The Journal of Thailand Nursing and Midwifery Council

Full issue

Professor Dr. Noppawan Piaseu — 2024-10-15

Editorial Note

Professor Dr. Noppawan Piaseu — 2024-10-15

Passive Smoking during Pregnancy as Unrecognized Harms at Home: Nurses’ Role in Prenatal Care

Idchayar Mornsaeng — 2024-10-15

Passive smoking at home refers to pregnant women’s exposure to second-hand and/or third-hand smoke from their husbands or family members that brings unfavorable impacts on developing fetus during pregnancy. This situation revealed that pregnant women have a poor understanding of harmful substances in cigarette smoke, the severity, and the impacts of passive smoking at home on fetus and birth outcomes. All pregnant women and fetus have the right to live in a smoke-free environment at home. Pregnant women alone cannot deal with smoking at home on their own, so they need help from healthcare professionals. As nurse-midwives are the closest healthcare professionals to pregnant women, they play a vital role in the prevention and management of passive smoking at home during pregnancy. This paper aims to describe the harmful substances in cigarettes, the impacts of passive smoking on birth outcomes and babies, and the roles of nurse-midwives in the prevention and management of passive smoking at home among pregnant women.

Cigarette smoke contains many teratogens that are toxic to the fetus, especially carbon monoxide, tar, cadmium, nicotine, formaldehyde, and nitrogen dioxide. Passive smoking has both short-term and long-term negative impacts on the fetus and later in life, including preterm birth, stillbirth, low birth weight, small for gestational age, and congenital heart defects. Moreover, cardiovascular diseases, respiratory diseases, and metabolic diseases are likely found in grown-up children exposed to second-hand smoke while in utero. The roles of nurse-midwives include assessing tobacco use and passive smoking at home, providing comprehensive education on passive smoking using media or self-learning materials, and offering counseling emphasizing women’s context and gender-sensitive approaches.

Nurse-midwives can apply knowledge from this article as a guide to prevent and manage to achieve a smoke-free home for pregnant women to minimize adverse pregnancy outcomes and optimize fetal well-being.

Palliative Care Service Situation of Palliative Care Ward Nurses in Srinagarind Hospital

Parichart Piasupun — 2024-10-15

Introduction Exploring the situation of palliative care services led by palliative care ward nurses (PCWNs) will lead to the development of more efficient and effective palliative care services.

Objectives To describe the provision of palliative care services by PCWN in the nursing department at Srinagarind Hospital

Design A cross-sectional descriptive design

Methodology This study was conducted in a population of 103 PCWPs who met the inclusion criteria. Data were collected using a questionnaire developed based on the nurse role effectiveness model by Lukewich et al. The questionnaire consisted of three dimensions: 1) Structure included personal data, organization data consisting of policy, support from the administrative team in delivering services according to the nurse’s role, and support for training; 2) Process included challenges and needs related to providing palliative care services following the major role of nurses, and 3) Outcomes consisted of outcomes of the nurses’ role in palliative care, including assisting patients and families access to palliative care, setting palliative care indicators such as pain and discomfort management, and patient and family satisfaction. The questionnaire was examined by three experts, yielding an index of item objective congruent of .85. The researchers distributed the questionnaire for self-administration by the participants, and data were collected from December 2022 to February 2023. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed using simple content analysis.

Results Almost half of the participants aged 31-40 (47.5%) worked at a practitioner level (57.0%). Most of them worked for more than 10 years (81.6%), worked as PCWNs for 7-10 years (40.8%), and were trained for 6-week palliative care training (51.5%). Organizational information included 1) policy for training support from the administrative team. The PCWNs had a perception of policy on the organization’s palliative care (90.3%), perceived that policy transmitted through the headward and that a palliative care center is a core unit for training for hospital staff; 2) On average, each ward had 1-2 PCWNs (61.2%) providing care to 3-5 patients per month (43.7%). Regarding the process, challenges and obstacles included 1) Support from the administrative team including limited support, lack of clear role definitions and work instructions, and lack of continuous training for skill enhancement; 2) Support from teams of all professions consisting of lack of knowledge, skills, and understanding of palliative care concepts and limited teamwork efficiency; 3) workload including a heavy, time-intensive workload, inadequate manpower, and unable to manage workload effectively; and 4) lack of preparedness and attitude towards palliative care, lack of major caregiver and confidence in care, and misconception of care concept. Needs of the PCWNs included 1) Service development strategies, including increasing PCWN staffing, training palliative care concepts for physicians, and facilitating case-based learning between physicians and nurses’ teams; 2) Work support for PCWNs, including updated knowledge and continuous skill development. Administrators should clearly define the roles and responsibilities of PCWNs and provide support with tools and educational materials for patient and family care. Additionally, palliative care case conferences should be facilitated and supported for quality improvement initiatives and research efforts. The outcomes showed that: 1) PCWNs performed screenings and assisted with access to palliative care for patients and families (47.0%); 2) palliative care indicators were established (50.7%), and 3) patient and family satisfaction ranged from 83.3% to 97.9%.

