Journal of Thailand Nursing and Midwifery Council

Effects of a Pre-clinical Preparation Program on Stress in Nursing Students

Sukit Thonepila, Ketnarin Bunklai, Gitipong Pinichpan, Teeradech Sreechat — Tue, 23 Dec 2025 00:00:00 +0700

Introduction Clinical learning management is a vital component of the Bachelor of Nursing Science curriculum, which aims to equip students with the competencies necessary to provide holistic healthcare services to the public. Stress during clinical practice often arises when nursing students encounter expectations, responsibilities, and unfamiliar situations. This phenomenon can be explained through Lazarus and Folkman’s stress theory, which posits that stress results from an individual’s appraisal of the interaction between themselves and their environment. When individuals perceive that a situation exceeds the resources available to them for coping, stress arises. Therefore, adequate preparation in terms of knowledge, skills, and psychological readiness serves to enhance personal resources, restore balance, and mitigate stress. Such preparation provides a foundation for advancing the nursing profession toward greater effectiveness in the future.

Objective This study aimed to compare nursing students’ stress before and after participating in a pre-clinical preparation program prior to clinical practice in inpatient wards.

Design This study employed a quasi-experimental design with one-group pretest–posttest, applying Lazarus and Folkman’s stress theory to develop a preparation program prior to clinical practice in inpatient wards. Stress is conceptualized as the relationship between individuals and their environment, wherein individuals appraise events as having implications for their well-being and requiring the use of personal resources or abilities to adapt, sometimes to the extent of exceeding their coping capacity. In the context of pediatric and adolescent nursing practice, nursing students face unique challenges during their initial clinical experiences. These include the need for specialized communication skills with children of different developmental stages, interactions with parents and families, unfamiliarity with ward personnel and environments, assigned clinical tasks, and supervision by clinical instructors. Each student appraises these situations differently and adopts distinct coping strategies depending on their available resources and limitations. The preparation program was designed as an essential resource to reduce stress among second-year nursing students enrolled in the pediatric and adolescent nursing practicum. The program consisted of three structured activities delivered over four days, totaling 30 hours: 1) Course orientation and review of pediatric and adolescent nursing principles to enhance students’ understanding of practicum details, concepts, and theoretical foundations, 2) Ward orientation by staff nurses to familiarize students with the clinical context, work characteristics, and patient care approaches in each unit, and 3) Preparation in four core nursing skills: (a) growth and developmental assessment, (b) immunization practices, (c) administration of inhalation therapy, suctioning, and oxygen delivery, and (d) administration of oral, injectable, and inhaled medications. These activities were intended to strengthen students’ confidence and competence in pediatric and adolescent nursing practice.

Methodology The study participants comprised 98 nursing students from a nursing educational institution, selected through purposive sampling. The inclusion criteria were as follows: 1) second-year nursing students, enrolled in the Pediatric and Adolescent Nursing Practicum during the second semester of the 2024 academic year; 2) aged 18 years or older, both male and female; 3) able to communicate in Thai through speaking, reading, and writing; and 4) willing to participate in the study. The research instruments included: 1) the readiness program prior to clinical practice in inpatient wards, which was validated for content validity by three experts, yielding a content validity index (CVI) of .89; 2) a general information questionnaire; and 3) the Suan Prung Stress Test (SPST-20), with the original version reporting a Cronbach’s alpha coefficient of .70. Data were collected between January and March 2025. Following participation in the four-day readiness program, students undertook clinical practice in two pediatric wards and one well-child clinic, each for one week according to a rotation schedule. Upon completion of the practicum, students completed the posttest stress assessment. Data analysis was conducted using Paired t-test.

Results The majority of participants were female (91.83%), with a mean age of 20.28 years (SD = 1.00). More than half (58.16%) had a high cumulative grade point average (GPAX). After participating in the preparation program, students’ mean stress score (M = 37.85, SD = 7.51) was significantly lower than their pre-program score (M = 58.64, SD = 12.27), with statistical significance (t = 28.560, p < .001).

Recommendation Clinical learning within the Bachelor of Nursing Science curriculum can incorporate the preparation program prior to ward-based practice as part of the preparatory process to reduce nursing students’ stress before clinical training. This approach enhances students’ competencies in nursing practice, ensuring alignment with the learning outcomes of the course and curriculum. Moreover, it provides a framework for developing nursing practice competencies effectively in accordance with professional standards for the future.

The Effects of Suicide Motivation Inhibition Model on Suicidal Ideation in Patients with Major Depressive Disorder

Wattanaporn Piboonarluk, Sawitree Suriyachai, Wenich Buracharin — Tue, 23 Dec 2025 00:00:00 +0700

Introduction Major depressive disorder (MDD) is one of the most significant global challenges in mental health. It is characterized by persistent emotional distress that may escalate suicidal behavior. Although patients with MDD often receive antidepressant medication, suicidal ideation may persist and, in some cases, result in suicide, particularly during the critical period immediately following hospital discharge. The suicide motivation inhibition model for patients with MDD emphasizes modifying automatic thoughts and problem-solving perspectives, especially those shaped by feelings of defeat and entrapment by their circumstances. This therapeutic approach represents a promising strategy to mitigate suicidal ideation and reduce the risk of suicide.

