Nursing Research and Innovation Journal

Editorial Note

2025-04-23T10:32:33+07:00

บทบรรณาธิการ

Factors Predicting the Intention to Perform Prevention Behaviors for Coronavirus 2019 among Junior High School Students

2024-08-03T20:15:44+07:00

While the immediate danger of COVID-19 has decreased, emerging infectious diseases remain a global concern. As restrictions ease, maintaining preventive behaviors like wearing masks,practicing hand hygiene, and maintaining social distancing becomes increasingly challenging,especially among younger populations. Adolescents who are often asymptomatic may act as disease carriers and may become less vigilant about preventive practices, potentially spreading the infection to others in their families and communities through transmissions within schools. Adolescents in junior high school represent a critical group for interventions. They are at a developmental stage where habits and attitudes toward health behaviors are formed, making them an ideal target for reinforcing long-term preventive practices. Moreover, schools serve as high-contact environments where infectious diseases can spread rapidly. Understanding the factors that influence adolescents who are junior high school students to continue practicing preventive behaviors is essential for long-term preparedness for future pandemics.This predictive correlational study aimed to investigate the ability of study variables,including attitudes, subjective norms, and perceived behavioral controls, to predict the intention to perform preventive behaviors for COVID-19 among junior high school students. The Theory of Planned Behavior (TPB) was used as a conceptual framework for this study. Three key factors, which consist of attitudes, subjective norms, and perceived behavioral control, play a crucial role in shaping intention and, in the end, behavior. Attitudes refer to students’ evaluations of preventive measures. If students perceive these behaviors as valuable and efficient, they are increasingly likely to keep practicing them. Subjective norms involve the influence of peers, family, teachers, and society on students’ behavioral choices. Social pressure or encouragement from significant others can shape students’ decisions regarding health behaviors. Perceived behavioral control reflects students’confidence in their ability to engage in preventive measures. If they believe they have the resources and ability to continue these behaviors, they are more likely to do so.The sample consisted of 99 junior high school students who attended a school in the Secondary Education Service Area Office 33, Surin province, during the academic year 2022. The sample was selected through purposive sampling based on the following criteria: age 12-15 years old,proficiency in reading, writing, and listening in the Thai language, willingness to participate in the study, and parental or guardian consent. The sample size was calculated using the G*Power program based on the multiple regression analysis formula. The effect size was set at 0.15, the test power at 0.80, and the significance level at 0.05, resulting in a sample size of 77 participants. The researchers increased the sample size by approximately 30% to account for any incomplete data. Therefore, the total sample was 99 students. The research instruments included the Demographic Data Record Form,the Attitude Questionnaire, the Subjective Norms Questionnaire, the Perceived Behavioral Control,and the Intention Questionnaire. All instruments were developed by Park and Oh and then were translated into Thai using the back-translation technique. Data were collected from February to March 2023 through on-site data collection and analyzed using descriptive statistics and stepwise multiple regression analysis.The results showed that most of the sample were female and their age ranged from 12 to 15 years, with an average age of 13.85 (SD = 1.04). Most participants had prior knowledge about the COVID-19 infection and had experience accessing information about COVID-19 provided by national-level organizations. Additionally, most of the sample had experiences related to self-isolation due to COVID-19. The mean scores of variables indicated a positive attitude towards coronavirus 2019 infection prevention behaviors, good subjective norms, a high level of perceived behavioral control, and a high level of intention to perform prevention behaviors among the sample. The correlational analysis results indicate that intention is positively and significantly correlated with all three predictor variables. Perceived behavioral control exhibit the strongest correlation with Intention (r = .64, p < .001), followed by subjective norms (r = .52,p < .001). The weakest correlation is observed between attitude and intention (r = .41, p <.001).Attitudes and perceived behavioral control can collectively predict the intention to perform prevention behaviors for COVID-19 at a statistically significant level of 43.9% (R2=.44, p-value=.027). However, subjective norms do not predict the intention to perform prevention behaviors.This suggests that while subjective norms influenced how participants felt about social distancing,they did not directly translate into behavioral intentions. The baseline questionnaire on subjective norms showed that items related to reference figures like teachers, schools, and parents, had the highest average scores, while peer-related items had the lowest.This study’s findings can inform school-based health education programs that focus on promoting positive attitudes toward COVID-19 prevention behaviors and enhancing perceived behavioral control that encourages intention to perform these behaviors. Future research should consider exploring additional variables to better explain the variability in the intention to perform these behaviors.
Keywords: Adolescents, Coronavirus 2019, Intention, Prevention behaviors, Planned behavior

