Development of a Nursing Care Model for Older Adults with Hip Fractures Undergoing Surgical Treatment at Pranangklao Hospital

Abstract

This study aimed to develop a nursing care model for elderly patients with hip fractures undergoing surgery. The research was conducted in three phases: Phase 1 involved a situation assessment; Phase 2 focused on the development of the nursing care model; and Phase 3 evaluated the outcomes following model implementation. The samples included of 70 medical records, an interdisciplinary team of 11 members, a quality improvement committee, 22 registered nurses, and 30 elderly patients with their caregivers in each group. Data were analyzed using content analysis, percentage, means, standard deviation, and dependent t-test. Results from Phase 1 revealed that patients had a mean length of hospital stay 10.8 days. Reported Complications included pressure ulcers 12.9%, urinary tract infections 10%, and deep vein thrombosis 4.3%. The key issues identified were non-standardized nursing practices, a lack of care coordinators, and the absence of continuity of care. Phase 2 resulted in the development of a nursing care model consisting of three stages of care planning, six categories of clinical practice guidelines, information-transfer protocols based on clinical pathway, patient and caregiver participation strategies, and a monitoring and evaluation system. In Phase 3, findings indicated that the mean length of hospital stay decreased to 7.36 days. The incidence of pressure ulcers declined to 3.3%, and no cases of urinary tract infections or deep vein thrombosis were reported. Patients expressed high levels of satisfaction, caregivers demonstrated moderate knowledge levels, and nurses showed statistically significant improvement in knowledge p < .01, with the highest level of adherence to the care model.