Thai Journal of Nursing Council วารสารสภาการพยาบาลเป็นวารสารทางวิชาการที่มีการประเมินบทความและงานวิจัย โดยผู้ทรงคุณวุฒิที่มีความเชี่ยวชาญเฉพาะสาขา (peer review) กำหนดออกรายสามเดือน ปีละ 4 ฉบับ จัดทำโดยสภาการพยาบาล เพื่อเป็นแหล่งในการเผยแพร่ผลงานวิชาการ ทั้งด้านการพยาบาลทางคลินิกและชุมชน การศึกษาพยาบาล การบริหารการพยาบาล Thailand Nursing and Midwifery Council en-US Thai Journal of Nursing Council 1513-1262 Nurses and Their ‘Spirit of the Second Mile’ Service during Covid-19 Pandemic <p><span class="fontstyle0">This article was written during the time when most countries in the world,including Thailand, were faced with the Covid-19 pandemic. The main purpose of thisarticle is to propose the ‘Spirit of the Second Mile’ principle, which was implemented andproved to be effcient during the Covid-19 pandemic as a concretely valuable nursing care practice.</span></p> <p><span class="fontstyle0">Covid-19 is a new emerging, dangerously contagious disease. Not only doesCovid-19 spread easily and quickly, it also is a disease for which there is neither a directcure nor a vaccine. As a result, a large number infections and fatalities have resulted,mounting increasing pressure and challenge on nurses, who are part of the healthcarepersonnel.</span></p> <p><span class="fontstyle0">Despite the apparent risk to their health, nurses were a vital force against thisdisease, performing their duty courageously, like frontline soldiers, to fght this pandemic with the spirit of the second mile. The ‘Spirit of the Second Mile’ is characterised by (i) serving with willingness, self-sacrifce, and accountability; (ii) spontaneous readiness to perform more than the duty requirements and beyond the predetermined standards, to ensure accomplishment of the mission; and (iii) affection and compassion for other peopleas if for those in one’s own family, in an equal, impartial, and boundless, manner, withoutexpecting anything in return.</span></p> <p><span class="fontstyle0">Serving with the spirit of the second mile could effectively reduce service recipients’physical and mental health damage and loss of lives. Thus, the benefts and value of thespirit of the second mile were concretely and evidently recognised as contributing enormously to the service recipients, healthcare organisations, healthcare profession, and the nurses themselves, who played an integral part in helping Thailand become successful in handling this crisis more effciently than several other countries. Nurses, therefore, became admired as the ‘white gown warriors’ against this unprecedented disease outbreak.</span></p> ศรินทร์ทิพย์ ชวพันธุ์ พนิดา เซ็นนันท์ รัตนาภรณ์ ธนศิริจิรานนท์ Copyright (c) 2020 Thai Journal of Nursing Council 2020-12-23 2020-12-23 36 1 5 17 Impact of Humanitude Palliative Care Programme on Comfort of Older Cancer Patients on Palliative Care <p><span class="fontstyle0">Objective: </span><span class="fontstyle2">To examine how the Humanitude palliative care programme could impact the comfort of older person who received palliative care<br></span><span class="fontstyle0">Design: </span><span class="fontstyle2">Two-group quasi-experimental study with a pretest and a posttest<br></span><span class="fontstyle0">Methodology: </span><span class="fontstyle2">This study was conducted on a sample of 44 cancer patients aged 60 and higher who were receiving palliative care in the in-patient department of a cancer hospital. Recruited by means of purposive sampling, the subjects were equally divided into an experimental group and a control group. The experimental group was given, for a period of five days, the Humanitude palliative care program, which integrated four nursing care components designed to enhance patients’ comfort. The control group, on the other hand, received standard care. Data were collected from January to March 2020, via 1) a demographic data collection form; and 2) Hospice Comfort Questionnaire (Patient). The data were analysed using descriptive statistics, independent t-test, and paired t-test.<br></span><span class="fontstyle0">Results: </span><span class="fontstyle2">The experimental group, which received the Humanitude palliative care programme, displayed a statistically significant increase in their comfort level than the control group, which was given standard care (p= .05). The experimental group also showed a signifcantly increased level of comfort after receiving the palliative care programme than before receiving it (p = .05).