Journal of Thailand Nursing and Midwifery Council

Full issue

Professor Dr. Noppawan Piaseu — Wed, 09 Apr 2025 00:00:00 +0700

Editorial Note

Professor Dr. Noppawan Piaseu — Wed, 09 Apr 2025 00:00:00 +0700

Nursing Management of Patients with CAR T-cell Therapy: A Case Study

Thachamon Sinsoongsud, Porawan Witwaranukool — Wed, 09 Apr 2025 00:00:00 +0700

Cell therapy is an emerging treatment technology for hematologic cancers. It utilizes genetic engineering knowledge to modify T-cell receptor molecules to bind to specific proteins on the surface of cancer cells, without relying on the expression of genes and proteins on the cancer cell surface. This allows cell therapy to target and kill cancer cells precisely. Nurses play a crucial role in caring for patients undergoing cell therapy, from the admission process to assessing physical and mental readiness. These patients often endure suffering from multiple chemotherapy and/or radiotherapy regimens, leading to physical decline and anxiety due to previous treatment failures. Fear of disease recurrence or ineffective cell therapy constantly troubles patients. Establishing a relationship between nurses and patients is essential. Listening to patients’ thoughts and feelings about the treatment, their past experiences with illness, and assessing their understanding of cell therapy helps nurses gain deep insights into patients. Providing treatment information at appropriate times, informing patients about potential side effects such as fever, low blood pressure, or low blood oxygen levels, teaching patients to keep records, and instructing relatives to observe patients’ behavior, speech, and memory during treatment can be initiated from the first day of hospitalization. Any changes after cell therapy must be reported to the medical team immediately, as they may indicate complications such as acute inflammatory cytokine release syndrome or neurological disorders. Listening, providing information, and co-designing self-care processes with patients help alleviate anxiety, build trust in nurses, and foster cooperation with the treatment team, leading to positive nursing outcomes. This article aims to analyze patients’ health problems to enhance nurses’ understanding of risk factors, symptoms, and laboratory findings related to complications from cell therapy, and the role of nurses in managing these complications. This knowledge enables nurses to anticipate potential complications and provide timely assistance, reducing patient mortality. The case study involves a patient with stage 4 (diffuse large B-cell lymphoma) lymphoma, with lesions in the central nervous system and refractory disease, classified as having a poor prognosis. After responding to the third chemotherapy regimen, the patient continued treatment with cell therapy. During hospitalization, complications to monitor include: 1) tumor lysis syndrome, 2) acute inflammatory cytokine release syndrome, 3) neurological disorders known as ICANS, 4) severe acute allergic reactions, and 5) bone marrow suppression leading to low blood cell counts. Post-discharge, during the follow-up period after cell therapy, the patient is at risk of infection due to immune system dysfunction. During this period, patients must continue self-care at home. The total hospitalization period was 30 days. Laboratory follow-up over nine months revealed immune system dysfunction, with no detectable B-cell activity due to cell therapy’s inability to distinguish between normal and cancerous B-cells sharing the CD19 antigen. Immunoglobulin G levels, which protect against infections, were below standard, increasing the patient’s infection risk. Educating patients on self-care post-discharge and enhancing communication channels between the hospital and patients will boost patients’ confidence in self-care, adaptation, acceptance of treatment plans, and appropriate self-care.

The Relationships between Health Beliefs, Perceived Self-Efficacy, and Coronary Artery Disease Prevention Behaviors among Patients with Uncontrolled Hypertension

Sireeruk Wayobut, Apinya Wongpiriyayothar — Wed, 09 Apr 2025 00:00:00 +0700

Introduction Uncontrolled hypertension is a major cause of coronary artery disease. The patients can reduce their risk of coronary artery disease by adopting appropriate health behaviors.

Objectives This study aimed to 1) describe the health beliefs, perception of self-efficacy, and coronary artery disease prevention behaviors among patients with uncontrolled hypertension, and 2) examine relationships between health beliefs about coronary artery disease, perceived self-efficacy in coronary artery disease prevention, and coronary artery disease prevention behaviors among patients with uncontrolled hypertension.

Design This study employed a descriptive correlational design using the Health Belief Model as a conceptual framework. The model’s five factors influencing health behaviors were selected for the study, including perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and perceived self-efficacy.

Methodology The study participants comprised 80 patients with uncontrolled hypertension who received services at a community health center of a hospital in the northeastern region. Participants were randomly selected using a random number table. The inclusion criteria were: 1) blood pressure > 140/90 mmHg, 2) aged 18 years and over, and 3) absence of comorbidities. The exclusion criteria included: 1) presence of abnormal symptoms during data collection, such as headaches and dizziness, and 2) complications of hypertension. The research instruments included questionnaires assessing: 1) health beliefs about coronary artery disease, 2) perceived self-efficacy in coronary artery disease prevention, and 3) coronary artery disease prevention behaviors. The content validity indices of the instruments were 0.93, 1.0, and 1.0, respectively. The reliability coefficients were 0.87, 0.72, and 0.70, respectively. Data were collected between March and April 2024. The data were then analyzed using descriptive statistics and Pearson’s product-moment correlation coefficients.

