The Journal of Chulabhorn Royal Academy

Role of Outpatient Nurses in Managing Patients with Acute Upper Airway Obstruction Prior to Tracheostomy

Kanjana Chidpalad — 2026-02-16

Acute upper airway obstruction is a severe emergency condition that can be life-threatening. Tracheostomy is therefore considered the definitive treatment to secure the airway and prevent death. However, assessment of upper airway obstruction and initial airway management to stabilize the patient before undergoing
tracheostomy are critically important.
Outpatient nurses play a vital role starting from patient assessment and triage, initial airway management, appropriate oxygen administration, preparation for emergency tracheostomy, as well as effective coordination and referral. These roles help reduce the risk of complications, enhance patient safety, and decrease mortality rates.
Therefore, nurses must possess the knowledge and skills to screen and assess upper airway obstruction, plan nursing care from the early stage, and appropriately prepare patients for urgent surgery, ensuring that patients receive safe, effective, and optimal care outcomes.

Innovative Strategies: Harnessing Digital Technology for Efficient Nursing Administration and Healthcare Delivery in Thailand

santi bunfoo — 2026-02-16

The integration of digital technology in nursing administration is revolutionizing healthcare delivery
optimizing workflows and enhancing patient outcomes. This article explores innovative strategies for
harnessing digital technology to streamline nursing administration and improve healthcare delivery
efficiency. It discusses the impact of digital technologies such as electronic health records (EHRs) telehealth wearable technology artificial intelligence (AI) blockchain and mobile health (mHealth) applications on nursing administration.
Despite the numerous benefits offered by these technologies, challenges such as privacy concerns adoption
barriers and security issues must be addressed. The article highlights the importance of careful planning and strategic implementation in overcoming these challenges. Furthermore, it explores future trends and implications, emphasizing the potential of emerging technologies to revolutionize nursing administration and enhance patient care. Recommendations for staying ahead of technological advancements are provided stressing the importance of ongoing education collaboration and strategic planning.
Ultimately, the article underscores the transformative role of digital technology in nursing administration and its potential to humanize healthcare delivery ensuring a more patient-centered efficient and innovative healthcare ecosystem.

Mapping Inferior Epigastric Artery Relative to Abdominal Landmarks: Defining Surgical Safe Zones and Risks

Perawat Garunyapakun — 2026-02-16

Abstact

The inferior epigastric artery (IEA) is a critical landmark during laparoscopic surgery. While IEA injuries occur in only up to 2% of procedures, they can lead to serious complications such as port-site hematomas or life-threatening hemorrhage. This systematic review aims to clarify the IEA’s anatomical course relative to key abdominal landmarks to define surgical safe zones. We synthesized data from cadaveric dissections, radiologic imaging (CT and ultrasound), and surgical anatomy reviews. The IEA consistently courses within a paramedian "danger zone," typically located 4-8 cm lateral to the midline. Variations exist based on population and side; for instance, some studies show the vessel as close as 2 cm or as far as 10 cm from the midline. Higher BMI also tends to push the IEA slightly more lateral. To minimize injury risk, trocars should be placed in identified "safe zones": the avascular midline (linea alba) or areas >8 cm lateral to the midline. Given the current lack of Thai-specific anatomical data, local cadaveric studies are essential to refine these safety guidelines for regional populations.

Prevalence and Risk Factors of Frailty among Aged 50 Years and Over in Sakon Nakhon Province

Benyapha Sripanya — 2026-02-16

Abstract

Frailty is a biopsychosocial syndrome characterized by changes in all physiological systems that are age-related conditions and contribute to adverse health outcomes. This cross-sectional analytical study aimed to investigate the prevalence and risk factors of frailty among people aged 50 years and over. Sample groups are 356 people that aged 50 years and over in Sakon Nakhon province. Data were collected using a personal information form, social support questionnaire, Thai Geriatric Depression, Mini-Mental State examination, and the Tilburg Frailty Indicator. Data analysis was performed using Binary Logistic Regression Model showing the Odds Ratio and 95% Confidence Interval.

The results showed that most of the participants were female (72.19%). The average age was 63.92 ± 8.38 years, and 31.18% (95%CI: 26.4, 36.0) were detected as being frail. The factors predicted the development of frailty syndrome, were age (OR = 2.367, 95%CI 1.490 - 3.759, p <0.001), low level education (OR = 4.267, 95%CI 2.339 - 7.784, p <0.001), chronic medical condition (OR = 3.086, 95%CI 1.870 - 5.091, p <0.001), the number so medications used (OR = 2.026, 95%CI 2.281 - 3.202, p = 0.003), the history of fall during the last six mouth (OR = 2.153, 95%CI 1.356 - 3.418, p = 0.001), insufficiency of income (OR = 1.649, 95%CI 1.007 - 2.701, p = 0.047) low level of social support (OR = 1.632, 95%CI 1.039 - 2.564, p = 0.034), and cognitive impairment (OR = 1.888, 95%CI 1.194 - 2.986, p = 0.007).

