Thai Journal of Nursing and Midwifery Practice

Roles of Advanced Practice Nurses for Self-Management Support in New Older Patients of Chronic Obstructive Pulmonary Disease with an Acute Exacerbation: A Case Study

2024-09-19T22:00:35+07:00

Abstract: Elderly patients with newly diagnosed chronic obstructive pulmonary disease (COPD) experiencing acute exacerbation often have complex issues that require specialized care to enhance their ability to self-manage appropriately. This case study presents self-management support by an advanced practice nurse, using the self-management support concept based on the Chronic Care Model. This model is a process that helps patients manage and avoid factors that lead to breathing difficulties and acute exacerbations, as well as enabling them to make informed decisions about health behaviors through six steps:1) Setting mutual goals between the patient and the healthcare team; 2) Collecting data through self-monitoring, self-observation, and recording personal information; 3) Processing and evaluating the data to help the patient learn about their own illness; 4) Making decisions based on the gathered information regarding their illness. 5) Taking action to manage and control factors that lead to acute exacerbations; and 6) Self-reflection: evaluating the actions taken to meet the set goals, as well as promoting continuous behavior change to prevent and avoid triggers that cause acute exacerbations. The advanced practice nurse used various competencies to support self-management continuously, from the crisis phase through rehabilitation. The results showed that patients were able to adjust their behaviors to prevent and avoid triggers that lead to acute exacerbations, resulting in improving outcomes, such as no readmissions within 28 days, and reducing acute exacerbation rate.

Advanced Practice Nursing: A Case Report of Pediatric Patients with Graft-versus-Host Disease

2025-03-20T19:18:49+07:00

Abstract: Hematopoietic stem cell transplantation (HSCT) is a treatment option for patients with cancer and other diseases related to abnormal hematopoiesis in the bone
marrow. Although this treatment increases the chances of recovery from the disease, patients remain at risk of severe complications after HSCT, especially complication of graft-versus-host disease (GvHD) in pediatric patients. If pediatric patients have received untimely assessment and treatment, it could potentially lead to life-threatening consequences. This article presents an approach to caring for pediatric patients with GvHD, applying Orem’s nursing theory framework and the principles of empowerment to enhance the capacity of pediatric patients and their families in managing these disease conditions. Furthermore, the article highlights the role of Advanced Practice Nurses (APN) in providing holistic care to pediatric patients and their families, including assessment, planning, and psychosocial support to achieve positive health outcomes for pediatric patients, including improving the quality of life for pediatric patients and their families over the long term.

Application of Orem's Theory in Nursing Care for Patients with Ischemic Stroke: A Case Study

2025-03-02T13:16:46+07:00

Abstract: Ischemic stroke is a significant health issue that impacts the quality of life of patients. Therefore, self-care and appropriate behaviors are essential to prevent complications and recurrence. The theories related to stroke care includes Orem's Self-care Nursing Theory, which encompasses three interrelated theories: the theory of Self-care, the theory of self-care deficit, and the theory of nursing systems. This case study applied the nursing systems theory, divided into three phases: 1) the total compensatory phase, 2) the partial compensatory phase, and 3) the supportive-educative nursing phase. This approach was utilized in the care of a 59-year-old male patient diagnosed with ischemic stroke who received thrombolytic therapy. The patient exhibited an imbalance between his self-care abilities and the demands placed upon him, facing challenges during the acute, post-acute, and rehabilitation phase. The nurse's role involved promoting the patient's self-care abilities through education, guidance, counseling and encouragement, while collaborating with the healthcare team for continued home care. The outcome of the nursing intervention allowed the patient to safely navigate through the crisis without complication, leading to successful rehabilitation and discharge after six days of hospitalization. In conclusion, the application of Orem's nursing theory concerning nursing systems in this case study enabled nurses to effectively assessed the patient's health status, formulated appropriate nursing diagnoses, and provided suitable nursing care leading to good outcomes for patients with ischemic stroke.

Development and Evaluation of a Triage Model Determining the Severity of Outpatients Using the Emergency Severity Index Combined with Early Warning Signs

2024-12-28T11:45:20+07:00

Abstract: This research and development (R&D) study aimed to develop and evaluate a triage model for determining the severity of outpatients using the Emergency Severity Index (ESI) combined with Early Warning Signs (EWS) of critical conditions. The framework for model development was based on Soukup's evidence-based practice model. The sample included 15 outpatient nurses and medical records of 18 patients who were referred from the outpatient department to the emergency room. Data were collected using instruments including a questionnaire of satisfaction of nurses using the triage model, an assessment form of consistency in triage between outpatient (OPD) nurses and emergency room (ER) nurses, and incidents of patients deteriorating into critical conditions while waiting for examination. Data were analyzed using descriptive statistics. The findings revealed that the developed triage model comprises two main components: 1) the ESI with EWS, including the assessment of respiratory rate, heart rate, oxygen saturation, systolic blood pressure, body temperature, level of consciousness, pain score, and fatigue, and 2) guidelines for patient care. Nurses were highly satisfied score with the developed triage model (Mdn=5, IQR=1. There was an 83.3% consistency in triage between outpatient and ER nurses. Furthermore, no incidents of patient deterioration to a critical condition while they were waiting to be examined at OPD. The results support the continuous use of this triage model by outpatient nurses to enhance patient safety and improve the quality of care.

