The Journal of Thailand Nursing and Midwifery Council

Full issue

Professor Dr. Noppawan Piaseu — Tue, 26 Mar 2024 00:00:00 +0700

Factors Associated with Social Media-Induced Risk Behaviors among Adolescents in a Community in Bangkok

Pilaiwan Jaichaun — Tue, 26 Mar 2024 00:00:00 +0700

Introduction Utilizing online social media has its advantages for knowledge acquisition, skill development, and communication. However, the lack of media literacy skills may pose risks, particularly among adolescents who frequently engage in online social platforms.

Objectives 1) To describe personal characteristics, media literacy skills, and social media-induced risk behaviors in adolescents, and 2) To investigate the relationship between personal characteristics (gender, age, education level) and media literacy skills with social media-Induced risk behaviors among adolescents in a community in Bangkok.

Design A descriptive correlational design

Methodology The participants included 371 adolescents aged 13-19 years, attending schools under the Bangkok Metropolitan Administration in the Laksi district. The participants were recruited through a multi-stage random sampling. Data were collected from January to March 2022 using questionnaires on personal information and social media use, media literacy skills, and social media-induced risk behaviors. The questionnaires were high in item objective congruence, with an index of .98 and 1.00, respectively. The reliability of the instruments was assessed using Cronbach’s alpha coefficient, obtaining values of .88 and .95, respectively. Data analysis was conducted using Spearman correlation, Point biserial correlation, and Biserial correlation.

Results The participants consisted of females (49.87%), with an average age of 15.27 years (SD=1.67). Most participants were in junior high school (49.33%), and the majority used smart phones (84.90%). The peak usage time for online social media was between 16:01 and 24:00 (66.04%). The primary reason for using online social media was for entertainment (78.44%). The average score for overall media literacy skills was at good level (M=3.58, SD=0.77), while the average score for social media-induced risk behaviors was at low level (M=1.94, SD=0.43). There was a statistically significant with low correlation between gender and age with social mediainduced risk behaviors (rpb=-.112, p=.032 and rs=.139, p=.007, respectively). However, there was no significant relationship between education level and media literacy skills with social media-induced risk behaviors (rb = .064, p=.216 and rs=-.003, p=.948, respectively).

Recommendation The results provide fundamental evidence for the community in the Laksi district. This information is crucial for multidisciplinary teams and stakeholders to plan for monitoring and surveillance of social media-induced risky behaviors, particularly in sleep quality and online social media addiction. Additionally, the results highlight the importance of promoting media literacy skills, focusing on creativity, and encouraging adolescent participation in sharing their opinions.

The Effect of Self-management Program on Preventive Relapse Behaviors in Adolescents with SLE

Tue, 26 Mar 2024 00:00:00 +0700

Introduction Systemic Lupus Erythematosus (SLE) is characterized by variations in the immune system leading to the production of autoantibodies, resulting in tissue damage, often prevalent in adolescents. Proper and continuous management by adolescents with SLE can help prevent disease relapse and shorten hospital stays.

Objective To examine the effect of the self-management program on preventive relapse behaviors in adolescents with SLE.

Design Two-group pretest-posttest quasi-experimental research

Methodology The participants consisted of 40 adolescents with SLE, aged 10 – 18 years, receiving care at nephrology and rheumatology pediatric clinics in a super tertiary hospital in Bangkok. They were purposively selected based on inclusion criteria, then were purposively assigned to either control or experimental group, each comprising 20 patients. The control group received standard nursing care, while the experimental group received standard nursing care and a self-management program. The self-management program, based on Creer’s self-management of chronic illness framework, focused on providing knowledge, practicing self-management skills, and engaging in the self-management process. Data collection instruments included a personal information form, a questionnaire on SLE knowledge for adolescents, and a questionnaire on preventive relapse behaviors. Content validity testing yielded validity indices of .88 and .95, while reliability testing obtained a Kuder-Richardson 20 coefficient of .74 and a Cronbach's alpha coefficient of .73. Data were analyzed using descriptive statistics, Chi-square test, Dependent t-test, and Independent t-test, with a significance level set at .05.

