Journal of Thailand Nursing and Midwifery Council

Editorial Note

Professor Dr. Noppawan Piaseu — 2026-09-18

Factors Predicting Heat Stroke Preventive Behaviors Among Ground Service Staff at Suvarnabhumi Airport

Songkrot Saringkarn — 2026-09-18

Introduction Over the past decade, rising global temperatures and increasingly severe climate change have subjected outdoor workers to escalating heat exposure. Heat stroke represents the most critical heat-related illness and constitutes a medical emergency, arising from the failure of thermoregulatory, circulatory, and central nervous system functions. Without timely prevention or intervention, heat stroke can lead to serious complications and death. Thailand, as a tropical country, experiences high temperatures throughout most of the year, with summer temperatures often reaching levels that are hazardous to health. Outdoor workers are therefore at greater risk of heat-related illnesses compared to the general population. Ground service personnel at Suvarnabhumi Airport are particularly vulnerable, as their duties require prolonged work on aircraft aprons where heat is intensified by concrete surface reflection, engine exhaust, and strict operational time constraints. These conditions may limit opportunities for rest breaks, hydration, and self-monitoring of abnormal symptoms. This study aims to identify predictive factors for heat-stroke preventive behaviors among ground service personnel at Suvarnabhumi Airport, with the ultimate goal of informing the development of appropriate strategies and interventions to safeguard their health.

Objectives The objectives of this study were twofold: 1) To examine the levels of heat stroke preventive behaviors and individual perceptions (perceived susceptibility to heat stroke, perceived severity of heat stroke, perceived benefits of preventive behaviors, perceived barriers to preventive behaviors, and perceived self-efficacy in performing heat stroke prevention behaviors), support from related persons; organizational management for heat stroke prevention; and knowledge about heat stroke, and 2) To identify factors predicting heat stroke preventive behaviors among ground service personnel at Suvarnabhumi Airport.

Design This study adopted a predictive correlational design, applying the Health Belief Model to investigate factors influencing heat stroke preventive behaviors among ground service personnel. Within this framework, three dimensions were examined, 1) individual perceptions, including perceived susceptibility to heat stroke, perceived severity of heat stroke, perceived benefits of preventive behaviors, perceived barriers to preventive behaviors, and perceived self-efficacy in performing such behaviors; 2) cues to action, specifically support from related persons and management for heat stroke prevention; 3) modifying factors, including knowledge about heat stroke.

Methodology The study sample consisted of 176 ground service personnel employed at Suvarnabhumi Airport, Samut Prakan Province, who had been in their current positions for at least 6 months. Participants were selected using a two-stage random sampling with proportion. The research instrument was a self-administered questionnaire comprising seven parts: (1) personal information, (2) knowledge about heat stroke, (3) perceptions related to heat stroke, (4) perceived self-efficacy in performing heat stroke preventive behaviors, (5) support from related persons, (6) management for heat stroke prevention, and (7) heat stroke preventive behaviors. Data were collected through self-administered questionnaires and analyzed using descriptive statistics, Pearson’s correlation analysis, and Stepwise multiple regression analysis.

Results The majority of the sample were male (87.50%), single (66.50%), and most frequently aged 35–39 years (25.57%). The highest proportion had completed upper secondary/ vocational education (34.10%). More than half had work experience as ground service personnel for 1–5 years (55.68%) and worked five days per week (58.00%). Regarding individual perceptions, perceived susceptibility to heat stroke, perceived severity of heat stroke, and perceived benefits of preventive behaviors were high, whereas perceived barriers to preventive behaviors and perceived self-efficacy in performing preventive behaviors were moderate. For cues to action, support from related persons was low, while management for heat stroke prevention was moderate. Knowledge about heat stroke, as a modifying factor, was at a good level. Heat stroke preventive behaviors among ground service personnel were found to be at a moderate level. Stepwise multiple regression analysis revealed that significant predictors of heat stroke prevention behaviors included support from related persons (β = .429, p < .001), perceived self-efficacy in performing preventive behaviors (β = .216, p < .001), management for heat stroke prevention (β = .221, p < .001), and perceived barriers to preventive behaviors (β = -.163, p = .003). Together, these factors explained 51.1% of the variance in heat-stroke preventive behaviors among ground service personnel at Suvarnabhumi Airport (Adjusted R² = .511, p < .001).

Recommendation Executives, supervisors, occupational safety officers, and nurses can apply the findings of this study to promote heat stroke preventive behaviors by encouraging and supporting ground service personnel at the individual level, providing reminders regarding heat stroke prevention, and developing models or programs for prevention. These efforts should emphasize enhancing perceived self-efficacy and reducing perceived barriers to preventive behaviors among ground service personnel. At the policy level, organizational executives can use the results to develop policies, training curricula, alert systems, and workplace management strategies that systematically facilitate the practice of heat-stroke prevention behaviors among ground service personnel.

Effects of Traverse Bed Sheet Innovation to Promote Breastfeeding on Maternal-Infant Bonding and Attachment, Milk Flow, and Breastfeeding Success in Mothers after Cesarean Section

Piyarat Rodkaew — 2026-09-18

Introduction Cesarean section affects maternal breastfeeding and serves as a major barrier to successful lactation. Specifically, it impedes early breastfeeding initiation within the crucial first hour postpartum and suppresses maternal-infant bonding. The application of a Traverse Bed Sheet Innovation allows mothers after cesarean section to engage in skin-to-skin contact immediately upon admission, thereby fostering maternal-infant attachment, facilitating prompt and sustained breastfeeding initiation, and promoting breastfeeding success.

