Journal of Thailand Nursing and Midwifery Council

Editorial Note

2026-08-04T16:01:14+07:00

Effectiveness of a Joint Contracture Prevention Innovation in Improving Range of Motion and Activities of Daily Living among Patients Undergoing Shoulder and Elbow Surgery: A Quasi-Experimental Study

2026-07-31T09:41:35+07:00

Background Joint contracture is a common complication following shoulder and elbow surgery, significantly impacting patients’ activities of daily living (ADLs) and quality of life. Current rehabilitation approaches have several limitations: 1) Institutional physical therapy is mostly limited to one to two sessions daily due to a shortage of physical therapists, 2) Continuous passive motion (CPM) devices are relatively expensive, complex to operate, and require substantial storage space, making them unsuitable for small community hospitals or home-based use, and 3) Although passive exercises help improving the range of motion, they are less effective at preventing muscle atrophy compared to active exercises; furthermore, patients often lack the confidence to perform independent movements. While empirical evidence strongly supports early, continuous, and high-frequency mobilization, there is a critical shortage of low-cost, locally manufactured, innovative devices that patients can safely use independently without constant therapist supervision. Such innovations should feature structured guidance to ensure proper execution across all directions of motion and enable high-frequency utilization of six to eight times per day. Consequently, there is an urgent need to improve the efficacy of postoperative rehabilitation for patients undergoing shoulder and elbow surgery.

Objective The objective of this study was to investigate the effects of an innovative joint contracture prevention device on the range of motion (ROM) and ADLs in patients following shoulder and elbow surgery.

Design This study employed a quasi-experimental design, applying the concepts of Mobility and Rehabilitation Theory, which focuses on consistent and continuous joint mobilization to achieve the following outcomes: (1) maintaining and increasing the ROM, (2) preventing tissue adhesions, (3) promoting localized blood circulation around the joint, and (4) stimulating muscle and tendon function. This framework was integrated with the Enhanced Recovery After Surgery (ERAS) pathway, emphasizing early mobilization and active patient participation. The innovative joint contracture prevention device developed in this study was designed to enable patients to safely perform self-directed active exercises. The device features a structured configuration consisting of five distinct movement patterns that include all anatomical directions for both the shoulder and elbow joints, including flexion–extension, abduction, adduction, and rotation. These five movement configurations are categorized as follows: the Straight Pattern, Low-Level Pattern, High-Level Pattern, Inward Curve Pattern, and Outward Curve Pattern. Patients performed the protocol for six sets per day over three consecutive days. Each set required approxi- mately 15–20 minutes to complete and comprised all five patterns, with five repetitions executed per side for each pattern, interspersed with a 1–2 minute rest period between patterns.

Methodology The sample comprised 60 postoperative shoulder and elbow surgery patients admitted to the orthopedic ward at Uttaradit Hospital. Participants were selected via purposive sampling according to the inclusion and exclusion criteria. The sample size was calculated using the formula for comparing means between two independent groups. The effect size was set at 0.8 based on a previous study demonstrating that structured exercise yields an effect size of 0.75-0.85. With a statistical power of .80 and a significance level of .05, a sample size of 26 participants per group was required. This was increased by 15% to compensate for potential attrition, resulting in a total sample size of 60 participants. Participants were allocated to either the experimental group (n = 30) or the control group (n = 30) in matched pairs. The experimental group received the innovative joint contracture prevention device in conjunction with standard care and performed the exercise protocol 6 times daily for 3 consecutive days, while the control group received standard care alone. Pre- and post-intervention data were collected to evaluate the ROM (measured with a universal goniometer) and ADLs (assessed with a modified Barthel Index). Data were analyzed using the Paired t-test, Independent t-test, and Chi-square test.

Results The experimental and control groups had a mean age of 52.8 years (SD 11.2) and 51.4 years (SD 10.8), respectively, with males accounting for 56.7% and 60.0% of the participants. The mean body mass index (BMI) was 24.6 kg/m2 (SD 3.4) for the experimental group and 24.9 kg/m2 (SD 3.2) for the control group. The mean number of postoperative days was 1.8 days (SD 0.6) and 1.7 days (SD 0.7), respectively. There were no statistically significant differences in baseline demographic and clinical characteristics between the two groups (p > .05). Post-intervention, the experimental group demonstrated a mean increase in ROM of 15.2 degrees (SD = 8.4), which was significantly higher than the mean increase of 4.8 degrees (SD = 6.2) observed in the control group (p < .001). Notably, shoulder flexion improved by greater than 20 degrees. Regarding functional ability in ADLs, the experimental group showed a mean increase of 19.3 points, significantly outperforming the control group’s increase of 6.6 points (p < .001). Furthermore, 73.3% of patients in the experimental group achieved a high level of functional independence, compared to only 26.7% in the control group. Patients in the experimental group reported high satisfaction with the innovative device (mean score of 4.39 out of 5.00), and no serious adverse events were reported.

Recommendation The innovative joint contracture prevention device is effective in improving the ROM and functional ability in ADLs among patients following shoulder and elbow surgery. As a user-friendly, low-cost tool that enables self-directed use, it is highly suitable for application in orthopedic rehabilitation. However, long-term follow-up studies are recommended to evaluate the sustainability of these outcomes.

Effects of Herbal Balm on Pain Relief from Primary Dysmenorrhea in Nursing Students

2026-07-31T09:41:37+07:00

Introduction Dysmenorrhea is a prevalent gynecological problem among women of reproductive age, significantly impacting both physical and psychological quality of life. This condition is particularly problematic for nursing students, who already experience substantial academic stress from both coursework and clinical practice. Consequently, menstrual pain can severely disturb their learning capabilities and overall well-being during menstruation. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed to alleviate these symptoms; however, they are frequently associated with adverse gastrointestinal side effects. Therefore, it is imperative to investigate the effects of a herbal balm containing Plai (Zingiber montanum) and ginger oils in reducing primary dysmenorrhea, thereby providing a safe and appropriate alternative intervention for nursing students.

