Thai Journal of Nursing Council วารสารสภาการพยาบาลเป็นวารสารทางวิชาการที่มีการประเมินบทความและงานวิจัย โดยผู้ทรงคุณวุฒิที่มีความเชี่ยวชาญเฉพาะสาขา (peer review) กำหนดออกรายสามเดือน ปีละ 4 ฉบับ จัดทำโดยสภาการพยาบาล เพื่อเป็นแหล่งในการเผยแพร่ผลงานวิชาการ ทั้งด้านการพยาบาลทางคลินิกและชุมชน การศึกษาพยาบาล การบริหารการพยาบาล en-US (รศ. ดร สายพิณ เกษมกิจวัฒนา) (นางสาวภูษณิศา แก้วเขียว) Fri, 08 Feb 2019 15:44:33 +0700 OJS 60 Nurses’ Competency and Public Healthcare Innovations in Thailand 4.0 Era <p>This article presents the progress of Thailand’s healthcare innovations according to the national ‘Thailand 4.0’ policy, which spans from 2017 to 2036. In response to the policy, Thai healthcare organisations have adjusted and improved their services, their primary goals being to enhance healthcare providers’ competency, reduce unnecessary procedures in the healthcare system, increase public accessibility, and raise service recipients’ satisfaction. Also, healthcare personnel have integrated healthcare innovations with healthcare services to educate and enable the public to improve their self-care abilities, minimise consumption of healthcare resources, and reduce the number of patients in healthcare facilities<br>This article, which concentrates on enhancement of public knowledge and understanding of healthcare innovations for the Thailand 4.0 era, attempts to empower healthcare personnel to adopt the knowledge-based operation approach in place of the conventional skill-based approach, in response to public and social needs and expectations. The contents of this article cover the progress of healthcare innovations<br>for the Thailand 4.0 era, enhancement of nurses’ competency, and application of the Principle of Suffciency Economy as a cornerstone of happy living in the Thailand 4.0 era</p> ฐิติณัฏฐ์ อัคคะเดชอนันต์ ##submission.copyrightStatement## Fri, 08 Feb 2019 11:00:23 +0700 Management of Violence Risk in Workplaces: Emergency Departments <p>&nbsp; &nbsp; &nbsp; &nbsp; Workplace violence refers to any act that physically or psychologically threatens any of a workplace’s staff during their operation, whether directly or indirectly. Violence in an emergency department, which could range from physical assaults to verbal abuse, negatively affects the service providers, the clients, and the entire organisation. To ensure effective risk management, it is imperative that the organisation’s administrators, the department-managing nurses, the department’s staff, and the hospital’s security staff be engaged in the process of hospital violence prevention and control.<br>&nbsp; &nbsp; &nbsp;&nbsp; This article attempts to describe workplace violence in terms of its defnition, types, risk factors, and effects. To contribute to more competent management of violence risk in emergency departments, the article also proposes guidelines for better prevention of violence, as well as effective management during and after an act of violence.</p> ทรงวุฒิ สังข์บุญ ##submission.copyrightStatement## Fri, 08 Feb 2019 11:36:34 +0700 Stroke Patients’ Self-Management: Application of Empirical Evidence <p>&nbsp; &nbsp;&nbsp; Strokes have for decades been a major health threat in countries around the world, including Thailand. Prevention and control of stroke-related complications and stroke recurrence are of paramount importance to every stroke patient. Currently, empirical evidence from various countries demonstrates that self-management is integral to the control of strokes and care for stroke patients. Good healthcare behaviour and improved health-management ability directly contribute to stroke patients’ recovery, reduce stroke recurrence, and improve the patients’ quality of life. For the above reasons, registered nurses play a signifcant role in caring for and promoting self-management amongst stroke patients.<br>&nbsp; &nbsp; &nbsp;&nbsp; This article presents 1) self-management concepts, theories, and programmes; 2) application of Thai and foreign empirical evidence to developing self-management methods for stroke patients; and 3) recommendations on the role of nurses in promoting self-management amongst stroke patients. According to the applied empirical evidence, registered nurses’ roles should include: 1) educating stroke patients and their family members both on the disease and on self-management principles; 2) creating motivation and positive reinforcement for the patients and their families; 3) gathering support from the patients’ families and communities; 4) counselling for the patients and their families; 5) building the necessary self-management skills; and 6) establishing favourable nurse-patient relationships and coordinating between the patients and their families. This article recommends that self-management programmes be applied by healthcare organisations and that their administrators and policy setters integrate this approach to develop a high-quality procedure for stroke care and prevention in Thailand.