Effects of Nursing Team Development on Quality of Nursing Care in a Cardiovascular-Thoracic Surgical Intensive Care Unit - ผลการพัฒนารูปแบบทีมการพยาบาล ต่อคุณภาพการพยาบาล ในผู้ป่วยหนักศัลยกรรมหัวใจและทรวงอก

Abstract

           The objective of this study was to evaluate the effects of nursing team development on the quality of nursing care in the cardiovascular-thoracic surgical intensive care unit of Buddhachinaraj Phitsanulok Hospital, Phitsanulok Province, Thailand. The effects to be assessed were the mortality rate, the incidence of ventilator-associated pneumonia, and the opinions of nurses about the nursing team development. It was conducted as a mutual collaborative action research. Participants were 18 registered nurses working at the cardiovascularthoracic surgical intensive care unit of the hospital during October 2010 to September 2013. The study process consisted of three steps: first, situation analysis to assess the current situation and the need to develop a nursing team; second, developing the nursing team through mutual collaboration; and third, evaluating the team development through participants’ opinion and treatment outcome data from patient’s medical records. Research instruments included nosocomial infection record form, demographic data of registered nurses, and records of participating nurses regarding the nursing team development. Quantitative data were analyzed by using frequency and percentage. Qualitative data were analyzed by using content analysis. As for the results, 3 different team patterns were sequentially organized. In 2011 the nursing team was organized by assigning as an individual case assignment with mentor (not included in personnel shift ratio). In 2012, the nursing team was fromed by individual case assignment with incharge supervisors who were included in the personnel shift ratio. In 2013, individual case assignment was continued, and the nurses were divided into 2 teams. Each team had a leader performimg quick round. The
latest arrangement was found to be more efficient as observed by the improve in quality of nursing care in the unit. The mortality rate of patients decreased from 11.2 to 11.3, and 9.25 percent in 2011 - 2013, respectively. The incidence of ventilator-associated pneumonia dropped from 11.1 to 11.5, and 6.7 times per 1,000 ventilator days, respectively. The majority of nurses agreed with the third nursing arrangement because it provided opportunities of working together as a team. The results of this study suggested that participation to reflect the problem situation together will lead to an effective plan, which in turn can help to improve the effectiveness of the nursing system. This nursing team model should be widely applied in other similar settings.
Key words: patterns of nursing team; quality of nursing care