Result After the experiment, the mean score of preventive relapse behaviors in the control group significantly higher than before the experiment (t = -2.656, p = .016). In the experimental group, mean score for preventive relapse behaviors after the program (M = 2.334, SD = 0.296) was significantly higher than before the program (M=2.072, SD = 0.475), (t = -3.285, p = .002). There was no significant difference in mean scores of preventive relapse behaviors between the experimental group (M = 2.334, SD = 0.296) and the control group (M = 2.188, SD = 0.326, t = -1.481, p = .074). These results indicate that the program was not effective in modifying preventive relapse behaviors in adolescents with SLE.

Recommendations While the self-management program did not have a significant effect on preventing relapse behaviors, there appears to be an inclination towards higher efficacy. Therefore, it is advisable for nurses to design targeted programs aimed at empowering adolescents with SLE to effectively and appropriately self-manage across three key areas: eating behaviors, taking medications, and practicing general activities.

The Perception and Expectation Regarding Hospital Violence Management among Healthcare Workers in Emergency and Intensive Care Units

Tippawan Ruangchuphong — Tue, 26 Mar 2024 00:00:00 +0700

Introduction The violence perpetrated by patients and their relatives to healthcare workers continuously increases. Studying the perception and expectation of healthcare workers regarding hospital management is crucial for effective direction to prevent and address such instances of violence.

Objectives To study perceptions and expectations of healthcare workers towards hospital violence management among healthcare workers in emergency and intensive care units, both at the unit and hospital levels

Design A descriptive research using the workplace violence administrative guideline as the conceptual framework of the study

Methodology The participants comprised 111 healthcare workers, including 79 registered nurses and 32 other healthcare workers, working in the emergency and intensive care units of a University Hospital in Phitsanulok province. The participants were selected through purposive sampling according to the inclusion criteria. The sample size was determined based on Yamane’s principles. Data were collected using a self-administered questionnaire that encompassed personal information, perceptions, and expectations regarding the hospital violence management at the unit and hospital levels, and open-ended questions. The content validity of the research instrument was examined by qualified experts, yielding an index of item – objective congruence at .96. The reliabilities of the instrument were assessed, resulting in Cronbach’s alpha coefficients of .98 and .97 for the perception and expectation questionnaires, respectively. Data analysis was conducted using descriptive statistics.

Results The majority of the participants were females (82.9%) and registered nurses (71.2%). Perceptions of the hospital’s violence management, both at the unit and hospital levels, were at moderate levels (M=3.04, SD=0.71; M=2.80, SD=0.83, respectively), while expectations for violence management were at high levels (M=4.42, SD=0.75; M=4.42, SD=0.86, respectively). The participants’ perceptions of violence management in the emergency unit were rated from low to moderate, while the intensive care unit fell within the moderate level. Findings from open-ended questions revealed that the participants suggested clear measures and guidelines for violence management.

Recommendation Hospitals should establish clear measures and guidelines for managing violence within healthcare facilities, especially in emergency units, to support the expectations of healthcare workers.

Clinical Outcomes of Nurse-Led Cardiac Rehabilitation Programs in Patients with Heart Failure: A Systematic Review

Waiyaporn Promwong, Jaroonsree Meenongwah — Tue, 26 Mar 2024 00:00:00 +0700

Introduction Patients with complex conditions experiencing heart failure require long-term care and are at risk of hospitalization. Therefore, cardiac rehabilitation (CR) becomes vital to enhance clinical outcomes and decrease overall mortality risks.

Objective To assess clinical outcomes of the nurse-led cardiac rehabilitation programs (NLCRP) in patients with heart failure.

Design This study employed a systematic review.

Methodology The studies included in this review comprised randomized controlled trials (RCTs), both published and unpublished, in Thai and English between 2014 and 2023. The search comprised the following databases: Thai Thesis Database, ThaiJo, PubMed, CINAHL, Clinical Key for Nursing, ScienceDirect, and ProQuest Nursing. The selected studies underwent appraisal utilizing critical appraisal tools developed by the Joanna Briggs Institute, and their key findings were extracted. Data analysis was conducted using a summary narrative approach.

