Nursing Research and Innovation Journal

Perioperative Care for Patients Undergoing Right Mini-Thoracotomy Sutureless Aortic Valve Replacement: A Case-Based Approach

2023-11-05T17:29:19+07:00

Right mini-thoracotomy sutureless aortic valve replacement (RMT-SLAVR) is a novel cardiac surgical technique that combines the advantages of minimally invasive surgery and sutureless valve implantation. This approach enhances surgical efficiency, reduces cardiopulmonary bypass (CPB) time and aortic cross-clamp time, and lowers the risk of complications, particularly in older or high-risk patients for conventional open-heart surgery. This article aims to present perioperative nursing care plans based on a case study of a 64-year-old Thai female diagnosed with aortic valve stenosis and regurgitation who underwent RMT-SLAVR. Nursing care was structured using the Perioperative Nursing Data Set (PNDS) developed by the Association of Perioperative Registered Nurses (AORN), which consists of nursing diagnoses, interventions,and expected outcomes. The care plan emphasized a holistic approach, identifying five primary nursing diagnoses: 1) Knowledge deficit related to the surgical procedure; 2) Anxiety about the surgery and outcomes; 3) Risk of retained surgical items; 4) Risk of injury from operating room instruments and environment; and 5) Risk of impaired cardiac, cerebral, or vascular tissue integrity due to CPB.

Nurses play a crucial role in assessing both physical and psychosocial risk factors,especially in older patients with comorbidities such as diabetes, hypertension, or cognitive impairment. Preoperative preparation includes providing visual materials, encouraging patient questions, and involving family members to reduce anxiety. Intraoperatively, nurses required specialized skills to prepare and handle devices such as video-assisted equipment and extended retractors, as well as to ensure accurate instrument counts to prevent the retention of items. Nursing care also included proper patient positioning, temperature regulation, emergency readiness (e.g.,defibrillator setup), and collaboration with the multidisciplinary team, including surgeons,anesthesiologists, and perfusion technologists. Postoperatively, nurses were responsible for assessing vital signs, circulation, and level of consciousness prior to transferring patients from the operating room.

This case study highlights the need for specialized knowledge and skills in perioperative nursing care for RMT-SLAVR patients, as well as systematic interdisciplinary collaboration. The PNDS framework supports comprehensive planning to address both physical and psychological aspects of care, aiming for optimal safety, comfort, and outcomes. Future applications of this nursing approach could extend to other minimally invasive cardiac surgeries, such as mitral valve repair, minimally invasive coronary artery bypass, or hybrid procedures. The dissemination of such case-based knowledge is valuable for both clinical practice and professional development in cardiac surgical nursing.

Keywords : Aortic valve, Case study, Minimally invasive surgery, Perioperative nursing,Perioperative Nursing Data Set (PNDS), Sutureless

A Comparative Study of Nursing Practices and Outcomes of Care for Children with Sepsis Using Systemic Inflammatory Response Syndrome and Thammasat Pediatric Early Warning Scores Criteria and Thammasat University Hospital Pediatric Sepsis Screening Scores

2025-03-09T11:40:34+07:00

Sepsis is a life-threatening condition and a leading cause of morbidity and mortality in hospitalized children. Early recognition of sepsis and timely initiation of treatment can reduce complications and mortality. The Thammasat University Hospital pediatric sepsis protocol consists of a sepsis screening tool and pediatric sepsis guidelines based on the Surviving Sepsis Campaign Guidelines for Pediatrics. Clinical tools, such as the Systemic Inflammatory Response Syndrome (SIRS) criteria, combined with the Thammasat Pediatric Early Warning Scores (TPEWS), have long served as standard frameworks in pediatric sepsis screening and care escalation. However, a new version of institution-specific screening tools, the Thammasat University Hospital Pediatric Sepsis Screening Score (TUH pediatric sepsis screening score), has been developed aiming at improving early detection. This retrospective comparative study aimed to evaluate nursing practice and clinical outcome associated with the use of SIRS plus TPEWS criteria versus the TUH pediatric sepsis screening score. The study applied the Donabedian Model of quality assessment, consisting of three components,which include 1) the structure component covering the original and new versions of sepsis screening protocol, 2) the process involving the actual activities, such as assessment of sepsis according to sepsis screening protocol and timely administration of antibiotic within one hour, and 3) the outcome dimension encompassing key clinical indicators, such as incidence of septic shock, sepsis-related mortality, and registered nurse satisfaction with the screening tools used.