This study indicates demographic factors. Health status, economic, and psychosocial conditions are all risk factors for frailty and lead to frailty among people in pre-aging and elderly age. Therefore, monitoring and managing these risk factors is important to reduce adverse health outcomes in the future.

Effects of a Social Support Program Delivered via Electronic Media on 3 - Months Exclusive Breastfeeding Among First-time Mothers

Somyaporn Puttaraksa — 2026-02-16

This quasi-experimental study aimed to examine the effects of an electronic social support program on 3 - months Exclusive breastfeeding in first-time mothers. The sample comprised 42 first-time mothers who gave birth and received postpartum care at Pho Prathap Chang Hospital and Pho Thale Hospital, Phichit Province. Participant were assigned to an experimental group (n = 21) and a control group (n = 21) using matched paring. The research instruments included a social support program for breastfeeding in first-time mothers, a telephone follow-up record, a LINE application, a personal data questionnaire, and a breastfeeding questionnaire used a double-test method, resulting in a reliability coefficient of 1. The experiment all group was conducted and collected from December 2023 to October 2024. Descriptive statistics were used to analyze the data. Fisher's Exact test
The study found a significant difference in the rate of exclusive breastfeeding for 3 months between the control and experimental groups (p < .05).
These finding suggest that midwives could apply an electronic media - based social support programs to promote breastfeeding among first-time mothers.

Effectiveness of an Oral Health Literacy Enhancement Program for Gingivitis Prevention among Ninth-Grade Students in Sawang Weerawong District, Ubon Ratchathani Province

Nutchanun Kamonroek — 2026-02-16

This one-group pretest-posttest quasi-experimental study aimed to investigate the effect of an oral health literacy enhancement program on the prevention of gingivitis in ninth-grade students. A purposive sample of 57 students was recruited, and the intervention was implemented over a six-week period. Data were collected using a self-administered questionnaire, an oral health literacy assessment, and the oral health literacy enhancement program kit, which was developed based on the six dimensions of the Health Literacy Theory. A paired t-test was used for data analysis, with a significance level set at 0.05. Results: The majority of the participants were female (56.1%), with an average age of 15 years. Before the program, the students' overall oral health literacy for gingivitis prevention was at a low level. Following the program, their oral health literacy scores increased significantly across all dimensions (p < 0.001), with the overall average score improving from a low to a moderate level. Conclusion: The oral health literacy enhancement program was effective in improving oral health literacy and preventing gingivitis among early adolescents. Recommendations: Future applications should extend the program duration to at least eight weeks and should include a comparative study with a control group to more clearly evaluate the program's effectiveness.

The Influence of Health Literacy on Alcohol Consumption Behaviors Among the Working-Age Population in Kaeo Saen Subdistrict, Na Bon District, Nakhon Si Thammarat Province

Chakkarin Parimanon — 2026-02-16

This cross-sectional study aimed to assess health literacy levels and alcohol consumption behaviors, and to analyze the influence of health literacy on alcohol use among the working-age population (aged 15 - 59 years) in Kaeo Saen Subdistrict, Na Bon District, Nakhon Si Thammarat Province. The sample consisted of 215 individuals selected through simple random sampling via a non-replacement lottery method. The research instruments included a health literacy assessment for alcohol consumers-validated with a Cronbach’s alpha coefficient of 0.82 -and the Alcohol Use Disorders Identification Test (AUDIT) developed by the World Health Organization. Data were analyzed using descriptive statistics, including frequency, percentage, mean, standard deviation, minimum, and maximum values , as well as stepwise multiple regression analysis.
The results revealed that a combined 67.44% of alcohol consumers had inadequate or problematic health literacy levels, while only 21.86% and 10.70% reached sufficient and excellent levels, respectively. Regarding consumption behavior, the majority were classified as hazardous drinkers (65.12%), followed by low-risk drinkers (18.60%), while harmful and dependent drinkers accounted for 12.56% and 3.72%, respectively. The regression model was statistically significant (F = 173.364, p < 0.001), accounting for 62.10% of the variance in alcohol consumption behavior (R2 = 0.621). Decision-making and inquiry skills were found to have a significant negative correlation with alcohol consumption, indicating that higher proficiency in these skills leads to reduced alcohol use; decision-making skill was the most influential factor. It is recommended that health literacy be enhanced, particularly in decision-making and inquiry skills. Strategies should include developing easy-to-understand health media, creating environments that discourage drinking, and providing holistic therapy for harmful drinkers. In conclusion, strengthening individual skills alongside community-based surveillance and policy support will help reduce risky drinking and its long-term impacts.

