Thai Journal of Nursing and Midwifery Practice

Development and Evaluation of Nursing Practice Guideline in Patients with Severe Traumatic Brain Injury in the Resuscitation Room at an Accident and Emergency Department

Kanlayarat Larthum — 2024-05-30

Abstract: This research and development aimed to 1) develop nursing practice guidelines to prevent hypoxia and increase in intracranial pressure condition, 2) evaluate the feasibility and satisfaction of using nursing guidelines, and 3) evaluate patient outcomes. This study used Soukup’s evidence framework as a guide. The sample group consisted of 37 nurses and 63 patients with severe traumatic brain injuries. The research tools were the nursing practice guidelines, patient outcome record form, and a questionnaire on feasibility and satisfaction of use form. Data were analyzed using descriptive statistics and paired t-test. Results showed that the nursing guideline to prevent hypoxia and increase in intracranial pressure was developed from 14 items of evidence-based medicine, comprising 4 categories: (1) ventilator care, (2) patient positioning, (3) airway management, and (4) monitoring and used in patient care. After implementing, the guideline was highly feasible to use (M = 2.9, SD = 0.3) and nurses reported the highest level of satisfaction (M = 4.7, SD = 0.5). Patient outcomes were shown that average fingertip oxygen saturation and the carbon dioxide concentration in the end-exhaled breath before discharge were significantly increased than those at admission (p < .05), while the level of consciousness and blood pressure values at admission and before discharge were not different. So, clinical nursing practices should be used in patients with severe traumatic brain injury in the resuscitation room for preventing hypoxia and reducing the increase in intracranial pressure.

Post Baccalaureate Residency Training Program: An Evaluation of 5-year Performance

Pataraporn Kheawwan — 2024-06-03

This retrospective and cross-sectional study aimed to evaluate the post baccalaureate residency training program using the evaluation frameworks of Stufflebeam’s CIPP Model and Kirkpatrick’s Model. Retrospective data covering the period from 2018 to 2023 were gathered from the program’s database, involving 422 participants. Additionally, cross-sectional descriptive data using questionnaire were collected from 291 respondents, including nursing administrators, unit-based clinical nurse educators, and nurse preceptors. Statistical analyses included descriptive statistics, ANOVA, and paired t-tests. The findings regarding program context, input, and processes consistently revealed a high to exceptionally high level of appropriateness. In terms of program products, trainees reported moderate to high levels of satisfaction. All participants successfully met competency standards in their respective specialties, achieving a 100% pass rate. Post-training, there was a significant improvement in specialized nursing competencies, and this positive trend persisted at the 6-month follow-up, with statistically significant changes in behavior (p < .05). Job confidence levels showed a substantial increase, while job-related stress significantly decreased (p < .05). The findings of this study can serve as initial data for nursing departments seeking to collaborate with educational institutions in the planning for appropriate curriculum development by considering factors such as context, input, processes, and outcomes.

Incidence of Central Line-Associated Bloodstream Infection: A 6-year Report in the Medical Intensive Care Unit at a University Hospital

Rungtip Darayon — 2024-06-03

Central line associated bloodstream infection (CLABSI) is a significant complication in critically ill patients undergoing catheter placement. This research was a retrospective study to determine the incidence of bloodstream infections associated with catheter placement in patients admitted to the medical intensive care unit from January 2017 - December 2022. A demographic data and diagnosis of CLABSI form was used for data collection. Data were analyzed using descriptive statistics. The results showed that there were 1868 patients with catheters; most were male. The most common catheter insertion position was a jugular vein. A total of 13 infections were found per 10,019 total catheter days. The lowest average number of catheter days was 4.6 days in 2019 and the highest 6.2 days in 2020. The highest infection rate was 1.51 times per 1,000 catheter days in 2017 and the lowest 0.63 times per 1,000 catheter days in 2022. The most common causative bacteria were gram-negative bacteria which are multidrug resistant, including Klebsiella pneumoniae and Acinetobacter baumannii. In conclusion, the incidence of infection tended to decrease continuously. Nurses should play a significant role to review the problem and search for practical preventive procedures, such as by increasing the scrub hub and using an antiseptic barrier cap, as well as by
monitoring and supervising practices.

