The Development of Clinical Nursing Practice Guidelines for Anesthesia to Prevent Postoperative Delirium in Elderly Patients in Sunpasitthiprasong Hospital

Abstract

This action research aimed to 1) develop nursing guidelines for providing anesthesia to prevent postoperative delirium in elderly patients and 2) test the effectiveness of the nursing guidelines developed in a two cycle process. Cycle 1 was the development of the nursing guidelines according to Soukup's model for using evidence-based practices in nursing. Cycle 2 provided testing of the effectiveness of the nursing guidelines using a quasi-experimental study to evaluate the practice guidelines. The study participants included a group of 30 nurse anesthetists and 10 professional nurses who provided care based on the guidelines and a group of 30 elderly surgery patients who received care based on the guidelines. To test the effectiveness of the guidelines, data was retrieved from the medical records of 132 elderly patients who were randomly selected from the hospital’s database, 66 of the patients were assigned to the comparison group and 66 were assigned into the experimental group. The research tools were: 1) the nursing practice guidelines that were developed; 2) the Confusion Assessment Method Thai version (CAM-T); 3) the patient information records and POD assessment forms: 4) an opinion evaluation form for the nurse anesthetists and registered nurses who followed the guidelines; 5) a satisfaction assessment form for the nurse anesthetists and registered nurses; 6) a patient satisfaction assessment form; and 7) an assessment of ability to follow the recommendations within nursing practice guidelines  collected from the nurse anesthetists and registered nurses. Data were analyzed using descriptive statistics, Chi-square tests, and Mann-Whitney U Tests.

Results:  The quality of the guidelines that were developed was assessed based on criteria from 18 prior studies and the AGREE II standards, which yielded an overall score of 83.60%, indicating high quality. Nurse and healthcare professional opinions on the practices were highly agreeable. After implemantation of the guidelines, the effectiveness of the practices resulted in a) an immediate reduction of postoperative confusion from 15.20% to 7.60%, b) no complications, c) 70.60% compliance by the nurses with the nursing practice guidelines, d) 72.50% of nurses anesthetists expressing high satisfaction with the guidelines, and e) 86.70% of patients expressing that they were highly satisfied with the guidelines. In conclusion, the implemented nursing practices effectively prevented immediate postoperative confusion, indicating increased knowledge and ease of application among nurses and high satisfaction levels among patients.