Outcome data were collected using the original pediatric sepsis protocol, which included the SIRS criteria and the TPEWS from December 2020 to March 2022, and the new version of the TUH Pediatric Sepsis Screening Score from April 2022 to July 2023. Data were collected from the Electronic Medical Records (EMR) of a sample of pediatric patients at risk for sepsis who were admitted to the pediatric ward at Thammasat University Hospital. The sample was selected through purposive sampling. Inclusion criteria comprised pediatric patients with a fever and a body temperature above 38.5 °C. Exclusion criteria were: 1) presentation with septic shock prior to hospital admission,2) incomplete or missing data, 3) family refusal or termination of treatment, and 4) being transferred to another healthcare facility. The researcher obtained patient medical records that met the inclusion criteria from the Information Technology Office at Thammasat University Hospital. The patient sample was categorized into two groups: 281 pediatric patients who received the original version of the pediatric sepsis protocol, and 514 pediatric patients who received the new version of the protocol.Nurse satisfaction with the pediatric sepsis protocol was assessed from 43 registered nurses. Inclusion criteria for the nurse participants: 1) a minimum of three years of experience in pediatric care, 2) prior experience with nursing practices under both the original and new versions of the pediatric sepsis protocol, and 3) willingness to participate in the study. The researcher collected data using questionnaires enclosed in an envelope and distributed directly to the selected nurse participants for self-completion. The research instruments included: the Pediatric Patient Data Recording Forms, the SIRS and TPEWS Assessment Form, the TUH Pediatric Sepsis Screening Score Assessment Form,the Nursing Care Documentation Forms, the Clinical Outcomes Assessment Form, the Nurse Demographic Data Recording Forms, and the Nurse Satisfaction with the Pediatric Sepsis Protocol Questionnaire. The content validity index (CVI) of all research instruments was equal to 1. The reliability coefficients of the satisfaction of nurses with the original version and the new version of the Pediatric Sepsis Protocol Questionnaire, as measured by Cronbach’s alpha, were .95 and .97,respectively. SPSS version 29 was used to analyze the data and determine statistical significance at .05. Data were analyzed using descriptive statistics, chi-square, Fisher’s exact test, independent t-tests, and paired t-tests.

The research findings revealed that the sepsis in pediatrics using the TUH pediatric sepsis screening score assessment and the administration of the antibiotic within one hour were significantly greater, but the rate of septic shock was significantly lower than using the SIRS plus TPEWS assessment (χ2 = 10.66, p < .05); the mortality from sepsis was not a significant difference (p > .05). Registered nurses reported significantly higher satisfaction both overall and across all dimensions when using the new version of the pediatric sepsis protocol than the original version (t = -5.50, p < .05). The findings of this study have significant implications for pediatric sepsis management. These results support the use of the TUH Pediatric Sepsis Screening Score as a more effective and user-friendly tool for early identification and management of pediatric sepsis in clinical practice.

Keywords: Mortality, Pediatric sepsis protocol, Pediatric sepsis nursing care, Sepsis, Septic shock

Effects of Self-management on Blood Pressure in Thai Older Adults with Hypertension: A Systematic Review and Meta-Analysis

2025-03-24T08:06:41+07:00

Hypertension is one of the most prevalent chronic conditions among older adults and a major contributor to cardiovascular morbidity and mortality. In Thailand, the aging population is rapidly increasing, and the burden of uncontrolled hypertension among older adults presents a significant public health challenge. Effective and sustainable strategies for hypertension management are therefore essential. Self-management interventions, grounded in behavioral and theoretical frameworks, have been widely promoted as a patient-centered approach to chronic disease control.This systematic review and meta-analysis aimed to assess the effectiveness of self-management theory based interventions in reducing blood pressure among older adults with hypertension in Thailand.

A comprehensive search of both international and Thai databases—including PubMed,Embase, Scopus, and the Thai Journal Citation Index (TCI) was conducted to identify relevant studies published between January 2018 and December 2023. The review specifically included studies employing randomized controlled trial (RCT) or quasi-experimental designs involving self-management interventions targeting older adults aged 60 years and above diagnosed with hypertension. The selection process followed PRISMA guidelines. After rigorous screening and quality appraisal using the JBI Critical Appraisal Checklist for Quasi-Experimental Studies, only quasi-experimental studies were included as randomized controlled trials were absent from our search results. The results showed that five studies met the inclusion criteria. All included studies were conducted in Thailand, targeted older adults and implemented interventions grounded in self-management theoretical frameworks. These interventions commonly incorporated components such as health education, self-monitoring, behavior modification, goal setting, and reinforcement strategies, with the overarching aim of improving hypertension control and enhancing patient engagement. The five included studies encompassed a total of 379 older adults, with 188 participants assigned to various self-management intervention groups and 189 to control groups receiving usual care. Meta-analyses were conducted separately for systolic blood pressure and diastolic blood pressure outcomes using a random-effects model.

