Nursing Journal CMU

Diabetes Self-management Behaviors and Influencing Factors Among Elderly Patients with Type 2 Diabetes Post-COVID-19 Pandemic in Wenzhou, China

2025-06-04T16:36:58+07:00

In the aftermath of the COVID-19 pandemic, despite healthcare recovery and digital health additions, diabetes self-management behavior (DSMB) among elderly patients in China remains poor, resulting in increased complications, mortality, and economic burden. This predictive correlational study investigated diabetes self-management behavior among elderly type 2 diabetes mellitus patients post-COVID-19 in Wenzhou, China, examining potential predictors including health literacy, perceived diabetes self-efficacy, and social support. Purposive sampling was conducted with 109 early elderly patients, aged 60-69 years, from the diabetes outpatient department at the First Affiliated Hospital of Wenzhou Medical University. Data was collected using questionnaires including the Diabetes Self-Management Behavior Scale, Health Literacy Management Scale for Chronic Diseases, Diabetes Self-efficacy Scale, and Social Support Rating Scale. Data analysis was conducted using descriptive statistics and multiple linear regression.

The findings revealed that diabetes self-management behavior in elderly patients was at a low level (M = 34.53, SD = 9.65). Perceived diabetes self-efficacy was the only factor that could significantly predict diabetes self-management behavior (β = 0.837, p < .001), explaining 65.8% of the variance in diabetes self-management behavior. Neither health literacy (β = -0.070, p = 0.377) nor social support (β = 0.045, p = 0.535) demonstrated significant predictive value.

The findings indicate that within the rapidly changing Chinese cultural context after the COVID pandemic, healthcare for elderly diabetic patients should prioritize building patients' confidence in managing their own condition.

Work Engagement and Organizational Citizenship Behavior of Nurses in the Referral Hospital, the Republic of Kiribati

2024-10-17T07:27:59+07:00

Work engagement of employees is an important factor related to organizational citizenship behavior. This descriptive correlational study aimed to describe the level of work engagement and organizational citizenship behavior and to examine the relationship between work engagement and organizational citizenship behavior among nurses in a referral hospital in Kiribati. A stratified random sampling technique was used to select 89 nurses from every ward of Tungaru Central Hospital (TCH). The research instruments were the demographic data form, the 17-item Utrecht Work Engagement Scale (UWES), and the Organizational Citizenship Behaviour Scale (OCBS). The data were analyzed by descriptive statistics and Pearson’s correlation coefficient.

The findings were as follows:
1. The overall work engagement as perceived by nurses was at a high level (M = 5.16, SD = .62). The three dimensions of work engagement including vigor, dedication, and absorption were at high levels (M = 4.94, SD = .77; M = 5.60, SD = .54; and M = 5.02, SD = .78, respectively).
2. The overall organizational citizenship behavior as perceived by nurses was at a high level (M = 5.45, SD = .40). The five dimensions of organizational citizenship behavior including altruism, civic virtue, conscientiousness, courtesy, and sportsmanship were all at high levels, (M = 5.59, SD = .46; M = 5.24, SD = .56; M = 5.41, SD = .58; M = 5.58, SD = .47; and M = 5.41, SD = .88, respectively).
3. There was a positive statistically significant relationship between work engagement and organizational citizenship behavior in the referral hospital (r = .53, p < 0.01).

This study’s findings provide vital evidence for nurse administrators to maintain and support work engagement to improve citizenship behaviors among nurses in a referral hospital, the Republic of Kiribati.

Length of Hospital Stay, Quality of Discharge Teaching, and Readiness for Hospital Discharge Among First-Time Mothers, the Republic of Burundi

2024-09-10T07:49:14+07:00

Readiness for hospital discharge is a key moment for ensuring that postpartum women and newborns receive the support they need to care for themselves and their babies at home. This descriptive correlational research aimed to explore the length of hospital stay, quality of discharge teaching, and readiness for hospital discharge among first-time mothers in the Republic of Burundi. The relationship between these factors was also determined. The participants were 101 first-time postpartum women in three general hospitals in the Republic of Burundi. Research instruments were translated into Kirundi, and included the Demographic Data Form, the Length of Hospital Stay Questionnaire, the Quality of Discharge Teaching Scale-New Mother Form, and the Readiness for Hospital Discharge Scale-New Mother Form. Data were analyzed using descriptive statistics and Spearman's rank correlation.

The results of this study revealed that all of the first-time mothers (100%) were discharged from hospitals within 24 hours after childbirth with a median of 12 hours (IQR: 9.00-15.50 hours). Almost all of the first-time mothers (96.04%) perceived the quality of discharge teaching at a low level with a median score of 1.15 (IQR: 0.35-4.60). All first-time mothers (100%) perceived readiness for hospital discharge at a low level with a median score of 0.82 (IQR: 0.68-1.05). The quality of discharge teaching was moderately positively correlated with readiness for hospital discharge (r = .459, p < 0.001). The length of hospital stay was not correlated with readiness for hospital discharge.