The Effect of Frequency of Sucking Stimulation with Emptied Breast on Breastfeeding Behaviors in Preterm Infants

2023-10-20T20:09:02+07:00

Emptied breast-sucking stimulation is the 6th step in the 10-step process to promote breastfeeding in sick infants. This involves the mother expressing or pumping milk to empty the breast, followed by allowing the infant to suckle on the emptied breast. This stimulation can be introduced after the removal of the ventilator, regardless of gestational age,postnatal age,or weight of the infant.Preterm infants often experience difficulties with sucking and swallowing due to a lack of coordination between breathing, sucking, and swallowing,putting them at risk of choking on milk. Emptied breast-sucking stimulation helps strengthen the muscles in the mouth and allows the infant to learn and become accustomed to breastfeeding.This way promotes breastfeeding behaviors and reduces the transition period from tube feeding to breastfeeding. It also helps stimulate the secretion of hormones and enzymes that aidinthe digestion and absorption of nutrients and empower the mother to actively participate in stimulating the infant’s sucking and swallowing, while also helping increase breast milk production.This quasi-experimental research aimed to investigate the effectof the frequency of the sucking stimulation with emptied breasts on breastfeeding behaviors among preterm infants by comparing the breastfeeding behaviors between the preterm infants receiving emptied breast-sucking stimulation once a day and those receiving emptied breast-sucking stimulation twiceaday. The samples included 44 dyads of mothers and preterm infants receiving treatment at the Pediatric Ward 2, Nakhonphanom Hospital, recruited by a purposive sampling method according to the inclusion criteria. The first group of 22 preterm infants received emptied breast-sucking stimulation once a day and another group of 22 preterm infants received emptied breast-sucking stimulation twice a day, for 10 minutes each time for seven consecutive days.The Preterm Infant Breastfeeding Behavior Scale (PIBBS) was employed to assess the breastfeeding behaviors of preterm infants once they started breastfeeding for the first time.Data were analyzed using an independent t-test. The results showed that the breastfeeding behavior scores of the preterm infants receiving emptied breast-sucking stimulation once a day was 12.86 (SD= 1.52)and twice a day was 13.31 (SD= 2.27). However,the difference between the two groups was not statistically significant(t = 0.78,p>.05). Therefore,nurses caring for preterm infants should advise mothers to stimulate their infants’sucking performance by emptied breast-sucking at least once a day 10 minutes each, for seven days to help prepare preterm infants for breastfeeding and enhance the preterm infants’ breastfeeding behaviors.
Keywords: Breastfeeding behaviors, Emptied breast sucking, Preterm infants, Sucking stimulation

Development and Feasibility Testing of Clinical Nursing Practice Guidelines for Prevention of Perioperative Hypothermia

