การพัฒนารูปแบบการพยาบาลผู้ป่วยโรคหลอดเลือดสมองตีบหรืออุดตันระยะเฉียบพลัน โรงพยาบาลอุตรดิตถ์

Pornchanida Kaewpea; Somporn Meechai; Kanyarat Naklek

Authors

Pornchanida Kaewpea Accident and Emergency Nursing Department, Uttaradit Hospital
Somporn Meechai Accident and Emergency Nursing Department, Uttaradit Hospital
Kanyarat Naklek Accident and Emergency Nursing Department, Uttaradit Hospital

Keywords:

Development of Nursing Care Model, Acute Ischemic Stroke Patient, Nursing outcomes

Abstract

Objective: To develop a nursing care model for acute ischemic stroke patients at Uttaradit Hospital and to evaluate the outcomes of its implementation.
Methods: This study employed a research and development (R&D) design conducted in three phases. Phase 1 involved a situational analysis Phase 2 focused on developing the acute ischemic stroke patient care model
and Phase 3 assessed the outcomes of the implemented nursing model. The participants were selected from 31 professional nurses from the Accident and Emergency Department and the Stroke Patient Unit and 60 stroke patients who received thrombolytic medication, divided into two development cycles. The research will be conducted between May 2023 and May 2024. Data collection instruments included medical record review forms, in-depth interview guides, nursing knowledge and supervision knowledge assessments. Content validity was verified with an IOC value of (IOC=0.97), reliability was tested with an ICC value of (ICC=0.96), and (KR-20=0.98 and 0.95). Qualitative data were analyzed using content analysis, and quantitative data were analyzed using descriptive statistics, t-test, Wilcoxon signed rank test and the Mann-Whitney U test.
Results: The developed nursing model for acute ischemic stroke patients comprised three key components: 1) Clinical nursing practice guidelines covering pre-hospital care, nursing in emergency room and continuous nursing care in the stroke unit. 2) Nursing competence enhancement. 3) A nursing supervision framework aligned with Proctor’s model. Following the implementation of the nursing model, nurses achieved 100% adherence to the established clinical practice guidelines. The average competency score was 4.46 (SD=0.49). Both nurse and patient satisfaction were at the highest level. Regarding clinical outcomes, the average
Door-to-Needle time decreased to 45.90 minutes. No complications from rt-PA administration were found. The number of hospital days showed statistically significant improvement (p<0.05). The knowledge score on the Proctor model of nursing supervision increased significantly (p<0.001).
Conclusions: The developed nursing model enhances care efficiency, reduces treatment time, costs, increases the satisfaction of both nurses and patients. and provides a guideline for improving care for patients with other conditions.

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