Objectives This study aimed to investigate the effectiveness of an herbal balm in reducing dysmenorrhea, improving menstruation-related quality of life, and assessing the satisfaction levels among nursing students utilizing the herbal balm.

Design This study utilized a quasi-experimental with two-group pretest-posttest design, in which the experimental group received the herbal balm intervention and the control group received a placebo balm. The innovative herbal balm, designed to alleviate primary dysmenorrhea among nursing students, was developed based on Amabile’s health innovation framework. This development process comprised six distinct stages: 1) identifying the problems associated with managing dysmenorrhea; 2) reviewing relevant concepts, theories, and literature, as well as consulting experts regarding herbal balm formulation for primary dysmenorrhea; 3) formulating the herbal balm prototype; 4) conducting expert validation; 5) pilot-testing the intervention; and 6) refining the final herbal balm product.

Methodology The sample comprised 70 undergraduate nursing students from a faculty of nursing at a university in southern Thailand. Participants were selected via simple random sampling based on the following inclusion criteria: 1) female students aged 18–25 years; 2) regular menstrual cycles; 3) presence of primary dysmenorrhea with a pain score of ≥ 3 and 4) voluntary willingness to participate fully in all program activities and adhere to continuous follow-up. Participants were purposively assigned to either the experimental group(n = 35) or the comparison group (n = 35). The sample size was determined using G*Power software. The research instruments included: 1) the innovative herbal balm for menstrual pain relief; 2) a demographic questionnaire; 3) a pain scale; 4) a menstrual quality of life scale; and 5) a satisfaction questionnaire regarding the herbal balm. Data collection was conducted between February and April 2025. Data were analyzed using descriptive statistics and inferential statistics, including the Independent -test and Two-way repeated measures ANOVA, with Bonferroni post-hoc test for pairwise comparisons.

Results The experimental group had a mean age of 20.49 years (SD=1.25), while the comparison group had a mean age of 20.37 years (SD=1.35). The average duration of dysmenorrhea was 3.68 days and 2.88 days, respectively. The average daily menstrual flow (measured by sanitary pad usage) was 2.71 pads for the experimental group and 2.94 pads for the comparison group. As for physical and mental discomfort that occurred during menstruation (apart from menstrual pain), the experimental group primarily reported back pain (74.29%), followed by irritability (65.71%) and fatigue (54.29%). Conversely, the comparison group most frequently experienced irritability (71.42%), followed by back pain and fatigue (both at 68.57%). Two-way repeated measures ANOVA revealed that on days 1 and 2 of both the first and second menstrual cycles, primary dysmenorrhea severity differed significantly across the measured time points before application, and at 15 minutes, 30 minutes, and 1 hour post-application (F = 144.22,p<.001; F = 189.69, p <.001; F = 193.43, p <.001; and F = 127.04, p <.001, respectively). The effect sizes were 0.68, 0.74, 0.74, and 0.65. Furthermore, a statistically significant interaction effect between time and treatment group was observed (F = 23.02, p <.001; F = 9.19, p <.001; F = 24.22, p <.001; and F = 11.74, p <.001). Between-group analysis demonstrated that pain significantly differed between the experimental and comparison groups across all specified intervals (F =4.02, p = .049; F =5.73, p =.019; F =4.24, p =.043; and F =5.28, p =.025). Bonferroni post-hoc pairwise comparisons confirmed these differences were significant (p <.001). Post-intervention results indicated that the experimental group achieved a significantly higher menstruation-related quality of life than the comparison group (t = 3.79, p <.001). In the experimental group, overall satisfaction with the herbal balm was highest. In terms of sub-dimensions, satisfaction with the balm texture was high, while satisfaction with the packaging was highest.

Recommendations The study findings support the integration of herbal balm as a complementary intervention for reducing mild-to-moderate dysmenorrhea among nursing students. Nevertheless, certain limitations must be acknowledged. First, the precise dosage of the applied herbal balm was not strictly quantified. Second, the high-temperature manufacturing process utilized during production may have inadvertently degraded the therapeutic properties of the volatile essential oils. Finally, because the sample was drawn from undergraduate nursing students at a single institution, the generalizability of these findings to other populations may be limited.

Development of Clinical Practice Guidelines for Post-Stroke Pneumonia Prevention among Stroke Patients in Phetchabun Hospital

2026-07-31T09:41:31+07:00

Introduction Post-stroke pneumonia is a clinical condition that typically occurs within 48 hours to 7 days after the onset of stroke in non-intubated stroke patients, with the highest incidence observed during the first 72 hours. When pneumonia develops in the acute phase of stroke, it can expand the ischemic area, thereby reducing recovery potential and increasing disability. All stroke patients are at risk of aspiration due to multiple factors, such as decreased consciousness, advanced age, or dysphagia. These conditions elevate the risk of post-stroke pneumonia, with subsequently increase the likelihood of respiratory failure, prolong hospitalization, and increase in-hospital mortality. Prevention of post-stroke pneumonia requires coordinated care among multidisciplinary teams. Thus, the development and implementation of evidence-based clinical practice guidelines can provide a unified framework for healthcare teams, ensuring consistent patient management and reducing the incidence of post-stroke pneumonia.

Objectives: To develop clinical practice guidelines and to assess the quality and feasibility of preventing post-stroke pneumonia in patients with stroke.

