การพัฒนาและประเมินผลแนวปฏิบัติการพยาบาลในการดูแลสุขภาพช่องปากในผู้ป่วยที่มีภาวะพึ่งพา

Abstract

The purpose of this study was to develop and evaluate a clinical nursing practice guideline (CNPG) for oral health care in dependent patients in a medical ward of a tertiary hospital. The CNPG was developed by applying the framework of development of clinical practice guideline of Australia National Health and Medical Research Council (NHMRC, 1999). The study consisted of three phases. The first phase was the CNPG development by indicating problems, purposes, target group, and outcomes of the CNPG; and searching and using evidences to develop the CNPG. The content of the CNPG was validated by three experts. The content validity index of the CNPG was 93. The second phase was disseminating and promoting the implementation of the CNPG through advertisement, meeting and training, then doing a trial the CNPG. The third phase, evaluation of CNPG implementation was conducted in three main steps, 1) evaluation of the correctness of practising of the CNPG, 2) evaluation of the feasibility of implementing the CNPG, and 3) evaluation of the oral health of patients. Data were analyzed by using Frequency Distribution and Wilcoxon Signed-Rank Test. The results were as follows: 1. The CNPG for oral health care in dependent patients in both intubated and non-intubated oral endotracheal tube patients, including patients not opening the mouth was composed of four components: 1) oral assessment, 2) products and equipment for oral health care selection, 3) oral care, and 4) oral health care education to caregiver. 2. After the implementation of the CNPG, the correctness of nurses' practising following CNPG in all activities was increased, particularly in the item of using the oral assessment guide to assess patient's oral health, which was increased at 55.56%. 3. The feasibility of implementing the CNPG for oral health care in dependent patients was at a high level (M=4.18, SD = 0.39). 4. The oral health of patients in both intubated and non-intubated oral endotracheal tube patients after receiving oral health care following the CNPG was statistically significant improved (Z= -3.21, p = .001). The results of this study showed that the CNPG for oral health care in dependent patients can be implemented in the practice in both intubated and non-intubated oral endotracheal tube patients and can improve the patients' oral health. Therefore, this CNPG should be continuously supported to use in nursing practice.