Recommendation The findings from this study can be used to develop a model of palliative care led by PCWNs to improve the screening process, ensuring that the patients and their families have better access to care, more effective management of pain and symptom distress, and greater satisfaction with the services.

Factors Predicting Sleep Quality in Patients with Chronic Obstructive Pulmonary Disease

Marisa Potham — 2024-10-15

Introduction It is evident that sleep quality affects health outcomes for patients with chronic obstructive pulmonary disease. However, factors affecting sleep quality remain limited, particularly in Thai patients with chronic obstructive pulmonary disease.

Objective This study aimed to describe sleep quality and examine the predictive power of body mass index, fatigue, inhaled corticosteroids, stress, and caffeine consumption on sleep quality in patients with chronic obstructive pulmonary disease.

Design Descriptive correlational predictive design, employing Spielman’s concept of chronic insomnia as a conceptual framework

Methodology The participants consisted of 137 patients with chronic obstructive pulmonary disease, aged 40 or over, who attended follow-up visits at a chronic obstructive pulmonary disease clinic in a secondary hospital in Chonburi province from March to June 2023. The study participants were selected through purposive sampling with inclusion criteria. The sample size was determined using power analysis. Data were collected using a record form of demographics and history of illness, the Pittsburgh Quality of Sleep Index (PSQI) Thai version, the Piper Fatigue Scale-12 (PFS-12) Thai version, the Suanprung Stress Test -20 (SPST-20), and the caffeine consumption questionnaire. Data were analyzed using descriptive statistics and Multiple regression analysis.

Results The participants had a mean age of 71.87 years (SD=12.04). Most of them were male (83.2%). Their sleep quality was poor (81.0%). Body mass index, fatigue, inhaled corticosteroids, stress, and caffeine consumption jointly explained 77.5% of variances in sleep quality in patients with chronic obstructive pulmonary disease (R2 = .775, F = 90.437, p < .001). Fatigue, stress, and caffeine consumption were significant predictors of sleep quality in these patients (β = .116, .159, and .724 respectively, p < .001)

Recommendation Nurses should assess fatigue and stress in patients with chronic obstructive pulmonary disease and develop approaches to preventing and managing these symptoms, including providing information on the negative effects of caffeine consumption on sleep quality in these patients.

Effects of the Nutrition Promotion Program on Health Behaviors and Hematocrit in Pregnant Women with Anemia

Mariam Sajjapod — 2024-10-15

Introduction Anemia is caused by abnormalities in red blood cell production, often resulting from iron deficiency, which decreases both red blood cell count and hemoglobin synthesis. This can cause symptoms including fatigue, lack of energy, difficulty performing activities, and reduced ability to work. Without proper management, anemia can adversely affect the health of both mothers and their fetus.

Objective To compare the average health behaviors (food consumption behavior and iron supplement consumption behavior) and blood concentration levels in pregnant women with anemia, before and after participating in the program.

Design This study employed a quasi-experimental design with a one-group, pre-test, and post-test design.

Methodology The participants were 30 pregnant women with anemia who received care at the antenatal clinic of a community hospital in Nakhon Si Thammarat province between January and March 2024. They were purposively selected according to inclusion criteria. The sample size was determined based on a literature review, using a test power of .80, a significance level of .05, and an effect size of 0.5. The research tools included: 1) a nutrition promotion program developed by the researchers, based on Pender’s health promotion theory, with content validity confirmed by experts, indicated by a content validity index (CVI) of 1.00, and 2) data collection tools including a general information questionnaire, a pregnancy-related questionnaire, and a food consumption and iron supplement consumption behavior questionnaire, developed by the researchers, with a CVI of 1.00 and reliability indicated by a Cronbach’s alpha coefficient of .84. Data were analyzed using descriptive statistics and Paired t-test.

