Thai Journal of Nursing and Midwifery Practice

Application of Orem’s Theory in Nursing Care for Patients with Ischemic Stroke Receiving Thrombolytic Drugs and Mechanical Thrombectomy: A Case Study

Supaporn Sripanom — 2026-06-27

Abstract: Ischemic stroke is a leading cause of death and disability in adults, with survivors often experiencing severe functional impairment that significantly affects their physical, psychological, social, and economic quality of life. Therefore, promoting self-care and preventing complications are of paramount importance. This case study applied Orem’s SelfCare Theory as a conceptual framework for the care of a 72-year-old male patient diagnosed with ischemic stroke who received intravenous thrombolytic therapy and subsequent mechanical thrombectomy. The nursing outcomes revealed that the patient experienced self-care deficits during the acute, post-acute, and rehabilitation phases. The nurse’s crucial role focused on promoting the patient’s self-care agency through physical rehabilitation, modifying health behaviors to reduce risk factors, and managing the condition at home. Key complications prevented included intracranial hemorrhage, complications at the puncture site (e.g., hematoma), and aspiration pneumonia. Furthermore, the nurse collaborated with the multidisciplinary team on planning continuous rehabilitation and coordinating transitional care following discharge (Intermediate Care: IMC). Consequently, the patient safely passed the critical phase, achieved appropriate functional recovery, and was discharged home within 8 days. In conclusion, Orem’s Self-Care Deficiency Theory systematically guides nurses in assessing the patient’s needs and self-care abilities, formulating nursing diagnoses, and planning appropriate interventions across all stages of illness, from the critical phase to discharge planning and rehabilitation. Integrating care from the multidisciplinary team is essential to empower patients to manage their self-care, modify behaviors, prevent complications, and achieve a good quality of life.

Outcomes of Holistic Healthcare for Elderly Patients with Mild Cognitive Impairment and Chronic Kidney Disease: A Case Report

Paungpech Jantabood — 2026-06-27

Abstract: This case study presents a holistic health care approach for older adults with mild cognitive impairment (MCI) and chronic kidney disease (CKD). These conditions are commonly found among older adults with multiple chronic illnesses and are associated with a decline in physical functioning and cognitive performance. Such deterioration may progress to dementia, a common neurological disorder characterized by impairments in memory, thinking, decision-making, and language, as well as behavioral and emotional changes. These impairments can limit the ability of older adults to perform self-care and may lead to significant impacts on families and society. Holistic health care for older adults at risk of dementia focuses on the prevention and delay of cognitive decline through two main approaches: psychosocial and biological interventions. In this case study, psychosocial interventions were primarily implemented. These included sensory stimulation through group activities and cognitive stimulation training aimed at improving memory, attention, calculation, and language abilities. Activities were conducted both in community settings and continuously at home. In addition, problem-solving and communication skills were promoted through group activities, and follow-up care was provided through home visits. Family and community participation were also encouraged through health education for family health leaders and caregivers, the development of social support networks through group activities, and the modification of the home environment to facilitate cognitive stimulation activities. This holistic approach promotes self-care among older adults and strengthens social support from families and communities. As a result, it contributes to improved cognitive functioning and better physical, psychological, and social well-being, helping to delay cognitive deterioration and enhance the quality of life of older adults.

Nursing Care for a Child with Congenital Pulmonary Airway Malformation (CPAM) Undergoing General Anesthesia: A case study

Duangned Litu — 2026-06-27

Abstract:Congenital Pulmonary Airway Malformation (CPAM) is a rare congenital respiratory anomaly occurring in infants and young children. Advances in modern medical technology have enabled prenatal diagnosis, allowing for timely treatment planning and optimization of preoperative preparation. Surgical management of CPAM in this population is highly challenging due to significant risks, including air trapping, tension pneumothorax, and potential hemodynamic complications. To support the development of appropriate nursing guidelines for future care, this case study aimed to examine optimal nursing management for pediatric patients with CPAM and to enhance the competencies of nurse anesthetists across all dimensions. The goal is to ensure safe and effective care through application of Gordon’s Eleven Functional Health Patterns as a framework for identifying patient problems and care needs. The case involved a 6-month-old infant undergoing right thoracoscopic right lower lobectomy under general anesthesia, during which oliguria occurred intraoperatively. Nursing care and assessment were performed according to Gordon’s functional patterns, enabling identification of the following nursing diagnoses: the caregiver has insufficient knowledge regarding (1) the surgical procedure, anesthesia, and pediatric care, (2) the risk for hypoxia related to difficult intubation, (3) the risk for cardiovascular dysfunction, (4) the risk for hypothermia, (5) the risk for shock due to dehydration and blood loss, (6) the risk for impaired gas exchange leading to oxygen deficiency, (7) the risk for infection, (8) acute postoperative pain, and (9) the risk for falls.