Objective This study aimed to examine the effects of Traverse Bed Sheet Innovation in promoting maternal breastfeeding on maternal–infant bonding, the level of breast milk flow, and the success of breastfeeding prior to hospital discharge.

Design This study employed a quasi-experimental, posttest-only design with two groups. The intervention integrated concepts including breastfeeding positioning for mothers following cesarean section, the physiology of lactation and milk secretion, and the promotion of maternal–infant bonding through skin-to-skin contact. These were combined to enhance breastfeeding initiation and continuity during the first 24 hours postpartum.

Methodology The study participants comprised postpartum mothers who had undergone cesarean section and were admitted to the postpartum ward of a general hospital in a southern province between July and October 2024. Participants were purposively selected according to inclusion criteria: aged 20–45 years, full-term pregnancy, no postoperative complications, normal breast and nipple anatomy, and full-term newborns with a birthweight of 2,500–3,999 grams, with no sucking or swallowing difficulties, and no tongue-tie. All participants provided informed consent. Sample size was determined with a significance level (α) of .05, statistical power of .80, and effect size of 0.8, yielding a total of 60 participants randomly assigned to the experimental group (n = 30) and the control group (n = 30). The research instrument was the Traverse Bed Sheet Innovation for breastfeeding support. This bed sheet was designed with a slot for inserting a pillow to support the infant’s trunk and an additional cloth to wrap the infant and secure mother–infant positioning. The innovation facilitated alignment of the infant at the level of the maternal nipple, reduced maternal movement and pressure at the surgical site, and enabled breastfeeding in modified supine and side-lying positions while promoting skin-to-skin contact in the immediate postpartum period. Data collection instruments included: (1) personal and obstetric data questionnaire, (2) maternal–infant bonding assessment scale, (3) breast milk flow assessment scale, and (4) breastfeeding success assessment scale prior to hospital discharge. Content validity was examined by three breastfeeding experts, yielding content validity indices of 1.00 for both the milk flow and breastfeeding success scales. Interrater reliability was established between the researcher and ward nurses using Weighted Cohen’s kappa, with values of .80 for both scales, based on 15 mothers with similar characteristics to the study sample. The maternal–infant bonding scale demonstrated a Cronbach’s alpha coefficient of .88. Data collection was conducted by providing the experimental group with the Traverse Bed Sheet Innovation in conjunction with routine nursing care, promoting skin-to-skin contact and breastfeeding initiation within the first 24 hours postpartum every 2–3 hours for 10–15 minutes per breast. The control group received routine nursing care without innovation. Data analysis employed descriptive statistics for demographic information. Maternal–infant bonding was compared using Independent t-test, breast milk flow using Mann–Whitney U test, and breastfeeding success before discharge using Fisher’s exact test.

Results The majority of participants were aged 25–29 years (35.00%). Post-intervention comparisons revealed that the experimental group demonstrated significantly higher maternal–infant bonding scores (M = 109.53, SD = 11.85) than the control group (M = 77.30, SD = 12.06), with statistical significance (t =10.440, p < .001). Breast milk flow levels on Day 1 (M =1.57, SD = .77), Day 2 (M = 2.43, SD = .63), and at hospital discharge (M = 2.87, SD =.57) were significantly higher in the experimental group compared to the control group (M =.90, SD =.48; M = 1.50, SD = .51; M = 2.23, SD =.63) (p < .001). Breastfeeding success before discharge also differed significantly between groups (p = .009), with the experimental group 13.57 times more likely to achieve successful breastfeeding than the control group (95% CI: 1.63–113.16).

Recommendation The findings of this study indicate that the Traverse Bed Sheet Innovation, when combined with routine nursing care for mothers following cesarean section, effectively enhances maternal–infant bonding, promotes breast milk flow, and increases the likelihood of successful breastfeeding before hospital discharge. Health care personnel responsible for caring for mothers after cesarean may apply this innovation to promote breastfeeding practices more efficiently.

The Effects of a Case Management Model in Palliative Care Transitioning from Hospital to Home on Pain and Suffering in Terminal Cancer Patients

Benjamaporn Boonrak — 2026-09-18

Introduction In 2015, the Ministry of Public Health established a national policy requiring hospitals nationwide to establish palliative care units for terminally ill patients, with the aim of providing comprehensive care that addresses physical, psychological, and quality-of-life needs. Between 2020 and 2022, statistics indicated a continuous increase in the number of terminal cancer patients requiring palliative care. In response to this policy, the Warinrak Center at Warinchamrap Hospital developed a case management model for palliative care of terminal cancer patients, transitioning care from hospital to home beginning in 2016 and refining it through 2022. This model integrates the nursing process framework with case management, including problem assessment, nursing diagnosis, individualized care planning, nursing interventions, and outcome evaluation, with particular emphasis on pain management as a common and critical symptom. Although this care model has been implemented in patient care, systematic evaluation of its outcomes remains limited.

Objectives This study aimed to 1) compare pain, distress, and functional performance and self-care ability among terminal cancer patients before and after receiving the case management model of palliative care from hospital to home; and 2) describe patient and family satisfaction with the case management model.

