A Model for Organizing a Case-based Bursing Service Network for Terminally Ill Patients in Karuna Pee Khumton Hospice Center, Roi Et Hospital
The purpose of this participatory action research were to develop and evaluate the outcomes of the case
based nursing service network model for terminally ill patients in Karuna Pee Khumton Hospice Center, Roi Et Hospital. The research participants were divided into 2 groups: 1) 26 professional nurses working at the terminal care centers of hospital, center and all community hospitals in Roi Et Province, and 2) 86 terminally ill patients admitted to the Hospice Center. The research process consisted of 4 phases: analyzing the situation of nursing service for terminally ill patients, developing the model, experimenting and improving the model, and evaluate the outcomes. Data were collected by observation, in-depth interviews, focus-group, questionnaires, brainstorming and reflection. Data collection tools were questionnaires, interview forms, and focus-group guidelines. The research was done during 1st-June 2016-31st -July 2018. Quantitative data were analyzed by frequency distribution and percentage. Qualitative data was analyzed by content analysis.
Results: The analysis of the situation of nursing service for terminally ill patients found that the services had
a variety of service forms resulting in terminally ill patients and their families receiving different care. Nursing staff and multidisciplinary teams were lack of knowledge, skills and positive attitude in caring for the patients. Lack of funding, lack of equipment needed for home care for terminally ill patients were aslo found. As for the patients, it was found that some patients and their families were poor: and some families were unable to take the patients home by themselves. The developed model of case-based nursing service network for terminally ill patients, Karuna Pee Khumton Hospice Center, Roi Et Hospital consisteds of 3 components, First, the concept for identifying problem issues of the care for terminally ill patients from hospitals to the community had 6 aspects. Secound, management of pallitative nursing service system for terminally ill patients. Third, the operational process of the case-based nursing service network for terminally ill patients. The outcomes of the developed model were found that nurses case managers and ultidisciplinary hospice care network have good knowledge, skills, and attitudes about hospice care, competency assessed through 80%, target patients increased access to hospice center services, increased use of opioid for pain management and patient relief, and the patients had pain symptoms decreased from severe to moderate, patients and their relatives were less stressed and nervous, receive more continued care at home, and the overall satisfaction of the caretaker relatives was at a high level. Evaluating the pattern and acceptance level of nurses using the development model found that overall was at a high level. Conclusion: The development of a case-based nursing service network model for terminally ill patients, provides holistic care through the participation of a multidisciplinary team, resulting in higher quality and efficient services, and also resulting in high levels of satisfaction for patients and caregivers. Therefore, the developed model should be used continuously in taking care of patients with regular follow up and evaluation.
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