Results The majority of the participants were female (58.80%), older adults (57.50%), and had blood pressure levels between 140/90 and 159/99 mmHg (82.50%). Regarding health beliefs, the mean scores for perceived susceptibility to the risk of coronary artery disease (M = 3.08, SD = 0.42), perceived severity of coronary artery disease (M = 3.53, SD = 0.58), and perceived benefits of coronary artery disease prevention practices (M = 3.20, SD = 0.45) were at a moderate level. The mean score for perceived barriers to coronary artery disease prevention practices (M = 3.84, SD = 0.40) was at a high level. The mean scores for perceived self-efficacy in coronary artery disease prevention (M = 2.58, SD = 0.36) and coronary artery disease prevention behaviors (M = 3.47, SD = 0.34) were at a moderate level. The results of the correlation analysis indicated that perceived susceptibility to the risk of coronary artery disease, perceived benefits of coronary artery disease prevention practices, and perceived self-efficacy in coronary artery disease prevention had significant positive correlations with coronary artery disease prevention behaviors (r = .191, r = .500, and r = .714, respectively, p < .05). Conversely, perceived barriers to coronary artery disease prevention practices had a significant negative correlation with coronary artery disease prevention behaviors (r = -.593, p < .05). However, perceived severity of coronary artery disease did not show a correlation with coronary artery disease prevention behaviors.

Recommendation Nurses should develop strategies to promote health beliefs about coronary artery disease, focusing on enhancing perceived susceptibility, perceived benefits, and perceived barriers to practices, and promoting perceived self-efficacy among patients with uncontrolled hypertension to perform appropriate behaviors to prevent coronary artery disease.

Relationships among Oral Care Behaviors, Quality Relationship of Family Caregivers, and Nutritional Status of Older Adults with Colorectal Cancer Undergoing Chemotherapy

Wed, 09 Apr 2025 00:00:00 +0700

Introduction Older adults with colorectal cancer undergoing chemotherapy are at risk of malnutrition due to a combination of complex disease conditions, frequent and ongoing treatments, side effects of treatment, and the aging process, which collectively increase energy requirements. Maintaining good nutritional status plays a crucial role in enhancing recovery during treatment, ensuring treatment proceeds as planned, and reducing the incidence of severe complications. Additionally, oral care behavior is associated with the nutritional status of older adults, contributing to the alleviation and prevention of severe complications, as well as reducing barriers to food consumption. This positively affects overall quality of life. Furthermore, support and care from family caregivers, both in hospital settings and continuing care at home, are of paramount importance.

Objectives This study aimed to 1) describe the nutritional status of older adults with colorectal cancer undergoing chemotherapy, and 2) examine the relationship between oral care behaviors, the quality relationship of family caregivers, and the nutritional status of older adults with colorectal cancer undergoing chemotherapy.

Design This study employed a descriptive correlational design, utilizing literature reviews of factors associated with the nutritional status of older adults with colorectal cancer undergoing chemotherapy.

Methodology The sample consisted of 110 older adults aged 60 years and over and 110 family caregivers who met the inclusion criteria. The research instruments included screening tools, which were the Mini-Cog, with a Cronbach’s alpha coefficient of .810, and the Barthel Activities of Daily Living Index, with a Cronbach’s alpha coefficient of .723. The researchers conducted content validation test through expert review by three specialists and then analyzed reliability coefficients to ensure the quality of the instruments. Data were collected through structured interviews using 1) a demographic questionnaire for older adults, an oral care behaviors questionnaire yielded an Item-level content validity index (I-CVI) of .920 and Cronbach’s alpha coefficient of .890, and a mini nutritional assessment, a Cronbach’s alpha coefficient of .723; 2) a demographic questionnaire for family caregivers and the Thai quality relationship scale for family caregivers of patients with cancer, a Cronbach’s alpha coefficient of .890; and 3) The World Health Organization classification of oral mucositis, a Cronbach’s alpha coefficient of .706. Data were collected through structured interviews. Data were then analyzed using descriptive statistics, Pearson correlation coefficient, and Spearman’s correlation.

Results The sample had an average age of 66.43 years (SD = 5.67). The majority were married (75.45%), more than half were male (54.55%), and were at risk of malnutrition (57.27%). Approximately one-third were malnourished (33.64%). Most had good oral care behaviors (86.36%). The highest severity of oral mucositis was found at level 2. The quality relationship of the family caregivers, particularly in terms of affection, was the highest. Oral care behaviors were positively correlated with the quality relationship of the family caregivers (r = .240, p < .05). The quality relationship of the caregivers was positively correlated with the nutritional status of older patients undergoing chemotherapy from the 6th cycle onwards (r = .443, p < .001). However, oral care behaviors was not significantly correlated with nutritional status.

Recommendation The results of this study provide basic health information and are beneficial for older patients with colorectal cancer undergoing chemotherapy. Gerontological nurse practitioners can apply these findings in screening, assessment, and promoting the quality relationships of family caregivers to enhance oral care behaviors and improve the nutritional status of older adults with colorectal cancer undergoing chemotherapy.