The results demonstrated statistically significant reductions in both systolic blood pressure and diastolic blood pressure in the intervention groups compared to the control groups.For diastolic blood pressure, the pooled mean difference was -9.34 mmHg (95% confidence interval [CI]: -10.95 to -7.72), indicating a substantial improvement in blood pressure control associated with the interventions. The effect was statistically significant (z = -11.32, p < 0.001).Similarly, for systolic blood pressure, the meta-analysis showed a mean difference of -16.79 mmHg (95% CI: -25.21 to -8.38), also favoring the intervention groups. The effect was statistically significant (z = -3.91, p < 0.001).Overall, the findings from this review highlight the effectiveness of self-management theory based interventions in significantly lowering both systolic and diastolic blood pressure among older adults in Thailand. These interventions not only contribute to improved clinical outcomes but also promote patient autonomy and long-term adherence to treatment regimens—key components in managing a chronic condition such as hypertension. Given the growing emphasis on person-centered care in aging populations, these results support the integration of self-management programs into routine hypertension care, particularly in community and primary care settings. Despite these positive outcomes, some limitations should be acknowledged. Notably,the number of eligible studies was relatively small, which may limit the generalizability of the findings.

Keywords: Hypertension, Meta-analysis, Older adults, Systematic review, Thailand

Development of a Training Manikin for Intramuscular Injection into the Gluteal Muscle*

2025-01-03T23:19:57+07:00

Administering intramuscular injections is an essential fundamental nursing skill that requires meticulous care in medication administration. Knowledge of anatomy is crucial in selecting appropriate injection sites, as well as understanding the principles and techniques of injection.Such knowledge is particularly important for administering intramuscular injections in the hip area, as an incorrect identification of the injection site poses a risk of damaging the sciatic nerve and blood vessels surrounding the hip muscles. Therefore, training nursing students in the skill of performing intramuscular injections in the hip is vital for safe and effective nursing care.However, traditional training still relies on imported, expensive simulation models that are limited in number. This may raise ethical concerns, safety issues, and accessibility limitations. These problems are especially significant in nursing schools that lack realistic and affordable simulation models for practicing hip muscle injections. As a result, nursing students have fewer opportunities for practical training, which can reduce their confidence and effectiveness. Consequently, there is a necessity to develop durable, cost-effective, and anatomically realistic simulation models to enhance the learning outcomes of nursing students. The main objectives of this study were 1) to develop a training manikin for intramuscular injection into the gluteal muscle and 2) to evaluate the effectiveness of the developed training manikin for intramuscular injection into the gluteal muscle.

The development of the training manikin uses the Research and Development (R&D)methodology, which is divided into four steps, including 1) identifying the requirements for developing the hip intramuscular injection training manikin and reviewing relevant literature; 2)developing the training manikin using a combination of soft and firm silicone materials to simulate muscle and bone layers based on anatomical characteristics. The model enables palpation of key bony landmarks used to identify suitable injection sites. Experts evaluated the prototype for its anatomical accuracy and the suitability of needle insertion points. Subsequently, an electronic circuit was integrated into the model, consisting of two main components: a metal needle detection sensor and a processing and control unit; 3) evaluating the effectiveness of the manikin with a sample group consisting of 30 nursing students and 5 nursing instructors. The research instrument used was an evaluation form assessing the effectiveness of the intramuscular gluteal injection training manikin. Data were analyzed using descriptive statistics, including mean, standard deviation, frequency, and percentage; and 4) refining and improving the manikin.

The results indicated that the developed hip intramuscular injection training manikin achieved a high level of overall effectiveness. The top three highest-scoring aspects were ease of use, ability to support self-directed learning, and cost-effectiveness compared to its benefits. The five lowest-rated aspects were 1) the flexibility and realistic tactile sensation of the manikin, 2)the realistic appearance, 3) demonstration of the external hip structure, 4) portable design, and 5) the accuracy of feedback signals. The developed intramuscular injection model for the gluteal site was shown to be an effective educational tool. It not only enhanced the knowledge and skill level of nursing students but also offered a safe, repeatable, and realistic method for practice. The high satisfaction scores further validate the model's utility in nursing education. Moreover, its cost-effectiveness and ease of production make it accessible to various educational institutions,especially those with limited resources. Further recommendations for future development and research include 1) enhancing manikin quality: improvements should be made to increase the material’s flexibility and make it more closely resemble human skin. Additionally, the alert system should be optimized for greater accuracy and expanded to provide broader coverage. Consideration could also be given to designing manikins that represent patients with varying ages and physical conditions to improve realism and diversity in training; and 2) the development of an application or computer program integrated with the manikin to record students' practice sessions and provide real-time feedback for skill assessment and personalized learning planning.