Results Seven RCTs met the inclusion criteria. The CR programs applied concepts and theories including motivational interviewing, empowerment, perceived self-efficacy, and the theory of planned behavior. The intervention mainly focused on an exercise alone. Program outcomes demonstrated improvements in laboratory test results, functional capacity, and quality of life, except for B-type natriuretic peptide (BNP) levels. However, it is important to note that these conclusions are derived from 1-3 studies for each clinical outcome. While this systematic review supports the NLCRP, the limited number of studies on the NLCRP prevents a clear confirmation of its efficacy.

Recommendations Further research is necessary to assess the effectiveness of the NLCRP. Nurses should provide health education using motivational interviewing for home-based cardiac rehabilitation, and telephone support.

Implementing Nurse-Led Case Management Guideline for Vulnerable Children and Their Families

Emon Tharakum, Choknitiphat Wisoon — Tue, 26 Mar 2024 00:00:00 +0700

Introduction The challenge of vulnerable children in Thailand is on the rise, affecting both urban and rural communities. Collaborative efforts among multidisciplinary teams and community networks that bridge clinics and local communities are anticipated to bolster the capabilities of healthcare teams in promoting the well-being of vulnerable children and their families.

Objective To assess the feasibility and effects of implementing nurse-led case management guidelines for vulnerable children and their families

Design The design of this study was implementation research.

Methodology This study included a sample of 18 vulnerable children admitted to a secondary-level hospital in a northeastern province, 18 family caregivers and 15 multidisciplinary health professionals, all recruited through purposive sampling. Data collection involved a demographic questionnaire, case management guidelines, satisfaction questionnaires for both vulnerable children and their families, and a satisfaction questionnaire for the multidisciplinary care team. The content validity indices for the case management guideline and satisfaction questionnaires were .81, .80 and .85, respectively. Reliability testing for satisfaction questionnaires resulted in Cronbach’s alpha coefficients of .79 and .76, respectively. Specific guidelines tailored to each type of vulnerability were implemented in all cases, including four post-hospitalization visits. Satisfaction data were collected both before and after the fourth visits. Descriptive statistics and the Wilcoxon Signed Rank test were employed for data analysis.

Results Most of the vulnerable children were female (72.22%) with an average age of 11.66 years (SD = 3.18). The primary vulnerabilities observed among children in this study included social vulnerability (61.1%), psychological vulnerability (33.33%), and physical vulnerability (5.56%). Family caregivers were predominantly female (77.78%), with an average age of 53 years (SD = 3.64). Most caregivers were grandparents (55.56%) and mothers (38.89%). The multidisciplinary team comprised professional nurses, pediatricians psychologists, pharmacists, and physical therapists. Results revealed that the guidelines were applied at almost every step, with the exception of emergency planning, which was executed only in some cases. Following the nurse-led case management guidelines, satisfaction scores significantly increased for vulnerable children and families (z = -3.626, p<.001) and the multidisciplinary team (z = -3.430, p = .001), respectively. Importantly, there were no records of recurrence admission or complications following the intervention.

Recommendations The study’s findings highlight the effectiveness of nurse-led case management, revealing positive initial outcomes. Establishing a long-term care management system and strengthening the team’s capacities to address the sophisticated challenges faced by children and their families, along with providing sustained support over time, will empower teams to improve a greater number of children and families from vulnerability.

Factors Related to Stress in Nursing Staffs at Emergency Department During COVID-19 Pandemic at a University Hospital in Bangkok

Sirinat Loungnarin, Saowaros Kongcheep, Chanchanok Wandee — Tue, 26 Mar 2024 00:00:00 +0700

Introduction The recent COVID-19 pandemic has presented significant challenges in delivering healthcare services, particularly by nursing staff in emergency care units responsible for urgent patient care and serving as the front line of hospitals. This has led to increased stress in the workplace. Additionally, various contributing factors may mutually impact and elevate stress levels, affecting the overall health of healthcare professionals and the quality of patient care.

Objectives To investigate stress levels and factors related to the stress in nursing staff at emergency department during the COVID-19 pandemic.