Factors Predicting Covid-19 Self-Protective Behaviors among Pregnant Women

Sasitorn Kampan — 2024-06-15

This research aimed to study self-protective behaviors against COVID-19 infection and its predictors among pregnant women. Two hundred and seventy-eight pregnant women receiving antenatal care at a Provincial Hospital in the south of Thailand were selected through simple random sampling. Data were collected using a set of questionnaires including demographics, COVID-19 preventive knowledge, perceived severity of the disease, attitudes towards self-protection, adherence to reference groups, perceived self-efficacy, and self-protective behavior against COVID-19 infection questionnaires. The instruments’ reliability was tested using Cronbach’s alpha coefficients, yielding values of 0.76, 0.90, 0.99, 0.94, 0.71, and 0.84, respectively. Statistical analysis included percentages, means, standard deviations, and stepwise multiple regression analysis. The findings revealed that 92.40% of pregnant women rated a high level of self-protective behavior against COVID-19 infection. Stepwise multiple regression analysis indicated that perceived self-efficacy and adherence to reference groups significantly predicted self-protective behavior against COVID-19 infection, accounting for 71.70% of the variance (R² = .717, p < .001). Therefore, both factors should be included in designing programs to promote self-protection against COVID-19 in pregnant women and applying in preparedness of emerging infectious
diseases in the future.

Development of a Self-efficacy in Breast Milk Expression Promoting Program for Cesarean Mothers with Gestational Diabetes Mellitus: A Pilot Study

Anchalee Intasorn — 2024-06-03

This research aimed to design, determine and evaluate a Self-efficacy in Breast Milk Expression Promoting Program among cesarean mothers with gestational diabetes mellitus (GDM). The research was divided into three phases: 1) program design, 2) determining its quality, and 3) evaluating the practicability of the program. The participants consisted of 10 cesarean mothers with GDM who were selected according to inclusion criteria. The data were analyzed using descriptive statistics, percent, mean and standard deviation. The developed program consists of 2 parts: 1) the self-efficacy promoting in breast milk expression activity, comprising 4 steps and 2 sessions, and taking 30 minutes per session; and 2) the instruments, comprising 2.1) the intervention and control instruments including lesson plan, manual, and visual media, the assessment tool for hand breast milk expression skill, and the hand breast milk expression recording form, and 2.2) the data collecting instruments including a personal data form, and the milk ejection assessment and the onset of lactation questionnaires. This development program was evaluated by experts, its reliability determined, and its practicability verified. After intervention at 72 hours postpartum, 80 percent of participants had milk ejection equal to or more than level 3 (M = 2.80, SD=1.14). Moreover, 90 percent of participants had the onset of lactation earlier than a criterion-referenced standard, (M= 66.89, SD=13.85). The program can be used as a guide for nursing care to promote breastfeeding for cesarean mothers with GDM. However, its effectiveness should be tested with a larger sample size before being applied.

Innovation Development of Port for Abdominal Pressure Measurement: Design and Development Research

Supatra Phaopant — 2024-06-09

This design and development research aimed to develop a port for intraabdominal pressure measurement, and evaluate the effectiveness of the port in measuring pressure in the abdomen. The research process comprised three phases: phase 1, identifying needs or problems from the workplace; phase 2, design and development of the port for measuring pressure in the abdomen based on the design thinking process; and phase 3, evaluating the effectiveness of the port in measuring pressure in the abdomen. The sample consisted of 33 pediatric critical care nurses and 10 pediatricians selected by convenience sampling. Instruments were the port for measuring pressure in the abdomen and a questionnaire to elicit the participants’ opinions regarding use of the port in measuring pressure in the abdomen. The data were analyzed using descriptive statistics. The results revealed that the port received a high mean score (M = 4.49; SD = 0.55), and a very high mean score (M = 4.80; SD = 0.42) for the effectiveness in measuring pressure in the abdomen from pediatric critical care nurses and pediatricians, respectively. The results of this study indicate that the port of pressure measurement in the abdomen was applicable for clinical practice and was safe.

Development of an Arm Elevation Device for Reducing Pain and Swelling in Patients Undergoing Hand and Arm Surgery: Design and Development Research