Objectives To compare suicidal ideation scores between patients with MDD who received standard care incorporating care through the suicide motivation inhibition model, and those who received standard care alone, assessed at baseline, immediately after intervention, two weeks after discharge, and four weeks after discharge.

Design This study employed a two-group experimental design with repeated measures. It applied the Integrated Motivational Volitional (IMV) model of suicidal behavior, combined with principles of cognitive behavioral therapy (CBT) and problem-solving therapy (PST), to develop an intervention framework aimed at inhibiting suicidal motivation among patients with MDD. The intervention was delivered individually over a two-week period, consisting of three sessions per week. Each session incorporated six structured activities: 1) understanding the illness, 2) exploring feelings of defeat and entrapment, 3) identifying automatic thoughts, 4) developing new perspectives, 5) learning problem-solving strategies, and 6) choosing new solutions to address problems.

Methodology The participants comprised patients diagnosed with MDD who met the following inclusion criteria: 1) admission to inpatient psychiatric care within 72 hours, 2) aged between 18 and 60 years, 3) a history of suicide attempt within the past month, 4) a suicidal ideation score of 19 or higher on the Thai version of the Suicidal Ideation Questionnaire, and 5) the ability to listen, speak, read, and write in Thai. A total of 40 participants were recruited through simple random sampling and subsequently assigned to either the experimental group (n = 20) or the control group (n = 20). The experimental group received the suicide motivation inhibition model in conjunction with standard care for a duration of two weeks, while the control group received standard care based on the level of suicide risk. Research instruments included the Suicide Motivation Inhibition Model, which demonstrated a content validity index of .89, and the Thai version of the Suicidal Ideation Questionnaire, which showed a reliability coefficient of .81. Suicidal ideation scores were assessed at four time points: baseline, immediately after intervention, two weeks after discharge, and four weeks after discharge. Data were collected between January and June 2025. Descriptive statistics were used to analyze demographic characteristics, while suicidal ideation scores were compared within and between groups using repeated measures two-way analysis of variance (ANOVA). Pairwise comparisons were further examined using Bonferroni post hoc tests.

Results In the experimental group, the majority of participants were female (60%), with a mean age of 25.05 years (SD = 5.34), and most were single (80%). The predominant method of suicide attempt was drug overdose (55%). The average duration of illness was 2.7 years (SD = 1.55), with a mean of 1.70 prior hospitalizations (SD = 0.73). In the control group, the majority were also female (55%), with a mean age of 26.75 years (SD = 4.68), and most were single (90%). The most common method of suicide attempt was drug overdose (30%). The average duration of illness was 2.85 years (SD = 1.49), with a mean of 1.45 prior hospitalizations (SD = 0.68). Comparative analysis of baseline demographic and clinical characteristics revealed no statistically significant differences between the two groups. Repeated measures two-way ANOVA demonstrated that suicidal ideation scores in the experimental group differed significantly across the four assessment points: baseline, immediately after intervention, two weeks after discharge, and four weeks after discharge (F = 398.160, p < .001). A significant interaction effect was observed between time and the intervention model (F = 12.115, p < .001). Between-group analysis further indicate d that suicid al ideation scores differed significantly between the experimental and control groups (F = 24.945, p < .001). Pairwise comparisons revealed that suicidal ideation scores at baseline were significantly higher than those immediately after intervention (MD = 18.50, p < .001), two weeks after discharge (MD = 17.175, p < .001), and four weeks after discharge (MD = 14.450, p < .001). Additionally, scores immediately after intervention differed significantly from those at two weeks after discharge (MD = -1.325, p < .001) and four weeks after discharge (MD = -4.050, p < .001). Finally, suicidal ideation scores at two weeks after discharge were significantly different from those at four weeks after discharge (MD = -2.725, p < .001).

Recommendation The suicide motivation inhibition model demonstrated effectiveness in preventing suicidal ideation during the 2–4 week period following hospital discharge. Psychiatric nurses can apply this intervention in the treatment of inpatients with MDD in psychiatric hospitals to enhance patient safety and reduce the risk of suicide.

Factors Predicting Health Risk Prevention Behaviors among Adolescents in Urban Communities

Tasaneewan Purksametanan, Thapatlada Kiatlertdecha, Thitiphorn Suwan-ampa — Tue, 23 Dec 2025 00:00:00 +0700

Introduction Adolescence is a developmental stage characterized by significant physical, psychological, and social changes. During this period, adolescents are more likely to engage in health risk behaviors, which constitute a critical concern with long-term implications for overall well-being. This issue is particularly marked in urban communities, where complex social, cultural, and environmental dynamics are rapidly evolving. Investigating the predictive factors of health risk prevention behaviors among adolescents can provide valuable insights for developing effective strategies to reduce health risk behaviors in this population.

Objectives The objectives of this research were to study: 1) the health risk prevention behaviors among adolescents in urban communities; 2) the level of health literacy among adolescents in urban communities; and 3) the factors predicting health risk prevention behaviors among adolescents in urban communities.

