Development of a Nursing Management Model for Preventing Pressure Ulcers among Neurosurgical Critical Patients

Abstract

This research and development aimed to develop and study the effectiveness of a nursing management model for preventing pressure ulcers among neurosurgical critical patients, Mahasarakham Hospital. Four steps in the development of a model were: 1) situational analysis; 2) model development; 3) implementation to determine a model’s effectiveness with 120 neurosurgical critical patients and 18 registered nurses; and 4) model evaluation, improvement, and confirmation. The research instruments consisted of the pressure ulcer record form, the questions for a focused group discussion, the questionnaire of model’s structure, the nursing care observation checklist with reliability of 1, the questionnaire of nurses’ competency on pressure ulcer prevention with reliability of .82, and the questionnaire of nurses’ opinions on the developed model with reliability of .87. The implementation and data collection were conducted from October, 2020 to March, 2022. Data were analyzed using frequency, percentage, mean, standard deviation, Chi-square test, Mann-Whitney U Test, and content analysis.

The research results revealed that 1) the nursing management model for preventing pressure ulcers consisted of three elements as following: (1) inputs, including policy and improvement plan, structure, job description of head ward and nursing supervisor, nursing competency, and facilities; (2) process, P-PECS Framework for implementation of pressure ulcer prevention, including participation, patients center, evidence based practice, nursing competency enhancement, and nursing supervision; and (3) outcomes, including key performance indicators about structures, processes, and outcomes. 2) After implementing the model, the patients had statistical significance lower incidence of pressure ulcer than before implementing the model (p < .001). All nurses had practiced following the guideline and they had statistical significance perceived patient care competency to prevent pressure ulcers higher than before implementing the model (p < .001). 86.54% of the nurses highlighted that the model improvement was good at quality with a high satisfaction level of the model (M = 4.35, SD = .87).

This research suggests that other healthcare facilities should adopt this nursing management model to prevent pressure ulcers among neurosurgical critical patients.