Effectiveness of Nursing Practice Guidelines for Acute Stroke Patients in the Emergency and Forensic Medicine Department, Bandanlanhoi Hospital, Sukhothai Province

Abstract

ABSTRACT

            This action research aimed to develop nursing practice guidelines for acute stroke patients and compare outcomes between nurses and patients before and after implementation at the Emergency and Forensic Medicine Department, Bandanlanhoi Hospital, Sukhothai Province. The sample consisted of 10 registered nurses and 25 acute stroke patients. The instruments included nursing guidelines based on the PAOR cycle of Kemmis & McTaggart combined with the Collaborative Quality Improvement concept of IHI, covering 7 care steps, along with assessment tools for knowledge, practice, satisfaction, and NIHSS scores. Data were analyzed using descriptive statistics, Wilcoxon Signed-Rank Test, and McNemar Test.

            The results revealed that after implementation, nurses' median knowledge scores significantly increased from 14.0 to 18.0 points (Z=2.810, p<0.001), and practice scores increased from 25.0 to 30.0 points (Z=2.528, p<0.001), with satisfaction at the highest level (Mean=4.43, SD=0.37). For patient outcomes, the time from ER arrival to CT Brain significantly decreased from 90.0 to 40.0 minutes (Z=4.286, p<0.001), hospital length of stay decreased from 128 to 62.0 days (Z=4.298, p<0.001), and NIHSS score differences increased from 2.0 to 7.0 points (Z=4.124, p<0.001). Patients with mild impairment increased from 12.0% to 60.0% (χ²=17.000, p<0.001). The developed practice guidelines proved highly effective in enhancing nurses' knowledge and practice, as well as significantly improving patients' clinical outcomes. The guidelines should be expanded to other community hospitals with long-term follow-up.