The Journal of Thailand Nursing and Midwifery Council

Full issue

2024-06-21T13:22:52+07:00

Editorial Note

2024-06-21T13:31:01+07:00

Situations of Non-Communicable Diseases among Adults and Older Adults Living in Urban Community, Bangkok, Thailand

2022-09-12T13:25:06+07:00

Introduction Non-communicable diseases (NCDs) are increasing as a health concern in urban Bangkok communities. The Princess Agrarajakumari College of Nursing at Chulabhorn Royal Academy is dedicated to serving communities experiencing diverse socio-economic challenges associated with NCDs. It is therefore crucial to study the situation of non-communicable diseases in the community in order to develop proactive care plans.

Objective To describe the situations of NCDs in the communities, including health problems, the impact of NCDs, and health practices to control and prevent the severity of NCDs in adults and older people living in communities of a district in the Bangkok metropolitan.

Design A descriptive study using the framework of non-communicable disease surveillance and control concepts of the World Health Organization, the Ministry of Public Health, and literature review.

Methodology The sample consisted of 1,360 adults and older adults with NCDs registered at a public health center in the study area of Bangkok. They were selected through simple random sampling from the list of adult and older people with NCDs registered from 68 communities, with 20 participants from each community who met the inclusion criteria. Data were collected using questionnaires on health problems, the impact of NCDs, and health practices to control and prevent the severity of NCDs. The questionnaires were developed by the researchers and assessed for content validity, revealing a content validity index of .90. The reliability of the questionnaire on the impact of NCDs was assessed using Cronbach’s alpha, resulting in a coefficient of .90, while the questionnaire on health practices to control and prevent the severity of NCDs yielded a Cronbach’s alpha coefficient of .91. Data were analyzed using descriptive statistics, including percentage, mean, standard deviation, median, minimum, and maximum values.

Results Most of the sample were female (62.50%), with ages ranging from 20 to 95 years, and a mean age of 57.80 years (SD = 14.6). The majority of the sample utilized universal health coverage (87.36%), while over half had a monthly income below 1,000 baht (56.47%) and were overweight (67.96%). The top three prevalent NCDs were hypertension (61.76%), dyslipidemia (46.18%), and diabetes (30.74%). Most of them had two or more chronic diseases, with complications such as heart disease, stroke, and chronic kidney disease. More than 40% of the sample experienced moderate to severe impacts on daily activity disturbance due to their conditions, including knee pain, back pain or shoulder pain, headache, insomnia, fatigue, distracted, irritable mood, anxiety, fear of burdening family, despair, bored, reduced daily activities, and decreased income. Additionally, there were challenges in health practices to control and prevent severity of NCDs including lack of exercise, poor dietary control, insufficient sleep, alcohol consumption, and smoking. Concerning medication adherence, nearly half of the sample (47.46%) did not regularly visit healthcare professionals but self-medicated, while 29.7% shared medications with neighbors experiencing similar symptoms.

Recommendations The findings of this study provide an initial recommendation for developing health behavioral modification programs for those with NCDs in the community focusing on dietary consumption, physical activity, and medication adherence. This includes improving health service systems to ensure continuous access to healthcare services for this population.

Factors Influencing Adherence to Treatment in Adult Patients with Hypertension

2024-03-16T06:46:12+07:00

Introduction Adherence to treatment including medication and lifestyle modification is crucial for improving health outcomes in patients with hypertension. However, there is limited research investigating the factors influencing adherence to medication and lifestyle modification, particularly among adult patients diagnosed with hypertension.

Objective To investigate adherence to treatment and the predictive power of work status, comorbidity, complexity of medication regimens, perceived severity and risk of hypertension complications, and quality of care affecting adherence to treatment in adult patients with hypertension.

Design Cross-sectional correlational predictive research using the multidimensional adherence model as the conceptual framework.

