Development of Nursing Guidelines for Hemorrhagic Stroke atients in the Neurosurgery Intensive Care Unit at Roi Et Hospital

Abstract

This research and development project aimed to develop evidence-based nursing practice guidelines for hemorrhagic stroke patients in the neurosurgery intensive care unit at Roi Et Hospital.  The study was divided into four phases: study of the situation, development of the nursing guidelines, testing, and evaluation. There were two groups of participants: the providers, which included 37 nurses and other multidisciplinary professionals in the care teams, and the recipients: 70 hemorrhagic stroke patients and their families. The participating patients and their families were spread across the four phases of the study as follows: 35 patients participated in the situation study phase with 30 patients serving as a control group and five patients acting as key informants providing qualitative data, another five patients participated in the program testing phase, and the remaining 30 patients participated in the evaluation phase. The research instruments included in-depth interviews, group discussion questions, a satisfaction with practice guidelines assessment form, an implementation of practice guidelines observation form, complication record forms, and a knowledge test form. The percentage of complications, satisfaction score, and implementation of practice guidelines scores were analyzed using averages and standard deviations; the mean nurse's knowledge scores on the pre-post tests were compared using paired sample t-tests; and content analysis employed for qualitative data analysis. 

      The results revealed weak points which needed to be improved: 1) the recipients experienced complications and their families were stressed and anxious and 2) the providers had a lack of nursing practice guidelines and outcome measurements. The development process was implemented and included cultivating a spirit of inquiry; asking clinical questions in PICO format; searching for the best evidence; determining the evidence; and development and evaluation of the evidence-based guidelines. Assessment of the guidelines by clinical experts revealed a guideline quality score of 91%. Additionally, the nursing guidelines were composed of two points of care, specifically critical emergencies and rehabilitation. The results showed that 53.33% of the experimental group did not have secondary complications, while 46.67% did have complications, but they were under control. The guidelines were implemented at a “most level”. The nurses' satisfaction was high and their knowledge scores were significantly different before and after implementing the guidelines (p<.05).