These results provide baseline information regarding length of hospital stay, quality of discharge teaching, and readiness for hospital discharge during the discharge transition. Nurse-midwives should develop strategies to enhance the quality of discharge teaching to improve readiness for hospital discharge among first-time mothers.

The Development of a Dietary Behavioral Modification Model for Persons with Type 2 Diabetes in Nakhon Ratchasima Province

2025-08-07T11:45:00+07:00

Type 2 diabetes is a major public health problem. Ineffective disease control resulting from inappropriate dietary behaviors can lead to severe multisystem complications. Therefore, knowledge and modification of dietary behaviors can help reduce the risk of complications in patients with type 2 diabetes. This research and development study aimed to create a dietary behavior modification model for patients with type 2 diabetes and to evaluate its effectiveness on the stages of behavior change, knowledge, and eating behavior. The study proceeded in three phases: situational analysis, model design and development, and pilot testing and evaluation. Participants were patients with uncontrolled blood glucose and family meal managers; simple random sampling was applied to recruit individuals in the Contemplation or Preparation stages. Instruments included assessment tools for stage-of-change, knowledge, and dietary behavior. Data were analyzed using descriptive statistics, the Wilcoxon signed-rank test, and the Mann–Whitney U test.

The results from Phase 1 found that over half of the patients demonstrated good nutrition knowledge, whereas most exhibited moderate eating behaviors and remained in the Contemplation stage; dietary habits, attitudes toward diabetes, and household income influenced their readiness to change. In Phase 2, a Transtheoretical-based model (TTM-based model) comprising 13 activities over 5 weeks yielded statistically significant improvements in stage-of-change, knowledge, and eating behavior (p < .001), though time and activity formats limited participant understanding and engagement. Accordingly, in Phase 3, the format was revised to an 8-week program consisting of 14 activities, with additional content and methods and a reordering of the activities. Consequently, the intervention group in this phase showed statistical significantly greater improvements in the stage of behavior change, knowledge, and dietary behavior compared with baseline and the control group
(p < 0.001).

The findings indicate that the developed model effectively enhances knowledge and modifies eating behavior in patients with type 2 diabetes. Therefore, it should be implemented to control the disease and reduce the risk of complications.

Situational Analysis of Practices Among Nurse Practitioners Transferring to Local Administrative Organizations in Chiang Mai Province

2024-11-20T12:50:09+07:00

The transfer of sub-district health promoting hospitals to local administrative organizations may have an impact on the professional practice of nurse practitioners. This descriptive research study aimed to analyze the practices of nurse practitioners transferred to local administrative organizations. The analysis was performed using Donabedian's systems theory framework which consists of three domains: structure, process, and outcome. The participants consisted of 6 public health administrators for analyzing the structural domain, 10 practicing nurses for analyzing the process domain, and 73 nurse practitioners for analyzing the outcome domain. The research instruments included a semi-structured interview used for the structural and process domains, and a questionnaire used for the outcome domain. Data were analyzed using descriptive statistics, content analysis, and group classification.

The results found that, regarding the structural domain: 1) characteristics of the organization's public health development policy/plan operated according to the policy of the local administrative organization; 2) resources and tools, including the manual of standards and guidelines for public health work, were developed from multidisciplinary work, and the operations of practical nurses were directly dependent on the Public Health and Environment Division; and 3) in terms of human resources, there has been an increase in the number of professional nursing workforce frameworks being opened. Regarding the process domain, nurse practitioners performed their duties according to their main roles and professional competencies, adjusting the service model to the CUP Split format. The outcome domain also revealed that nurse practitioners who transferred their role reported satisfaction at a high level (M = 3.90, SD = 0.95).

These results can be used by the executive committee of the PAO as fundamental information for determining public health policies and for developing service models for health promotion, prevention, treatment, and rehabilitation to better align with operators and service recipients.

Quality of Primary Health Care Services Provided by Health Personnel in Sub-district Health Promoting Hospitals after the Transfer of Responsibilities to the Kalasin Provincial Administrative Organization

2025-02-26T10:07:15+07:00

The transfer of sub-district health promoting hospitals to provincial administrative organizations represents a decentralization of power to local levels, and this has impacted the delivery of services to local populations. This study aimed to examine the quality of primary health care services provided by health personnel in sub-district health promotion hospitals after the transfer of responsibilities to the Kalasin Provincial Administrative Organization. The study was conducted with the entire population of 206 health personnel in 51 sub-district health promoting hospitals. Data were collected using a questionnaire developed by the researchers which applied Donabedian’s framework for quality assessment, comprising three sections: 1) personal characteristics, 2) service quality in three domains–structure, process, and outcomes related to staff satisfaction with their own performance, and 3) opinions and suggestions for service quality improvement. Data were analyzed using descriptive statistics, including frequency, percentage, median, mean, and range. Data from comments and suggestions for service quality improvement were summarized by categorizing and tabulating frequencies.

