Ramathibodi Nursing Journal 2020-09-06T17:38:25+07:00 Supreeda Monkong Open Journal Systems <p>รามาธิบดีพยาบาลสาร เป็นวารสารทางการพยาบาลราย 4 เดือน จัดทำขึ้นโดยโรงเรียนพยาบาลรามาธิบดี คณะแพทยศาสตร์โรงพยาบาลรามาธิบดี และสมาคมศิษย์เก่าพยาบาลรามาธิบดี มีระบบการบริหารจัดการแบบสากล คือ มีกองบรรณาธิการและผู้ทรงคุณวุฒิภายนอกตามจำนวนที่ สกอ.และ TCI กำหนด มีวัตถุประสงค์เพื่อเผยแพร่ผลการศึกษาค้นคว้า โครงการกิจกรรม การวิจัยทางการพยาบาลและสาขาอื่นที่เกี่ยวข้อง</p> Acute Confusional State and Management by Healthcare Personnel among Medical Elderly Patients in a Tertiary Care Hospital 2020-09-01T18:35:10+07:00 Chulaluk Jaipang Porntip Malathum Nuchanad Sutti Yuttachai Likitjaroen <p>Acute confusional state (ACS) is a common condition in hospitalized elderly patients.However, little is known about the prevalence and incidence, and how healthcare personnel manage the ACS in hospitalized elderly patients. This prospective descriptive study aimed to explore the prevalence and incidence of ACS in elderly patients, and management by the healthcare personnel in elderly patients with ACS admitted to medical wards. Purposive sampling was used to recruit a sample of 192 elderly patients in medical wards at a tertiary hospital, and consecutive sampling was used to recruit a sample of 31 healthcare personnel working in those wards. The data collection was conducted from August to November 2018, using questionnaires and assessment forms. The data were analyzed using descriptive statistics, Chi-square, and content analysis. The point prevalence rate of ACS in elderly patients at admission was 3.65%, while its incidence was 5.21%, so the period prevalence rate was 8.85%. Risk factors associated with ACS included dementia, hypoxemia, advanced age,infection, and insomnia. For management by physicians, all elderly participants received medical<br>treatment to minimize risk factors of ACS. The management by other healthcare personnel included<br>participation in the treatment of underlying causes, managing ACS behaviors, prevention of complications, and restoration of functions. In addition, facilitators for management included family participation in patient care, the interdisciplinary team, care management guidelines, and educational training. Barriers to management consisted of workload and inadequate experience or knowledge of the personnel. Findings suggest that healthcare personnel should proactively assess, prevent, and manage ACS in elderly patients to resume normal as soon as possible.</p> 2020-08-28T14:24:10+07:00 Copyright (c) 2020 Ramathibodi Nursing Journal Effectiveness of Coaching on Adherence towards Guidelines for Prevention of Ventilator-Associated Pneumonia and Clinical Outcomes 2020-09-06T12:24:54+07:00 Srisuda Assawapalanggool Mongkol Surimuang <p>This quasi-experimental research aimed to compare the adherence towards guidelines for the prevention of ventilator-associated pneumonia (VAP) and clinical outcomes, including the incidence rate of VAP, the length of intubation, the hazard ratio of successful extubation, tracheostomy incidents, length of hospital stay, and costs of treatment between a reference group (usual care) and the intervention group (coaching following Hass’ conceptual framework). The study was conducted in four medical wards in Mae Sot Hospital, Tak Province. Purposive sampling was performed to recruit 64 nurses and 150 ventilated patients aged 15 years or older during the study period. Data collection tools consisted of 1) the Nosocomial Surveillance Form, and 2) an observation checklist. The proportion of accurate nursing practices adhering to guidelines for the prevention of VAP, the duration of mechanical ventilation, tracheostomy incidents, length of hospital stays, and cost of treatment between groups were analyzed using descriptive statistics, Wilcoxon's rank-sum and chi-square test. The VAP incidence rate was estimated using Poisson regression. The hazard ratio of successful extubation along the cohorts was analyzed in a Cox proportional hazards regression model. The results revealed that staff nurses in the intervention group significantly more increased accurate practices<br>adhering towards guidelines for the prevention of VAP than those in the reference group. The VAP incidence rate significantly more decreased three times in the experimental group than the reference group. The mean intubation period significantly decreased among the experimental group. The hazard ratio of successful extubation significantly more increased in the experimental group 2.05 times than in the control group. Tracheostomy, length of hospital stays, and total cost were significantly lower among patients in the experimental group than those in the reference group. In conclusion, coaching staff nurses to adhere to guidelines for the prevention of VAP in this study improved nursing care practice and clinical outcomes.