การวิเคราะห์สถานการณ์การใช้แนวปฏิบัติทางคลินิกในกลุ่มงานออร์โธปิดิกส์ โรงพยาบาลน่าน

Abstract

Clinical practice guidelines are very helpful for nursing practice. However there are still problems with their implementation in hospitals. This research was to analyze the situation concerning clinical practice guidelines implementation in the Orthopedics Department, Nan Hospital. The population included documents relating to the clinical practice guidelines in Nan Hospital, 5 hospital managers and 10 nurses who are working in Nan Hospital. The instrument consisted of an interview guideline for nurses and hospital managers developed by the researcher, based on the concept of the Institute of National Health Medicine and Research Council Australia (1998). Data were analyzed using content analysis. Results of this study revealed that the situations concerning clinical practice guidelines implementation in the Orthopedics Department, Nan Hospital were as follows: 1. The stage of clinical practice guidelines dissemination: Head nurses informed on policy and details of clinical practice guidelines to nurses in regular ward meetings. There were manuals and evidence to provide details about clinical practice guidelines as well as having a database to assist in searching the guidelines easily. Many problems were found in this dissemination stage. These included unclear guidelines and an ineffective database management system of the guidelines. 2. The stage of clinical practice guidelines implementation: There was multidisciplinary meetings to yield a consensus about the details of the guidelines and develop strategies for guidelines implementation. Informing and clarifying the guidelines to health workers was performed in order to increase a sense of involvement and acceptance to comply with the guidelines. Many problems were also found in this stage. These included no regular monitoring of non-compliance to guidelines, high workload and lack of nurses’ awareness on importance of the guidelines. 3. The stage of evaluating the use of clinical practice guidelines: Hospital guidelines evaluation in the short and long term was found in this stage. Results of guidelines evaluation given in ward meeting on a wall board. Problems in this stage included no regular monitoring of the results and nurses being informed late about the results of evaluation. Many participants suggested that the hospital has to adjust the database management system of guidelines, frequently reminding health workers to practice compliance with the guidelines, while frequently monitoring and evaluating the use of the clinical practice guidelines. The findings of this study are essential information for hospital managers and nurses to improve clinical practice guidelines implementation in the Orthopedics Department, Nan Hospital.