Thai Red Cross Nursing Journal

Applying Lean Principles to Develop a Care System for Patients Undergoing Robotic-Assisted Kidney Cancer Surgery at a Special Clinic

Puthachart Iamsa-ard — 2025-04-30

Kidney cancer patients who have undergone robotic-assisted surgery and previously received pre- and post-operative care at a specialized clinic encountered challenges related to the limitations of the original care system. These challenges included overlapping activities between departments, nurses experiencing stress due to time constraints, and patients lacking comprehensive knowledge and confidence in self-care. In response to these concerns, nursing services have adopted Lean principles as a tool to improve the quality of the nursing system by focusing on eliminating waste, maintaining value-added activities to continuously develop a smooth workflow, reducing patient waiting times, decreasing the incidence of adverse events, and ensuring that patients receive standardized and safe care. After implementing this nursing system, various positive outcomes were observed: 1) Nurses provided knowledge and skill training to patients in a more systematic and standardized manner through the use of video media. 2) The number of repetitive activities was reduced by 11. 3) The time spent on the operation was decreased by 100 minutes. 4) Relatives correctly performed wound care techniques with a rate of 100%. 5) The cost of care was reduced by approximately 25,000–30,000 baht per case. 6) The length of hospital stay decreased from 5–7 days to just 3–4 days. 7) Patient and nurse satisfaction reached a very high level of 100%. 8) Nurse anxiety levels significantly decreased from 7.5 to 3.0 on a 10-point scale. 9) The job satisfaction rate among nurses, ranging from high to very high, was 100%.

Effects of an Enhanced Self-Efficacy Program on Stroke Prevention Behaviors among Patients with Hypertension

Trinnachart Borthai — 2025-04-30

Patients with hypertension are at increased risk of stroke, which can result in disability and death; however, stroke can be prevented by promoting appropriate preventive behaviors among patients. This quasi-experimental study aimed to investigate the effects of an enhanced self-efficacy program on stroke prevention behaviors in patients with hypertension. The sample consisted of 34 hypertensive patients receiving treatment at the Chronic Illness Clinic of Non Din Daeng Hospital. The participants were assigned to experimental and control groups, with 17 participants in each group. The experimental group received the enhanced self-efficacy program for eight weeks, while the control group received routine nursing care. The instrument for collecting data was a questionnaire on stroke prevention behaviors with a Cronbach's alpha coefficient of 0.81. The Thai Mental State Examination (TMSE.) was also used for screening elderly patients. Data were analyzed using descriptive statistics, chi-square test, Fisher’s exact test, paired sample t-test, and independent sample t-test.

The results showed that after the experimental group received the intervention, the mean score for stroke prevention behaviors (𝑥̅ = 4.02, S.D. = .31) was significantly higher than before the intervention (𝑥̅ = 3.57, S.D. = .29, t = 6.39, p < .05). Additionally, the experimental group’s post-intervention scores were higher than those of the control group (𝑥̅ = 3.75, S.D. = .29, t = 2.60, p < .05). These findings suggest that nurses caring for hypertensive patients in chronic illness clinics should apply enhanced self-efficacy programs to promote effective stroke prevention behaviors.

Interprofessional Collaboration in Promoting the Rational Use of Antibiotics in a Medical Intensive Care Unit of a Tertiary Hospital in Southern Thailand

Uraiwan Samranrat — 2025-04-30

This qualitative study aims to describe the work of a multidisciplinary team promoting rational antibiotic use in the intensive care unit (ICU) of a tertiary hospital in Southern Thailand. The conceptual framework comprises four aspects: values and ethical issues, roles and responsibilities, communication, and teamwork. The study involved a multidisciplinary team consisting of five experts, nineteen nurses, three physicians, and three pharmacists. Data were collected through in-depth interviews and focus group discussions and analyzed using thematic analysis. The findings revealed four key themes affecting rational antibiotic use: (1) the value placed on interprofessional collaboration among team members, (2) communication gaps within the team, (3) unclear roles and insufficient collaboration among team members, and (4) inadequate knowledge among doctors and nurses regarding the rational use of antibiotics, indicating the need for appropriate capacity building. These findings could be utilized to develop models for interprofessional collaboration that support rational antibiotic use within organizations.

The Relationship between Resilience and Professional Quality of Life among Nurses in Secondary Hospitals, Northeastern Region

Tutsanee Yordklar — 2025-04-30

The purposes of this research were to study the resilience, professional quality of life, and to study the relationship between resilience and professional quality of life of nurses in secondary care hospitals in the northeastern region of Thailand. The sample consisted of 138 professional nurses selected using multistage random sampling. Research tools included three questionnaires: 1) a personal characteristics questionnaire, 2) the Resilience Scale questionnaire with a reliability coefficient of 0.88, and 3) the Professional Quality of Life Scale (ProQOL5) tool with an overall reliability coefficient of 0.85. Data were analyzed using descriptive statistics and Spearman’s rank correlation.