</p> วิไลเลิศ คำตัน ##submission.copyrightStatement## Fri, 08 Feb 2019 11:54:50 +0700 Impacts of an Individualised Lifestyle Adjustment Programme on Glycosylated Haemoglobin Levels in Older People with Type-2 Diabetes <p>Objective: To study what impacts an individualised lifestyle adjustment programme<br>could have on the levels of glycosylated haemoglobin in older people with type-2 diabetes.<br> Design: Two-group experimental research with a pre-test and a post-test.<br> Methodology: Through purposive sampling, 44 elderly type-2 diabetes patients were recruited as participants. All of the patients were receiving treatment at the diabetes clinics of two health-promoting hospitals in Chiang Mai province between October 2017 and March 2018. First, the participants were paired according to their similarities in age, sex, duration of diabetes, type of orally administered diabetes medication, and co-morbidity. Then, each pair was split, with one member assigned to the control group and the other to the experimental group. The experimental group received a 12-week individualised lifestyle adjustment programme, whilst the control group was given standard care. Data were collected before<br>and after the experiment, through a personal information questionnaire and a measurement of glycosylated haemoglobin level using the COBAS C501 machine. The data were analysed using descriptive statistics, independent t-test, and paired t-test.<br> Results: The decrease in glycosylated haemoglobin level was signifcantly greater (p &lt; 0.05) in the experimental group than in the control group. Moreover, after completing the programme, the experimental group had a signifcantly lower glycosylated haemoglobin level than before participating in the programme (p &lt; 0.001).<br>Recommendations: The results indicate that the individualised lifestyle adjustment programme could be used to effectively control the glycosylated haemoglobin levels in older people with type-2 diabetes.</p> พิมพ์วีรา ละลำ, โรจนี จินตนาวัฒน์, ลินจง โปธิบาล ##submission.copyrightStatement## Fri, 08 Feb 2019 13:31:59 +0700 Predictive Factors of Hypoglycaemia in Neonates Delivered by means of Caesarean Sections <p>Objective: To investigate factors that could predict occurrences of hypoglycaemia in neonates delivered<br>by means of caesarean sections.<br> Design: Retrospective case-control study.<br>Methodology: The study sample, obtained through simple random sampling, consisted of 260 neonates who were delivered by means of caesarean sections and admitted to the neonatal care units of Phra Chom Klao Hospital and Hua Hin Hospital. Half of the neonates were classifed as a study group and half of them as a control group based on the criteria. Data were collected through a retrospection of medical records and a hypoglycaemia prediction form. Descriptive statistics and logistic regression analysis were used for data<br>analysis.<br>Results: Body mass index (BMI), nothing-per-oral (NPO) duration, types of intravenous fluid<br>(IVF) for the mothers, and disproportionate birth weight for gestational age could jointly predict 74.3% of hypoglycaemia in neonates delivered by means of caesarean section (p &lt; .01). First, neonates whose mothers had BMI ≥ 25 kg/m2 were 7.88 times more likely to develop hypoglycaemia than those whose mothers had BMI &lt; 25 kg/m2 (95% CI: 3.23-19.18). Second, neonates whose mothers received NPO for ≥ 6 hours were 26.41 times more likely to develop hypoglycaemia than those whose mothers received NPO for &lt; 6 hours (95% CI: 8.32-83.77). Next, neonates whose mothers were given glucose-free intravenous fluid displayed a 5.03-time greater likelihood to develop hypoglycaemia than those whose mothers received glucose-containing intravenous fluid (95% CI: 2.19-12.02). Finally, neonates who were too small and too large for gestational age (SGA and LGA) were respectively 12.97 and 64.06 times more likely to develop hypoglycaemia than those with appropriate weight for gestational age (95% CI: 1.20-139.55; 95% CI: 14.42-284.43).