Empowering Volunteers at Tawanchai Centre for Patients with Cleft Lip and Palate.

BACKGROUND: Cleft lip and palate (CLP) congenital anomalies have a high prevalence in the Northeast of Thailand. A care team's understand of treatment plan would help to guide the family of patients with CLP to achieve the treatment. OBJECTIVE: To examine the impact of the empowering volunteer project, established in the northeast Thailand. MATERIAL AND METHOD: The Empowering Volunteer project was conducted in 2008 under the Tawanchai Royal Granted project. The patients and family's general information, treatment, the group brainstorming, and satisfaction with the project were analysed. RESULTS: Participants were 12 children with CLP their families and five volunteers with CLP; the participating patients were predominantly females and the mean age was 12.2 years. The treatment comprised of speech training, dental hygiene care, bone graft and orthodontic treatment. Four issues were addressed including: problems in taking care of breast feeding, instructions' needs for care at birth, difficulty in access information and society impact, and needs in having a network of volunteers. CONCLUSIONS: Empowering volunteer is important for holistic care of patients with CLP which provides easy access and multiple channels for patients and their families. It should be developed as part of the self-help and family support group, the development of community based team and comprehensive CLP care program.

Development and Monitoring the Key Performance Indicators of the Quality of Care for Patients with Cleft Lips/Palates at Srinagarind Hospital.

BACKGROUND: Congenital deformities, such as cleft lips and/or cleft palates (CLP), have high incidences in the Northeast of Thailand. These birth defects can affect patient's quality of life. CLP patients need crucial and long-term treatments by a multidisciplinary team starting from prenatal stage to late adulthood. Patients and their families should involve in their own care, and their care objectives should correspond with healthcare providers. Besides the clinical outcome of interdisciplinary team, key performance indicators (KPIs) need to be developed in the hospital service unit in order to improve quality of care and treatment outcomes. OBJECTIVE: 1) to establish KPIs in hospital service units, and 2) to develop the information system to collect, analysis and improve the quality of CLP care. MATERIAL AND METHOD: A nurse coordinator was appointed in the Tawanchai Center to coordinate care. The three periods were conducted for the nurse coordinator to work with nine service units in Srinagarind Hospital for consensus on both qualitative and quantitative data to be used as service unit quality measurement. RESULTS: Thirty one KPIs from nine service units were established, collected and analyzed during a four-month period in 2014. The 20 KPIs achieved the unit targets. Two PKIs of the rates of complication with anesthesia during/after surgery in the first 24 hours and the rates of patient/caregiver's satisfaction in acquiring information from the officer were improving. There were 11 KPIs that did not achieve the targets. The coordinator nurse of the Tawanchai Center discussed with the service unit for the cause and how to improve the outcome. CONCLUSION: The monitoring KPIs will lead to improvement of outcome for better patient quality as well as benchmarking with other hospitals of Cleft Center. The KPIs from hospital service units with the monitoring and analysis of information by the nurse coordinator will enhance and lead to improvement of the quality of the patients and family centered care process.

Development of Information System for Patients with Cleft Lip and Palate undergoing Operation.

BACKGROUND: Srinagarind Hospital has 150-200 patients with cleft lip and palate each year. When patients are admitted to hospital for surgery patients and family feel they are in a crisis of life, they feel fear anxiety and need to know about how to take care of wound, they worry if patient will feel pain, how to feed patients and many things about patients. Information is very important for patients/family to prevent complications and help their decision process, decrease parents stress and encourage better co-operation. OBJECTIVE: To develop information system for patients with cleft lip-palate undergoing operation. MATERIAL AND METHOD: This is an action research divided into 3 phases. Phase 1 Situation review: in this phase we interview, nursing care observation, and review nursing documents about the information giving. Phase 2 Develop information system: focus groups, for discussion about what nurses can do to develop the system to give information to patients/parents. Phase 3 evaluation: by interviewing 61 parents using the structure questionnaire. RESULTS: 100 percent of patients/parents received information but some items were not received. Patients/parents satisfaction was 94.9 percent, no complications. CONCLUSION: The information system development provides optimal care for patients and family with cleft lip and palate, but needs to improve some techniques or tools to give more information and evaluate further the nursing outcome after.

