The Development of Clinical Nursing Practice Guidelines for Weaning from Mechanical Ventilator Support in General Wards at Somdech Phra Pinklao Hospital

Abstract

          This research and development aimed to develop clinical nursing practice guidelines and examine the effects of implementing these guidelines for weaning from mechanical ventilator support in general wards at Somdech Phra Pinklao Hospital. The guidelines were developed by applying Soukup’s four-step evidence-based approach: identifying and analyzing clinical problems, searching for evidence, trial and evaluation of the practice guidelines, and implementing and evaluating the guidelines in practice. The weaning process was divided into three phases: pre-weaning, weaning, and post-weaning. The sample included two groups: 24 professional nurses and 30 patients diagnosed with respiratory failure who were treated with intubation and mechanical ventilation in male and female general medical wards at Somdech Phra Pinklao Hospital from March to June 2024. The research instruments were clinical nursing practice guidelines for ventilator weaning in general wards, a knowledge assessment form on ventilator weaning, a satisfaction questionnaire on the use of the guidelines, a readiness assessment form for ventilator weaning, a weaning phase record, and an evaluation of the weaning outcomes. The content validity index (CVI) values were 0.83, 0.80, 0.80, and 1, respectively. The reliability of the knowledge assessment on ventilator weaning was 0.92, while the reliability of the satisfaction questionnaire on the use of the guidelines was 0.71. Data were analyzed using descriptive statistics, and knowledge scores were compared using the t-test.
          The results showed that the average knowledge scores after training were significantly higher than those before training at the .05 level. Overall, the nurses’s satisfaction with the guidelines was high (Mean = 4.10, SD = 0.74), with the highest satisfaction in the aspect of enhancing nurses' knowledge and confidence in caring for patients undergoing ventilator weaning (Mean = 4.54, SD = 0.50). Regarding clinical outcomes, the success rate of weaning from mechanical ventilation increased from 58.67% to 90.00%. The average weaning time was 38 hours, and the average duration of mechanical ventilation was 3.87 days.