Development of Clinical Guideline for Surgical Nursing Practice in Intensive Care Unit Based on FAST HUG Concept

Abstract

The objectives of this study were to develop a clinical guideline on surgical nursing practice in intensive care unit (ICU) based on FAST HUG concept and to compare the quality of care between before and after the implementation of the guidelines. Study subjects were 24 nurses, 120 surgical patients (60 for assessing the outcomes of pre-implementation of the guidelines and the other 60 for the post-implementation) and 56 primary caregivers of the ICU patients at Maharaj Nakhonsithammarat hospital. The study was conducted during October 2012 - May 2013. Chi-square and Mann-Whitney U tests were used for data analysis. It was found that the clinical guideline for surgical nursing practice improved the quality of care in three aspects including the process, the patient services and the guideline implementation. For the process, the participating nurses were able to increase care modalities and to initiate care plan to cover at the range of 63.3 to 93.7 percent of all 7 areas of FAST HUG at the admission. In terms of patient aspect, the implementation of the guideline had resulted in significant increase in the rate of early feeding of patients within the first 72 hours after admission (χ2=16.41; p =.00); and effective pain assessment for the patients (χ2= 6.31; p =.012). The patients reported significant decrease of their pain scores (Z=-4.579; p<0.01). The rate of head of bed elevation at 30 degree angle was also significantly increased. Regarding the guideline implementation, majority of the participating nurses reported that the guidelines were considerably appropriate and very easy to use; and gave opinions that the guideline was an important key to improving quality of care. In conclusion, the clinical guideline for surgical nursing practice in ICU based on FAST HUG concept improved the quality of care. Effective nursing participation with continuous monitoring would help improving health and preventing complications in the patients.