Journal of Thailand Nursing and Midwifery Council

Editorial Note

2026-04-10T13:16:12+07:00

Nursing Care for Patients with Septic Shock Undergoing Hemoperfusion Therapy

2026-04-16T13:41:27+07:00

Septic shock is a severe complication of infection, closely associated with immune dysregulation resulting from an overwhelming host response. This condition leads to profound circulatory abnormalities and ultimately progresses to multiple organ dysfunction syndrome (MODS). Septic shock remains a major cause of mortality among critically ill patients. Standard treatment strategies emphasize the prompt administration of antibiotics, effective source control, and stabilization of hemodynamic balance. However, in certain cases, these measures may not adequately suppress the inflammatory response. Recent advances in extracorporeal blood purification technologies have introduced hemoperfusion therapy as an adjunctive approach in the management of septic shock. The primary objective of this therapy is to remove pro-inflammatory mediators, such as endotoxins and cytokines, from the bloodstream. By reducing circulating levels of these mediators, hemoperfusion may attenuate systemic inflammation, restore immune homeostasis, and improve hemodynamic stability, thereby potentially enhancing patient survival. Critical care nurses play a pivotal role in the holistic management of patients undergoing hemoperfusion therapy. Their responsibilities include comprehensive patient assessment, vigilant monitoring of clinical status, and prevention of treatment-related complications. Systematic nursing care facilitates the early detection of abnormalities and contributes significantly to the overall effectiveness of therapy. This article aims to synthesize and present empirical knowledge regarding nursing care for patients with septic shock undergoing hemoperfusion therapy. The content is organized into four key domains: (1) Principles of hemoperfusion, an extracorporeal blood purification technique based on adsorption, which removes inflammatory mediators and toxins from the bloodstream through high-surface-area sorbent materials with specific binding properties. These materials effectively capture medium- to large-sized molecules such as cytokines, endotoxins, and other pro-inflammatory substances implicated in the pathophysiology of sepsis. This process reduces circulating inflammatory mediators, thereby attenuating systemic inflammation and restoring immune balance, (2) Systematic patient assessment and monitoring before, during, and after therapy, with emphasis on close observation of vital signs, hemodynamic status, and the function of major organ systems including cardiovascular, renal, and respiratory systems as well as laboratory parameters related to inflammation and organ function (e.g., lactate levels, renal function tests, and inflammatory markers). Vascular access readiness is also evaluated to ensure effective extracorporeal circulation, (3) Prevention and management of potential complications associated with hemoperfusion therapy, including hypotension, circuit clotting, thrombocytopenia, hypothermia, fluid and electrolyte imbalances, and complications related to central venous catheter insertion. Continuous surveillance enables early detection and timely intervention, and (4) System and process management of hemoperfusion therapy, encompassing preparation of equipment and devices, verification of circuit readiness, adjustment of machine settings according to patient condition and treatment plan, vascular access care, infection control, systematic documentation of clinical data, and interdisciplinary team coordination. These elements are essential to ensure that therapy is delivered effectively and in accordance with critical care standards. The knowledge presented in this article provides a framework for advancing nursing practice in the care of patients with septic shock receiving hemoperfusion therapy, thereby promoting the quality and efficiency of critical care nursing.

Prevalence and Factors Predicting Sarcopenia in Community-Dwelling Older Adults: A Secondary Data Analysis

2026-04-16T13:41:29+07:00

Introduction Sarcopenia is characterized by the progressive loss of muscle mass, strength, and function. It is commonly observed among older adults, particularly those with comorbidities, and is associated with an increased risk of falls, disability, and reduced quality of life. In its early stages, sarcopenia often remains asymptomatic; however, early detection at the preclinical or at-risk stage can help mitigate adverse health outcomes. Despite its significance, empirical data on sarcopenia among community-dwelling older adults in urban settings, especially in Bangkok, remain limited. Furthermore, predictive models for primary-level screening of older adults are not yet available.

Objective This study aimed to examine the prevalence and predictive factors of sarcopenia at the stages of risk, possible sarcopenia, and confirmed sarcopenia among older adults residing in urban communities in Bangkok. It was hypothesized that personal factors (age and gender), together with health-related factors (comorbidities, body mass index, and waist circumference), can jointly predict the risk of sarcopenia, possible sarcopenia, and presence of sarcopenia in community-dwelling older adults in Bangkok.

Design This correlational predictive study is a secondary data analysis of 117 older adults residing in urban communities in Bangkok, drawn from a nationwide project. Screening for sarcopenia was conducted in accordance with the 2019 consensus guidelines of the Asian Working Group for Sarcopenia (AWGS), which specify standardized methods for assessing muscle strength, muscle mass, and physical performance.