Design This study employed an operational research design to develop clinical practice guidelines (CPGs) according to the ADAPTE Collaboration, version 2.0. The process comprised three phases: (1) set-up phase: checking whether the adaptation is feasible, establishing the guideline development team, reviewing relevant existing guidelines, identifying essential team competencies, outlining team activities, and drafting the guideline development protocol. (2) adaptation phase: defining the scope and objectives of the guideline, conducting systematic searches, screening and appraising existing guidelines, selecting appropriate guidelines, and drafting the adapted guideline with revised core content. (3) evaluation phase: assessing guideline quality by external experts, pilot testing with patients and revising accordingly, and finalizing the guideline for institutional implementation. Data collection was conducted over a period of 22 weeks.

Methodology The participants comprised three groups: (1) six healthcare professionals who served as the guideline development team, (2) seven healthcare personnel who acted as guideline users, and (3) five stroke patients admitted to the stroke unit at Phetchabun Hospital who received care based on the developed guideline. Patients were eligible if they were aged 20 years or older, diagnosed with either ischemic or hemorrhagic stroke, had a glasgow coma scale, (GCS) score greater than 8, and demonstrated stable clinical symptoms and hemodynamic status for at least 24 hours. Exclusion criteria included respiratory failure, brain surgery or other conditions requiring endotracheal intubation, severe receptive aphasia, absence of a primary caregiver, and presence of pre-existing post-stroke pneumonia. Participation was terminated in cases of death or transfer to another ward. The sample size was determined in accordance with recommendations for operational research in guideline development. Research instruments included (1) a guideline screening form including a table for summarizing guideline characteristics and a table for summarizing guideline content, (2) Appraisal of Guidelines for Research and Evaluation II (AGREE II), (3) the GCS, and (4) outcome evaluation tools including an aspiration pneumonia assessment form, patient and caregiver satisfaction questionnaires regarding the CPGs, staff satisfaction questionnaires, and CPGs practice adherence checklists. All instruments were validated for quality prior to use. Data were analyzed using descriptive statistics, including frequency and percentage.

Results The CPG developed in this study was intended for use by multidisciplinary healthcare professionals involved in the care of stroke patients, including physicians, nurses, nutritionists, occupational therapists, and nurse aides. The guideline comprised 81 recommendations organized into six categories, aligned with The Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The categories were: (1) patient rights protection and ethics, ensuring that all stroke patients receive care consistent with principles of patient rights and health ethics; (2) screening and assessment of dysphagia, requiring all stroke patients to undergo dysphagia screening, with high-risk patients assessed using validated tools; (3) prevention of post-stroke pneumonia, recognizing that all stroke patients are at risk of pneumonia due to physical impairments and therefore should receive preventive measures; (4) patient and family education, providing knowledge to patients and caregivers regarding pneumonia prevention; (5) management of dysphagia, ensuring effective care for stroke patients with swallowing difficulties; and (6) continuous monitoring and quality improvement, promoting ongoing evaluation and enhancement of care practices. The strength of recommendations was determined according to the evidence-based criteria of the Oxford Centre for Evidence-Based Medicine. A quality assessment of the CPGs by five experts indicated that all domains achieved AGREE II scores exceeding 90%. The CPGs were judged to be comprehensive, clearly written, and feasible for implementation. Feasibility testing was conducted with five stroke patients: one without dysphagia, two with dysphagia who were able to eat orally, and two receiving nasogastric tube feeding. Of the 81 recommendations, 77 were applied in practice, while four were not applicable due to the absence of relevant conditions among the sample patients. Implementation of the guideline in this patient group resulted in no incidence of post-stroke pneumonia. Overall satisfaction with the guideline-based care was rated at a high level by both patients and their families, as well as by the healthcare personnel who applied the CPGs.

Recommendation: It is recommended that the CPGs be promoted for implementation in routine practice, and that further studies be conducted to evaluate their effectiveness on both clinical outcomes and process-related outcomes.

Effectiveness of a Preparedness Training Program for Postpartum Hemorrhage Prevention and Management Among Nursing Students Prior to Clinical Practice in Maternal–Newborn and Midwifery Nursing II Course

2026-07-31T09:41:33+07:00

Introduction Postpartum hemorrhage (PPH) is an obstetric emergency and the leading cause of maternal mortality worldwide, accounting for 27.10% of maternal deaths. This figure is consistent with data from Thailand, where PPH contributes to 25.86% of maternal deaths. Effective prevention and management require rapid, accurate decision-making in accordance with the World Health Organization (WHO) guidelines. Data from fourth-year nursing students at the Faculty of Nursing, Rajamangala University of Technology Thanyaburi, revealed that 28.50% demonstrated clinical decision-making skills in obstetric emergencies at a level below the expected standard. This highlights the urgent need to develop a preparedness program that integrates Kolb’s Experiential Learning Theory, Tanner’s Clinical Judgment Model, and WHO evidence-based nursing practices for the prevention and management of postpartum hemorrhage.

Objectives The objectives of this study were to: (1) compare nursing analytical thinking and clinical decision-making scores related to the prevention and management of PPH among nursing students before and after participating in the preparedness program; (2) compare nursing students’ confidence scores in performing nursing practices for the prevention and management of PPH before and after participating in the preparedness program; and (3) describe nursing students’ satisfaction with the preparedness program.

Design This study employed a quasi-experimental design with one-group pretest–posttest.