Comparison of wound dehiscence and parent's satisfaction between spoon/syringe feeding and breast/bottle feeding in patients with cleft lip repair.

BACKGROUND: Cleft lip and cleft palate are the most common craniofacial anomalies affecting approximately 2.49 of every 1,000 children born in North-east of Thailand. Srinagarind Hospital has 100-150 cases of cleft lip each year. Children with cleft lip and palate need surgical procedures as soon as possible. After lip repair the normal recommendation is not using bottle or breast feeding for 2 weeks to avoid tension at the sutured area during sucking and possible cause of wound dehiscence. So this is quite complicated for the parents, and patients feel frustrated, cry, and move their head around, because of hunger which cannot easily be satisfied. Previous research found that sucking does not cause wound dehiscence, but mentioned no detail about severity of cleft. OBJECTIVE: Primary objective is to compare surgical wound dehiscence between breast feeding/bottle and spoon/syringe feeding after lip repair. MATERIAL AND METHOD: This is an experimental study: non-inferiority trials study. The population is the patients with cleft lip who underwent lip repair in Inpatient Department 3C, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. The study period is during May 2010-February 2013. The total sample size in the present study is 192 participants, 96 cases breast/bottle feeding, 96 cases spoon/syringe feeding. The wound dehiscence rate was analyzed by Z-test. Parents'satisfaction is a qualitative data and was analyzed through content analysis. RESULTS: No statistical significant diference between breast/bottle and spoon/syringe groups (p-value = 0.320, 95% confidence interval -0.031-0.010). Parents were more satisfied to feed children by breast/bottle and patients were more relaxed with breast/bottle feeding. CONCLUSION: Breast/bottle feeding and syringe/spoon feeding have the same result on the surgical wound. Breast/bottle feeding are not causes of wound dehiscence.

Nursing care system development for patients with cleft lip-palate and craniofacial deformities at Srinagarind Hospital.

BACKGROUND: A holistic nursing care system for patients with cleft lip-palate (CLP) and/or craniofacial deformities was arranged by the Nursing Department, Srinagarind Hospital, which provides tertiary nursing care. The nursing care system was developed as per system theory via participating management with action research following the Deming Cycle (PDCA) divided into 3 phases. Participants included 117 nurses from 8 divisions caring for patients with CLP and 128 parent caregivers. The research instruments included: 1) situation analysis, 2) meeting and planning and 3) self-administered questionnaire. Groups were divided according to the age, physical and mental aspects of the patients. RESULTS: 1) The nursing care system under study comprised psychosocial care, breastfeeding, counseling, providing assistance in various ways in order to respond to problems of patients/families by the multidisciplinary team. There was also follow-up to evaluate the results and in order to give patients/families longitudinal and continuing care. 2) Minor research of 4 nursing sections was initiated. 3) Nursing care standards, manuals, regulations and innovations for the organization of eight nursing sections were created and implemented. CONCLUSION: The present study on developing a nursing care system for patients with CLP helped the team to (a) understand the overall nursing care system (b) to develop the organization of nurses by conducting research and (c) to create 12 works for developing care. The latter aimed to establish or create standards, nursing manuals, caring manuals, regulations, innovations, CDs, portfolios and informative cartoons to be applied systematically and shared across and between communities. The model for nursing care for patients with CLP in tertiary hospitals was clearly demonstrated.

Nursing outcome in patients with craniofacial anomalies who underwent operation.

