Development and Implementation of a Clinical Nursing Practice Guideline for Prevention and Management of Increased Intracranial Pressure in Hemorrhagic Stroke Patients.

Abstract

Background: Hemorrhagic stroke is a serious condition that leads to high morbidity and mortality rates, particularly within the first 30 days following the stroke. One serious complication is increased intracranial pressure (IICP), which worsens neurological symptoms and can result in death or disability.

Purposes: To develop and implement a clinical nursing practice guideline (CNPG) for prevention and management of IICP in hemorrhagic stroke patients.

Methods: This study had two phases: (1) Evidence trigger and support, identifying clinical problems and gathering empirical evidence, and (2) Evidence-observed, where a CNPG was developed and implemented. The CNPG was based on the Nursing Role Effectiveness Model and Soukup's Nursing Practice Development Model, covering preoperative and postoperative care and key nursing activities such as assessment, prevention, and management. The study assessed the CNPG's impact on nurses' knowledge, practices, and implementation feasibility. Nineteen registered nurses from the Surgical Intensive Care Unit were included and analyzed using descriptive statistics, interquartile range, and the Wilcoxon signed-rank test.

Results: The findings showed a significant improvement in nurses' mean knowledge scores after implementing the nursing guideline for preventing IICP in hemorrhagic stroke patients (p < 0.000). The overall mean knowledge score was high (X̄ = 23.11, SD = 2.54, Mdn = 23, IQR = 5). Additionally, the total mean nursing practice score (X̄ = 122.53, SD = 17.80) and overall mean perceived implementation feasibility score were both high (X̄ = 4.68, SD = .35).

Conclusions: The findings suggest that integrating nursing practice guidelines and providing training to enhance nurses' knowledge significantly contribute to positive outcomes in both structure and process. Regarding structure, nurses demonstrated increased knowledge and proficiency in nursing practices. Regarding process outcomes, evidence-based guidelines were effectively utilized, paving the way for practical application in future nursing practice.