Methodology The sample included 156 adult patients with essential hypertension aged 18 to 59 years old who had received antihypertensive medication and lifestyle modification treatment for at least six months at a super-tertiary hospital’s hypertension clinic. Data were collected between April and July 2023. The research instruments consisted of a general profile questionnaire, a treatment adherence questionnaire for patients with hypertension, a perceived severity and risk of hypertension complications questionnaire, a patient assessment of chronic illness care, the Charlson Comorbidity Index, a medication regimen complexity index, and an illness record form. These instruments were examined for content validity by experts and tested for reliability prior to use in data collection. The reliability ranged from .77-1.00. The data were analyzed using descriptive statistics and multiple linear regression.

Results The sample had an average age of 46.50 years (SD = 9.65); 63.46% were female. The average score for adherence to treatment was 87.97 (SD = 9.02), with the highest score for average medication adherence of 34.37 (SD = 2.52) and the lowest score for average exercise adherence of 4.33 (SD = 1.89). Additionally, 14.74% were overweight, and 71.80% were obese. The majority were employed (83.33%), without any comorbidities (62.82%), and had a low level of medication regimen complexity (68.59%). Furthermore, they demonstrated a high level of perceived severity and risk of hypertension complications (96.15%) and reported a high level of quality of care (61.54%). In the Multiple linear regression, 30.9% of the variance in adherence to treatment was explained (Adjusted R2 = .309 F(5,150) = 14.858, p < .001). Work status (β = -.262, p < .001), comorbidity (β = -.184, p = .020), perceived severity and risk of hypertension complications (β = .466, p < .001), and quality of care (β = .165, p = .017) together were significant predictors of adherence to treatment in adult patients with hypertension.

Recommendation To promote adherence to treatment in adult patients with hypertension, nurses should develop strategy to improve quality of care within hypertension clinics and enhance the perceived severity and risk of hypertension complications as well as enhance lifestyle modifications particularly regarding diet and exercise for overweight and obese adults with hypertension.

Factors Influencing Low Muscle Strength among Community-Dwelling Older Adults with Non-Communicable Diseases

2024-04-10T13:42:57+07:00

Introduction The presence of low muscle strength serves as a major indicator of sarcopenia and health status in older adults with non-communicable diseases (NCDs), leading to increased morbidity and mortality among them.

Objective 1) To describe the prevalence of low muscle strength, and 2) To investigate personal and health factors predicting low muscle strength in community-dwelling older adults with NCDs

Design This study employed a correlational predictive design, guided by physiological theory and literature as its conceptual framework.

Methodology The participants consisted of 192 community-dwelling older adults diagnosed with non-communicable diseases in Samut Prakan province. Purposive sampling was employed according to the inclusion and exclusion criteria. Data were collected using the Global Physical Activity Questionnaire (GPAQ) version 2, the Thai Geriatric Depression Scale (TGDS-15), and nutritional and muscle strength assessments. Data were then analyzed using descriptive statistics and logistic regression analysis.

Results Most of the participants were female (65.1%), with a mean age of 69.60 years (SD = 7.60). The prevalence of low muscle strength among older adults with non-communicable diseases was 54.17%. Personal and health factors including age (OR= 3.47, 95% CI = 1.91-6.33), weight loss (OR= 4.05, 95% CI = 1.11-14.70), physical activity (OR= 0.37, 95% CI = .19-.73), and depression (OR= 3.06, 95% CI = 1.16-8.03) were significantly predicted low muscle strength. Multiple logistic regression analysis revealed that age (OR= 3.02, 95%CI = 1.63-5.59) and physical activity (OR= 0.48, 95%CI = 0.24-0.97) together could predict low muscle strength among older adults with NCDs, accounting for 14.3% of the variance.

Recommendation This study demonstrates that age and physical activity significantly predict low muscle strength among older adults with NCDs in the community. Therefore, health promotion programs addressing physical activity should be developed to reduce risk factors and to prevent and delay sarcopenia particularly in older adults of advanced age with NCDs.

Factors Predicting Caregiver Contributions to Self-care in Patients with Heart Failure

2024-03-23T05:56:30+07:00

Introduction Caregivers play an important role in contributing to self-care in patients with heart failure (HF). To date, knowledge regarding factors associated with caregiver contributions to self-care remains limited, particularly in Thai patients with HF.

