Nursing Research and Innovation Journal

Editorial Note

2026-04-28T17:19:48+07:00

บทบรรณาธิการ

Factors Related to Mother’s Intention to Donate Breastmilk at Ramathibodi Milk Bank

2025-06-01T14:23:13+07:00

Breast milk is an essential source of nutrition for newborns,particularly for preterm infants,as it supports growth and development, strengthens immune protection,and reduces the risk of complications such as necrotizing enterocolitis.Preterm infants are especially vulnerable because their organs and immune systems are not fully developed.Breast milk contains essential nutrients, antibodies, and bioactive components that promote infant health and survival.However,many preterm infants have immature sucking and swallowing reflexes and are unable to breastfeed directly from the breast.As a result, mothers may experience difficulties establishing an adequate milk supply during the early postpartum period, especially when infants are hospitalized. To address this challenge, the World Health Organization and the American Academy of Pediatrics recommend the use of donor human milk from human milk banks when a mother’s own milk is unavailable or insufficient, particularly for preterm or low birth weight infants. Donor human milk provides protective benefits similar to maternal breast milk and is considered the safest alternative feeding option.Human milk banks,therefore,play a crucial role in supporting neonatal care and enhancing health outcomes among vulnerable infants. However, statistics from Ramathibodi Hospital indicate that the number of preterm infants has steadily increased in recent years, resulting in a growing demand for donor human milk. Meanwhile, the current supply of donated breast milk remains insufficient to meet this demand. This shortage highlights the importance of encouraging more mothers to participate in breast milk donation programs. Understanding the factors influencing mothers’ intentions to donate breast milk is essential for developing effective strategies to promote donation and ensure an adequate supply of donor milk for infants in need. Identifying these factors can provide valuable baseline information for healthcare providers and policymakers in designing interventions that support and encourage breast milk donation.This study employed a descriptive cross-sectional design to examine factors associated with mothers’ intention to donate breast milk to the human milk bank at RamathibodiHospital. The Theory of Planned Behavior was used as the conceptual framework guiding the study, which proposes that behavioral intentionis influenced by attitudes, subjective norms,and perceived behavioral control. The study sample consisted of 83 mothers who donated breast milk to the human milk bank at Ramathibodi Hospital between March 2019 and June 2023.Participants were recruited using purposive sampling based on predetermined inclusion criteria. Eligible participants were breastfeeding mothers whose current infant was aged four months or younger and who had passed the screening criteria of the breastfeeding clinic. These criteria ensured that participants were healthy and suitable donors,in accordance with the human milk bank’sstandards.Data were collected using a structured questionnaire consisting of four sections: demographic characteristics; attitudes toward breast milk donation; subjective norms related to breast milk donation; perceived behavioral control for breast milk donation, and intention to donate breast milk.Descriptive statistics were used to analyze participants’ characteristics, including frequencies,percentages, means, and standard deviations. The relationships amongthe study variables were examined using Spearman’s rank correlation coefficient to determine the associations between attitudes, subjective norms, perceived behavioral control, and intention to donate breast milk.The results showed that most mothers donated breast milk during their maternity leave. The average amount of donated breast milk was 16.43 liters per person.Mothers demonstrated positive attitudes toward breast milk donation, with a mean score of 24.57 (SD = 1.16). Subjective norms regarding breast milk donation were high, with a mean score of 13.00 (SD = 2.54),indicating that mothers generally perceived strong social support from people around them regarding breast milk donation.Perceived behavioral control for breast milk donation was also high, with a mean score of 33.40 (SD = 2.19), suggesting that mothers felt confident in their ability to donate breast milk. In addition, intention to donate breast milk was at a high level, with a mean score of 18.73 (SD = 1.51).Further analysis revealed that perceived behavioral control had a low but positive statistically significant correlation with the intention to donate breast milk (r =.26, p =.02). This finding suggests that mothers with greater confidence in their ability to donate breast milk were more likely to report a stronger intention to donate. In contrast,attitudes toward breast milk donation and subjective norms were not significantly associated with mothers’intention to donate in this study. These results highlight the importance of strengthening mothers’confidence in donating breast milk. Healthcare professionals,particularly nurses,play a key role in promoting breast milk donation by providing information, education, and practical guidance about donor human milk and the operation of human milk banks. Such support can enhance mothers’ confidence and encourage their intention to donate breast milk, ultimately increasing the availability of donor human milk for vulnerable infants inneed.

Keywords: Breast milk, Donor human milk, Human milk bank,Mothers’ intention,Perceived behavioral control

Author Contributions:
WK: Conceptualization, Method and design, Tool validation, Data collection, Data analysis,Writing and revising the manuscript
TD: Conceptualization, Method and design, Tool validation, Data analysis, Writing and revising the manuscript, Corresponding with the editor-in-chief
JP: Data analysis, Writing and revising the manuscript
PN: Conceptualization, Method and design, Tool validation

Effects of Oropharyngeal Colostrum Administration in Premature Infants on Late-Onset Sepsis, Necrotizing Enterocolitis, and Length of Hospital Stay

