The Development of Clinical Supervision Model of Executive, Primary Level for Increase Quality Care in Patient with Sepsis, Phangnga Hospital
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Abstract
This research and development study aimed to (1) develop a clinical supervision model for executive-level nurse managers and (2) evaluate its effects on the knowledge, skills, attitudes, and satisfaction of first-line nurse managers and professional nurses, as well as patient outcomes in cases of sepsis. The study was conducted in four phases: (1) assessment of existing problems and needs, (2) model development, (3) implementation to assess effectiveness, and (4) evaluation and refinement of the model. Participants included 14 first-line nurse managers, 45 professional nurses, and medical records of sepsis patients before and after model implementation, with 30 cases per group. Research instruments consisted of: (1) focus group interview guidelines, (2) a clinical supervision manual, (3) knowledge tests, (4) skill assessment forms, (5) attitude questionnaires, (6) satisfaction surveys for both groups, and (7) care process records and patient outcomes. The content validity index (CVI) ranged from 0.93 to 1.00, and Cronbach’s alpha coefficients ranged from 0.656 to 0.990. Data were analyzed using descriptive statistics, paired t-test, Wilcoxon matched-pair signed-rank test, and chi-square test.
The findings revealed that the clinical supervision model comprised four components: supervisor preparation, supervision planning, implementation of supervision activities, and supervision outcome summarization. After implementation, both nurse managers and professional nurses demonstrated statistically significant improvements (p < .05) in knowledge, skills, attitudes, and satisfaction. Regarding patient outcomes, the rates of antibiotic administration within one hour, fluid resuscitation (1,000–1,500 ml/kg) within one hour, and ICU admission within three hours increased, while sepsis-related mortality and the incidence of septic shock decreased after applying the model.
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