การพัฒนาและการใช้แนวปฏิบัติการพยาบาลทางคลินิกสำหรับการจัดการภาวะช็อกจากการสูญเสียสารน้ำในร่างกายในผู้ป่วยวิกฤต

Abstract

The incidence of hypovolemic shock has increased in critically ill patients. Critically ill patients with shock are managed with multidisciplinary clinical practice guidelines. However, there are no clinical nursing practice guidelines (CNPGs) for hypovolemic shock management that focus on nursing roles. The implementation research aimed to develop CNPGs for hypovolemic shock management among critically ill patients and to study the outcomes of implementing CNPGs at Angthong Hospital. The framework of this study is based on the Australian National Health and Medical Research Council guidelines for development, implementation and strategy utilization of clinical practice guidelines (NHMRC, 1999, 2000). Participants consisted of two groups: 1) all critically ill surgical patients (older than 18 years) who were admitted to the intensive care unit before and during implementation of CNPGs (51 and 45 participants, respectively), and 2) 14 nursing personnel who utilized CNPGs. Data collection instruments consisted of 1) the CNPGs Implementation Opinion Survey Form, and 2) the Outcome Evaluation Form. Data were analyzed using descriptive statistics. The results revealed that: 1. The CNPGs for hypovolemic shock management among critically ill patients at Angthong Hospital consisted of six components including 1) protection of patient rights and ethics, 2) educating nurses about hypovolemic shock, 3) patient care for hypovolemic shock prevention, 4) management of patients with hypovolemic shock, 5) continuous care for patients, and 6) improvement of quality of care. The CNPGs were approved with good quality for all components by the Appraisal of Guidelines for Research & Evaluation II [AGREE II] (80.55-91.66%). Moreover, most of the nursing personnel strongly agreed on the feasibility of the CNPGs implementation at a high level (85.70-92.90%). 2. All participants in the CNPGs implementation group were assessed for shock using the shock index while none of those from the before-CNPGs implementation group were assessed by the shock index. Participants in the CNPGs implementation group received continuous shock prevention by accurate intravenous fluid infusion higher than the before-CNPGs implementation group (100.00% and 89.41%). Participants in the CNPGs implementation group were provided with comprehensive shock management by assessing the adequacy of intravenous fluid infusion higher than those in the before-CNPGs implementation group (100.00% and 87.42%), and were provided comprehensive nursing care for shock with other methods by elevating patients’ legs position higher than the before-CNPGs implementation group (100.00% and 88.07%). The results of this study revealed that CNPGs for hypovolemic shock management among critically ill patients are appropriate for implementation in clinical practice and enhance positive outcomes. Additionally, these results should be presented to hospital administrations for supporting continuous CNPGs implementation to develop quality of care.