Development of Nursing Service and Rehabilitation Guidelines for Stroke Patients with Intermediate Care

Abstract

This research and development study aimed to develop nursing care and rehabilitation guidelines for intermediate-stage stroke patients at Kasetwisai Hospital, Roi Et Province. The study was comprised of three phases: situation and problem assessment, development of nursing care and rehabilitation guidelines, and evaluation of implementation. The sample consisted of 35 stroke patients and 25 professional nurses and multidisciplinary team members. The research instruments included medical record data forms, focus group discussion guidelines, personal information questionnaires, knowledge assessment forms (CVI = 0.94), nursing practice evaluation forms (CVI = 0.90), quality of life assessment forms, satisfaction assessment forms (CVI = 0.92), and activities of daily living assessment forms. The study was conducted from October 2023 to September 2024. The data were analyzed using descriptive statistics, paired t-tests, and content analysis.

The situation and problem assessment revealed a re-admission rate of 30.35%, unclear and unsystematic patient care guidelines, and the staff’s lack of specialized knowledge and skills in patient care. Following this development, clear nursing care guidelines consistent with the organizational context were developed which were comprised of: 1) staff knowledge and skill development, 2) collaborative care among multidisciplinary professionals, 3) education and skill training for relatives and caregivers, 4) home and medical equipment preparation, and 5) follow-up systems using information technology. Results from the implementation of the nursing care guidelines showed that staff knowledge increased significantly (p < .001), with a high-level of guideline adherence (87.64%), which resulted in significantly increased patient Barthel Index scores. Additionally, 78.62% of patients showed reduced dependency levels and improved quality of life, and there was significantly increased satisfaction among both service providers and recipients (p < .001). This demonstrates that developing a service system with clear guidelines results in higher quality nursing care and patients receiving appropriate rehabilitation, which leads to improved ability to perform daily activities and a better quality of life.