Design This study employed a descriptive predictive correlational design, applying the concept of social determinants of health as its theoretical framework. The World Health Organization defines social determinants of health as the conditions in which individuals are born, grow, work, and live, as well as the broader systems that shape daily life, including economic policies, social norms, social policies, and political structures. This perspective highlights the complexity of health problems and emphasizes the need for new paradigms in healthcare, with three key aspects: 1) recognition that the causes of disease and illness extend beyond individual-level factors such as genetics, physiology, or behavior; 2) consideration of holistic influences that affect health across the lifespan; and 3) emphasis on strengthening disease prevention rather than focusing solely on medical treatment. Understanding the social determinants of health provides a foundation for more effective approaches to promoting and protecting individual and population health.

Methodology The sample comprised 382 adolescents enrolled in educational institutions located in the Lak Si district of Bangkok. Participants were selected through multistage random sampling. Inclusion criteria were: 1) being between 13 and 19 years of age, and 2) obtaining parental consent and providing voluntary assent to participate in the study. Data were collected using a self-administered questionnaire consisting of four sections: 1) demographic information, 2) school health service system, 3) a health literacy assessment, and 4) an assessment of health risk prevention behaviors. Data analysis was conducted using descriptive statistics and multiple regression analysis.

Results More than half of the participants were female (55.20%), with a mean age of 15.78 years (SD = 1.73). The majority were enrolled in lower secondary education (59.00%) and reported a grade point average between 3.00 and 4.00 (58.10%). Most adolescents lived with their parents (75.70%), and close friends were identified as the most influential figures in their life decisions (54.90%). Regarding school health service systems, most institutions had policies promoting student health (94.2%), including smoke-free school policies (68.4%), activities to strengthen schools (71.2%), supportive health environments (86.9%), safe and hygienic cafeterias (63.4%), and provision of health information to students (90.6%). Overall, health literacy among participants was at a good level (M = 2.65, SD = 0.15). When examined by domain, all aspects of health literacy were rated good, except for the domain of creating health-related information and activities, which was rated moderate (M = 2.38, SD = 0.13). In contrast, preventive health-risk behaviors were generally poor (M = 1.52, SD = 0.08). By specific domains, only the “3E behaviors” (exercise, eating, and emotional management) were rated moderate (M = 2.22, SD = 0.12), while three domains were rated poor: avoidance of harmful substances (M = 1.11, SD = 0.06), social behaviors (M = 1.37, SD = 0.08), and sexual risk reduction behaviors (M = 1.37, SD = 0.08). Multiple regression analysis using the Enter method revealed that health literacy, educational level, and academic performance significantly predicted health risk prevention behaviors (F = 21.580, p < .001), accounting for 21.5% of the variance (Adjusted R² = 0.215). Health literacy was the strongest positive predictor (β = .620, p < .001), while educational level showed a negative influence (β = –.100, p = .023), and academic performance demonstrated a weak positive influence (β = .090, p = .032).

Recommendation Relevant governmental and private sectors may utilize the findings of this study to develop programs that promote modifiable social determinants of health, with particular emphasis on enhancing health literacy related to risk prevention among urban adolescents. Such initiatives aim to foster more appropriate health risk prevention behaviors among adolescents residing in urban communities.

The Development of a Safe Childbirth Preparation Model for Pregnant Women with Premature Labor

Mon, 29 Dec 2025 00:00:00 +0700

Introduction The care of pregnant women with preterm labor requires thorough preparation to ensure safe childbirth. Hospitalized women with preterm labor often experience considerable stress and heightened anxiety regarding their own health and the well-being of the fetus. Therefore, establishing a clear and structured approach to childbirth preparation enables professional nurses to make accurate and timely nursing diagnoses, closely monitor changes in maternal condition, communicate effectively, and deliver comprehensive nursing interventions. Such systematic preparation contributes significantly to maternal safety from the time of hospital admission through delivery.

Objectives The objectives of this study were: 1) to describe the current situation of childbirth preparation among pregnant women with preterm labor; 2) to develop a model of safe childbirth preparation for women with preterm labor; and 3) to evaluate the outcomes of implementing this safe childbirth preparation model among women with preterm labor in the delivery room at Chonburi Hospital.

Design This study employed a research and development design. The researcher applied the concept of case management and the Plan–Do–Check–Act (PDCA) cycle.

Methodology The study was conducted in three phases. Phase 1 involved describing the situation of safe childbirth preparation among pregnant women with preterm labor at Chonburi Hospital. This phase included a review of medical records of women with preterm labor and focus group discussions. The discussions were divided into two groups: healthcare team (n = 6), consisting of one obstetrician, four professional nurses, and one practical nurse; and postpartum mothers with a history of preterm labor (n = 5). Phase 2 focused on developing a model of safe childbirth preparation for women with preterm labor. Phase 3 examined the outcomes of implementing this model. The study sample comprised 17 professional nurses working in the delivery room at Chonburi Hospital and 50 pregnant women with preterm labor admitted to the delivery room, selected purposively. Sample size was determined using the n4Studies program, and participants were purposively assigned into experimental and control groups (25 per group). Data collection instruments included guidelines for focus group discussions with healthcare team and postpartum mothers with a history of preterm labor, a questionnaire for the model possibility, and an anxiety scale for pregnant women. All instruments were validated for content validity by experts, yielding a content validity index (CVI) of 1.00. Reliability testing using Cronbach’s alpha coefficients demonstrated high internal consistency at .95 for the anxiety scale, .87 for the questionnaire on model possibility, and .74 for the nurse satisfaction scale. Data collection was conducted between December 2024 and May 2025. Data were analyzed using descriptive statistics, Independent t-test, Paired t-test, and Chi-square test.