<br></span><span class="fontstyle0">Recommendations: </span><span class="fontstyle2">It is recommended that this nursing care programme be applied to promoting well-being and comfort into older cancer patients receiving palliative care</span></p> Nanthiya Kaeowwongsa Jiraporn Kespichayawattana Copyright (c) 2020 Thai Journal of Nursing Council 2020-12-28 2020-12-28 36 1 18 33 Family-Promoting Programme to Enhance Self-Management Ability in Older Persons with Knee Osteoarthritis and Its Impact on Fall Prevention <p>Objective: To study impacts that a family-promoting programme for self-management, designed for older persons with knee osteoarthritis, could have on fall prevention<br>Design: One-group quasi-experimental research with a pretest and a posttest<br>Methodology: This study was conducted on 23 purposively sampled participants and their family members. They participated in a seven-week family-promoting programme designed to enhance the self-management ability in older persons suffering from knee osteoarthritis. The programme comprised self-management education and skill-building activities, to promote thigh muscle exercise, practice in using walking sticks, and environment management. The instruments for data collection consisted of 1) a demographic questionnaire; 2) the Thai fall risk assessment test (Thai-FRAT); and 3) the ‘Time-Up-And-Go Test’ (TUGT). The data, collected from January to March 2020, were analysed using descriptive statistics, the McNemar test, and the Wilcoxon<br>matched pairs signed-ranks test.<br>Results: A comparison of the participants’ pre- and post-intervention risk of fall showed a signifcant decrease in their fall risk, with 23 identifed as facing risk of fall before the experiment versus three after the experiment (p &lt; .001). Before the programme, 65.20% and 34.80% of the participants were found to have moderate and low balance and walking ability, respectively. After the programme, signifcant improvement was evident, with high balance and walking ability found in 56.52%, moderate ability in 39.13%, and low ability in only 4.35% of the participants. It could be concluded that the participants’ balance and walking ability improved signifcantly after the experiment (z = -4.47, p &lt; .001).<br>Recommendations: This programme can be applied as a community-level guideline to<br>support older persons with knee osteoarthritis and their family members to improve their selfmanagement ability in prevention of falls.</p> <p>&nbsp;</p> Threeraphan Janpeng Rangsiya Narin Wilawan Tuanrat Copyright (c) 2020 Thai Journal of Nursing Council 2020-12-29 2020-12-29 36 1 34 51 Effects of Self-Efficacy-Promoting Programme on Self-Care Ability of Persons with Stoma <p>&nbsp;Objective: To compare the self-effcacy and self-care ability of persons with stoma, before and after receiving a self-effcacy-promoting programme<br>Design: Two-group quasi-experimental research with a pretest and a posttest<br>Methodology: The subjects of the study were 57 patients who, by prior appointment, received permanent stoma surgery. After being recruited by means of simple random sampling, 29 of the patients were assigned to the control group, which received standard care, whilst the other 28 were assigned to the experimental group, which was given the self-effcacy promoting programme. Data gathering was conducted using a personal information record form, the Stoma Self-Effcacy Scale, and the Stoma Self-Care Ability Scale. Descriptive statistics and t-test were employed for data analysis.<br>Results: First, the experimental group’s post-intervention perceived self-effcacy score was signifcantly higher than its pre-intervention score (by p &lt; 0.05), and signifcantly higher than that of the control group (by p&lt;&nbsp;0.05). Second, the experimental group scored signifcantly higher on self-care ability than the control group did (by p &lt;0.05).<br>Recommendations: It is recommended that nurses and healthcare teams implement this self-effcacy promoting programme to promote self-effcacy and self-care ability in stoma surgery patients, in the pre-operative, post-operative, and post-discharge stages.</p> <p>&nbsp;</p> Siriphan Phamornpon Bangon Nooyam Prapon Kanjanasilp Copyright (c) 2020 Thai Journal of Nursing Council 2020-12-29 2020-12-29 36 1 52 70 Grandchildren-Raising Burden of Older People in Skipped-Generation Families <p>Objective: To examine older people’s experience in raising their grandchildren in skipped-generation families<br>Design: Interpretive phenomenological study<br>Methodology: This study was conducted on 40 purposively sampled informants who were older people raising their grandchildren in skipped-generation families. The informants were recruited based on the inclusion criteria. Data were collected in three districts of Nakhon Ratchasima province for a period of 8 months, from February to September 2019, by means of in-depth interviews, non-participatory observation, and feld records. The data were analysed using Diekelmann &amp; Allen’s seven-step method and subjected to a reliability check.<br>Results: Eight major types of experience were identifed by the informants: 1) struggle; 2) working fngers to the bone; 3) sleeplessness; 4) endless work despite age; 5) health deterioration; 6) suffering worse illnesses during grandchildren’s ailments; 7) stressinduced depression; and 8) endless rearing duty. The majority of the informants were faced with both physical and mental diffculties caused by the heavy and numerous responsibilities in raising their grandchildren. At the same time, the older people made all efforts to maintain<br>the families, due to their love and affection for their children and grandchildren.