The results illustrated that the overall professional quality of life among the sample was at a moderate level, with a mean score of 30.30(S.D. = 0.58), while the mean score
for resilience was at a high level (𝑥̅ = 2.65, S.D. = 0.31). There was a moderate positive correlation between resilience and compassion satisfaction (r_s= 0.559, p < 0.01); however, the relationship between resilience and professional quality of life showed no significant correlation (r_s= 0.159, p > 0.05). When considering each dimension, it was found that resilience exhibited a moderate negative correlation with burnout (r_s = -0.383, p < 0.01), while considering each the dimensions of professional quality of life, compassion satisfaction (CS) had the highest mean score (𝑥̅ = 37.59, S.D. = 0.59), followed by burnout (BO) (𝑥̅ = 25.84, S.D. = 0.46), and compassion fatigue (CF) (𝑥̅ = 24.49, S.D. = 0.68). These findings suggest that nursing administrators should screen resilience and the nurses’ professional quality of life periodically and also use resilience as a strategy to enhance the nurses’ professional quality of life.

The Effects of an Integrated Instructional Program Using the Hot Salt Pot Method for Treatment of Postpartum Mothers on Nursing Students’ Cultural Awareness

Poonsab Lapchiem — 2025-04-30

This quasi-experimental study intended to compare the cultural awareness of nursing students before and after integrating the hot salt pot method for the treatment of postpartum mothers into a nursing instructional program, and to compare the cultural awareness between nursing students who had received and not received this integrated instruction. The sample group consisted of 126 second-year Bachelor of Nursing Science students divided into two groups, consisting of an experimental group of 65 students and a control group of 61 students. The instruments used for data collection consisted of a general information form and a cultural awareness questionnaire related to the instructional program using the hot salt pot for the treatment of postpartum mothers. Content validity, verified by three experts, was between 0.78 and 0.82, respectively, and the reliability of the questionnaire, using Cronbach’s alpha, was 0.97. Data were analyzed using descriptive statistics, including mean, percentage, and standard deviation. Paired t-test was used to compare pre- and post-instruction mean scores within the experimental group, and independent t-test was used to compare post-instruction mean scores between the experimental and control groups.

The results showed that nursing students in the experimental group had higher mean scores in cultural awareness after receiving the integrated instruction (Mean = 4.57, S.D. = 0.54) than before receiving the instructional integration (Mean = 3.83, S.D. = 0.66) at the .05 level of significance. It was also found that the experimental group had higher mean scores in cultural awareness (Mean= 4.57, S.D. = 0.54) than the control group, who had received the conventional training program (Mean= 4.37, S.D. = 0.86) at the .05 level of significance (t = 2.827).

The Relationships between Attitudes, Perceived Benefits, Perceived Barriers, and Breastfeeding Behaviors among Postpartum Adolescent Mothers at Jainad Narendra Hospital

Sinaporn Klomyong — 2025-04-30

Postpartum adolescent mothers often experience problems with breastfeeding. Hence, it is important to investigate the factors related to breastfeeding behaviors among postpartum adolescent mothers. This descriptive correlation study aimed to examine the relationships between attitudes, perceived benefits, perceived barriers, and breastfeeding behaviors. The sample consisted of 130 postpartum adolescent mothers at Jainad Narendra Hospital. The research instruments included a demographic questionnaire and an assessment tool on patients’ attitudes toward breastfeeding, perceived benefits of breastfeeding, perceived barriers to breastfeeding, and breastfeeding behaviors. Reliability coefficients obtained for the questionnaire and assessment tool were .78, .95, .91, and .96, respectively. Data were analyzed using descriptive statistics and Spearman’s correlation analysis.

The findings revealed that adolescent postpartum mothers demonstrated a high level of breastfeeding behaviors (Mean = 3.81, S.D. = 0.35). Attitudes toward breastfeeding were strongly positively correlated with breastfeeding behavior (rs = .77, p < .05), while perceived benefits of breastfeeding showed a low positive correlation with breastfeeding behavior (rs = .50, p < .05). Meanwhile, perceived barriers to breastfeeding were moderately negatively correlated with breastfeeding behavior. (rs = -.58, p < .05)

In conclusion, nurses working in postpartum units should promote positive attitudes toward breastfeeding, provide knowledge about its benefits, and offer guidelines for overcoming barriers to breastfeeding to adolescent mothers during the pregnancy, delivery, and postpartum periods.

Factors Predicting Hospital Readmission within One Year among Patients with Heart Failure after Hospital Discharge

Sirinan Chaluaisaeng — 2025-04-30

This study investigates the predictive relationship of various factors associated with hospital readmission within one year among patients with heart failure. The participants were 130 patients with heart failure treated at the outpatient department of a general hospital in Udon Thani province from January to April 2024. The research tools included personal information, medical history, a health literacy assessment (Cronbach's alpha = .94), and a family support scale (content accuracy = 0.90, Cronbach's alpha = .95). Data analysis was performed using descriptive statistics and binary logistic regression.

The results show that the incidence of hospital readmission within one year for patients with heart failure was 45.40% (n = 59). Age, health literacy, and family support were significant predictors of hospital readmission, accounting for 69.20% of the variance. Patients aged 49-59 and 59-69 were six times more likely to be readmitted than those aged 69-79 (OR 6.68 ; 95%CI 1.67-26.71, p < 0.05 and OR 6.28; 95%CI 1.88-21.03, p < 0.05, respectively). Patients with moderate health literacy were more than four times more likely to be readmitted to the hospital compared to those with very good health literacy (OR 4.05; 95% CI 1.20-13.90,
p < 0.05). Additionally, patients with moderate family support were more than three times more likely to be readmitted to the hospital compared to those with high family support (OR 3.40 ; 95% CI 1.18-9.74, p < 0.05).

The study suggests that further research should focus on reducing readmission rates by developing programs that consider age, health knowledge, and family support.