Methodology Participants were purposively selected based on the inclusion criterion of having complete data for all three indicators used to assess sarcopenia: calf circumference, handgrip strength, and the time to complete the five-time sit-to-stand test. Data were collected using structured record forms. Descriptive statistics and multinomial logistic regression were employed to analyze predictive factors for sarcopenia across three levels: risk of sarcopenia, possible sarcopenia, and confirmed sarcopenia.

Results The majority of older adults in the community were female (68.4%), with a mean age of 69.7 years (SD = 7.2). Most participants reported comorbidities (70.9%), with the three most prevalent conditions being hypertension (58.1%), diabetes mellitus (37.6%), and hyperlipidemia (15.4%). The mean body mass index (BMI) was 24.69 kg/m² (SD = 5.31). Among females, the majority had waist circumferences above the normal criteria (70.3%), whereas most males had waist circumferences within the normal range (54.0%). The prevalence of risk for sarcopenia (low calf circumference), possible sarcopenia (low calf circumference combined with either low handgrip strength or prolonged five times sit-to-stand test), and confirmed sarcopenia (low calf circumference, low handgrip strength, and prolonged five-times sit-to-stand test) was 43.6%, 12.7%, and 28.2%, respectively. These findings indicate that nearly half of community-dwelling older adults were at risk of sarcopenia. Predictive analysis revealed that body mass index was a statistically significant predictor of the sarcopenia risk (OR = 0.672, 95% CI: 0.488–0.926, p = .015). Body mass index also predicted the possible sarcopenia (OR = 0.775, 95% CI: 0.641–0.937, p = .009). Predictors of sarcopenia included age (OR = 1.094, 95% CI: 1.017–1.177, p = .016) and body mass index (OR = 0.736, 95% CI: 0.626–0.865, p < .001)

Recommendation The findings of this study highlight the necessity of early screening for sarcopenia, particularly among older adults with low body mass index. Moreover, the development and implementation of programs aimed at enhancing muscle strength and physical performance from the early stages may help mitigate the adverse consequences of sarcopenia and promote overall quality of life among community-dwelling older adults in urban Bangkok.

Impact of Cardiac Implantable Electronic Devices on Sexual Function in Males: A Systematic Review

2026-04-16T13:41:20+07:00

Introduction The implantation of cardiac implantable electronic devices (CIEDs) to regulate cardiac function is an important treatment for preventing life-threatening cardiac arrhythmias and reducing mortality. However, such device implantation may affect multiple aspects of quality of life, particularly sexual function in male, which is an issue often overlooked in patient care.

Objective This study aimed: (1) to examine the impact of cardiac implantable electronic devices on sexual function in male patients, and (2) to identify factors that positively and negatively influence sexual function in male patients with implanted cardiac electronic devices.

Design This study employed a systematic review.

Methodology The studies included in this review were identified through searches of seven databases in both Thai and English: THAIJO, PubMed, CINAHL (EBSCO), ProQuest, Wiley Online Library, ScienceDirect, and the Cochrane Library from 2014–2024. The inclusion criteria were determined using the Population–Exposure–Outcome (PEO) framework. Population consisted of males aged 20 years and older who had undergone cardiac implantable electronic device implantation and received care at hospitals. Exposure was cardiac implantable electronic devices (CIEDs), including implantable cardioverter defibrillators (ICDs), cardiac resynchronization therapy (CRT), and permanent pacemakers (PPMs). Outcome was sexual function, including both positive outcomes such as improvement in erectile function, decreased orgasmic problems, and increased sexual satisfaction and negative outcomes, including an inability to reach orgasm, decreased sexual desire, and reduced satisfaction with sexual activity. Studies were screened by title and abstract and then full-text review. Two researchers independently appraised study quality and extracted data using the Joanna Briggs Institute (JBI) critical appraisal tools. Both researchers also validated the accuracy of data extraction and quality assessment. Studies that did not meet the inclusion criteria or were of low quality were excluded. In cases where the two researchers disagreed, a consultation with an expert was sought to reach a consensus. Because the included studies measured sexual function at different time points following device implantation and used varying assessment tools, the data were synthesized using a narrative summary approach.

Results A total of five studies were included in the systematic review, with data collected from five countries: Denmark, the United States, Switzerland, Turkey, and Poland. No studies on this topic were found that collected data in Thailand or other Asian countries. Four of the studies employed crosssectional designs, and one was a noncomparative observational study. All participants were male, totaling 901. The instruments used to assess sexual function included the International Index of Erectile Function15 (IIEF15), the International Index of Erectile Function5 (IIEF5), the Sexual Health Inventory for Men (SHIM), and the Sexual Confidence Index (SCI). Findings from this systematic review indicate that: (1) different types of CIEDs have varying effects on sexual function. Implantation of ICDs was associated with negative impacts, including inability to achieve orgasm, decreased sexual desire, reduced sexual satisfaction, lower overall satisfaction, erectile difficulties, and reduced frequency of sexual activity. In contrast, implantation of CRT and PPM devices was associated with positive effects, such as decreased severity of erectile dysfunction, reduced difficulty achieving orgasm, increased sexual satisfaction, and improved overall satisfaction. (2) Negative factors influencing sexual function included age, anxiety, and various fears stemming from patients’ symptoms, concerns about device malfunction, and especially lack of confidence in the operation of ICDs. Positive factors included reduced anxiety and increased senses of security and confidence associated with CRT and PPM devices.

