Development of Tele-Nursing Guidelines to Improve the Quality of Services in Diabetic Wound Care: A Case Study of Mae Chan Hospital, Mae Chan District, Chiang Rai Province, Thailand
ABSTRACT
Background:
The majority of patients with diabetic wounds live in the community; however, there are not enough nurses to meet the increasing demand for care and other issues in the community, such as lack of health equipment, resources, and access to health services, communication channel for healthcare advice, and continuity of care rehabilitation. Therefore, strategies for caring for diabetic wounds are necessary, such as creating a network of channels for giving advice from specialists to nurses, caregivers, and patients in the community, monitoring and following up with patients, and providing quality of service through online channels.
Objective:
To develop tele-nursing guidelines for caring for patients with diabetic wounds and foot ulcers and to study the effects of tele-nursing towards wound healing.
Methods:
The participatory action research, which divided into three cycles: 1) Study the current situations, problems and needs of patients with diabetic wounds and the feasibility of using tele-nursing guidelines; 2) Study tele-nursing guidelines towards diabetic wound healing; 3) Study the effects of tele-nursing on diabetic wound healing by evaluating the wounds, foot or leg amputation, and satisfaction with the use of tele-nursing. The informants were 20 patients with diabetic ulcers, multidisciplinary team including a surgeon, a pharmacist, a nutritionist, and 9 professional nurses at a subdistrict health promoting hospital in the Mae Chan Hospital network total of 12 people, and 1 computer technical officer.
Results:
The results showed that the mean of diabetic wound severity scores after receiving tele-nursing care in the 2nd, 4th, 6th, and 8th weeks had decreased with a statistical significance level of .001. No patients were found to have foot or leg amputation. The patients in the group that received tele-nursing care showed that their wounds healed in an average of 8.6 weeks (mean 8.6, S.D.= 4.3). Out of 5, the satisfaction score for tele-nursing care was 4.7 (S.D.= 0.2).
Conclusions:
This study results indicated that tele-nursing might be effective to improve self-care behaviors, reduces the use of resource use in treating diabetic wounds, reduce hospital admissions and expenses of the patients and maintain service quality on the remote area of Mae Chan District, Chiang Rai Province, Thailand.
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