2024-08-31T18:19:22+07:00

Intraoperative hypothermia is a preventable condition. Therefore, establishing nursing practice guidelines for its prevention can ensure systematic and comprehensive patient care, including assessment and preventive measures. The implementation of such guidelines has been shown to reduce the incidence of intraoperative hypothermia significantly. These guidelines should be tailored to the specific context of each healthcare setting. This study focused on the development of nursing practice guidelines for preventing intraoperative hypothermiaina in a secondary hospital setting.The research process involved a review of evidence-based practices and an assessment of feasibility and anesthetic nurses’satisfaction with guideline implementation. The goal is to create standardized nursing tools that enhance the quality of anesthesia services, ensuring that patients receive optimal care for hypothermia prevention throughout the perioperative period.This study aimed to develop and evaluate clinical nursing practice guidelines(CNPGs) for the prevention of perioperative hypothermia.Based on Soukup’s and Donabedian’sframeworks, the study was divided into two phases.Phase 1, the development of CNPGs for the prevention of perioperative hypothermia, consisted of five steps: 1)defining the problem and scope, 2)defining the objectives, target group,and outcome of the guideline, 3)searching and evaluating the evidence-based practices, 4)drafting the CNPGs,and 5)content validation conducted by three experts.Phase 2 included feasibility testing and evaluation of the CNPGs.The study consisted of two sample groups. The Phase 1 sample group included academic articles and research studies related to patient care guidelines for preventing intraoperative hypothermia in anesthetized patients. The selected publications, both in Thai and English,were published between 2011 and 2021. The Phase 2 sample group included nine anesthetic nurses who implemented the CNPGsand 35 surgical patients who received anesthesia during the designated study period. The four research instruments were used in this study: 1) the CNPGs for preventing intraoperative hypothermia, 2)a feasibility and satisfaction assessment form for the implementation of the CNPGs, 3) an intraoperative data recording form, and 4)core body temperature measurement devices. Data were analyzed using descriptive statistics and repeated measures analysis of variance.The results revealed that the CNPGs covered risk assessment, hypothermia prevention,and management throughout the operation. After the CNPG implementation in 35 patients for three months, it could prevent perioperative hypothermia in surgical patients. It was found that the CNPGs could prevent perioperative hypothermia by maintaining a core body temperature not lower than 36oC throughout the operation. The average core body temperature intraoperative was significantly lower bothpre- and post-operative(F = 46.65,p < .05). Nurse anesthetists reported that the CNPGs were highly feasible and satisfying to use. The CNPGs could improve the quality of nursing care and increase patient satisfaction with the quality of health care services. The recommendations include the implementation of the CNPGs for intraoperative hypothermia prevention in other hospitals, which may require modifications to align with the specific context of each institution. Further studies explore additional risk factors for intraoperative hypothermia, including the size of the surgical site and the duration of the procedure. Additionally,patient demographic data, such as underlying medical conditions and types of surgical procedures performed should be collected. This would allow for a more detailed discussion of potential complications related to intraoperative hypothermia and improve the overall effectiveness of preventive strategies.
Keywords: Clinical nursing practice guidelines, Feasibility, Perioperative hypothermia,Prevention,Satisfaction

Comparison of Ventilator-Associated Pneumonia between Oral Care with Normal Saline Solution and Chlorhexidine in a Medical Intensive Care Unit*

2024-07-08T19:39:03+07:00

Ventilator-associated pneumonia (VAP) is pneumonia that occurs in patients who have been on a ventilator for more than two calendar days. The occurrence of VAP affects the patient, causing increased hospitalization time, medical care costs, and increased mortality Also, VAP can aggravate the development of drug-resistant microorganisms and prolong intubation the length of stay in the intensive care unit. Oral care is one part of reducing the pathogens that cause VAP . Patients who are on ventilators will have their oral care with chlorhexidine. However, it was found that the effects of using chlorhexidine have side effects in both local areas and various body systems. It was found that when chlorhexidine is aspirated into the lungs, it can be harmful to lung tissue, causing acute respiratory distress syndrome and an allergic reaction to chlorhexidine, leading to anaphylaxis in some cases. In current practice,ventilator patients receive daily oral chlorhexidine care. However,recent research has called into question the efficacy and safety of oral chlorhexidine in VAP prevention.There is a study on oral care in patients who use ventilators using other liquids or solutions.Studies have been conducted on oral care in mechanically ventilated patients using various solutions or agents.The results of these studies comparing different oral care solutions, such as normal saline solution and povidone-iodine, showed no difference in the occurrence of VAP. As a result, the research team decided to investigate and compare the use of normal saline solution for oral care to determine whether it could prevent VAP as effectively as chlorhexidine, given that saline can prevent and reduce the potential harms associated with chlorhexidine use. This research aimed to 1) compare the incidence of ventilator-associated pneumonia between oral care with normal saline solution and chlorhexidine,2) identify the side effects of oral care with with normal saline solution and chlorhexidine, and 3)compare the oral health status between oral care with with normal saline solution and chlorhexidine This research is a noninferiority randomized controlled trial. The literature review was used to develop the clinical nursing practice guidelines.The sample group in the study was a group of patients who were admitted to the medical intensive care unit. The criteria were 1)using a ventilator for more than 2 calendar days, 2)being aged 18 years and older, 3)having platelet more than 50,000 cells/mm3.The exclusion criteria were 1) having an allergy to chlorhexidine and/or mouth ulcers, 2) being re-intubated within 24 hours, 3) being re-admitted and had participated in the study, 4) requiring surgery, and 5)being were diagnosed with VAP prior to participating in the trial. This research was conducted between February 2022 and April 2023. . The sample size was determined using a computer program, the Power and Sample Size Calculators, with an acceptable level of confidence (α) = .05, a test power (1-β) = .80, and the size of the non-inferiority margin (δ) = .05,resulted in a sample size of 69 people per group. Another 10% of the sample was added to prevent sample loss during the study, thereby having a total sample of 158 participants, which were then randomly divided into two subgroups,each with 79 people. The tools used for data collection included a personal data recording form,a VAP diagnosis data recording form,and an oral health data recording form. Data were analyzed using the chi-square statistic, Mann-Whitney U test, t-test, and Fisher’s exact test.The results showed that the participants of each group (n = 79) had similar baseline characteristics. A comparison was made between the occurrence of VAP during oral care with normal saline solution saline and chlorhexidine. The normal saline solution NSS group had a rate of 6.30% of VAP,while the chlorhexidine group had a rate of 7.60%,with no statistically significant difference.The difference in the proportion of VAP occurrence between the normal saline solution NSS group and the 0.12% chlorhexidine group was -1.30%(95%CI: -9.20 to 6.70%).The incidence of oral mucositis in normal saline solution and chlorhexidine was 0%and 7.6%, respectively. The oral health scores of both groups were mostly categorized as fair . The oral health scores in the saline and chlorhexidine groups were 64.56% and 49.37%, respectively.The oral health status between the two oral care groups was not statistically significantly different. In conclusion, the study’s results could not conclude that oral care with normal saline solution had the same chance of occurring VAP as using chlorhexidine solution. However, there was a side effect of using chlorhexidine solution,which wasoral mucositis. Therefore, research should be conducted in other contexts or organizations to verify the findings from this study or to conduct a long-term study. Additionally, factors that may affect oral health should be more strictly controlled.
Keywords: Chlorhexidine,Normal saline solution,Oral care,Oral mucositis,Ventilator-associated