</p> 2020-08-28T15:20:33+07:00 Copyright (c) 2020 Ramathibodi Nursing Journal Evaluation of the Utilization of Nursing Practice Guidelines for Sepsis Management on Clinical Outcomes among Patients with Sepsis in Medical Units. 2020-09-06T12:29:26+07:00 Tarntana Wongtawee Apinya Siripitayakunkit Soontaree Jianvitayakij <p>This quasi-experimental research aimed to evaluate the utilization of nursing practice guidelines for sepsis management on clinical outcomes among patients with sepsis. Donabedian’s model was used as a conceptual framework for the implementation of guidelines. The samples consisted of 32 patients with sepsis and 43 medical staff nurses who were recruited for this study from September 2019 to January 2020. The research instrument included the Nursing Practice Guidelines for Sepsis Management, the Personal Data Recording Form, the Nursing Care’ s Checklist Form, the Sequential Organ Failure Assessment (SOFA) Form, the Septic Shock Assessment Form, and the Feasibility of Nursing Practice Guidelines for Implementing in Medical Units Questionnaire. Descriptive statistics and Mann-Whitney U test were used to analyze the<br>data. The results showed that the most common signs and symptoms of patients with sepsis were fever, SBP lower than 100 mmHg, tachypnea, and tachycardia, respectively. Almost all of the nurses practiced and followed the guidelines. However, some activities that did not completely adhere to the guidelines included recording of mean arterial pressure, giving broad-spectrum antibiotics within one hour, and monitoring of patients during the transfer, respectively. After using the guidelines, the level of SOFA decreased in 48 hours as compared to the baseline SOFA scores. Approximately 10% of sepsis patients turned to have septic shock and were transferred to the ICU within 6 hours. From this study, most nurses were satisfied with the guidelines and reported that it is feasible to manage the sepsis. However, the more specific guidelines that should be developed include the protocol of early antibiotic administration within one hour, the training<br>program for nurses to care for patients with sepsis, and practice guidelines in collaboration with the multidisciplinary team to improve the care quality in patients with sepsis.<br><br></p> <p>&nbsp;</p> <p>&nbsp;</p> 2020-08-28T15:42:33+07:00 Copyright (c) 2020 Ramathibodi Nursing Journal Effects of a Physical Activity Promoting Program on Self-Efficacy for Physical Activity, the Severity of Knee Osteoarthritis, and Balance among Persons with Knee Osteoarthritis. 2020-09-06T13:38:36+07:00 Siraphob Tosem Teeranut Harnirattisai Thongchai Suntharapa Borwarnluck Thongthawee <p>This study used a quasi-experimental research design with pretest-posttest control groups and aimed to examine the effects of a physical activity promoting program on self-efficacy for physical activity, the severity of knee osteoarthritis, and balance among persons with knee osteoarthritis.The program was developed based on the self-efficacy theory. The study recruited 78 persons with knee osteoarthritis who sought care service at an outpatient clinic. The sample was randomly assigned either to the experimental (n = 39) or control group (n = 39). Those in the experimental group received the physical activity promoting program, while those in the control group received routine care. The instruments used in this study included the Demographic Questionnaire, the Self-Efficacy Scale for Physical Activity, the Severity of Knee Osteoarthritis Questionnaire and the Timed Up and Go Test. Data were analyzed using descriptive statistics, independent sample t-test, and repeated measures ANOVA. The results showed that the experimental group had a significantly higher mean score of self-efficacy for physical activity and a significantly lower mean score of the severity of knee osteoarthritis at weeks 4 and 8 after receiving the program than did the control group. Although the physical activity program could not change the balance significantly, the experimental group improved its mean score for balance over time. The findings suggested that the program should be applied to enhance the perceived self-efficacy for physical activity, balance, and reduced the severity of knee<br>osteoarthritis in persons with knee osteoarthritis. The healthcare team should use this program continuously for decreasing the severity of knee osteoarthritis and increasing balance to prevent falls among persons with knee osteoarthritis.