2025-06-04T20:57:52+07:00

Late-onset sepsis and necrotizing enterocolitis are major causes of morbidity and mortality in preterm infants, particularly those born at a gestational age of less than 32 weeks.The high susceptibility of this population is largely attributable to the immaturity of their immune and gastrointestinal systems. The underdevelopment of both innate and adaptive immunity further limits preterm infants’ ability to mount an effective response to microbial invasion and inflammatory processes. Late-onset sepsis is defined as a bloodstream infection occurring after 72 hours of life and is commonly associated with prolonged hospitalization and higher healthcare costs.Similarly, necrotizing enterocolitis is a serious inflammatory disease of the intestine characterized by intestinal inflammation, necrosis, and possible perforation, which may result in life-threatening complications and long-term sequelae, including short bowel syndrome, growth failure, and neurodevelopmental impairment. These conditions also lead to prolonged hospital stays and increased healthcare expenditures. Colostrum, the first milk produced by mothers after delivery,is rich in immunological components, including immunoglobulins, cytokines, growth factors,lactoferrin, and other bioactive substances that support immune protection and intestinal development. However, preterm infants often cannot tolerate enteral feeding during the early postnatal period due to gastrointestinal immaturity and clinical instability, which limits their direct intake of maternal milk. Oropharyngeal colostrum administration, administered by dabbing on the cheek pouch, allows infants to receive immune substances, which are absorbed through the oral mucosa-associated lymphoid tissue. They play crucial roles in pathogen destruction,anti-inflammatory processes, growth inhibition, and reducing bacterial adherence in both respiratory and gastrointestinal systems, thereby reducing the incidence of late-onset sepsis and necrotizing enterocolitis in preterm infants.

This descriptive retrospective study aimed to investigate the effects of oropharyngeal colostrum administration in preterm infants on late-onset sepsis, and length of hospital stay. The study employed a pathophysiological framework emphasizing the immune system of preterm infants. The sample consisted of 276 preterm infants with a gestational age of less than 32 weeks,admitted to a tertiary hospital in Bangkok, Thailand, between January 2017 and December 2022.Participants were purposively selected based on the following inclusion criteria: 1) the mother had no medical contraindications for breastfeeding, 2) the mother had no history of substance abuse or HIV infection, 3) the infant was admitted to the ward within 24 hours of birth, and 4)the infants received 0.2 mL of oropharyngeal colostrum every 3 hours from birth until 144 hours (6 days) of age. The sample was divided into two groups of 138 infants each: those who received oropharyngeal colostrum administration before 72 hours of age and those who received it after 72 hours of age. Data were collected from medical records using a maternal and preterm infant data collection form. General data were analyzed using descriptive statistics. The incidence of late-onset sepsis and necrotizing enterocolitis was compared using chi-square tests, while differences in the length of hospital stay were analyzed using the Mann–Whitney U test due to the non-normal distribution of the data. Statistical significance was determined at a p-value of less than .05.

The study findings revealed that in the group receiving oropharyngeal colostrum administration before 72 hours of age, 91 infants (65.94%) developed late-onset sepsis, 42 infants (30.43%) developed necrotizing enterocolitis, and the mean length of hospital stay was 64.20 days (SD = 30.59). Among the group receiving oropharyngeal colostrum after 72 hours of age, 85 infants (61.59%) developed late-onset sepsis, 54 infants (39.13%) developed necrotizing enterocolitis, and the mean length of hospital stay was 62.10 days (SD = 28.51).Comparison of late-onset sepsis, necrotizing enterocolitis, and length of hospital stay between the two groups revealed no statistically significant differences. The findings of this study suggest that the timing of oropharyngeal colostrum administration, before or after 72 hours of life, did not significantly affect the incidence of late-onset sepsis, necrotizing enterocolitis, or length of hospital stay among preterm infants. Although the study results showed no statistically significant difference between oropharyngeal colostrum administration before and after 72 hours of age and the incidence of late-onset sepsis, necrotizing enterocolitis, or the length of hospital stay in premature infants, this may be due to other complication factors such as maternal antenatal history,neonatal hypoxia, and the increase in milk supply and osmolarity received by premature infants each day. Therefore, additional research is needed to more comprehensively assess the effectiveness of oropharyngeal colostrum administration on health outcomes in preterm infants. Future prospective multicenter studies are recommended to further examine the long-term impact of oropharyngeal colostrum administration and to determine the optimal timing and protocols for improving health outcomes of premature infants. The findings from this study can serve as a guideline for enhancing immune function in premature infant care and improving the efficiency of nursing practices.

Keywords: Late-onset sepsis, Length of hospital stay, Necrotizing enterocolitis, Oropharyngeal colostrum administration, Premature infants

Author Contributions:
PS: Conceptualization, Method and design, Data collection, analysis, and interpretation, writing-original draft preparation, Revised manuscript
TD: Conceptualization, method and design, data analysis and interpretation, Writing-review and editing the manuscript, Corresponding with editor-in-chief
JP: Conceptualization, Method and design, Data interpretation, Revising manuscript

Factors Predicting Nurses’ Intention to Practice Patient and Family-Centered Care in Medical and Surgical Wards

2025-05-24T18:20:48+07:00

The healthcare system has established clear operational standards to ensure patients receive safe and high-quality care. The Healthcare Accreditation Institute has defined standards that emphasize patient and family participation to enhance healthcare quality and safety. This approach aligns with the concept of patient and family-centered care,a care model that promotes collaboration among patients,families,and healthcare teams under the principle of mutually beneficial partnerships.Patient and family-centered care has been developed from the concepts of patient-centered care and family-centered care. The patient and family-centered care concept consists of four core principles:1)dignity and respect, 2)information sharing, 3)participation,and 4)collaboration. The literature review reveals that patient and family-centered care leads to positive service outcomes by increasing patients’self-management skills, shortening hospital stays,reducing readmission rates,and improving quality of life. Furthermore, families experience diminished anxiety and improved relationships with the healthcare team, while the healthcare team reports increased satisfaction and confidence in their work. Thus,patient and family-centered care promotes family participation and effective coordination between the healthcare team, patients, and families. However, implementing patient and family-centered care in healthcare services is not easy.Professional nurses, who are the primary healthcare team working closely with patients 24 hours a day, often face multiple barriers. These include organizational factors, such as overly strict visiting policies and limited space for families. More importantly,human resource issues such as nursing shortages,high workloads,and operating under time constraints cause nurses to focus primarily on medical orders to address patients’ physical problems.Consequently ,prioritizing and meeting psychosocial needs and communicating with patients and families are assigned to be a lower priority.