Design This study employed a quasi-experimental design using a one-group pretest–posttest approach. The study was conducted at the Warinrak Center, including the medical and surgical wards of Warinchamrab Hospital, Ubon Ratchathani Province, Thailand. Following hospital discharge, continuity of care during the transition from hospital to home was provided through telephone follow-up and consultation via the Warinrak Center’s LINE Official Account. Methodology The study sample comprised 16 terminal cancer patients experiencing pain who were admitted to the inpatient wards of Warinchamrap Hospital, Ubon Ratchathani Province. Participants were purposively selected according to the inclusion criteria. The sample size was determined using power analysis, with an effect size of 0.80, a statistical power of .80, and a significance level of .05. Data collection instruments included: a personal information record form, the Brief Pain Inventory–Short Form (BPI-SF), the Distress Thermometer, the Palliative Performance Scale (PPS) for assessing self-care ability in terminal cancer patients receiving palliative care, and a satisfaction questionnaire. The intervention was the case management model of palliative care for terminal cancer patients transitioning from hospital to home, developed by integrating the nursing process framework with case management principles. Each participant was enrolled in the study for 21 days. Data were collected between November 2023 and January 2024 and analyzed using descriptive statistics and Wilcoxon Signed-Rank test.

Results The majority of participants were female (56.3%) and aged 60 years or older (87.5%). Equal proportions (12.5% each) were diagnosed with colorectal cancer, lung cancer, and cervical cancer. The most frequently reported discomfort was pain (87.5%), followed by fatigue (68.8%) and insomnia (43.8%). After the intervention, pain scores were significantly lower than before the intervention across all dimensions: worst pain (Z = -2.783, p = .005), least pain (Z = -2.834, p = .005), average pain (Z = -2.939, p = .003), and current pain (Z = -2.956, p = .003). The impact of pain on daily activities across seven domains also decreased significantly, as did psychological distress levels (Z = -3.256, p = .001). However, no statistically significant difference was observed in functional performance and self-care ability, as measured by the Palliative Performance Scale (PPS), before and after the intervention (Z = -1.000, p = .317). Patient and family satisfaction with case management after the intervention was high, particularly regarding the healthcare team’s responsiveness to patient needs (81.3%), followed by the provision of information on symptom management and family involvement in care-related decision-making, both rated at 75.0%.

Recommendations The case management model of palliative care was found to significantly reduce pain and distress among patients, thereby alleviating the impact on the quality of life of terminal cancer patients. In addition, patients and their families expressed high levels of satisfaction, particularly with the quality of care and their involvement in decision-making. The application of this hospital-to-home case management model of palliative care should be considered in the development of service systems for terminal cancer patients, as it can effectively relieve pain and distress, enhance nurses’ competencies in symptom management, and strengthen continuity of care between hospital and home.

Factors Predicting Catheter-Associated Urinary Tract Infections Among General Medical and Critically Ill Patients

Krittra Noowilai — 2026-09-18

Introduction Urinary tract infections (UTIs) are among the most common hospital-acquired infections, with approximately 75% associated with indwelling urinary catheters, referred to as Catheter-Associated Urinary Tract Infections (CAUTIs). These infections contribute to increased morbidity, healthcare costs, and length of hospital stay. According to the Centers for Disease Control and Prevention (CDC), CAUTIs are classified into symptomatic urinary tract infections and asymptomatic bacteriuria. Both categories require a history of catheterization for more than two calendar days or of catheter removal within one calendar day, together with urine culture results that meet the specified criteria. Prolonged catheterization and suboptimal catheter care are recognized as major risk factors. At Songklanagarind Hospital, the incidence of CAUTIs remains above the institutional benchmarks, particularly among general medical and critically ill patients. Although several risk factors have been reported, evidence specific to medical patients whose clinical conditions and care practices differ from those of other groups remains limited. This study, therefore, aims to identify risk factors for CAUTIs to strengthen surveillance efforts and inform the development of nursing practice guidelines to enhance patient safety.

Objectives The objectives of this study were twofold: 1) to determine the incidence of catheter-associated urinary tract infections (CAUTIs) among general medical and critically ill patients, and 2) to investigate factors predicting CAUTIs in general medical and critically ill patients.

Design This study employed a retrospective analytical design, guided by the epidemiological framework of infectious diseases, which explains infection as a consequence of imbalance among three principal factors: 1) host factors, 2) agent factors, and 3) environmental factors. Applied to catheter-associated urinary tract infections (CAUTIs), these three domains contribute to the increased risk of infection. However, the present study focused specifically on host and environmental factors associated with CAUTIs, as pathogen-related factors involve microbiological data that fall beyond the scope of this investigation.

Methodology Data were retrieved from the information system of Songklanagarind Hospital. The study participants comprised medical patients admitted to general medical wards and intensive care units, aged 18 years or older, who had indwelling urinary catheters for more than two calendar days. Data were collected retrospectively from patients admitted between July 2024 and April 2025, yielding a total of 848 cases. The research instrument was a data collection form developed by the investigator based on a literature review, with a content validity index (CVI) of .98. Prior to formal data collection, the form was pilot tested with a subset of medical records to ensure completeness and consistency of documentation. Data analysis employed descriptive statistics. The incidence of CAUTIs was compared between general medical and critically ill patients using the Chi-square test, with CAUTI incidence calculated as infections per 1,000 catheter-days. Risk factors associated with CAUTIs were analyzed using the Wilcoxon rank-sum test, Chi-square test, or Fisher’s exact test, as appropriate. Factors predicting CAUTIs were further examined using multiple logistic regression analysis.