</p> 2020-08-29T15:32:26+07:00 Copyright (c) 2020 Ramathibodi Nursing Journal The 6 Item Cognitive Function Test- Thai Version: Psychometric Property Testing 2020-09-06T14:21:08+07:00 Suparb Aree-Ue phichpraorn Youngcharoen <p>This descriptive study aimed to translate the 6 Item Cognitive Impairment Test (6CIT) that was originally developed by Brooke and Bullock in 1999 from English to Thai and to preliminarily examine its validity and reliability. This study included two phases. Phase 1 consisted of translating the 6CIT into Thai using the back translation method and assessing content validity by a panel of experts in gerontology and cognitive<br>impairment in older people. Phase 2 comprised concurrent validity testing and stability reliability testing. Participants in this study were older people who participated in two senior citizens clubs, Bangkok. A hundred older people who met the inclusion criteria were invited to participate in this study. Participants were interviewed using the demographic questionnaire, the Mini-Cog-Thai version, and the 6CIT-Thai version. Fifty participants out of a hundred who had the same inclusion criteria were asked to complete the 6CIT-Thai version again in the next two weeks. Data were analyzed using Spearman’s rank correlation coefficients. The results indicated that the content validity index for item and scale level index reflected its validity. The 6CIT-Thai version showed acceptable concurrent validity. There was a statistically significant moderate negative correlation between the score of the 6CIT-Thai version and the Mini-Cog-Thai version.<br>Also, the stability reliability was validated through the test-retest reliability coefficient and it showed a significant strong positive correlation between a score of the 6CIT-Thai version at the first round and the second round, two weeks apart. In summary, the 6CITThai version has shown to be valid and reliable to use for initial screening for dementia in older adults living in a community and for conducting research.</p> 2020-08-30T09:48:55+07:00 Copyright (c) 2020 Ramathibodi Nursing Journal The Development of an Innovative Work Behavior Scale for First-line Nurse Managers in Private Hospitals 2020-09-06T15:09:15+07:00 Bubpha Kitsahawong Phechnoy Singchungchai Netchanok Sritoomma <p>The purpose of this study was to investigate the components of an innovative work behavior scale for the first-line nurse managers of private hospitals. A sample of 242 first-line nurse managers was recruited from 19 private hospitals. The research instrument was De Jong and Hartog’s Innovative Work Behavior Scale with 17 question items and a 5-point rating scale. Content validity was validated by a panel of experts;the content validity index, the reliability, and the power of discrimination met the criteria.The statistics used for construct validity were exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The study found that the Innovative Work Behavior Scale consisted of 16 items with four components: 1) surveying of innovative<br>development ideas behavior (idea exploration) with five indicators, 2) innovative ideaforming behavior (idea generation) with three indicators, 3) adoption of innovative behavior (idea championing) with four indicators, and 4) implementation of innovative behavior (idea implementation) with four indicators. The reliability of each scale component was good. The construct validity of confirmatory factor analysis revealed that the development of innovative work behavior among first-line nurse managers was consistent with the empirical data. Therefore, the results of this study could be used in the development of an innovative work behavior scale for first-line managers of nursing organizations.