The Journal of Chulabhorn Royal Academy

Nursing Care for Adults with Sepsis in the Emergency Department: Evidence-Based Approaches and Critical Nursing Roles

2026-04-20T08:59:37+07:00

Sepsis is a life-threatening medical emergency with high morbidity and mortality, particularly when recognition and treatment are delayed. Disease progression may lead to septic shock and multiple organ dysfunction, resulting in poor clinical outcomes and reduced quality of life. Survivors may experience physical impairment, decreased functional ability, and greater dependence on others. The emergency department (ED) is a key setting for the early identification and management of sepsis. As the first point of care, the ED plays an important role in screening, diagnosis, and timely treatment. Emergency nurses are essential in recognizing early signs of sepsis, monitoring physiological changes, and supporting treatment in collaboration with multidisciplinary healthcare teams.

Current evidence highlights the importance of initiating sepsis management within the first hour of recognition, particularly in older adults, to improve survival and reduce complications. This article presents evidence-based nursing approaches for the care of patients with sepsis in the emergency department. The discussion includes patient assessment, recognition of physiological deterioration, physical examination and screening tools, guideline-based interventions, monitoring for treatment-related complications, ongoing evaluation, and patient safety considerations. These approaches aim to support emergency nurses in providing timely, effective, and high-quality care while improving patient outcomes in emergency settings.

The Role of Emergency Nurses in Managing Pregnant Women with Hypertensive Crisis

2026-01-09T09:48:13+07:00

Hypertensive crisis in pregnancy is a critical obstetric emergency associated with a high risk of maternal and fetal morbidity and mortality. This article aims to review the role of emergency nurses in the management of pregnant women with this condition, based on clinical practice guidelines published within the past five years, including those from the American College of Obstetricians and Gynecologists (ACOG), World Health Organization (WHO), International Society for the Study of Hypertension in Pregnancy (ISSHP).

A review of current clinical practice guidelines indicates that the role of emergency nurses in managing pregnant women with hypertensive crisis can be categorized into four key domains: 1) rapid assessment and triage to identify severe hypertension and acute hypertension-mediated organ damage (A-HMOD); 2) timely initiation of evidence-based treatment, including antihypertensive agents and magnesium sulfate; 3) continuous clinical monitoring, particularly of vital signs, neurological status, and urine output; and 4) coordination of multidisciplinary care and handover using structured communication tools such as ISBAR.

Emergency nurses therefore play a crucial role in supporting time-sensitive care, which requires rapid, accurate, and systematic responses to reduce treatment delays and enhance maternal and fetal safety. They serve as a key mechanism in driving emergency response within the first 60 minutes, thereby improving the quality and safety of healthcare delivery in the Thai context.

Nursing Management of Thai Buddhist Monks on Hemodialysis during Religious Intermittent Fasting: A Narrative Review and Practical Guidance

2026-02-25T09:18:44+07:00

Hemodialysis is life-sustaining for end-stage renal disease patients; however, managing therapy in Thai Buddhist monks is complex due to strict religious fasting and dietary constraints. This challenge is particularly acute in elderly, frail monks with multiple comorbidities.

This narrative review synthesizes evidence on the impact of religious fasting on hemodialysis outcomes and proposes tailored nursing management strategies. Findings indicate that fasting in this population can exacerbate malnutrition, electrolyte imbalance, and hemodynamic instability.

Effective management requires a structured, culturally sensitive approach, including tailored nutritional support, rigid electrolyte monitoring, medication adjustment, and care plans that honor monastic rules. This review provides a comprehensive framework to support safe, holistic care in this unique population.

Active Warming Technologies for preventing Perioperative Hypothermia: A Narrative Review of Evidence and Clinical Practice

2026-02-27T08:46:41+07:00

Perioperative hypothermia, defined as a core body temperature below 36°C, remains a frequent and preventable complication during anesthesia and surgery. It contributes to adverse outcomes, including increased blood loss, wound infection, delayed anesthetic recovery, and prolonged hospital stay.

This review aims to summarize current evidence regarding active warming technologies—Forced-Air Warming, Warming Mattress, and Intravenous Fluid Warmer—as evidence-based tools for preventing perioperative hypothermia. However, limited evidence is available comparing commonly used warming technologies in routine clinical anesthetic practice. Relevant clinical and experimental studies published over the past decade were reviewed to assess device performance, thermal efficacy, safety, and cost-effectiveness.

Evidence consistently supports Forced-Air Warming as the most validated and effective method for maintaining intraoperative normothermia, supported by multiple randomized controlled trials and meta-analyses. Warming mattresses provide additional conductive heat but are less efficient when used alone; their effectiveness improves when integrated into multimodal warming protocols. Intravenous fluid warmers are particularly valuable in surgeries involving large-volume fluid administration, minimizing heat loss through cold infusions. Despite strong validation, limitations remain, including variations in device design, incomplete standardization of testing methods, and potential safety concerns related to misuse or infection risk.

