Development of Clinical nursing management model in patient with head injury in Emergency department
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Abstract
Abstract
This research and development study aimed to develop and evaluate the outcomes of a clinical nursing management model for patients with head injuries in the Emergency Department of Hatyai Hospital. The study was conducted in two phases: (1) development of the model based on the National Health and Medical Research Council (NHMRC) framework, and (2) implementation and evaluation. The participants included 35 emergency nurses and 230 patients with mild to moderate head injuries. Research instruments included a clinical screening and management assessment form, a nursing competency assessment form, and a patient data record form. All instruments were validated by three experts, and reliability coefficients (Cronbach’s alpha) were 0.80, 0.70, and 0.89, respectively. Quantitative data were analyzed using descriptive statistics and Chi-square tests, while qualitative data were analyzed using content analysis.
The developed model consisted of six key components: (1) nursing competency, (2) triage and reassessment, (3) clinical nursing practice guidelines, (4) referral processes, (5) monitoring and continuous follow-up, and (6) continuity of care through multidisciplinary collaboration. After implementation, nurses’ knowledge and competency scores showed an increasing trend but were not statistically significant (p > 0.05). In terms of process outcomes, nurses rated the model as clear, easy to use, and feasible for implementation at a high level (Mean = 3.63-4.34). For clinical outcomes, patients with mild head injuries demonstrated significantly improved pain management, with the proportion achieving a pain score ≤ 3 increasing from 67.9% to 81.7% (χ² = 5.471, p = 0.014). Among patients with moderate head injuries, pain control and body temperature regulation improved significantly (p < 0.05), while levels of consciousness, blood glucose, and oxygen saturation showed improving trends but were not statistically significant. Additionally, the completeness of reassessment documentation increased significantly from 57.1% to 97.6% (p < 0.001), and family satisfaction was rated at a high level (Mean = 4.40, SD = 0.603).
These findings indicate that the developed model can effectively improve the quality of care for patients with head injuries in both care processes and clinical outcomes, particularly in pain management and continuity of care.
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