Results The participants had a mean age of 69 years (SD = 17.61). The mean duration of urinary catheterization was 6.37 days (SD = 4.45). The overall incidence of CAUTIs was 3.70 per 1,000 catheter-days. The incidence rates among general medical patients and critically ill patients were 3.45 and 4.07 per 1,000 catheter-days, respectively, with no statistically significant difference (p = .500). The majority of causative organisms were Gram-negative bacteria, with Klebsiella pneumoniae being the most common (25%), followed by Pseudomonas aeruginosa (20.8%) and Escherichia coli (12.5%). Risk factor analysis revealed significant associations between CAUTIs and a history of urinary tract infection within the past six months (p = .013), duration of catheterization (p < .001), catheter insertion in inpatient wards (p = .020), catheter reinsertion (p = .022), length of hospital stay (p = .001), and diarrhea (p = .005). Multiple logistic regression analysis identified three significant predictors of CAUTIs: (1) duration of catheterization, with each additional day increasing the risk by 19% (OR = 1.190, 95% CI: 1.110–1.290, p < .001); (2) catheter insertion in inpatient wards, which carried a 10.68-fold higher risk compared with insertion in the emergency department or operating room (OR = 10.680, 95% CI: 1.760–228.530, p = .040); and (3) diarrhea, which increased the risk of CAUTIs by 3.26 times compared with normal bowel function (OR = 3.260, 95% CI: 1.170–10.010, p = .028).

Recommendation Nurses and multidisciplinary teams can apply the findings of this study to guide strategies for preventing CAUTIs. Prevention efforts should emphasize systematic reduction of catheterization duration, coupled with continuous reassessment of catheter necessity, particularly among patients with diarrhea who are at elevated risk of CAUTIs. In addition, catheter insertion practices in inpatient wards should be reviewed and standardized to minimize the risk of contamination during the procedure. Implementation of these measures will help reduce catheter-related complications, strengthen infection prevention protocols, lower the incidence of CAUTIs among hospitalized patients, and ultimately enhance patient safety and overall quality of care.

Factors Predicting Access to Contraceptive Services Among Reproductive-Age Female Migrant Workers

Rachada Phuangprasonka — 2026-09-18

Introduction Thailand employs a significant number of female migrant workers, many of whom are of reproductive age and exposed to the likelihood of pregnancy. Previous studies indicate that antenatal care (ANC) clinics are the most frequently utilized healthcare service among this population. Concurrently, pregnancy-related health complications are prevalent, particularly gestational diabetes mellitus (GDM) and neonatal abnormalities. Samut Prakan province ranks third in Thailand in terms of its migrant worker population. Notably, at Samut Prakan Hospital, female migrants accounted for 30.80% to 32.06% of total births between 2021 and 2023. Despite this burden, research examining access to contraceptive services and its associated factors among migrant workers in Thailand remains limited. Investigating these issues is crucial to promoting access to contraception and family planning, thereby mitigating health risks for both mothers and newborns.

Objectives This study aimed to examine factors predicting access to contraceptive services among female migrant workers of reproductive age. The predictive factors included age, nationality, health welfare, gravidity, contraceptive use, contraceptive knowledge, contraceptive beliefs, and the influence of contraceptive beliefs among family or peers.

Design This study employed a predictive research design.

Methodology The study sample consisted of 326 reproductive-age female migrant workers who received services at Samut Prakan Hospital between April 2024 and January 2025. Purposive sampling was employed based on the following inclusion criteria: 1) aged 15–49 years; 2) employed as a wage earner under any job category in Samut Prakan Province; 3) holding a legally valid migrant worker card; 4) having utilized contraceptive services in Thailand at least once; 5) able to communicate proficiently in spoken Thai without an interpreter or translation application; 6) literate in reading and writing their native language; and 7) providing informed consent to participate in the study. Exclusion criteria were unable to provide complete information or complete the questionnaire. The research instrument was a questionnaire comprising five parts: 1) demographic data, 2) contraceptive knowledge, 3) contraceptive beliefs, 4) the influence of contraceptive beliefs among family and peers, and 5) access to contraceptive services. Content validity was assessed, yielding Item-Objective Congruence (IOC) indices of .92 for contraceptive knowledge, .88 for contraceptive beliefs, .95 for family and peer influence, and .94 for access to contraceptive services. Internal consistency reliability was demonstrated by a Kuder-Richardson 20 (KR-20) coefficient of .71 for the contraceptive knowledge questionnaire. Additionally, Cronbach’s alpha coefficients for the contraceptive beliefs scale, the influence of contraceptive beliefs among family and p eers scale, and the access to contraceptive services scale were .88, .88, and .80, respectively. Data were analyzed using descriptive statistics, including percentages, means, and standard deviations, and predictive factors were identified using Stepwise multiple regression analysis.