Design A descriptive correlational design.

Methodology This study focused on a population of professional nurses and practical nurses working in the emergency department of a university hospital in Bangkok, with a total of 118 participants. Data were collected from December 2022 to February 2023 through self-administered questionnaires, including 1) personal information, 2) factors related to the stress, developed by the researchers through a literature review, and 3) the stress assessment tool from the Department of Mental Health, verified by three experts, resulting in a content validity index of 1. The reliability of the instrument was tested in 30 nurses in a different setting with a Cronbach’s alpha coefficient of .93 and .96, respectively. Data analysis involved descriptive statistics, and Spearman’s correlation coefficient.

Results The emergency department nursing staff comprised 118 individuals, predominantly female (90.7%). The average age was 30.34 years (SD = 7.03). The majority held nursing positions (58.5%), were single (79.7%), and had a median work experience in the emergency department of 5.5 years. The median monthly income was 30,000 Baht, with approximately half reporting insufficient income (50.8%). Most worked 41-49 hours per week (71.2%). All staff had received at least one dose of the COVID-19 vaccine. The average stress level among emergency department nursing staff was classified as severe. Factors positively related to stress included changes in work conditions and systems (r=.533, p<.001), fear of infection or spread of COVID-19 (r=.408, p<.001), economic strain due to decreased income (r=.431, p<.001), changes in the work environment (r=.401, p<.001), moral distress in caring for COVID-19 patients (r=.595, p<.001), adapting to a new normal (r=.527, p<.001), and communication and coordination (r=.587, p<.001).

Recommendation The findings of this study can be utilized by administrators to develop stress management guidelines, providing support to emergency department nursing staff as they navigate their responsibilities amid the challenges posed by the COVID-19 pandemic.

The Lived Experiences of Cognitive Impairment in Older Adults

Wiwin Purana — Tue, 26 Mar 2024 00:00:00 +0700

Introduction Cognitive impairment is a common problem for older adults, arising from both common aging and premature dementia. The aging process often involves pathological changes, such as the death of nerve cells in various brain areas, leading to memory decline, reduced selfconfidence, stress, fear of dependency, diminished motivation in daily life, and a decline in social interactions among older individuals.

Objective To explore the experiences of cognitive impairment in the daily lives of older adults

Design A descriptive qualitative design

Methods The informants comprised individuals aged 60 years and above, residing in a sub-district within a central province in Thailand. A purposive sampling was employed to select 15 individuals who met the inclusion criteria. In-depth interviews were conducted at a mutually convenient time for each participant between May and October 2023. Data were analyzed using content analysis based on Sandelowski’s concept. The research’s trustworthiness was assessed through credibility, confirmability, and transferability.

Findings The experience of cognitive impairment in the daily life of the older adults can be summarized into three main themes: 1) forgetfulness, consisting of the recognition of forgetfulness, forgotten daily routine, and forgetfulness occurring outside the home, 2) emotional changes as a results of forgetfulness including irritability, anxiety and fear, and 3) management of forgetfulness, consisting of starting over, help from relatives, specifying the placement point, and doing activities.

Recommendations This study reveals that forgetfulness, emotional changes, and management of forgetfulness are significant experiences among the older adults. The healthcare team can use this information for collaborative planning with the families of older adults to screen, monitor, and provide cognitive-stimulating activities to delay dementia in the older adults.

Factors Predicting Contrast Induced Acute Kidney Injury in Patients Undergoing Contrast Enhanced Computed Tomography

Tue, 26 Mar 2024 00:00:00 +0700

Introduction Contrast-induced acute kidney injury (CI-AKI) is an important adverse condition among patients undergoing contrast-enhanced computed tomography (CECT). Investigating the predictive factors of CI-AKI can help assess and monitor the risk of developing CI-AKI or mitigate its severity when it occurs.

Objective The aims of this study were 1) to investigate the incidence of CI-AKI in patients underwent CECT, 2) to identify the relationship between systolic blood pressure (SBP) levels before CECT, diabetes mellitus (DM), estimated glomerular filtration rate (eGFR) before CECT, and consecutive CECT examinations within 24-72 hours and the risk of CI-AKI in patients undergoing CECT and 3) to investigate the predictive power of those variables to the risk of CI-AKI.