Results The safe childbirth preparation model for pregnant women with preterm labor developed in this study comprised six key components: 1) assessment of maternal needs across physical, psychological, emotional, social, and spiritual dimensions; 2) evaluation of maternal condition and problem analysis, followed by case management planning with caregiver participation in decision-making, guided by clear information and practice protocols; 3) goal setting and implementation to achieve the defined objectives effectively; 4) collaborative planning with a multidisciplinary team to promote shared responsibility in maternal care; 5) monitoring of maternal self-care practices to ensure appropriateness and accuracy; and 6) outcome evaluation at delivery, including monitoring of gestational age and neonatal safety. Following implementation, results indicated that pregnant women with preterm labor in the experimental group demonstrated significantly lower anxiety levels (M = 16.84, SD = 3.44) compared to their pre-intervention scores (M = 24.20, SD = 4.66) and to the control group (M = 20.44, SD = 1.92) (t = 7.553, p < .001; t = 4.575, p < .001, respectively). The rate of full-term delivery in the experimental group was significantly higher than in the control group (χ² = 4.504, p = .034). However, the incidence of complications, such as palpitation/tachycardia and birth asphyxia, did not differ between groups. Professional nurses adhered to the model and reported satisfaction levels exceeding the target benchmark of 80%, with statistical significance (p < .001).

Recommendation The safe childbirth preparation model developed for pregnant women with preterm labor proved effective in reducing maternal anxiety and promoting full-term delivery. It is recommended that this model be implemented in the care of women with preterm labor and that its outcomes be monitored.

Effectiveness of a Self-Management Program among Patients with Uncontrolled Hypertension

Sathorn Ponpong, Maliwan Silarat, Wasana Ruaisungnoen — Mon, 29 Dec 2025 00:00:00 +0700

Introduction Overweight and obesity are significant factors associated with poor blood pressure control among patients with hypertension. Self-management plays a crucial role in enhancing skills for health behavior modification, which contributes to weight reduction and achieving clinically targeted blood pressure levels.

Objectives This study aimed to examine the effects of a self-management program on self-management behaviors, body weight, and systolic blood pressure among patients with uncontrolled hypertension.

Design This study employed a quasi-experimental design with two groups, pretest and posttest based on the self-management concept. This framework has been proven to be effective in disease control, reducing the risk of complications, and enhancing quality of life among patients with chronic illnesses. The program was developed using the self-management model proposed by Nonglak Methakanjanasak, aiming to comprehensively empower patients in managing their own health. It emphasized the development of four key self-management skills: 1) self-monitoring, 2) performing specific tasks, 3) information seeking, and 4) self-adjusting to accommodate changes in disease progression and treatment. The program was tailored to the context of patients with uncontrolled hypertension, with the goal of promoting weight reduction and lowering systolic blood pressure through the continuous improvement of self-management skills.

Methodology This study was conducted at a hypertension clinic in a tertiary hospital between September 2022 and March 2023. The sample consisted of 60 patients purposively selected according to inclusion criteria: diagnosed with hypertension with uncontrolled blood pressure, not in a critical stage, aged between 18 and 60 years, with a body mass index greater than 25 kg/m², able to communicate in Thai, without limitations in ambulation, capable of using a mobile phone and the LINE application, and willing to participate in the study. Participants were randomly assigned to either the experimental or control groups, with 30 participants in each group, using a lottery method on the day of clinic visit. The research instruments included: 1) a personal information questionnaire; 2) a 25-item self-management behavior questionnaire focusing on dietary control and exercise, validated by five experts with a content validity index of .96 and a Cronbach’s alpha coefficient of .83; and 3) a 12-week self-management program. The program comprised four main activities: (1) self-monitoring, including recording blood pressure, body weight, dietary intake, and step counts; (2) performing specific tasks, such as practicing dietary control, food selection, calorie restriction, and walking with step counting; (3) information seeking, through an 8-minute educational video and additional counseling; and (4) self-adjusting, involving modification of behaviors or activities in response to disease progression and treatment, supported by weekly individual counseling via the LINE application (approximately 5 minutes per session). Data collection included self-management behavior scores, body weight, and systolic blood pressure, which were measured before the intervention and at week 12. Data were analyzed using descriptive statistics and inferential statistics, including Independent t-test and Paired t-test.