Results The majority of reproductive-age female migrant participants were of Myanmar nationality (73.60%), followed by Cambodian (16.90%) and Lao (8.90%). The predominant age group was 26–30 years. Most participants lacked health insurance coverage (66.60%) and had been pregnant once (53.37%). Regarding contraceptive use, 96.93% reported prior contraceptive use, with oral contraceptive pills being the most common method (47.15%). Overall, participants demonstrated low contraceptive knowledge (59.81%), moderate contraceptive beliefs (70.55%), moderate family and peer influence (51.84%), and moderate access to contraceptive services (80.68%). Stepwise multiple regression analysis revealed that contraceptive beliefs and the influence of contraceptive beliefs among family or peers significantly predicted access to contraceptive services, jointly accounting for 14.0% of the variance (R2=.146). Contraceptive beliefs emerged as the strongest predictor (β=.248, p <.01), followed by the influence of contraceptive beliefs among family or peers (β=.204, p <.01).

Recommendations Nurse-midwives and healthcare providers can integrate clients’ contraceptive beliefs and the influence of contraceptive beliefs among family or peers into routine counseling and delivery of contraceptive services. Tailoring care to these factors can enhance access to contraceptive services and empower reproductive-age female migrant workers to select birth control methods that align with their specific and cultural contexts.

Effects of an Early Postoperative Ambulation Program on Bowel Function and Recovery Among Patients After Open Appendectomy

Phanthiwa Aunkham — 2026-09-18

Introduction Acute appendicitis is the most common condition among patients presenting with acute abdominal pain. Open appendectomy under general anesthesia remains the standard and widely practiced treatment. However, the most frequent postoperative complication is postoperative ileus, which arises from multiple causes, including direct manipulation of the intestines during surgery, the inhibitory effects of general anesthetics or opioid analgesics on bowel movement, and delayed mobilization due to postoperative fatigue. These factors result in impaired peristalsis, leading to abdominal distension, pain, nausea, vomiting, inability to belch, and absence of bowel sounds. Management typically requires prokinetic agents or nasogastric decompression. Currently, recovery programs designed to reduce postoperative ileus following open appendectomy are limited and lack clear implementation in clinical practice. Their effectiveness depends on several factors, such as the type of surgical incision, the timing of ambulation, and the risk of postoperative complications. Previous studies have demonstrated that early mobilization after surgery is the most effective strategy to facilitate the return of bowel function. Therefore, the researchers developed an early postoperative ambulation program to systematically promote prompt mobilization, stimulate intestinal activity, and enhance overall postoperative recovery.

Objective The objective of this study was to examine the effects of an early postoperative ambulation program on bowel function and overall recovery among patients undergoing open appendectomy.

Design This study employed a quasi-experimental design with a two-group repeated measures design. The investigation was guided by the core pathophysiological concept of postoperative ileus (POI) as the primary framework for examining postoperative outcomes.

Methodology The study participants comprised 62 patients, both male and female, who underwent open appendectomy at a hospital in Ubon Ratchathani Province. Participants were purposively selected based on the following inclusion criteria: 1) age 18 years or older; for those aged 60 years or above, normal cognitive function was required as assessed by a cognitive impairment screening tool; 2) undergoing open appendectomy for either uncomplicated appendicitis or perforated appendix, with a minimum preoperative hospital stay of six hours; and 3) administration of general anesthesia during surgery. Exclusion criteria were: 1) acute appendicitis requiring true emergency surgery without prior inpatient preparation; 2) concurrent abdominal surgery for other conditions performed in the same operative session; 3) pre- or postoperative musculoskeletal disorders such as fractures, dislocations, muscle weakness, herniated discs, Parkinson’s disease, or physical limitations including hemiplegia, paraplegia, or limb amputation; 4) psychiatric diagnoses including depression, schizophrenia, bipolar disorder, panic disorder, or alcohol withdrawal; and 5) pregnancy. Participants were allocated into a control group (n = 31) and an experimental group (n = 30). The program began 6 hours before surgery and emphasized postoperative mobilization, including in-bed, bedside, and out-of-bed activities. Data were collected using demographic form, illness and treatment records, a bowel function recovery assessment, and a postoperative recovery quality assessment. Data collection in the control group was completed first. Statistical analyses included Chi-square test, Fisher’s exact test, Independent t-test, Mann–Whitney U test, and Two-Way Repeated Measures ANOVA at postoperative intervals of 12, 24, and 36 hours.

Results The majority of participants were in middle adulthood (aged 45–59 years), accounting for approximately 30%. A statistically significant difference was observed between the two groups in the incidence of postoperative ileus (POI) (p = .005), with the experimental group demonstrating a lower incidence than the control group (10.00% vs. 41.94%, respectively). This finding was consistent with the mean bowel function scores, which were higher in the experimental group across all time points. The difference between groups was statistically significant (F = 4.034, p = .049), and bowel function increased progressively at 12, 24, and 36 hours postoperatively (F = 77.659, p < .001). Pairwise comparisons revealed significant differences at all time intervals (p < .001). However, no significant interaction effect was found between the intervention program and time (F = 2.801, p = .065). In terms of overall postoperative recovery scores, no statistically significant difference was found between the experimental and control groups (F = 0.028, p = .869). Nevertheless, both groups exhibited continuous improvement over time at 12, 24, and 36 hours postoperatively (F = 111.459, p < .001), with pairwise comparisons showing significant differences at all intervals (p < .001). Similar to bowel function outcomes, no significant interaction effect was observed between the intervention program and time (F = 0.159, p = .853).