Factors Associated with Family Caregiver’s Fall Preventive Behaviors for Older Adults with Low Vision

Auraiwan Somjai, Phichpraorn Youngcharoen, Apinya Siripitayakunkit — Wed, 09 Apr 2025 00:00:00 +0700

Introduction Older adults with low vision usually have visual impairments associated with eye diseases, leading to reduced vision, decreased ability to focus, difficulty distinguishing colors, trouble adjusting to low-light conditions, and a narrowed field of vision. They also encounter difficulty perceiving depth and may have difficulty seeing peripheral images, resulting in inaccurate distance judgment, leading to accidental collisions and an increased risk of falling. In addition, older adults often experience physical degeneration, which affects their balance and movement, further increasing the risk of falls. Older adults with low vision often experience a self-care deficit, which makes them reliant on family caregivers. Therefore, family caregivers play a crucial role in reducing fall risks by assisting with physical tasks and activities of daily living and providing close supervision. They are also responsible for improving environmental safety, particularly in areas where falls have previously occurred. Encouraging older adults to engage in physical exercises and adhere to fall prevention guidelines is essential. Family caregivers who demonstrate appropriate fall preventive behaviors are vital in minimizing the risk of falls and the resulting harm to these older adults.

Objective This study aimed to investigate the relationships among family caregivers’ fall preventive knowledge, fear of falling, experience in caring for older adults, and fall preventive behaviors in older adults with low vision.

Design A descriptive correlational design was used in this study. The Orem’s self-care agency theory was applied as a conceptual framework. According to Orem’s theory, self-care ability refers to the capacity of an individual to provide care to someone who needs support through deliberate actions with defined goals and who can predict, adapt, and implement actions to meet the comprehensive care needs of the dependent person. The ability to care for older adults involves the caregiver’s capability to perform self-care actions, the ten power abilities, and the fundamental skills and attributes required. The ten power abilities support deliberate self-care, encouraging family caregivers to seek knowledge on self-care and develop skills using thinking and reasoning. Additionally, when family caregivers have prior experience in caring for older adults, they tend to learn, develop skills, and become more proficient in providing appropriate care. Moreover, if caregivers have a fear of falls, this can lead to better prediction of fall risks for older adults.

Methodology Participants were family caregivers aged 18 years and older who provided direct care for older adults (aged 60 and above) with low vision who were appointed at the ophthalmic outpatient department and low vision clinic at two university-affiliated hospitals in Bangkok from August to November 2023. Participants were purposively selected based on the following inclusion criteria: 1) The caregiver must be a family member with a close relationship, living in the same household, and the primary caregiver of an older adult with low vision; 2) The caregiver must be providing care for older adults with moderate to severe dependency, as assessed by the Chula ADL Index, with a score of 9 or lower; 3) If caregivers are 60 years or older, the 6CIT score must be 7 or lower; 4) The caregiver must be fully conscious and proficient in the Thai language, including listening, reading, and writing; and 5) The caregiver must voluntarily agree to participate in the study by signing the consent form. Exclusion criteria included caregivers of older adults who were bedridden. The sample size was determined using the G*power program version 3.1.9.7 with a significance level of .05, with a power set at .80, and an effect size of 0.29, resulting in a sample size of 91 participants. The researchers increased the sample size by approximately 10% to account for incomplete data. Therefore, the study included 100 participants. Data were collected using the demographic questionnaire, the fall preventive knowledge questionnaire, the fear of falling questionnaire, and the fall prevention behavior questionnaire. The reliability of the fall knowledge assessment tool was tested using the Kuder-Richardson coefficient, which yielded a value of .82. The fear of falling questionnaire and the fall prevention behavior questionnaire had Cronbach’s alpha coefficients of .82 and .85, respectively. Data were analyzed using descriptive statistics, Pearson’s correlation coefficient and Spearman’s rank correlation coefficients.

Results The majority of family caregivers (64%) were female, with a mean age of 44 years (SD = 12.63), and completed a bachelor’s degree (51%). The duration of care ranged from 1 to 12 years, with a mean of 4.22 years (SD = 2.95). Approximately one-fourth of caregivers had two years of experience in caring for older adults with low vision (24%). The mean score for fall preventive knowledge was 15.59 (SD = 2.47). The mean score for fear of falling was 20.29 (SD = 2.70), and the mean score for fall preventive behaviors was 67.87 (SD = 6.74). Factors significantly associated with fall preventive behaviors included fall preventive knowledge (r = .197, p < .05) and fear of falling (r = .599, p < .01). However, experience in caring for older adults was not significantly associated with fall preventive behaviors (rs = -.114, p > .05).

Recommendation The study results highlight the importance of fall preventive behaviors among family caregivers of older adults with low vision. The results can serve as preliminary data for future research on the factors predicting fall preventive behaviors in family caregivers of older adults. Additionally, the results can contribute to developing guidelines focused on educating family caregivers about environmental modifications and promoting exercises that enhance balance to prevent falls in older adults.