BACKGROUND: The Northeast of Thailand has patients with craniofacial anomalies about 2.5: 1,000 children birth. Ward 3C Srinagarind Hospital has about 150-200 cases of patients with craniofacial anomalies each year. Some of them have an operation about 10 times. When the patients go to hospital to undergo operation, patients and families experience fear and anxiety. They need information about their disease, operation, feeding and wound care. Nurses who work continuously and closely with the patients need to have ability to support patients needs by using nursing process. Nursing outcome will help nurses to measure the quality of nursing care. OBJECTIVE: To study nursing outcome in the patients with craniofacial anomalies who were admitted in 3C ward. MATERIAL AND METHOD: The present study is retrospective descriptive study. Data was collected from medical records of 27 patients with craniofacial anomalies who were admitted in 3C ward Srinagarind Hospital between June 2010 to May 2011. Medical records were purposively selected for the study and recorded with a data collection form. RESULTS: The authors found that 2.36% of patients had wound infection. 100% of parents received information about disease, medication, self care but some information was not received or was received but not understand. 1 case of patients unplanned readmit. Length of stay of patient 2.74 days. Parents satisfaction is 91.81%. CONCLUSION: Patients had wound infection when back home because care giver cannot clean patients wound correctly, parents and care giver did not receive enough information or did not understand all information.

Nursing outcome in patients with cleft lip and palate who underwent operation: follow-up cases.

BACKGROUND: Cleft lip and cleft palate are the most common craniofacial anomalies affecting approximately 2.5 of every 1,000 children born in North East of Thailand. Srinagarind Hospital has 150-200 cases of cleft lip and palate each year. The lengthy treatment process of care, requires continuity of care involving a multidisciplinary team. The holistic and interdisciplinary care is very important to patients, family, health care professionals and the health care system. After operation patients stay in hospital about 2-3 days, during this time they will receive information regarding how to take care of the wound,feeding and details about activities to avoid. Before patients leave hospital the nurse will confirm if parents can take care of patients wound, feeding, know about avoiding activities. The Nurses or health care professional can check patients progress again when they come back to hospital for follow-up. OBJECTIVE: To promote continuity care and resolve any problems for developing quality of care. MATERIAL AND METHOD: The present study is retrospective descriptive study. Data was collected from follow-up case forms using 205 medical records of patients with cleft lip and palate who were admitted in 3c ward Srinagarind Hospital between June 2010 to May 2011. The records were purposively selected for the study and recorded with a data collection form. RESULTS: 95.12% of patients with cleft lip and palate came back for follow-up. 2.44% of patients had wound infection. 7.69% of patients have flap separation. The authors also found that some care givers could not take care of the patients correctly and were not concerned about follow-up. CONCLUSION: To contracts the patients and family when they visit hospital for follow-up can make health care professional ensure the patients understand what they need to know and do, also can find any uncomfortable points/problem of patients/ family then can develop the strategies or system to solve the problem.

Home visit patients and family with cleft lip and palate.

BACKGROUND: The operating process for cleft care, requires continuity of care involving a multidisciplinary team. When the patient goes to hospital to receive surgery, parents and family feel nervous about their children and need to know how to take care of their children afterwards. Some patients will have operations into their teenage years. The scar on their face will give them low self esteem and feelings of isolation. Patients and family need information and encouragement. Home visit should be a good process to convey information and encourage patients and family. OBJECTIVE: Of this project were to convey information and encourage patients and family and to evaluate patients/family problems and needs as well as to promote networking. MATERIAL AND METHOD: A team meeting took place to decide about the families to be visited. After selection the family nurse coordinator contacted them by telephone, as well as contacting the primary care unit near to the family and then travelled to visit the family. The collected data was by questionnaire, observation and in-depth interview. RESULTS: 2 families were visited before and after operation, 8 families were visited 2-3 days after operation. The families have better knowledge, more confidence and can take better care of their children. Unfortunately health care professionals in primary care unit were too busy to join with the team. CONCLUSION: Home visit is a good process to convey information and find patients and family problems/needs because they are more relaxed than in hospital, so can better understand and talk more easily. The families are happy to see the home visit team and are more confident to take care of their children after visit.

Nursing care system development for patients with cleft lip-palate and craniofacial deformities in Srinagarind Hospital: pre-post operation.