Recommendation The implantation of cardiac implantable electronic devices (CIEDs) in male has both positive and negative impacts on sexual function, particularly among those with ICDs, who frequently experience fear and anxiety, factors that adversely affect their sexual function. Therefore, patient care should not focus solely on physical treatment but should also include psychological support and interventions that strengthen intimate relationships, in order to promote sustainable improvement in sexual quality of life. This includes establishing teams to provide sexual health counseling or mental health assessment, enhancing interprofessional communication regarding sexual health, and integrating sexual health components into cardiac rehabilitation programs.

Effects of an Enteral Feeding Program on Nutrition-Related Outcomes in Critically Ill Medical Patients

2026-04-16T13:41:25+07:00

Introduction Malnutrition among critically ill medical patients is a major yet often overlooked problem. Despite its high prevalence, it signif icantly impacts clinical outcomes, including prolonged hospital stays, increased risk of complications, and higher mortality rates. Systematic and appropriate nutritional management in this patient group not only enhances the efficiency of enteral feeding but also reduces risks, improves safety, and contributes to faster recovery and better nutritional outcomes.

Objective This study aimed to investigate the effects of an enteral feeding program for critically ill medical patients by comparing their outcomes with those of patients receiving standard enteral feeding care. The primary outcomes evaluated included the percentage of targeted energy intake achieved during the specified period, the average time to initiation of enteral feeding, and the incidence of complications including aspiration, diarrhea, and gastric residual volumes (GRV).

Design This study employed a quasi-experimental, two-group repeated measures design. The conceptual framework guiding this study was adapted from Van Blarcom’s Nutrition Bundle including six systematic steps: (1) assessing patients’ nutrition status to identify those at risk for malnutrition by conducting an initial screening to pinpoint high-risk individuals and formulate an appropriate care plan; (2) initiating and maintaining enteral nutrition by promoting early feeding within 24 to 48 hours of achieving hemodynamic stability and systematically planning the regimen; (3) reducing risks for aspiration through preventive measures such as maintaining Fowler’s position, verifying feeding tube placement, and appropriately assessing GRV; (4) implementing enteral feeding protocols and avoiding the use of gastric residual volumes as the strict determinant for feeding tolerance, advocating instead for continuous feeding even when certain levels of GRV are detected within safe clinical thresholds; (5) considering parenteral nutrition early when enteral feedings cannot be initiated; and (6) evaluating nutrition outcomes and complications to continuously monitor the intervention’s efficacy and overall patient safety.

Methodology The sample consisted of 36 patients admitted to a medical semi-intensive care unit at a university hospital in Northeastern Thailand between June and September 2024. Purposive sampling was employed to select participants based on inclusion criteria. The required sample size was determined through power analysis. The participants were purposively allocated into either an experimental group or a control group, with 18 participants in each arm. The research instruments consisted of three primary components: (1) the enteral feeding program for critically ill medical patients, (2) a demographic data recording form, and (3) an enteral feeding data recording form. The enteral feeding program underwent content validity testing by a panel of f ive experts, achieving a Content Validity Index (CVI) of 1.0. Furthermore, a feasibility study of the program was conducted by f ive nurses actively practicing in the medical semi-intensive care unit. Data were analyzed using descriptive statistics, Independent t-tests, Incidence Rate Differences, and Two-way Repeated Measures Analysis of Variance.

Results The majority of the participants in both the control and experimental groups were male (67% and 83%, respectively). The mean ages were 69.39 years (SD = 14.98) for the control group and 72.56 years (SD = 10.82) for the experimental group. The mean Body Mass Index (BMI) was 21.96 kg/m² (SD = 6.62) and 22.16 kg/m² (SD = 4.25), respectively. Clinical severity, measured by mean Acute Physiology and Chronic Health Evaluation II (APACHE II scores), was 21.72 (SD = 5.52) in the control group and 22.16 (SD = 5.27) in the experimental group. The mean nutritional risk scores, assessed using the Nutrition Alert Form (NAF), were 16.50 (SD = 3.15) and 16.05 (SD = 3.78), respectively. A baseline comparison of these demographic and clinical characteristics revealed no statistically signif icant differences between the two groups. After the program, the experimental group achieved a signif icantly higher percentage of energy intake relative to their targeted energy requirements during the specif ied period compared to the control group (η = .402, p < .001). Furthermore, the mean time to initiate enteral feeding was signif icantly shorter in the experimental group (t = 9.004, p = .001). The incidence of complications was also signif icantly lower in the experimental group compared to the control group, including aspiration (IRD = -47.62, 95% CI = -91.62, -3.62; p = .034), diarrhea (IRD = -87.30, 95% CI = -165.08, -9.53; p = .027), and gastric residual volumes (η = .075, p = .047).