Social Determinants of Health Predicting Asthma Control in Patients with Asthma

Waraporn Testong, Warunee Phligbua, Doungrut Wattanakitkrileart — Wed, 09 Apr 2025 00:00:00 +0700

Introduction Despite the advancements in asthma treatment approaches and medications, the prevalence rate of good asthma control remains low, leading to hospitalizations and emergency visits from exacerbations among patients. The primary goals of asthma control are to reduce emergency visits and hospitalizations due to acute asthma exacerbations and to improve quality of life. The social determinants of health affecting asthma control were the focus of this study, which will lead to more effective short-term and long-term asthma control approaches.

Objective This study aimed to examine factors including income sufficiency, health literacy, environments at risk of asthma exacerbation, adherence to inhaled corticosteroids, fear of asthma symptoms, and barriers to receiving care in predicting asthma control that predict asthma control in patients with asthma.

Design This study was descriptive research with a cross-sectional design, using the concept of social determinants of health as the conceptual framework, explaining that a person’s disease control is not merely influenced by individual, genetic, physiological, or behavioral factors. It may also be caused by social and environmental factors in which a person lives. These factors may contribute to differences in health determinants among individuals, ultimately influencing health outcomes and health equity.

Methodology The sample consisted of 130 asthma patients who attended follow-up appointments at the outpatient department of a tertiary hospital in Bangkok from February to April 2024. The sample size was determined using power analysis principles with the G*Power software for logistic regression analysis. The significance level was set at an alpha (α) of .05, the power of test at .80, and an odds ratio of 3.64, based on previous research studying adherence to inhaled corticosteroids and clinical control outcomes in asthma patients. Through purposive sampling, the inclusion criteria were 1) aged 20 years and older and 2) diagnosed with asthma and used inhaled corticosteroids for at least 3 months. Instruments included a personal information and medical history questionnaire, the Hill-Bone Medication Adherence Scale (HB-MAS), the Environment at Risks of Asthma Exacerbation Questionnaire, the Barriers to Receiving Care Questionnaire, the Fear of Asthma Symptoms Scale (FAS), the short version of the European Health Literacy Survey (HLS-EU-Q16), and the Asthma Control Questionnaire based on the GINA guideline 2023. The quality of the instruments was evaluated by determining their reliability. The Cronbach’s alpha coefficients were used for assessing the reliability of the research instruments as follows: the HB-MAS, the Environment at Risks of Asthma Exacerbation Questionnaire, the Barriers to Receiving Care Questionnaire, and the FAS were equal to .83, .71, .75, and .87, respectively. Additionally, the Kuder-Richardson-20 was used to assess the reliability of the HLS-EU-Q16 and the Asthma Control Questionnaire, obtaining values of .87 and .83, respectively. Data were collected using self-administration and were analyzed using descriptive statistics and logistic regression.

Results More than half of the sample was aged 60 – 79 years (56.10%) and female (66.90%). Less than half of the sample (39.20%) had a monthly income of less than 10,000 baht, while 43.10% had insufficient income. The factors correlated with asthma control were found to be environments at risk of asthma exacerbation (c2 = 20.615, p < .001), adherence to inhaled corticosteroids (c2 = 16.830, p < .001), fear of asthma symptoms (c2 = 14.282, p < .001), and barriers to receiving care (c2 = 13.593, p < .001). Environments at risk of asthma exacerbation and adherence to inhaled corticosteroid use were able to predict asthma control with statistical significance (OR = 7.08, 95%CI = 2.27, 22.08, p < .001 and OR = 13.15, 95%CI = 2.21, 78.18, p = .005, respectively).

Recommendation According to the findings in this study, nurses should prioritize the assessment of environmental factors and patient adherence to inhaled corticosteroid use. This approach enables asthma patients to avoid risky environments and promotes adherence to inhaled corticosteroid use.

The Effects of an Aggression Management Program on Risk of Violence in Male Schizophrenia Patients

Wed, 09 Apr 2025 00:00:00 +0700

Introduction Schizophrenia is a psychiatric disorder characterized by abnormalities in brain neurotransmitters, resulting in disturbances in emotional regulation, cognitive processes, perception, and general behaviors. Patients diagnosed with schizophrenia demonstrate a higher propensity for violent behavior compared to the general population, particularly in male patients, who exhibit a higher incidence of aggressive behaviors than females. Aggressive behaviors exhibited by patients with schizophrenia have profound effects on the patients themselves, disrupt familial relationships, and evoke apprehension within society. Such behaviors pose threats to both life and property, affecting the patients and those in their vicinity, leading to substantial social and economic ramifications. Due to these severe implications, patients exhibiting violent behaviors are considered psychiatric emergencies that necessitate immediate and comprehensive intervention.

Objectives 1) To compare the risk scores for violent behavior among male patients with schizophrenia within the experimental group at pre-intervention, post-intervention, and two-week follow-up phases, and 2) To compare the risk scores for violent behavior between the experimental and control groups of male patients with schizophrenia at pre-intervention, post-intervention, and two-week follow-up phases.