When considering nursing care behaviors through the Theory of Planned Behavior(TPB), whether patient and family-centered care behaviors occur depends not only on time and nursing skills but also,significantly on the nurse’sintention.According to the TPB,a nurse’sintention to provide patient and family-centered care depends on three factors: 1)attitude toward the behavior,arising from the evaluation of whether patient and family-centered care will result in good outcomes for the patient; 2) subjective norm, which are social pressure from influential people affecting the nurse’smotivation for patient and family-centered care,such as physicians,ward heads,the healthcare team, patients,and families;and 3)perceived behavioral control, which is the assessment of nurses’ own ability to provide patient and family-centered care and manage problems and obstacles arising in patient and family-centered care.From the current situation, it is found that most patients admitted to medical and surgical wards have severe illnesses and constantly changing symptoms. Nurses must monitor and manage patients’conditions when they deteriorate ,which is a heavy and urgent workload that may compromise patient and family-centered care. Therefore, studying the factors influencing nurses’ intentions to practice patient and family-centered care in general medical and surgical wards based on the TPB will identify the determinants of these intentions. This will lead to the establishment of guidelines for promoting patient and family-centered care practices that are appropriate for the specific context of the clinical units.

This study examined the predictive power of variables related to patient- and family-centered care (i.e.,attitude,subjective norm,and perceived behavioral control)on registered nurses’intention to practice patient and family-centered care in medical and surgical wards. A predictive,descriptive research design was used, guided by the patient and family-centered care concept and the TPB. The study sample included 185 registered nurses in 14 medical and surgical inpatient units at Ramathibodi Hospital.Participants were selected through purposive sampling based on the criterion of being professional-level nurses with at least one year of experience in their respective units. Data were collected using a five-section questionnaire comprising 1) demographic data, 2) attitudes toward patient and family-centered care practice, 3)subjective norm in patient and family-centered care practice, 4) perceived behavioral control in patient and family-centered care practice, and 5)intention to practice patient and family-centered care.Descriptive statistics and hierarchical multiple regression analysis were employed for data analysis.

The results revealed that attitudes toward patient and family-centered care practice,subjective norm in patient and family-centered care practice, and perceived behavioral control in patient and family-centered care practice collectively predicted the intention to practice patient and family-centered care at a statistically significant level, explaining 70% of the variance (R² = .70,p < .001). Among the predictors, subjective norm (b = .45, p < .001) and perceived behavioral control (b = .78, p < .001) were statistically significant, while attitudes were not (b = –.02, p = .759). Perceived behavioral control strongly influenced intention to practice patient and family-centered care(β = .69,p<.001), followed by subjective norm(β = .25,p<.001). These findings suggest that nursing administrators can use this evidence as a foundation to promote patient and family-centered care practices by enhancing nurses’ perceived behavioral control and reinforcing supportive subjective norm. Doing so may increase patient and family engagement, improve care quality, and lead to better health outcomes.

Keywords: Intention to practice, Medical and surgical wards,Patient and family-centered care,Perceived behavioral control,Subjective norm

Author Contributions:
SR: Conceptualization,Method and design, Tool development, Tool validation,Data collection,Data analysis, Wrote manuscript, Revised manuscript
SD: Conceptualization, Method and design, Supervision, Analysis and interpretation of data,Manuscript editing and revising, Corresponding with editor-in-chief
NP: Conceptualization, Method and design, Analysis and interpretation of data, Manuscript revising

Use of Anticholinergic Medications, Adverse Drug Reactions, and Knowledge about Medication Use in Older People

2025-06-05T14:54:24+07:00

Physiological and pathological changes associated with aging directly affect pharmacokinetics—specifically absorption, distribution, hepatic metabolism, and renal excretion—as well as pharmacodynamics, thereby increasing drug sensitivity. These complexities heighten the risk of adverse drug reactions among older adults, particularly with anticholinergic agents,which are widely used for chronic conditions such as Parkinson’s disease, hypertension, and depression. Despite their therapeutic efficacy, the inhibition of acetylcholine may lead to severe anticholinergic burden, manifesting as cognitive impairment, acute delirium, and urinary retention,all of which adversely affect hospitalization and mortality rates. Furthermore, polypharmacy in older adults with multiple comorbidities exacerbates the risk of drug-drug interactions and cumulative adverse effects. However, current research on anticholinergic use is predominantly limited to international contexts, which may not align with the Thai public health landscape due to differences in genetics, lifestyles, and social support systems—notably the prevalence of self-medication and herbal supplement use that may inadvertently potentiate anticholinergic effects.Consequently, this study aimed to investigate anticholinergic medication use behaviors,anticholinergic-related adverse drug reactions, and medication knowledge among older adults,to serve as a guideline for enhancing medication safety and preventing drug-related harm in this vulnerable population.

