Development and Evaluation of a Clinical Nursing Practice Guideline for Patients Receiving High-Flow Nasal Cannula Oxygen Therapy in the Male Medical Ward of Kumphawapi Hospital
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Abstract
This research and development study aimed to develop a nursing practice guideline for patients receiving high-flow nasal cannula (HFNC) oxygen therapy in the male medical ward and to evaluate the outcomes following its implementation. The study was conducted from October 2025 to March 2026 and included 45 participants. The research instrument was a researcher-developed nursing practice guideline, which was reviewed by three experts. The Index of Item-Objective Congruence (IOC) values ranged from 0.67 to 1.00. The study comprised three phases: (1) situational analysis, (2) development of the nursing practice guideline using the DORAWS HFNC Safety Bundle, and (3) evaluation of the guideline within the framework of evidence-based practice and clinical context. The guideline consisted of six components: Device Preparation, Oxygen Optimization, ROX Assessment, Airway Care, Weaning, and Safety Prevention. Data were analyzed using descriptive statistics, the paired t-test, and the Friedman test, with statistical significance set at .05.
Following implementation of the guideline, the patients’ mean oxygen saturation (SpO₂) increased from 88.49 ± 2.55% to 96.93 ± 1.71% (p < .001), while the mean respiratory rate decreased from 27.33 ± 1.54 to 19.47 ± 2.35 breaths/minute (p < .001). The mean PaO₂/FiO₂ (P/F) ratio increased from 229.80 ± 38.88 to 403.00 ± 42.16 (p < .001). The ROX Index also increased significantly (p < .001). Dyspnea and the use of accessory respiratory muscles progressively decreased. HFNC failure occurred in 4.44% of patients (2 cases). Among the eight patients who received HFNC following extubation, none required reintubation. Most complications were mild, including nasal irritation (13.33%) and pressure injuries (8.89%). Registered nurses reported the highest level of satisfaction with the guideline, with a mean score of 4.79 (SD = 0.41).
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