Results On average, the participants were 30.10 years old (SD = 6.85). Most of them were multiparous (70%), with an average gestational age of 7-13 weeks for their first antenatal care visit. After participating in a nutrition promotion program, the participants showed higher health behaviors including food consumption behavior and iron supplement consumption behavior (M = 3.52, SD = 0.09) compared to before the program (M = 2.40, SD = 0.13) with statistical significance (t = 37.214, p < .001). Hematocrit (M = 34.33, SD = 2.09) was also higher than before the program (M = 31.17, SD = 1.56) with statistical significance (t = -9.185, p = .001).

Recommendation Nurse midwives working in the antenatal care department can use the program for pregnant women with characteristics similar to those of the study participants to promote proper food consumption and iron supplement consumption behaviors.

Prevalence of Frailty and Its Association with Health Conditions among Community-Dwelling Older Adults with Knee Osteoarthritis

Witthawat Porthao — 2024-10-15

Introduction Frailty is a common health issue in older adults, arising from age-related declines in body reserves and the impairment of various physiological systems due to inflammation. Older adults suffering from knee osteoarthritis experience an increased risk of frailty. As the disease progresses, inflammation-induced knee pain can emerge, resulting in limited mobility and balance. This increases the risk of falls, decreased physical function, limited life-space mobility, and ultimately disability.

Objective To explore the prevalence of frailty and examine the association between frailty and health conditions (falls, limited physical function, and life-space mobility) among community-dwelling older adults with knee osteoarthritis

Design A cross-sectional correlational study

Methodology The participants comprised 210 community-dwelling older adults aged 60 years and older diagnosed with knee osteoarthritis and/or showed clinical symptoms of knee osteoarthritis and living in the health service areas of the three health-promoting hospitals in Nakhonphanom province. The participants were recruited through multi-stage random sampling. Sample size was determined based on power analysis. Data were collected from February to November 2022 and involved interviews using the following instruments: Demographic and Health Information Questionnaire, Reported Edmonton Frail Scale-Thai version (REFS), Knee Osteoarthritis Outcome Score (KOOS-ADL), and University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA). The descriptive statistics and Spearman’s rank correlation coefficients were used for data analysis.

Results Most participants were female (69.0%), with an average age of 69.49 years (SD = 7.23). Over half reported health problems (54.3%), primarily hypertension. The median score for osteoarthritis symptoms was 5, while the average severity of knee pain was 4.51 (SD = 1.75). The prevalence of frailty in the study participants was 33.8%. Frailty was positively associated with health conditions, including falls (r = .265, p < .001) and limited physical function (r = .415, p < .001), while negatively associated with life-space mobility (r = -.284, p < .001).

Recommendation Findings from this study indicate that frailty is common among older adults with knee osteoarthritis and is related to health conditions. Healthcare professionals should be aware of early screening for frailty in this population. Planning for interventions to promote health may result in delaying dependency and preventing adverse health consequences in older adults with knee osteoarthritis.

Development and Evaluation of the Mini Congestion Score in Patients with Acute Heart Failure

Linda Butte — 2024-10-15

Introduction Congestion is the primary reason patients with acute heart failure require hospitalization. A standardized, user-friendly, and accurate bedside tool for assessing fluid status could assist nurses in evaluating the severity and progression of fluid overload, improving care decisions and communication with physicians.

Objective To develop and evaluate the quality of the mini congestion score (MCS) in assessing congestion among patients with acute heart failure

Design Research and development

Methodology The development of the MCS assessment tool for fluid congestion followed a three-phase evidence-based nursing framework of the advanced nursing practice center: 1) clinical problem identification (evidence triggered), 2) evidence review and retrieval (evidence supported), and 3) tool implementation and outcome evaluation (evidence observed). The MCS and a nurse user manual were developed based on 14 retrieved and quality-appraised evidence items, following the Joanna Briggs Institute criteria. To assess its effectiveness, the MCS was tested in 50 critically ill patients admitted to the medical intensive care unit to evaluate fluid congestion.

Results The MCS consisted of an assessment of jugular venous pressure, rales, and edema, with a score of 0-3 for each item. The overall score of the tool is interpreted as including no congestion (score = 0), mild congestion (score = 1-3), moderate congestion (score = 4-6), and severe congestion (score = 7-9). Inter-rater reliability analysis revealed a very good level (Intraclass correlation coefficient = .980, 95%CI = .964 - .989, p<.001). The efficiency test of the MCS revealed that, at the cut-off of 3, the MCS had a sensitivity of 90.7%, specificity of 94.7%, and an area under the receiver operating characteristics curve (AUC) of .962 (95%CI = .909 – 1.00, p<.001)

Recommendation The MCS tool effectively evaluates and monitors fluid congestion during treatment. Its user-friendly design allows nurses to learn to use it independently with the provided manual. To optimize accuracy, it is recommended to combine its use with the hospital’s standard fluid congestion assessment protocol.