In clinical practice, selection of warming strategies should consider patient risk factors, surgical duration, and expected fluid administration. Future research should focus on standardizing protocols, optimizing integration with perioperative temperature monitoring systems, and exploring emerging technologies for precise thermal control.

Effectiveness of Using Google Forms and Form Approvals as an Online WorkSlot Exchange System for Personnel in the Department of Family Medicine, Ramathibodi Hospital

2026-05-11T13:22:23+07:00

Background: This research evaluates the performance of an online WorkSlot Exchange system developed using Google Forms and Form Approvals, replacing the traditional paper-based system. The study investigates technology acceptance among staff in the Department of Family Medicine at Ramathibodi Hospital.

Objectives: To compare the efficiency of the online WorkSlot Exchange system with the traditional paper-based system, and examine personnel's opinions, perceptions, and attitudes toward using the online WorkSlot Exchange system. (Google Forms).

Methods: A descriptive study employing the Technology Acceptance Model (TAM) for research instrument design. The sample included 81 personnel from the Department of Family Medicine, of whom 74 were active users of the online system. Data analysis was conducted using descriptive statistics and paired t-tests.

Results: A performance comparison revealed that the online system scored higher (Mean = 4.00) than the traditional paper-based system (Mean = 3.48), with a statistically significant difference (p < .05). These improvements were consistent across all dimensions: convenience, ease of use, operational tracking, and accuracy. Regarding technology acceptance, users reported high to very high levels of Perceived Usefulness (Mean = 4.56), Perceived Ease of Use (Mean = 4.30), and Attitude Toward Use (Mean = 4.38).

Conclusions: Implementing the online WorkSlot Exchange system, which utilizes Google Forms and incorporates Form Approvals into working slot management, enhances efficiency and agility in the department’s operations. It also serves as an essential tool demonstrating that selecting appropriate and accessible technology can foster acceptance and promote a positive work experience for staff.

Effectiveness of Super Rapid-Readout Versus Rapid-Readout Biological Indicators in Steam Sterilization: A Case Study in the Central Sterile Supply Department, Mae Fah Luang University Medical Center Hospital

2026-04-02T08:44:56+07:00

Background: Biological indicators (BIs) are essential tools for verifying the effectiveness of steam sterilization processes, particularly in Central Sterile Supply Departments, where accurate and timely confirmation of sterilization cycles is required. Objective: This study aimed to compare the effectiveness of a 5-minute super rapid-readout biological indicator and a 24-minute rapid-readout biological indicator during pre-vacuum steam sterilization at 134 °C in the Central Sterile Supply Department of Mae Fah Luang University Medical Center Hospital. Methods: This comparative experimental study evaluated two types of biological indicators: Brand A, a 5-minute super rapid-readout BI, and Brand B, a 24-minute rapid-readout BI. A total of 600 BI samples were tested. The experiment was conducted under three steam exposure durations: 1, 3, and 5 minutes, representing suboptimal, marginal, and adequate sterilization conditions, respectively. The proportions of positive and negative results between the two products were compared at each exposure duration. Statistical significance was set at p < 0.05. Results: In the 1-minute cycle,
representing a suboptimal sterilization condition, both biological indicators yielded 100.00% positive
results, with no statistically significant difference between Brand A and Brand B. In the 3-minute cycle, representing a marginal condition and a critical point for assessing BI sensitivity, Brand A yielded 95.00% positive results, whereas Brand B yielded 85.00%. This indicated a 10-percentage-point difference in
sensitivity, which was statistically significant (p = 0.032). In the 5-minute cycle, which represents an adequate sterilization condition, both biological indicators yielded 100.00% negative results, indicating specificity under the experimental conditions. Conclusion: The 5-minute super rapid-readout biological indicator demonstrated significantly higher sensitivity than the 24-minute rapid-readout biological indicator in the 3-minute marginal cycle, which is a critical condition for detecting steam sterilization process failure. These findings support the potential suitability of super-rapid-readout BIs for load-by-load quality monitoring in settings that require rapid, highly sensitive verification. However, further studies are needed to evaluate workload, cost, and occupational health implications.

Evidence-Based Approaches to Temperature Management in Patients with Traumatic Brain Injury

2026-07-09T08:48:27+07:00

Severe traumatic brain injury (TBI) is a critical condition associated with a high risk of secondary brain injury, particularly due to fever. This evidence synthesis aimed to summarize current evidence on temperature management in patients with severe TBI. Studies published between 2016 and 2025 were searched in ThaiJo, Google Scholar, PubMed, and the Cochrane Library using the PICO framework. Articles were selected according to the PRISMA guidelines. A total of 198 studies were identified, and six studies met the inclusion criteria.
The findings showed that temperature management strategies include physical cooling, targeted
temperature management (TTM), and therapeutic hypothermia (TH). Cooling devices and selective brain cooling applied to the head and neck were more effective than conventional methods in reducing body
temperature and intracranial pressure (ICP). Although therapeutic hypothermia effectively reduced ICP, current evidence does not demonstrate significant improvements in mortality or long-term neurological outcomes.
In conclusion, temperature management, particularly selective brain cooling and maintaining a target temperature of 36.0 - 37.5°C, plays an important role in preventing secondary brain injury and supports effective clinical management of patients with severe traumatic brain injury.