Keywords: Intramuscular injection, Nursing simulation, Research and development

Effects of Mutual Goal Setting Program on Face Down Behavior and Clinical Outcomes in Patients after Gas-Filled Retinal Detachment Surgery

2025-03-05T11:00:49+07:00

The retina acts as a screen to receive images. When the vitreous humor adheres too tightly to the retina, it can cause traction, leading to retinal detachment. This condition affects the patient's quality of life and, if left untreated, may lead to vision loss. Vitrectomy is a common and effective treatment involving surgery inside the eyeball, where gas is injected to help the retina reattach. Patients must maintain a face-down position after surgery for successful reattachment.This requirement can hinder daily activities. Patients often experience discomfort, neck pain, and back pain, which makes it difficult to maintain the face-down position consistently. Setting shared goals regarding face-down positioning and following up on clinical outcomes in patients after retinal detachment surgery with gas tamponade involves active interaction between nurses and patients. Nurses educate patients using materials, videos, and explanations about retinal detachment and the importance of face-down positioning after surgery. Patients are trained in this positioning before surgery, using personalized strategies and shared goals to determine the number of required hours. This helps patients understand and manage self-care at home, improving surgical outcomes.This study aimed to compare the mean number of hours patients with gas tamponade retinal detachment spent in the face-down position over a 24-hour period between those who received a mutual goal-setting program and those who received standard nursing care. Additionally, it seeks to compare clinical outcomes, including visual acuity and retinal reattachment, between the two groups.

This study was a quasi-experimental research design using a two-group pretest-posttest design with an experimental and a control group. The participants were patients who underwent gas-filled retinal detachment surgery due to retinal holes or tears, traction caused by membranes or vitreous humor, or fluid leakage and accumulation under the retina. The study took place between May 1 and December 25, 2023. A total of 50 patients were purposively selected based on inclusion criteria: aged 18 years or older, undergoing their first retinal detachment surgery, receiving gas tamponade with Octafluoropropane (C3F8) or sulfur hexafluoride (SF6),scheduled for surgery in one eye only with the other eye not diagnosed with blindness, and able to be contacted via telephone or the LINE application. If post-surgery vision was impaired,communication via LINE could be facilitated by a relative. Moreover, those aged 60 and above were screened for cognitive impairment using the Thai version of the 6 Cognitive Impairment Test (6 CIT), with eligible participants scoring less than 8. The sample size was calculated using G*Power, with a power of 0.50, a significance level (α) of 0.05, and an effect size of 0.50,resulting in 23 participants per group, increased by 10% to 25 participants per group to account for incomplete data. The researchers purposively selected all participants for the experiment. Data were collected first from the control group and then from the experimental group using a mutual goal-setting program based on King’s Goal Attainment Theory, along with a demographic form,a 24-hour face-down behavior log, a visual acuity record, and a retinal reattachment record. Data analysis was performed using descriptive statistics and a two-factor repeated measures ANOVA.

The experimental group had a mean number of face-down positioning hours equal to or greater than 16 hours, which was higher than that of the control group. When comparing the mean hours of face-down positioning at different time points, the experimental group demonstrated significantly higher means on postoperative days 1-2, 6-7, and 13-14 (F = 93.39, p < .05).Within the experimental group, the mean hours of face-down positioning one month before surgery were significantly different from those on postoperative days 1-2 (t = .79, p < .05), 6-7(t = .94, p < .05), and 13-14 (t = .88, p < .05). Additionally, the mean hours on postoperative days 1-2 were significantly different from those on days 6-7 (t = .63, p < .05) and 13-14(t = .43, p < .05). However, there was no significant difference between days 6-7 and 13-14.The experimental group also showed significantly better visual acuity one month after surgery than at 6-7 days (t = 0.10, p < 0.05), but there was no significant difference between the experimental and control groups. Furthermore, the percentage of patients with successful retinal reattachment after surgery was higher in the experimental group than in the control group. This research recommends that nurses adopt a mutual goal-setting approach with patients before and after surgery, focusing on maintaining the face-down posture after gas-injection retinal detachment surgery to improve outcomes. Follow-up care should be extended to 3-6 months, including studies on patients' post-surgery quality of life. A program to set behavioral goals for face-down posture in patients with silicone oil injections is suggested to reduce reoperation rates. Future research should investigate factors such as body weight, retinal detachment location, and diabetes that may influence face-down posture.