<br><br></p> 2020-08-30T10:19:23+07:00 Copyright (c) 2020 Ramathibodi Nursing Journal A Study of Collaborative Problem-Solving Competency for Nursing Students 2020-09-01T17:56:29+07:00 Jirarporn Tunksakool Danulada Jamjuree Montree Yamkasikorn Chuanruedee Kongsaktrakul <p>This qualitative descriptive research aimed to examine collaborative problemsolving competency in nursing students. In-depth interviews were used for data collection with eight participants who were nurse instructors and nurses who had received the Nursing Practice Excellence Awards from their hospitals or nursing organizations. The result of the study illustrated that the meaning of collaborative problem solving<br>competency for nursing students was the student’s behaviors to motivate others to engage in team-based problem solving, to think about all possible solutions to solve a problem,and reach the ultimate goal and everybody’s satisfaction by taking the benefit of the group into account. The collaborative problem-solving competency comprised three different competencies with eight total components: 1) the competency of establishing and maintaining their understanding of each other, consisting of three components<br>(Collecting/Researching Data, Sharing Data, and Confirming Data); 2) the competency of selecting a proper solution in solving problems, consisting of two components (Connecting Data, Making Decisions); 3) the competency of establishing and maintaining an organizational team, consisting of three components (Teamwork, Support Groups, and Evaluation and Improvement). Therefore, this collaborative problemsolving<br>capability in nursing students can be used to determine expected learning outcomes and to design learning management that empowers nursing students with collaborative problem-solving abilities to work effectively with health teams.</p> 2020-08-30T10:35:39+07:00 Copyright (c) 2020 Ramathibodi Nursing Journal The Effect of a Competency-Strengthening Program to Use Geriatric Health Assessment Tools among Nursing Students 2020-09-06T16:50:02+07:00 Winthanyou Bunthan <p>This quasi-experimental study aimed to examine the effects of a competencystrengthening program to use geriatric health assessment tools on knowledge and perceived skills in using the tools of nursing students. The concept of experiential learning was used to guide the study. The sample consisted of 48 third-year nursing students by which 24 students were in the experimental group and 24 students were in the control group.Research instruments included: 1) the Knowledge to Use Geriatric Health Assessment Tools Scale), and 2) the Perceived Skills to Use Geriatric Health Assessment Tools Scale. Data were analyzed using descriptive statistics, Wilcoxon signed-rank test, and Mann-Whitney U test. The results showed that the mean rank of knowledge and perceived skills in using geriatric health assessment tools after the experiment were significantly higher than those before the experiment, as well as higher than those in the control group.<br>Therefore, the competency-strengthening program to use geriatric health assessment tools should be applied to nursing students before practicing in nursing practicum.</p> 2020-08-30T11:53:35+07:00 Copyright (c) 2020 Ramathibodi Nursing Journal Psychomotor Entrustable Professional Activities of Newly Graduated Nurse-Midwives: A Delphi study 2020-09-06T17:38:25+07:00 Streerut Thadakant Sumolchat Duangbubpha <p>This research study aimed to study psychomotor activities that newly graduated nurse-midwives could practice with and without supervisors by using the entrustable professional activities framework (EPAs). The Delphi technique was used to gather information. A sample of 30 nursing experts was recruited. Fifteen of them were from nursing education, while the other 15 were from nursing services. One hundred and<br>forty-seven psychomotor activities with 5-point rating scales of newly graduated nurse’s practice ability were listed as a tool. Data were analyzed using median and interquartile range to get the consensus of experts. The research findings showed that the psychomotor activities, which newly graduated nurse-midwives could practice without supervisors as the expert consensus, included 23 activities. However, the psychomotor activities,which newly graduated nurse-midwives could practice with supervisors as the expert consensus, consisted of 1) 51 activities that could practice under available distancesupervision, 2) 49 activities that could practice under vision supervision, 3) 18 activities that could practice under close supervision, and 4) four activities that were not allowed to practice at all, but just observe outside with supervisor. These findings can be used as guidelines for teaching and learning of the bachelor of nursing science program to strengthen nursing students’ practice skills, according to the professional requirements.Also, these can be used as an agreement between educational institutions and employers of the nurse-midwives in clinics about entrustable activities of newly graduated nurses-midwives.<br><br></p> 2020-08-30T12:18:04+07:00 Copyright (c) 2020 Ramathibodi Nursing Journal