Factors Predicting Health-Promoting Behaviors in Delaying Health Deterioration among the Community-Dwelling Older People in Samut Prakan Province

Winthanyou Bunthan — 2024-10-15

Introduction Older people experience normal changes in the aging process that lead to health deterioration. Although this health deterioration is unavoidable, it can be prevented and delayed through health-promoting behaviors. Examining factors predicting health-promoting behaviors in delaying health deterioration is therefore important to plan for the proper care of older adults.

Objective To investigate factors predicting health-promoting behaviors that delay the health deterioration in older people

Design This study employed correlational predictive design.

Methodology The participants comprised 148 older people aged 60 to 74 years residing in Samut Prakan province. Systematic random sampling was used. The sample size was determined according to power analysis. The research instruments included questionnaires on factors affecting health-promoting behaviors, and health-promoting behavior in delaying health deterioration. The reliability was tested, obtaining Cronbach alpha coefficients of .86 and .84, respectively. The data were collected from October-December 2023 using self-administration and structured interviews. Data were then analyzed using descriptive statistics and stepwise multiple regression analysis.

Results The majority of participants were female (63.51%), with an average age of 66.63 years (SD = 4.74, Min-Max = 60-74). Most of them had a health problem (75.00%) and a caregiver (73.65%). Factors predicting health-promoting behaviors in delaying health deterioration included perceived self-efficacy (β = .392, p < .01) and situation influences (β = .332, p < .01) that could together predict a 39.00% variance of health-promoting behaviors in delaying health deterioration. Perceived self-efficacy could explain the participants’ highest variance of health promotion behaviors.

Recommendation Nurses and the healthcare team should promote perceived self-efficacy and situational influences, increasing health-promoting behaviors and delaying health deterioration among older adults.

Developing Resilience Through the Inner Arts Process in Nursing Students: A Pilot Study

Thida Mulalint — 2024-10-15

Introduction Developing resilience is essential for nursing students to cope with the challenges of their studies and future careers. Based on Anthroposophy principles, the inner arts process is a unique approach that can help foster resilience in nursing students.

Objectives 1) To compare the mean scores of resilience in nursing students before, after, and 3-month follow-up period; and 2) To compare subscales of resilience, including flexibility, sense of self-efficacy, ability to regulate emotion, optimism, and cognitive focus/maintaining attention under stress before, after, and 3-month follow-up period.

Design A quasi-experimental with one-group repeated measures design

Methodology The participants consisted of 23 first-year nursing students who volunteered to participate in resilience development through the inner arts process, including four sessions, each lasting seven hours, for a total of 28 hours. Data were collected using the 10-item Davidson Resilience Scale (CD-RISC10-Thai version) and reflection journals on Google Forms. Data were analyzed using descriptive statistics, One-way repeated measures ANOVA, and Bonferroni pairwise comparisons.

Results Most participants were females (95.7%), with an average age of 19.57 years (SD = 0.79). One-way ANOVA with repeated measures revealed that time had a statistically significant effect on overall resilience (F(2,44) = 5.815, p = .006, partial η² = .209). After the program, the overall resilience (M = 32.70, SD = 4.09) was significantly higher than before (M = 30.26, SD = 3.35; p = .006). Comparisons of resilience subscales revealed that flexibility at the 3-month follow-up (M = 3.44, SD = 0.55) was significantly higher than flexibility before (M = 2.91, SD = 0.65; p = .004). Flexibility after the program (M = 3.39, SD = 0.52) was also higher than before the program (p = .014). However, no statistically significant differences were found in the sense of self-efficacy, ability to regulate emotion, optimism, and cognitive focus/maintaining attention under stress.

Recommendation Developing resilience through the inner arts process can enhance the overall resilience of nursing students. This approach can be applied to promote resilience among nursing students. However, this study has limitations, and future research should be designed with more stringent controls.

The Caring System Development for Diabetic Patients with Missed Appointments, Phrasaeng Hospital

Anussara Kongubol — 2024-10-15

Introduction Diabetes is a condition that requires continuous care. Missed appointments can cause uncontrolled blood sugar levels, resulting in complications. Therefore, hospitals should develop an effective care system for diabetic patients who miss appointments.

Objectives 1) To develop a care system for diabetic patients who miss appointments, 2) To compare knowledge about diabetes, self-care behaviors, and blood sugar levels in diabetic patients who miss appointments before and after the program, 3) To compare knowledge about diabetes, self-care behaviors, and blood sugar levels between the control and the experimental groups, and 4) To compare satisfaction with the caring system for diabetic patients who miss appointments between the control and the experimental groups.

