การพัฒนาและประเมินผลแนวปฏิบัติทางการพยาบาลสำหรับการส่งเสริมการฟื้นสภาพของผู้ป่วยสูงอายุที่ผ่าตัดเปลี่ยนข้อเข่าเทียม

Abstract

This developmental study aimed to develop and evaluate a clinical nursing practice guideline (CNPG) for promoting the recovery of older patients with total knee arthroplasty. The CNPG development process was based on the principle and guideline of the National Health and Medical Research Council (NHMRC) and included: 1) initiating a working group to identify clinical problems, 2) determining the study aim and outcomes, 3) searching the related evidence, 4) appraising the evidence, 5) formulating the tentative CNPG, 6) validating content of the CNPG, and 7) applying the CNPG in the practical situation with 19 older patients and 9 nurses. The process was evaluated by the nurse perception related to practicability and satisfaction. The clinical outcome was evaluated by the knee joint range of motion and the 6-minute walk test. The data were analyzed by descriptive statistics and content analysis. The results of this study revealed that: 1. The content of CNPG for promoting the recovery of older patients with total knee arthroplasty comprised 3 phases: 1) the preoperative phase including educational information about osteoarthritis and total knee arthroplasty, preoperative preparation, pain management, and exercise for recovery, 2) the postoperative phase including pain management, covering for early ambulation, and 3) the discharge phase including continuing safety exercise. 2. The process evaluation showed that all of nurses (100%) agreed over the guideline practicability and were satisfied with using this CNPG at a high level. Two nurses (22.296) suggested improving the exercise record form. 3. Clinical outcome showed that on the day before discharge, all of patients (100%) had a knee joint range of motion on flexion at an average of 91.68 ± 1.78 degree. Then 2 weeks later, all of them (100%) had a knee joint range of motion on flexion at an average of 96.53 ± 5.76 degree, and all of them (100%) were able to walk on a horizontal surface within 6 minutes in the target distance that is more than 20 meters, both on the day before discharge (M = 41.78, SD = 8.49) and 2 weeks after returning home (M = 54.69, SD = 1.56). The results of this study indicate that the CNPG can help nurses provide nursing care to promote the recovery of older patients with total knee arthroplasty and help older patients to recover after total knee arthroplasty. Therefore this CNPG could be continuously practice. However applying to another context requires adaptation.