Methodology The population and sample consisted of all fourth-year nursing students enrolled in the course Maternal, Infant, and Midwifery Nursing Practice II during the first semester of the 2025 academic year at the Faculty of Nursing, Rajamangala University of Technology Thanyaburi, totaling 87 students. Students who were unable to participate throughout the program, withdrew from the course, or took academic leave were excluded. The research was conducted between June and September 2025. The preparedness program was developed by the researcher and implemented over two days. It comprised four main activities: (1) a two-hour session was conducted to enhance knowledge of postpartum hemorrhage (PPH) based on WHO guidelines (4Ts), corresponding to Kolb’s stage of concrete experience; (2) students engaged in small-group case study analysis of four scenarios for two hours, applying Tanner’s model of noticing, interpreting, responding, and reflecting, which aligned with Kolb’s stage of reflective observation; (3) three progressively complex PPH simulation scenarios were carried out in small groups over three hours, followed by structured debriefing. This activity integrated Tanner’s framework and encompassed all four stages of Kolb’s experiential learning cycle, and (4) a one-hour session was devoted to summarizing and discussing learning outcomes. The program was validated by five experts and pilot-tested with 15 nursing students, yielding a Content Validity Index (CVI) of .96. Research instruments were tested for reliability with 30 nursing students outside the sample group. Five instruments were employed: (1) a demographic questionnaire; (2) a nursing analytical thinking assessment (CVI = .95, ICC = .88); (3) a clinical decision-making assessment (CVI = .92, ICC = .89); (4) a confidence in nursing practice scale (CVI = .96, Cronbach’s alpha coefficient = .91); and (5) a program satisfaction questionnaire (CVI = .94, Cronbach’s alpha coefficient= .89). Data analysis was performed using descriptive statistics, Paired t-test, and One-sample t-test, with the level of significance set at .05.

Results The majority of participants were female (94.25%), with a mean age of 22.45 years (SD = 0.68). The average theoretical course grade point average was 2.85 (SD = 0.42). The findings revealed that, following participation in the preparedness program, nursing students demonstrated significantly higher scores in analytical thinking (M = 17.86, SD = 1.62) compared to before the program (M = 11.38, SD = 2.85), t = 28.512, p < .001. Similarly, clinical decision-making scores were significantly higher after the program (M = 17.82, SD = 1.68) than before (M = 11.08, SD = 2.92), t = 28.847, p < .001. Confidence in nursing practice also increased significantly, with post-program scores (M = 41.93, SD = 4.82) exceeding pre-program scores (M = 24.39, SD = 5.68), t = 31.244, p < .001. In addition, students reported a very high level of satisfaction with the program (M = 4.46, SD = 0.48), which was significantly higher than the criterion score of 3.50, t = 18.734, p < .001.

Recommendation The preparedness program, which integrated Kolb’s Experiential Learning Theory, Tanner’s Clinical Judgment Model, and the World Health Organization’s evidence-based guidelines, was effective in enhancing nursing students’ competence and confidence. Nursing education institutions may incorporate this program into clinical practice courses prior to actual clinical training. Successful implementation requires access to a nursing laboratory equipped with clinical mannequins, simulation scenarios designed according to the 4Ts causes of postpartum hemorrhage, and faculty members with expertise in midwifery to facilitate post-simulation debriefing and reflective learning.

Development of a Competency-Based Short Course Training for Nurse Managers in the New Normal Era

2026-07-31T09:41:06+07:00

Introduction In Thailand, the Nursing and Midwifery Council currently offers only general nursing administration programs. While these programs provide a broad foundation in administrative theory, they place limited emphasis on the specific competencies required of contemporary nurse administrators and fail to fully address the complexities of the “new normal” era. The COVID-19 pandemic, coupled with rapid technological change, demographic shifts, and evolving healthcare demands, has highlighted critical gaps in leadership readiness, digital literacy, and crisis management. Nurse managers, who play a pivotal role in ensuring quality of care, staff resilience, and organizational adaptability, require specialized training that goes beyond traditional administrative frameworks. This study responds to that urgent need by developing a competency-based short-course curriculum tailored to nurse managers, aligned with both national priorities and international standards.

Objectives The primary objectives of this research were threefold: (1) to determine the core competencies required for nurse managers in Thailand’s post-pandemic healthcare landscape; (2) to design a competency-based education (CBE) curriculum that directly addresses these competencies; and (3) to validate the quality, relevance, and suitability of the curriculum through expert review. By achieving these aims, the study sought to bridge the gap between existing general administration programs and the specialized skills needed for effective leadership in the new normal era.

Design This study employed a research and development (R&D).

Methodology This study included three phases. Phase 1: Identification of core competencies: A comprehensive literature review was conducted, drawing on frameworks from the American organization for nurse executives (AONE), the American organization for nursing leadership (AONL), and recent scoping reviews. Nine experienced nursing administration experts from both public and private sectors synthesized findings and collaboratively defined essential competencies. To ensure impartiality, five internationally recognized external experts validated the draft competencies. The content validity index (CVI) was calculated, yielding a robust score of .96, confirming strong agreement and content validity. Phase 2: curriculum development: The validated competencies informed the design of a competency-based curriculum. The development process followed the Nursing and Midwifery Council’s criteria for specialized training, incorporated blended learning through massive open online courses (MOOCs), and applied the Professional Standards Framework for higher education. The curriculum was structured into three modules, each comprising 10 units, totaling 400 hours of instruction, 200 hours of online theoretical learning and 200 hours of practical administrative training. Phase 3: curriculum validation: Five independent experts, including nursing executives, administrators, and educators, evaluated the curriculum’s quality and relevance. Their feedback was gathered through questionnaires and focus group discussions, ensuring consensus on the curriculum’s suitability. The CVI for the curriculum was 1.00, indicating unanimous agreement on its validity and appropriateness.