Results The mean age of participants in the experimental group (M = 50.02, SD = 7.12 years) and the control group (M = 52.56, SD = 6.01 years) did not differ significantly. After the intervention, the experimental group demonstrated significantly higher mean scores for self-management behaviors in dietary control (M = 2.81, SD = 0.37) compared with the control group (M = 2.53, SD = 0.44; t =2670, p < .01), as well as in exercise behaviors (M = 3.12, SD = 0.51 vs. M = 2.01, SD = 0.68; t = 7.150, p < .001). In addition, the experimental group experienced a greater mean reduction in body weight of 1.90 kg compared with the control group (95% CI: –2.67 to –1.13, t = 5.967, p < .001). Furthermore, systolic blood pressure decreased significantly more in the experimental group than in the control group (mean difference = –10.57 mmHg, 95% CI: –15.56 to –5.57, t = –4.040, p < .001).

Recommendation The self-management program was effective in promoting self-management behaviors, reducing body weight, and lowering systolic blood pressure among patients with uncontrolled hypertension who were overweight. Therefore, healthcare professionals may apply this program in the care of patients with similar contexts, with ongoing monitoring and evaluation to support effective achievement of target blood pressure control.

The Development of Learning Model of Nursing Quality Improvement for the First Line Nurse Executives: A Case Study of University Hospital in the Northern Region

Monthanut Pala — Mon, 29 Dec 2025 00:00:00 +0700

Introduction First-line nurse executives play a pivotal role in driving hospital service quality toward achieving established standards. However, evidence from prior practice suggests that these executives frequently encounter limitations in both experience and understanding of quality development standards, particularly in relation to professional nursing governance. Consequently, the development of appropriate learning models constitutes a critical mechanism for enhancing managerial competencies and advancing the quality of nursing services at the unit level.

Objectives 1) To develop a learning model for nursing quality improvement tailored to first-line nurse executives; 2) To evaluate the outcomes of implementing the learning model in terms of knowledge acquisition and perceived satisfaction among first-line nurse executives.

Design Research and Development (R&D)

Methodology This study employed a developmental research design comprising four sequential phases: Phase 1: Problem and Needs Assessment Examination of existing challenges and the need for a learning model in nursing quality improvement for first-line nurse executives. The sample consisted of 26 first-line nurse executives with less than 10 years of managerial experience in the hospital setting. Data were collected through surveys and focus group discussions. Phase 2: Design and Development Construction of the learning model for nursing quality improvement tailored to first-line nurse executives. The same sample of 26 participants contributed through brainstorming sessions and focus group discussions. Phase 3: Implementation Application of the developed learning model in practice according to the predetermined plan. Phase 4: Evaluation Assessment of the outcomes of the learning model for nursing quality improvement among first-line nurse executives. The sample again comprised 26 participants. Evaluation was conducted using post-test knowledge assessments and surveys measuring executives’ perceptions of the learning model. The content validity of the four research instruments was examined by five experts using the Index of Item-Objective Congruence (IOC). The experts’ assessments were analyzed item by item, and revisions were made for any items with an IOC value below .50. The overall IOC value for the instruments was .92. Specifically, the results were as follows: Survey for Phase 1 (assessment of problems and needs regarding the learning model for nursing quality improvement among first-line nurse executives): IOC = .99; Focus group questions for Phase 1: IOC = .92; Focus group questions for Phase 2: IOC = .80; Expert evaluation form for the learning model: IOC = 1.00. Questionnaire for Phase 4 (evaluation of the learning model based on first-line nurse executives’ perceptions): IOC = .98. The reliability of the questionnaires used in Phase 1 and Phase 4 was tested using Cronbach’s alpha coefficient, yielding values of .99 and .98, respectively.

Results In Phase 1, the current state of nursing quality management was found to be at a moderate level overall (M 3.16, SD 0.62). The lowest mean score was observed in the domain of evaluating the achievement of nursing management goals, which remained at a moderate level (M 3.11, SD 0.52). In contrast, nursing operations were rated at a high level overall (M 3.59, SD 0.63). Within this domain, the lowest mean score was found in monitoring and evaluating nursing outcomes, continuous improvement, and goal achievement (M 3.54, SD 0.74). Focus group discussions revealed several challenges, including heavy workloads, insufficient time for learning, limited knowledge and understanding of professional nursing governance standards, incomplete coverage of nursing quality improvement learning, weak linkage between theory and practice, and an overemphasis on theoretical rather than practical learning. Most first-line nurse managers expressed a preference for a blended, practice-oriented learning model. Phase 2: Design and Development The learning model was designed and developed using active learning principles in combination with hospital and healthcare quality standards (HA, Section II-2.1: Professional Nursing Governance). First-line nurse executives participated in decision-making regarding topics and active learning approaches through brainstorming and focus group discussions. From ten active learning methods presented, three were selected as most preferred: cooperative learning, inquiry-based learning, and project-based learning. The program was structured into two components: a 15-hour nursing management learning program and a 10-hour nursing operations learning program. Content validity was assessed by five experts using the Index of Item-Objective Congruence (IOC), yielding a score of 1.00, indicating the highest level of appropriateness. Phase 3: The developed learning model was implemented, comprising seven topics in nursing management, aligned with HA standards (Section II-2.1a), totaling 900 minutes (15 hours), and four topics in nursing operations, aligned with HA standards (Section II-2.1b), totaling 600 minutes (10 hours). The sessions were scheduled at times convenient for the participating first-line nurse executives. Phase 4: Evaluation of the learning model outcomes, based on the perceptions of first-line nurse executives, indicated that knowledge and understanding in nursing management reached the highest level (M 4.52, SD 0.59), as did nursing operations (M 4.56, SD 0.56). Satisfaction with the learning model was also rated at the highest level for both nursing management (M 4.62, SD 0.57) and nursing operations (M 4.20, SD 0.50). Post-test knowledge scores averaged 87.75% in nursing management and 96.69% in nursing operations. Follow-up conducted three months after implementation demonstrated tangible outcomes, including the development of a complete Service Profile, comprehensive nursing supervision plans, unit-level quality improvement projects and activities, continuous quality improvement (CQI) initiatives and innovations, as well as disease-specific nursing care and discharge plans.

