Development of a Seamless Integrated Palliative Cancer Care Nursing System within the Maharat Nakhon Ratchasima Hospital Network in Nakhon Ratchasima Province
Keywords:
action research, caregivers' perception of patients' peaceful end of life, palliative care outcomes, health related quality of life, seamless nursing systemAbstract
End-stage cancer care in Thailand faces challenges regarding continuity of care services. This action research aimed to: 1) develop a seamless nursing care system, 2) study the outcomes of the seamless nursing care system, and 3) synthesize policy recommendations. The study was conducted from September 2024 to August 2025 and was divided into three phases: 1) situational analysis, 2) development of the seamless nursing care system, and 3) outcome evaluation with 46 end-stage cancer patients and 46 caregivers, divided into experimental and control groups of 23 participants each. Data was collected through in-depth interviews, focus group discussions, natural conversations, observations, document analysis, a palliative care outcome evaluation form, a quality of life assessment form, a caregiver perception assessment of patients' peaceful end of life, and a caregiver satisfaction questionnaire regarding palliative care. Data was analyzed using descriptive statistics, two-way repeated measures analysis of variance, t-tests, and content analysis.
The research findings revealed that the seamless nursing care system was comprised of three main components: 1) Input factors including patient factors, nursing factors, and service system factors; 2) Process components, consisting of a 5-phase care plan driven by the peaceful end of life theory concept, case management, primary nursing, nursing process, and telenursing; 3) Outcomes of the nursing system implementation demonstrated that the experimental group demonstrated superior palliative care outcomes, quality of life, caregiver perceptions regarding the patients' peaceful end of life experience, and caregiver satisfaction compared to the control group. The research findings led to the following significant policy recommendations: 1) consideration of curriculum revisions for Bachelor of Nursing Science and advanced specialty nursing programs; 2) identification of case manager roles in health service plans; 3) support for telenursing information technology, and 4) adjustment of indicators to reflect good death through peaceful end of life.
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