Results The finalized curriculum comprises three modules, each designed to cultivate specific competencies essential for nurse managers: Module 1: Nurse Managers and Health Policies focuses on leadership, strategic alignment, and continuous quality improvement. Learners engage in policy analysis, strategic planning, and organizational alignment exercises. Module 2: Self-, People-, and Work Development emphasizes personal development, workforce planning, and resource management. Practical tasks include case studies on leadership, retention planning, and budget management. Module 3: Expertise of Nurse Managers concentrates on precision nursing, digital health literacy, and innovative practices. Learners apply health informatics tools and explore innovative models of care delivery. The blended learning approach reinforces theoretical knowledge through practical application, preparing nurse managers to navigate complex healthcare environments.

Recommendation This study highlights the urgent need for specialized competency-based training for nurse managers in Thailand. By systematically identifying core competencies, developing a tailored curriculum, and validating its quality, the research provides a practical, evidence-based solution to strengthen nursing leadership in the new normal. The proposed curriculum not only addresses current gaps but also equips nurse managers with the skills, knowledge, and resilience required to lead effectively in dynamic healthcare environments. Addressing training gaps and aligning outcomes prepares nurse managers to meet evolving healthcare challenges. Successful implementation of this curriculum requires: (1) systematic planning and sustained commitment from administrators to support the transition to competency-based training, (2) technology integration and infrastructure support to facilitate blended learning delivery, (3) stakeholder engagement and continuous feedback to maintain curriculum relevance and effectiveness, and (4) promotion of lifelong learning and faculty development to sustain the competency-based model. Future research should focus on longitudinal evaluation of the curriculum’s impact on leadership performance, clinical readiness, and organizational outcomes. Additionally, ongoing reassessment of competencies is necessary to adapt to emerging healthcare trends, digital innovations, and evolving international standards.

Factors Affecting Rational Use of Medicine Competency of Nurse Practitioners: An Application of the Social Ecological Model

2026-07-31T09:41:04+07:00

Introduction Rational use of medicines (RUM) is a fundamental principle aimed at ensuring that patients receive medications appropriate to their health conditions, while maximizing benefits for patients, families, communities, and the health care system. Within the context of primary care units, which are responsible for managing both common illnesses and chronic non-communicable diseases on a continuous basis, RUM is particularly critical. Inappropriate medication use can lead to adverse drug events as well as unnecessary expenditures. In Thailand, nurse practitioners (NPs) serve as a cornerstone of primary care services. Therefore, competencies in RUM among NPs should not be regarded merely as individual skills. Examining the socio-ecological factors that influence these competencies will provide valuable insights for strengthening and sustaining RUM among NPs.

Objectives This study aims to examine the factors affecting the competencies of NPs in RUM within primary care settings. The specific objectives are: (1) to describe the RUM competency of NPs, and (2) to investigate the socio-ecological factors that jointly predict the RUM competency of NPs.

Design This study employed a cross-sectional correlational descriptive design, guided by the socio-ecological framework. The framework includes multiple levels of influencing factors, including individual-level factors, interpersonal relationship factors, organizational factors, community-level factors, and policy-level factors.

Methodology The study participants comprised 272 nurse practitioners working in primary care units in Suphanburi Province. They were selected using stratified random sampling proportional to the number of practitioners in each district, followed by simple random sampling within each stratum. Inclusion criteria were: holding a professional nursing and midwifery license; completion of the four-month short-course program in primary medical care accredited by the Thailand Nursing and Midwifery Council, or a master’s degree in community nurse practitioners; full-time employment in a primary care clinic; at least one year of work experience in such settings; and willingness to participate in the study. Exclusion criteria included failure to meet the inclusion requirements or submission of incomplete questionnaires. Sample size was determined using G*Power 3.1.9.6 for multiple regression analysis, with a medium effect size, a significance level of .05, and a statistical power of .80. An additional 25% was added to account for potential incomplete data. The research instrument was a questionnaire developed by the researchers, consisting of seven parts: (1) demographic information; (2) individual-level factors, including knowledge of RUM, attitudes toward RUM, self-efficacy, motivation for RUM, and work-related stress associated with medication delivery; (3) interpersonal-level factors, including communication with patients, physicians, pharmacists, and multidisciplinary teams; (4) organizational-level factors, including policies and practices, resource support, personnel development, work support systems, work environment, and workload; (5) community-level factors, including access to medications, community beliefs and culture, and community health networks; (6) policy-level factors, including national policies, professional laws and regulations, and patient care guidelines; and (7) competencies in RUM among NPs. Data collection was conducted between June and September 2025 in primary care units and through online distribution via Google Forms, achieving a 100% response rate. Data analysis employed descriptive statistics, Pearson’s correlation coefficients, and Stepwise multiple regression analysis.

Results The participants had a mean age of 39.14 years (SD = 10.43). The majority were female (56.25%), married (56.99%), and held a bachelor’s degree (95.22%). Most participants (70.59%) reported 1–10 years of experience in caring for patients with non-communicable diseases. Descriptive analysis indicated that all levels of factors within the socio-ecological framework were rated at high to very high levels. Stepwise multiple regression analysis identified eight significant predictors. The final model was statistically significant (F = 71.74, p < .001) and accounted for 67.6% of the variance in RUM competency (Adj. R² = .676; R = .828, R² = .686). Examination of standardized beta weights revealed that workload was the strongest negative predictor (β = -0.25, p < .001), followed by organizational policies and practices (β = 0.22, p < .001), knowledge of RUM (β = 0.18, p < .001), interprofessional communication (β = 0.14, p = .002), work-related stress (β = -0.10, p = .015), work support systems (β = 0.09, p = .028), self-efficacy in RUM (β = 0.08, p = .037), and experience in caring for patients with chronic diseases (β = 0.07, p = .049).

