An Action Research Study on Development of Nursing Practice Guidelines for Orthopedic Surgical Patients in Operating Room, Kasetwisai Hospital

Abstract

Purposes: To study current conditions and problems, develop nursing practice guidelines, implement and evaluate them, and revise and disseminate the nursing practice guidelines for orthopedic surgery patients.

Study design: Research and Development (R&D)

Materials and Methods: The sample group, selected through purposive sampling, consisted of surgeons, operating room nurses, professional nurses, surgical assistants working in the operating room, and patients receiving orthopedic surgery services. The study was conducted from December 2023 to November 2027. The research was divided into four phases: (1) studying current conditions and problems, (2) developing the guidelines, (3) implementing and experimenting with the guidelines, and (4) revising, improving, and disseminating them. Data were collected using recording forms, focus group interview guides, and evaluation forms, and were analyzed using descriptive statistics and content analysis.

Main findings: 1)Practice gaps were identified across multiple dimensions, particularly in nursing practice and empowerment, which had the highest Priority Needs Index (PNI = 0.412), followed by specific care plans (PNI = 0.397), and identification of problems and needs (PNI = 0.362).  2)The developed nursing practice guidelines consist of seven steps: (1) physical examination and diagnosis, (2) verification of patient data accuracy, (3) provision of information and care plans, (4) preoperative assessment and preparation, (5) implementation of the surgical safety checklist, (6) postoperative monitoring and care, and (7) discharge planning. These guidelines demonstrated the highest level of appropriateness and feasibility 3)Following implementation, adherence to the nursing practice guidelines reached 100%. Patient safety outcomes showed successful prevention of severe errors, a 100% enhancement in the utilization of the Surgical Safety Checklist, and high levels of satisfaction, and 4)The revision and dissemination phase yielded additional recommendations to further enhance comprehensiveness, including the integration of a risk alert system, post-discharge patient follow-up, and the development of diverse communication media.

Conclusion and Recommendations: Based on these findings, the developed nursing practice guidelines effectively improve nursing outcomes and enhance patient safety.