<br>Recommendations: Throughout pregnancy, pregnant women should be monitored to avoid becoming<br>overweight and prevent their newborns from having disproportionate birth weight for gestational age. During the prepartum period, the mothers should undergo an NPO period of less than 6 hours and should receive intravenous fluid with suffcient glucose content, to prevent their caesarean-delivered neonates from developing hypoglycaemia. Additionally, a screening process is highly recommended for all caesarean-delivered neonates with any of the above-stated risk factors.</p> สุชาดา บัวประคอง; วัลยา ธรรมพนิชวัฒน, สมสิริ รุ่งอมรรัตน์ ##submission.copyrightStatement## Fri, 08 Feb 2019 14:37:37 +0700 Community-Dwelling Older Adults’ Attitudes, Subjective Norm, Perceived Behavioural Control, and Intention to Make Living Wills <p>Objective: To investigate, amongst community-dwelling older adults, the relationships between their attitudes, subjective norms, perceived behavioural control, and intention to make their living wills (statements concerning their choice of end-of-life medical treatment and care).<br>Design: Descriptive correlation research.<br>Methodology: The study, using the Theory of Planned Behaviour as a framework, was conducted on a sample of 88 older adults who met the pre-set study criteria, namely, being 60 years old or above and being residents of Bangkok Noi district of Bangkok. Five interview forms were used to collect data pertaining to the participants’ (a) basic factors, (b) attitudes towards making their living wills, (c) compliance with subjective norm on their intention to make their living wills, (d) perceived behavioural control regarding making their living wills, and (e) intention to make their living wills. The data were analysed using descriptive statistics and Spearman’s rank correlation coeffcient.<br>Results:According to the fndings, the participants’ attitudes towards making living wills were generally moderate (52.3%), and so was their level of compliance with subjective norm (42%). They displayed a fairly high level of perceived behavioural control (61.4%), with a slightly lower livingwill intention level (56.9%). Furthermore, their attitudes and perceived behavioural control were found to have a signifcant positive relationship with their intention (r = .585, p &lt; .01, r = .615, p &lt;.01, respectively), whilst no signifcant relationship was found between their compliance with subjective norm and their intention (p &lt; .05).<br>Recommendations: Thorough assessment of older adults’ attitudes and perceived behavioural control is highly recommended in the process of encouraging them to make their living wills.</p> อภิรฎี พิมเสน; วิราพรรณ วิโรจน์รัตน์, นารีรัตน์ จิตรมนตรี ##submission.copyrightStatement## Fri, 08 Feb 2019 14:51:16 +0700 Factors Predicting Constipation in Critically Ill Patients <p style="margin: 0px;">Objective :To study factors that could predict constipation in critically ill patients.<br>Design : Descriptive predictive study.<br>Methodology : This study was conducted on 102 critically ill patients recruited by means of purposive sampling. The participants were at least 18 years old, and had been in the ICU for at least 4 days. Data were collected using 1) a personal information recording form; 2) a factor recording form; and 3) a constipation scale. Hierarchical regression was employed for data analysis.<br>Result: The patients’ intake of opioid analgesics, serum potassium levels, amounts of food intake through oesophagus, and amounts of physical activity were identifed as capable of jointly predicting up to 46% (R2 = .460) of instances of constipation. The most powerful predictive factor was the amounts of food intake through oesophagus (β = -.495, p &lt; .01), followed by the intake of opioid analgesics (β = .214, p &lt; .01) and amounts of physical activity (β= -.169, p &lt; .05), respectively. The least powerful predictive factor was the level of serum potassium, on the other hand, was capable of predicting only the preliminary stage of constipation (β = -.261, p &lt; .01). However, as no signifcant relationship between fluid balance and constipation was found.<br>Recommendation: It is recommended that nurses closely monitor constipation in patients having received opioid analgesics and in those with Hypokalemia. In addition, nurses should be prepared to feed the patients as soon as the patients are ready. Nurses are also advised to promote physical activity and bowel movement in the patients, to prevent constipation.