Nursing Research and Innovation Journal

The Effects of Health Belief Promotion Program on Caregivers’ Behaviors in Prevention of Acute Respiratory Infection and Health Outcomes of Preschool Children

2024-07-10T22:04:34+07:00

Acute respiratory infections are a significant public health concern, particularly among preschool-aged children who have underdeveloped immune systems and immature respiratory tracts. These children are susceptible to infections an average of 6 to 8 times per year. Without appropriate care, complications or even death may occur. Although advances in modern medicine have improved survival rates, the incidence of illness remains high. Factors contributing to acute respiratory infections can be categorized into three main areas: child-related, caregiver-related, and environmental. Among these, the caregiver’s role is particularly critical in monitoring, prevention, and making timely decisions regarding access to medical care. The Health Belief Model is a conceptual framework used to promote health behaviors by emphasizing perceived susceptibility, perceived severity of disease, perceived benefits of preventive actions, and perceived barriers, thereby encouraging the adoption of appropriate behaviors. Previous research has primarily applied the Health Belief Model to individuals with chronic illnesses. However, few studies have adapted this model for caregivers of preschool-aged children to prevent acute respiratory infections.

Additionally, long-term outcome evaluations in this area remain limited. This quasi-experimental study aimed to examine the effects of a health belief promotion program on caregivers’ behaviors to prevent acute respiratory infections., as well as on the health outcomes of preschool-aged children. The objectives of the study were: 1) to compare the acute respiratory infection prevention behaviors of caregivers between the experimental and control groups after the intervention; 2) to compare the acute respiratory infection prevention behaviors of caregivers in the experimental group before and after the intervention; and 3) to compare the health outcomes of children in the experimental and control groups. The sample consisted of 68 caregivers of children aged 2 to 6 years, equally divided into an experimental group and a control group, with 34 participants in each. The experimental group received the health belief promotion program,which included the provision of information about acute respiratory infections, individual and group discussions, demonstrations, hands-on activities, and weekly follow-up for 4 weeks. Data were collected using a personal information questionnaire, a questionnaire on preventive behaviors related to acute respiratory infections, and a child health outcomes assessment form. Data were analyzed using frequency and percentage, mean and standard deviation, and analysis of covariance.

Among the 68 participants, 91.18 percent were female, and 8.82 percent were male, aged 20 to 65 years, with the majority aged 30 to 39. No statistically significant differences were found in general characteristics between the experimental and control groups at the .05 significance level, indicating that both groups were comparable. After receiving the health belief promotion program, caregivers in the experimental group had significantly higher mean scores for acute respiratory infection prevention behaviors compared to their pre-intervention scores (t = -5.13, p < .001) and to those of the control group (F_1,65 = 25.46, p < .001). These results demonstrate the effectiveness of the health belief promotion program in promoting preventive behaviors, particularly when supported by enhanced self-efficacy and social support. The study found no statistically significant differences in children’s health outcomes between the experimental and control groups. This may be attributed to external factors, such as increased public health awareness during the COVID-19 pandemic and the relatively short follow-up duration of the study. The findings of this study suggest that healthcare professionals should consider implementing programs based on the Health Belief Model to promote preventive behaviors among caregivers of preschool-aged children. Future research should include longer follow-up periods and explore factors influencing the adoption of such programs in various settings to ensure sustainability and long-term benefits.

Keywords : Caregiver behaviors, Health belief promotion program, Health outcomes, Preschool children, Prevention of acute respiratory infection

Author Contributions

VS: Conceptualization, method and design, tool validation, data collection and analysis, and writing and revising the manuscript

RP: Conceptualization, method and design, data analysis, writing, revising, and editing the manuscript, and corresponding with the editor-in-chief

PS: Conceptualization, method and design, data analysis, and revising the manuscript

Factors Predicting Quality of Life in Obese Patients after Bariatric Surgery

2025-05-12T23:15:46+07:00

Obesity is a global public health concern that leads to pathophysiological changes. These changes significantly impair mobility, hinder daily functioning, reduce sleep quality, and ultimately deteriorate an individual’s overall quality of life. Excessive accumulation of adipose tissue also in obese patients increases the risk of accidents, particularly motor vehicle accidents, which in turn impacts occupational performance and restricts job opportunities. As the prevalence of obesity continues to rise globally, effective treatment strategies have become increasingly crucial. Bariatric surgery has emerged as a standard and effective treatment modality for patients suffering from severe obesity, particularly those with a body mass index (BMI) ≥ 40 kg/m². This surgical intervention effectively reduces excess body weight and helps manage or even resolve obesity-related comorbidities. Moreover, it improves physical appearance, self-confidence, and quality of life. Key factors influencing postoperative quality of life include the percentage of excess weight loss (%EWL), depression, physical functioning, and social support.