The results indicated that, after the transfer of responsibilities to the Kalasin Provincial Administrative Organization, overall service quality among health personnel in sub-district health promotion hospitals was rated highly (M = 3.73, SD = .43). Specifically, the process domain was rated high (M = 3.88, SD = .59), structural quality was moderate (M = 3.58, SD = .47), and the outcome domain, measured as staff satisfaction with their own performance, was also high (M = 3.86, SD = .47).

The findings of this study can serve as a baseline for relevant organizations in providing services and planning service quality improvements for sub-district health promotion hospitals. Recommendations include enhancing structural aspects and developing personnel capacity.

Effects of a Family Caregivers Empowerment Program on Rehabilitation Practices in Intermediate Patients with Mobility Impairment in a Community

2024-09-18T14:27:08+07:00

The rehabilitation of intermediate patients with mobility impairment requires high-quality and standardized care, which necessitates the active involvement of family caregivers. This quasi-experimental study, designed with two groups and pre-and post-tests, aimed to compare the rehabilitation practices of family caregivers for intermediate patients with mobility impairment in a community, both before and after receiving an empowerment program. It also compared the results between the experimental group, which participated in the empowerment program for 6 weeks, and the control group, which followed standard rehabilitation practices. The participants consisted of 50 family caregivers of intermediate patients with mobility impairment in the community, divided into an experimental group (25 participants) and a control group (25 participants).The research tools included: 1) an empowerment program developed by the researchers based on Gibson’s empowerment concept; 2) materials used in the activities, including manuals, posters, and video media shared via LINE groups, covering topics such as joint stiffness assess- ment, joint and muscle exercises, and posture management; and 3) an observation form to evaluate rehabilitation practices for intermediate patients with mobility impairment in the community. Data were analyzed using descriptive statistics, paired t-tests, and independent t-tests.

The research results indicated that after receiving the empowerment program, the experimental group showed statistically significant higher scores in rehabilitation practices for intermediate patients with mobility impairment compared to their scores before the program (t = -6.157, p < .001), as well as higher than the control group which followed standard care practices (t = 5.14, p < .001).

This research demonstrated that the empowerment program for family caregivers in relation to rehabilitation practices for intermediate patients with mobility impairment in a community can serve as a guideline for community nurse practitioners, case managers, and healthcare personnel. It can be used to effectively promote family caregivers’ involvement in the rehabilitation of intermediate patients with mobility impairment.

The Effects of an Individual and Family Self-Management Promotion Program Based on PITS Education on Self-Management Behaviors in People with Uncontrolled Type II Diabetes for Slowing Renal Impairment and Improving Clinical Outcomes

2025-04-02T14:14:02+07:00

Chronic kidney disease is a serious complication for uncontrolled diabetic patients, affecting them physically, mentally, socially, and economically, as well as impacting their quality of life. This two-group quasi-experimental approach with pretest-posttest design aimed to examine the effects of a self-management promotion program for individuals and families, providing knowledge based on PITS principles, on self-management behaviors to slow kidney deterioration and improve clinical outcomes in patients with uncontrolled type 2 diabetes. The participants were divided into an experimental group and a control group of 12 each. The experimental group received the self-management program based on the PITS Model and conducted 8 times at weekly intervals. Data were collected before the experiment, after the experiment (Week 8), and during follow-up (Week 12) using a self-management behavior assessment questionnaire. Clinical outcomes (HbA1c, systolic blood pressure, and diastolic blood pressure) were recorded. Data were analyzed using descriptive statistics, t-test, and repeated measures ANCOVA.

The findings revealed that the experimental group had a mean score of self-management behavior for slowing renal impairment in the post-test and follow-up periods that was significantly higher than before receiving the program (F = 101.22, p-value < .001), and significantly higher than the control group (F =129.19, p-value < .001). Additionally, the experimental group exhibited statistically significant improvements in glycated hemoglobin (HbA1c) levels and both systolic and diastolic blood pressure from pre-intervention levels (p < .001). Nevertheless, these clinical parameters showed no statistically significant differences when compared to the control group.

The findings could help the creation of guidelines for nurses to manage patients with uncontrolled diabetes, with the goal of preventing early-stage kidney disease within communities.