The Effects of Participatory Learning and Self-Efficacy Program on Stroke Prevention Behaviors Among Older adults in a Community, Nakhon Pathom Province

2024-11-30T21:07:18+07:00

Abstract: This quasi-experimental study examined how self-efficacy development programs and participatory learning affected older adults' stroke prevention practices. 60 senior men and women age over 60 years were purposively selected. The samples were assigned randomly into two groups: 30 in the experimental group, who received a program for the self-efficacy development and participatory learning, and 30 in the control group, who received a standard care. The research tools included an 8-week experimental program developed based on the self-efficacy theory, which was verified by three experts. The data were collected using questionnaires on personal information and stroke preventive practices of the elderly which tested for the instruments' dependability yielding the Cronbach alpha coefficient of yielding a value 0.95. Descriptive statistics were used to evaluate the data, and t-test statistics were used to check for group differences. The study's findings show that the experimental group's mean scores for stroke prevention behaviors were significantly higher than those of the control group (p <.05). After intervention, the mean scores for stroke prevention self-efficacy in the experiment group in terms of exercise, diet control, and emotional management were significantly higher than those before and those of the control group. In order to consistently encourage stroke prevention behaviors, nurses should incorporate self-efficacy building and participatory learning into their planning of health promotion programs for the community's senior citizens.

The Effectiveness of the 3D Indoor Walking Garden Innovation Among Older People in the Chronic Disease Clinic of Si Sa Ket Hospital

2024-12-01T20:53:30+07:00

Abstract: This quasi-experimental study employed a two-group repeated measures design to evaluate the effectiveness of a 3D indoor walking garden innovation on walking ability, balancing and fall/near-fall incidents among older people with chronic diseases at Si Sa Ket Hospital's chronic disease clinic. A total of 86 participants at risk of falling were equally divided into experimental (n = 43) and control (n = 43) groups. The experimental group engaged in structured walking training using the 3D indoor walking garden during months 1-3, followed by home-based training supervised by caregivers over months 4-12, simulating the innovation environment. Training was complemented by fall prevention education grounded in Goal Attainment Theory, emphasizing collaborative goal setting and continuous monitoring. Data collection included fall risk screening forms, walking ability assessments, Activities of Daily Living (ADL) evaluations, balance tests, and fall/near-fall incident questionnaires. Results indicated that the experimental group experienced significant improvements (p < .05) in ADL scores, walking ability, balance duration, and reduced fall/near-fall incidents compared to baseline and the control group. These findings underscore the potential of the 3D indoor walking garden innovation as an effective intervention for improving walking ability and preventing falls among older adults with chronic diseases.

The Effects of a Health Literacy Enhancement Program on Stroke Prevention Behavior of High-Risk Individuals Living in a Community

2024-09-16T15:21:09+07:00

Abstract: This quasi-experimental research aimed to examine the effects of a health literacy enhancement program on stroke preventive behavior of a high-risk group. Sixty participants were working-age adults (aged 35-59 years) with high-risk of stroke in a community of Phetchaburi province. A risk assessment form based on the seven risk factor assessment criteria was used to screen this group for cardiovascular disease risk. They were purposefully selected and divided into two groups. Thirty participants in the experimental group received the health literacy enhancement program on stroke prevention behavior based on Nutbeam, Sorensen' s health literacy concept and Stretcher, Rosentock, and Becker's health belief model for 7 weeks. Another 30 participants in the control group received routine health promotion. Data were collected before and after the intervention period using two questionnaires: health literacy and stroke preventive behavior of high-risk groups, with reliabilities of 0.91 and 0.96 respectively. Data were analyzed using descriptive statistics and inferential statistics for comparisons using t-tests and ANCOVA. The research results revealed that, after participating in the program, the experimental group had significantly higher mean scores of health literacy and stroke preventive behavior than before receiving the program, and higher than the comparison group (p < .01) Therefore, the health literacy enhancement program is effective in modifying behavior for stroke prevention. This program should be used in integrating healthcare services for prevention of stroke in high-risk groups in other communities.

