การใช้โปรแกรมบูรณาการบทบาทผู้ปฏิบัติการพยาบาลขั้นสูงร่วมกับการดูแลแบบสหสาขาวิชาชีพในการพัฒนาคุณภาพการดูแลผู้ป่วยปวดหลังส่วนล่างที่ได้รับการผ่าตัด

อัญชลี ยศกรณ์; สุภาพ อารีเอื้อ; พงษ์วัฒน์ พลพงษ์

Authors

อัญชลี ยศกรณ์ สถาบันประสาทวิทยา กรมการแพทย์ กระทรวงสาธารณสุข
สุภาพ อารีเอื้อ Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University
พงษ์วัฒน์ พลพงษ์ Department of Neurosurgery, Prasat Neurological Institute

Keywords:

advanced practice nurse, low back pain, spine surgery

Abstract

This quasi-experimental research, two-group pre-posttest, aimed at investigating the effects of the advanced practice nurse role integrated with a multidisciplinary approach program on patients outcomes including functional ability and complications (deep vein thrombosis, surgical site infection, and urinary tract infection) and hospital outcomes which included length of hospital stay and patient satisfaction to nursing care. Sixty patients with low back pain who underwent surgery in a tertiary hospital in Bangkok, from June, 2016 to February 2017, were recruited to participate in this study based on the inclusion criteria. The control group (n = 30) received usual care, while the intervention group (n = 30) was given usual care plus the advanced practice nurse role integrated with multidisciplinary approach program (intervention program). Data were collected on the day of admission, discharge, and 4-week post-surgery by using standard measurements. Data were analyzed by using descriptive statistics, Chi-square statistics, and t-test. A statistically significant level was set at .05.

The results showed that the intervention group had a better functional ability differently from the control group with no statistical significance at the level of. 156. For postoperative complications including deep vein thrombosis and surgical wound infection, there were differences between groups, but they were not reached to a statistically significant difference (p = 1.000 and .237, respectively). Urinary tract infection was not found in both groups. For the hospital outcomes, it was found that the average length of hospital stays in the intervention group was less than that in the control group (M ± SD = 6.85 ± 4.07; 7.28 ± 3.59, respectively), but no statistically significant difference (p = .681; t = .414). However, for patient satisfaction with nursing services, it was found that the intervention group had a higher mean score than the control group (M ± SD = 65.93 ± 5.34; 59.48 ± 7.11, respectively) with a statistically significant difference at the level of .000 (t = 3.808).

Downloads

Download data is not yet available.

References

Army Medical Department, The Royal College of Neurological Surgeons of Thailand, The Rayal College of Orthopaedic Surgeon of Thailand, Office of the Higher Education Commission, & Prasat Neurological Institute. (2558). Guideline for management of thoracolumbar spine injury. In K. Veerasarn (editor). Bangkok.

Azizpour, Y., Delpisheh, A., Montazeri, Z., & Sayehmiri, K. (2017). Prevalence of low back pain in Iranian nurses: a systematic review and meta-analysis. Biomed Central Nursing, 16, 50. doi:10.1186/s12912-017-0243-1

Bryant-Lukosius, D., Dicenso, A., Browne, G., & Pinelli, J. (2004). Advanced practice nursing roles: Development, implementation and evaluation. Journal of Advanced Nursing, 48(5), 519-529. doi:10.1111/j.1365-2648.2004.03234.x

Chiangthong, K., & Bunmaprasert, B. (2007). Degenerative diseases of the spine. Chiangmai: Sangsilp Printing.

Desai, A., Ball, P. A., Bekelis, K., Lurie, J., Mirza, S. K., Tosteson, T. D., . . . Weinstein, J. N. (2012). Surgery for lumbar degenerative spondylolisthesis in SPORT: Does incidental durotomy affect outcome? Spine, 37(5), 406-41. doi:10.1097/BRS.0b013e3182349bc5

Earsing, K. A., Hobson, D. B., & White, K. M. (2005). Best-practice protocols: Preventing central line infection. Nursing Management, 36(10), 18-24.

Farajirad, E., Tohidi, H., & Farajirad, M. (2016). Comparison of the frequency of psychiatric disorders among patients with chronic low back pain and control group. Asian Journal of Neurosurgery, 11(3), 287-291. doi:10.4103/1793-5482.175618

Fry, D., & Fry, R. (2007). Understanding what it takes to stop surgical site infections. Mater Manag Health Care, 16(5), 26-30.