Design A quasi-experimental design with two-group repeated measures was employed, utilizing Ajzen’s Theory of Planned Behavior, which posits that an individual’s behavior is driven by their intentions and rational considerations. Individuals can effectively control their behaviors if they are committed to doing so, leading to the desired behaviors being sustained and enduring. This theory comprises three belief components: 1) Behavioral beliefs, 2) Normative beliefs, and 3) Control beliefs. Additionally, Rosenbaum’s concept of self-control was integrated, which asserts that individuals can refrain from certain actions through rational behavior control and patience to achieve desired outcomes. Individuals also have the ability to manage emotional stress and appropriately regulate their emotions according to the situation. The researchers incorporated these concepts to design therapeutic activities within a behavioral management program aimed at adjusting beliefs, attitudes, and perspectives toward aggressive behavior to be more appropriate and socially acceptable. The program consists of six activities: 1) Building positive relationships, 2) Enhancing understanding of illness and aggressive behavior, 3) Creating a safe environment, 4) Developing behavioral attitudes and beliefs, 5) Strengthening self-control confidence, and 6) Planning for relapse prevention.

Methodology The sample consisted of 60 male patients with schizophrenia receiving treatment at a psychiatric hospital in a northeastern province. The participants were purposively selected based on the following inclusion criteria: 1) aged 20-59 years, 2) diagnosed with schizophrenia according to ICD-10 criteria (F20.0 - F20.9), 3) assessed with a high risk of violence using the Prasri Violence Severity Scale (PVSS) with pre-experiment scores ranging from 14 to 32, 4) stable psychiatric symptoms, 5) proficient in Thai communication, 6) no prior participation in an aggressive behavior therapy program, and 7) willingness to participate in the program. The sample was divided into two groups: 30 patients in the experimental group from the first male psychiatric ward and 30 patients in the control group from the second male psychiatric ward. The research instruments included: 1) a personal information questionnaire, 2) the PVSS, a 9-item scale with a content validity index (CVI) of .89, and 3) a 6-activity aggressive behavior management program. The content validity of the program was verified by three experts, yielding a CVI of .86. Data collection was conducted from July to October 2024. Due to the varying lengths of hospital stays and the average hospitalization period of 6-8 weeks, the experimental group was divided into three subgroups of 10 patients each, with staggered activity start times. Activities and data collection for the experimental group were conducted in the group activity room of the male psychiatric ward. Post-program and 2-week follow-up assessments of the risk of violence were conducted using the PVSS. The control group received regular nursing care, including individualized mental health education based on their needs, followed by immediate and 2-week follow-up PVSS assessments before discharge. Data were analyzed using descriptive statistics and two-way repeated measures ANOVA to compare the mean risk of violence scores between the experimental and control groups.

Results The sample was aged between 21 and 51 years, with a mean age of 36.62 years (SD = 8.98). The majority were single (75.00%) and had been diagnosed with schizophrenia for 1 to 5 years (56.67%). On average, they had been hospitalized with a median of 3 times. An analysis of the differences in personal characteristics between the experimental and control groups revealed no statistically significant differences. Prior to the experiment, the control group had a high mean score for risk of violence (M = 21.37, SD = 3.59), which decreased to a moderate level immediately post-experiment (M = 12.87, SD = 2.30) and increased to a high level at the 2-week follow-up (M = 15.87, SD = 3.31). In contrast, the experimental group had a high mean violence risk score before the experiment (M = 21.77, SD = 2.79), which decreased to a low level immediately post-experiment (M = 3.73, SD = 0.64) and increased to a moderate level at the 2-week follow-up (M = 6.53, SD = 2.81). The results of the two-way repeated measures ANOVA indicated that the violence risk in male patients with schizophrenia in the experimental group differed significantly across the pre-experiment, immediate post-experiment, and 2-week follow-up periods (F = 802.246, p < .001). The interaction between time and the program had a statistically significant effect on the violence risk in male patients with schizophrenia (F = 127.574, p < .001). Furthermore, an analysis of the violence risk between the experimental and control groups revealed a statistically significant difference (F = 106.529, p < .001).

Recommendation The findings of this study indicate that the aggressive behavior management program for male patients with schizophrenia effectively reduces the risk of violence in these patients. Psychiatric nurses can apply this program in the care of male patients with schizophrenia who share similar contexts with the study sample. Additionally, long-term studies may be beneficial in enhancing the safety of both patients and staff in psychiatric wards.

Effects of a Planned Behavioral Modification and Family Support Program on Weight Control Behaviors and Muscle Mass in Overweight Late School-aged Children

Nitinapa Kul-Ak, Jeeraporn Kummabutr, Panida Siriumpunkul — Wed, 09 Apr 2025 00:00:00 +0700

Introduction Overweight and obesity among school-aged children are significant public health problems at both national and global levels. Previous studies on various weight management programs for school-aged children have found that children exhibit inconsistent food consumption behaviors and physical activity. Therefore, promoting weight control in school-aged children with overweight, along with family support, will result in appropriate food consumption behaviors and physical activity. This approach can help children maintain healthy and sustainable behaviors into adulthood.

Objective This study aimed to investigate the effects of a Planned Behavioral Modification and Family Support Program on weight control behaviors and muscle mass among overweight late school-aged children.

