การพัฒนาและประเมินผลแนวปฏิบัติการพยาบาลเพื่อส่งเสริมการฟื้นตัวในผู้ป่วยสูงอายุหลังผ่าตัดช่องท้อง

Abstract

This developmental research aimed to develop and evaluate the effectiveness of a nursing practice guideline for enhancing recovery after abdominal surgery in elderly patients. The quality of care model of the National Health and Medical Research Council (2000) and evidence related to enhancing recovery after abdominal surgery were used as a framework for this study. The study was conducted in 2 stages: 1) developing the clinical nursing practice guideline, and 2) evaluating the guideline. The participants included 14 professional nurses of the Male Surgical 510 Ward, Hat Yai Hospital, and 25 elderly patients were undergone abdominal surgery and admitted at the ward during September and October 2018. Data were analyzed using descriptive statistics. Findings of this study revealed that: 1. The newly developed nursing practice guideline for enhancing recovery after abdominal surgery in elderly patients has 3 components: 1) pre-operative care; 2) post-operative care - 24 hours after surgery; and 3) post-operative care 1-7 days after surgery, divided into 2 periods, 1-3 days after surgery and 4-7 days after surgery. There are three categories of recovery indicators: 1) clinical outcomes: evaluation of pain level, and bowel function; 2) psychosocial outcome:evaluating the level of anxiety; and 3) the functional ability: evaluation of physical movement. The content validity index of the guideline verified by three experts was 0.96. 2. Fifty-seven point one percent of nurses who used CNPG perceived the overall feasibility of the CNPG at a high level (M = 2.57, SD = 0.51). 3.One hundred percent of nurses who used CNPG were satisfied with the CNPG. 4. Level of recovery among elderly patients after abdominal surgery in three aspects was better than before using the CNPG. 5. Seventy-six percent of elderly patients after abdominal surgery who were cared for according to the CNPG perceived the overall feasibility of the CNPG at a high level (M = 2.93, SD = 0.27). This CNPG should be applied in the male surgical wards and other similar setting. Long-term clinical outcome such as postoperative complications and cost outcome should be further studied.