Development of Clinical Nursing Practice Guideline for Surgical Patients with Community Acquired Severe Sepsis and Septic Shock in Surgical Intensive Care Unit,Saraburi Hospital

Abstract

The objective of this research and development study was to develop and examine the results of the clinical nursing practice guidelines for surgical patients with severe septicemia. There were 4 steps: (1) situation analysis, (2) guideline development, (3) guideline implementation, and (4) evaluation. A sample of 30 professional nurses and 72 surgical patients with severe septicemia were selected using purposive sampling technique. The research instrument included the nursing practice guideline yielding IOC of 0.93 and the practical manual, yielding the AGREE II value of 89.72 percent. The data collection tools consisted of the knowledge test yielding KR-20 of 0.81, the practice checklist and the clinical outcomes yielding IOC of 0.93 and 0.95, respectively, and the competency of registered nurses and their opinions toward CNPG using Cronbach’s alpha coefficient yielding a value of 0.89 and 0.84 respectively. Data were analyzed using descriptive statistics, t-test and Fisher's exact test.

The results showed that the guideline for nursing surgical patients with severe septicemia consisted of 11 aspects (1) assessment and surveillance (2) nursing of patients with severe septicemia (3) management of respiratory nursing (4) pre- and post-operative nursing (5) evacuation of critically ill patients (6)) prevention of complications (7) promotion of nutrition (8) anxiety reduction (9) health rehabilitation (10) discharge planning (11) nursing records. After using the guideline, professional nurses had statistically significant increase in practice, competency and knowledge (p < .05). The number of patients received antimicrobial drugs within 1 hour had increased.  Length of stay in ICU, medical expense, and the mortality rate were decreased. The incident rate of septicemia was not found.