Design This quasi-experimental study with a two-group repeated measures design applies the Theory of Planned Behavior to promote positive attitudes towards weight control in children. The children developed positive beliefs and attitudes towards their weight control behaviors due to receiving specific, individualized information. Additionally, the study considered the subjective norms, including the opinions of significant individuals such as caregivers or parents and peers, which are crucial for children’s weight-control behaviors. Furthermore, the children’s control beliefs about their ability to manage their weight were expressed with confidence and intention, leading to appropriate weight control behaviors.

Methodology The sample consisted of overweight children studying in grades 4-5 at schools under the jurisdiction of a provincial primary education office in northeastern Thailand during the 2022 academic year. A multi-stage sampling method was used, with schools randomly selected to form one experimental and one control group. Classrooms and students were selected to ensure similar characteristics and assessed using the weight-for-height reference charts for Thai children aged 6-19 years from the Department of Health, Ministry of Public Health, 2021. The sample size was calculated using G Power, resulting in 54 participants, divided into 27 for the experimental group and 27 for the control group, matched by gender. Research instruments included: 1) a child information questionnaire, 2) a weight control behavior questionnaire, 3) a food consumption and physical activity behavior log, 4) a weight, height, and muscle mass record form, and 5) a 4-week Planned Behavioral Modification and Family Support Program, developed by the researchers based on the Theory of Planned Behavior. The content validity of each instrument was confirmed with a content validity index of 1. The reliability of the weight control behavior questionnaire was tested with a Cronbach’s alpha coefficient of .73. Data were collected from June 7 to August 14, 2023. The experimental group received the program, consisting of two activities: 1) a 3-hour training session for primary caregivers, providing knowledge on their roles and guidelines for managing overweight children and promoting family support for weight control, and 2) four 2-hour weekly training sessions for overweight children over 4 weeks. The control group received usual care from their families. Data on weight control behaviors were collected 2 and 4 weeks after the program (weeks 6 and 8), and muscle mass was assessed immediately after the program. Data were analyzed using descriptive and inferential statistics, including Chi-square test, Independent t-test, Paired t-test, and Two-way repeated measures ANOVA, with a significance level set at .05.

Results The experimental group had a mean age of 10.4 years (SD=0.52), a mean weight of 59.48 kilograms (SD=10.64), and a mean height of 145.93 centimeters (SD=7.13). They were classified as overweight (44.44%) and obese (55.56%). Most of them were from nuclear families, with mothers being the primary food providers (63%). The control group had a mean age of 9.96 years (SD=0.71), a mean weight of 58.89 kilograms (SD=11.60), and a mean height of 147.67 centimeters (SD=7.99). This group was classified as overweight (63.00%) and obese (37.00%). Most children were also from nuclear families, with mothers being the primary food providers (51.85%). Comparing characteristics between the experimental and control groups showed no statistically significant differences (p>.05). After participating in the program, weight control behaviors were significantly different over time (F=728.927, p<.001). The interaction between the program and time significantly affected the weight control behaviors of the participants (F=316.027, p<.001). When analyzing between groups, the control and experimental groups showed statistically significant differences in weight control behaviors (F=734.303, p<.001). Additionally, the experimental group had a statistically significant increase in muscle mass compared to before the program (t=2.635, p=.014), but there was no significant difference compared to the control group (t=0.077, p>.05).

Recommendation The results of this study indicate that the Planned Behavioral Modification and Family Support Program is effective in weight management among late school-aged children who are overweight. The experimental group demonstrated improved weight control behaviors and increased muscle mass. Therefore, school health nurses or teachers can implement this program for weight management by involving primary caregivers, to promote appropriate weight control behaviors in those children.

Factors Associated with Breastfeeding Intention among Late Adolescent Female Students

Wed, 09 Apr 2025 00:00:00 +0700

Introduction Breast milk contains essential nutrients, including proteins, carbohydrates, fats, vitamins, and minerals. Breastfeeding benefits both mothers and infants by enhancing the immune system and reducing respiratory and gastrointestinal infections. However, the breastfeeding rates among adolescent mothers worldwide and in Thailand remain low. As adolescents transition to adulthood, it is crucial to promote breastfeeding intention before pregnancy, particularly among late school-aged students in vocational education. Previous studies have shown that breastfeeding knowledge, attitudes toward breastfeeding, subjective norms, and perceived behavioral control are associated with breastfeeding intention. However. studies are limited in late adolescent female students in vocational education.

Objective This research aimed to 1) study the intention to breastfeed and 2) investigate factors associated with breastfeeding intention, including breastfeeding knowledge, attitudes toward breastfeeding, subjective norms about breastfeeding, and perceived breastfeeding behavioral control among late adolescent female students in vocational education.

Design A descriptive correlational design. This study utilized the Theory of Planned Behavior (TPB) by Ajzen, which explains that a person’s intention is related to their attitudes toward breastfeeding behavior, subjective norms about breastfeeding behavior, perceived behavioral control over breastfeeding, and breastfeeding knowledge, which is a background factor associated with breastfeeding intention.