Recommendation Nurses should integrate this program into the care of patients undergoing open appendectomy by providing preoperative guidance and systematically implementing early postoperative mobilization activities. These activities should be conducted progressively, beginning in bed, continuing at the bedside, and extending to out-of-bed exercises in a consistent and structured manner to promote bowel function and enhance postoperative physical recovery. For future research, it is recommended that the program be further developed into a mobile application with an accompanying online manual, thereby increasing patient accessibility and convenience in performing recovery activities.

Prevalence of Cognitive Frailty and Its Correlation to Self-Perceived Functional Ability Among Older Adults with Mild Cognitive Impairment

Sawitri Usaha — 2026-09-18

Introduction Cognitive frailty (CF) refers to the co-occurrence of physical frailty and mild cognitive impairment (MCI), which shares common pathological mechanisms. It is associated with multiple factors, including inflammation, impaired nutrition, vascular integrity, metabolic dysregulation, oxidative stress, cellular senescence, mitochondrial dysfunction, hypothalamic-pituitary axis dysregulation, metabolic imbalance, and neuroendocrine dysfunction. Cognitive frailty complicates health care management and constitutes a risk factor for progression to dementia. Moreover, it is linked to adverse health outcomes among older adults, such as falls, dependency or disability, hospitalization, dementia, reduced quality of life, and increased mortality. Currently, evidence regarding the association between cognitive frailty and functional ability in both basic activities of daily living (ADL) and instrumental activities of daily living (IADL) remains limited, with most studies focusing on community-dwelling older adults. Furthermore, there is a lack of research exploring cognitive frailty among older adults with mild cognitive impairment in hospital settings. As aging may accelerate the progression of both cognitive frailty and chronic diseases, early identification of cognitive frailty during hospital visits and follow-up could provide valuable insights for promoting health and quality of life in this population.

Objectives This study aims to examine the prevalence of cognitive frailty and to investigate the association between cognitive frailty and self-perceived functional ability among older adults with mild cognitive impairment.

Design This cross-sectional study was conducted based on a conceptual framework developed by the researcher through a comprehensive review of the literature.

Methodology The study participants comprised 145 older adults aged 65 years and above who had been diagnosed with mild cognitive impairment and received services at the Outpatient Department of Ramathibodi Hospital during August 2023 to August 2024. Participants were purposively selected based on the following inclusion criteria: 1) diagnosed with mild cognitive impairment by a specialist physician, without clinical manifestations of dementia, and 2) no hearing or visual impairment, with the ability to understand and communicate in Thai. The exclusion criteria were a diagnosis of Alzheimer’s disease, dementia, or current psychiatric treatment. Data were collected through structured interviews using questionnaires consisting of: 1) a personal information interview form, 2) the Thai version of the Reported Edmonton Frail Scale, 3) The Barthel Activity Daily Living Index, assessing basic activities of daily living (ADL), and 4) The Lawton Instrumental Activity of Daily Living Scale, assessing instrumental activities of daily living (IADL). Data were analyzed using descriptive statistics and Spearman’s rank correlation coefficient.

Results The majority of participants were female (70.3%), aged between 65 and 96 years, with a mean age of 76 years (SD = 7.3). Most were married (69.7%). The highest level of education attained was a bachelor’s degree (31.7%), followed by primary education (27.6%). The prevalence of cognitive frailty was 62.1%. Regarding self-perceived functional ability, most participants were able to perform basic activities of daily living (ADLs) independently (97.2%), while 65.5% required assistance with instrumental activities of daily living (IADLs). Spearman’s correlation analysis revealed that cognitive frailty was moderately and negatively correlated with both basic ADL performance (rs = -.418, p < .01) and IADL performance (rs = -.494, p < .01).

Recommendation The findings of this study highlight the importance of screening for cognitive frailty. Health care teams may apply these results to improve the efficiency of public health services in screening, assessment, care, prevention, and health promotion, thereby enhancing the quality of life for older adults.

Effects of Art Therapy-Based Cognitive Stimulation Program on Dementia Risk Among Older Adults in the Community

Pisan Pachachoo — 2026-09-18

Introduction Dementia is a major public health concern among older adults worldwide. The World Health Organization reports that approximately 55 million people are currently living with dementia, and this number is projected to rise to 78 million by 2030. Thailand has officially entered a complete aged society since 2021. Older adults in community settings who experience declines in their ability to perform activities of daily living are at heightened risk of dementia due to limitations in mobility, reduced social interaction, and insufficient cognitive stimulation. Cognitive stimulation through creative activities, such as art therapy, has been shown to enhance brain function, improve memory, reduce stress and anxiety, foster self-esteem, and alleviate social isolation, all of which are factors associated with lowering dementia risk. Nevertheless, research on the application of art therapy among older adults with mobility limitations in community contexts in Thailand remains scarce.

Objective This study aimed to compare dementia risk scores among community-dwelling older adults before and after participating in an Art Therapy-Based Cognitive Stimulation Program.

Design A quasi-experimental one-group pretest–posttest design was employed to test a program integrating Stern’s Cognitive Reserve theory, the concept of Neuroplasticity, and Judith A. Rubin’s art therapy framework. The intervention comprised four types of activities: Color Stories of Mine, Touch and Shape Feelings, Crafts from My Heart, and Life Reflection Collage. Sessions were conducted once weekly, lasting 60–90 minutes each, over a total period of 10 weeks.