This descriptive study collected data from a purposive sample of 110 older adults (aged 60 years and older) across four outpatient departments at a tertiary care hospital in Bangkok,Thailand, between November 2020 and 2022. Inclusion criteria required participants to be:using at least one anticholinergic agent, demonstrating Thai language proficiency, and providing voluntary consent. Participants were screened using the Thai version of the 6-Item Cognitive Impairment Test (6-CIT) to assess the absence of cognitive impairment, ensuring the validity of the interview-based data. Exclusion criteria included individuals who withdrew consent or declined to provide information during the data collection process. The research instrumentation comprised five sets of structured interview forms designed to collect demographic data, current medication profiles, and the incidence of anticholinergic-related adverse drug reactions. The Naranjo Scale was used to determine the causality probability of reported adverse drug reactions, alongside data on medication use knowledge. Data were analyzed using descriptive statistics,including frequency distributions, percentages, means, standard deviations, and ranges.

The study findings revealed that the participants’ average age was 68.45 years, witha female majority (68.18%). Most participants presented with 2–4 comorbidities, most notably hypertension and dyslipidemia, respectively. Lorazepam was identified as the most frequently used anticholinergic medication (45.45%), with benzodiazepines as a class accounting for the highest overall usage (56.36%). Adverse drug reactions from the use of anticholinergic medications in the last 2 weeks were reported by 12.73% of the older people, as perceived, with common symptoms including blurred vision, xerostomia (dry mouth), and fatigue. However,the Naranjo Scale used to assess causality categorized these occurrences only as “possible” or "doubtful." Furthermore, the study showed that 29.09% of the sample experienced adverse drug reactions from using this medication group in the past, with the top five symptoms, including nausea/vomiting, rash, blurred vision, dry mouth, and fatigue, respectively. Regarding medication knowledge, although most participants (over 80%) demonstrated an understanding of therapeutic indications, administration, and storage, only 30% were able to identify their medications by name, and 73.64% lacked knowledge about potential adverse effects.

These findings highlight the need to develop comprehensive guidelines for the rigorous assessment and monitoring of anticholinergic medication use, alongside the implementation of systematic surveillance for adverse drug reactions and strategies for enhancing medication literacy.Such measures are essential for ensuring patient safety and reducing drug-related risks among the older population in the Thai healthcare system.

Keywords: Adverse drug reactions, Anticholinergic medications, Knowledge about medication use, Naranjo Scale, Older people

Author Contributions:
PS: Conceptualization, method and design, tool validation, data collection, data analysis, writing and revising the manuscript
NS: Conceptualization, method and design, data analysis, writing, revising, and editing the manuscript, corresponding with the editor-in-chief
MD: Conceptualization, method and design, data analysis, recommendation, revising the manuscript
PM: Conceptualization, method and design, data analysis, conclusion, revising and editing the manuscript

Predicting Factors of Preparation Practices for Smoking Cessation among Persons with Stroke

2025-05-22T07:54:08+07:00

Stroke is a leading cause of morbidity and mortality worldwide, including in Thailand,where it ranks among the top causes of death within non-communicable diseases, particularly affecting the elderly and individuals with high-risk health behaviors. Globally, stroke is the second leading cause of death. Major risk factors for stroke include hypertension, diabetes,dyslipidemia, cardiac arrhythmias, and, notably, smoking, which is a modifiable risk factor. Empirical evidence shows that smokers have twice the risk of stroke compared to non-smokers,with risk increasing proportionally to the amount and duration of smoking. Nicotine and carbon monoxide in cigarette smoke contribute to arterial narrowing, stiffening, and impaired blood flow, thereby increasing the likelihood of thrombosis and ischemic stroke. Moreover, smoking elevates low-density lipoprotein cholesterol and blood pressure, both of which exacerbate stroke severity.

Previous studies have found that stroke patients who continue to smoke have twice the risk of recurrence and mortality compared to those who quit smoking. Therefore, smoking cessation is critically important and serves as a key health promotion goal to prevent complications and recurrence, enhance recovery, reduce disease burden, and improve quality of life. However,smoking cessation is a complex process requiring strong intention and preparatory behaviors to achieve success. Literature reviews identify factors such as attitudes, social support, and behavioral control as influential in sustaining cessation behaviors and achieving successful quitting. Thus,effective preparatory behaviors for smoking cessation constitute a crucial process driving successful quitting. This study focuses on the preparatory behavioral stage of smoking cessation.

The theoretical framework for this study is Ajzen’s Theory of Planned Behavior,which posits that health behavior is primarily determined by attitude toward the behavior (beliefs about the behavior’s consequences), subjective norm (perceived social pressure or expectations from significant others), perceived behavioral control, and behavioral intention. This study aimed to examine factors predicting preparation practices for smoking cessation, specifically attitude towards quitting, subjective norm regarding quitting, perceived behavioral control over quitting,and intention to quit. The sample comprised 116 individuals with stroke who were current smokers, recruited from the outpatient clinic of the Prasat Neurological Institute between September 2022 and May 2023, using purposive sampling criteria that included an age of at least 18 years and continued smoking in the 6 months preceding enrollment. Research instruments included a demographic questionnaire, a cognitive impairment screening test, questionnaires assessing attitudes towards quitting, subjective norms regarding quitting, perceived behavioral control over quitting, intention to quit, and preparation practices for smoking cessation. The research participants completed the questionnaires without assistance. Data were analyzed using descriptive statistics and multiple logistic regression analysis.