Objective This study aimed to 1) describe caregiver contributions to self-care, and 2) examine factors predicting caregiver contributions (self-care maintenance, symptom perception, self-care management) of patients with HF.

Design This correlational predictive study was guided by a situation-specific theory of caregiver contributions to heart failure self-care. Methodology The study included 128 caregivers of patients with heart failure, who were purposively selected based on the following inclusion criteria: aged at least 18 years, unpaid for their caregiving tasks, and living with the patients who attended the heart failure clinic and general internal medicine clinic at an outpatient department of a super-tertiary hospital from April to August 2023. Data collection was conducted using questionnaires and record forms, and the data were analyzed using descriptive statistics, simple linear regression, and multiple linear regression.

Results The majority of the participants were female (75.78%), with an average age of 46.10 years (SD = 13.74). Caregiver contributions (CC) to symptom perception and self-care maintenance were found to be adequate, with means of 73.38 (SD = 14.83) and 72.72 (SD = 13.75), respectively. In contrast, self-care management was deemed inadequate, with a mean of 68.83 (SD = 16.56). Multiple linear regression analysis revealed that health perception and self-efficacy together predicted CC for symptom perception, explaining 35.20% of the variance. Health perception, self-efficacy, and positive aspects of caregiving together predicted CC to self-care maintenance, explaining 31.50% of variance. Self-efficacy and comorbidities in patients together predicted CC to self-care management, explaining 21.20% of variance. While the status of caregivers to patients was not a statistically significant predictor of all three dimensions of CC to self-care in the patients with HF in this study.

Recommendation The results of this study can be utilized to develop specific programs aimed at enhancing caregiver contributions to the self-care of patients with HF, particularly in promoting self-efficacy, positive aspects of caregiving, caregivers’ health perception, and managing the comorbidities of the patients.

Factors Associated with Health-Related Quality of Life among Older Adults undergoing Hemodialysis

2024-04-11T10:46:03+07:00

Introduction Hemodialysis has a significant effect on the quality of life in older adults with chronic kidney disease. Investigating factors related to the quality of life in the older adults with chronic kidney disease undergoing hemodialysis can offer crucial information to provide care for them with quality of life.

Objective 1) To describe malnutrition, adequacy of hemodialysis, frailty, and health-related quality of life, and 2) To examine relationships among malnutrition, adequacy of hemodialysis, frailty, and health-related quality of life in older adults who undergo hemodialysis.

Design A descriptive correlation design was used with application of Ferrans’s conceptual model of health-related quality of life as the conceptual framework.

Methodology Participants were 100 older adults who undergo hemodialysis at an outpatient dialysis unit in 2 university hospitals were recruited in this study following the inclusion criteria. The instruments used for data collection were the demographic questionnaire, the Malnutrition-inflammation score, the Simple FRAIL questionnaire screening tool, and the Thai-Health-Related Quality of Life. Cronbach’s alpha coefficients of the Malnutrition-inflammation score, and the Thai-Health-Related Quality of Life were .83 and .81, respectively. The test-retest reliability within 7 days of the Simple FRAIL questionnaire screening tool using, Spearman correlation coefficient was 1. Data were analyzed using descriptive statistics and Pearson or Spearman Rank correlation coefficient statistics.

Results The mean age of participants was 72.46 years (SD = 8.25), with 55% were female. Most of them were unemployed/ retired (94%) and had a primary caregiver (82%). The median dialysis period was 36 with interquartile range [IQR] between 17.25 and 73.50 months. The overall mean score of malnutrition status was risk for severe malnutrition (M = 8.87, SD = 3.88); adequacy of hemodialysis was normal (M = 1.99, SD = .49); frailty (M = 2.16, SD = 1.29) and health-related quality of life (M = 129, SD = 7.51) were at good level. Malnutrition and frailty had a significant moderate negative correlation with health-related quality of life (r = -.351, p < .001, rs = -.393, p < .001, respectively). However, the adequacy of hemodialysis was not correlated with health-related quality of life (r = .121, p > .05).