Methodology The study sample consisted of 40 older adults aged 60 years and above who scored between 5 and 11 on the Barthel ADL Index. All participants were registered at a subdistrict health-promoting hospital in Mueang Pathum Thani District, Pathum Thani Province, between September and December 2025. Purposive sampling was used, with inclusion criteria including an AD8 score ≥ 2, the ability to communicate in Thai, and willingness to participate in the study. Research instruments included the program manual, the Barthel ADL Index, and the AD8 Dementia Screening Interview. Data were collected between September and December 2025 at a subdistrict health-promoting hospital located in a central province of Thailand. Data were then analyzed using Descriptive statistics and Paired t-test.

Results The majority of participants were female (60%), with a mean age of 72.3 years (SD = 7.24). Most identified as Buddhist (94%) and had completed primary education (45%). Hypertension was the most prevalent chronic condition (65%). Following participation in the program, the mean AD8 score decreased significantly from 2.82 (SD = 0.89) at baseline to 2.22 (SD = 1.08) post-intervention (t = 6.958, p < .001). Cohen’s d = 0.673 indicated a mediumto- large effect size. AD8 Score decreased in 55% of participants, 37.5% remained stable, and increased in 7.5%.

Recommendation Nurses and healthcare personnel can apply the four program activities in community-based care for older adults. Village health volunteers may be trained to serve as facilitators, while families can be encouraged to implement activities at home regularly to promote cognitive stimulation. Future studies should incorporate a control group and include long-term follow-up to strengthen the evidence base.

Development of ERCP Care Model: A Transitional Nursing Model in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography, Lampang Hospital

Sudthida Inprasit — 2026-09-18

Introduction The incidence of biliary and pancreatic diseases has been increasing worldwide, including in Thailand. Endoscopic retrograde cholangiopancreatography (ERCP) is a therapeutic procedure for managing biliary and pancreatic disorders; however, it carries a complication risk of approximately 5–10%, including pancreatitis, bleeding, and infection. The operating theater at Lampang Hospital initiated ERCP services in fiscal year 2023. Since its implementation, challenges have been observed during the pre-, intra-, and post-procedural phases, as well as in cases of unplanned hospital readmission prior to scheduled follow-up. These issues highlight gaps in transitional care for patients undergoing ERCP. Therefore, the researchers developed a transitional nursing care model for patients undergoing ERCP.

Objective This study aimed to develop a transitional nursing care model for patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) at Lampang Hospital.

Design This Research and Development employed the ADDIE model as the major conceptual framework for developing the transitional nursing care model. The process consisted of four phases: the analysis phase, which involved assessing the situation, identifying problems and obstacles, and determining the needs for transitional nursing care among patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) at Lampang Hospital; the design and development phase, which focused on constructing the model, verifying its quality, and refining its components; the implementation phase, which entailed piloting the model and examining its outcomes in practice; and finally, the evaluation phase, which assessed the effectiveness of the model.

Methodology Phase 1 involved brainstorming sessions on patient care for those undergoing endoscopic retrograde cholangiopancreatography (ERCP) in the operating theater at Lampang Hospital. Participants were divided into two groups: 1) key informants, consisting of six multidisciplinary team members, one gastrointestinal surgeon, one nurse anesthetist, two operating room nurses, one inpatient ward nurse, and one surgical outpatient nurse; and 2) five patient representatives who had undergone ERCP. Data were collected using a personal information questionnaire and semi-structured interviews, which informed the drafting of the initial model. In Phase 2, the draft model was subjected to quality validation by five experts, piloted with ten patients, and subsequently refined to yield a new model entitled the ERCP Care Model. Phase 3 involved implementing the newly developed model. The sample comprised 20 operating room nurses responsible for ERCP patient care and 60 patients scheduled for ERCP, divided equally into control and experimental groups (30 participants each). Sample size was determined using the G*Power program. Research instruments included the ERCP Care Model, developed based on Naylor et al.’s transitional care framework, a nursing practice manual, patient and family educational leaflets, and an ERCP checklist. Data collection instruments consisted of a patient knowledge test (IOC = .80; KR-20 = .75), a nurse knowledge test (IOC = .80; KR-20 = .77), an anxiety assessment scale (Cronbach’s alpha coefficient, α = .87), a complication record form, and a satisfaction questionnaire (IOC = 1.00; α = .81). All instruments were validated by five experts. In this phase, outcomes before and after implementation were compared, including patient and nurse knowledge, patient anxiety, and incidence of complications. Finally, Phase 4 evaluated the model in terms of satisfaction among both patients and nurses. Data collection was conducted between June 2025 and January 2026. Statistical analyses included descriptive statistics, Paired t-test, Independent t-test, Wilcoxon signed-ranks test, and Chi-square test.