Development of a Nursing Model to Prevent Acute Pulmonary Embolism in Surgical Patients Undergoing Anesthesia

2025-02-09T07:47:52+07:00

Abstract: This research and development aimed to develop a Nursing Care Model for preventing acute pulmonary embolism in surgical patients undergoing anesthesia. There were 2 phases: 1) development of the Nursing Care Model; and 2) implementation and outcome evaluation. The sample comprised: 1) 61 healthcare personnel consisting of 33 healthcare team members and 28 nurse anesthesists; and 2) 58 patients undergoing surgical anesthesia divided into pre- and post-implementation of the model, 29 in each group. Research instruments included focus group interview guidelines, a handbook of the Nursing Care Model, and tools to assess the use and outcomes of the Nursing Care Model. Qualitative data were analysed using content analysis, and quantitative data were analysed by descriptive statistics and paired t-test. Findings showed that the Nursing Care Model consisted of 3 components: 1) Structure, comprising nursing management; 2) Process, comprising nursing guideline implementation, capacity buiding of the personnel, and supervision; and 3) Outcomes, comprising providers’ outcomes, clients’ outcomes, and organizational outcomes. Implementation and outcome evaluation of the Nursing Care Model showed the following: 1) urse anesthesists had statistically significant higher scores on knowledge regarding acute pulmonary embolism (p<0.01); they agreed with the Nursing Care Model at a high level (x̅=4.25, SD=0.75); and their performances according the nursing guidelines were high (99.61%); 2) Patients’ satisfaction was at a high level (x̅=4.40, SD=0.51); even though 6.89% of the patients with at high risk, there were no serious complications; and 3) All patients received screening for risk before the operations and were assessed for risk prevention during the operations. The Nursing Care Model can enhance nurses’ performance to ensure patients’ safety.

Evaluation of Using Preparation Media via LINE OFFICIAL for Receiving Anesthesia on Knowledge and Anxiety in Patients with Same-day Colonoscopy

2025-03-28T21:24:24+07:00

Abstract: This quasi-experimental research one group pre-posttest design aimed to compare the knowledge and anxiety of patients who were prepared for anesthesia before and after receiving learning media through the Line Official Account (LOA). The sample group consisted of 150 patients who received anesthesia and underwent day colonoscopy at a hospital, during August 2024 to February 2025. The instruments consisted of learning media via the developed LOA channel. Data were collected using a knowledge and anxiety assessment form and tested for validity and reliability. The analysis was performed using descriptive statistics and pair t-test. The results showed that most patients were female, aged over 55, housewives-husbands, graduated below a bachelor's degree, and had the universal health coverage. After being prepared through the LOA for anesthesia for day colonoscopy, patient’s knowledge was significantly higher than before (p<.05). The anxiety after receiving anesthesia was also lower than before receiving the learning media (p<.05). The patients were most satisfied with the learning media received. Therefore, the learning media through the LOA channel should be used as one method to increase knowledge and reduce anxiety in patients who received anesthesia and underwent a same day colonoscopy. However, further research with a comparison group is recommended.

Development of Guidelines for Preventing Catheter Associated Urinary Tract Infections in Stroke Patients at Chumphon Khet Udomsakdi Hospital

2025-01-12T20:09:34+07:00

Abstract: This developmental research aimed to develop and study the outcomes of using the guidelines for preventing catheter associated urinary tract infections (CAUTIs) in stroke patients at Chumporn Khet Udomsakdi Hospital from May to July 2024. The samples were 1) 14 professional nurses who used the guidelines, and 2) 34 patients with indwelling catheters in the stroke ward. The research instruments were the guidelines for preventing CAUTIs from indwelling catheters in stroke patients, which the researcher developed from review literature, the developed of innovations in preventing CAUTIs, the knowledge assessment form for professional nurses in using the guidelines, the observation record form for nursing behavior, the satisfaction questionnaire for professional nurses on the the guidelines development, and the observation record form for CAUTIs. The content validity was checked with a criterion between 0.90-1.00. The data were analyzed using descriptive statistics, chi-square statistics, and Paired t-tests. The findings showed that professional nurses had achieved 100% of knowledge score after using the guidelines and the average knowledge score was significantly statistically increased than before. Professional nurses followed the guidelines after promoting the correct use at 100 percent. The CAUTIs rate after using the guidelines decreased from 12.41 to 1.96: 1,000 retained catheter days and has shown significantly difference (p<.001). Nurses were satisfied with the overall guidelines at a high level. It is recommended to promote effective use and ensure sustainable use of guidelines by continuous supervision, listening to problems and obstacles, and evaluating for further quality improvement.