การพัฒนาและประเมินผลแนวปฏิบัติการพยาบาลในการสื่อสารระหว่างพยาบาลและผู้ป่วยที่ใส่ท่อช่วยหายใจในหอผู้ป่วยวิกฤต

Abstract

This study was a developmental research aimed at developing and evaluating a clinical nursing practice guideline (CNPG) for communication between nurses and endotracheal- intubated patients in the medical intensive care unit of a general hospital in southern Thailand. The researcher developed the CNPG by following the process adapted from Australian National Health and Medical Research Council (1998). This study consisted of three phases: phase 1 development of the CNPG, phase 2 dissemination and implementation of the CNPG, and phase 3 evaluation of the CNPG. The research instruments included (1) the CNPG, (2) the Nurses' CNPG Implementation Feasibility Questionnaire, (3) the Nurses' Satisfaction of the CNPG Questionnaire, (4) the Patients' Frustration in Communication Questionnaire, and (5) the Patients' Satisfaction in Communication Questionnaire. These instruments ware examined by three experts. The instrument no. 1 yielded a score quality for clinical practice guideline of 82.23 percent and the instruments no. 2-5 yielded scale content validity average (S-CVI-Ave) were 0.88, 1.00, 0.90 and 0.85, respectively. The instruments no. 2, 4, and 5 yielded Cronbach's alpha coefficients of 0.90, 0.93 and 0.80, respectively. Sixteen nurses implemented the CNPG with endotracheal-intubated patients in the medical intensive care unit and patient outcomes were compared between in the pre- implementation group and the post implementation group. The results were as follows: 1. The CNPG for communication between nurses and endotracheal-intubated patients in the critical care unit comprised three components: (1) Assessment of communication ability of endotracheal-intubated patients, (2) Communication between nurses and endotracheal-intubated patients, and (3) Recording of communication information pattern with endotracheal intubated patients. 2. Nurses reported that the CNPG had the highest feasibility to be implemented (M=4.12, SD = .50). 3. Nurses reported a high level of satisfaction in using this CNPG (M=8.38, SD = .96) 4. Patients' frustration in communication of the pre-implementation group (grouped median = 7.90) was significantly higher than that of the post-implemention group (grouped median = 4.25) (Z=-4.02, p = .000). 5. Patients' satisfaction in communication of the pre-implementation group (grouped median = 3.83) was significantly lesser than that of the post-implemention group (grouped median = 4.19) (Z=-4.02, p = .000). The finding showed that this CNPG could be applicable for implementation and should be continuously updated. In order to improve the quality of care for the endotracheal- intubated patients in the critical care unit, knowledge about communication with the endotracheal- intubated patients should be offered for staff nurses and health care teams.