This predictive correlational study was designed to examine the influence of selected variables on the quality of life among individuals who had undergone bariatric surgery. The conceptual framework was based on Wilson and Cleary’s model of health-related quality of life, which integrates biological and psychological aspects to offer a comprehensive view of factors influencing patient well-being. A purposive sampling approach was utilized to recruit participants who met specific inclusion criteria. Eligible participants were aged 18 years or older, of both sexes, had been clinically diagnosed with obesity, and had undergone either Laparoscopic Sleeve Gastrectomy or Roux-en-Y Gastric Bypass surgery at least six months before the study—individuals who were not diagnosed with cancer, kidney disease, heart failure, or stroke. Additionally, participants were required to have no impairments in vision, hearing, or other sensory functions. All participants were required to be fluent in Thai and willing to engage fully in the research process. Data collection involved the use of five well-established instruments. These included: a demographic and health information questionnaire; the Center for Epidemiologic Studies Depression Scale (CES-D), which measures depressive symptoms; the Karnofsky Performance Status Scale, used to assess physical functioning; the Social Support Questionnaire; and the Obesity and Weight-Loss Quality of Life Instrument. Descriptive statistics, including means and standard deviations, were used to summarize participant characteristics, while hierarchical regression analysis was employed to identify significant predictors of quality of life.

The results indicated that participants had a generally good quality of life (Mean = 53.30, SD = 26.17). The average %EWL was 58.42% (SD = 17.63), indicating a substantial reduction in excess body weight. In terms of mental health, participants, on average, did not report clinical levels of depressive symptoms, as reflected in the mean CES-D score of 11.40 (SD = 8.76). Social support was also reported to be good, with a mean score of 3.55 (SD = 0.54), suggesting that most individuals had access to supportive interpersonal relationships following surgery. Hierarchical regression analysis demonstrated that depression and physical functioning were statistically significant predictors of postoperative quality of life, jointly accounting for 25.40% of the variance in quality of life scores (R² = .25, F = 6.37, p < .001). Among these two factors, depression emerged as the most influential predictor (β = -0.38, p < .001), followed by physical functioning (β = 0.36, p = .002).

These findings have important implications for healthcare providers and policymakers involved in the postoperative care of bariatric patients. Interventions should prioritize regular screening and management of depression, as untreated psychological distress can significantly undermine the benefits of surgical weight loss. Additionally, programs aimed at promoting physical rehabilitation and functional independence can further enhance long-term outcomes. Emphasis should also be placed on reinforcing social support systems, as positive interpersonal interactions contribute to emotional resilience and encourage sustained lifestyle changes. Ultimately, maintaining weight loss, fostering self-worth, and promoting a positive body image are essential components in achieving a lasting improvement in quality of life after bariatric surgery.

Keywords: Bariatric surgery, Obese patients, Quality of life

Author’s contributions:

PK: Conceptualization, method and design, tool validation, data collection, data analysis, wrote manuscript, revised manuscript

SC: Conceptualization, method and design, data analysis, wrote manuscript, revised manuscript, edited manuscript, corresponding with editor-in-chief

PP: Conceptualization, method and design, data analysis, revised manuscript

The Effects of Self-Care Promoting Program on Knowledge and Self-Care Behaviors Among Patients with Kidney Stone post- Extracorporeal Shock Wave Lithotripsy

2025-05-03T21:11:27+07:00

Kidney stones are more prevalent in developed countries, while kidney and bladder stones are common in developing countries, likely due to dietary habits, environmental factors, and advancements in diagnostic techniques. Recurrence rates have reached up to 75% over 20 years. Kidney stone formation is a multifactorial condition influenced by both intrinsic risk factors and extrinsic environmental determinants, leading to metabolic disorders and urinary compounds. Additionally, low urine volume can lead to the aggregation and crystallization of stones in the urinary system. Kidney stone disease affects the quality of life and families of patients in multidimensional effects, including physical, as kidney stones can cause discomfort, suffering, and chronic illness, leading to stress and anxiety. These conditions may alter patients’ roles and responsibilities and adversely affect their financial status and overall economic well-being, affecting both patients and their families. The treatment of large kidney stones through extracorporeal shock wave lithotripsy (ESWL). ESWL is the first-line treatment using high-energy sound waves from outside the body to break down the stones without damaging tissues, resulting in minimal side effects and high effectiveness. After ESWL, there is a chance of recurrence and new stone formation within the first 12 months. Changing health behaviors to be appropriate by eating a variety of foods, drinking about 2,500-3,000 ml of water per day, urinating 2-2.5 L per day, exercising regularly, and controlling weight to be in the standard range (body mass index: BMI =18.50-22.90 kg/m2). Therefore, patients must acquire health-promoting knowledge and adopt appropriate self-behaviors to prevent the recurrence of kidney stone disease. The reduction of severe post-ESWL complications and recurrent kidney stone formation significantly enhances patients' quality of life.

