Effects of Evidence-based Nursing Practice Guidelines for Monitoring and Preventing Deterioration due to Complication in Ruptured Cerebral Aneurysm Patients

Abstract

This research and development aimed to develop evidenced-based nursing practice guidelines for ruptured cerebral aneurysm (EBNPG-RCA) patients who were admitted at Maharat Nakhon-Ratchasima Hospital for monitoring and preventing deterioration. The study had been conducted from September 2022 to December 2023. It consisted of three stages: 1) Developing the guidelines (from evidence-based nursing practice guidelines based on framework of Soukup [2000]. The guidelines were verified in accordance with the AGREE-II guidelines by five experts. The developed set of guidelines’s AGREE-II value was 88.98. The second stage was conducting trials of the guidelines and improving them. The final stage was the evaluation of the guidelines that were developed with a group of 50 patients who were recruited into the study by purposive sampling and that met the study’s inclusion criteria (i.e. first-time having an RCA diagnosis and aneurysm clipping). The participants were placed in an experimental group (n=25) and a control group (n=25) to allow comparison of the two groups’ outcomes. The research tools included the new EBNPG-RCA guidelines, the deterioration assessment form, the clinical practice assessment form, and the satisfaction toward EBNPG-RCA implementation assessment form. The data were analyzed using frequencies, percentages, Chi-square tests, and Mann–Whitney U tests.

       The study yielded an EBNPG-RCA for monitoring and preventing deterioration from complication was developed. However, when the clinical outcomes (e.g. deterioration incidence caused by delay in physician consult, complications, mortality rate, re-operation within 24 hours, unplanned return to ICU, ICU admission days, and in-hospital days) of the experimental and control groups were compared, they were no statistically significantly different. Nevertheless, the ICU admission days and hospital days for the experimental group were lower than those of the control group. This would suggest that the quality of guidelines had shown an acceptable level of benefit to justify their use in practice. Therefore, the EBNPG-RCA guidelines that were developed would be a useful tool for assessing and monitoring t patients to prevent deterioration from complications in order to treat them properly and immediately.