Effects and development of a Pneumonia Prevention Program Applying Orem's Self-Care Theory on Caregiver Competency for Patients with Tracheostomy Tubes and Nasogastric Feeding Tubes Prior to Discharge, Udonthani Hospital

Abstract

     This research was a Research and Development study aimed to investigate the situation and problems of discharge planning for patients with tracheostomy tubes and nasogastric feeding tubes, to develop and implement a pneumonia prevention program applying Orem's Self-Care Theory, and to evaluate the program's effectiveness on caregiver competency prior to discharge. The study was conducted from August 2024 to August 2025, spanning a total of 13 months, using Orem's Self-Care Deficit Theory and Systems Theory as conceptual frameworks. The sample consisted 187 patients together with 187 caregivers, totaling 374 participants, for program evaluation. Research instruments included focus group discussion guides, general data recording forms, program appropriateness assessment forms, knowledge assessment forms, caregiver competency assessment forms, satisfaction questionnaires, and clinical outcome data collection forms. Statistical methods employed were frequency, percentage, mean, standard deviation, and Paired t-test for pre- and post-comparison.

     The findings revealed that program development yielded a pneumonia prevention program comprising seven content domains delivered over three days, namely preparation, oral care, suctioning, tracheostomy wound care, inner cannula cleaning, nasogastric tube feeding, and pneumonia symptom surveillance, along with four follow-up sessions within 28 days post-discharge. Expert evaluation of program appropriateness was at the highest level (Mean = 4.72, SD = 0.21). Program implementation results demonstrated that caregivers' knowledge scores increased from a low level (Mean = 12.45, SD = 3.21) to a high level (Mean = 26.83, SD = 1.74), and caregivers' competency scores increased from a low level (Mean = 73.42, SD = 12.58) to a high level (Mean = 178.65, SD = 8.34), with statistically significant differences in both variables at the .05 level (p < .001). The incidence rate of pneumonia within 28 days post-discharge was 4.28 percent, and the readmission rate due to pneumonia was 3.21 percent. Caregiver satisfaction was at the highest level (Mean = 4.71, SD = 0.19), and professional nurse satisfaction was at the highest level (Mean = 4.68, SD = 0.22). The effective in enhancing caregiver knowledge and competency, reducing pneumonia incidence and hospital readmission rates, and can be practically applied within hospital discharge planning service systems.