การพัฒนารูปแบบการพยาบาลเจ้าของไข้ในห้องคลอด โรงพยาบาลเกาะคา จังหวัดลำปาง

Abstract

Primary Nursing is a mode of delivering nursing care which promotes nurses to work in a professional way with a responsibility for individual patients. This developmental study aimed to develop a primary nursing model for the delivery room of Kokha Hospital, Lampang Province. The study methodology was guided by the PDCA quality improvement process (Deming, 1986), which consists of 4 steps: 1) plan the improvement; 2) do the improvement; 3) check the results, collect and analyze data; and 4) act to maintain and continue improvements. The population in this study consisted of 10 professional nurses. The research instruments included: 1) interview guidelines, and 2) the Primary Nursing Practice Check List. The data were analyzed by using descriptive statistics and content analysis. Primary nursing model in delivery room, Kokha Hospital was designed. For the developed model, primary nurses were accountable for organizing the total nursing care for an assigned obstetric patient throughout the patient’s hospital stay. When primary nurses were off-duty, other nurses would take care of the patient according to a nursing care plan made by the primary nurse. A manual for the primary nursing model was developed and consisted of 6 parts: 1) nursing assignment in the labor room; 2) communication and coordination; 3) recording and reporting; 4) the nursing conference; 5) the nursing round; and 6) standards of obstetric nursing care. After implementation of the model the researcher audited the nursing documents and monitored the incidence of adverse events. It was found that the quality of nursing documentation improved from 81.2 % to 88.7% and that no adverse events occurred during the study. Some problems occurred during quality improvement process including 1) unclear criteria relating to the delegation of responsibility to primary nurses, and 2) increased stress levels among junior nurses who were operationally responsible for providing care to patients from admission to discharge. The results of this study showed that the primary nursing model developed could increase the quality of nursing care for patients in the delivery room. Nursing administrators could also apply the principles of primary nursing to improve the quality of nursing care in other departments of the hospital.