The Development of Effective Nursing System to Prevent Drug-resistant Infections in Newborns in Phra Nakhon Si Ayutthaya Hospital

Abstract

     This action research aimed to (1) determine the situation, problem and obstacles (2) develop an effective nursing system and (3) study the result of develop an effective nursing system prevent drug-resistant infections in newborns in Phra Nakhon Si Ayutthaya Hospital. The research was conducted during October 2017 - March 2019 and divided into 3 phases. Phase 1 began with the thorough investigation of situations by reviewing the 138 medical records of newborn with drug-resistant infections in 2017 and group discussion between 24 nurses who taking care of newborn with drug-resistant infections. The content analysis was done by using the descriptive statistics such as percentage. Then, several changes were made in phase 2 in order to improve the nursing system for preventing drug-resistant infections in newborns by using the Kermmis & Mc Taggart concept in term of PAOR and using Proctor concept for clinical supervision in nursing. The participants consisted of 110 newborns and 75 professional nurses who worked within the neonatal care unit of Phra Nakhon Si Ayutthaya Hospital. The data collection tools were (1) the guideline to the prevention of infections and the distribution of drug-resistant pathogens in newborns, (2) the competency evaluation form, (3) the compliance evaluation form, (4) the personal data collection forms for nurses and newborns, and (5) the incidence report form. The quantitative data analysis was done by using the descriptive statistics such as percentage, mean and standard deviation. In phase3 Evaluate the results of development in nursing system to preventing drug-resistant infections in newborns. The quantitative data analysis was done by using the descriptive statistics such as percentage, mean and standard deviation, t-test and z-test, while the qualitative data analysis was done by using content analysis. The results of each phase were as follows. In phase 1, it was found that several areas within the current nursing system still needed to be addressed such as the operation-unfriendly environment, the nonsystematic work process and the inappropriate management. In phase 2, several changes were implemented within the neonatal care unit of Phra Nakhon Si Ayutthaya Hospital in order to better prevent drug-resistant infections in newborns. Such improvements included revising the practice guidelines, strengthening knowledge and competencies of the participating nurses, and enhancing the nursing administration system, the environmental system inside the ward and the risk management system. In phase 3, the transparent policy affected the working process where the comparisons were made between before and after implementing the such changes from phase 2, several improvements were observed. In terms of average knowledge score, the nurses performed better with a statistical significance (p<.05) after receiving the training. As for competencies, the nursing quality development, the nursing management, and the drug administration demonstrated statistically significant rise (p<.05). While the ethical decision making was the only competency that did not show a significant increase. Therefore, in terms of competency, the nurses performed better overall with statistical significance (p<.05) after receiving the training. Meanwhile, the hospital infection rate and the drug-resistant infection rate in newborns tended to decrease with statistical significance (p<.05). Also, the mortality rate of newborns due to drug-resistant infections and the incidence of pandemic infections tended to reduce. However, the complaints regarding the quality of newborn care showed the tendency to build up. From all the evidences stated above, it could be concluded that the nursing system to prevent drug-resistant infections in newborns would be effective only if all parties developed a common awareness and shared responsibility in following the practice guidelines and established the systematic work process, together with a regular creative supervision.