Development of a Nursing Care Model for Patients with Acute Ischemic Stroke at Ched Samian Hospital, Ratchaburi Province

Abstract

     This quasi experiment research study aimed to develop a nursing care model for patients with acute ischemic stroke that is appropriate for the context of a community hospital and to evaluate the effects of implementing the model on nurse-related and patient-related outcomes. The study was conducted in three phases. Phase 1 involved an analysis of existing problems and care processes using medical records of 30 patients with acute ischemic stroke and data from 11 emergency department registered nurses, together with in-depth interviews. Phase 2 focused on developing the nursing care model by integrating systems theory, patient safety concepts, standard clinical guidelines, and the community hospital context. Phase 3 involved implementation and evaluation of the model. Research instruments included a medical record review form, a questionnaire assessing nurses’ knowledge and competencies, and a patient outcome evaluation form. Data were analyzed using descriptive statistics, the Wilcoxon Signed-Rank Test, and the Chi-square test.

     The results showed that nurses’ mean knowledge scores significantly increased from 6.91 ± 1.32 to 9.91 ± 0.83 (Z = −2.93, p = .003), and overall competency scores significantly increased from 5.81 ± 1.39 to 9.27 ± 0.79 (Z = −2.84, p = .004). Regarding patient outcomes, access to services within 4.5 hours increased from 40.0% to 72.0%, timely referral increased from 56.7% to 96.0%, survival within 48 hours after referral increased from 90.0% to 100.0%, and acute complications decreased from 30.0% to 19.2%.