<br>Recommendations: It is recommended that nurses provide proactive care for older people raising their grandchildren in skipped-generation families, conduct regular assessments of their physical and mental health, and provide them with other types of necessary care.</p> Kerdsiri Hongthai Darunee Jongudomkarn Copyright (c) 2020 Thai Journal of Nursing Council 2020-12-29 2020-12-29 36 1 71 88 A Study of Incidence and Correlational Factors and Comparison of Effects of Ventilator-Associated Pneumonia in Young and Adolescent Brain Trauma Patients <p>Objective: To study the incidence of ventilator-associated pneumonia (VAP) in young and adolescent brain trauma patients, with an emphasis on its correlational factors and a comparison of its effects<br>Design: Descriptive retrospective analysis research<br>Methodology: The sample consisted of 121 purposively sampled young and adolescent brain trauma patients who were on operating ventilators for at least 48 hours as they were treated in the intensive care unit of a tertiary hospital in Northeastern Thailand between 1 January 2015 and 31 December 2019. Data were collected from medical records, using data-gathering forms. The data were analysed using 1) incidence rate computation; 2) descriptive statistics (for demographic data); 3) inferential statistics (for VAP effects); and 4) multiple correlational logistic regression analysis.<br>Results: Of the 121 patients, there were 45 VAP patients (59 episodes). The VAP incidence rate was 37.19 or 46.83 episodes per 1,000 ventilator days. The three most common pathogens of VAP were Acinetobacter baumannii (44.08%), Klebsiella pneumonia (25.42%), and Pseudomonas aeruginosa (16.95%). Factors associated with VAP in the young and adolescent brain trauma patients were the use of cooling blankets (OR Adj 7.39; 95% CI = 2.60, 21.02; p &lt; .001) and continuous intravenous administration of fentanyl (OR Adj 12.28; 95%CI = 4.04, 37.36; p &lt; .001). A comparison of effects of VAP showed statistically signifcant differences between the patients with and without VAP. That is, the patients without VAP spent less time on ventilators (4 days VS 18 day; p &lt; .001), shorter time in the intensive care unit (4 days VS 20 day; p &lt; .001), fewer days of hospitalisation (8 days VS 28 day; p &lt; .001), and lower hospitalisation costs (57,862.75 baht VS 183,202 baht; p &lt; .001) than those with VAP. However, no statistically signifcant difference in the mortality rate was found between the two groups (4.44% VS 15.79%; p = .059).<br>Recommendations: Nurses and multidisciplinary team caring for young and adolescent brain trauma patients should pay close attention to factors associated with VAP, namely, the use of cooling blankets and continuous intravenous administration of fentanyl. Also, clinical nursing practice guidelines should be developed to prevent VAP in young and adolescent brain trauma patients. Further prospective studies on other VAP factors in young and adolescent brain trauma patients are recommended.</p> Wuttichai somgit Copyright (c) 2020 Thai Journal of Nursing Council 2020-12-29 2020-12-29 36 1 89 109 Comparison of Clinical Factors in Adult, Young Older,and Older Trauma Patients <p>Objective: To compare differences of clinical factors involving severity of injury (CRAMS), physiologic deterioration (MEWS), probability of survival (TRISS), length of stay (LOS) and in-hospital mortality rate among adult, young older and older traumatic injury patients.<br>Design: Retrospective comparative study<br>Methodology: The researcher recruited a total sample of 627 traumatic injury patients receiving care at emergency department (ED) concerning inclusion criteria. The data from medical records database of Tertiary hospital between 2015 and 2018 were gathered. The instruments for data collection composed of demographic and clinical data at ED visits record forms including severity of injury, physiologic deterioration and probability of survival. LOS and in-hospital mortality were also noted. A sample was divided into 3 groups regarding age; Group I: adult (18-54 years), Group II: young older (55-65 years), and Group III: older traumatic injury patients (over 65 years). Chisquare and Kruskal-Wallis test were employed for statistical analyses with level of signifcance at .05.<br>Results: The higher the age of a sample group increased, the more the female patients were reported. Overall analysis demonstrated that severity of injury (χ2 =22.76, p&lt;.001), physiologic deterioration (χ2 =21.39, p&lt;.001), probability of survival (χ2=311.83, p&lt;.001) were statistically different among patients with different age groups. As for the analysis of patients having mechanism of injury as blunt injury in different age gropus, the finding revealed the differences among severity of injury (χ2 =18.00, p&lt;.001), physiologic deterioration (χ2 =21.50, p&lt;.001) and probability of survival (χ2 =244.40, p&lt;.001). Additionally, among those with head injury in different age groups, the results indicated that only probability of survival (χ2 =60.00, p&lt;.001) differed. Otherwise, ED LOS and inhospital mortality rate showed no differences (p&gt;.05).