Keywords: Clinical outcomes, Face-down positioning, Mutual goal setting, Retinal detachment,Retinal detachment surgery with gas tamponade

Effects of a Self-Efficacy Enhancing Program on Bowel Preparation Behavior and Bowel Cleanliness Quality in the Older Persons Undergoing Colonoscopy

2025-02-12T10:13:51+07:00

Older adults undergoing outpatient colonoscopy need to perform proper bowel preparation behaviors themselves to achieve adequate bowel cleanliness, ensuring safety during the procedure. Promoting bowel preparation behavior by increasing confidence in the practice should lead to correct behavior, resulting in good bowel cleanliness quality. This study aimed to investigate the effects of a self-efficacy enhancement program on bowel preparation behavior and bowel cleanliness quality. This quasi-experimental research included a sample of older adults undergoing colonoscopy at the special endoscopy unit of Nopparat Rajathanee Hospital. The inclusion criteria were: aged 60–79 years, medically indicated for colonoscopy, no previous colonoscopy experience, able to care of themselves, fully conscious and oriented as determined by a cognitive screening tool, able to communicate in Thai, and possession of a smartphone with internet access and the LINE application. Participants were divided into two groups: an experimental group and a control group, each comprising 35 participants. The control group received standard nursing care. The experimental group received the self-efficacy enhancement program during the pre-colonoscopy period, which consisted of four components: 1) physical and emotional readiness were assessed for fatigue, abdominal discomfort, and emotional state through inquiry and observation of facial expressions and body language. They were given time to rest and attend to their personal needs before participating in educational activities; 2) mastery experiences were provided with knowledge on bowel preparation through various media, including pamphlets, educational videos , and electronic documents sent via the LINE application. They also engaged in hands-on activities, such as planning meals that aligned with their daily routines; 3) vicarious experiences participants watched testimonial videos featuring older adults who had successfully completed bowel preparation; and 4) verbal persuasion motivational messages and reminders were delivered via the LINE official account on days 8, 7, 5, 2, and 1 prior to the scheduled colonoscopy. The research instruments included a personal information questionnaire, a bowel preparation behavior assessment form, which was validated by three experts with a content validity index (CVI) of 1 and a reliability coefficient (KR-20) of .714 and a bowel cleanliness record form, which is a standardized tool used to document the quality of bowel cleanliness as assessed by the colonoscopist and recorded in the patient’smedical records. Data collection was conducted from December 2023 to March 2024.The data were analyzed using descriptive statistics,including mean, percentage,and standard deviation,as well as inferential statistics, including the t-test and
Mann–Whitney U test.

The findings revealed that, followingthe intervention, the experimental group had a significantly higher mean rank score for overall bowel preparation behavior compared to the control group, with statistical significance at the.05 level.(U = 490,p<.05). Regarding the mean rank of bowel preparation behaviors in each aspect: the mean rank of the appropriate dietary intake aspect was not statistically significantly different (U = 542.50, p > .05) the mean rank of the laxativeuse aspect was statistically significantly different (U = 525,p<.05) and the mean rank of the medication use aspect affecting colonoscopy and proctoscopy was not statistically significantly different (U = 612.50,p> .05). However, the mean scores for bowel cleanliness quality in the left colon (t = -1.22,p> .05), transverse colon(t = -1.63,p> .05) , right colon(t = -.50,p> .05), and overall colon (t = -1.27, p > .05) showed no statistically significant differences between the groups. The findings of this study highlight the effectiveness of enhancing self-efficacy in promoting proper bowel preparation behavior. Therefore, nurses should support bowel preparation practices among older adults undergoing colonoscopy by providing close guidance and continuous motivational reminders. These efforts help strengthen confidence in performing bowel preparation correctly and effectively.

Keywords: Bowel preparation behavior, Colonoscopy, Quality of bowel cleanliness,Self-efficacy

The Effect of Self-Efficacy Promotion Combined with Self-Regulation Program on Physical Activity in Patients with Chronic Coronary Syndrome