BACKGROUND: Cleft lip and palate are the most common craniofacial anomalies. Srinagarind Hospital has 150-200 cases each year. The operating process of care requires continuity of care involving a multidisciplinary team. When the patients go to hospital to have operation, pain, limited activity and food are very different from normal life. During pre and post operative care nurses who work continuously and closely with the patients should have knowledge, experience and ability to take excellent care of their patients and families. This can prevent complications and help their decision process, decrease parents stress and encourage better co-operation. OBJECTIVE: To develop a nursing care system for patients with cleft lip-palate undergoing operation. MATERIAL AND METHOD: This is an action research divided into 3 phases. Phase 1, situation review: review of nursing care process by interview, focus group, observation and nursing documents. Phase 2, nursing system management: developing guidelines, composing nursing manual, handbook for parents, VCD for patients and family and story telling. Following that announcement and implementation. Phase 3: evaluation. RESULT: The authors found that guidelines, nursing manual, handbook for parents, VCD for patients and family and story telling are appropriate and have good utilization, but the pictures in handbook for parents and storytelling were not clear, too small and not attractive. CONCLUSION: Nursing manual for giving information about pre-post operative care, handbook for parents, story telling and VCD about pre-post operative care provide optimal care for patients and family with cleft lip and palate, but need to evaluate further the nursing outcome after this nursing system development.

Postoperative pain in patients with cleft lip and palate in Srinagarind Hospital.

BACKGROUND: Srinagarind Hospital has about 150-200 cases of patients with cleft lip and cleft palate each year. The operating process requires continuity of care involving a multidisciplinary team. When the patients go to hospital to undergo operation, pain is one of the most important symptoms to try and control effectively. During pre and post operative care nurses who work continuously and closely with the patients are the best persons to assist with pain relief. They need to have knowledge, experience and ability to take excellent care about pain control as well as having to have continuing assessment and selection of pain measurement tool. They can then better help to relieve patients pain, decrease parents stress and encourage better cooperation. OBJECTIVE: To the present study pain score level in patients with cleft lip cleft palate during the 24 hour period after operation. MATERIAL AND METHOD: This is the retrospective descriptive study. Data was collected from medical records. 86 Medical records of the patients with cleft lip cleft palate who were admitted in 3c ward between January to December 2010. Medical Records were purposively selected for the study and recorded with a data collection form. RESULT: 39% of patients after cheiloplasty and 55.6% of patients after palatoplasty received painkillers before leaving operating room, 29.29% of patients after cheilopalsty and 15.50% of patients after palatoplasty had severe pain immediately in ward. 48.8% of patients after cheiloplasty have moderate to severe pain at the 4th hour. Pain score was less when longer time after operation. Only 7.3% have pain after the 16th hour and pain finish after the 20th hour after operation. 51.1% in patients after palatoplasty have moderate to very severe pain at the 4th hour and 15.6% have moderate to very severe pain still occurring until the 24th hour. CONCLUSION: Some of the patients with cleft lip and palate after operation received painkillers before leaving operating room. Pain score immediately at ward is severe to very severe pain. 22.09% of patients after cheiloplasty and palatoplasy have moderate to severe pain at the 4th hour. For patients after cheiloplasty pain will continue until the 16th hour after operation, but patients after palatoplasty pain will continue more than 24 hours.

Quality of life in patients with cleft lip and palate after operation.

BACKGROUND: Cleft lip and cleft palate are the most common craniofacial anomalies. Srinagarind Hospital has 150-200 cases each year. The operating process of care, requires continuity of care involving a multidisciplinary team. When the patients go to hospital for an operation they experience pain, limited activity and also food is very different from normal life. When attending school they suffer speech articulation problems and feel shy and isolated, which has a detrimental affect on their life style and quality of life. OBJECTIVE: The main purpose of the study is to the present study quality of life in patients with cleft lip and palate after operation. MATERIAL AND METHOD: The present study is descriptive research using qualitative and quantitative approaches. The studied population were patients age 8-18 years old who were admitted at 3C Ward and Outpatient Department, Srinagarind Hospital. 33 patients were interviewed for the quantitative approach. Guideline for in-depth interview with 15 patients were used for the qualitative approach. Quantitative data were analyzed and presented in frequency, percentage and standard deviation. The qualitative data were analyzed through content analysis. RESULTS: Patients consider their QOL is high level, but in detail they still worry about self concept psychological well-being. From indept interview patients would like to get further treatment to minimize their scar as soon as possible. CONCLUSION: Patients consider their quality of life as high level, but they would like to get further treatment.