The Development of Anesthesia Care Management Model for Aging Patients undergoing Total Hip Arthroplasty through Applying Enhanced Recovery After Surgery Model in Krabi Hospital
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Abstract
This research and development aimed to study the situation, develop a model, and examine the effectiveness of anesthesia care management model among older adults undergoing total hip arthroplasty by applying recovery enhancement program after surgery in Krabi hospital. The implementation process had 3 stages. Stage 1 was study the situation by analyzing documents and using qualitative method. The informants were 15 nurse anesthetists. Data were analyzed using content analysis. Stage 2 was development of a model by using research results from stage 1 before drafting a model which was validated by a panel of 3 experts. Stage 3 was study the effectiveness of developed model by using one group pretest and posttest quasi-experimental research. The sample were 15 nurse anesthetists and 50 patients. Data were analyzed using descriptive statistics, one sample t-test, Wilcoxon signed-rank test and repeated measure ANOVA. The research results were as follows:
1. For the situation, it was found that patients undergoing total hip arthroplasty had physical deterioration and co-morbidities which resulted in late recovery after surgery, caused complications and nurse anesthetists lacked training of rapid recovery.
2. The model of anesthesia care management among older adults undergoing total hip arthroplasty consisted of 3 phases including pre-anesthesia, peri-anesthesia and post- anesthesia. The model emphasized patient preparation by a multidisciplinary team from the preoperative phase to ensure safety, prevent complications, and promote faster recovery, as well as information transfer and post-discharge follow-up.
3. After using the model, nurse anesthetists at Krabi hospital had significantly higher knowledge and satisfaction of using the model (p = .001). Whereas older adults undergoing total hip arthroplasty with anesthesia had significantly lower mean pain scores. The average pain scores tended to decrease from the first 24 hours after surgery, and all elderly patients had pain scores not exceeding 3 at 72 hours and before discharge, which was statistically significant (F = 27.26, p < .001). The patients could perform the same activities of daily living after 1 week of discharge (88%) and had significantly higher satisfaction of using the model more than 80% of criteria (p = .001).
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