ประสิทธิผลของการพัฒนาระบบการพยาบาลการใช้แนวปฏิบัติที่สร้างจาก หลักฐานเชิงประจักษ์ต่อคุณภาพการดูแลผู้บาดเจ็บที่ศีรษะชนิดรุนแรง(Effectiveness of Nursing System Development in Using Evidence-based Protocol on Quality of Care in Patients with Severe Traumatic Brain Injury)

บทคัดย่อ

The purposes of this study were to examine the effectiveness of nursing system development in usingthe evidence-based protocol, regarding clinical and hospital outcomes, in patients with severe traumatic braininjury. Eighty –three nurses in three units including emergency, intensive care and surgical units participated inthis study. A purposive sampling of 56 patients (30 for retrospective and 26 for prospective group) were recruitedfor the study. CURN model was used as a conceptual framework for the system development, which includedidentifying problem, protocol development, implementing protocol, and evaluation of the system and outcomes.The evidence-based protocol designed for each unit was used in caring of the patients during hospitalization.Instruments used to collect data included nurse’s satisfaction questionnaire, caregivers’ satisfaction questionnaire,and quality of care recording form. Descriptive statistics, paired t-test, Mann-Whitney U test and Chi-Squarewere used to analyze data.The findings showed that after the system development, nurses had a higher job satisfaction, hypotensionand hypoxemia were found in the early stage, ventilator using day decreased from 6.05 days to 5.48 days, costper day reduced from 20,237 to 12,756 Baht. No incidence of VAP and unplanned extubation was found. Themean scores of caregivers’ satisfaction were at a high level. This study suggests the benefits of CURN model inusing the evidence-based protocol for caring patients with severe traumatic brain injury regarding hospital andpatients outcomes.