Recommendation The newly developed learning model for nursing quality improvement provides an effective approach to strengthening the competencies of first-line nurse executives. It addresses organizational needs and serves as a prototype for future scaling and broader application. This model can be adapted for training nurse managers in other institutions, and long-term follow-up is recommended to examine its sustained impact on managerial practice and service quality outcomes.

Effectiveness of the Training Program for Prison Health Volunteers in Caring for Prisoners with Diabetes and Hypertension

Sitthiphon Thongkhram, Lukawee Piyabanditkul — Mon, 29 Dec 2025 00:00:00 +0700

Introduction Non-communicable diseases (NCDs), particularly diabetes and hypertension, represent major health challenges within correctional facilities, with prevalence rates continuing to rise. The increasing incidence of NCDs among incarcerated populations mirrors the upward trend observed in the general population outside prisons, thereby intensifying the demand for healthcare services. However, the limited number of medical personnel available in correctional institutions poses significant constraints. Reliance solely on healthcare professionals is insufficient to ensure comprehensive and continuous care for the growing number of inmates affected by chronic conditions. To address this issue, the Department of Corrections has implemented a policy to strengthen the prison healthcare system through the training of Prison Health Volunteers (PHVs). These trained volunteers are equipped to assist health staff in providing basic healthcare services to fellow prisoners, particularly those living with diabetes and hypertension. Their role includes supporting self-care practices, promoting appropriate health behaviors, and reducing the risk of complications. Consequently, PHVs play a vital role in advancing sustainable health promotion within prisons, despite the limitations in healthcare resources.

Objective This study aims to examine the effectiveness of the Prison Health Volunteer (PHV) training program in supporting the care of inmates with diabetes and hypertension. The specific objective is to compare participants’ disease-related knowledge, skills, values and attitudes toward the role of PHVs in caring for prisoners with diabetes and hypertension, both before and after the training program.

Design This quasi-experimental study employed a one-group pretest–posttest design. The researchers developed a training curriculum for Prison Health Volunteers (PHVs) in accordance with correctional facility regulations. The curriculum was grounded in Kolb’s experiential learning model, which emphasizes knowledge construction through prior experience, reflective observation, conceptualization, and application. In addition, the program integrated and adapted elements from the existing Village Health Volunteer (VHVs) training framework to suit the prison context. The training program comprised a total of 75 hours, including 15 hours of theoretical instruction and 60 hours of practical training. It was structured around four core activities: 1) Sharing Experience, 2) F rom Awareness to Understanding, 3) S ummarizing for Meaningful Practice, and 4) P racticing for Skill Development.

Methodology The study sample consisted of 27 prisoners who completed the Prison Health Volunteer (PHV) training program between 2020 and 2023 at a correctional facility located in northeastern Thailand. The sample size was calculated using the G*Power software, and participants were selected through stratified random sampling based on their PHV responsibilities in providing healthcare services across different prison zones. Data collection was conducted between March and April 2025. Two sets of research instruments were employed: 1) A training instrument, specifically the PHV training curriculum for the care of inmates with diabetes and hypertension, and 2) Data collection instruments: (1) A knowledge assessment on diabetes, hypertension, and health communication, (2) A skills assessment for inmate care related to diabetes and hypertension, and (3) An evaluation of values and attitudes toward the PHV role in caring for prisoners with diabetes and hypertension. The quality of the instruments was examined by experts. The content validity index (CVI) of the training curriculum was 1.00, while the CVI for the knowledge, skills, and values/attitudes assessments was .97. Reliability testing indicated that the knowledge assessment had a Kuder–Richardson Formula 20 (KR-20) coefficient of .76, whereas the skills and values/attitudes assessments demonstrated Cronbach’s alpha coefficients of .89 and .71, respectively. Data were analyzed using descriptive statistics and Paired t-test.