2025-03-14T15:27:53+07:00

Cardiac rehabilitation in patients with chronic coronary syndrome, focusing on enhancing cardiac function through engagement in daily physical activities, plays a vital role in preventing recurrence. However, most patients tend to exhibit low levels of physical activity,primarily engaging in light-intensity movements. Therefore, promoting a systematic and structured increase in physical activity intensity is crucial for the care and rehabilitation of this patient population. This study employed a quasi-experimental research design with a two-group pretest-posttest approach. Its objective was to examine the effects of a self-efficacy combined with self-regulation
program on physical activity in patients with chronic coronary syndrome. The sample consisted of 50 patients classified as Class I–II in disease severity who received care at the outpatient department of internal medicine at a tertiary hospital. The participants were randomly assigned to either a control group (n = 25), which received routine nursing care, or the experimental group (n = 25), which received the self-efficacy combined with self-regulation program for 30 days. The program included: 1) Physical and emotional readiness assessment by inquiring about current symptoms, allowing time for personal needs, and observing facial expressions and body language prior to the educational session on day 1; 2) Mastery experiences: this component involved providing knowledge about the disease, its treatment, and appropriate physical activities for the condition. Participants were also trained in skills such as self-monitoring of pulse rate,calculating their target heart rate, and recording physical activity in a physical activity handbook developed by the researcher on the first day of the program. Training continued until participants could perform these tasks accurately and indepen dently; 3) Vicarious experiences: this involved observational learning through exposure to successful behavioral models. On the first day of the program, participants viewed a video clip featuring patients with chronic coronary artery disease who had successfully engaged in physical activity consistent with their individualized goals; 4) Verbal persuasion: this strategy involved the use of verbal encouragement combined with motivational text messages to promote engagement in physical activity. These persuasive messages were delivered on days 5, 10, 15, and 20 of the program. Additionally, follow-up and reinforcement were conducted via an official LINE account on days 7, 14, 21, and 28 to maintain adherence and motivation throughout the intervention. These strategies were combined with self-regulation,which is known to support lasting behavioral change by enhancing personal motivation and autonomy. Self-regulation was implemented through two main processes: 1) goal setting,where weekly physical activity intensity targets were established for each participant, and 2) self-monitoring, tracking, and recording physical activity behaviors in a personal logbook. The data collection instrument included a physical activity questionnaire. Its content validity was confirmed by expert review, yielding a content validity index (CVI) of 0.83. The reliability of the instrument was assessed using Cronbach’s alpha coefficient, which was found to be 0.71.Data were analyzed using descriptive statistics, the chi-square test, and t-tests.

The results showed that before the intervention, the control group had a mean physical activity score of 26.61 METs (SD = 11.11) in the control group and 25.23 METs (SD = 10.34)in the experimental group, with no significant difference between groups (t = .45, p = .65).Post-intervention, the experimental group showed a significant increase in physical activity scores compared to their baseline (t = -4.88, p = < .001). The post-intervention mean scores were 27.16 METs (SD = 8.56) in the control group and 33.99 METs (SD = 10.48) in the experimental group, with a significant difference between groups (t = -2.53, p = .01) The findings indicate that the self-efficacy combined with self-regulation program effectively increased physical activity levels in patients with chronic coronary syndrome. Nurses should implement this program to promote moderate to vigorous physical activity in this patient population.

Keywords: Chronic coronary syndrome, Physical activity, Self-efficacy, Self-regulation

Factors Predicting Self-Care Behavior among Older Adults with Type 2 Diabetes Mellitus

2025-03-06T19:47:38+07:00

Diabetes is a non-communicable disease that is a major public health problem and affects the quality of life, especially among older adults. Older adults with diabetes will experience changes in the body due to increasing age, further affecting self-care behavior. Understanding the predicting factors of self-care behavior of older adults with type 2 diabetes will be helpful to properly create a nursing care plan in promoting self-care behaviors for older adults with type 2 diabetes mellitus. This descriptive predictive study aimed to investigate the predictability of cognitive function, ability to perform daily activities, perceived self-esteem, and social support to self-care behavior in older adults with type 2 diabetes mellitus. The sample consisted of 141 older adults diagnosed with type 2 diabetes who came to follow-up at the outpatient department of internal medicine specializing in diabetes, thyroid, and hormone clinics at King Chulalongkorn Memorial Hospital. The sample was selected through purposive sampling. The inclusion criteria included older adults who were aged 60 years and older, diagnosed with type 2 diabetes by a doctor at least six months, able to communicate in Thai, and willing to participate by signing a consent form. Data were collected between November 2022 and July 2023 through interviewing with older adults using a demographic questionnaire, the Montreal Cognitive Assessment (MOCA),the Summary of Diabetes Self-care Activities Measure, the Rosenberg’s Self-Esteem Scale, the Social Support Questionnaire, and the Chula Activities of Daily Living Index. Inter-rater reliability of the Montreal Cognitive Assessment (MOCA) was .99. Cronbach’s alpha coefficients of the Summary of Diabetes Self-care Activities Measure, the Rosenberg’s Self-Esteem Scale, the Social Support Questionnaire, and the Chula Activities of Daily Living Index were .75, .87, .87,and .88, respectively. The data were analyzed using descriptive statistics, Pearson’s correlation coefficients, Spearman’s rank correlation coefficient, and hierarchical multiple linear regression analysis.

