การพัฒนาระบบบริการพยาบาลผู้ป่วยมะเร็งต่อมน้ำเหลืองที่ได้รับยาเคมีบำบัด โรงพยาบาลหนองคาย The Development of Nursing Service System for Patients with Lymphoma receiving chemotherapy at Nongkhai Hospital

Abstract

This action research aimed to develop the nursing services system for patients with lymphoma receiving chemotherapy and to study its outcomes at Nong Khai Hospital. The participants were eleven nurses, four health care professionals and 30 non-hodgkin's lymphoma patients admitted during October 1, 2016 to September 30, 2017. The study methodology followed the regulation of Kemmis & Mc Taggart (Planning Acting Observing Reflecting )and the Donabedian model.(Structure ProcessOutcom) The tools were the lymphoma’s patient care system receiving chemotherapy, which were operated by case managers. Data were collected by using observation, interview, test, focus group, and questionnaire. Quantitative data were analyzed by descriptive statistic and pair t-test. Qualitative data were analyzed by content analysis.

The results showed that the nursing services system of lymphoma’s patients receiving chemotherapy developed a structure and process by nurse case management system and coordinating of multidisciplinary team including the planning of Lymphoma management guideline, coordination, monitoring, and evaluation. The outcomes of the development of nursing services system are as follows: 1) The mean score of patients quality of life after receiving chemotherapy were statistically higher than those before (p<0.01), 2) The mean score of self care behavior after receiving the 2^nd chemotherapy were statistically higher than those in the 1^stchemotherapy (p<0.01), 3) The mean score of patients’ satisfaction was at the highest level (x ̅= 4.53 from 5), 4) The knowledge competency of nurse were at 90.8% , skill competency of nurses  were at 97.7% ,nursing practice using the guideline from the development of nursing services system were at 96% and they agreed to use the development of nursing service system at highest level (x ̅= 4.59 from 5), 5) The quality outcomes were revealed that the chemotherapy error (GHI Level) including extravasations and hypersensivity were not occurred. The adverse event of complication was at 20% and there was no patients denied chemotherapy treatment.

The development of nursing service system of lymphoma’s patients receiving chemotherapy by nurse case manager and multidisciplinary teams approaches had led to enhancing nursing competencies which can improve patients’ quality of life. It also suggests to promote more nurse case managers and continuity sharing knowledge of case management with multidisciplinary health care team to improve quality of care in this group of patients.