Development of a Nursing Care Model for End-Stage Liver Cancer Patients in the Service Area of Ban Non Rang Subdistrict Health Promoting Hospital, Sawathi Subdistrict, Mueang District, Khon Kaen Province

Abstract

This action research aimed to study the situation and develop a nursing care model for end-stage liver cancer patients; to compare quality of life, pain level, and family anxiety before and after implementing the model; and to examine care outcomes and the satisfaction of patients and families with the model in the service area of Ban Non Rang Subdistrict Health Promoting Hospital, Sawathi Subdistrict, Mueang District, Khon Kaen Province. The study applied the palliative care concept, Watson's Theory of Human Caring, and one cycle of the PDCA quality cycle, and was conducted from November 2024 to March 2025, a total of 5 months. The participants comprised two groups: 12 health personnel and village health volunteers, and 8 end-stage liver cancer patients referred from Khon Kaen Hospital for continuing home care. The research instruments consisted of the NONRANG Model, a general information form, a focus group guideline, a quality of life assessment, a pain assessment, a family anxiety assessment, a model appropriateness assessment, and a satisfaction questionnaire, whose content validity was confirmed by three experts. Qualitative data were analyzed using content analysis, quantitative data were analyzed using descriptive statistics, and pre-post comparisons were performed using the paired t-test and the Wilcoxon signed-rank test.

          The results showed that the developed nursing care model, the NONRANG Model, consisted of five main components: holistic needs assessment, family-centered care planning, palliative nursing activities, multidisciplinary and community coordination, and continuous monitoring with bereavement care. The model was rated by experts as highly appropriate at the highest level (4.47 ± 0.38). Most patients were male (62.50%), with a mean age of 61.38 years; 75.00% had completed primary education, and 87.50% were farmers or general laborers. After implementing the model, the mean overall quality of life score increased from 52.38 ± 7.14 to 71.25 ± 5.83, changing from a moderate to a good level; the mean pain score decreased from 6.25 ± 1.28 to 2.88 ± 1.13; and the mean family anxiety score decreased from 8.13 ± 1.46 to 3.75 ± 1.28 (all p < .05). All patients received continuous care until the end of life, and 87.50% died peacefully at home as desired by the patients and families. Of the primary caregivers, 75.00% demonstrated good caregiving skills, and overall satisfaction of patients and families with the model was at the highest level (4.51 ± 0.42 out of 5). The study concludes that the NONRANG Model, which integrates the palliative care concept, Watson's Theory of Human Caring, and family and community participation through the PDCA process, can reduce pain, improve quality of life, and promote a peaceful and dignified death at home, and can serve as a guideline for subdistrict health promoting hospitals in similar rural contexts