Recommendation Nurses working in medical intensive care units with similar contexts to this study can implement this program into their practice. The application of this program should emphasize assessing patients’ readiness for feeding initiation, evaluating energy requirements in patients, and establishing specif ic targeted energy goals. Integrating these practices into patient care will facilitate patient recovery, mitigate the risk of complications, and enhance the overall eff iciency of critical care management.

Factors Associated with Death Literacy Among Older Persons with Multimorbidity

2026-04-16T13:41:24+07:00

Introduction Multimorbidity is highly prevalent in older persons and is associated with increased mortality. At the end of life, older persons who lack adequate preparation often experience a poor quality of death. Death literacy is defined as the knowledge and skills necessary to access, understand, and make informed decisions about end of life and death care. Factors influencing death literacy include six domains: attitudes toward death, attitudes toward end-of-life care, death anxiety, religious beliefs, religious practices, and social support.

Objective This study aimed to examine the relationships of attitudes toward death, attitudes toward end-of-life care, death anxiety, religious beliefs, religious practices, social support and death literacy among older persons with multimorbidity.

Design This study employed a correlational descriptive design, drawing upon the concept of death literacy, which extends from the framework of health literacy proposed by Sorensen and colleagues. Health literacy is defined as encompassing knowledge, competencies or abilities, and motivation, with three principal determinants: personal, situational, and societal and environmental determinants. Guided by this framework, this study selected factors hypothesized to be associated with death literacy, including death anxiety, attitudes toward death, attitudes toward end-of-life care, religious beliefs, religious practices, and social support.

Methodology The sample consisted of 240 participants aged 60 years and above, each diagnosed with at least two chronic diseases, cognitively intact, adherent to Buddhism, able to communicate in Thai, and willing to participate in this study. Multistage sampling was used. First, Mueang District in Chiang Mai Province was selected; then, one subdistrict was randomly selected based on geographic criteria. Participants were recruited from each subdistrict using proportionate random sampling among those who voluntarily enrolled. Data were collected using the following instruments: the Death Literacy Index, Death Attitude Profile - Revised (DAP-R), Frommelt Attitude Toward the Care of Dying, the Religious Belief Scale, the Religious Practices Scale, and the Social Support Scale. All instruments underwent content validity assessment. The Thai-translated versions of the Attitudes Toward Death Scale and Death Literacy Scale demonstrated content validity indices exceeding .80. Reliability testing indicated Cronbach’s alpha coefficients greater than .80 for all measures. Data were analyzed using descriptive statistics and Pearson’s correlation.

Results The mean score of death literacy was 7.77 (SD = 1.05) out of a maximum of 10. Attitudes toward death, death anxiety, religious beliefs, religious practices, and social support were at moderate levels, while attitudes toward end-of-life care were positive. Attitudes toward end-of-life care, attitudes toward death, and social support showed positive correlations with death literacy at a low level (p < .05; r = .126, .133, and .133, respectively). Religious practices demonstrated a positive correlation with death literacy at a low level (p < .01; r = .193). While death anxiety and religious beliefs were negatively correlated with death literacy at a low level (p < .01; r = –.181 and –.194, respectively).

Recommendation The results of this study suggest approaches to promote death literacy among older persons with multimorbidity by focusing on fostering positive attitudes toward death and end-of-life care, reducing death anxiety, and enhancing social support and engagement in religious practices.

Effects of a Mobile Phone-Based Health Behavior Modification Program on Health Outcomes in Overweight Community-Dwellers with Prediabetes

2026-04-16T13:41:22+07:00

Introduction Prediabetes is a major public health problem both globally and in Thailand, particularly given the increasing prevalence of prediabetes. With current technological advancements, the use of social media as a tool for health behavior modification represents an important strategy for promoting care and support for prediabetes within primary care settings.

Objectives The objectives of this study were: 1) to compare the mean blood glucose, body weight, body mass index, and waist circumference in the experimental group before and after participating in the program; 2) to compare the mean blood glucose, body weight, body mass index, and waist circumference between the experimental and comparison groups after the program; and 3) to compare the proportion of participants who achieved normal status between the experimental and comparison groups.

Design This study employed a quasi-experimental design with two groups, pre- and post-test. The researchers developed a mobile phone-based health behavior modification program that applied the 3-Self approach: self-efficacy, self-regulation, and self-care. The program was structured according to the PROMISE Model, which comprises: Positive reinforcement (P), emphasizing encouragement through positive feedback; Result-based management (R), focusing on outcome-oriented strategies; Optimize (O), fostering optimism; Motivation (M), promoting sustained behavioral modification; Individual or Client-centered approach (I), tailoring interventions to the specific health problems and needs of participants; and Self-esteem (SE), enhancing personal value and confidence.