Implementation of the Enhanced Recovery AfterSurgery Protocol with Orem’s Self-Care Theory in Nursing Care for a Patient with PerihilarCholangiocarcinoma: A Case Study

Orathai Kaewjaladvilai — 2026-06-27

Abstract: Perihilar cholangiocarcinoma (pCCA) is a common cancer in Thailand and is often diagnosed at an advanced stage. Hepatectomy is the primary treatment for patients with resectable disease; however, it is a complex surgical procedure associated with a high risk of postoperative complications. Therefore, systematic patient care is essential to prevent complications and promote postoperative recovery. The Enhanced Recovery After Surgery (ERAS) protocol has been widely implemented to reduce complications, enhance recovery, and shorten hospital length of stay. This case study aimed to analyze patients’ problems and needs, and to propose approaches for implementing ERAS protocol in combination with Orem’s Self-Care Theory to promote self-care abilities among patients with perihilar cholangiocarcinoma undergoing hepatectomy, through the role of advanced practice nurses. In this case study, patient care covered both preoperative and postoperative phases. The APN played a key role in patient assessment, evidence-based nursing care planning, preoperative counseling and preparation, postoperative complication monitoring, pain management, early mobilization promotion, and nutritional support to enhance the patient’s self-care ability. The results showed that integrating the ERAS protocol with Orem’s Self-Care Theory, implemented through the role of the Advanced Practice Nurse, effectively promoted postoperative recovery, reduced complications, and enhanced the patient’s self-care capacity.

Effectiveness of Implementing of Clinical Nursing Practice Guideline for Dyspnea in Congestive Heart Failure Patients with Noninvasive Positive Pressure Ventilation Therapy in Resuscitation Room

Pongladda Paralee — 2026-06-07

Abstract: Purpose: to study the nursing outcomes of congestive heart failure (CHF) patients who received nursing care according to clinical nursing practice guidelines (CNPG) for dyspnea in CHF patients with noninvasive positive pressure ventilation (NIPPV) therapy in the resuscitation room, emergency department (ED). Design: Action research. Methods: Thirtytwo congestive heart failure patients with dyspnea who were treated with NIPPV in ED and received nursing care according to CNPG were included in this study. The study tools included a demographic data record form, nursing outcome record form, and the CNPG for dyspnea in CHF patients with NIPPV therapy in ED. Descriptive statistic, paired t-test, and Wilcoxon matched-pairs signed-rank test were used for data analysis. Results: The average age of participants were 66.87±2.42 years. The most chief complaints were dyspnea (28.13%), chest pain and dyspnea (21.88%) and fatigue (15.63%). Participants who received nursing care according to CNPG had statistically significant improvements in vital signs (systolic blood pressure, heart rate, respiratory rate, and oxygen saturation) before dispose from ED compare to vital signs in admission to ED, (p < .05). The successful rate of NIPPV therapy was 90.62%, and the average mask compliance score was 3.65±0.11. Recommendations: Performing emergency nursing according to CNPG promoted standardized nursing care and enhanced better nursing outcome including physiological and clinical parameter in CHF patients in ED.