Effectiveness of an Innovation “Sugar Safety Alert” for Using the LINE Application on People with Type 2 Diabetes

2024-11-06T15:15:08+07:00

Type 2 diabetes is a chronic disease and a public health issue that has seen an increasing incidence, with a continuous upward trend. Education and guidance on self-care practices to prevent complications, delivered in an accessible, rapid, and suitable online format, are still limited. This study was a two-group quasi-experimental study with pre- and post-test measurements, aimed at investigating the effectiveness of the “Sugar Safety Alert” innovation via the LINE application for people with type 2 diabetes. The sample consisted of 63 individuals aged 20–65 years with type 2 diabetes, divided into an experimental group (n = 32) and a control group (n = 31). The participants were randomly selected from a list of eligible individuals with type 2 diabetes. The experimental group received content via the LINE application, which was developed based on the Health Belief Model combined with the Seven Colors Life Traffic Ping Pong Program. The content validity of the application was confirmed with a content validity index of .94. The application included features for recording blood sugar levels, displaying blood sugar level warnings, knowledge on self-care for persons with diabetes, risk level of diabetic complications and specific advice on blood sugar levels specific for person with diabetes, including risk, severity of diabetic complications, benefits of preventing diabetic complications, guidelines for the prevention of complications and the promotion of behaviors aimed at preventing and managing the severity of the disease.The application was used for four weeks. In the first week, the researcher explained how to use the application, including access methods, and guided participants through the use of various parts of the LINE application. Participants were also given a blood sugar level situation journal for weeks 1–4, which included various blood sugar levels to be completed by each individual. The experimental group was instructed to enter the information and study the content from the application as a guideline for self-management. For weeks 2–4, participants filled in blood sugar level data according to situational prompts provided in week 1, twice a week with one blood sugar value per session, totaling eight values for the entire period, in order to study the recommendations from the LINE application for future use. The control group received standard healthcare services. After the experiment, the control group was also introduced to the LINE application. The effectiveness of the“Sugar Safety Alert” innovation was assessed in week 4 using a questionnaire that included measures of knowledge about diabetes and complications, perceived risk, perceived severity of diabetes complications, perceived benefits of complication prevention, behaviors to prevent and control diabetes severity, as well as blood sugar levels. Blood sugar data were collected from the participants after the experiment, using data from health records (secondary data) with consent from the participants. Data were analyzed using descriptive statistics, paired t-test for within-group comparisons, and independent t-test for between-group comparisons.The results showed that the experimental group had significantly higher levels of knowledge, perceived risk, severity, and perceived benefits of complication prevention from diabetes compared to the pre-test and compared to the control group. However, no significant differences were found in prevention behaviors or blood sugar levels. This suggests that providing comprehensive information, which is not exclusively focused on complications, along with a shorter trial period than previous studies, might contribute to the lack of noticeable significant changes in prevention behaviors or blood sugar levels. Therefore, extending the trial period is recommended to allow for the manifestation of prevention behaviors and the control of blood sugar levels. Nevertheless, the findings of this study provide healthcare professionals with an alternative approach to conducting activities across various channels more effectively. The LINE application can be used as a tool to educate and promote positive self-care attitudes, and it should be developed further to enable continuous blood glucose monitoring, thereby improving diabetes care in community settings.
Keywords: Blood sugar level, Health Belief Model, LINE application, Type 2 diabetes

