Nursing Care Improvement for Spinal Cord Injury Patients with Pressure Ulcers in the Community

Abstract

This action research aimed to improve nursing care for spinal cord injury patients with pressure ulcers in the community, within the context of Wapipathum district, Mahasarakham province, from October 2016 to September 2020. The participants consisted of four sectors (health, family, social, and community) and ten spinal cord injury patients with pressure ulcers. The study involved three phases: 1) situational analysis; 2) improvement; and 3) evaluation. Data collection was conducted using in-depth interview questions, questions for focused group discussions, observation methods, field notes, wound healing assessment forms, and quality of life questionnaires. The data were analyzed using descriptive statistics and content analysis.

Results revealed that spinal cord injury patients with pressure ulcers needed continuing care, but the services in the four sectors were fragmented. The nursing care model consisted of three elements as follows: (1) Inputs, including situational analyses within patient, caregiver, healthcare provider, community, and network. (2) process, T3C-MSE Model, including care Team : T, Community participation: C, Customer  focus: C, Modeling: M, Social support: S, Evaluation: E, Continuing: C.
(3) outcomes, including key performance indicators about patients, community networks, and healthcare provider team. After implementing the model, the average severity score of the patients' wounds decreased. The admission rate also decreased by 70%, and there were no readmitted patients. The average quality of life score reached a good level. Community networks and integrated care management were established. Nursing care management in transitional care and continuing care, as well as the tools and innovations throughout the trajectory of illness and care, were implemented and managed. The healthcare providers' team emphasized that the model improvement showed high-quality outcomes, with a high level of satisfaction.

Keywords : Nursing care improvement, Pressure ulcer care, Spinal cord injury patients,

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