Recommendation The findings of this study support the development of nurse practitioners’ competencies in RUM through multi-level strategies. At the knowledge level, RUM content should be more explicitly integrated into both pre-service curricula and continuing professional development, with emphasis on knowledge application, self-confidence building, ethical decision-making, and interprofessional communication. At the practice level, administrators should strengthen work support systems to mitigate the impact of workload on medication-related decision-making. Examples include using information systems or clinical decision-support tools to screen for medication risks, alert providers to duplicate prescriptions or contraindications, and allocate additional nursing staff in primary care units or during high-risk periods. Work processes should also be redesigned to facilitate effective coordination. At the policy level, existing RUM guidelines should be translated into clear, practical, and contextually appropriate tools that can be readily applied within primary care services.

A Comparative Study of Symptom Distress, Anxiety, Depression, And Quality of Life in Women with Cervical Cancer from the Completion of Radiotherapy Combined with Chemotherapy to over 5 Years of Survivorship

2026-07-31T09:41:08+07:00

Introduction Cervical cancer remains one of the most prevalent malignancies among Thai women. Although treatment has significantly improved survival rates, many patients continue to endure both acute and long-term side effects. These include distressing conditions such as vaginal stenosis and dryness, as well as alterations in urinary and bowel function resulting from radiation-induced tissue damage. Such complications not only compromise physiological functioning but also exert profound psychological consequences, leading to anxiety and depression associated with changes in body image and the loss of sexual function. These sequelae directly impair long-term quality of life. Accordingly, systematic follow-up and investigation of post-treatment effects across different phases of survivorship are essential for holistic rehabilitation. A deeper understanding the trajectory and nature of symptoms at each stage enables nurses to provide patient-centered care strategies that effectively support recovery. Ultimately, such approaches promote well-being and empower cervical cancer survivors to resume their lives with greater happiness and sustained quality of life.

Objective The objective of this study was to compare symptom distress, anxiety, depression, and quality of life among women with cervical cancer following completion of concurrent chemoradiotherapy, across three distinct post-treatment groups: (1) within 0–1 year post-treatment, (2) more than 1 to 5 years post-treatment, and (3) beyond 5 years post-treatment.

Design This study employed a descriptive comparative design, guided by a quality-of-life framework derived from a review of the literature, integrating with the Functional assessment of cancer therapy–cervix (FACT-Cx). Quality of life is conceptualized as an individual’s perception of well-being despite illness or treatment, including five domains: physical, social/family, emotional, functional, and cervical cancer-specific aspects. Patients undergoing concurrent chemoradiotherapy frequently experience side effects and complications, which tend to intensify with prolonged treatment. Moreover, patients differ in their perceptions and responses to these symptoms. Assessing quality of life across all five domains provides health professionals with essential information for nursing care and symptom management. The impact of disease and treatment extends across physical, social, emotional, and functional dimensions, thereby influencing overall well-being. Systematic monitoring of quality of life offers a critical foundation for holistic rehabilitation, enabling healthcare teams to design patient-centered strategies that promote recovery and support cervical cancer survivors in regaining normalcy and sustaining a good quality of life.

Methodology The sample comprised 150 women diagnosed with cervical cancer who had completed concurrent chemoradiotherapy according to the prescribed treatment plan and were attending scheduled follow-up visits at the National Cancer Institute. Participants were selected purposively based on inclusion criteria and stratified into three groups of 50 individuals each, according to survivorship duration: Group 1, patients within one year post-treatment; group 2, patients between more than one year and up to five years post-treatment; and Group 3, patients beyond five years post-treatment. Sample size determination was conducted using the G*Power program, with an effect size of 0.19, a significance level (α) of .05, and a desired statistical power of .80. To account for potential dropout, the sample size was increased by 5%, resulting in 50 participants per group, for a total of 150. Data collection instruments included: (1) a personal information questionnaire, (2) a symptom assessment form related to disease and treatment, (3) anxiety and depression questionnaires, and (4) the FACT-Cx quality-of-life instrument. Data were collected between May 2023 and October 2024 in the outpatient clinic following medical examina- tions. Data analysis was performed using descriptive statistics and the Kruskal–Wallis test.

Results The participants had a mean age of 54.5 years (SD = 10.75). The majority were married (64.7%), utilized the Universal Health Coverage scheme (64.0%), and were diagnosed primarily with stage II and III cervical cancer equally (41.3%). Significant differences were observed across groups in symptom distress, anxiety, depression, and overall quality of life (χ2 = 75.932, p < .001; χ2 = 48.558, p < .001; χ2 = 37.546, p < .001; χ2 = 75.932, p < .001, respectively). Pairwise comparisons revealed statistically significant differences among all groups in symptom distress, anxiety, depression, and overall quality of life, except for depression between group 1 (≤ 1 year post-treatment) and group 3 (> 5 years post-treatment), where no significant difference was found.

Recommendation The findings of this study can be applied to the development of nursing strategies aimed at managing symptoms, alleviating distress, reducing anxiety and depression, and ultimately enhancing the quality of life of cervical cancer patients following treatment. Nurses should conduct regular assessments of symptom burden, symptom perception, anxiety, and depression across different survivorship phases. Such systematic evaluation enables timely, individualized, and patient-centered interventions that effectively respond to patients’ evolving needs, thereby supporting holistic recovery and promoting sustained well-being.

