การพัฒนารูปแบบบริการพยาบาลเพื่อป้องกันการพลัดตกหกล้มของผู้ป่วยที่รับรักษาในโรงพยาบาล
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พ.ค. 1, 2021
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การพัฒนารูปแบบ พลัดตกหกล้ม ผู้ป่วยที่รับรักษาในโรงพยาบาล
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บทคัดย่อ
การวิจัยนี้มีวัตถุประสงค์เพื่อศึกษาสถานการณ์พลัดตกหกล้มของผู้ป่วยในโรงพยาบาล พัฒนารูปแบบ ศึกษาผลลัพธ์ และประเมินประสิทธิภาพของรูปแบบบริการพยาบาล ใช้กระบวนการวิจัยและพัฒนา 4 ระยะคือ 1) วิเคราะห์สถานการณ์พลัดตกหกล้มของผู้ป่วย 2) พัฒนารูปแบบบริการพยาบาล 3) ศึกษาผลลัพธ์การนำรูปแบบบริการพยาบาลไปใช้ และ 4) ประเมินประสิทธิภาพของรูปแบบบริการพยาบาล กลุ่มตัวอย่างคือ ผู้ป่วยใน จำนวน 367 คน ด้วยการสุ่มอย่างง่าย เครื่องมือวิจัย ได้แก่ แบบบันทึกการพลัดตกหกล้ม แบบประเมินรายการปฏิบัติเพื่อป้องกันการพลัดตกหกล้ม แบบประเมินความพึงพอใจต่อการบริการ และแบบประเมินประสิทธิภาพของรูปแบบบริการพยาบาล ตรวจสอบความตรงเชิงเนื้อหาได้ค่า IOC 0.90, 0.90, 0.85 และ 0.85 ตามลำดับ วิเคราะห์ข้อมูลเชิงปริมาณด้วยความถี่ ร้อยละ ค่าเฉลี่ย และส่วนเบี่ยงเบนมาตรฐาน วิเคราะห์ข้อมูลเชิงคุณภาพด้วยการวิเคราะห์เนื้อหา
ผลการวิจัย พบว่า สถานการณ์พลัดตกหกล้มของผู้ป่วยมีแนวโน้มสูงขึ้น จากการประเมินที่ไม่ครอบคลุม การเฝ้าระวังที่ไม่เพียงพอ ปัจจัยเสี่ยงด้านสิ่งแวดล้อม และการเคลื่อนย้ายผู้ป่วย รูปแบบบริการพยาบาลที่พัฒนาขึ้นมี 4 องค์ประกอบ คือ การประเมินความเสี่ยงต่อการพลัดตกหกล้ม การกำหนดวิธีปฏิบัติเพื่อป้องกันการผลัดตกหกล้ม การพัฒนานวัตกรรมเพื่อลดภาวะเสี่ยงและป้องกันการพลัดตกหกล้ม และการนิเทศทางการพยาบาล การนำรูปแบบบริการพยาบาลไปใช้ พบจำนวนผู้ป่วยพลัดตกหกล้มลดลง ไม่พบการพลัดตกหกล้มซ้ำ มีการปฏิบัติการพยาบาลเพื่อป้องกันการพลัดตกหกล้ม ร้อยละ 92.50, ค่าเฉลี่ยคะแนนความพึงพอใจต่อบริการ และ ค่าเฉลี่ยคะแนนประสิทธิภาพของรูปแบบบริการพยาบาลอยู่ในระดับมาก (Mean 4.42, SD 0.75 และ Mean 4.20, SD 0.73 ตามลำดับ)
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References
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Thai.
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University; 2014. Thai.
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41. Evans D, Hodgkinson B, Lambert L, Wood J, Kowanko I. Fall in acute hospital: A systemic review. The Jonna Briggs Institute for Evidence Based Nursing and
Midwifery. [Internet]. 1998 [cited 2019 Apr 2]; Available from: http://www.joannabriggs.edu.au/FALLS/fallsreview
42. Agency for Health Care Policy and Research [AHCPR]. Clinical practice guideline No.1. AHCPR, Publication, No.92-0032. [Internet]. 1992 [cited Feb 28];
Available from: www.ahcpr.org.
43. Benjaporn P Phlaayoi, Chanphen S Monyaphong. The effective of the participatory nursing supervision program of head nurses on the performance of
professional nurses in specialized cancer hospitals. Journal of Cancer. 2017;2(35):46-55. Thai.