Methodology The study participants consisted of 70 overweight adults aged 35–59 years in Surat Thani Province who had prediabetes. Participants were selected using simple random sampling based on the following inclusion criteria: 1) adults aged 35–59 years with no history of diabetes, hypertension, or dyslipidemia; 2) a history or prior record of fasting blood glucose levels between 100–125 mg/dL after at least 8 hours of fasting; 3) a body mass index (BMI) ≥ 23 kg/m²; 4) ownership and ability to use a mobile phone with internet access and application functionality; 5) ability to communicate, read, and understand Thai; and 6) willingness to participate in the study. Participants were assigned to the experimental and comparison groups (35 per group) through matched pairs. The sample size was determined using power analysis with the G*Power program. Research instruments included: 1) the mobile phone-based health behavior modification program, 2) a handbook for transitioning from prediabetes to normal status, 3) role model video clips, 4) a personal information record form, 5) a blood glucose meter, 6) a weighing scale and stadiometer, and 7) a measuring tape. Data collection was conducted between March and May 2025. Data were analyzed using descriptive statistics, Chi-square test, Independent t-test, Paired t-test, and Z-test.

Results The mean age of participants in the experimental and comparison groups was 49.31 years (SD = 7.16) and 51.26 years (SD = 7.18), respectively. Most participants had completed secondary education (60.00% and 48.57%, respectively), and the majority reported no first-degree relatives with diabetes (60.00% and 85.71%, respectively). After participating in the program, the experimental group demonstrated a statistically significant decrease in mean fasting blood glucose from baseline (M = 108.49 mg/dL, SD = 16.15) to after the program (M = 98.86 mg/dL, SD = 7.83; t = 4.410, p < .001). Similarly, the comparison group showed a significant decrease in mean fasting blood glucose (M = 102.49 mg/dL, SD = 5.58) compared with baseline (M = 106.69 mg/dL, SD = 5.49; t = 5.209, p < .001). After the program, the experimental group also exhibited significant lower in mean body weight (M = 69.17 kg, SD = 11.79 vs. M = 70.57 kg, SD = 12.28; t = 4.663, p < .001), body mass index (M = 27.63 kg/m2, SD = 3.78 vs. M = 28.35 kg/m², SD = 3.69; t = 5.046, p < .001), and waist circumference (M = 88.91 cm, SD = 9.93 vs. M = 91.11 cm, SD = 11.33; t = 2.427, p = .021). However, no statistically significant differences were observed between the experimental and comparison groups in these outcomes. When examining the proportion of participants who transitioned from prediabetes to normal status, the experimental group (77.14%) had a significantly higher proportion than the comparison group (51.43%; Z = 5.040, p = .025).

Recommendations Community nurse practitioners and public health personnel can adopt the program developed in this study, which integrates social media as a tool to promote health behavior modification for diabetes prevention among prediabetes in the community.

Factors Influencing the Digital Health Technology Use Behavior among the Older Adults in Phetchaburi Province

2026-04-16T13:41:14+07:00

Introduction Currently, Thailand has experienced a continuous increase in the proportion of its older population, having fully transitioned into an aged society and projected to become a super-aged society in the near future. Consequently, health and quality of life in older adults have emerged as a matter of urgent priority, particularly regarding the widely applied role of digital technologies in healthcare. Nevertheless, the acceptance and use of digital technologies among older adults remain constrained by various factors, including age, education, income, prior technological experience, and attitudes and social influences. Therefore, it is necessary to investigate factors influencing older adults’ acceptance and adoption of digital healthcare technologies. Such research is essential for designing approaches that genuinely address their specific needs. This understanding will facilitate the development of user-friendly and appropriate health technologies that are congruent with the socio-cultural context of Thai older adults. Ultimately, this ensures that health technology serves as a pivotal mechanism that empowers older adults to engage in self-care effectively, thereby enhancing their overall quality of life in an aging society.

Objective: The objectives of this study were 1) to investigate the digital health technology use behaviors in older adults, and 2) to examine factors predicting digital health technology use behaviors, including personal factors and digital technology acceptance factors among older adults.

Design This study employed a predictive descriptive design, applying the conceptual framework of the Technology Acceptance Model 2 (TAM2) to investigate the factors influencing the digital health technology use behaviors of older adults. The model suggests that digital health technology use behavior stems from cognitive appraisal and social environmental influences. Building upon the original TAM, it incorporates additional components to provide a more comprehensive explanation of real-world behaviors. Specifically, TAM2 categorizes its core components into two primary domains: social influence processes and cognitive instrumental processes.

