Development of Clinical Nursing Practiec Guidelines for Critical ILL Patients in Emergency Department Kumphawapi Hospital, During COVID-19 Pandemic

Abstract

             The objectives of this research and development were to develop and evaluate the practice guideline for critically ill patients visited to emergency department, Kumphawapi hospital, during the COVID–19 pandemic from December, 2021 to March 2022. Twenty–four samples of registered nurses (RN) and emergency medical technician worked at emergency department and 248 patients were enrolled. The secondary patient data in electronic medical records were systemically sampled. The research tools included, nursing practice guidelines for emergency patients, personnel questionnaire and the outcome record form for critically ill emergency patients. Data were analyzed using the statistics included, percentages, means
(x ̅ ), standard deviation (S.D.), one samples t–test, Wilcoxon match–paired test and binary logistic regression with adjusted odds ratios (ORadj). The level of significant was taken at 0.05.

The results revealed that the nursing care skills for critically ill emergency patients during the COVID–19 outbreak statistically significant increased (p < 0.001) were the average knowledge scores (from 14.53 to 19.33, S.D. = 1.11) and nursing behavior. The most improved nursing behavior was the location of resuscitation (from 1.56 to 4.76, S.D. = 0.45) followed by the equipment cleaning and negative pressure chamber (from 1.88 to 4.55, S.D. = 0.32) and personnel preparation (from 1.79 to 4.45, S.D. = 1.02), respectively. The observation of compliance with nursing practice guidelines found that of 91.2% the correct practice was. The satisfaction with the nursing practice guideline implementation at the highest level were the practicable guideline (x ̅  = 4.67, S.D. = 0.49), multidisciplinary using ( x ̅ = 4.67, S.D. = 0.62) and easier decision–making in choosing practice ( x ̅= 4.60, S.D. = 0.51). The patient outcome showed that after using the nursing practice guideline, the factors affected the return of spontaneous circulation within 30 minutes significantly (p < 0.05) were the 10–min airway insertion (ETT) (OR_adj = 3.049), pulse rate (OR_adj = 0.318), blood oxygen saturation (OR_adj = 0.309), systolic blood pressure (OR_adj = 0.134) and body temperature (OR_adj = 0.116).

           Keywords: Development, Nursing practice guidelines, Critically ill emergency patients, COVID–19 situation