<br>Recommendations: It can be concluded that the selected clinical factors in this study had different impacts on adult, young older and older traumatic injury patients visiting emergency department according to effects from aging adaptation.Therefore, ED nurses need to assess and prioritize which clinical factors should be managed concerning patient’s age, be sensitive for any alterations and monitor those physiologic parameters, specifcally, in older patients as to promote effective physiologic adaptation, maximize probability of survival, and minimize LOS and in-hospital mortality rate.</p> Pornthip Suyasith Prangtip Chayaput Orapan Thosingha Jatuporn Sirikun Copyright (c) 2020 Thai Journal of Nursing Council 2020-12-29 2020-12-29 36 1 110 128 Factors Predicting Acute Post-Operative Delirium in Peripheral Arterial Disease Patients <p>Objective: To investigate the rate of acute post-operative delirium and the predictive power of sleep quality, pre-operative serum albumin level, and post-operative analgesics, on acute post-operative delirium (POD) in peripheral arterial disease (PAD) surgery patients<br>Design: Descriptive predictive study design<br>Methodology: The sample comprised 130 PAD patients having undergone vascular surgery at two tertiary hospitals. The patients were monitored during the frst to the seventh days after the surgery, according to the predetermined requirements. The instruments for data collection consisted of 1) the Thai version of the Pittsburg Sleep Quality Index; 2) a postoperative analgesic administration record; and 3) the Thai version of the Confusion Assessment Method. The data were analysed using descriptive statistics and binary logistic regression analysis, with the signifcance level set at .05.<br>Results: The majority of the patients (63.8%) were male, averagely aged 65.83 years (SD = 13.63). Most cases of PAD found (71.5%) were of the chronic type, with 86% having critical limb ischaemia. Acute POD was found in 10.8% of the patients, with 64.29% (mean = 42.86 ± 31.47 hours) occurring in the first 24 hours after surgery. Multiple symptoms were found in 42.86% of the patients, 50% of whom had acute POD within one to three days after surgery (mean = 3 ± 1.62 days). A predictive power analysis revealed that the pre-operative serum albumin level of lower than 3.5 g/dL was capable of significantly predicting occurrences of acute POD (OR 8.51, 95% CI [1.06-68.06], p = .044).<br>Recommendations: The pre-operative serum albumin level has significant power to predict occurrences of acute POD in PAD patients. Nurse, the refore, should consider assessing the albumin level pre-operatively in order to prevent acute POD.</p> Puraporn Chokcharoemwong Kessiri Wongkongkam Suporn Danaidutsadeekul Khamin Khamin Chinsakchai Copyright (c) 2020 Thai Journal of Nursing Council 2020-12-29 2020-12-29 36 1 129 149 Factors Predicting Family Caregiver's Strain from Care Activities for Bed-Bound Older Adults at Home <p>Objective: To examine factors capable of predicting caregivers’ strain caused by caregiving activities for bed-bound older adults at home<br>Design: Predictive research&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Methodology: Purposive sampling was performed to recruit a sample of 117 family caregivers aged 18 and higher who serve as primary caregiver for bedridden older persons. Data were collected between June and October 2019 using these instruments: 1) a demographic questionnaire; 2) a health perception questionnaire; 3) the Preparedness for Caregiving Scale; 4) the Mutuality Scale; 5) a Social Support Questionnaire; and 6) the Caregiving Activities Scale. The data were analysed using descriptive statistics, Spearman’s Rho correlation coefficients, and multiple regression analysis.<br>Results: Age, perceived income adequacy, health status, preparedness, mutuality, and social support could be jointly predicted caregiver role strain from caregiving activities for bed bound older adults with statistical significance by 31.9% (R2 = .319, F = 8.574, p &lt; .05). The caregivers’ health status was identified as the most powerful predictor (Beta = -.285, p = .001), over the caregivers’ preparedness (Beta = -.254, p = .002), age (Beta = .220, p = .008), and adequacy of income (Beta = -.214, p = .014), respectively. On the other hand, mutuality and social support were unable to predict strain caused by caregiving activities for bed-bound older adults.<br>Recommendations: The findings of this study could be used by healthcare providers as a guideline for promoting family caregivers’ health and preparedness, for the purpose of reducing their strain from caregiving activities and enabling them to provide better care for older adults at home.</p> Chariya Sumcharoen Supreeda Monkong Nuchanad Sutti Copyright (c) 2020 Thai Journal of Nursing Council 2020-12-29 2020-12-29 36 1 150 166