Phetcharat Yodchareon — 2024-06-17

This design and development research aimed to develop an innovative arm elevation device by utilizing design thinking, pathophysiology, and a literature review as the research framework. The sample group consisted of thirty post-arm and hand surgery patients admitted in a surgical ward between February and June 2022. The research instrument was an arm elevation device that can be adjusted to 4 different angles. The instruments for data collection included: 1) swelling assessment form by measuring the size of the circumference, middle of the upper arm, middle of the lower arm, and wrist; 2) pain assessment form; and 3) satisfaction assessment form. The instruments were assessed for content validity by five experts and for reliability using Cronbach’s alpha coefficients yielding values of 1.00, .94, and .95, respectively. Descriptive statistics were used to analyze personal information and one-way repeatedmeasures analysis of variance was used to examine differences of mean pain levels and mean circumference among the three sites. The findings demonstrated a substantial difference both in the mean pain scores [F(3,87) = 504.09, p <.001] and in the mean circumferences among the three locations [F(3,87) = 1,090.46, p <.001]. Patients reported a high satisfaction with the innovation. The findings revealed that this innovation assists in the continuous elevating of the arm in accordance with the physician’s treatment plan. This innovation provides a guide for the creation of future innovations in nursing since it assists in the promotion of blood circulation, which could potentially lower pain scores and swelling rates post-surgery.

Effects of Implementing an Oral Feeding Readiness Assessment Guidelines on Transition Time from Tube to Oral feeding and Length of Stay in Preterm Infants

Jananya Sukkasem — 2024-06-17

This research adopted a quasi-experimental design to explore the effects of using oral feeding readiness assessment guidelines on the transition time from tube to oral feeding and length of stay in preterm infants admitted in the Neonatal Intensive Care Unit (NICU) and sick newborn at a tertiary hospital. Purposive sampling was performed to recruit 42 preterm infants. Subjects were assigned to an experimental group to receive oral feeding readiness assessment based on guideline (n = 21) or to a control group to receive routine nursing care for oral feeding (n = 21). The instruments included oral feeding readiness assessment guidelines developed from evidence synthesis and oral feeding readiness assessment, feeding volume and time, and vital signs. The data were analyzed using Chi-square test and Independent t-test. The results revealed that the mean transition time from tube to oral feeding and the mean length of stay in the experimental group were significantly less than those in the control group (t = 4.04, p = .00), (t = 2.08, p = .04) respectively. The results suggest that oral feeding in preterm infants can be started at less than 34 weeks. Using guidelines for assessing the readiness for oral feeding can help nurses make appropriate decisions to start oral feeding earlier in premature infants and achieve recognized standards in nursing practice.

Implementation Outcomes of a Fast-Track Nursing Management Model for Patients with Traumatic Brain Injury with Increased Intracranial Pressure

Supornpan Kitbunyonglers — 2024-06-17

This retrospective study aimed to evaluate the implementation outcomes of a fast-track nursing management model for patients with traumatic brain injury (TBI) and increased intracranial pressure (IICP) at a tertiary hospital. The model was developed based on the Donabedian quality of care framework, which includes structure, process, and outcomes. The model was implemented in 2018 and revised until integrated in routine work. Data were collected from the “Neurobyte” database for the fiscal years 2021-2023. Descriptive statistics were used for data analysis. Results showed that the number of patients with severe TBI were 113, 123, and 164, respectively. They were middle-aged adults. One-third of the patients underwent brain surgery. Outcomes evaluated in each aspect were as follows: For structure, neurosurgical nurses demonstrated knowledge of the care of patients with IICP higher than the predetermined criterion (> 70%). For process, although the mean of emergency department waiting time before admission to the ward was more than 100 minutes was longer than the standard (< 60 min), the mean preoperative time for urgent surgery (both order to operating room and order to time-in operation) was less than the standard (< 30 minutes and < 60 minutes, respectively). For patient outcomes, the mortality rates declined from 41.6% to 31.7%. The percentage of patients with good recovery at discharge increased from 40.7 to 48.2. The median length of hospital stay was 6-7 days. The study findings specified the following issues for further improvement: evaluation of care outcomes should commence at the emergency room, and quality improvement should be focused continuously.

Strategies for Promoting Healthcare Workers’ Compliance with Guidelines for Prevention and Control of Hospital-associated Infections

Wilawan Picheansathian — 2024-06-15

Healthcare-associated infections (HAI) are considered one of the most important healthcare problems because they significantly affect the quality of healthcare and prognosis of patients. However, a large proportion of HAIs are preventable by improving the compliance of healthcare workers (HCWs) with infection prevention and control (IPC) guidelines. Low adherence of HCWs to IPC guidelines is a major obstacle to global efforts to reduce HAIs. Several factors may affect HCWs’ compliance and noncompliance with the IPC measures. Behavior change of HCWs may require various approaches to improve adherence to IPC guidelines. Multifaceted intervention strategies have been found to be more effective in addressing low compliance rates as compared to strategies focused on simple interventions. It requires appropriate strategies and outcome evaluation for continuous improvement.