The Development of Evidence-Based Nursing Practice Guidelines for the Care of Patients with Intercostal Chest Drain in the Surgical Trauma Ward at Roi Et Hospital

Abstract

Purposes: The study aimed to investigate and analyze nursing problems in patients with chest tube drainage, to develop nursing practice guidelines for patients with chest tube drainage, and to evaluate the outcomes of implementing the nursing practice guidelines for these patients in the Trauma Surgery Ward of Roi Et Hospital.

Study design: This study was research and development.

Materials and Methods: The study was conducted from June to September 2025 and consisted of four phases: (1) situation analysis, (2) development of nursing practice guidelines, (3) implementation of the guidelines, and (4) evaluation. The participants were purposively selected and included 54 medical records of patients with chest tube drainage, 18 registered nurses, and 12 patients with chest tube drainage. The research instruments included a clinical data recording form, a guideline development record form, and a satisfaction evaluation form. Data were analyzed using descriptive statistics and content analysis.

Main findings: The study found that among 54 patients with chest tube drainage in the surgical trauma ward, most were male 90.7%with mean age 32 years. Adverse events occurred in 57.4% of patients, most commonly tube disconnection 45.2%, followed by pneumonia and lung atelectasis, each accounting for 16.1%. The mortality rate was 9.7%. Among nurses, it was found that they lacked sufficient knowledge and skills in monitoring complications, had inadequate equipment preparation, insufficient patient education and rehabilitation before discharge, and experienced communication gaps within the healthcare team. The developed nursing practice guideline for patients with chest tube drainage consisted of five phases: (1) patient admission, (2) patient preparation, (3) care during tube insertion, (4) lung re-expansion phase, and (5) tube removal and post-removal care. After implementing the guideline, patients showed a reduction in chest tube duration, hospital length of stay, and incidence of complications. Furthermore, nurses who applied the guideline reported a high level of satisfaction with its clarity, practicality, and effectiveness in improving patient outcomes.

Conclusion and recommendations: The developed nursing practice guideline for patients with chest tube drainage was effective in reducing post-procedure complications, shortening the duration of chest tube placement, and decreasing the length of hospital stay. It also enhanced staff satisfaction, reflecting outcomes consistent with evidence-based practices and demonstrating the potential for improving nursing service quality in the surgical trauma ward of Roi Et Hospital. For practical application, it is recommended that this guideline be formalized as a standard nursing manual for chest tube care and that regular workshops be organized for nurses in the surgical trauma ward to ensure consistent and effective implementation.