Development of Clinical Nursing Practice Guideline for Weaning the Pediatric Patients from Mechanical Ventilator Admitted in Pediatric Intensive Care Unit, Saraburi Hospital
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Abstract
This research and development study was conducted to develop and explore a clinical nursing practice guideline (CNPG) for weaning from ventilator in pediatric patients and the effect of using the guideline for weaning from ventilator in pediatric patient at Saraburi hospital. This CNPG was based on the evidence-based practice of the Australian National Health and Medical Research Council as a conceptual framework. The implementation has four phases: 1) situation analysis 2) guideline development 3) guideline implementation and 4) evaluation of guideline implemented. The purposive sampling consisted of 12 registered nurses and 30 pediatric patients who were treated with ventilator in pediatric intensive care unit at Saraburi Hospital between the dates of 22 October 2020 to 30 June 2021. The research tool was CNPG for weaning the ventilator in a pediatric patient. The content validity was verified by 5 experts by reviewing the quality of clinical guidelines based on the Appraisal of Guideline for Research & Evaluation II (AGREE II) with all aspects scored greater than 60%, the overall mean score on 6 areas was 85.84%. The data were collected by the following questionnaires: the test of knowledge for nursing care for weaning from ventilator in pediatric patients, the ability to follow the CNPG, registered nurses' opinions toward CNPG, caregivers' satisfaction, recorded clinical results using CNPG. Data analysis used descriptive statistics consisting of frequency, percentage, mean, and standard deviation.
The results after applying the CNPG were as follows: 1) For the service providers, it was found that the questionnaire on the ability to follow the guideline to complete the 57 activities was 92 percent. The registered nurses agreed to apply the CNPG at a very high level (X̄ = 4.93, SD = .24). The knowledge before and after using the nursing practice guide was statistically significant (P < .05). 2) For the customers, the caregivers' satisfaction was at a high level (X̄ = 4.29, SD = .51). The outcome after applying the CNPG showed that the success weaning rate increased from 69.23% to 96.67%, the rate of re-intubation decreased from 6.67% to 3.33%. In terms of quality of care, severe complications during ventilator including pneumonia associated with ventilator decreased from 9.63 to 3.33 times per 1000 ventilator days, the average duration of mechanical ventilator decreased from 13.77 days to 6.26 days per person, the average medical expenses decreased from 99,821 baht to 71,199 baht per person, and the average length of stay in PICU decreased from 15.24 days to 10.52 days per person.
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