Journal of Research in Nursing-Midwifery and Health Sciences

Nursing Management of Acute Stroke Patients in Emergency Department of the First level referral Hospitals

Apinya Kamchalee, Chatkhane Pearkao — Tue, 30 Dec 2025 00:00:00 +0700

Stroke is a critical medical emergency requiring timely and accurate assessment to ensure effective treatment. Emergency nurses at first-level referral hospitals play a vital role in the early identification and management of life-threatening conditions, despite limitations in resources and equipment. This study aimed to develop a nursing management guideline for patients with acute stroke and to evaluate its outcomes based on Soukup’s evidence-based nursing practice framework. The process involved identifying clinical problems, conducting an evidence search using the PICO-T framework, appraising evidence quality using the Joanna Briggs Institute criteria, and developing a nursing guideline from 17 selected studies. The developed nursing management guideline comprised 4 core components 1. patient screening, 2. assessment of clinical manifestations and stroke mimics, 3. nursing management in the emergency department, and 4. referral coordination. The guideline was piloted with 5 suspected stroke patients in a first-level referral hospital. Results indicated improvements in the accuracy of nurse-led screening, reduced time to physician notification, prevention of patient deterioration during referral waiting, and decreased time from admission to referral compared to previous practices. The findings demonstrated that the developed guideline enhanced the timeliness of patient care and was feasible for implementation in first-level referral hospitals. Nevertheless, individualized nursing care tailored to patients’ specific conditions remains essential to reduce mortality and long-term disability.

Development of Continuity of Care Management Model for High-Risk Preterm Infants, Yala Hospital

Shutiwan Purinthrapibal, Nittaya Sookkaew, Pramot Thongsuk, Kamonpan Ramkaew — Sat, 20 Dec 2025 00:00:00 +0700

Objectives: To develop a continuity of care management model (CoCM Model) for high-risk preterm infants Yala Hospital and to evaluate the model utilization results. Methods: Information from the study about the situation of continuing care for high-risk preterm infants in Yala Hospital was used to conduct this action research for developing the CoCM Model within two phases: I. The model development phase (two circles) and II. The model utilization evaluation phase. The fifty-two participants included five nursing administrators, 16 nurses who work in either hospital or community, nine public health personnel, 13 caregivers, and nine preterm infants. Instruments comprised the draft of the instruction of CoC of high-risk preterm infants, the satisfaction questionnaires for healthcare and caregivers approved by five experts, (CVI .94 and 1.00, respectively), a weighing scale and a measurement tape. Data collection was performed by answering questionnaires and measuring the infant’s weight, height, and head circumstances. Data was analyzed using descriptive statistics. Results: The model comprised three management dimensions 1) the structural dimension included policy communication, staff and environment preparation, using technology for information transference, and consultation. 2) the processes of continuity of care from admission until the infant turns one year old and caregiver training and 3) participatory evaluation for the management of outcomes. The results of the management model utilization found the model satisfaction score among healthcare providers was at a high level (M=3.96, SD=.30) and the satisfaction score among caregivers was at a high level (M=4.00, SD=.50). There were 88.89% of infants tended to have normal growth curves. Conclusion: the participatory management model with contextual appropriation, specific information technology to clients and consulting availability can enhance better continuing of care in high-risk preterm infants.

Development and Preliminary Evaluation of a Health Chatbot for Breast Milk Expression Promotion in Mothers of Preterm Infants Admitted to the Neonatal Intensive Care Unit

Phusanisa Nualtem, Pissamai Wattanasit, Sasikarn Kala — Sat, 20 Dec 2025 00:00:00 +0700

Objective: This developmental research aimed to develop and preliminarily evaluate the usability of a health chatbot designed to promote breast milk expression in mothers of preterm infants admitted to the Neonatal Intensive Care Unit (NICU). Methods: The chatbot development comprised two main phases. Phase 1 involved designing the content and conversational structure, which included reviewing health knowledge on breastfeeding in sick infants, investigating approaches for using chatbots in health behavior promotion, and developing the chatbot’s conversational flow. The content and conversational structure were validated for content validity by a panel of five experts and revised according to their recommendations. Phase 2 focused on constructing the chatbot and conducting preliminary system testing, which included alpha and beta testing. Subsequently, the chatbot was pilot tested with two mothers of preterm infants admitted to the NICU for at least four days. This pilot study aimed to assess the mothers’ engagement with the chatbot, including any usability issues, the frequency of breast milk expression, recording practices, and milk delivery to the NICU. Results: The chatbot, developed on the ManyChat platform, served as a virtual nurse to support mothers’ breast milk expression. It communicated through text messages, infographics, and videos over four consecutive days. System testing revealed that the chatbot consistently delivered automated messages for the entire four-day period. Users were able to read messages, access images and content within infographics, and view videos with clear visuals and audio. Pilot testing with mothers showed that both participants used the chatbot continuously for four days without any usability issues. Both mothers were able to express breast milk, record the time and volume of milk expressed, and deliver the milk to the NICU correctly as advised by the chatbot. Furthermore, the mothers recognized the benefit of the chatbot in reminding them to express milk on schedule. Conclusion: The study findings indicate that this chatbot functioned as intended. Users could consistently access and use it continuously for the specified duration. Furthermore, mothers successfully expressed, recorded, and delivered breast milk correctly according to the chatbot’s guidance. These results suggest the potential feasibility of using a chatbot to promote breast milk expression among mothers of preterm infants admitted to the NICU.