Factors Predicting Self-Protective Behaviors from Exposure to Particulate Matter 2.5 Microns or Less among Community-Dwelling Older Adults

2025-02-03T21:11:59+07:00

The modern world faces air pollution from exposure to particulate matter 2.5 microns or less (PM2.5), which significantly impacts health and mortality. Older adults are particularly at risk due to age-related physiological decline, pre-existing chronic diseases, weakened immune systems,and limited mobility,all of which reduce their ability to protect themselves from PM2.5 exposure.Such exposure is associated with respiratory diseases, cardiovascular diseases, mental health issues, and other chronic conditions.Therefore, older adults must adopt self- protective behaviors against PM2.5 exposure to prevent severe health complications or even death.These behavioral measures include wearing protective masks, monitoring air pollution levels, avoiding outdoor activities,staying in well-sealed indoor environments, using air purifiers, regularly cleaning living spaces, refraining from smoking or engaging in activities that generate dust,staying hydrated,ensuring the availability of necessary medications and medical equipment,and being aware of abnormal health symptoms. However, there is still a lack of direct research on the self-protective behaviors of older adults regarding PM2.5 exposure, as well as the factors predicting these behaviors in community settings. Identifying such predictive factors could help design activities or programs to promote self-protective behaviors among older adults in communities, ultimately reducing the health risks associated with PM2.5 exposure. This study aimed to 1) examine self-protective behaviors from exposure to PM2.5 among community-dwelling older adults and 2) identify the factors that predict self-protective behaviors from exposure to PM2.5 among community-dwelling older adults. This cross-sectional study examined predictive factors based on the Health Belief Model proposed by Rosenstock, Strecher , and Becker. The sample consisted of older adults aged 60 years who met the following inclusion criteria: 1) residing in Nong Tao Subdistrict for at least one year, 2) having a normal cognitive function, assessed by the Clock Drawing Test score of at least 6 out of a full score of 10, 3) being able to read and write Thai, and 4) providing written informed consent to participate in the study. The sample size was determined using the G*Power program with the following parameters: an effect size of 0.15, an alpha of 0.05,a statistical power of 0.95,and six predictor variables,resulting in a required sample size of 161 participants. The sample was selected using systematic random sampling. The research instruments included 1) a general information questionnaire for older adults, 2) the Health Belief Questionnaire, and 3) the Self-Protective Behavior from Exposure to PM2.5 Questionnaire. Data collection was conducted from January to April 2024 through structured interviews. Data were analyzed using descriptive statistics, spearman rank correlation coefficient, and multiple linear regression analysis.Most of the sample were female, with an average age of 70.33 years.Most had completed primary education and were married.Nearly half relied onolder living allowances as their primary source of income, and two-thirds had sufficient income for daily living.Additionally, almost two-thirds had no chronic diseases and were not on regular medication.The majority were primarily cared for by family members. The sample demonstrated a moderate level of self-protective behaviors from exposure to PM2.5 and a moderate level of some predictors—perceived susceptibility,perceived severity, and perceived barriers to self-protection. However, they had a high level of perceived benefits of self-protection,perceived self-efficacy, and cues to action.The variables of cues to action,perceived self-efficacy,perceived benefits of self-protection, and perceived severity of PM2.5 exposure were significantly related to self-protective behaviors from exposure toPM2.5 (r = .54,.53, .39, .18, p < .05, respectively). On the other hand, perceived susceptibility and perceived barriers to self-protection were not significantly related to self-protective
behaviors from exposure to PM2.5 (r = .13, .01, p > .05, respectively). The predictive factors collectively explained 41.00% of the variance in self-protective behaviors from exposure to PM2.5 (adjusted R² = .41,p = .009). The significant predictors were cues to action (Beta =.35,p<.001), perceived self-efficacy (Beta = .29,p<.001),perceived benefits of self-protection (Beta = .26, p = .001), and perceived susceptibility (Beta =-0.19,p = .009). Therefore, community nurses should encourage older adults to protect themselves from PM2.5 exposure through activities that enhance self-efficacy in practice.This can be achieved by integrating content on the benefits of self-protective behaviors, highlighting the risks of non-adherence to self-protection measures,and fostering motivation through support from nurses and family members.
Keywords: Community, Health belief model, Older adults Particulate matter 2.5,Self- protective behaviors

