Effects of Nurses' Competency Development to Care for Patient with Ventilator, Nakhon Pathom Hospital

Abstract

This research aimed to study the effects of nurses' competency development in caring for patients with ventilators in Nakhon Pathom Hospital. The quality development process was applied the Deming Cycle (PDCA) in this routine to the research study. The purposive sampling was registered nurses who work in a general or private-wards, and medical records of patients using ventilators. The research has conducted between October 2019-September 2020, divided into 2 phases. In phase 1, there are four steps which comprised: 1) situation analysis 2) adoption of the work instruction for patient care using a ventilator 3) conduct of a meeting among nurses to clarify guidelines on how to care for patients using ventilators to nurses and apply the guidelines by self-review and use 4) monitor and evaluate nursing competency in caring for patients with ventilators. And phase 2 comprised of the development of nursing competency for nurses who had been less competent in ventilator care in phase 1 by organizing group meeting, reviewing the nursing work instructions, sharing each other knowledge, raising awareness on the implementation of the nursing work instruction, then evaluating the knowledge of competency and directing the application of the guideline to the participants. The patient outcomes who used ventilators are measured by monitoring the results from the patient's medical record. Data were analyzed using descriptive statistics by percentage, mean, standard deviation, and paired t-test. The research results were: In phase 1, nurses had the highest level of competency assessment score after attending the meeting and self-reviewing the guideline patient care with a ventilator (􀝔=78.46, SD=11.63), and passed 79.80% of the competency evaluation criteria. In phase 2, the nurses who received competency improvement through group review activities had a higher knowledge score than before developed competency (p < .001). The rate of infection with ventilator-associated pneumonia decreased from 7.72 to 7.01 per 1,000 ventilator days. The location of the lower respiratory tract infection decreased from 30.79 % to 27.88 %. And the incidence rate of unplanned extubating had reduced from 9.10 to 8.31 per 1,000 intubation days. This study reflects that the participation of nurses in organizing group review activities by sharing each other knowledge and experience could lead to the development of nursing competency, improving quality, and standardized nursing practices for good outcomes in ventilator care.