This quasi-experimental, one-group pretest-posttest study recruited 30 patients with kidney stones post-ESWL from a university hospital in Bangkok, who were selected through purposive sampling. A self-care promoting program, grounded in the self-care theory by employing a supportive-educative nursing system as the conceptual framework, comprised four activities: building relationships and setting goals, teaching to provide knowledge about kidney stones, guiding on self-care practices and behavior modification to reduce risk factors and prevent stone formation, and supporting through educational tools, environmental modification, and interactive communication to foster effective self-care. The program was delivered in person and online via a video, a guidebook, and the Line Official Account (OA) application, enabling continuous contact between the researcher and participants. Data were collected using the Demographic Form, the Knowledge of Kidney Stone Disease Questionnaire, and the Self-Care Behavior Questionnaire. The analysis employed descriptive statistics, paired t-tests, and Wilcoxon signed-rank tests.

The study showed that after receiving the self-care promoting program, the mean rank score of knowledge about kidney stones was significantly higher than before receiving the self-care promoting program (Z = -4.72, p < .05), and the mean score of self-care behaviors among participants was significantly higher than before receiving the self-care promoting program (t = 16.91, p < .05). In short, the self-care promoting program significantly enhanced knowledge and self-care behaviors among patients with kidney stones following ESWL. However, the lack of a control group restricts the ability to confirm its effectiveness. Further research is necessary to include a control group and evaluate the sustainability of the outcomes over time.

Keywords: Extracorporeal shock wave lithotripsy, Kidney stones, Knowledge about kidney stones, Self-care behaviors, Self-care promoting program

Author’s contributions:

JJ: Conceptualization, method and design, tool validation, data collection, data analysis, writing manuscript, revising manuscript
SC: Conceptualization, method and design, data analysis, writing, editing, and revising the manuscript, and corresponding with the editor-in-chief
NB: Conceptualization, method and design, data analysis, revising manuscript

Effects of a Supportive-Educative Program on Caregivers’ Knowledge and Behaviors in Volume Control and People Receiving Hemodialysis’s Interdialytic Weight Gain

2025-06-01T10:37:38+07:00

People receiving hemodialysis in the contemporary healthcare landscape demonstrate an increasing demographic trend toward elderly individuals or those requiring assistance with activities of daily living. Consequently, there exists a critical necessity to provide education, support, and enhanced skills development for primary caregivers. This caregiver preparation facilitates collaborative care management with hemodialysis nursing staff when they are in the home environment. Particular emphasis must be placed on fluid volume management protocols to prevent volume overload. This quasi-experimental study investigates the effects of an educational support program on caregivers’ knowledge and behaviors regarding volume control for patients receiving hemodialysis. This study used Orem's self-care theory as a conceptual framework to develop the program. The 24 pairs of caregivers and people receiving hemodialysis at the Somdech Phra Debaratana Medical Center Hemodialysis Unit at Ramathibodi Hospital were recruited based on the inclusion criteria, with people receiving hemodialysis experiencing intradialytic weight gain (IDWG) exceeding 2 kilograms at least once per week, along with their caregivers and underwent a 4-week supportive education program.

Data were collected from April to July 2021. The supportive education program consisted of three phases: self-awareness and knowledge promotion, skill training, and continuous care for four weeks. A follow-up evaluation was conducted for another two weeks. This study employed five instruments: 1) a personal information questionnaire for patients, 2) a personal information questionnaire for caregivers, 3) the Caregivers’ Knowledge of the Volume Control Assessment Form, 4) the Caregivers’ Behaviors Towards Volume Control Assessment Form to measure data before receiving the program, at week 4 and week 6, and 5) the Six Item Cognitive Impairment Test (6-CIT) to evaluate the cognition status of caregivers aged 60 and above. Data were analyzed using descriptive statistics, repeated-measures ANOVA, and the Friedman test.

The descriptive statistics showed that the study sample consisted predominantly of female caregivers (87.50%), with an age range of 40-75 years, and the people receiving hemodialysis in their care were 54% female, with an age range of 55-87 years. Regarding knowledge assessment, statistical analysis revealed that caregivers' mean knowledge scores in weeks 4 and 6 post-intervention were significantly higher than baseline (Z = 3.71, p < .01 and Z = 4.11, p < .01, respectively). However, there was no statistically significant difference between the mean knowledge scores at week 4 and week 6 (Z = 2.27, p =.13). Mean scores for caregiver behavior in controlling fluid intake at week 4 (MD = 8.67, p < .01) and Week 6 (MD = 10.08, p < .01) post-intervention were significantly higher than pre-intervention scores, indicating a progressive improvement in behavior. Nonetheless, the mean fluid control behavior scores between week 4 and week 6 were not statistically different (MD = 1.42, p = .24).