Comparison of Direct Medical Costs between Integrated Care with Palliative Care and Standard Treatment in Older Patients with Cancer

2024-10-13T10:01:02+07:00

Integrated treatment with palliative care is a comprehensive approach addressing both disease management and symptom relief. It emphasizes holistic care and early palliative planning,enhancing the quality of life for patients with advanced cancer. Integrated treatment with palliative care is an approach that combines disease-targeted therapies with palliative interventions to improve patients quality of life. It is important for individuals with serious, chronic, or life-threatening illnesses to ensure that they receive comprehensive care that addresses both physical symptoms and psychosocial well-being. Evidence-based medicine strongly supports the benefits of early and continuous integration of palliative care into standard treatment. Previous studies found that patients with advanced cancer who received early palliative care reduced emergency visits, intensive care unit (ICU) admissions, and aggressive end-of-life interventions, and systematic reviews reported that integrated palliative care significantly improved suffering symptom management, psychosocial support,and satisfaction in cancer care. In contrast, standard treatment primarily focuses on disease management without a structured palliative care plan, which may impact patient expenses, particularly among older patients.However, studies on the costs of palliative care for older patients with cancer (aged ≥ 60 years) in Thailand remain limited. This study aimed to compare direct medical costs between older patients with cancer receiving integrated care with palliative care and those receiving standard treatment in the last six months before death. The definition of direct medical costs refers to the actual expenses incurred for medical services, treatments, and interventions directly related to patient care. These costs are essential in evaluating the economic impact of healthcare intervention. A retrospective analysis was conducted using data from patients with cancer aged 60 and older who died between January 1, 2016 and December 31, 2021. Clinical and cost data were systematically recorded in the Faculty of Medicine Ramathibodi Hospital's database and the hospital-based cancer registry. All cost values were adjusted for inflation to 2021 values. Descriptive statistics and multiple regression analyses were used to assess medical expenses while controlling for variables such as sex, age group,cancer type, and healthcare entitlement. The study included a total of 1,013 older patients with cancer,with 52.00% being male and an average age of 72.37 years. The most common causes of cancer-related deaths were lung cancer (20.40%),colorectal cancer (15.79%), and hepatobiliary cancers (10.90%). Regarding healthcare entitlements, the majority of patients were covered under the government employee healthcare scheme (56.86%), while the lowest proportion was covered under social security. Among the patients, 798 received standard treatment, while 215 received integrated palliative care. Receiving integrated palliative care had a significantly lower median number of hospital visits, including emergency department and inpatient admissions, compared to those receiving standard treatment (z = 3.04, p = .002; z = 2.54, p= .011). Regarding direct medical costs, patients who received integrated palliative care had total costs of 125,764.90 THB, 269,619.90 THB, and 362,806.00 THB at 1, 3, and 6 months before death, respectively. In contrast, those receiving standard treatment incurred higher costs of 258,476.00 THB, 376,494.80 THB, and 494,303.20 THB at the same time intervals. Cost reductions in the integrated care group were 44%, 28%, and 27% at 1, 3, and 6 months before death, respectively. Among patients covered under the government employee healthcare scheme, integrated care resulted in a cost reduction of 198,769.60 THB over six months compared to standard treatment. The findings confirm that older patients with cancer receiving integrated palliative care incur significantly lower hospital expenses than those receiving standard treatment (t = 4.40, p < .001). Patients under the government employee healthcare scheme had higher end-of-life medical costs than those under other schemes, likely due to more comprehensive coverage and access to medical services. However, although Thailand's universal health coverage system has included palliative care services in all healthcare schemes since 2002, this study found that only 20% of patients received integrated treatment with palliative care. This may be due to limitations in the number of palliative care personnel and insufficient awareness of the benefits of this type of care. This study concludes that integrated treatment with palliative care is a crucial component of healthcare for older patients with cancer, improving patient outcomes, enhancing quality of life,it also helps reducing medical costs. To enhance patient quality of life and reduce healthcare costs,policymakers and healthcare providers should expand access to integrated palliative care, ensuring that older patients with cancer benefit from a holistic and cost-effective approach to end-of-life care.
Keywords: Cancer patient, Medical Cost, Older adults, Palliative Care, Treatment expenses