A Process-Based Framework to Calculate the Carbon Footprint of Sterile Processing in Central Sterile Supply Departments

2026-04-20T09:04:38+07:00

Background and Purpose: Central sterile supply departments are essential to surgical and procedural services using reusable medical devices. Their workflows consume energy, water, and packaging materials, continuously generating waste. However, practical frameworks for calculating carbon footprints from routine sterile processing activities and translating them into decision-ready indicators remain limited. This article proposes a process-based framework for calculating the carbon footprint of sterile processing in central sterile supply departments, integrating quality management, occupational safety, and sustainability. Methods: This methodological academic article synthesized relevant evidence and developed a seven-step framework based on process-based carbon accounting and life-cycle thinking. The steps include defining system boundaries and functional units; developing an instrument set database; collecting daily activity data for washer-disinfectors and steam sterilizers; calculating per-cycle emissions from activity data and emission factors; allocating emissions to instrument sets and individual instruments; incorporating sterile barrier systems and waste-management pathways; and linking the results to surgical case-level indicators. Results: The proposed framework establishes per-cycle emissions as an auditable starting point and converts them into per-set, per-instrument, and per-case indicators. These indicators reflect machine capacity utilization, quality-related reprocessing, packaging choices, and waste-management pathways. Quality control points are embedded in each step to support carbon reduction without compromising patient safety, infection prevention, or occupational safety. Conclusions: The framework provides a transparent and repeatable management tool for central sterile supply departments. It can support integrated decision-making on quality, safety, and sustainability, and can serve as a basis for field testing and the development of hospital-specific carbon reference values.

Effects of a Self-Care Model on the Prevention of Kidney Complications in Patients with Type 2 Diabetes: A Quasi-Experimental Study

2026-04-02T08:29:01+07:00

Background and Objectives: Diabetic kidney disease is a major complication among patients with type 2 diabetes mellitus and is associated with progressive renal deterioration, reduced quality of life, and increased healthcare burden. This study aimed to examine the effects of a self-regulation-based self-care promotion model on knowledge, self-regulation ability, and self-care behaviors among patients with type 2 diabetes mellitus. Methods: This quasi-experimental study employed a one-group pretest-posttest design. The study was conducted between June and August 2025. The participants consisted of 44 patients with type 2 diabetes mellitus receiving services at the diabetes clinic of Makha Subdistrict Health Promoting Hospital, Nakhon Ratchasima Province. The research instruments included: (1) a self-care promotion model developed by the researcher, (2) a questionnaire on diabetes knowledge and prevention of diabetic kidney complications, (3) a self-regulation ability questionnaire, and (4) a self-care behavior questionnaire. Data were analyzed using descriptive statistics and paired t-test. Results: After participation in the program, the participants demonstrated significantly higher mean scores in diabetes knowledge, self-regulation ability, and self-care behaviors compared with the pre-intervention period (p < .05). Conclusion: The developed self-care promotion model was effective in enhancing self-care capacity among patients with type 2 diabetes mellitus and supporting the prevention of diabetic kidney complications. The findings suggest that the model could serve as a practical approach for strengthening diabetes care and promoting self-management in primary healthcare settings.

HER2 Testing in Breast Cancer: Correlation between Immunohistochemistry and FISH Using the Updated 2023 ASCO/CAP Guidelines

2026-04-30T15:19:36+07:00

Background Human epidermal growth factor receptor 2 (HER2) is an important prognostic and predictive marker in breast cancer patients. HER2 amplification status is a prognostic factor for the response to HER2-targeted therapy. HER2 status can be screened via immunohistochemistry (IHC). HER2 gene amplification can be detected by fluorescence in situ hybridization (FISH) according to ASCO/CAP 2018 guidelines. In 2023, the ASCO/CAP guidelines for HER2 testing by FISH were updated. We analyzed the correlation between HER2 IHC status and FISH-HER2 expression according to updated guidelines. Methods Female patients with histologically confirmed invasive breast cancer were enrolled at Chulabhorn Hospital. HER2-IHC staining was performed and interpreted according to the 2023 ASCO/CAP guidelines. Equivocal (2+) or positive (3+) IHC results were confirmed with FISH testing. Results A total of 263 patients was classified into 192 patients in the HER2-IHC 2+ group and 71 patients in the HER2-IHC 3+ group. Among patients in the HER2-IHC 2+ group, 138 had negative FISH results, and 54 had positive FISH. Results All 71 patients with IHC 3+ had positive HER2 FISH results. Our study revealed a statistically significant relationship between positive (3+) IHC and FISH for HER2, with a correlation rate of 100% in the IHC 3+ group (rs=0.639, p<0.001) and 28% in the equivocal (2+) IHC group. Conclusion In accordance with the 2023 ASCO/CAP recommendations, our findings support that FISH testing is not required for patients with HER2 IHC 3+ breast cancer, which may help expedite therapeutic decision-making and treatment initiation.