Methodology The participants comprised 250 older adults, aged 60 years and older, who were members of senior clubs in Phetchaburi Province. Data collection was conducted between May and June 2025. The participants were recruited using a multistage random sampling, with the sample size determined according to the guidelines proposed by Hair et al. The research instruments consisted of five questionnaires: 1) a demographic information questionnaire; 2) a digital technology perception questionnaire, including perceived usefulness and perceived ease of use; 3) a social influence on digital technology use questionnaire; 4) an attitude toward digital technology use questionnaire; and 5) a digital healthcare technology utilization behavior questionnaire. The instruments were validated for content validity by a panel of six experts, yielding Content Validity Indices (CVI) for the second through the fifth instruments of .92, .89, 1.00, .98, and .95, respectively. Reliability testing resulted in Cronbach’s alpha coefficients of .91, .91, .96, .94, and .96, respectively. Data were collected via self-administered questionnaires and analyzed using both descriptive and inferential statistics, including Pearson’s correlation coefficient and Stepwise Multiple Regression analysis.

Results The sample consisted of 250 older adults aged between 60 and 92 years (M = 69.01, SD = 7.22). More than half were classified as young-old (56.40%). The most prevalent educational attainment was primary education (50.80%), and the most common occupation was housewife (24.40%). The majority reported an income between 500 and 10,000 THB (81.20%). Most participants had over 6 years of experience with technology (68.80%), with the mobile phone as the most frequently used digital device (94.40%). Furthermore, a significant majority had underlying health conditions (77.20%), with the three most common conditions being hypertension (69.43%), hyperlipidemia (49.74%), and diabetes mellitus (34.72%). Regarding digital health technology use behaviors, the overall use of digital technologies for healthcare among older adults was moderate (M = 2.76, SD = 1.12). When examined by specific domains, health communication was the most frequently used function, followed by health information seeking and health monitoring and management, in which older adults periodically used technology to check their basic health data. Conversely, health promotion and online health transactions, such as playing brain-training games, purchasing health products, and scheduling medical appointments or medication pick-ups, were the least utilized domains. Finally, a Stepwise Multiple Regression analysis revealed that the factors significantly predicting the digital healthcare technology use behaviors among older adults included social influence (β = .288, p < .001), attitude toward digital technology use (β = .253, p < .001), perceived ease of use (β = .175, p = .002), age (β = -.143, p = .002), experience using digital technology (β = .120, p = .009), and education (β = .110, p = .015). Together, these variables accounted for 52.9% of the variance in digital healthcare technology utilization behaviors among older adults (Adjusted R² = .529, p = .015).

Recommendations Community nurse practitioners can utilize these research findings to design and implement interventions aimed at promoting digital health technology use behaviors among older adults. This can be achieved by fostering social support networks involving family members, peers, and community health volunteers. Furthermore, practitioners should enhance positive attitudes and self-efficacy regarding technology adoption through constructive health communication. It is also essential to organize accessible training programs on health technologies that are comprehensible and explicitly tailored to the cognitive and functional capacities of older adults.

Factors Related to Recovery Capital of People with Substance Use Disorder in Northeastern Thailand

2026-04-16T13:41:16+07:00

Introduction Drug problems are an issue currently confronting both Thailand and the global community, with their severity continuing to escalate. Prolonged and high-level substance use can lead to mental illness and may develop hallucinations and psychiatric disorders, which can lead to violent behaviors, self-harm, or harm to close associates. Such consequences pose serious threats to the safety of life, health, and property of family members and the general public, thereby undermining national stability in both economic and social dimensions. Recovery capital refers to all resources available to people with substance use disorders that can support their recovery process. These resources include physical health, psychological flexibility, social relationships, economic aspects, and cultural assets, all aimed at enabling sustainable abstinence and improving quality of life. Accordingly, it is essential to investigate the factors associated with recovery capital among people with substance use disorders in this study.

Objective The objective of this study is to examine the relationships between self-esteem, psychological flexibility, friendship intimacy, and social support, and recovery capital among people with substance use disorders in the Northeastern region of Thailand.

Design This study employed a descriptive correlational design, applying the concept of recovery capital as proposed by Groshkova and colleagues. A comprehensive literature review was conducted, through which the factors associated with recovery capital were categorized into four domains: 1) self-esteem, 2) psychological flexibility, 3) friendship intimacy, and 4) social support.

Methodology The sample consisted of 320 people with substance use disorders in the rehabilitation phase who were receiving treatment at two Thanyarak hospitals in the Northeastern region of Thailand. The sample size was determined based on principles of power analysis, and participants were selected using systematic random sampling. Inclusion criteria were: 1) age 18 years or older; 2) currently undergoing rehabilitation for substance use disorders with rehabilitation duration of at least one month; 3) absence of withdrawal symptoms; 4) voluntary participation and willingness to cooperate in the study; and 5) ability to read and write in Thai. Research instruments included: 1) the Rosenberg Self-Esteem Scale; 2) the Acceptance and Action Questionnaire - Substance Abuse Thai Version (AAQ-SA); 3) the Friendship Intimacy Questionnaire (FIQ); 4) the Multidimensional Scale of Perceived Social Support (MSPSS); and 5) the Brief Assessment of Recovery Capital (BARC-10). The Cronbach’s alpha coefficients for these instruments were .80, .68, .88, .87, and .87, respectively. Data were collected between July 1 and December 31, 2024, through self-administered questionnaires. Descriptive statistics were used to analyze demographic and baseline characteristics, while Pearson’s correlation coefficient was applied to examine the relationships between self-esteem, psychological flexibility, friendship intimacy, and social support with recovery capital among people with substance use disorders.