Methodology The participants included late adolescent students aged 17-19 years who were studying in the third year of vocational program and the first and second year of higher vocational program under the Vocational Education Commission in Bangkok from May to June 2024. The sample size was calculated using the G*Power program. The effect size was set at 0.184, the power of the test was .95 and the level of significance was .05, obtaining 311 participants. The researchers added 10% to account for data incompletion, resulting in a total of 342 participants. The research instruments consisted of 6 parts, including 1) a personnel information questionnaire, 2) breastfeeding knowledge questionnaire, 3) attitudes toward breastfeeding questionnaire, 4) subjective norm about breastfeeding questionnaire, 5) perceived behavioral control questionnaire, and 6) breastfeeding intention questionnaire. In this study, the content validity indices of the breastfeeding knowledge questionnaire, attitudes toward breastfeeding questionnaire, subjective norms about breastfeeding questionnaire, perceived breastfeeding behavioral control questionnaire, and breastfeeding intention questionnaire were .96, 1, .80, .96, and 1 respectively. The reliability, Kuder-Richardson 20 for the breastfeeding knowledge questionnaire was .72. The attitudes toward breastfeeding questionnaire, subjective norms about breastfeeding questionnaire, and perceived breastfeeding behavioral control questionnaire had Cronbach’s alpha coefficient of .74, .86, and .93, respectively. Data were collected using self administration, from May to June 2024. Data were then analyzed using descriptive statistics and Pearson’s product moment correlation coefficient.

Results Among 342, 332 participants met the criteria in this study. The average age of the participants was 18.27 years old (SD = 0.69). Most of them lived with their parents (78.31%). The family income of 10,001-20,000 baht/month was the highest frequency (34.6%). The results showed that breastfeeding intention was high. It was significantly associated with breastfeeding knowledge (r = .172, p = .002), attitudes toward breastfeeding (r = .190, p < .001), subjective norm about breastfeeding (r = .389, p < .001), and perceived breastfeeding behavioral control (r = .429, p < .001).

Recommendation This study provides preliminary data for nurses to plan the promotion of breastfeeding knowledge, attitudes toward breastfeeding, subjective norms about breastfeeding, and perceived breastfeeding behavioral control. These efforts will contribute to increasing breastfeeding rates in the future.

The Effectiveness of Mindfulness-Based Therapy in Pregnant Women with Depression, Anxiety, and Stress: A Systematic Review

Wed, 09 Apr 2025 00:00:00 +0700

Introduction Pregnancy is a vulnerable period that can lead to significant depression, anxiety, and stress in pregnant women. Research has shown that mindfulness-based cognitive therapy can alleviate these symptoms in pregnant women. While mindfulness-based cognitive therapy has started to be applied in Thailand for patients with depression, there is no literature review available on the effects of mindfulness-based cognitive therapy in reducing depression symptoms in pregnant women in Thailand.

Objective This study aimed to evaluate the effectiveness of mindfulness-based therapy in pregnant women experiencing depression, anxiety, and stress.

Design Systematic review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines

Methodology The criteria for selecting research articles are based on the PICO framework. Population: pregnant women. Intervention: mindfulness-based intervention (MBI). Comparison: other therapeutic programs designed to reduce depression symptoms in pregnant women. Outcomes: reduction of depression symptoms. The selected research articles have the following characteristics: 1) Studies that investigate the effects of mindfulness-based therapy on depression, stress, or anxiety in pregnant women; 2) Experimental or quasi-experimental studies testing the effectiveness of MBI in reducing depression, anxiety, and stress in pregnant women; 3) Comparison groups are control groups using other psychotherapies, such as cognitive-based therapy or routine care; and 4) Outcome measures include at least one of the following: reduction in depressive symptoms, anxiety, or stress. Research articles are searched using both Thai and English databases, including PubMed, PsycINFO, CINAHL, Embase, ThaiJo, and ThaiLIS. The scope of the research is set between January 1, 2013, and December 31, 2023. Thai search keywords include (mindfulness* OR mindfulness-based intervention* OR meditation) AND (pregnancy OR prenatal) AND (depression* OR anxiety OR stress). Research selection is based on inclusion criteria from titles and abstracts, and full-text articles. The quality of the research is assessed using the Joanna Briggs Critical Appraisal Tools. Two researchers work independently, and studies that do not meet the inclusion criteria or are of low quality are excluded. A third researcher is consulted to conclude if there is a disagreement between the two researchers. Data from selected articles are extracted into a data extraction table and synthesized using a narrative summary.

Results A search yielded 650 research articles, of which 19 met the inclusion criteria. These included 17 randomized controlled trials and 2 quasi-experimental studies, all conducted internationally. Mindfulness-based interventions (MBIs) were delivered both face-to-face and digitally, effectively reducing depression, anxiety, and stress in pregnant women. The effects of face-to-face mindfulness-based cognitive therapy were systematically reviewed. It was found that pregnant women who received traditional face-to-face mindfulness-based cognitive therapy showed more significant reductions in depression, anxiety, and stress compared to other depression, anxiety, or stress reduction interventions. Online mindfulness-based interventions for pregnant women to reduce depression, anxiety, and stress were delivered through various methods, predominantly via mobile applications, which are easily accessible and convenient for pregnant women. Pregnant women who participated in mindfulness interventions were better able to adapt to stress and manage their emotions compared to those who did not participate in mindfulness-based interventions.