The majority of the sample were male (87.93%), aged 18 to 85 years, with a mean age of 54 years. Most participants (74.14%) had at least a secondary education level, and 85.34% were employees or laborers. Hypertension was present in 49.13% of the sample, and diabetes in 35.34%. Approximately 30.17% had family members who smoked. Participants had smoked for 2 to 50 years, with 56.03% exhibiting a low level of nicotine dependence and 22.41% moderate dependence. The variables of attitude, subjective norms, perceived behavioral control, and intention to quit smoking collectively predicted preparation practices for smoking cessation with statistical significance (p < .05). The predictive model correctly classified 69% of cases. Perceived behavioral control had the strongest influence on preparation practices for smoking cessation (OR = 1.06, 95% CI = 1.02–1.10, p = .004). These findings can be applied to develop care models focused on enhancing perceived behavioral control to promote appropriate and sustained preparation practices for smoking cessation, thereby increasing the success rate of smoking cessation.

Keywords : Planned behavior, Preparation practices for smoking cessation, Smoking cessation, Stroke

Author Contributions:
SN: Conceptualization, Method and design, Tool validation, Data collection, Data analysis,Writing and revising manuscript
NP: Conceptualization, Method and design, Data analysis, Writing, revising, and editing manuscript, Corresponding with editor-in-chief
SJ: Conceptualization, Method and design, conclusion, Recommendation, Revising the manuscript

Symptom Experiences, Management Strategies, and Outcomes on Oxaliplatin–Induced Peripheral Neuropathy among Persons with Cancer

2026-01-12T20:35:01+07:00

Oxaliplatin-induced peripheral neuropathy is a common and disabling neurotoxic effect that greatly affects the peripheral nervous system. Symptoms may appear quickly after drug administration and last long after treatment ends, with severity often linked to the total dose received. This condition greatly hampers patients’ ability to perform daily activities and diminishes their quality of life. Despite its high occurrence, effective pharmacological treatments for oxaliplatin-induced peripheral neuropathy remain limited. Therefore, a thorough investigation of patients’ symptom experiences, self-management strategies, and clinical outcomes is essential.This descriptive-comparative study aimed to compare symptom experiences, management strategies, and outcomes among cancer patients receiving oxaliplatin at four different time points,guided by Dodd and colleagues’ Symptom Management Theory.

The participants were 140 cancer patients from a university-affiliated hospital; those aged 16 years or older and those aged 60 years or older must pass the cognitive screening with the Mini-Cog, developed by Borson and colleagues. They were divided into four groups of 35 participants each: after receiving the 1st and 6th cycles of oxaliplatin, during follow-up at the 1st and 6th months after completing 12 cycles of oxaliplatin. Data were collected between September 2021 and May 2022 using three questionnaires: 1) the Demographic Characteristics and Information about Health, Disease, and Treatment developed by the researchers from the literature review; 2) the Oxaliplatin-Associated Neurotoxicity Questionnaire developed by Leonard and colleagues; and 3) the Management Strategies and Outcomes of Oxaliplatin-Induced Peripheral Neuropathy Questionnaire modified from Panyainkaew and colleagues. The latter two instruments were validated by three experts, with a content validity index of .92. The test-retest reliability for the Oxaliplatin-Associated Neurotoxicity Questionnaire for the symptom occurrence,severity, and interference with daily life was .89, .75, and .74, respectively. In addition, the test-retest reliability for the Management Strategies and Outcomes of Oxaliplatin-Induced Peripheral Neuropathy Questionnaire for the number of management strategies, frequency of strategies used, symptom status, and daily life interference after management was .97, .96, .99,and .97, respectively. Data analysis used descriptive statistics and the Kruskal–Wallis test.

The study revealed that the average age among 140 participants was 68.63 years(SD = 10.23). The majority of them were male (58.60%), had colorectal cancer (64.30%)and were at cancer stage III (58.60%). Participants were divided into four groups following the cycle of chemotherapy, each consisting of 35 individuals. Among patients receiving oxaliplatin at cycle 1, most reported mild symptoms, predominantly numbness in the hands and feet. Facial and oral symptoms were rare and transient. However, after the 6th cycle and during post-treatment follow-ups at 1 and 6 months, patients commonly reported persistent symptoms in the upper limbs—such as numbness, tingling, and burning pain or discomfort without cold stimulation.Symptoms in the lower limbs included numbness, burning pain, or discomfort without cold stimulation, as well as leg heaviness. Symptom severity gradually worsened and became chronic,significantly impacting daily functioning. The three most frequently used self-management strategies were physical exercise (61.42%), heat application (18.57%), and behavioral modification (12.85%). Among these, physical exercise and heat application were reported as the most effective in reducing symptom severity and enhancing patients’ ability to perform daily activities. When comparing each variable across time points, findings revealed statistically significant differences in symptom perceptions, symptom severity, symptom distress, the number of symptom management methods, and symptom outcomes. However, there were no statistically significant differences in the management frequency and symptom status across these time points.

These findings provide essential baseline data for developing nursing practice guidelines. Nurses play a key role in educating patients about symptom progression and practical management strategies before treatment. Implementing structured patient education and symptom-monitoring systems can enhance symptom control, help maintain functional independence, and ultimately improve the quality of life for patients experiencing oxaliplatin-induced peripheral neuropathy. Therefore, further longitudinal research is warranted to evaluate the long-term effectiveness of symptom management strategies in improving patients’ quality of life.