Results The participants had a mean age of 30.43 years (SD = 7.43). The majority were male (77.20%), single (80.60%), and reported a monthly family income below 25,000 THB (85.94%). The primary substance used was methamphetamine (91.90%), followed by cannabis (2.80%), alcohol (2.50%), cigarettes (1.90%), and mixed substance use (0.90%). The most frequently reported reason for substance use was stress reduction and mood regulation (41.90%). The overall mean score of recovery capital among people with substance use disorders was 44.48 (SD = 10.44). Significant positive correlations were found between recovery capital and self-esteem (r = .425, p < .01), psychological flexibility (r = .392, p < .01), friendship intimacy (r = .256, p < .01), and social support (r = .666, p < .01).

Recommendation Nurses and mental health teams providing care for people with substance use disorders in inpatient rehabilitation units can apply the findings of this study to inform them of treatment and rehabilitation planning. Interventions should be planned to emphasize enhancing knowledge and beliefs related to self-esteem, psychological flexibility, friendship intimacy, and social support, as these factors are positively associated with recovery capital among people with substance use disorders. Future research should further examine the predictive power of these factors for recovery capital.

The Effect of a Supportive-Educative Nursing Program on the Knowledge and Behaviors of First-Time Mothers in Caring for Premature Infants at Home

2026-04-16T13:41:18+07:00

Introduction Caring for premature infants at home is a complex responsibility due to their physiological immaturity and vulnerability across multiple systems. Although these infants are discharged after clinical stabilization, they remain at high risk, particularly during the transition from hospital to home. First-time mothers often have basic knowledge but lack practical experience, confidence, and continuous support, which can compromise the effectiveness of caregiving. This situation highlights a gap in structured supportive-educative interventions during the post-discharge period. Therefore, the researchers developed the Supportive Educative Nursing Program (SENP), guided by Orem’s theory, with the aim of enhancing maternal competence to ensure appropriate and sustainable infant care.

Objectives This study aimed to 1) compare the mean scores of knowledge and caregiving behaviors related to premature infants among first-time mothers in the experimental group before and after participating in the program, and 2) compare the mean scores of knowledge and caregiving behaviors between first-time mothers in the experimental group and the control group.

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

Methodology The study participants comprised first-time mothers caring for premature infants at home at least four days per week. Eligible infants had no congenital anomalies and had previously been admitted to neonatal units of public hospitals in Health Region 5 before discharge. A total of 76 participants were recruited through simple random sampling. Participants were then matched according to key infant criteria. The experimental group received the Supportive Educative Nursing Program (SENP), developed based on Orem’s theory, and implemented in four phases: 1) assessment of individual caregiving needs; 2) knowledge enhancement and skill development through practice, self-learning materials, and counseling via the Line Application “Growing Well, Caring for Your Baby”; 3) review and repeated practice to build confidence in caregiving; and 4) follow-up through home visits and outcome evaluation to provide psychological support and refine caregiving approaches. The control group received routine care. Research instruments included 1) a general information questionnaire, 2) a knowledge assessment on premature infant care, and 3) a caregiving behavior assessment covering four domains: general care, developmental promotion, health problem management, and disease prevention. Content validity indices (CVI) for the program, knowledge questionnaire, and behavior questionnaire were 1.00, .86, and .82, respectively. Reliability testing yielded a Kuder-Richardson (KR-20) coefficient of .82 for the knowledge questionnaire and a Cronbach’s alpha of .78 for the behavior questionnaire. The SENP was conducted over 12 weeks. In week 1, participants underwent needs assessment, received introductory knowledge, and were trained in the use of the manual. Weeks 2–3 focused on skill development and learning support through online media and counseling via the Line Application, twice weekly. Weeks 4–5 emphasized review and repeated practice to strengthen caregiving confidence. In week 6, follow-up was conducted through home visits with ongoing psychological support, continuing until week 12, when post-intervention evaluations of maternal knowledge and caregiving behaviors were performed. The control group received standard instruction on breastfeeding, developmental stimulation, and the Developmental Assessment for Intervention Manual (DAIM). Data were analyzed using Descriptive statistics for general information, Paired t-test to compare pre- and post-program scores within the experimental group, and Independent t-test to compare post-program scores between the experimental and control groups.