Knowledge, Attitudes, Experiences, and Obstacles in Conducting Clinical Research among Professional Nurses at the Faculty of Medicine Siriraj Hospital, Mahidol University

2026-07-31T09:41:10+07:00

Introduction Mahidol University has established its vision as a research-intensive institution, developing policies and strategies to foster high-quality research and to develop effective support systems. Current data indicate that within the Faculty of Medicine Siriraj Hospital, Mahidol University, professional nurses constitute as much as 89.4% of the support staff. However, only a small proportion of these nurses have initiated or participated in research projects, which in turn limits their opportunities for advancement within professional development. Furthermore, evidence from studies conducted both in Thailand and internationally highlights similar challenges in nursing research: insufficient time due to heavy workloads, limited research skills and knowledge, lack of proficiency in English, and inadequate access to funding sources. These barriers underscore the need for foundational studies to inform strategic planning aimed at strengthening nurses’ research capacity. Such efforts are essential not only to achieve the university’s research goals but also to elevate the overall quality of nursing practice.

Objective This study aimed to describe the knowledge, attitudes, experiences, and obstacles related to clinical research among professional nurses at the Faculty of Medicine Siriraj Hospital. The conceptual framework was developed through a comprehensive review of the literature.

Design This study employed an observational study.

Methodology The sample consisted of professional nurses who had been employed for at least one year at the Faculty of Medicine Siriraj Hospital, Mahidol University. A total of 283 participants were recruited between July 1 and December 31, 2023. Stratified proportional sampling was applied, based on the characteristics of the departments and units in which the nurses worked, as well as their length of service. Participants were categorized into three groups: group 1 included nurses with 1 to 10 years of experience (50% of the sample); group 2 comprised those with more than 10 but not exceeding 20 years of experience (25%); and group 3 consisted of nurses with more than 20 years of experience (25%). The sample size was determined using an estimated prevalence of 10–50%, with a margin of error of 10%, and a minimum response rate of 60%, yielding a final sample of 300 participants. The data collection instrument was a questionnaire developed by the researchers based on a literature review. The questionnaire comprised four parts: (1) demographic and background information, (2) knowledge of clinical research, (3) attitudes toward clinical research, and (4) experiences and obstacles to conducting research. The instrument was validated by experts in epidemiology. Data collection was conducted between July 1 and December 31, 2023, through self-administered questionnaires.

Results The response rate was 94.3%. The participants had a mean age (M) of 35.51 years with a standard deviation (SD) of 9.35. The majority were female (95.8%), held staff nurse positions (90.5%), and had graduated from Mahidol University (90.8%). Overall, the participants demonstrated overall knowledge in clinical research, with a mean score of 8.65 (SD 2.10), equivalent to 57.7%. Regarding knowledge subscales, knowledge of research methodology accounted for 36.7% (M 2.57, SD 1.29), while knowledge of clinical research ethics accounted for 76.0% (M 6.08, SD 1.37). Regarding interest in research, 59.4% expressed a desire to pursue further training. However, 50.9% had never attended training in research ethics or Good Clinical Practice (GCP), and 48.1% were aware of training opportunities offered by their institution. In terms of attitudes toward clinical research, most participants agreed or strongly agreed with Mahidol University’s research vision, recognizing research as a means to advance new medical knowledge. Conversely, the majority disagreed with the notion that research benefits only the researchers or poses harm to patients. With respect to research experience, 47.7% of participants reported having previously participated in research projects. The principal barriers identified included lack of research experience (75.6%), insufficient time due to heavy workloads (74.6%), and inadequate support teams (44.5%).

Recommendation The findings of this study suggest several recommendations for planning initiatives to strengthen nurses’ research capacity. Priority should be given to enhancing knowledge, particularly in research methodology, as most nurses lack prior research experience. Strategies to reduce barriers should include establishing structured mentorship and consultation programs with experienced researchers, ensuring accessible funding opportunities, and fostering motivation to engage in research activities. Furthermore, incorporating research training and practical experience into undergraduate nursing education should be considered, thereby equipping future nurses with foundational competencies that support the university’s research vision and contribute to the advancement of nursing practice.

Factors Predicting Quality-of-Life Difficulty among Early Adolescent Students in Bangkok: A Secondary Analysis

2026-07-31T09:41:02+07:00

Introduction Quality of life is a critical outcome indicator in both school health nursing and adolescent nursing. Urban students, particularly those in Bangkok, experience multiple pressures related to academic demands, sleep and rest, family, and social contexts, all of which may be associated with difficulties in quality of life. Previous projects have examined health behaviors and quality of life among adolescents in Bangkok; however, the primary studies reported only prevalence and bivariate associations. The present secondary data analysis was therefore conducted to investigate predictors of quality-of-life difficulties among early adolescents in Bangkok, utilizing data from the main project and guided by the conceptual framework of stress and coping. The findings are intended to inform strategies to improve the quality of life of early adolescents in Bangkok.

Objective The objective of this study was to examine the jointly predictive ability of risk factors (sleep related daytime dysfunction, emotional distress, and strengths and difficulties) and protective factors (health behavior, perceived social support, self-esteem, and general self-efficacy) in explaining quality-of-life difficulties among early adolescent students in Bangkok.

Design This research employed a cross-sectional design through predictive secondary data analysis.

Methodology The study sample comprised 1,614 students in Bangkok, ranging from Grade 4 in primary school to Grade 9 in lower secondary school, drawn from the main project. Data collection in the primary study utilized a series of standardized instruments, including: a personal information questionnaire; a quality-of-life questionnaire encompassing domains of health and activities, emotional well-being, social relationships, and learning; the Adolescent Lifestyle Questionnaire (ALQ); the Sleep-Related Daytime Dysfunction scale (SRDD); the Multidimensional Scale of Perceived Social Support (MSPSS); the Rosenberg Self-Esteem Scale (RSES); the General Self-Efficacy scale (GSE); the Depression Anxiety Stress Scale (DASS); and the Strengths and Difficulties Questionnaire (SDQ). Data were analyzed using descriptive statistics, independent t-tests, one-way analysis of variance (ANOVA), Pearson’s correlation analysis, and multiple regression analysis with the Enter method.