The mean interdialytic weight gain (IDWG) was 2.22 kg (SD = 0.83) pre-intervention, which decreased to 1.56 kg (SD = 0.58) at week 4 and further to 1.30 kg (SD = 0.61) at week 6. An ANOVA revealed a statistically significant difference among the three time points (pre-intervention, week 4, and week 6) (F = 18.69, p < .01). Post-hoc analyses demonstrated that mean IDWG at week 4 (MD = 0.66 kg, p < .01) and week 6 (MD = 0.91 kg, p < .01) were significantly lower than the pre-intervention IDWG. Furthermore, the mean IDWG at week 6 was significantly lower than that at week 4 (MD = 0.26 kg, p = .03), indicating a sustained and progressive reduction in fluid gain. In terms of clinical implications, the intervention protocol and subsequent findings provide substantive evidence for the development of evidence-based nursing care protocols within hemodialysis units. Implementation of similar educational programs may enhance caregiver competence across multiple domains: fluid intake management, restriction of high-sodium food, weight assessment techniques, intradialytic weight gain monitoring, assessment and management of volume overload, and supervision of appropriate diuretic administration.

However, the single-group pretest-posttest design without a control group limits the ability to draw definitive conclusions about intervention efficacy. Future research should incorporate continuous longitudinal assessment of caregiver competencies throughout the care continuum. Program dissemination to the broader population of caregivers of people receiving hemodialysis is recommended, with appropriate modifications to accommodate clinical workflow constraints and time limitations of hemodialysis nursing personnel.

Keywords: Behaviors in volume control, Caregivers, Hemodialysis, Knowledge, Volume overload Supportive-Educative Program

Author’s contributions:

YC: Conceptualization, method and design, tool validation, data collection, data analysis, wrote manuscript, revised manuscript

NP: Conceptualization, method and design, data analysis, wrote manuscript, revised manuscript, edited manuscript, corresponding with editor-in-chief

SC: Conceptualization, method and design, conclusion, recommendation, and revised manuscript

Relationships among Nurses’ Personnel Factors, Knowledge, Attitudes, and Lower Extremities Deep Vein Thrombosis Prophylaxis Practices in Patients undergoing Surgery

2025-05-09T10:17:16+07:00

Deep vein thrombosis (DVT) is a condition in which blood clots adhere within the veins, most commonly found in the distal veins of the lower extremities. This condition is prevalent among surgical patients. Several contributing factors including prolonged surgery lasting more than 30 minutes, administration of general anesthesia, vascular injury during surgery, and prolonged bed rest due to restricted mobility after surgery. Currently, hospitals have developed practices to prevent DVT from the preoperative to the postoperative stages. Therefore, continuous nursing care can help reduce the incidence of DVT after surgery, as well as avoid potential harm to patients, especially sudden death after surgery. However, there remains a notable deficiency in research that explores the factors influencing nursing practices related to the prevention of lower extremity DVT in patients undergoing surgery. Addressing this knowledge gap is essential for the development of effective nursing interventions aimed at preventing DVT within surgical settings.

This descriptive correlational study examined relationships among nurses’ personal factors, knowledge of DVT, attitude toward DVT prevention, and DVT prophylaxis practices in patients undergoing surgery. The researcher applied the Nursing Role Effectiveness Model (NREM) along with a literature review as the conceptual framework for the study. The NREM assesses the quality of nursing care by defining components that are more specific to the nursing context: consisting of structure, process, and outcomes. Internal factors within the structural components of nursing influence the nursing process, which, in turn, impacts patient outcomes. The sample consisted of 93 full-time registered nurses from surgical nursing units with at least one year of experience in postoperative surgical patient care, working in inpatient departments at two tertiary care hospitals under the Royal Thai Navy, Ministry of Defense. Participants were selected using purposive sampling based on inclusion criteria. Data were collected between September and November 2024. The sets of questionnaires included the demographic questionnaire, the nurses’knowledge about DVT questionnaires, the nurses’ attitudes toward DVT prophylaxis questionnaire, and the nurses’ practices on DVT prophylaxis for patients undergoing surgery questionnaire. Data were analyzed using descriptive statistics, Spearman’s rank correlation coefficients, and point-biserial correlation coefficients.

The results demonstrated that participants had a mean age of 31.92 years, with an average of 9.02 years of work experience in postoperative surgical patient care. The mean scores showed a relatively good level of knowledge about DVT, a positive attitude toward DVT prophylaxis, and satisfactory DVT prophylaxis practices. Significant low positive correlations were found among years of working experience (r = .22, p < .05), DVT training (r = .21, p < .05), nurses’ knowledge of DVT, (r = .25, p < .05), and DVT prophylaxis practices. Moreover, nurses’ attitudes toward DVT prevention showed a statistically significant moderate positive correlation with nurses’ lower extremities DVT prophylaxis practices (r = .33, p < .01). The results in this study can be served as foundational data for nursing care planning to enhance the effectiveness of nursing interventions in preventing lower extremity deep vein thrombosis in surgical patients. Furthermore, it can be utilized to reinforce attitudes, promote knowledge, and improve surgical nurses’ skills regarding lower extremity deep vein thrombosis prevention.