Keywords: Cancer, Management strategies, Outcomes, Oxaliplatin-induced peripheral neuropathy, Symptom experiences

Author Contributions:
CK: Conceptualization, Method and design, Tool validation, Data collection, Data analysis,Writing and revising the manuscript
BS: Conceptualization, Method and design, Data analysis, Writing, revising, and editing the manuscript, Corresponding with the editor-in-chief
SC: Conceptualization, Method and design, Conclusion, Recommendation, Revising the manuscript

Symptom Experiences of Bowel Problems, Management Strategies, and Management Outcomes in Patients with Colorectal Cancer after Surgery

2025-05-19T21:36:13+07:00

Patients with colorectal cancer after surgery without colostomy are more likely to receive less information than those with colostomy. This notion may be due to health care providers focusing on patients with colostomies, who often need more care than individuals without one.Previous studies on the experiences of bowel problems were limited to the symptom perception not expanding to other dimensions of the symptom experience, including symptom evaluation anddistress. Inaddition,previous research studied on management strategies for bowel problems was still limited in its outcomes. Thus, studying symptom experiences of bowel problems,management strategies, and management outcomes is essential in this patient group. This descriptive research study aimed to describe symptom experiences, management strategies, and management outcomes in patients with colorectal cancer after surgery using the Symptom Management Theory as the conceptual framework.

The participants consisted of 60 patients with a new diagnosis of colorectal cancer who received treatment after surgery without colostomy;age equal to or over 18 years; participants aged over or equal to 60 years were screened for cognitive impairment by the Short Portable Mental Status Questionnaire developed by Pfeiffer.All of them sought follow-up at a university’s outpatient surgical department from June 2021 to June 2023. Data were collected using three questionnaires:1)the Personal Information,Health Status,Diseases,and Treatment Questionnaire;2) the Symptom Experience Questionnaire for Patients with Colorectal Cancer after Surgery;and 3) the Management Strategies and Outcome of Symptom Management in Patients with Colorectal Cancer after Surgery. These three instruments were developed by researchers from the literature review. The content validity index was validated by three experts: 1 physician expert in gastrointestinal system and colorectal surgery, 1 nursing faculty expert in gastrointestinal system and general surgery and 1 advanced practice nurse (APN) expert in wound and ostomy care. Two questionnaires, the Symptom Experience Questionnaire and the Management Strategies and Outcome of Symptom Management, were examined by three experts with CVIs of .85 and .80, respectively. They were also tested for face validity in 5 patients, who found them clearly relevant to what they measure,appropriate for the participants,and adequate for its purpose. The data were analyzed using descriptive statistics: frequency, percentage, mean, and standard deviation.

Results showed that participants’ ages ranged from 35 to 88 years, with a mean of 67.70 years (SD = 10.39). The three most common symptoms were flatus incontinence (48.30%), constipation(45.00%),and incomplete evacuation(41.70%). The top three most frequent symptoms were loose stool (mean = 2.74,SD = .99), incomplete evacuation (mean= 2.71, SD = .78), and constipation (mean = 2.65, SD = 1.02). The top three of symptom severity were anxiety(mean = 2.07,SD = .80), stool incontinence(mean = 2.05,SD = .50),and diarrhea (mean = 2.00,SD = .81). The three most common symptoms distress were flatus incontinence (mean = .80, SD = .94), constipation (mean = .80, SD = .97), incomplete evacuation (mean=.73,SD=.97)and abdominal bloating (mean=.73,SD=.99). Management strategies for physical were drugs used to reduce constipation (16.70%),abdominal bloating (8.30%), diarrhea (3.30%), and stool incontinence (1.70%). For the psychosocial aspect,participants used talking with spouses/friends or trusted relatives 3.30%. The mean effectiveness of all management strategies was quite high(mean = 3), ranging from 0 to 4. The results of this study serve as a basis for guiding nursing practice to promote nursing care plans and self-care for colorectal patients upon discharge from the hospital enabling them to manage bowel problems effectively.

Keywords: After surgery, Colorectal cancer, Management strategies, Management outcomes,Symptom experience

Author Contributions:
PS: Conceptualization, Method and design, Tool validation, Data collection, Data analysis,Writing and revising the manuscript
BS: Conceptualization, Method and design, Data analysis, Writing, revising, and editing the manuscript, Corresponding with the Editor-in-Chief
PP: Conceptualization, Method and design, Conclusion, Recommendation, Revising the manuscript

Holistic Health Lived Experiences of Thai Participants in the Dao De Online Group during the COVID-19 Pandemic

2025-10-14T21:02:51+07:00

Dao De Xin Xi techniques are holistic health practices that integrate gentle and flowing movements similar to Tai Chi with the teachings of the Tao Te Ching, which emphasize living in harmony through the principle of Wu Wei, or non-resistance to the natural flow of life. These techniques not only promote physical and mental health but also contribute to the cultivation of ethics and virtues that foster peaceful coexistence in society. Over the past three decades, Dao De Xin Xi techniques have been increasingly recognized in Thai society, with empirical studies supporting their benefits for practitioners’ health and quality of life. However, during the COVID-19 pandemic, government-mandated social distancing measures led to the temporary suspension of the group practice of Dao De Xin Xi in various settings. In this context, Dao De Xin Xi practitioners in Thailand collaboratively established online practice groups via the Zoom platform, marking the first application of Dao De Xin Xi techniques in an online format in the country. This qualitative study aimed to understand the lived experiences of holistic health among Dao De Xin Xi practitioners through online platforms during the COVID-19 pandemic. A phenomenological methodology based on Martin Heidegger’s approach was employed. The study was grounded in the perspective that practicing Dao De Xin Xi online during this period constituted a meaningful process that enabled individuals to confront, adapt to, and transform their experiences of health and existence amidst the crisis. Informants were purposively selected to obtain information aligned with the research objectives, and a snowball sampling technique was additionally employed to capture perspectives across different age groups.