Effects of a Structured-nursing Acute Exacerbation Intervention Program for Selected Outcomes in Patients with Chronic Obstructive Pulmonary Disease

Sane Putti — 2026-06-27

Abstract: This quasi-experimental research aimed to examine the effects of nursing practice using an acute exacerbation care program for patients admitted and readmitted within 28 days to the Department of Medical Nursing, Phukhieo Chalermprakiat Hospital. A total of 76
patients were recruited and divided into two groups: 38 in the control group and 38 in the experimental group. The control group received routine nursing care according to the hospital’s standard guidelines, whereas the experimental group received the same standard care in combination with the acute exacerbation nursing care program. Outcomes were evaluated in two domains: nursing practice outcomes and patient outcomes. Research instruments consisted of (1) the acute exacerbation nursing care program and (2) data collection tools, including a general information form, a record of acute exacerbation episodes, and a readmission record within 28 days. Data were analyzed using frequency, percentage, mean, standard deviation, Chi-square test and Mann Whitney U test The results revealed that nursing practice outcomes
in the experimental group showed a statistically significant higher adherence to care guidelines compared to the control group group (p < .05). Regarding patient outcomes, the number of acute exacerbation episodes was lower in the experimental group than in the control group. A difference in 28-day readmission rates was observed between the experimental group and the control group. Therefore, continuity of care provided at home is essential in reducing hospital readmissions within 28 days after discharge.

Development of a Community-Participatory Health Modification Model for NCDs High-Risk

Rattikarn Roungrit — 2026-06-27

Abstract: This participatory action research aimed to develop a Community-Participatory Health Behavior Modification Model for NCD-high-risk individuals and to evaluate the effectiveness of the model. The study was conducted in two phases: 1) model development through community participation with 20 stakeholders, and 2) effectiveness testing among 50 NCD-high-risk participants. Research instruments demonstrated content validity (CVI = 0.91–0.95) and reliability (KR-20 = 0.82, Cronbach’s alpha = 0.88–0.91). Qualitative data were examined via content analysis, while quantitative outcomes were analyzed using descriptive statistics and paired t-tests. The findings revealed that the developed model, driven by the 'PROMISE' process, consists of five pivotal components: Positive reinforcement combined with Optimum state to encourage participant self-care; Result-based management; Individual or client-centered approaches promoting self-regulation; Motivation; and Self-esteem and Empowerment fostering participant self-efficacy. Observation and evaluation, integrated within a systematic community participation mechanism, were conducted. Following the intervention, participants demonstrated significantly higher mean scores in knowledge (t = 19.30, p < .001) and all dimensions of preventive behaviors (t = 5.97-7.71, p < .001). Clinical outcomes significantly improved, including reductions in systolic blood pressure (t = 3.45, p < .05), body weight and waist circumference (t = 4.36-4.46, p < .001), fasting blood sugar (t = 7.09, p < .05), and HbA1c (t = 5.65, p < .01). The developed model serves as a sustainable community-based prototype for health behavior modification.

The Effectiveness of Cognitive Behavioral Treatment (CBT) to Reduce Aggressive Behaviors in Amphetamine Induced Psychosis at Sakon Nakhon Hospital

Parichat Khunsri — 2026-06-27

Abstract: This quasi-experimental research employed a two-group pretest-posttest design. The purposes of this study were to compare aggressive behavior among patients with amphetamine use disorder and comorbid psychiatric conditions before and after receiving a cognitive behavioral therapy program and to compare aggressive behavior between the experimental and control groups. The sample consisted of 34 patients with amphetamine use disorder and comorbid psychiatric conditions receiving treatment at Sakon Nakhon Hospital. Participants were selected using purposive sampling and assigned to either an experimental group or a control group, with 17 participants in each group. The research instruments included a cognitive behavioral therapy program The quality of the program was checked using the index of item objective congruence (IOC) method, and its value was equal to 1 and an aggressive behavior assessment scale with a reliability coefficient of .90. The intervention was conducted over a period of six weeks. Data were analyzed using descriptive statistics, including frequency, percentage, mean, and standard deviation. Paired t-test and independent t-test were used to compare mean scores. The results revealed that, after participating in the cognitive behavioral therapy program, the experimental group demonstrated significantly lower aggressive behavior scores compared to the pre-intervention period (p < .001). In addition, the experimental group showed significantly lower aggressive behavior scores than the control group (p < .001). These findings suggest that the cognitive behavioral therapy program was effective in reducing aggressive behavior among patients with amphetamine use disorder and comorbid psychiatric conditions.