看護とケアのジャーナル

Development of a Trauma-based Continuing Care Model for Enhancing Care Outcomes in Social Unrest Area: A Case Study

Abstract

Praneed Songwathana, Wipa Sae-Sia, Luppana Kitrungrote and Benjawan Manoonya

Background: Improving care outcomes in trauma patients is regarded as important and linked to an appropriate model of care particularly in social unrest area where there are limited resources and accessibility after discharge. To facilitate prompt management to improve patient recovery or quality of life and decrease some complications, a specific model of continuing care for those trauma survivors is required. Objective: This participatory action research (PAR) aimed to develop the trauma-based continuing care model (TCCM) for enhancing care outcomes in trauma patients affected from Social Unrest area. Method: A three-phase of PAR design was implemented with stakeholders in both hospital and community services related to care for trauma survivors and their families. In the first phase, 11 trauma survivors were interviewed and 3 focus group discussions with nurses and related health care staff were conducted to identify existing systems and problems encountered. The second phase consisted of two workshops, involving 20 key informants and allied health staff for the purpose of developing the model. The final phase evaluated the initial effects of the model after implementing with 20 patients by measuring the care process and outcomes such as nurses’satisfaction, patients’quality of life, patients’self care ability, caregivers’ ability to care. Data were analyzed using descriptive statistics for care outcomes and content analysis for the care process. Result: The model consisted of a) trauma-care process through a trauma nurse-initiated discharge planning program b) patient-family follow up. With the PAR process, the following steps included 1) preparing the multidisciplinary health care team including patient and family caregivers, 2) organizing the system, identifying individual role and function for continuing care, and 3) collaborating with community support network for patient and family management. The main strategies to drive all process were teamwork involvement, care coordination, and staff education. The model could enhance both health care staff and family caregivers in providing better care. In this study, most patients were able to manage themselves. Twenty patients and 10 family caregivers were satisfied with the care process and obtained better outcomes regarding health status and quality of life. In addition, the developed trauma nurse-initiated discharge planning program was also discussed for further implication. Conclusion: The key success was derived from trauma nurse-initiated discharge planning process and collaborating with community support network. To enhance the sustainability of the model, care managed by enhancing networking of community nurse, patient and family after discharge needs to be further explored.