Nursing Students’ Experiences of Simulation-Based Learning for Preparing First-Time Childbirth Assistance

Mingkamon Uttasuradee, Warangkana Chatchawet, Jitranan Kultanan — Tue, 23 Dec 2025 00:00:00 +0700

Objective: To explore nursing students’ experiences of simulation-based learning for preparing first-time childbirth assistance. Methods: A qualitative descriptive design was employed. Participants were nursing students who had enrolled in and completed the practicum course Maternal, Newborn, and Midwifery Nursing Practicum I during the academic year 2021 at an institution in southern Thailand. Purposive sampling was used based on predefined inclusion criteria. Data were collected between January and April 2023 through six focus group discussions, each comprising 6–8 participants, and through in-depth interviews with two students who had participated in the focus group discussions and required further inquiry. A semi-structured interview guide was used, and data collection continued until saturation was reached. Data were analyzed using content analysis. Results: Three main themes emerged: (1) Learning enablers (two subthemes: virtual learning media and appropriately designed simulation scenarios); (2) Key persons facilitating learning (two subthemes: instructors: learning facilitators who build confidence, and peers: sources of learning and emotional support); and (3) Outcomes of virtual simulation practice (two subthemes: perceived self-worth and professional role, and ensuring maternal safety). Conclusion: The findings highlight that preparation through virtual simulation scenarios not only enhances students’ knowledge and technical skills in childbirth assistance, but also fosters their awareness of their own value and roles within the healthcare team, and nurtures confidence in their professional identity for providing safe care to women in labor in the future. These insights can be used as a guideline for further development of teaching and learning using virtual simulation in childbirth assistance.

Development and Initial Validation of the Insulin Injection Behavior Assessment Tool (IIBAT) for Adolescents with Type 1 Diabetes Mellitus

Sujika Komjakraphan, Surasak Treenai, Chollada Jongsomjitt — Thu, 25 Dec 2025 00:00:00 +0700

Objective: To develop and initially validate an Insulin Injection Behavior Assessment Tool (IIBAT) for adolescents with type 1 diabetes mellitus (T1DM), based on the Five Rights framework of medication administration. Methods: This cross-sectional pilot study involved the construction of the tool based on literature review, clinical guidelines, and expert input. Five experts evaluated content validity using the Content Validity Index (CVI). Pilot testing was conducted with 34 adolescents with T1DM to assess clarity, feasibility, and reliability. A ceiling effect analysis was also performed. Results: The initial version of the IIBAT consisted of 24 items across three domains: preparation, storage/transportation, and adverse effect management. Content validity was strong (I-CVI = 0.80–1.00; S-CVI = 0.83), and no significant ceiling effect was found (2.94%). Corrected item–total correlations ranged from –0.30 to 0.60. Conclusion: The refined IIBAT demonstrated strong content validity and feasibility for assessing insulin injection behaviors in adolescents with T1DM. The removal of two low-performing items improved the conceptual alignment of the final 22-item version, supporting its use as a developmentally appropriate tool for clinical assessment and educational intervention.