Results The situational analysis revealed that ERCP patient care lacked a systematic guideline, patient and family education was inconsistent, team roles were not clearly defined, and post-discharge follow-up was insufficient. Based on these findings, the transitional nursing care model was developed, validated, and refined to yield the ERCP Care Model, which comprises four core components: E: Engagement & Education, providing knowledge and fostering patient and family participation; R: Responsibility & Readiness, defining responsibilities and preparing the multidisciplinary team; C: Continuity of Care, ensuring seamless care throughout the treatment pathway; and P: Patient Well-being & Prevention, promoting health and preventing complications. Following implementation, patients in the experimental group demonstrated significantly higher post-test knowledge scores compared with the control group (M = 14.50, SD = 2.30 vs. M = 10.40, SD = 2.10; p < .01). Among nurses, knowledge scores increased significantly from M = 11.30 (SD = 1.72) to M = 14.00 (SD = 0.97) (Z = -3.983, p < .001). Experimental group had significantly lower anxiety scores than controls (M = 41.33, SD = 4.87 vs. M = 51.17, SD = 5.41; p < .001). Although complication rates were lower in the experimental group (20.00%) compared with the control group (36.67%), the difference was not statistically significant (p = .252). Patient satisfaction with the model was rated at the highest level (M = 4.85, SD = 0.37), consistent with nurse satisfaction (M = 4.81, SD = 0.40).

Recommendations The ERCP Care Model enhanced the quality of patient care by increasing patient knowledge and reducing anxiety, strengthening nurses’ competencies, and achieving high levels of satisfaction among stakeholders. Moreover, it demonstrated a trend toward reducing post-procedural complications. Therefore, the ERCP Care Model should be adopted as a standard nursing practice guideline in operating rooms for patients undergoing ERCP. In addition, it has potential for adaptation to other endoscopic interventions and same-day surgery.

Factors Predicting Intention of Adequate Protein-Energy Consumption in Patients Undergoing Hemodialysis

Charunya Boonmadong — 2026-09-18

Introduction Malnutrition is recognized as one of the long-term complications in patients with end-stage renal disease (ESRD) undergoing hemodialysis. It predisposes patients to inflammatory processes, increases the risk of cardiovascular disease, and contributes to higher morbidity and mortality rates. The primary causes can be categorized into two domains: 1) patient-related factors and 2) the dialysis process itself. Despite ongoing nutritional health promotion, patients often fail to maintain adequate protein and energy intake over time because sustaining consistent dietary behaviors is challenging. Additional factors may also influence patients’ intention to consume sufficient protein and energy. Investigating the predictors of such intention provides valuable insights for assessing and developing care models to improve nutritional status and clinical outcomes in this population.

Objectives This study aimed: 1) to examine age, nutritional status, attitude towards protein-energy consumption, subjective norm, perceived behavioral control, and intention of adequate protein-energy consumption; and 2) to investigate factors predicting intention of adequate protein-energy consumption among patients undergoing hemodialysis.

Design This study employed a cross-sectional descriptive design to examine predictive relationships, applying Ajzen’s Theory of Planned Behavior as the conceptual framework. The Theory of Planned Behavior posits that most human behaviors are governed by intention, which is influenced by three key determinants: attitude towards behavior, subjective norms, and perceived behavioral control. Attitude is shaped by individuals’ beliefs and evaluations of behavioral outcomes, while learning through life experiences or knowledge transfer fosters positive attitudes and strengthens behavioral intention. Furthermore, people assess their own capability to perform and regulate their behavior. When adequate skills are developed and perceived behavioral control is enhanced, intention is strengthened, thereby increasing the likelihood of actual behavior.

Methodology The study participants comprised 97 patients with end-stage renal disease, both male and female, undergoing hemodialysis. Data were collected between March and May 2023 through purposive sampling. Inclusion criteria were: 1) patients who had received hemodialysis for at least three months; 2) ability to communicate in Thai; 3) patients aged ≥ 60 years who achieved a 6-Item Cognitive Impairment Test (6CIT) score ≤ 7; and 4) clinically stable status without acute complications such as intradialytic hypotension, with the ability to consume food orally. Data collection was conducted during periods of stable vital signs and was discontinued if abnormalities were observed. The research instruments demonstrated reliability coefficients ranging from .67 to .87. Data were analyzed using descriptive statistics, and relationships among study variables were examined using Spearman rank correlation. After confirming normality, predictive analysis was performed using Multiple regression.

Results The study sample consisted of 97 patients with end-stage renal disease undergoing hemodialysis. More than half were male (56.7%), with a mean age of 63.7 years (SD 14.3; ranging from 22–86 years). The majority had attained at least a bachelor’s degree (65.0%), were employed in government service (68.0%), reported sufficient income with savings (70.1%), and utilized civil servant or state enterprise health benefits for themselves or their children (77.3%). The findings revealed that age, nutritional status, attitude towards protein-energy consumption, subjective norms, and perceived behavioral control significantly predicted intention (F 22.564, p < .001), accounting for 55.4% of the variance (R² .554, Adjusted R² .529). Attitude towards protein-energy consumption emerged as the strongest predictor β 0.409, p <.001, followed by subjective norms (β 0.228, p .006), perceived behavioral control (β 0.250, p .016), and age (β 0.166, p .029). However, nutritional status did not significantly contribute to the prediction of intention.

Recommendations The findings should be applied to the development of programs that emphasize the promotion of attitudes towards protein-energy consumption, enhancement of perceived behavioral control, and reinforcement of support from reference groups. Such interventions are expected to strengthen the intention of adequate protein-energy consumption and, consequently, lead to adequate protein and energy consumption.