Keywords: Attitude, Deep vein thrombosis prophylaxis practices, Knowledge, Personnel factors, Surgical nurses

Author contributions:

WP: Conceptualization, method and design, tool validation, data collection and analysis, and writing and revising the manuscript

PY: Conceptualization, method and design, data analysis, writing, revising, and editing the manuscript, and corresponding with the editor-in-chief

SC: Conceptualization, method and design, data analysis, revising the manuscript

The Relationship among Health Beliefs, Social Support, and Health-Promoting Behaviors in Obese Patients after Bariatric Surgery

2025-05-19T19:45:19+07:00

Obesity is a risk factor for various diseases affecting health, quality of life, economy, and society in a wide range. According to the effects on health, patients with obesity try to seek various ways to lose weight by themselves, resulting in both good and undesirable effects on health and well-being. Bariatric surgery is another option for patients with obesity who have attempted weight loss through many methods but have not succeeded. The benefits of bariatric surgery do not only provide weight loss but also reduce the long-term comorbidity rates. It is found that maintaining stable body weight after bariatric surgery is extremely challenging. An important factor is changes in physical and psychological behaviors that lead to successful long-term maintenance of body weight. This descriptive correlational research aimed to examine the relationships among health belief factors, social support, and health-promoting behaviors and to compare those variables in successful and unsuccessful groups in bariatric surgery. Purposive sampling was performed to recruit 57 obese patients after bariatric surgery with continuous follow-up at the outpatient department. Data were collected using four questionnaires, including a personal information form, the Health Belief Questionnaire, the Social Support Questionnaire, and the Health-Promoting Behaviors Questionnaire. Data were analyzed using descriptive statistics, Pearson’s product-moment correlation, and an independent t-test.

The results of the study found that the sample had a high level of perceived susceptibility (mean = 24.98, SD =1.69) and perceived severity (mean = 26.91, SD = 3.32) and a moderate level of perceived benefit (mean = 23.10, SD = 1.94), perceived barriers (mean = 24.00, SD = 2.79), and health motivation (mean = 25.21, SD = 2.66). The social support scores were high (mean = 52, SD = 11.34) and health-promoting behaviors were moderate (mean = 2.73, SD = 17.86). Perceived severity, perceived benefit, and social support were positively correlated with health-promoting behaviors with statistical significance (r = 0.47, p < .01, r = 0.38, p <.01 and r = 0.12, p < .05, respectively). However, perceived susceptibility, perceived barriers, and health motivation were not significantly associated with health-promoting behaviors (r = 0.05, p > .05; r = 0.15, p > .05; and r = 0.20, p > .05, respectively).

Furthermore, a comparison of the studied factors between the successful and unsuccessful surgery groups revealed no statistically significant differences in perceived susceptibility, perceived severity, perceived benefit, perceived barriers, health motivation, social support, and health-promoting behaviors. The successful group scored slightly higher than the unsuccessful group. Upon further examination of health-promoting behaviors, no significant differences were found between the two groups in physical activity and exercise, nutrition, spiritual development, interpersonal relationships, and stress management. However, there was a statistically significant difference in health responsibility, with the successful surgery group scoring slightly higher than the unsuccessful group (t = -2.48, p < .05). Overall, the successful group had slightly higher scores in all areas except stress management, with the unsuccessful group had slightly higher scores in stress management, but there was no significant difference.

The study findings can be applied to assess social support and to organize activities that encourage participation from family members, friends, and healthcare teams in promoting health behaviors. The results also serve as a basis for developing programs that enhance family involvement in self-care before and after surgery, increase confidence in performing health-promoting behaviors, emphasize supervision, care, and continue follow-up to maintain a stable body weight after surgery.

Keywords: Bariatric surgery, Health beliefs, Health promoting behavior, Obesity, Social support

Author contributions:

NS: Conceptualization, method and design, tool validation, data collection and analysis, and writing and revising the manuscript

SC: Conceptualization, method and design, data analysis, writing, revising, and editing the manuscript, and corresponding with the editor-in-chief

PS: Conceptualization, method and design, data analysis, revising the manuscript

Development of the Blood Pressure Assessment Interactive Learning Package for First-Year Nursing Students