The sample consisted of eight informants, including seven women and one man,aged between 18 and 71 years, with a mean age of 55.63 years. Of these, six were older adults,one was an adult, and one was an adolescent. All informants practiced Dao De Xin Xi techniques via Zoom between July 2021 and October 2022. The majority of participants, 87.5 percent,practiced online daily, while 12.5 percent participated five to six days per week. Data were collected through in-depth interviews conducted via the Zoom platform. The core questions were:“Please describe your experiences of participating in the online Dao De Xin Xi group” and “How has continuous participation in the group affected your overall health and well-being?” Data collection and analysis were conducted concurrently, allowing the researchers to adapt the interview guide based on newly emerging information. After each interview, detailed verbatim transcripts were produced and reviewed with the research team to refine the interview guide and gain deeper insights into the informants’ lived experiences.

Data analysis was conducted using the interpretive approach of Cohen, Kahn, and Steeves, which involved repeated reading of the transcripts, cross-checking with reflexive journals,line-by-line coding, clustering of subthemes, and synthesizing the data into overarching themes that reflected the informants’ lived experiences. Data saturation was achieved after interviews with eight informants. The trustworthiness of the study was ensured following Ahmed’s guidelines,through member checking with participants and peer debriefing within the research team. From the interview data, the lived experiences of holistic health among informants were categorized into two main themes. The first theme revealed that participating in the online Dao De Xin Xi group helped maintain the balance between body and mind amidst life’s uncertainties. The practice not only enhanced awareness and the connection between body and mind but also enabled informants to access their inner life energy, even as their physical bodies experienced age-related decline. The second theme indicated that online group participation contributed to the restoration of holistic well-being across physical, mental, social, and spiritual dimensions. Informants reported relief from physical ailments, improvements in mental health, perceiving expanded social connections and support, and spiritual growth. An essential factor enabling practitioners to attain genuine health benefits was the consistency and intentionality of their mindful practice,which fostered the integration of body, mind, and spirit as a vital foundation for holistic health development.

In conclusion, this study highlights the potential of online platforms in promoting holistic well-being across diverse age groups. It also underscores the importance of developing health programs that are flexible, easily accessible, and integrated with traditional wisdom, such as Dao De Xin Xi techniques, as alternative approaches for health promotion and disease prevention. Such programs should be designed to align with modern lifestyles while remaining adaptable to future uncertainties, particularly during complex crises such as outbreaks of emerging infectious diseases.

Keywords: COVID-19 pandemic, Dao De Xin Xi, Holistic health, Online group, Phenomenological research

Author Contribution:
SRY: Conceptualization, Method and design, Data collection, Analysis, Writing, Revising, and editing the manuscript
SP: Conceptualization, Method and design, Analysis, Revising and editing the manuscript,Corresponding with the editor-in-chief
WN: Conceptualization, Method and design, Analysis
YR: Conceptualization, Method and design
RC: Conceptualization, Method and design
CK: Conceptualization, Method and design

Relationships between Caregiver Burden, Financial Burden, Family Support, and Quality of Life among Caregivers of the Dependent Person

2025-05-18T08:02:29+07:00

Chronic illness-related health problems are a primary cause of limitations or loss of self-care ability in individuals, resulting in long-term dependency on others for continuous care throughout the course of their treatment. Not only do individuals who depend on others frequently face changes in the pathological progression of their diseases, but caregivers must also continuously adapt to evolving treatment plans. Therefore, chronic illness impacts not only the affected individuals but also their families or relatives who assume caregiver roles. The majority of dependent groups are older people and those with disabilities, bedridden, and complex health conditions. These groups require ongoing daily care and health support, particularly within the family context, where caregiver responsibilities predominantly fall on family members. These family caregivers are typically unpaid and lack formal health care training, yet they bear the burden of providing care. This responsibility often requires reallocating time from their own daily activities to care for the dependent individual, resulting in lost income and increased treatment and care expenses. Consequently, these factors directly affect the caregivers’ living conditions and overall quality of life, especially in communities lacking systematic support systems.

This descriptive study aimed to examine the relationships among caregiver burden,financial burden, and family support with the quality of life of caregivers of dependent persons.The study was guided by Oberst’s Caregiving Burden Theory, which posits that caregiver burden arises from the complexity, intensity, and duration of continuous caregiver activities. Such a burden affects the caregiver’s overall well-being, including physical, psychological, and social dimensions. In particular, when caregiver demands exceed the caregiver’s capacity to cope, this may result in fatigue, stress, and a sense of isolation. In addition, the study incorporated Orem’s Self-Care Deficit Theory, which helps explain the condition of dependent individuals who are unable to care for themselves adequately.Consequently, caregivers must step in to support daily living activities across physical, emotional, and social domains. This caregiving role is carried out under the constraints of time, energy, and personal resources. The sample consisted of 85 pairs of caregivers and their dependents who attended the outpatient department at Phra Nakhon Si Ayutthaya Hospital. Participants were selected through purposive sampling and screened using the Barthel Activities of Daily Living (ADL) assessment. Research instruments included a personal information questionnaire, the Perceived Financial Burden scale, the Caregiver Burden Scale, the Family APGAR Questionnaire, and the WHOQOL-BREF (Thai version) to assess quality of life. Data were analyzed using descriptive statistics and Spearman’s correlation coefficient.