Experiences in Health Care Using Local Wisdom of Older Cancer Survivors

2024-12-12T21:35:29+07:00

Thailand officially became an aged society in 2022 and is expected to reach a super-aged status by 2031. This demographic shift has led to an increased risk of cancer and higher mortality rates. Cancer survival depends on individual factors such as age, underlying health conditions, and health behaviors, as well as external factors such as access to treatment and support from family and the community. Older people are at higher risk and require continuous care after surviving cancer.In the Thai context, local wisdom plays a crucial role in maintaining both physical and mental wellbeing,as it is deeply connected to culture and spirituality. However, research on the firsthand experiences of cancer survivors who incorporate local wisdom into their care remains limited. Therefore,exploring this issue will be beneficial in developing a care approach that aligns with Thai lifestyles,culture, and context- emphasizing holistic, person-centered care. This study aimed to explore experiences in health care using the local wisdom of older adults who have survived cancer.This study employed a qualitative descriptive research approach, seeking to uncover and understand the natural phenomena experienced by older cancer survivors. It values the attitudes, thoughts, beliefs,behaviors, and cultural aspects of older adults, aiming for a holistic understanding of their experiences within the studied context called “naturalistic inquiry.” In the study, the researchers investigated real-life phenomena within the natural environment of older adults who have survived cancer. Data collection took place in locations convenient and private for participants, such as their homes,community health centers, gardens, and hospitals. The primary data collection methods included interviews and observations.The study sample consisted of 11 participants, both male and female, aged 60 years or older who had survived cancer for at least five years. The sample size was determined based on data saturation. Data collection took place between June 2019 and January 2020. Inclusion criteria included: 1) having experience using local wisdom for health care during and after cancer, 2) being able to perform daily activities independently, 3) being able to articulate their experiences and communicate in Thai clearly, 4) having normal cognitive function, 5) having no signs of depression,and 6) being willing to participate in the study. The exclusion criterion was having experienced severe illness during the study period. The participants were selected through purposive and snowball sampling.A researcher experienced in qualitative research and care of cancer patients was regarded as a research instrument. The data collection instruments included a personal information record form, a semi-structured interview guide, and observation and field note forms. Data collection involved in-depth interviews, observation of behaviors and health care practices, and review of relevant information.Data analysis was conducted simultaneously using inductive analysis, following Braun and Clarke's six-step thematic analysis approach.The sample had an average age of 66.54 years, and all were identified as Buddhists.Almost all of the participants were female. Breast cancer was the most common diagnosis (n = 5),followed by cervical cancer (n = 3). All participants possessed knowledge, beliefs, concepts, and behaviors accumulated through both direct and indirect experiences. These experiences were used to cope with life’s hardships, maintain their health, and were willingly shared with others—collectively eferrred to as the "wisdom of older people." Three main findings emerged: 1) Life skills for disease protection: living in the present, establishing healthy behaviors, and cultivating life skills; 2) Main support for success: the older people themselves, family members, health professionals, and communities; and 3) Dharma principles for life understanding: commitment to problem-solving,taking personal responsibility, and demonstrating perseverance and patience, acceptance of reality,letting go, understanding one's inner self, and following the middle path. The findings highlight that the wisdom of older adults serves as a vital tool for overcoming life’s adversity, leading to holistic well-being—physically, mentally, socially, and spiritually. Therefore, promoting and integrating this wisdom into healthcare approaches can play a crucial role in the recovery and well-being of older cancer survivors. Healthcare professionals can apply these research findings to develop care models that integrate traditional wisdom with modern medical practices. Additionally, rehabilitation programs should be designed to align with the cultural contexts of older adults in different regions, grounded in holistic traditional wisdom.
Keywords: Cancer survivorship, Experiences, Older people, Wisdom

