Development and Outcome Evaluation of Using Clinical Nursing Practice Guideline for Pain Management and Early Mobilization in Critically Ill Pediatric Patients
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Abstract
Abstract
This research and development aimed to develop a clinical nursing practice guideline for pain management and early mobilization in critically ill pediatric patients and evaluate outcomes of using the guideline. A sample consisted of 19 registered nurses and 102 critically ill pediatric patients. This study comprised of 2 phases: (1) guideline development (2) evaluation of using the guideline. Research instruments consisted of (1) clinical nursing practice guideline for pain management and early mobilization in critically ill pediatric patients, (2) practice assessment form, (3) satisfaction questionnaire of the guideline users (4) usability and feasibility of the guideline which had .95 of content validity index and 1 of inter-rater reliability. Data were analyzed using mean, standard deviation, and independent t-test.
Research results revealed that the clinical nursing practice guideline for pain management and early mobilization in critically ill pediatric patients consisted of (1) pain management activity that involved pain assessment, pain management, and assess the appropriateness of drug use (2) early mobilization activity that included assessment of limitations and risk, choosing appropriate early mobilization activity and safety monitoring. Outcome evaluation found that the mean of ventilator-days and PICU length of stay of the group after using the guideline was significantly lower than before using the guideline at p < .05 (Mean 2.84 SD 1.67 and Mean 3.73 SD 1.93) and (Mean 4.43 SD 2.28 and Mean 5.71 SD 1.97) respectively. Trend of ventilator-associated pneumonia rate after using practice guideline was reduced from 6.77 to 5.22:1,000 ventilator-days, percentage of using practice guideline was 96.01, feasibility of using practice guideline and nurses’ satisfaction was at a high level. (Mean 3.69 SD 0.47 and Mean 3.69 SD 0.47).
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