Development of a model for caring for stroke patients in the Accident and Emergency Department Mukdahan Hospital.

Abstract

     This research was action research aimed to current problems in stroke patient care; 2) To develop a stroke care model; and 3) To study the results of developing a stroke care model for the Accident and Emergency Department at Mukdahan Hospital. Two groups of subjects were used: 1) a multidisciplinary team to study the current problems and develop a care model for stroke patients, recruited through purposive sampling; and 2) 50 acute ischemic or occlusive stroke patients receiving intravenous thrombolytic therapy (RT-PA) who attended Accident and Emergency Department services at Mukdahan Hospital. Purposive sampling was used to collect data. The research instruments included: 1) a focus group discussion guide, a general information questionnaire, a stroke knowledge test, a satisfaction assessment form, and a model implementation observation record. and a data recording form for the results of using the model. 2) The experimental tools included the guidelines and activities for nursing care for acute stroke patients and the stroke care manual. The study was conducted between October 2024 and March 2025. Data were analyzed using descriptive statistics to determine frequency, percentage, and standard deviation. Paired t-tests were used to compare differences.

     Results : 1) Stroke patient care problems were: (1) In the health system, access to services was limited, coordination between agencies was inefficient, care was delayed, and guidelines were unclear. (2) In the health team, care was lacking skills, non-compliance with guidelines, and incomplete data recording. (3) In the patient and family or caregiver sectors, patients were unaware of warning signs of the disease and were unaware of the emergency medical services system. 2) The stroke patient care model consisted of: (1) guidelines and activities for nursing care for suspected acute stroke patients. In the case of patients coming to the hospital by themselves (Walk in), (2) in the case of patients coming to the hospital by the referral system (Refer), (3) in the case of patients coming to the hospital by the emergency medical services (EMS) system, and 3) the results of developing a care model for stroke patients found that after developing the model, (1) receiving treatment with blood thinning medication within 60 minutes increased, (2) complications after receiving blood thinning medication decreased, (3) professional nurses had a significantly higher average knowledge and compliance with the guidelines at the 0.05 level, and (4) the health team had the highest level of satisfaction with using the model.