Galvin, M., Ryan, P., Maguire, S., Heverin, M., Madden, C., Vajda, A., . . . Hardiman, O. (2017). The path to specialist multidisciplinary care in amyotrophic lateral sclerosis: A population- based study of consultations, interventions and costs. PLoS One, 12(6), e017979. doi:10.1371/journal.pone.0179796

Gearhart, M. M., Luchette, F. A., Proctor, M. C., Lutomski, D. M., Witsken, C., James, L., . . . Frame, S. B. (2000). The risk assessment profile score identifies trauma patients at risk for deep vein thrombosis. Surgery, 128(4), 631-640.
doi:10.1067/msy.2000.108224

Halpin, R. J., Sugrue, P. A., Gould, R. W., Kallas, P. G., Schafer, M. F., Ondra, S. L., & Koski, T. R. (2010). Standardizing care for high-risk patients in spine surgery: The Northwestern high-risk spine protocol. Spin, 35(25), 2232-2238. doi:10.1097/BRS.0b013e3181e8abb0

Haynes, A., Frederick, A., & Chirkoff, A. (2012). APN plan improves outcome for pregnant patient with congenital heart disease. AACN Advanced Critical Care, 23(2), 142-154. doi:10.1097/NCI.0b013e318245381a

Hsueh, M. T.-F., & Dorcy, K. S. (2016). Improving transitions of care with an advanced practice nurse: a pilot study. Clinical Journal of Oncology Nursing, 20(3), 240-243. doi:10.1188/16.CJON.240-243

Jane, W., Faux, S. G., Estell, J., Wilson, S., Harris, I., Poulos, C. J., & Klein, L. (2017). Early rehabilitation after hospital admission for road trauma using an in-reach multidisciplinary team: A randomised controlled trial. Clinical Rehabilitation, 31(9), 1189-1200. doi:10.1177/0269215517694462

Jonasson, L-L., Holgersson, A., Nytomt, M., & Josefsson, K. (2017). Preconditions for district nurses’ telephone counselling during call-time in municipal home care: An observational study. Nordic Journal of Nursing Research, 37(1), 12-19. doi:10.1177/2057158516658810

Knutsson, B., Michaelsson, K., & Sanden, B. (2013). Obesity is associated with inferior results after surgery for lumbar spinal stenosis: A study of 2633 patients from the Swedish spine register. Spine, 38(5), 435-441. doi:10.1097/BRS.0b013e318270b243

Leung, G. K., Ng, G. K., Ho, W., Hung, K. N., & Yuen, W. K. (2012). Impact of a multidisciplinary trauma team on the outcome of acute subdural haematoma. Injury, 43(9), 1419-1422. doi:10.1016/j.injury.2011.03.017

Malathum, K., & Asanasan, S. (2013). A Guide to precautiona and control of infection in hospital. Bangkok: Bamrasnaradura Institute Department of Disease Control, Ministry of Public Health.

Phillips, F. M., Slosar, P. J., Youssef, J. A., Andersson, G., & Papatheofanis, F. (2013). Lumbar spine fusion for chronic low back pain due to degenerative disc disease: A systematic review. Spine, 38(7), E409-422. doi:10.1097/BRS.0b013e3182877f11

Pothisarn, J. (2011). The synthesis of practice guidelines for prevention of deep vein thrombosis in hospitalized elderly undergoing knee and hip surgery (Master degree in adult nursing). Mahidol University, Bangkok.

Prasat Neurological Institute. (2551). Clinical nursing practice guidelines for Surgical Spine. Bangkok.

Roopsawang, I., Aree-Ue, S., & Putwatana. P. (2009). A follow-up study of health status in patients with chronic low back pain before and after spinal surgery. Ramathibodi Nursing Journal, 15(3), 344-360.

Sakulsriprasert, P., Vachalathiti, R., Vongsinavarat, M., & Kantasorn, J. (2006). Cross-cutural adaptation of modified oswestry low back pain disability questionnaire to Thai and Its Reliability. Journal of the Medical Association of Thailand, 89(10), 1694-1701.

Sathira-Angkura, T., & Khwansatapomkoon, K. (2014). PEPPA Framework for advanced practice nurse role development. Journal of Nursing Divition, 41(2), 84-96.

Sugrue, P. A., Halpin, R. J., & Koski, T. R. (2013). Treatment algorithms and protocol practice in high-risk spine surgery. Neurosurgery Clinics of North America, 24(2), 219-230. doi:10.1016/j.nec.2012.12.012

Suwisith, N., & Hanucharurnkul, S. (2011). Development of the patient satisfaction with nursing care questionnaire. Ramathibodi Nursing Jounal, 17(2), 264-277.

Vialle, E., Oliveira Pinto, B., Vialle, L., & Gomez, J. (2015). Evaluation of psychosomatic distress and its influence in the outcomes of lumbar fusion procedures for degenerative disorders of the spine. European Journal of Orthopaedic Surgery & Traumatology, 25, 25-28.