[Internet]. 2004 [cited 2019 Jun 20]; Available from: http://www.euro.who.int/document/
2. DeMaria J. Organizational Safety Culture. [Internet]. 2017 [cited 2019 Jun 28]; Available from: https://ishm.org/organizational-Safety-Culture.
3. Dzau VJ. Global Patient Safety 2017: A Call to Action. National Academy of Medicine Second Global Ministerial Summit on Patient Safety. [Internet]. 2017 [cited
2019 May 3]; Available from: https://www.bundesgesundheitsministerium.de/.../Patientensicherheit/Key.
4. Bureau of information. Office of The Permanent Secretary, MOPH. Safety patient and health personnel safety strategy of Thailand. [Internet]. 2017 [cited 2019
Jun 28]; Available from: https://pr.moph.go.th/iprg/include/admin_hotnew/show_hotnew.php?idHot_new
5. Malee Khamkong. Patient safety: Guidelines for nursing practice management. The Southern College Network Journal of Nursing and Public Health.
2018;6(1):216-28. Thai.
6. Saisamorn Chaleoykitti, Pornnapa Kamprow, Sompis Promdet. Patient safety and quality of nursing service. Journal of The Royal Thai Army Nurses.
2014;5(2):66-70. Thai.
7. Cox J, Thomas-Hawkins C, Pajarillo E, et al. Factors associated with falls in hospitalized adult patients. Appl Nurs Res. 2015;28(2):78-82.
8. Matarese M, Ivziku D, Bartolozzi F, Piredda M, De Marinis MG. Systematic review of fall risk screening tools for older patients in acute hospitals. J Adv Nurs.
2015;71(6):1198-209.
9. Loria G, Bhargava A . Prevention of patient falls: A case study. Apollo Medicine. 2013;10(2):175–80.
10. American Nurses Association [ANA]. The National Database of Nursing Quality Indicators. [Internet]. 2007 [cited 2018 Dec 30]; Available from:
https://www.nursingquality.org/data.aspx
11. Burston S, Chaboyer W, Gillespie B. Nurse-sensitive indicators to reflect nursing care quality: A review and discussion of the issues. J. Clin. Nurs, 2014; 23(13–
14): 1785-95.
12. Tipanetr Ngamkala, Prakong Intarasombat, Supreeda Monkong. Synthesis of knowledge about prevention and fall management in patients. Rama Nurse
Journal. 2011; 17(1):108-25. Thai.
13. Nursing Division, Ministry of Public Health. Guidelines for collecting indicators for nursing service quality development: Annual 2019. Nontaburee: Tawan
Media Publishing Co., L.ted; 2019. Thai.
14. University of York, Centre for Reviews and Dissemination. Preventing falls in hospitals. [Internet]. 2014 [cited 2019 Jun14]; Available from:
www.york.ac.uk/inst/crd
15. Prasert Assonchai. Common health problems in the elderly and prevention 5th ed. Department of Preventive and Social Medicine, Faculty of Medicine, Siriraj
Hospital Mahidol University; 2015. Thai.
16. Stanmore EK, Oldham J, Skelton D.A, et al. Fall Incidence and outcomes of falls in a prospective study of adults with rheumatoid arthritis. Arthritis Care Res
(Hoboken). 2013;65(5):737- 44.
17. Severo IM, Almeida MA, Kuchenbecker R, et al. Risk factors for falls in hospitalized adult patients: An integrative review. The Scientific Electronic Library Online:
SciELO Brasil. [Internet]. 2014 [cited 2016 Jun 28]; Available from:http://www.scielo.br/scielo.php?.
18. Yau S. Analysis on the high risk factors for elderly fall in hospital settings. [Internet]. 2017 [cited 2019 Jun 28]; Available from:
http://www3.ha.org.hk/haconvention/hac.
19. Cahill S, Stancliffe RJ, Clemson L, Durvasula S. Reconstructing the fall: Individual, behavioral and contextual factors associated with falls in individuals with
intellectual disability. J Intellect Disabil Res. 2014;58(4):321-22.
20. National Patient Safety Agency. Slips, trips and falls in hospital. [Internet]. 2007 [cited 2018 Oct 5]; Available from: http://www.npsa.nhs.uk
21. Oliver D, Daly F, Martin FC, McMurdo ME. Risk factors and risk assessment tools for falls in hospital in-patients: A systematic review. Age and Ageing.