Results The majority of participants were male (92.6%), with a mean age of 35 years (SD = 6.81). Most had attained secondary-level education (77.7%). Regarding their experience as Prison Health Volunteers (PHVs), more than half had served for at least two years (55.6%). Only 37% had previously received training in the care of people with diabetes and hypertension, while the majority (66.7%) reported prior experience in caring for patients with these conditions before incarceration. After the training program, participants demonstrated statistically significantly higher scores across all measured domains. The mean knowledge score increased from 13.48 (SD = 2.20) before training to 17.85 (SD = 1.40) after training (t = -9.034, p < .001). Similarly, the mean skills score rose from 13.07 (SD = 1.54) to 17.66 (SD = 1.70) (t = -10.339, p < .001). In addition, the mean score for values and attitudes toward the PHV role increased from 3.04 (SD = 0.39) to 3.54 (SD = 0.28), with statistical significance (t = -5.105, p < .001).

Recommendation The findings indicate that this training program can serve as a model for developing Prison Health Volunteers (PHVs), enhancing their competencies in the care of prisoners with diabetes and hypertension. The program strengthens both proactive health promotion roles and supportive functions for medical personnel, particularly in correctional facilities with similar contexts and organizational structures.

The Development of a Holistic Nursing Model for Preterm Infants to Promote Growth and Reduce Complications in the Neonatal Intensive Care Unit

Karaked Panturat, Sanyalak Suttana, Chintana Chaitham — Mon, 29 Dec 2025 00:00:00 +0700

Introduction Preterm infants admitted to neonatal intensive care units often present with immature organ systems, particularly the respiratory, neurological, and immune systems. This immaturity contributes to delayed growth, low birth weight, increased risk of severe complications, and long-term developmental abnormalities. Therefore, a holistic nursing approach is essential to promote optimal growth and minimize complications.

Objectives The objectives of this study were: 1) To examine the current situation and problems in providing nursing care for preterm infants admitted to the neonatal intensive care unit at Phrae Hospital, 2) To develop a holistic nursing model for the care of preterm infants, and 3) To evaluate the outcomes of implementing the holistic nursing model for preterm infants in the neonatal intensive care unit at Phrae Hospital.

Design This study employed a research and development with historical controlled design, guided by Donabedian’s service quality framework, which includes structure, process, and outcomes.

Methodology The study participants consisted of registered nurses, mothers, and preterm infants admitted to the neonatal intensive care unit at Phrae Hospital between March and July 2025. A purposive sample of 15 professional nurses was selected, while 48 preterm infants were recruited through simple random sampling and divided equally into experimental and control groups (24 infants per group). The research instruments included 1) a data collection form for the development of a holistic nursing model for preterm infants, 2) a semi-structured focus group discussion guide, 3) the holistic nursing practice guidelines for preterm infants developed in this study, 4) a compliance record for adherence to the holistic nursing practice guidelines (content validity index = .98), 5) a patient-assigned primary nursing system, 6) a satisfaction questionnaire for primary nurses, and 7) a satisfaction questionnaire for mothers regarding holistic nursing care. All instruments except for item 4 demonstrated a content validity index of 1.00. Qualitative data were analyzed using content analysis, while quantitative data were analyzed using Descriptive statistics (frequency, percentage, mean, and standard deviation) and Inferential statistics (Chi-square test and t-test).

Results 1) Situation analysis revealed that challenges in the care of preterm infants were identified, with an emphasis on crisis management through the critical phase while psychosocial care was insufficient. Family and maternal involvement in care planning was limited. In terms of care processes, continuity and integration of care plans were lacking, resulting in inconsistent practices. A unified, evidence-based approach centered on the infant and family, from admission through discharge, was therefore needed. 2) The Holistic Nursing Model for Preterm Infants comprised 2.1) Holistic Nursing Practice Guidelines: These guidelines included seven nursing activities that influenced the quality of care across three stages, initial admission care, post-crisis care, and discharge care. Each stage applied the five steps of the nursing process to ensure systematic and comprehensive care, 2.2 Primary Nursing Assignment System: Implementation of a patient-assigned primary nursing system, along with monitoring adherence to the holistic nursing practice guidelines, 2.3 Nurse Training and Competency Development: Provision of education and competency-building programs to strengthen nurses’ knowledge and skills in delivering holistic care for preterm infants. 3) Outcomes of Model Implementation: The development and application of the holistic nursing model resulted in a statistically significant increase in infant weight gain, averaging more than 20 grams per day (p = .036). Major complications, including bronchopulmonary dysplasia and ventilator-associated pneumonia, were significantly reduced compared with the conventional care group (p < .05). Furthermore, the length of hospital stay was significantly shortened (p < .001). Satisfaction with the holistic nursing model was rated at the highest level by primary nurses and at a high level by mothers of preterm infants.

Recommendation Neonatal intensive care units can apply the holistic nursing model for preterm infants to align with their specific contexts. The implementation of this model has resulted in positive outcomes, including improved weight gain and enhanced safety through a reduction in complications. These benefits are attributed to the continuity of care, the individual accountability of primary nurses, and the collaborative efforts of the multidisciplinary team. Consequently, the model has contributed to high levels of satisfaction among both mothers and healthcare personnel.