Recommendation The study results serve as fundamental information for healthcare providers in monitoring malnutrition and frailty. Additionally, health care providers should provide advice related to preventing malnutrition and promoting muscle strength and frailty for older adults undergoing hemodialysis. This could then lead to a good quality of life.

Development of the Nursing Practice Guidelines for Pain Management among Cancer Patients in Maharaj Nakorn Chiang Mai Hospital

2024-04-03T10:42:33+07:00

Introduction Pain is a significant problem experienced by cancer patients, affecting both the patients and their caregivers. Evidence-based clinical nursing guidelines are necessary for effective pain management.

Objective To develop nursing practice guidelines (CNPGs) for pain management in cancer patients.

Design Operational research

Methodology The development of the Nursing Practice Guidelines based on the ADAPTE Collaboration (version 2.0) consisted of three distinct phases: 1) the set up phase, 2) the adaptation phase, and 3) the finalization phase. Participants comprised three groups: 1) five healthcare professionals as the guideline development team, 2) three cancer patients in a private ward at Maharaj Nakorn Chiang Mai Hospital, who received care according to the guidelines, and 3) four healthcare personnel who implemented the Clinical Nursing Practice Guidelines (CNPGs) and adhered to all recommendations. The research instruments included 1) a guideline screening tool, 2) the Thai version of the Appraisal of the Guideline for Research & Evaluation II (AGREE II), 3) a cancer patient screening form, and 4) a clinical outcome and process evaluation form. These instruments were quality-checked before use. Data were analyzed using descriptive statistics, including frequency and percentage.

Results The CNPGs comprised five key components: 1) protecting patient rights and ethics, 2) conducting pain assessment, 3) implementing pain management, 4) educating patients on pain self-management, and 5) monitoring adherence to the CNPGs and ensuring continuous quality improvement. Experts evaluated the quality of these guidelines, with all AGREE II components scoring above 80%, indicating their clinical appropriateness. The patient handbooks on pain self-management were also considered appropriate, providing comprehensive and easy-to-understand information. The guidelines were considered feasible, as patients reported pain relief each time pain occurred (21 times). Patient satisfaction with the care provided using these guidelines was highest, and healthcare personnel reported satisfaction to highest satisfaction with their use.

Recommendation This study recommends implementing nursing guidelines for managing pain among cancer patients in clinical settings. Further research should focus on evaluating the effectiveness of these guidelines, considering both clinical outcomes, and process evaluation.

Effects of the Self-Regulation Program on Postpartum Weight Retention among First-Time Mothers

2024-03-13T15:39:58+07:00

Introduction Excessive postpartum weight retention in first-time mothers has an ongoing impact on their health. Self-regulation to maintain a normal weight range is therefore crucial.

Objective To 1) compare the average weight retention of experimental group before and after participating in a self-regulation program, and 2) compare the average weight retention between the control and experimental groups after the program

Design This study employed a quasi-experimental design with two-group pretest and posttest.

Methodology The study comprised 52 first-time mothers attending the Well-Baby Clinic, Health Promotion Center Region 1, Chiang Mai, with their infants for vaccinations between November 2021 and July 2022, post the fourth month of the postpartum period. Following inclusion criteria, participants were purposively selected and assigned to either an experimental or control group, each consisting of 26 participants. The control group received routine care, while the experimental group received a self-regulation program and routine care. Intervention tools included 1) an 8-week self-regulation program, 2) a self-regulation guide, 3) the Z-Size Ladies, and 4) a weighing scale. Data collection instruments included 1) personal data forms, 2) obstetric history forms, and 3) postpartum weight retention health behavior record books. Data collection was completed in the control group and then the experimental group. The data were then analyzed using descriptive statistics, Paired t-test, and Independent t-test.

Results The average postpartum weight retention among the experimental group after participating in the self-regulation program was lower than before the program with a statistical significance (t = 3.594, p = .001). Moreover, average postpartum weight retention among the experimental group after the program was lower than that of the control group with a statistical significance (t = 2.018, p = .02).

