การพัฒนารูปแบบบริการพยาบาลผู้ป่วยมะเร็งศีรษะและลำคอที่ได้รับรังสีรักษาร่วมกับยาเคมีบำบัด Development of a Nursing Care Model for Patients with Head and Neck Cancer Receiving Chemo-radiotherapy

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สุพิพัฒน์ พระยาลอ เขษมพร มโนคุ้น หนูเพียร ชาทองยศ เพชราภรณ์ ประสารฉ่ำ

Abstract

Caring of patients with head and neck cancer is a highly complicated task as patients often demand high-quality services from the health personnel team, patients’ families as well as the community. This participatory action research (PAR) aimed to develop a nursing care model for patients with head and neck cancer receiving chemo-radiotherapy based on the chronic care model at the Cancer Center of Khon Kaen Hospital. Participants were selected by purposive sampling to include 15 patients with head and neck cancer, 15 caregivers of the patients during hospitalization and 27 health personnel. This PAR utilized cooperative learning and reflection to raise the awareness of the problems that led to subsequent 2 phases of the study which were 1) development of a nursing care model and 2) implementation of the model.  Each phase consisted of a situational analysis, planning, implementation and evaluation and reflection.  Qualitative data were collected through in-depth interviews, focus group discussions, and brainstorming and data were analyzed using content analysis and triangulation.  Quantitative data were gathered using a mucositis assessment form and a nutritional assessment form and data were analyzed to obtain frequencies, percentages and standard deviation.     


                A situational analysis revealed that patients were solely dependent on health personnel to take care of their health and were unable to manage their own health.  There was no referral system for continuing care from the hospital to the community.  Subsequently, a nursing care model was developed with the following components; 1) a nurse case manager who empowered patients to do more self-management, 2) an evidence-based plan to care for the patients with clearly defined roles and responsibilities and channel for collaboration among health personnel, 3)a nursing practice guideline to assess oral hygiene and nutritional support, 4) a 24-hour telephone service to provide decisional support for patients and caregivers, 5) a database system to share clinical data and healthcare-related information between the patients and health personnel, and 6)a collaborative network between health personnel and existing patients to share their successful experience with new patients.         


After implementing the nursing care model, all 15 patients completed full-course treatment without severe malnutrition that required hospitalization.  Severe mucositis was found in only 13.3% of the patients.  Health personnel and registered nurses were satisfied with nursing care model and had a 93.7% adherence rate to the model activities.  A nurse case manager was functioning to coordinate care and referral of patients’ treatment plan and other healthcare-related information.  As a result, continuing care for patients with head and neck cancer receiving radiotherapy and chemotherapy between the Cancer Center, local health promoting hospitals and community leaders were established.      

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