Recommendation Mindfulness-based cognitive therapy is more effective in reducing depression and stress symptoms compared to other mindfulness interventions. Nurses can apply mindfulness-based cognitive therapy to alleviate depression in pregnant women both during the prenatal and postnatal periods, whether in hospitals or health service units. When applying mindfulness-based cognitive therapy in different contexts and addressing the specific issues of pregnant women, it is crucial to maintain the key principles of cognitive therapy, whether delivered online or face-to-face. This approach helps participants become aware of the present moment and distinguish themselves from old thought patterns and emotions. Further research is needed to test the effectiveness of these mindfulness-based cognitive therapies in reducing depression, anxiety, and stress in pregnant women with varying levels of depression. Additionally, meta-analyses should be conducted to evaluate the effectiveness of mindfulness-based cognitive therapy in reducing depressive symptoms in both prenatal and postnatal periods and among pregnant women with different severity levels of depression.

Effects of Implementing Pressure Injury Prevention Practice Guidelines in Preterm Neonates Using Non-invasive Ventilation

Wed, 09 Apr 2025 00:00:00 +0700

Introduction Non-invasive ventilation (NIV) is a standard treatment for respiratory support for preterm neonates, and its use has been increasing. However, it has been found that the use of NIV carries a high risk of nasal injury in preterm neonates, leading to pain, discomfort, nasal deformities, and prolonged hospital stays. Therefore, the development of nursing practice guidelines to prevent pressure injury from NIV in preterm neonates is crucial in preventing these injuries.

Objectives 1) To develop a nursing practice guideline for preventing pressure ulcers from noninvasive ventilation in preterm neonates and 2) To test the effects of implementing the guidelines on the incidence of pressure injuries, knowledge and skills of nurses in pressure injury prevention, adherence to the practice guideline, and satisfaction with the use of the practice guideline.

Research Design This study was a research and development.

Methodology This study was conducted in four phases: 1) Situation analysis, 2) Guideline development, 3) Guideline implementation, and 4) Outcome evaluation and improvement. The participants comprised 55 nurses working in neonatal intensive care units, sick newborn units, and preterm newborn units, and 308 preterm neonates receiving NIV. The neonates were divided into a control group (using existing guidelines) and an experimental group (using newly developed guidelines), with 154 participants in each group. The research instruments included: 1) A teaching plan on ‘Nursing to Prevent Pressure Ulcers from Non-Invasive Ventilation in Preterm Neonates’, 2) Nursing practice guidelines for preventing pressure injury from NIV in preterm neonates, developed based on empirical evidence, including six key issues: 1) Skin and pressure injury assessment, 2) Preparation of equipment and neonates, 3) Application of nasal continuous positive airway pressure (NCPAP), 4) Post-NIV placement monitoring and care, 5) Early weaning from NIV, and 6) Outcome evaluation. These practice guidelines were reviewed by registered nurses representing the users who implement the guidelines for feasibility, appropriateness, meaning, and effectiveness. The instruments for data collection included four sets: 1) A knowledge and skills assessment form for nurses on preventing pressure injury from NIV in preterm neonates, 2) A compliance assessment checklist for nurses following the practice guidelines, 3) A satisfaction assessment questionnaire for nurses on the practices, and 4) A skin and pressure injury assessment record form for neonates receiving NIV. Data were analyzed using descriptive statistics, Paired t-test, and Chi-square test.

Results The participants included 55 nurses and 308 preterm neonates, divided into a control group (n = 154) and an experimental group (n = 154). The incidence of pressure injury from NIV in the experimental group (1.9%) was significantly lower than the control group (6.5%) (χ2 = 3.935, p = .04). 3) The knowledge of nurses on preventing pressure injury from NIV in preterm neonates was significantly higher after the training (M = 13.93, SD = 1.74) compared to before the training (M = 10.04, SD = 2.76) (t = -10.380, p < .01). 4) The skills in pressure injury assessment of nurses were significantly higher after the training (M = 8.35, SD = 1.64) compared to before the training (M = 4.40, SD = 2.39) (t = -12.080, p < .01). 5). Nurses’ adherence to the nursing practice guidelines was at the highest level, with a mean score of 28.95 (SD = 2.22), representing 96.5% adherence, and 6) Nurses’ satisfaction with the practice guidelines was at the highest level (M = 4.66, SD = 0.42, Min-Max = 3.4-5.0).

Recommendation The developed practice guidelines are effective in preventing pressure injuries from NIV in preterm neonates. Nurses working in neonatal units that provide NIV can implement these guidelines to prevent pressure injuries by adapting them to the specific context of their units. Besides, preparing nurses with the necessary knowledge and skills to use the practice guidelines, monitoring adherence to the guidelines, and continuously measuring outcomes for ongoing improvement are keys to success.