Recommendation Nurses and midwives can use the self-regulation program for managing postpartum weight retention among first-time mothers, maintaining it within a normal range. Additionally, conducting a follow-up prospective study is essential to evaluate effectiveness of the program in controlling weight among participants in a subsequent pregnancy.

Effects of Self-management with Family and Village Health Volunteer Participation Program on Health Behaviors and Blood Pressure Levels among Muslim Patients with Uncontrolled Hypertension

2024-01-26T11:16:47+07:00

Introduction Hypertension is a major contributor to paralysis, paresis, and mortality. Encouraging patients with hypertension to adopt blood pressure control behaviors is crucial. However, prior behavioral modification efforts have shown limited long-term efficacy. Effective self-management, involving family and village health volunteers (VHVs), is essential for enhancing health behaviors and achieving controlled blood pressure among patients with uncontrolled hypertension. Designing a self-management program tailored to the culture and lifestyle of Muslim communities, with participation from family and VHVs, is pivotal in fostering improved health behaviors and reducing blood pressure levels among Muslim patients with uncontrolled hypertension.

Objectives This study aimed to examine the effects of self-management with family and VHV participation program on health behaviors and blood pressure level in Muslim patients with uncontrolled hypertension.

Design A quasi-experimental with a two-group pretest and posttest design, applying self-management model in primary care service that redesign service delivery for patients diagnosed with diabetes and hypertension (NCD-X) integrated with the social ecological model as the conceptual framework.

Methodology Participants were Muslim patients with uncontrolled hypertension, purposively selected according to the inclusion criteria. They were then randomly assigned to experimental and control groups, each including 28 participants. The experimental group underwent the self -management with family and VHV participation program for 12 weeks while the control group received usual care. The research instruments included demographic and health data form and health behavior questionnaire. The reliability of these instruments was confirmed by a Cronbach’s alpha coefficient of .70. Data were analyzed using descriptive statistics, Paired t-test and Independent t-test.

Results After participating in the program, the experimental group showed a mean score for health behaviors (M = 59.35, SD = 8.32), significantly higher than before the program (M = 48.92, SD = 6.28, t = -8.299, p<.001) and higher than the control group (M = 49.39, SD = 6.55, t = 4.970, p<.001). Moreover, the experimental group showed a mean difference in systolic blood pressure before and after the program (M = 25.89, SD = 11.74), significantly higher than the control group (M = 9.82, SD = 16.40, t = 4.210, p<.001). Similarly, the mean difference in diastolic blood pressure before and after the program (M = 8.89, SD = 11.90) was significantly higher in the experimental group than the control group (M = -0.75, SD = 12.76, t = 2.920, p = .005).

Recommendation The healthcare teams can apply this program within NCD clinics for Muslim patients, with similar contexts, to foster health behaviors and continuously monitor patients’ blood pressure levels.

Effectiveness of Health Promotion Program in People with Uncontrolled Type 2 Diabetes at a Tertiary Care Hospital, Samut Sakorn Province

2024-02-01T13:32:47+07:00

Introduction Type 2 diabetes is a non-communicable disease characterized by an increasing incidence with advancing age, leading to complications and premature mortality. Health promotion for people with uncontrolled diabetic is an approach to continuously control their blood sugar.

Objective To examine the effects of a health promotion program on health promoting behaviors and hemoglobin A1C in people with diabetes.

Design This study employed a quasi-experimental design with two-group pretest and posttest, applying Pender’s health promotion model as the conceptual framework.