2025-07-03T19:06:05+07:00

Blood pressure assessment is a vital sign assessment that indicates the function of key organs in the body. This assessment requires knowledge and practical skills to follow standard guidelines and obtain accurate, precise values that can be effectively used in vital sign assessment. The ultimate goal is patient safety. However, some nursing students lack confidence in applying knowledge of blood pressure assessment to nursing practice, and they have requested a media resource on blood pressure assessment to promote effective learning and increase confidence in this area. This research and development study aimed to develop an interactive learning package on blood pressure assessment, compare learning achievement before and after its use, and evaluate students' satisfaction with the package. The ADDIE Model framework by McGriff was applied, consisting of five systematic steps: 1) Analysis – identifying problems and needs through focus group discussions, course content review, subject evaluation analysis, and existing media survey; 2) Design – creating an interactive learning package structured in three connected parts: core concepts, a demonstration video with step-by-step explanations, and animated scenarios for practicing critical thinking and knowledge integration; 3) Development – producing interactive multimedia and refining it based on expert feedback from three experts; 4) Implementation – administering the package to the target group; and 5) Evaluation – collecting and analyzing data to enhance the package’s effectiveness.

The sample consisted of 122 first-year nursing students from Srisavarindhira Thai Red Cross Institute of Nursing who met the inclusion criteria. Research instruments included an interactive learning package, the Personal Data Form, the Blood Pressure Assessment Achievement Test, and the Satisfaction Questionnaire. All instruments were validated for content accuracy by three experts. Data collection involved a pre-test, a 5-day self-study period using the interactive package (approximately 20 minutes per session), followed by a post-test and the satisfaction survey. The researcher then sent a link to the interactive learning package on blood pressure assessment to the sample, allowing them to self-study the three-part media over a period of five days. It was recommended that each learning session take approximately 20 minutes. After the 5-day period, the participants completed a post-test on learning achievement and the Satisfaction Questionnaire regarding the interactive learning package. The data were analyzed using descriptive statistics (mean and standard deviation) and inferential statistics (paired t-test).

The results revealed that the pre-test on learning achievement was 5.76 (SD = 1.61), the post-test on learning achievement was 8.02 (SD = 1.33). The students' learning achievement after using the interactive learning package was significantly higher than before (p < .001). Additionally, students' satisfaction with the interactive learning package on blood pressure assessment was at the highest level, with an average score of 4.84 (SD = .43). When examining individual items, students expressed the highest level of satisfaction for all items. Specifically, the test is relevant to the content, convenient and accessible, receiving the highest average score of 4.88 (SD = 0.35). The font size is appropriate, the colors are easy to read and comfortable to the eyes, receiving the lowest average score of 4.76 (SD = 0.53). The study findings indicate that the interactive learning package promotes interaction and enhances learning efficiency among nursing students. Therefore, this interactive learning package should be further implemented to promote learning among nursing students.

Keywords: : Blood pressure assessment, Interactive learning, Nursing students

Author’s contributions:

PT: Conceptualization, methodology, design, tool validation, testing, data collection, data analysis, writing-original manuscript, writing-revision

PM: Conceptualization, methodology, testing, data collection, writing-revision, corresponding with editor-in-chief

Roles of Nurse Anesthetists in Caring for Patients Undergoing Robot-Assisted Nephrectomy

2025-01-24T23:00:59+07:00

Currently, robot-assisted nephrectomy is increasingly important in the medical field.Nurse anesthetists, as part of the anesthesia team, play a crucial role in patient care during robotic nephrectomy. This surgical method offers clear advantages, including smaller incisions, faster patient recovery, reduced pain, reduced blood loss, and fewer potential surgical complications.This article presents practice guidelines for preoperative, intraoperative, and postoperative care of patients undergoing robotic-assisted nephrectomy, enabling nurse anesthetists, anesthesiologists,and other relevant medical personnel to perform their duties efficiently and safely.

Robot-assisted nephrectomy differs significantly from conventional nephrectomy in several aspects. In the preoperative period, the preparation includes patient positioning, airway management, and intraoperative operating room management. The robotic system requires multiple mechanical arms positioned around the patient, which restricts the anesthetic team's workspace.Careful preoperative planning is essential for airway and venous access. Additionally, patient positioning in the lateral decubitus position with table flexion is crucial for expanding the operative field and facilitating surgical access. Securing the patient's hips and chest to the operating table to prevent movement, along with the use of padding to minimize nerve and soft-tissue injuries, are critical components. Furthermore, carbon dioxide insufflation affects the respiratory and circulatory systems; therefore, the anesthesia care team necessitates a deep understanding of physiological changes to plan anesthetic management appropriately.

During surgery, nurse anesthetists play a vital role in continuously monitoring the patient's vital signs to minimize cardiovascular complications. They are also responsible for fluid management to maintain hemodynamic stability and kidney function, and the use of non-depolarizing muscle relaxants to ensure optimal muscle relaxation and prevent unwanted movements.