The findings revealed that most dependent individuals were in late adulthood, with a mean age of 60.05 years (range 18–89 years). The majority were previously employed in agriculture (74.11%), utilized the Universal Health Coverage scheme (77.65%), and had a chronic illness lasting more than 10 years (40.03%). More than half of them required medical equipment for daily living (61.17%). All participants had high to very high levels of dependency (18.82% and 81.18%, respectively), with an average Barthel ADL score of 2.69 (SD = 1.67),indicating very limited self-care ability. Most caregivers were male, with a mean age of 57.02 years (range 17–84 years), and were predominantly in late working age to aging. The highest education level achieved was secondary school (31.76%), and their primary occupation was agriculture (37.65%). Caregivers reported a moderate level of caregiving burden. The highest caregiving expenses were for adult diapers, enteral feeding, and medical equipment. Family support was rated high, while caregivers’ quality of life was moderate. Statistical analysis showed a significant negative correlation between caregiver burden and quality of life (r = –.47, p < .01),and a significant positive correlation between family support and quality of life (r = .22, p = .04).However, no significant correlation was found between financial burden and quality of life (r = .04, p = .71). These findings highlight the critical role of family support and burden reduction strategies in promoting caregiver well-being and underscore the need for policies that address caregiver burden to improve their long-term quality of life.

Keywords: Caregivers, Caregiver burden, Dependent persons, Family support, Financial burden, Quality of life Caregiver burden

Author Contributions:
TS: Conceptualization, Method and design, Tool validation, Data collection, Data analysis,Writing and revising the manuscript
NP: Conceptualization, Method and design, Data analysis, Writing, revising, and editing the manuscript, Corresponding with editor-in-chief
AS: Conceptualization, Method and design, Conclusion, Recommendation, Revising the manuscript

Knowledge and Attitudes Toward Advance Directive among Patients with Chronic Illness and Relatives

2026-01-12T20:55:49+07:00

The prevalence of non-communicable diseases among early and middle adulthood populations has increased the risk of life-threatening emergencies. Preparing advance directives is essential to reduce patient suffering and ease the caregiving burden. This descriptive study aimed to examine knowledge and attitudes toward advance directives among patients with chronic illness and their relatives. The Knowledge, Attitudes, Practice (KAP) framework, as guided by Singh and Malaviya, was used for the study. Participants were 200 patients with chronic illness and 200 relatives aged 18-59 years who received treatment at a medical outpatient department in a university-affiliated hospital. Data were collected from August 2020 to May 2022 using self-administered questionnaires. Three questionnaires for both patients with chronic illness and their relatives included 1) a personal information questionnaire, 2) the Questionnaire on Knowledge of Advance Directives, and 3) the Questionnaire on Attitudes Toward Advance Directives. The two questionnaires on knowledge and attitudes toward advance directives were developed by researchers and validated by 5 experts with content validity indices of 0.94 and 0.98, respectively. The reliability of knowledge of advance directives among patients with chronic illness and their relatives were assessed using the Kuder-Richardson formula 20 (KR 20),yielding a coefficient of .66 and .62 respectively. Meanwhile, Cronbach’s alpha was used to assess the reliability of attitudes toward advance directives in patients with chronic illness and their relatives, yielding a value of .81 and .77 respectively. Descriptive statistics were used to analyze data by frequency, percentage, average, and standard deviation.

The study found that the average age of patients with chronic illnesses was 41.48 years (SD = 11.22), while the average age of relatives was 39.99 years (SD = 10.24). The majority of participants in both groups were unaware of advance directives and had not received any education on the topic; however, they expressed a strong interest in creating one to ensure a peaceful and reduced suffering. Most participants agreed to refuse life-sustaining treatment for themselves and their loved ones when nearing the end of life, favoring the option to pass away at home. In the knowledge section, patients with chronic illnesses demonstrated moderate knowledge with a mean of 5.99 (SD = 2.24). The most correct answer to the knowledge question among 88% of patients was: when making an advance directive, it should inform your family and healthcare providers of your wishes if hospitalized. The least correct answer to the knowledge question among 31% of patients was: keeping the original advance directive and copies at home to prevent misplacement. In addition, the relatives of patients with chronic illnesses demonstrated a moderate level of knowledge with a mean of 6.22 (SD = 2.16). The most correct answer to the knowledge question among 88.50% of relatives was: when making an advance directive, it should inform your family and healthcare providers of your wishes if hospitalized. Meanwhile,the least correct answer to the knowledge question among 38.00% of relatives was: an advance directive can only be created at a hospital. In the attitude part, both patients with chronic illnesses and their relatives had positive attitudes toward advance directives, 84.50% and 68.00%,respectively. The results of this study can be used to implement nursing planning, including promoting advanced care plans and enhancing the uptake of advance directives.

Keywords: Advance directive, Attitude, Knowledge, Patients with chronic illness, Relatives

Author Contributions:
KP: Conceptualization, Method and design, Tool validation, Data collection, Data analysis,Writing and revising the manuscript
BS: Conceptualization, Method and design, Data analysis, Writing, revising, and editing the manuscript, Corresponding with the Editor-in-Chief
TJ: Conceptualization, Method and design, Conclusion, Recommendation, Revising the manuscript