean, standard deviation. This study conducted from May to September 2021.

Results: 24 professional in charge nurses , mostly female (87.5%), mean age 35.25 years old (SD=8.04), 58.3% had been professional nurse position, mean experience time at the emergency room 6.96 years (SD=5.78). The incidence of clinical risk was 82 events and E-I risk level was 22 events with top 3 events were missed diagnosis and delayed diagnosis 36.36%, followed by un-planed cardiopulmonary resuscitation 18.18% and nurses miscommunication 13.64%. Development of participatory clinical supervision model in critically AE patients, coaching and mentoring was applied, enhanced in charge nurses for the role of clinical supervisors. Guidelines for implementation and assessment effectiveness of the supervision model used the competence of clinical supervision skills on the role of clinical supervisors and professional skills competence in accordance with the AE Patient Service Standards 10 component of in charge nurses with overall mean score 61.04 (SD=6.99) and 84.37 (SD=9.24) respectively. A small group discussion provided an opportunity for in charge nurses to express their opinions, learn and share, give and take recommendations. All of them agree that clinical supervision is important tools for consulting, monitoring and controlling the quality of nursing care according with nursing standard.

After participatory clinical supervision model by coaching and mentoring process was implemented for 6 months, 10 clinical risk had found but had no E-I risk level occurred.