Development of Discharge Plan Practice Guideline for Palliative Care Patients at Kosum Phisai Hospital

Abstract

Purposes: This study aimed to explore existing problems, develop, and evaluate the effectiveness of a discharge plan practice guideline for palliative care patients at Kosum Phisai Hospital, Maha Sarakham Province.

Study design: An action research design based on the framework of Kemmis and McTaggart was employed.

Materials and Methods: The participants consisted of three groups: 1) 10 registered nurses, 2) 30 hospitalized terminally ill palliative care patients, and 3) 30 primary caregivers. Research instruments included focus group discussion guidelines, quality of life assessment forms, self-care ability assessment forms, caregiver satisfaction questionnaires, nurse satisfaction questionnaires, and the developed discharge plan practice guideline. The content validity index (CVI) of the guideline was 0.96. Qualitative data were analyzed using content analysis, while quantitative data were analyzed using percentages and paired t-tests.                                                                                                                                                 

Main findings: The main problems identified were lack of holistic care, insufficient communication, and inadequate identification of primary caregivers. The developed discharge plan practice guideline was based on the D–METHOD–P framework, comprising: 1) communication with patients and caregivers for advance care planning, 2) symptom management and psychosocial support, 3) training of primary and secondary caregivers, 4) preparation of medical equipment, and 5) coordination with healthcare and community networks. After implementation, patients’ quality of life significantly improved (p < .001), while no significant difference was found in self-care ability. Caregivers reported the highest level of satisfaction (Mean = 4.61, SD. = 0.50), and registered nurses also demonstrated the highest level of satisfaction (Mean = 4.80, SD. = 0.43).                                                                                                                       

Conclusion and Recommendations: The developed discharge plan practice guideline effectively enhanced the quality of life of terminally ill palliative care patients and increased satisfaction among caregivers and registered nurses. It is recommended that home visit follow-up care be implemented to ensure continuity of care after hospital discharge.