Development of a Nursing Care Model for Critically Ill Patients with Respiratory Failure using the Six Building Blocks Framework based on Relationship-Based Care in the Intensive Care Unit, Lampang Hospital
Keywords:
Critically ill Patients, Relationship-Centered Care, Respiratory Failure Six Building BlocksAbstract
This research and development study aimed to 1) analyze the situation of patients with respiratory failure requiring mechanical ventilation, 2) develop a nursing care model for critically ill patients with respiratory failure, and 3) evaluate the outcomes of implementing this model. The study employed the Six Building Blocks framework, emphasizing Relationship-Based Care in the Intensive Care Unit at Lampang Hospital. This research was conducted in four phases: (1) analyzing medical records of 70 ventilated patients and conducting brainstorming group with 21 nurses; (2) developing a nursing care model based on the Six Building Blocks framework and the Relationship-Based Care Theory; (3) implementing the model with 42 randomly selected registered nurses and 140 patients using a quasi-experimental design with two-group posttest over 16 weeks; and (4) evaluating the model’s effectiveness using quantitative and qualitative methods, including descriptive statistics, paired t-tests, independent t-tests, Chi-square, multiple regression, and thematic analysis.
The results revealed that: (1) nursing practices for ventilated patients were outdated, with significant competency gaps and no clear policies; (2) the developed model included five components: respiratory care leadership, inter-professional clinical practice guidelines, nurse competency development, change management, and clinical supervision; and (3) after 16 weeks, nurses demonstrated significantly improved competencies and increased focus on relationship-centered care (t=5.59, p<.001). Patient outcomes also improved, including reduced ventilator weaning time (Mean=13.24, SD=2.50, p<.05) and significant reductions in ventilator-associated pneumonia (5.71%), reintubation (2.86%), and atelectasis (4.29%) (p<.05). The model effectively enhanced nursing competencies and reduced clinical complications.
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