Findings revealed that participants were aged 60-69 years (51.10%), with 62.40%being female. Most of them were married (61.00%), had a family history of diabetes (69.50%),and the duration of diabetes was 21-30 years (33.30%). Participants had mild cognitive impairment (mean = 21.48, SD = 2.64), a good level of ability to perform daily activities (mean= 8.38, SD = 0.99), a high level of perceived self-esteem (mean = 31.38, SD = 2.99), a high level of social support (mean = 64.06 , SD = 12.01) and a high level of self-care behavior(mean = 95.17 , SD = 13.72). All predictive variables could together explain 15.10% of the variance in self-care behavior (adjusted R2 = .15). Social support was the only variable significantly predicting self-care behavior (β = .38, p < .01). Meanwhile, cognitive function,perceived self-esteem, and ability to perform daily activities did not significantly predict self-care behavior in older adult patients with type 2 diabetes (β = -.01, p > .05; β = .03, p > .05; and β = .15, p > .05, respectively). The results from this study indicated that social support was a crucial predictor of self-care behavior in older adults with type 2 diabetes. Therefore, social support from family members, friends, and healthcare team members should be integrated into the intervention program to promote self-care behavior among older adults with type 2 diabetes,thereby achieving better health outcomes.

Keywords: Ability to perform daily activities, Cognitive function, Diabetes mellitus, Older adults,Self-care behavior

Factors Influencing Intention to Perform Patient and Family- Centered Care among Critical Care Nurses during COVID-19 Pandemic

2025-05-07T21:19:34+07:00

Patient- and family-centered care (PFCC) is a care concept that emphasizes collaboration among patients, families, and healthcare teams to maximize the benefits of care. It consists of four main concepts: 1) dignity and respect, 2) information sharing, 3)participation, and 4) collaboration. PFCC has been widely used in various patient groups, yielding favorable clinical outcomes for patients, their families, and healthcare teams. However, implementing PFCC in critically ill patients is challenging because the critical care system is designed to use various technologies as tools for treatment and monitoring. In addition, barriers to PFCC implementation in critically ill patients may come from the patients and their families, the environment in the critical care unit, and the healthcare team. Therefore, critical care nurses who provide continuous care to patients 24 hours a day play an essential role in PFCC. However, during the COVID-19 pandemic, there have been limitations in interactions and communication between patients, families,and critical care nurses, and critical care nurses have not been prepared for this situation. COVID-19 infection prevention guidelines, increased workload, fatigue, stress, and anxiety of COVID-19 infection may affect critical care nurses' intention to provide PFCC care. Understanding the factors affecting critical care nurses' intention to provide PFCC is significant. The Theory of Planned Behavior (TPB) is a widely used theory that investigate factors affecting individual behavior.According to the TPB, an individual's intention to perform a behavior is predicted by three key factors: 1) attitude toward the behavior, 2) subjective norm, and 3) perceived behavioral control.Therefore, using the TPB as a conceptual framework to study the factors affecting critical care nurses' intention to provide PFCC care during the COVID-19 pandemic will promote the understanding of critical care nurses' patient care behavior and improve the quality of care and patient safety.

This study aimed to examine the predictive factors for the intention to perform PFCC among critical care nurses during the COVID-19 pandemic, including education level, work experience in the critical care unit, attitude toward PFCC, subjective norms in PFCC, and perceived behavioral control in PFCC. This study employed a predictive correlational research design based on the conceptual frameworks of PFCC, TPB, and nurses' characteristics. The sample group consisted of 124 critical care nurses working in eight critical care units at Chulalongkorn Hospital,a facility affiliated with the Thai Red Cross Society. The sample was purposively selected to include only professional nurses with at least six months of experience working in a critical care unit. The instruments consisted of five questionnaires: 1) the Personal Data Questionnaire, 2) the Attitude toward PFCC Questionnaire, 3) the Subjective Norm in PFCC Questionnaire, 4) the Perceived Behavioral Control in PFCC Questionnaire, and 5) the Intention to Perform PFCC Questionnaire.The data were analyzed using descriptive statistics and multiple regression with the Enter method.

The results revealed that education level, work experience in the critical care unit,attitude toward PFCC, subjective norms in PFCC, and perceived behavioral control in PFCC could predict critical care nurses' intention to perform PFCC by 25% with statistical significance (F =7.849, p < .01). Perceived behavioral control in PFCC (β = .314, p = .002), subjective norms in PFCC (β = .223, p = .015), and education level (β = .175, p = .038) were significant predictors of critical care nurses' intention to perform PFCC. From the results of this study, nursing administrators should set up a PFCC training program to promote understanding and positive attitudes for critical care nurses, as well as establish a system to support communication and cooperation among patients, families, and the healthcare team, such as meeting rooms and a consultation team for patients and families.