Results The participants had a mean age of 12.44 years (SD = 1.76). The proportion of males (50.1%) was nearly equal to that of females (49.9%). More than half of the students were enrolled in lower secondary school (Grades 7–9) (52.7%). Fathers and mothers most frequently attained education at the bachelor’s level or higher (38.0% and 39.3%, respectively). Results from the multiple regression analysis indicated that the seven predictors together explained 32.7% of the variance in quality-of-life difficulties (R² = .327, adjusted R² = .324, F = 111.36, p < .001). Emotional distress emerged as the strongest predictor (β = .381, p < .001), followed by strengths and difficulties (β = .184, p < .001), self-efficacy (β = -.181, p < .001), sleep-related daytime dysfunction (β = .063, p = .005), self-esteem (β = .063, p = .003), and perceived social support (β = −.055, p = .024). Health behavior was not a significant predictor (β = -.034, p = .190).

Recommendation Given that emotional distress was identified as the strongest predictor of quality-of-life difficulties, school health nurses should prioritize the development of programs that emphasize mental health care and the empowerment of students. Such programs should integrate systematic assessment of students’ strengths and difficulties, alongside interventions that address emotional well-being, sleep hygiene, self-esteem, and social support. By adopting a comprehensive and integrative approach, school health nurses can help reduce quality-of-life difficulties and foster more effective learning within the school environment.

Conscious Relationships for Inner Development: Applications in Nursing and Interprofessional Practice

2026-07-31T09:41:29+07:00

Currently, the global community is confronting a constellation of complex challenges, ranging from public health crises and economic inequality to environmental degradation and social conflict. Empirical research indicates that these issues do not merely stem from external structural factors; rather, they reflect inner human conditions, such as self-centeredness, attachment to material possessions, fear, and a sense of disconnection from others and the world. These inner conditions manifest as behaviors that do not support both individual and collective well-being. Addressing these multifaceted challenges necessitates a balanced emphasis on both external and inner development. This can be achieved through the framework of the Inner Development Goals (IDGs), which comprises five interconnected dimensions: Being, Thinking, Relating, Collaborating, and Acting. Rather than operating in isolation, these dimensions continuously reinforce one another within an integrated process, wherein relationships serve as a critical crucible for holistic inner growth. Within this context, psychological and spiritual perspectives suggest that interpersonal relationships function both as a mirror that reflects psychological wounds in need of healing and as a transformative space for cultivating human potential.

This article presents the concept of conscious relationships as a fundamental process in inner development, guided by six core principles, intentional co-growth, (2) mindful presence and self-awareness, (3) personal responsibility, (4) authenticity and psychological safety, (5) openness to conflict, and (6) autonomy and balanced interdependence. Furthermore, the article outlines guidelines for developing conscious relationships within nursing practice and interprofessional collaboration, recognizing that interpersonal dynamics directly impact the quality of care, patient safety, and the well-being of healthcare professionals. These guidelines comprise eight interconnected practices: (1) grounding in the right understanding that relationships are spaces for inner learning, emotional responsibility, and openness toward others with mindfulness and compassion; (2) cultivating mindful presence through nonjudgmental awareness of one’s inner reactions, thereby supporting emotional regulation, reducing automatic reactivity, and fostering emotional stability; and (3) intentionally cultivating conscious relationships with clients and healthcare teams by viewing every interaction as an opportunity to take responsibility for one’s feelings and deepen self-awareness; (4) practicing deep listening by attending not only to others’ experiences but also to one’s own fears, needs, and inner reactions; (5) practicing compassionate communication through speaking with mindfulness and loving-kindness, including speaking gently to oneself with acceptance and forgiveness; (6) practicing gentle and mindful touch through physical touch, eye contact, tone of voice, and caring presence to support healing and human connection; (7) encouraging clients’ self-awareness and personal responsibility through gentle, nonjudgmental, and compassionate communication; and (8) being with suffering without rushing to fix or eliminate it, recognizing that some forms of suffering simply require compassionate presence and time for gradual unfolding. Finally, this article presents empirical findings on interpersonal mindfulness training in Thai nursing education.

Furthermore, this article proposes approaches for applying the concept of conscious relationships within interprofessional collaborative practice. This application includes establishing organizational core values and competencies, developing conscious relational leadership, designing systematic training programs, and integrating conscious relationships into routine practice. The article also provides concrete examples of implementing conscious relationships within interprofessional teams. Finally, it outlines approaches for evaluating outcomes associated with conscious relationships, which may reflect transformative changes at both the individual and organizational levels. Such evaluations can be conducted utilizing both quantitative and qualitative methodologies. It is critical to note, however, that the assessment tools presented herein should be regarded merely as preliminary guidelines. While they may capture certain dimensions of the quality of conscious relationships, they remain insufficient to fully capture the comprehensive complexity of this phenomenon. Consequently, further empirical research and the development of more comprehensive assessment tools are warranted.

In conclusion, conscious relationships serve as a vital foundation for both inner development and the overarching quality and value of nursing practice. Clinical nursing practice may move beyond focusing solely on patient care toward embracing moments of care as opportunities for nurses to cultivate self-care through mindful presence, while recognizing their shared humanity with colleagues and clients. Such processes may help reduce physical and emotional tension arising from resistance to lived experience and foster awareness of self-worth and inner vitality and promote healing and wholeness for all stakeholders involved. Therefore, conscious relationships should be systematically integrated into healthcare organizations, with leaders playing a vital role in supporting this systemic transformation.