Development of an Innovative Model for Training in Heart and Lung Auscultation

Malee Kumkong — 2026-02-16

Background: Cardiopulmonary examination is a critical assessment requiring careful attention to establish applicable nursing diagnosis(es). This study aimed to create and develop an innovative model for training in heart and lung auscultation, including testing the effectiveness of the innovation created. Methods: There were three phases: 1) studying the need(s) for the model conducted through a focus group discussion with nine people involved in teaching and learning and six of third and fourth-year nursing students per year; 2) creating and developing the model then trying out it by the groups of fourth-year nursing students and newly graduated professional nurses, 30 persons per group; and 3) proving the effectiveness of the model through 57 third-year nursing students. The instruments consisted of semi-structured focus group questions, a qualification assessment form, and an innovation effectiveness assessment form. The quality of the tools was examined by three experts. The content validity index of the tool set was 1.00, the reliability of a qualification assessment form, and an innovation effectiveness assessment form was 0.83 and 0.87 respectively. Descriptive statistics were employed for quantitative data analysis; content analysis was also applied for qualitative data interpretation. Results: The innovative model was an upper half-body, life-sized human-like mannequin. Its shape and ribs were simulated with hard plastic and were covered by natural rubber prepared from the foaming process. The sound system was connected with a built-in speaker for listening to heart and lung sounds, and narration. Trial results evaluated by nursing students and newly nurses showed good overall characteristics with an average score at 4.49 (SD.57) and 4.48 (SD.58), respectively. The overall effectiveness of the model was a very good level with an average score at 4.59 (SD.54). Conclusion: This innovation is easy and convenient to apply as well as meets the needs of the users.

The Molluscicidal Effects on Golden Apple Snail and Toxic Effects on Nile Tilapia (Oreochromis niloticus) from the Soapberry (Sapindus rarak) Pericarp Crude Extract

Tharinee Leelateep — 2026-02-16

The golden apple snail (Pomacea canaliculata Lamarck) is an invasive species that causes ecological damage, agricultural losses and public health concerns. It act as an intermediate host of the parasite Angiostrongilus cantonensis. Traditional eradication methods, such as physical and biological control, are often difficult to implement effectively. As a result, most farmers prefer to use chemical methods due to their high effectiveness. However, these methods can have negative impacts on both the environment and human health. Therefore, the use of herbal extracts with molluscicidal properties that are environmentally friendly and safe for human health, is a promising alternative for controlling this snail. The molluscicidal activity from the soapberry (Sapindus rarak) pericarp crude extract has been reported, but its toxic effects on other aquatic organisms have not been thoroughly investigated. This research aims to study: 1) the molluscicidal effect of the soapberry pericarp crude extract on the golden apple snails, 2) its bioactive compounds, and 3) its toxic effects on Nile tilapias (Oreochromis niloticus). The results showed that at the concentrations of 25 ppm and 50 ppm of soapberry pericarp crude extract caused 50% mortality in snails within 24 hours and 90% within 72 hours, respectively. However, this concentration caused 100% mortality in Nile tilapias within 48 hours. Hederagenin was the bioactive compound found at 0.44%. It is a glycoside saponin with hemolytic properties on organisms. Hence, it might be the cause of snail and Nile tilapia mortality in this study. Our findings recommended that farmers should avoid using soapberry crude extract to eliminate the golden apple snails in the rice fields, lotus ponds, fish ponds, shrimp ponds, or other aquatic animal nurseries, as it is toxic to aquatic animals.

Palliative Performance Scale and Survival Among Advanced Cancer Inpatients: A Retrospective Cohort Study

Tippamas Taechawiwat — 2026-02-16

Background: Prognosis discussions are essential for advance care planning in cancer patients, yet
uncertainty may delay them, leading to aggressive end-of-life care. The Palliative Performance Scale (PPS) was widely applied to estimate survival in palliative care.This study examined the relationship between PPS and survival in advanced cancer inpatients in Thailand and identified survival-associated factors.
Methods: A retrospective cohort study included advanced cancer inpatients who received consultation from the Palliative Care Unit at Chulabhorn Hospital from January 2016 to December 2021, with follow-up until June 2023. PPS, Edmonton Symptom Assessment System (ESAS), and distress thermometer (DT) were used. Kaplan-Meier survival analysis assessed associations with PPS, ESAS, DT, gender, age, and cancer type. The log-rank test was applied to compare survival between groups for each variable. A Cox proportional hazards model was utilized to identify significant predictors.
Results: Among 1054 patients (50.57% female, mean age 62.28 ± 13.65 years), PPS significantly correlated with survival. Median survival (days) by PPS scores of 10, 20, 30, 40, 50, 60, 70, and ≥80% were 2, 4, 17, 28, 44, 49, 105, and 623, respectively. Overall median survival was 30 days (95% CI: 27 - 34). Cancer type, severe drowsiness, and moderate to severe shortness of breath significantly impacted survival. Hematologic cancer had lower mortality than hepatobiliary and pancreas cancers (HR 0.44; 95% CI: 0.32 - 0.60). Severe drowsiness (HR 1.65; 95% CI: 1.31 - 2.06) and moderate to severe shortness of breath (HR 1.45 - 1.88) increased mortality risk.
Conclusions: PPS, cancer type, severe drowsiness, and shortness of breath are key prognostic factors in advanced cancer inpatients, aiding palliative care planning