2004;33:122-30.
22. Milisen K, Staelens N, Schwendimann R, et al. Fall prediction in inpatients by bedside nurses using the St. Thomas's Risk Assessment Tool in Falling Elderly
Inpatients (STRATIFY) instrument: A multicenter study. J Am Geriatr Soc. 2007;55(5):725-33.
23. Williams TA, King G, Hill AM, et al. Evaluate of a fall prevention programme in an acute tertiary care hospital. Journal of Clinical Nursing. 2007;16(2):316-24.
24. Heinrich HW, Peterson D, Roon N. Industrial Accident Prevention. New York: Mcgraw-Hill; 1980.
25. Orem D E, Taylor SG, Renpenning K M. Nursing: Concepts of practice 6th ed.St. Louis: Mosby; 2001.
26. Paisan Worrakam. Educational Research 4th ed. Mahasarakam: Takka-silakanpim; 2012.
27. Deming EW. Out of the Crisis. USA: The Massachusetts Institute of Technology Center for Advanced Engineering Study; 1995.
28. Tanin Silpjaru. Researching and analyzing statistical data with SPSS 7th ed. Bangkok; 2006. Thai.
29. Suree Rongchit .Development of Fall Risk Assessment Form for elderly patients Inpatient Department, Somdet Phra Phutlertla Hospital, Samut Songkhram
province in the national research Sukhothai Thammathirat University 6th; 2016. Thai.
30. Vassallo M, Mallela SK, Williams A, Sharma JC. Fall risk factors in elderly patients with cognitive impairment on rehabilitation wards. Geriatr Gerontol Int.
2009;9(1):41-6.
31. Perell KL, Nelson A, Goldman RL et al. Fall risk assessment measures: An analytic review. Gerontol A Biol Sci Med Sci. 2001;56(12):761-6.
32. Chiraphon Chanaipai. Safety management system for fall prevention among patients in private hospitals. Bangkok: Mahidol University; 2008. Thai.
33. Chiang Rai Prachanukroh Hospital. Regulations falling patient prevention, falling; 2017. Thai.
34. Nursing Division, Phramongkutklao Hospital. Practice Fall prevention; 2017. Thai.
35. Nursing Department, Thammasat University Hospital. Guidelines for fall prevention. Fall; 2018. Thai.
36. Dykes PC, Carroll DL, Hurley A, et al. Fall prevention in acute care hospitals: A randomized trial. Jama. 2010; 304(17):1912-18.
37. Zachary K, Awatef E, Wai YL, et al. Iterative user centered design for development of a patient-centered fall prevention toolkit. Applied Ergonomics.
2016;56:117-26.
38. Sirilak Phanthong, Orsa Unthawaraka , Sunantha Yodsima. Synthetic document analysis: Go back to prevent falls and falls of patients in the hospital from the
participation of patients or caregivers. In the design of safety marks. Document in academic conference project for Nursing Department, Siriraj Hospital; 2010.
Thai.
39. Amonrat Vanngein. The development of a prototype for prevention of falling patients from bed by using the technique of Classified. Bangkok: Chulalongkorn
University; 2014. Thai.
40. The Fall Prevention Board, the Lad Krabang Hospital team of Bangkok and the Faculty of Education Industrial and technology science, King Mongkut's
Institute of Technology Ladkrabang. Alarm for lifting bed rails. [Internet]. 2019 [cited 2019 Mar11]; Available from:
http://www.msdbangkok.go.th/vichakarn60/pdf/19
41. Evans D, Hodgkinson B, Lambert L, Wood J, Kowanko I. Fall in acute hospital: A systemic review. The Jonna Briggs Institute for Evidence Based Nursing and
Midwifery. [Internet]. 1998 [cited 2019 Apr 2]; Available from: http://www.joannabriggs.edu.au/FALLS/fallsreview
42. Agency for Health Care Policy and Research [AHCPR]. Clinical practice guideline No.1. AHCPR, Publication, No.92-0032. [Internet]. 1992 [cited Feb 28];
Available from: www.ahcpr.org.
43. Benjaporn P Phlaayoi, Chanphen S Monyaphong. The effective of the participatory nursing supervision program of head nurses on the performance of
professional nurses in specialized cancer hospitals. Journal of Cancer. 2017;2(35):46-55. Thai.