Design Retrospective predictive correlational study guided by Roy’s Adaptation Model

Methodology The data were collected from the medical records from the year 2016 to 2020 in a super-tertiary care hospital, Bangkok. Through purposive sampling, 260 in-patients met the inclusion criteria including aged 18 years old and above, and underwent CECT. The incidence of CI-AKI was analyzed using diagnostic criteria of Kidney Disease Improving Global Outcomes (KDIGO 2012). Logistic regression analysis was employed to examine the predictive power of CI-AKI risks, with the statistical significance level at .05.

Results The sample included an almost equal distribution of both male and female participants. Among the participants, 60.8% were older adults, with an average age of 62.5 years (SD = 17.7). The incidence of contrast-induced acute kidney injury (CI-AKI) from contrast media was 38.8%. The predictive factors for CI-AKI included systolic blood pressure before contrast-enhanced computed tomography (CECT) (OR 21.953, 95% CI [2.635–182.87], p = .004), eGFR before CECT less than 60 mL/min/1.73 m2 (OR 4.887, 95% CI [2.603–9.176], p < .001), and repeat contrast media administration within 24-72 hours (OR 2.351, 95% CI [1.047–5.278], p = .038). Together, these factors could predict CI-AKI in patients undergoing CECT with a variability of 27.3% (Nagelkerke R2= .273, p < .05).

Recommendation The study results indicate a higher incidence of kidney injuries resulting from contrast media exposure. The risk screening for patients is inadequate, and patients should be sufficiently protected against acute kidney injury (AKI) from contrast media due to various risk factors. Healthcare professionals should assess and closely monitor the occurrence of acute kidney injury in patients with low systolic blood pressure and low estimated glomerular filtration rate, and follow-up evaluations after repeated contrast media administration within 24-72 hours.

Factors Predicting Self-Care Behavior Among Pregnant Women in Nakhon Ratchasima Province

Tue, 26 Mar 2024 00:00:00 +0700

Introduction Pregnancy is a transformative period involving both physical and psychological changes. The provision of high-quality prenatal care is crucial for minimizing complications throughout all stages of pregnancy and childbirth.

Objective This study aimed to 1) describe self-care behaviors of pregnant women 2) describe the relationship between predisposing factors, enabling factors, and reinforcing factors with self-care of pregnant women, and 3) examine the predictive factors of self-care behaviors in pregnant women.

Design Descriptive predictive design using the PRECEDE-PROCEED Model as a conceptual framework

Methods The sample comprised 218 pregnant women aged 15-45 years receiving prenatal care at government hospitals in Nakhon Ratchasima Province. Sample selection employed a multi-stage random sampling. The research instrument consisted of a questionnaire with five sections including: 1) Personal characteristics, such as age, educational attainment, family income, and the quality of antenatal care; 2) Pregnancy knowledge; 3) Attitudes towards self-care behaviors, perceived benefits and barriers related to self-care during pregnancy, accessibility to antenatal care services, and support from family, friends, and medical personnel; 4) Self-care behaviors during pregnancy; and 5) Pregnancy and childbirth outcomes. Data were analyzed using descriptive and inferential statistics, including Pearson correlation, Chi-square test, and Multiple linear regression analysis.

Results In a sample of pregnant women with an average age of 27.22 years (SD=6.48), the mean score for self-care behaviors during pregnancy was high (M= 3.45, SD=0.27). Furthermore, 74.77% received quality antenatal care, 37.61% achieved weight gain within standard guidelines, 97.20% delivered at full term, and 96.33% of newborns had appropriate birth weights. Correlation analysis revealed significant associations between self-care behaviors and predisposing, enabling, and reinforcing factors. Self-care behaviors during pregnancy showed significant correlations with attitude towards self-care behavior, perceived benefits, and perceived barriers, (r=.426, .340, -.460, p<.001) and age (r=.201, p=.001). Additionally, knowledge about pregnancy was positively correlated with self-care behaviors (r=.163, p=.008), as well as access to prenatal health services (r=.411, p<.001) and social support from family, peers, and healthcare providers (r=.418, p<.001). Multiple regression analysis identified three variables predicting 28.10% of self-care behaviors during pregnancy (Adjusted R2= .271, F= 27.854, p<.001): age (β = .133, p=.024), perceived barriers to self-care during pregnancy (β = -.319, p<.001), and social support from family, peers, and medical personnel (β = .257, p<.001).