</p> ศิริพรรณ ภมรพล; จารุณี นุ่มพูล ##submission.copyrightStatement## Fri, 08 Feb 2019 15:04:13 +0700 Health Status of Older Adults with Cognitive Impairment <p>Objective: To investigate health conditions of older adults who have cognitive impairment.<br> Design: Descriptive research.<br> Methodology: This study was conducted in Chiang Mai Province, Thailand. The sample consisted of 40 cognitively impaired person aged 80 years or more, all of whom lived with their caregivers. The participants’ health conditions were examined following the comprehensive geriatric assessment principle. For cognitive assessment of the participant, data were collected using two methods: 1) a physical examination of each participants to acquire their physical health information; and 2) an interview with each participant’s caregiver(s) to acquire information on each participant’s functional ability, cognition, and social health status. The data were analysed using descriptive statistics.<br> Results: The participants, whose average age was 85.13 years, were mostly female. The participants’ health conditions examined included their physical health, functional ability, cognitive ability, and social health. In terms of physical health, one-fourth of the participants had lower-thannormal body mass, whilst one-third had higher-than-normal body mass. Most of the participants had hypertension and were medicated for the condition. Eighty percent of the participants had low grip strength, and four of the participants had a history of falls in the previous 6 months. Regarding function ability, it was found that the participants were able to carry out basic daily activities but needed help in performing instrumental activities of daily living. Concerning cognitive health, half of the participants faced a risk of dementia. Finally, concerning social health, half of the participant lived with their children, who were their primary caregivers. Almost all of the participant received the government’s allowances for senior citizens and regularly participated in religious activities, mainly praying and meditation.<br>Recommendations : The fndings of this study could provide basic information for a community to develop a health status monitoring and assessment system for its older adult members who have cognitive impairment.</p> ทัศนีย์ กาศทิพย์, สุปรีดา มั่นคง, พรทิพย์ มาลาธรรม ##submission.copyrightStatement## Fri, 08 Feb 2019 15:16:53 +0700 Factors Predicting the Severity of Acute Kidney Injuries in Trauma Patients within 48 Hours <p>Objective: To examine the predictive power of age, comorbidity, severity of injury, level of consciousness, and systematic inflammatory response syndrome on trauma patients within 48 hours of receiving acute kidney injuries.<br> Design: Predictive correlation research.<br> Methodology: The subjects were 170 trauma patients receiving treatment in the intensive care units of Pattani Hospital, Yala Regional Hospital, Naradhiwas Rajanagarindra Hospital, and Su-ngaikolok Hospital. The data-gathering instruments were 1) a demographic record form; 2) the Injury Severity Score (ISS); 3) the Glasgow Coma Score (GCS), 4) a co-morbidity assessment form; 5) the Systematic Inflammatory Response Syndrome Score (SIRS Score); and 6) the Kidney Disease Improving Global Outcomes Clinical Practice Guideline (KDIGO). The correlations were analysed using Point Bi-serial Correlation, whilst predictive power was examined using Logistic Regression Analysis.<br> Results:The majority of the subjects (78.8%) were male, averagely aged 39.58 years (SD = 17.37). One-third (30%) of the subjects displayed co-morbidity, and nearly half were suffering from severe injuries and had a moderate level of consciousness (47.6% and 46.5%, respectively). The systematic inflammatory response syndrome was detected in 86.5% of the subjects. On the other hand, acute kidney injuries were found only in 11.8% of the subjects. Based on the results, the severity of injury and systematic inflammatory response syndrome were signifcant factors jointly predicting up to 30% of acute kidney injury incidences in trauma patients within the frst 48 hours of injury (Nagelkerke R2 = .30).<br>Recommendations:It is highly recommended that nurses thoroughly assess trauma patients’ AKI within the frst 48 hours of injury. Nurses also should use the information on the patients’ injury severity and SIRS for early monitoring and prevention of the development of AKI.</p> อาซิห แวหะยี; วัลย์ลดา ฉันท์เรืองวณิชย์; อรพรรณ โตสิงห์, กฤษณ์ แก้วโรจน์ ##submission.copyrightStatement## Fri, 08 Feb 2019 15:29:35 +0700