การพัฒนารูปแบบการพยาบาลเจ้าของไข้ในห้องคลอด โรงพยาบาลลำปาง

Abstract

Primary nursing is a process for delivering continuously nursing care from admission to discharge. This study aimed to develop a Primary Nursing Model in the Labor Room of Lampang Hospital by using the PDCA Deming Quality improvement process, 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 improvement. The population included 16 registered nurses. The research instruments were the interview guidelines and the Primary Nursing Practice Check List. The data were analyzed by using descriptive statistics and content analysis. The primary nursing model was designed to incorporate the principles of primary nursing. A primary nurse is responsible for assessing, planning and evaluating nursing care for an individual patient day by day, from admission to discharge. Each primary nurse also acts as an associate nurse who carry the responsibility for implementing care as planned by the primary nurse when the primary nurse is not on duty. A manual for the primary nurse model was also developed. It consisted of six parts: 1) nursing practices in the labor room; 2) roles of primary nurses; 3) communication; 4) recording and reporting; 5) the nursing conference; and 6) standards of obstetric nursing care. After the 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 86.2% to 89.7% and that no adverse events occurred during the study. However, some problems with the Primary Nursing Model were noted. These included 1) junior nurses felt no confidence in being primary nurses for obstetric patients with complications, 2) criteria for delegating responsibility to primary nurses was unclear, and 3) there was inadequate nurse staffing. The study demonstrated that implementing this Primary Nursing Model developed yields a good quality of care for obstetric patients and increases the quality of nursing documentation. Therefore, nursing administrators should use the principles of primary nursing to improve the quality of nursing care.