The Effects of Self-Efficacy Enhancement in Paslop Exercise Program on Gait Balance and Fear of Falling Among Thai Elderly

Rattiporn Panitkul, Natenapha Khupantavee, Kanittha Naka — Tue, 30 Dec 2025 00:00:00 +0700

Objectives: to examine the effects of Self-Efficacy Enhancement in Paslop Exercise Program (SEEPEP)on balance and fear of falling among Thai older adults. Methods: this study was quasi-experimental two-group pretest-posttest study included seventy-four participants who met inclusion criteria were selected from older adults who live in Songkhla Province. The instruments used in this study consisted of 1) The Self-Efficacy Enhancement in Paslop Exercise Program 2) the demographic and health behavior questionnaire 3) the record form of exercise activities and 4) the falls efficacy scale. The content of the program and scale was evaluated by experts, yielding a content validity index (S-CVI = .90). The record form of exercise activities and the falls efficacy scale was assessed with reliability of .98 and .90 respectively. Data of demographic and health behavior data were analyzed using descriptive statistics, Paired t-test was used to compare gait balance within group and Independent t-test for between groups. Wilcoxon signed ranks test was used to compare fear of falling within group and Mann-Witney U test for between groups. Results: the results revealed that the mean score of balance at post-intervention in the experimental group was statistically better than that at pre-intervention (t = 8.08, p < .001) and significantly better than that in the control group (t = 4.31, p < .001). The mean rank of fear of falling at post-intervention in the experimental group was statistically lower than that at pre-intervention (Z = -3.71, p < .001) and statistically lower than that in control group (Z = -2.34, p < .05). Conclusion: The results of this study recommended to apply this SEEPEP for enhance balance and reduce fear of falling among community-dwelling Thai older adults.

Effects of the Nursing Care Integrating SKT 1 and 7 Program on Anxiety and Nausea and Vomiting in Patients with Lung Cancer Receiving Chemotherapy

Saowarat Praiin, Tippamas Chinnawong, Warangkana Keeratichananont — Tue, 30 Dec 2025 00:00:00 +0700

Objectives: This two-group repeated measure quasi-experimental study aimed to investigate the effects of a nursing care integrating Somporn Kantharadussadee Triamchaisri (SKT) 1 and 7 meditation (NCI-SKTM) program on anxiety, nausea and vomiting in patients with lung cancer receiving chemotherapy. Methods: Simple random sampling was used to assign 14 participants to the experimental and the control groups. The experimental group received NCPI-SKTM (SKT 1 and 7) four times per day for six weeks; combined with standard care, while the control group received only standard care. Anxiety was measured at baseline, week 3, and week 6 of the intervention using the State Anxiety Measurement. Acute and delayed nausea and vomiting were measured at baseline and at week 3 of intervention (on day 4 after receiving the first cycle and the second cycle of chemotherapy) using the Index of Nausea, Vomiting, and Retching (INVR) questionnaire. The reliability of the State Anxiety Scale, and INVR questionnaire were examined using Cronbach’s alpha coefficients of .94 and .96, respectively. Data were analyzed using descriptive statistics, Friedman test, and Mann-Whitney U test. The study indicated that the mean scores for the state of anxiety at week 3 and week 6 were statistically significantly lower than baseline within the group and lower than those of the control group (p < .01). Additionally, the mean severity and distress scores for both acute and delayed nausea and vomiting in the experimental group at week 3 were significantly lower than those of the control group (p < .05). Conclusion: The NCPI-SKTM program should be implemented to relieve anxiety and nausea and vomiting in lung cancer patients receiving chemotherapy.

Self-Care Behaviors of Persons with Hyperventilation Syndrome at a Community Hospital in Southern Thailand

Wanida Singchoo, Orawan Nukaew, Wandee Suttharangsee — Tue, 30 Dec 2025 00:00:00 +0700

Objective: To describe self-care behaviors of persons with hyperventilation syndrome. Methods: This descriptive research was applied. The participants comprised 58 persons with hyperventilation syndrome who had been treated at the emergency unit of a community hospital in southern Thailand, and the primary key-informant participants were 12 persons with hyperventilation syndrome. The research instruments consisted of; 1) a demographic data questionnaire; 2) a self-care behavior of persons with hyperventilation syndrome questionnaire; and 3) a semi-structured interview of self-care behaviors. Three experts examined the validity of the instruments part 2-3. The reliability of instrument part 2 was tested using the Cronbach’s Alpha coefficient, yielding a value of .89. Quantitative data were analyzed using descriptive statistics, and qualitative data was analyzed using content analysis. Result: The results of quantitative data showed that participants with hyperventilation syndrome had an overall mean score on self-care behaviors at a high level (M = 3.93, SD = .42). The results of qualitative data of self-care behavior revealed that there were two issues, in the following categories: 1) the direct management of hyperventilation symptom using a bag covering the nose and mouth, and 2) the avoiding triggers is an indirect self-care behavior, it involved reducing exposure to triggering events or stimuli by withdrawing from the situation or being alone. Conclusion: The results of this research support understanding that perception of the self-care behaviors’ persons with hyperventilation syndrome was at high level, and it could be used as a guideline for nursing practice to support the self-care behaviors of persons with hyperventilation syndrome.