Methodology Participants consisted of 60 people diagnosed with Type 2 diabetes, with hemoglobin A1C of over 7% in the past three months. They received treatment at a tertiary care hospital in Samut Sakhon province between October and December 2020. The participants were purposively selected based on following inclusion criteria: 1) residing in Ban Phaeo sub-district, Samut Sakhon province, 2) no cognitive decline and able to read and write Thai well, 3) having a contactable phone number and being able to use a smartphone, and 4) willing to participate in the study. The sample size was determined based on Krejcie and Morgan’s principle, with 30 participants each in the experimental and control groups, assigned purposively. The research tools included a 12-week health promotion program delivered in group sessions, with a content validity index of .85. Data collection tools consisted of a demographic questionnaire, a record form, and a health promoting behavior questionnaire, which had been validated in a group similar to the sample, obtaining a Cronbach’s alpha coefficient of .85. Data were collected from October to December 2020. The control group received routine care, while the experimental group participated in the 12-week group health promotion program in addition to routine care. Data were analyzed using descriptive statistics, including frequency, percentage, mean, standard deviation, and median. Inferential statistics included Chi-square tests, Paired t-tests, Independent t-tests, Mann-Whitney U tests, and Wilcoxon signed-rank tests.

Results The control and experimental groups did not significantly differ in personal characteristics, except for the time since diabetes diagnosis, with the control group having a median of 3 years and the experimental group having a median of 5 years. After participating in the program, the experimental group showed significant higher in overall health-promoting behaviors, including nutrition, exercise, stress management, and medication taking, compared to before the program (Z = -4.705, -4.794, -4.556, -3.625, -4.580, p < .001). However, these were not significantly different from the control group (Z = -0.573, -0.834, -0.243, -1.939, p > .05), except for medication taking, where the experimental group scored significantly higher than the control group (Median = 4.00, Z = -2.441, p = .015). Additionally, the experimental group had a significantly lower hemoglobin A1C after the program (Z = -3.259, p = .001) but did not differ significantly from the control group (Median = 7.25, Z = -1.761, p > .05).

Recommendation The healthcare team at a tertiary care hospital, whose context closely aligns with this study, can apply the health promotion program with routine care to monitor and support behavioral modifications in people with uncontrolled Type 2 diabetes.

The Development of a Family and Community-based Treatment and Rehabilitation Model for Substance Users

2024-05-21T13:55:20+07:00

Introduction Substance abuse has severe impacts on daily life and property of patients, families, and communities. Treatment and rehabilitation of drug users through a family and community-based approach is a key to promote and support family and community participation in addressing substance abuse. This approach centers on the patients, their families, and their communities, which enhances the effectiveness and sustainability of substance abuse resolution.

Objectives 1) To describe nurses’ and health team’s perception regarding factors influencing the treatment and rehabilitation of substance users through a family and community-based approach, and 2) To develop a family and community-based treatment and rehabilitation model for substance users.

Design This study employed Research and Development, conducted in four phases. This article presents phases 1 and 2.

Methodology The development of a family and community-based treatment and rehabilitation model for substance users in phase 1 consisted of 2 steps: 1) Describing nurses’ and health team’s perception regarding factors influencing the treatment and rehabilitation of substance users through a family and community-based approach, 2) Evaluation of the existing treatment and rehabilitation model for substance users. Phase 2 included the development of a new treatment and rehabilitation model for substance users through family and community based within the network of Phetchabun Province, using Appreciation-Influence-Control process. Data were collected from January to April 2024, utilizing a questionnaire on perceptions of factors affecting the rehabilitation of substance users through a family and community-based approach, and a guideline for focus group. Data analysis employed descriptive statistics including percentage, mean, standard deviations, Min-Max, and median. Qualitative data used content analysis.

Results The nurses and health team perceived factors affecting the treatment and rehabilitation of substance users within the community at a high-level including knowledge and skills, roles and responsibilities, structures, participation, and management. Evaluation of the traditional model (Community-Based Treatment and Care: CBTx) revealed opportunities for improvement including the database system, family and community participation, and clear coordination, leading to the development of a family and community-based rehabilitation model. The model included five parts: 1) Development of the capabilities of professional nurses and interdisciplinary teams in rehabilitating substance users in the community, 2) Peer support system, 3) Rehabilitation processes, 4) Family and community participation, and 5) Follow-up/empowerment visits.

Recommendation Nurses and health team can implement the family and community-based treatment and rehabilitation model for substance users within a community. It is recommended that future studies examine the effectiveness of this newly developed Family and Community-based Treatment and Rehabilitation model for substance users.