Keywords: COVID–19 pandemic, Critical care nurses, Intention, Patient and family-centered care

Evaluation of Patient Care Outcomes by a Multidisciplinary Team at a Chronic Obstructive Pulmonary Disease Clinic

2025-05-13T10:23:01+07:00

Chronic obstructive pulmonary disease (COPD) is a significant health concern and a leading cause of death in Thailand and worldwide. Chronic airway inflammation causes airflow obstruction and damage to lung tissues and alveoli, resulting in progressive, not fully reversible airflow limitation. Its condition leads to the decline of lung function and other systems, thereby reducing quality of life. The management of patients with COPD focuses on reducing symptoms and the future risk of exacerbations. Patients with COPD require comprehensive care; therefore,collaboration among a multidisciplinary team is needed to enhance patient outcomes and increase
patient satisfaction with care. Literature reviews have found that multidisciplinary team care of patients with COPD could improve clinical outcomes. However, there have been limited studies on the outcomes of changes in self-care behaviors among people with COPD resulting from a multidisciplinary team. Previous studies revealed that good self-care behaviors could positively affect patient outcomes. Therefore, evaluating the outcomes of multidisciplinary care for patients with COPD should encompass various aspects to clearly reflect the quality of care. According to Donabedian’s framework, the assessment of healthcare quality consists of three components:structure, process, and outcome. Outcomes refer to changes in the healthcare of patients that are influenced by the process and structure of healthcare providers.

This descriptive study aimed to examine the outcomes of patients with COPD under the care of a multidisciplinary team, which included self-care behaviors, dyspnea, physical activity,quality of life, and satisfaction with care. Purposive sampling was employed to recruit 87 participants at a tertiary hospital in Bangkok, Thailand from March to June 2022. Participants were patients diagnosed with COPD who met the following inclusion criteria: 1) aged 40 years and above, 2) received multidisciplinary care at COPD clinic for at least one year, 3) regularly attending follow-up treatment for at least 80% of the time, 4) were able to understand and communicate in Thai, 5) were willing to give informed consent, 6) for participants aged 60 years and above, having normal cognitive function, assessed by the Six-item Cognitive Impairment Test: 6CIT with a score less than 8 out of 28. Participants were asked to complete six questionnaires:the Patient Information and Health Data Questionnaire; the Dyspnea Assessment Scale; the Veterans Specific Activity Questionnaire; the Self-Care Behaviors for COPD Questionnaire; the Quality of Life Questionnaire for COPD; and the Satisfaction with Care Questionnaire. Data were analyzed using descriptive statistics.

The results showed that the participants were mostly men with a mean age of 64.49 years (SD = 10.72). They were diagnosed with COPD for 1-15 years (mean = 4.37 years, SD= 2.89), being in the COPD group A (52.9%), and most of them (55.2%) had moderate airflow limitation (GOLD stage 2). Most participants used combination inhalers for treatment; 49.43%of the participants experienced one or more exacerbations per year. However, 14.94% of all participants were hospitalized due to exacerbations of their conditions. The participants exhibited relatively high self-care behaviors with a mean score of 104.97 (SD = 9.14) out of a total score of 124, with the highest average score in the domain of appropriate medication use. Most participants reported the severity of dyspnea symptoms as grade 0 (37.93%), followed by grade 1 of dyspnea symptoms (33.33%). Almost all participants (93.10%) engaged in physical activity with a metabolic equivalent (MET) level of three or above. They reported a relatively high quality of life with a mean score of 79.08 (SD = 9.10) out of a total score of 100. In addition, participants reported satisfaction with care, with a mean score of 72.79 (SD = 1.95) out of a total score of 75. The majority of participants (94.25%) expressed the highest scores in the aspect of “being treated with dignity and respect,” followed by 91.95% of the participants for “having time to discuss their concerns” and “receiving continuity of care.” The positive outcomes of the participants reflect a well-structured organization, a systematic COPD clinic, and a process of care facilitated through the collaboration of a multidisciplinary team, which contributed to the outcomes. All outcomes of patients with COPD could reflect the quality of care provided by the multidisciplinary team. A multidisciplinary team-based care system for the patient with COPD should be established to enhance the quality of care and improve overall patient outcomes.

Keywords: Chronic obstructive pulmonary disease, Multidisciplinary care, Multidisciplinary team, Patient outcomes

Editorial Note

2025-08-28T15:29:15+07:00

บทบรรณาธิการ