Postoperatively, nurse anesthetists are responsible for comprehensive monitoring of recovery from anesthesia, including checking vital signs every five minutes during the first hour and every 15 minutes thereafter until stability is achieved. They must also monitor for complications, such as subcutaneous carbon dioxide accumulation, by assessing oxygen saturation, respiratory rate, and lung sounds, and by observing for numbness in the patient's extremities. Also, pain levels must be continuously assessed using a Numeric Pain Rating Scale, ranging from 0 (no pain) to 10 (the worst imaginable pain), along with monitoring for additional complications such as nausea and vomiting.

Comprehensive care roles by nurse anesthetists throughout all phases of management not only enhance patient safety and surgical success but also promote the delivery of high-quality care and support the effective and safe use of robotic technology.

Keywords: Anesthesia, Anesthesia services, Robotic-assisted nephrectomy, Nurse anesthetists

Author Contribution

LP: Conceptualization, Literature review, and Writing – original draft.

One Day Surgery Integrating the Digital Technology

2025-01-27T23:21:58+07:00

One day surgery refers to a surgical procedure that does not require patients to stay overnight in the hospital. Patients typically remain in the hospital for a minimum of 2 hours but no more than 24 hours. Patients are expected to prepare themselves at home prior to surgery and come to the hospital on the day of the procedure. Following post-surgical recovery, patients who are able to care for themselves can return home on the same day. This reduces the duration of hospital stays, minimizes the risk of hospital-acquired infections, shortens the waiting time for surgeries and alleviates hospital overcrowding. currently, digital technology is being used to care for one day surgery patients by linking the digital healthcare service system with health information technology. After surgery, there is a continuous home care system have doctors, nurses or multidisciplinary professionals take care and closely monitoring the patient’s condition via telemedicine, so that health care personnel can work efficiently. Patients who are far away can access health services quickly and monitor their condition continuously 24 hours. As digital healthcare technology becomes more embedded in social of Thailand, healthcare professionals should be knowledgeable and aware of the use of technology in caring for one day surgery patients,laws and guidelines for using social media by health care professionals and individuals that may affect patients, taking into account ethics, confidentiality, and the security of patients’ personal information and be able to apply digital technology to care for and continuously monitor patients.The care process for one day surgery begins with a diagnosis and an assessment by a physician to determine the patient’s eligibility for this type of surgery. The patient care process is divided into four stages: 1. pre-operative preparation time period starts from the patient is diagnosed and the doctor evaluation and decision this case is one day surgery until the patient of surgery. 2.perioperative care time period starts from the patient contacts to register to check the rights and ends with a follow-up visit after surgery within 24 to 72 hours after surgery. 3. post-operative recovery is a follow-up visit within the first week after surgery and 4. follow-up Treatment follow-up is a follow-up treatment after surgery at 1 month, 6 months, 1 year and 3 years. Traditionally , follow-up has been conducted via telephone, sometime to problems of not being able to contact patients and cannot being able to following patients’ symptoms after surgery.Therefore, digital technology is being used as a guideline for patient following. There is training for health personnel to understand the knowledge of the one day surgery system with continuous patient care via telemedicine 24 hours. Examples, the development of patient care one day surgery system using digital technology including 1. The home patient continuity care system, which is a tool for managing patients treated at home via telemedicine 24 hours a day. 2. The use of digital technology in the care of one day surgery patients at Phaholpolpayuhasaena Hospital, Kanchanaburi Province is collaborating with community hospitals via telemedicine, has greatly reduced the steps of work, time and costs of visiting the hospital for patients and their relatives. 3.The care of patients after one day appendectomy surgery is a development of a home patient continuity care system with care standards comparable to those of patients care in hospitals. In addition, foreign countries have also found various forms of innovation that apply digital technology to the care of patients one day surgery, such as the use of computer-based detectors or wearable devices that connect data to the Internet, allowing patients and health care teams to access real-time post-operative information, continuously monitor patient physiological changes, and allow patients to self-report their post-operative symptoms and seek advice from health care teams, etc.

One day surgery care using intelligently digital technology provides benefits in healthcare that connect to patients and health personnel. Health information can be accessed easily,conveniently, quickly, and seamlessly, reducing waiting times and costs for patients visiting the hospital. Patients receive remote care via telemedicine and can be monitored conveniently, quickly and continuously. Although digital technology brings convenience, healthcare personnel should take into account ethics, be aware of the laws in using technology and must be aware of the importance of confidentiality and patient rights. Executives should support more integrated one day surgery with telemedicine in hospitals to reduce steps of work time for healthcare personnel and alleviates hospital overcrowding, organize training on the use of digital technology to increase specialized skills and prepare healthcare personnel and there should also be primary care units responsible for home visits that have been referred from one day surgery units to ensure that the provision of digital healthcare technology services is safe, reliable and will lead to the stability and sustainability of Thailand’s public health system.