Transcultural Nursing Communication: Essential Skills in the 21st Century

Suree Trumikaborworn, Praneed Songwathana — Mon, 29 Dec 2025 00:00:00 +0700

In the 21st century, global health has been characterized by profound transformations, including demographic shifts, the increasing complexity of social problems, and growing cultural diversity, which directly influence healthcare systems. Within this context, cross-cultural communication has become a critical competency for nurses, enabling them to 1) assess, 2) identify problems, and 3) plan nursing care that is responsive to the needs of service users. As frontline providers, nurses must possess a deep understanding of cross-cultural communication to ensure effective and equitable care delivery. This article, therefore, aims to: 1) review key factors influencing cross-cultural communication, including the assessment of communication culture between senders and receivers and the essential skills required for nursing practice; and 2) propose practical guidelines for its application. Cross-cultural communication is shaped by multiple dimensions: 1) receiver-related factors, including physical readiness, language proficiency,attitudes, knowledge and experience related to the subject matter, and listening skills; 2) sender-related factors, including language ability, cultural understanding, positive attitudes toward caring for people from diverse backgrounds, and cultural competence or sensitivity; and 3) environmental factors, such as the communication setting, conversational atmosphere, the ability to foster a positive environment, and touch. Nurses should demonstrate competencies in two major areas: 1) assessing the communication culture of both senders and receivers, taking into account beliefs about health authority, emotional expression, information-seeking behaviors, eye contact, and perceptions of time; and 2) applying cross-cultural communication skills in practice, including deep listening, validation, feedback, focusing, mirroring, rapport, self-disclosure, and therapeutic relationship. Guidelines for effective cross-cultural nursing communication include: 1) assessing the beliefs of people from diverse cultural backgrounds; 2) identifying factors that may influence or hinder communication between nurses and patients; 3) planning and implementing nursing interventions; 4) adjusting communication methods to align with cultural needs and backgrounds; 5) delivering information and education through culturally appropriate strategies; 6) employing suitable communication techniques and attitudes; 7) monitoring and following up regularly; 8) utilizing interpreters to enhance understanding when necessary; 9) ensuring attentiveness and continuity of communication; and 10) collaborating with interpreters under clear ethical standards and protocols. Enhancing nurses’ cross-cultural communication competence is a vital strategy for improving the quality of nursing care in the 21st century. Recommendations are as follows: 1) institutions should provide in-service education to prepare nurses in language proficiency, cultural understanding, and problem-solving skills related to cultural differences, which are expected to increase continuously; and 2) communication applications may be used to support practice, though their limitations must be carefully considered to prevent errors in patient care.

Analysis and Evaluation of Nursing Theory: A Case Study of Peplau’s Interpersonal Relations Theory

Suphakit Krueaklat, Pisan Pachachoo, Wongduan Suwannakeeree, Orapin Jullmusi — Mon, 29 Dec 2025 00:00:00 +0700

The analysis and evaluation of nursing theory constitute a systematic process of examining theoretical frameworks to identify their strengths, limitations, and applicability within diverse professional nursing contexts. This article applies McEwen’s conceptual framework for theory analysis and evaluation, which consists of three stages: description, analysis, and evaluation. The interpersonal relations theory of Peplau is employed as a case study. Findings of this analysis and evaluation: 1) Theory description: Peplau’s theory is classified as a middle-range theory, developed through both inductive and deductive approaches. Its primary aim is to explain the relationship between nurses and patients. Four central concepts are identified: psychobiological experiences, the role of the nurse, phases of the nurse–patient relationship, and core psychological tasks. The theory includes the major paradigms of nursing: person, health, nursing, and environment; 2) Theory analysis: The four theoretical concepts are clearly defined. Relationships among the concepts, particularly the nurse’s role, phases of the nurse–patient relationship, and psychological tasks, are acknowledged, though the directionality of these relationships is not specified. Terminology is consistently used to represent concepts, their interrelationships, and the underlying assumptions of the theory. The arrangement of concepts is logical, and the outcomes of the theory are explicitly articulated in relation to nursing practice, patient care, and interpersonal relationships; 3) Theory evaluation: The theory demonstrates congruence with the nursing process and is applicable across education, research, practice, and administration. It emphasizes the importance of diverse sociocultural contexts. Empirical evidence indicates that the theory has been tested through research employing reliable statistical methods. It contributes to the advancement of the nursing profession by serving as a holistic framework for patient care, from admission to discharge, and has been further developed to generate new nursing knowledge and theories; 4) Key strengths of the theory include its alignment with the nursing metaparadigm and nursing process. The theory is adaptable to a wide range of global contexts and applicable across education, research, practice, and administration. It highlights the nurse–patient relationship and supports its appropriate development and growth; 5) Limitations of the theory include the absence of a clearly defined concept regarding nurses’ professional growth, incomplete definitions of certain conceptual relationships, and the lack of specified directionality among concepts, which may hinder clarity. Furthermore, empirical testing of diverse conceptual relationships remains limited. These findings support the practical application of the theory and provide guidance for the ongoing development of nursing knowledge as appropriate for dynamic and diverse contexts.

Editorial

ศาสตราจารย์ ดร. นพวรรณ เปียซื่อ — Tue, 23 Dec 2025 00:00:00 +0700