The Development of an Interactive Deltoid Intramuscular Injection Simulator and Its Effectiveness

2025-01-07T20:19:02+07:00

Intramuscular injection in the deltoid muscle is a critical nursing procedure for vaccine administration and injectable medications in clinical settings. This procedure requires knowledge of human anatomy, principles of medication preparation, aseptic techniques, and appropriate injection methods to minimize complications arising from incorrect muscle layer injection, improper site selection, and inappropriate needle size.Practicing intramuscular injections on simulation models in nursing skills laboratories provides essential learning experiences for nursing students. However, conventional simulation models lack real-time feedback on the accuracy of the procedure. This research and development study aimed to develop an interactive shoulder intramuscular injection simulator that provides practice feedback and compares its effectiveness with traditional muscle part and upper-arm simulators. The conceptual framework integrated Dale’s Cone of Experience with anatomical principles and biomedical engineering techniques,emphasizing realistic learning experiences. The developed simulator replicates an adult deltoid muscle. It incorporates a feedback system using electronic sensors and auditory signals to indicate correct needle placement and depth, allowing learners to self-assess and build confidence. The study was conducted in four phases: 1) needs assessment and literature review, 2) development of the interactive shoulder intramuscular injection simulator, 3) evaluation of the simulator’s effectiveness, and 4) refinement and modification of the simulator.The samples included 60 second-year nursing students enrolled in a fundamental nursing course at a university and six nursing instructors, totaling 66 participants. The study utilized three types of simulators: the interactive shoulder intramuscular injection simulator, a muscle part simulator, and an upper-arm simulator with straps, light signals, and sound feedback. Data collection involved participants performing intramuscular injections using each of the three simulators in the following order: the muscle part, the upper-arm, and the interactive simulators. Each injection session lasted five minutes per simulator, totaling 15 minutes for all three simulators.Additionally, participants completed an evaluation form assessing the effectiveness of the simulators in four dimensions: 1) Realism: Skin and muscle anatomy, 2) Skill enhancement in muscle injection: site and depth, 3) Attitude improvement toward nursing practice: Safety and comfort, and 4) Practical application: Ease and suitability. The evaluation took five minutes, bringing the total data collection time to 20 minutes. Data were analyzed using descriptive statistics, repeated measures ANOVA, and pairwise comparison analysis using Bonferroni correction in nursing students, including the Friedman test, and Dunn-Bonferroni post hoc test in nursing instructors.The interactive shoulder intramuscular injection simulator was designed as a half-body male adult with a deltoid muscle molded from yellowish-white silicone,equipped with electronic circuits to detect the position and depth of the needle and a sound system that provides verbal feedback when the needle is inserted correctly at the appropriate location and depth. The overall effectiveness of three types of simulators among nursing students differed significantly in at least one pair (F_2,118 = 56.83,p < .001). significance level. The overall effectiveness of the interactive simulator for nursing students was significantly higher than that of the muscle part simulator and upper-arm simulator (MD = -1.15, SE = .13, p < .001, 95% CI = [-1.469, -.840];MD = -.86, SE = .11, p < .001, 95% CI = [-1.122, -.597]) The overall effectiveness of the upper-arm simulator for nursing students was significantly higher than that of the muscle part simulator (MD = -.29, SE =.10, p < .05, 95% CI = [-.546, -.045]).Furthermore, among nursing instructors, the overall effectiveness of three types of simulators differed significantly in at least one pair χ2 (2, N=6) = 9.65, p < .01).The overall effectiveness of the interactive simulator for nursing instructors was significantly higher than that of the muscle part simulator (z = -1.75, p < .01).The findings indicate that a realistic simulator with feedback mechanisms enhances intramuscular injection procedures' accuracy, convenience, and self-assessment. The interactive shoulder intramuscular injection simulator should be integrated into nursing education to improve injection skills, promote safety awareness, and ensure patient comfort. Future development and research should incorporate a palpable scapula bone and an acromion process, enhance muscle resistance upon needle withdrawal, extend the evaluation period, and increase the nurse instructor sample size for effectiveness comparison.
Keywords: Deltoid muscle, Interactive simulator, Intramuscular injection, Simulator-training effectiveness