Recommendation The findings of this research have practical implications for promoting health behaviors in pregnant women. This includes designing age-appropriate activities, mitigating barriers to healthcare during pregnancy, engaging families in antenatal care, emphasizing the role of midwives in care, and providing comprehensive and easily accessible information to pregnant women.

Effectiveness of a Health Literacy Development Program for Patients with Hypertension at Risk of Cardiovascular Disease in Mueang Trang District, Trang Province

Suchinda Kongneam, Sutteeporn Moolsart, Somnuk Sakunhongsophon — Tue, 26 Mar 2024 00:00:00 +0700

Introduction Hypertension is a non-communicable disease that leads to complications in cardiovascular disease. Research indicates a significant correlation between self-care behaviors and health literacy in patients with hypertension. Therefore, promoting health literacy fosters improved self-care behaviors and the prevention of cardiovascular diseases.

Objective This study aimed to investigate the effects of a health literacy development program on health literacy, self-care behaviors, and the risk of cardiovascular diseases in patients with hypertension at risk of cardiovascular disease.

Design A quasi-experimental design with two-group pretest and posttest.

Methods Through stratified random sampling, the participants consisted of patients with uncontrolled hypertension residing in Mueang Trang District, Trang Province and met the following inclusion criteria: 1) having systolic blood pressure levels ranging from 140 to 179 mmHg or diastolic blood pressure levels ranging from 90 to 109 mmHg, and 2) being at risk of cardiovascular disease. They were assigned to experimental and comparison groups, each comprising 35 patients. The research instruments included: 1) a 12-week health literacy development program, consisting of training sessions to enhance processing capacity, general verbal knowledge, specific health knowledge, and followed up by community health volunteers; 2) a health literacy handbook for patients with hypertension at risk of cardiovascular disease; 3) a health literacy questionnaire; 4) a self-care behavior questionnaire; and 5) a 10-year cardiovascular disease risk score recording form. The content validity of instrument parts 1-4 was examined, revealing the content validity indices of 1.00, 1.00, .86, and 1.00 respectively. The reliability of the instrument parts 3-4 was tested, revealing a Kuder-Richardson 20 coefficient of .82 for the health literacy questionnaire, and Cronbach’s alpha coefficients of .90 for the self-care behavior questionnaire. Data analysis employed descriptive statistics, Independent t-test, Paired t-test, Mann Whitney U test, and Wilcoxon Signed Ranks test.

Results The experimental and comparison groups had similar characteristics, including average ages of 59.31 years (SD 7.38) and 59.63 years (SD 6.64) respectively, as well as educational attainment levels (74.29% and 68.57% respectively) at the primary education. After participating in the program, patients with hypertension at risk of cardiovascular disease in the experimental group demonstrated significantly higher overall health literacy (M 125.63, SD 4.33) and self-care behaviors (M 4.63, SD 0.23) compared to before participating in the program (M 84.71, SD 14.12, p<.001; M 3.50, SD 0.46, p<.001, respectively), and the comparison group (M 87.63, SD 13.91, p<.001; M 3.44, SD 0.37, p<.001, respectively). Additionally, risk of cardiovascular disease (M 7.26, SD 3.39) was significantly lower than before the program (M 9.92, SD 5.03, p<.001) and the comparison group (M 10.50, SD 6.28, p = .031).

Recommendation Registered nurses and healthcare teams can effectively implement health literacy development programs for patients with hypertension at risk of cardiovascular disease in the community thereby contributing to cardiovascular disease prevention.

Editorial Note

Professor Dr. Noppawan Piaseu — Tue, 26 Mar 2024 00:00:00 +0700