Design Action research

Methodology The participants consisted of 1) A task force for developing the care system for diabetic patients who miss appointments at Phrasaeng Hospital’s diabetes clinic, including 2 physicians and 5 nurses, and 2) 90 diabetic patients who missed appointments with uncontrolled blood sugar levels. Participants were selected according to the inclusion criteria and assigned to an experimental and control group, each consisting of 45 patients. The experimental group received the newly developed care system for missed appointments, while the control group received traditional care. The research instruments included focus group discussion guidelines, the developed caring system for diabetic patients with missed appointments, a personal information questionnaire, a diabetes knowledge questionnaire, a self-care behavior questionnaire, a satisfaction questionnaire regarding the diabetes care system, and a blood sugar level record form. Data were collected from September to December 2023 and divided into four phases: 1) Planning, 2) Implementing through system development, 3) Observing through system application, and 4) Reflecting on the implementation outcomes. Data analysis employed descriptive statistics, Chi-square test, Paired t-test, and Independent t-test.

Results The newly developed system for managing diabetic patients who miss appointments consists of four components: 1) Appointment reminders, 2) Medical care and education, 3) Monitoring and encouragement, and 4) Experience sharing. The results of using the newly developed system revealed that, after the program, the experimental group had greater knowledge about diabetes (M = 11.9, SD = 1.8) compared to before the program (M = 8.9, SD = 2.0) and significantly more than the control group (M = 9.2, SD = 2.1) (t = -11.667 and 6.344, p < .001). Additionally, the overall self-care behaviors of the experimental group (M = 66.0, SD = 6.2) were higher than before the program (M = 56.1, SD = 7.0) and significantly greater than the control group (M = 56.7, SD = 7.6) (t = -16.371 and 6.290, p < .001). Blood sugar levels in the experimental group (M = 127.8, SD = 27.3) were lower than before the program (M = 173.7, SD = 48.9) and significantly lower than those in the control group (M = 192.1, SD = 51.9) (t = 7.341 and -7.336, p < .001). Moreover, the experimental group reported higher satisfaction (M = 34.7, SD = 1.6) compared to the control group (M = 30.6, SD = 3.4) with statistical significance (t = 7.145, p < .001).

Recommendation The newly developed caring system for diabetic patients who miss appointments has proven to be effective, and patients have greater satisfaction compared to the traditional system. Therefore, it should be routinely implemented and expanded.

Live Experiences in People with Myasthenia Gravis: A Qualitative Study

Rungnapa Udomlap — 2024-10-15

Introduction Myasthenia gravis (MG) is an autoimmune disorder characterized by severe muscle weakness, which can lead to acute respiratory failure. The unpredictable symptoms of MG affect both physical and mental health, affecting daily activities, work, and social interactions. This can result in negative self-perception, ultimately diminishing patients’ quality of life. A comprehensive understanding of the condition is crucial for improving patient care.

Objective To explore the live experiences of people with MG regarding their perception of the disease, lifestyle changes, self-management, and perception of the remaining life

Design A descriptive qualitative design

Methods The informants included 15 people aged 18 and older who had been diagnosed with MG and had received treatment for at least six months at a super-tertiary hospital in Bangkok. Purposive sampling was used according to the inclusion criteria. In-depth interviews were conducted using semi-structured interview guides that focused on their experiences, perceptions of the disease, lifestyle changes, self-management, and perceptions of the remaining life. Data were analyzed using content analysis based on Colaizzi’s framework. The trustworthiness of the research was assessed through credibility, confirmability, and transferability.

Findings The informants, aged 27 to 85, had been diagnosed with MG for periods ranging from 1 to 40 years. Most were treated with medication, while some also received intravenous immunoglobulin. Findings were categorized into three main themes: 1) Life Will Never Be the Same, including living with uncertainty, living with limitations, and enduring suffering; 2) Self-Management, including strict adherence to medication and appointments, awareness and self-monitoring, avoidance of risk behaviors, keeping physical fitness, and acceptance of living with the illness; and 3) Perception of Remaining Life, including expecting to live still, expecting for treatment outcomes, expecting nothing, and expecting for support from others.

Recommendation Findings from this study highlight how people with MG navigate life and manage their chronic conditions. Healthcare teams can use this information to develop tailored care plans. Additionally, future research can use this information to develop strategies to improve patient care and their quality of life.