Keywords: Digital technology, Health innovation, Health service, One day surgery

Electronic Cigarette: Impacts among Children and Youth that Should not be Overlooked

2025-04-19T20:27:18+07:00

Electronic cigarettes (e-cigarettes) are products that deliver nicotine through electronic means, which are becoming widely popular around the world, including in Thailand, and are on the rise among children and youth. E-cigarettes are illegal products that cause harm to health.However, it has been popular among Children and youth. Because of distorted information claiming that e-smoking is safer than conventional cigarettes and is less addictive, this information provokes children and youth to try electronic cigarettes. This situation is becoming a concerning public health issue. Electronic cigarettes not only do not reduce the harm of traditional cigarettes as claimed, but also serve as a gateway to nicotine addiction and other substances among children and youth. This article aims to provide comprehensive information on e-cigarettes and the current situation regarding their use. It reviews existing knowledge and understanding of e-cigarettes,including the health impacts of e-cigarette addiction, and existing research on the guidelines for preventing e-cigarette use among children and youth.

Despite perceptions of being less harmful, e-cigarette use constitutes a form of nicotine addiction. E-liquids typically contain synthetic nicotine dissolved in propylene glycol, which transforms into vapor when heated and inhaled. This vapor contains ultrafine particles, approximately 1–2.5 micrometers in diameter, that can easily penetrate deep into the respiratory tract. In addition to nicotine, the vapor carries various chemical substances foreign to the human body. These substances can trigger an immune response, particularly involving white blood cells that attempt to eliminate the inhaled toxins, resulting in inflammation of lung tissue. This inflammatory process mimics the clinical symptoms of infectious pneumonia; however, microbiological cultures of sputum samples often reveal no pathogenic organisms. This condition is medically recognized as EVALI (E-cigarette or Vaping product use-Associated Lung Injury).

Regarding health impacts of E-cigarette use on children and adolescents across multiple body systems, e-cigarette use has been shown to negatively affect various organ systems in children and adolescents, posing both immediate and long-term health risks. In the cardiovascular system, growing evidence suggests that e-cigarettes contribute to increased arterial stiffness,elevated blood pressure, and heightened oxidative stress. These physiological changes elevate the risk of developing coronary artery disease. Furthermore, e-cigarettes impair myocardial blood flow, endothelial function, and nitric oxide production—all of which are essential for maintaining vascular integrity and function. The respiratory system is also highly vulnerable. E-cigarette aerosols contain numerous toxic substances that can damage lung tissue, particularly in young users. One of the most severe health conditions associated with vaping is EVALI, a form of acute lung inflammation that can progress to respiratory failure in severe cases and may be fatal without timely medical intervention. Within the nervous system, nicotine acts on the brain’s reward pathways, increasing the release of dopamine, which reinforces addictive behaviors. This mechanism contributes to the early onset of nicotine dependence in adolescents. Such widespread activation can lead to systemic physiological disruption and has been linked to neuropsychiatric disorders, including depression and schizophrenia.

From a mental health perspective, adolescents are particularly vulnerable to the neurological effects of nicotine, as key brain regions responsible for decision-making, emotional regulation, and impulse control are still developing. Nicotine's interference with these regions can lead to emotional dysregulation, increased irritability, aggression, anxiety, depression, sleep disturbances, and concentration difficulties. Withdrawal symptoms during periods of nicotine deprivation may further exacerbate these issues, reinforcing the cycle of addiction. Furthermore,fetal health may be compromised when pregnant individuals use e-cigarettes or are exposed to secondhand vapor. Nicotine can cross the placental barrier through maternal blood flow and interfere with fetal brain development. Prenatal exposure to nicotine has been associated with long-term neurodevelopmental consequences, potentially impairing the child’s cognitive, behavioral, and emotional development.

To effectively protect children and adolescents from accessing or experimenting with e-cigarettes, the most impactful measure is to maintain the ban on e-cigarette importation as an upstream prevention strategy. This must be supported by strict enforcement of existing laws regulating the illegal distribution of e-cigarettes, along with accelerated efforts to disseminate accurate information to all sectors of society, especially targeting children and youth. Findings from previous studies indicate that various prevention and cessation programs have been developed,primarily targeting high school and university students. Most of these programs have trial periods of less than six weeks. Research has shown that such programs significantly increase knowledge about e-cigarettes, enhance self-efficacy, and strengthen the intention to avoid e-cigarette use among adolescents and youth in Thailand. The review recommends that key stakeholders—nurses,teachers, educational administrators, and parents—work together to protect children and youth from the dangers of electronic cigarettes. They should be well-informed about vaping to effectively raise awareness and safeguard the well-being of this crucial demographic, which will be essential for Thailand's future.

Keywords: Addiction, Children and youth, Electronic cigarettes, Impact of electronic cigarettes

Author contribution

NW: Conceptualization, design, writing, revising, and editing the manuscript

SC: Conceptualization, design, writing, revising, editing the manuscript, and corresponding with the editor-in-chief

Editorial Note

2025-12-27T17:01:28+07:00

Editorial Note