Results The mean knowledge score regarding premature infant care among mothers in the experimental group after receiving the program (M = 23.50, SD = 3.02) was significantly higher than before the program (M = 8.79, SD = 2.68) and also higher than that of the control group (M = 15.50, SD = 2.82) (t = 12.698, p < .001; t = 10.850, p < .001, respectively). Similarly, the mean caregiving behavior score of the experimental group after the intervention (M = 98.00, SD = 10.84) was significantly greater than before the program (M = 32.08, SD = 14.32) and higher than that of the control group (M = 32.50, SD = 4.28) (t = 7.128, p < .001; t = 13.581, p < .001, respectively).

Recommendation Nurses can apply the program to support home-based care for premature infants as a complement to existing standard practices. Future research should employ more rigorous control designs to further validate the program’s effectiveness and incorporate long-term follow-up to assess sustained outcomes.

Sarcopenia After COVID-19 Infection and Rehabilitation in Former Homeless Older Adults Residing in Supportive Housing: A Case Study Research

2026-04-16T13:41:12+07:00

Introduction Sarcopenia is a multifactorial geriatric syndrome characterized by progressive loss of skeletal muscle mass, muscle strength, and physical performance, leading to functional decline and increased mortality among older adults. Major contributing factors include malnutrition, chronic inflammation, comorbidities, and physical inactivity. Coronavirus disease 2019 (COVID-19) infection induces a severe inflammatory and catabolic state that accelerates muscle protein breakdown, particularly in older adults with limited physiological reserve. During the post-acute phase, prolonged immobilization, fatigue, reduced physical activity, and inadequate nutritional intake further increase the risk of sarcopenia. Older adults with a history of homelessness are particularly vulnerable due to long-standing nutritional deficits, multimorbidity, and social disadvantage. Although supportive housing provides a structured care environment, evidence regarding post-COVID-19 sarcopenia and recovery among former homeless older adults remains limited.

Objective This study aimed to describe the progression of sarcopenia following COVID-19 infection and the rehabilitation in former homeless older adults residing in supportive housing, with an emphasis on nursing assessment, rehabilitation care, and functional outcomes.

Design This study employed a descriptive case study design.

Methodology The participants were two cases: an 84-year-old former homeless man who had resided in a supportive housing facility for 13 years and a 62-year-old former homeless man who had resided in the same supportive housing facility for 7 years, who were purposively selected for comparison based on similar exposure to COVID-19 infection and comparable baseline risk of sarcopenia. Following recovery from COVID-19 infection, post-infection screening was conducted as part of routine health monitoring. Sarcopenia risk and status were assessed using standardized screening and diagnostic criteria recommended by the Asian Working Group for Sarcopenia 2019. Nursing assessment focused on muscle strength, and physical performance. A multidisciplinary rehabilitation program was implemented, coordinated by nurse researchers in collaboration with supportive housing personnel. The program included individualized resistance exercise, balance and gait training, and mobility exercises performed three times per week. Nutritional management emphasized adequate energy intake and protein supplementation, with a recommended protein intake of 1.2 g/kg body weight/day. Ongoing nursing monitoring supported adherence, safety, and continuity of care throughout the rehabilitation period. Case 1 participated in the rehabilitation program, while Case 2 did not engage in the program and maintained usual daily activities. Clinical indicators were monitored 4 points of time in both cases (T1: 3 months post-COVID-19, T2: 1-year follow-up, T3: pre-rehabilitation baseline conducted 6 months after T2, and T4: post-rehabilitation assessment. A cross-case analysis was conducted to examine similarities and differences in sarcopenia progression and functional outcomes.

Results Across the 4 time points, Case 1 had calf circumference of 26.5, 23.5, 25.5, and 27.0 cm, respectively; handgrip strength of 15.5, 10.85, 11.3, and 19.5 kg, respectively; physical performance score of 17.4, 20.91, 12.00, 10.71, respectively. Appendicular skeletal muscle mass index (ASMI) at T1 and T4 was 6.74 and 7.56 kg/m2, respectively. In Case 2, calf circumference was 28.5, 28.0, 28.5, 28.0 cm, respectively; handgrip strength was 16.0, 17.5, 16.0, 10.5 kg, respectively; physical performance score was 19.08, 22.33, 20.55, 27.95, respectively. ASMI at T1 and T4 was 6.30 and 5.55 kg/m2, respectively.

Recommendation This case study highlights the importance of early nursing-led screening for sarcopenia following COVID-19 infection, particularly among vulnerable older adults. Supportive housing can serve as an effective setting for post-COVID-19 rehabilitation when structured exercise, nutritional support, and multidisciplinary collaboration are integrated into routine care. Nursing practice should emphasize early identification, individualized rehabilitation planning, and continuous functional assessment to promote recovery and prevent further functional decline. Further research is recommended to examine post-COVID-19 sarcopenia management strategies in supportive housing.