A causal model of factors influencing the quality of nursing care in psychiatric and substance abuse wards in hospitals under the Office of the Permanent Secretary, Ministry of Public Health, Thailand 10.55131/jphd/2026/240211
Article Sidebar
Main Article Content
Abstract
The quality of nursing care in psychiatric and substance abuse wards directly affects patient outcomes. The objective of this study was to examine the causal factors affecting the quality of nursing care in psychiatric and substance abuse wards in Thailand. A multi-site cross-sectional study was employed among 480 registered nurses with at least a Bachelor’s degree and experience in psychiatric and substance abuse care. Participants were purposively and conveniently sampled from 130 Ministry of Public Health hospitals across Thailand. Data were collected by an online survey using validated instruments, including the Practice Environment Scale of the Nursing Work Index (PES-NWI), a Nurses’ Clinical Competency Scale, a Work Engagement Scale, a Burnout Assessment Tool, and a Quality Nursing Care Scale. Structural Equation Modeling (SEM) was applied to test the hypothesized model, assessing both direct and indirect effects of study variables. The final model demonstrated a good fit (χ²/df = 2.67, RMSEA = 0.06, GFI = 0.96, TLI = 0.95, SRMR = 0.05). Nurses’ clinical competency had the strongest direct effect on the quality of nursing care (β = 0.63, p < 0.001), followed by work engagement (β = 0.16, p < 0.05). Burnout negatively influenced the quality of nursing care both directly (β = -0.09, p < 0.05) and indirectly through work engagement. Job satisfaction had an indirect effect on the quality of nursing care, whereas the nursing practice environment had no significant direct effect. Overall, the model explained 61% of the variance in the quality of nursing care. The findings suggested that improving nursing care quality in psychiatric and substance abuse settings requires enhancing clinical competency, work engagement, and reducing burnout. Implementation efforts should focus on training and burnout prevention, while future studies should examine the long-term effects and include diverse hospital settings.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Chitov A. The Concept of Drug Offenses in Thai Criminal Justice. Thammasat LJ. 2023;52(1):150-76.
Akahat N. Post-2021 Narcotics Code: Spatial Risk Assessment for Drug Control in Chiang Rai, Thailand. Asian Crime Soc Rev. 2024;12(1):Article 2.
Phoraksa T, Lerdtomornsakul U. Drug Addiction Rehabilitation Laws Comparing between the United States and Thailand. J. Thai Just Syst. 2023;16(2):49-62.
McLellan AT. Substance Misuse and Substance use Disorders: Why do they Matter in Healthcare? Trans Am Clin Climatol Assoc. 2017;128:112-30.
Volkow ND, Blanco C. Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention. World Psychiatry. 2023;22(2):203-29.
Wannasewok K, Suraaroonsamrit B, Jeungsiragulwit D, Udomratn P. Development of Community Mental Health Infrastructure in Thailand: From the Past to the COVID-19 Pandemic Consort Psychiatr. 2022;3(3):95-106.
Rotejanaprasert C, Thanutchapat P, Phoncharoenwirot C, Mekchaiporn O, Chienwichai P, Maude RJ. Investigating the spatiotemporal patterns and clustering of attendances for mental health services to inform policy and resource allocation in Thailand. Int J Ment Health Syst. 2024;18(1):19.
Thamduangsri P, Wongjumpa S. Enhancement of self-efficacy in substance abuse patients to prevent relapse. Nurs J Min Public Health. 2023;33(2):1-10.
Stewart D, Warren J, Odubanwo A, Bowers L. Nursing interventions for substance use during psychiatric hospital admissions: Clinical context and predictors. Int J Ment Health Nurs. 2015;24(6):527-37.
Panitrat R, Yuttatri P, Sittirak N. Relationship Between Negative Life Events, Rumination and Learned Resourcefulness and Psychiatric Problems Among Incarcerated Juveniles with a History of Substance Abuse. Songklanagarind Med J. 2012;30(1):21-31.
Petcharat B, Suwanchinda P, Suttharangsee W. Predictive factors of mental health and psychiatric nursing competencies of professional nurses working in psychiatric hospitals, southern Thailand. J Health Sci Med Res. 2007;25.
Hirani R, Podder D, Stala O, Mohebpour R, Tiwari RK, Etienne M. Strategies to Reduce Hospital Length of Stay: Evidence and Challenges. Medicina (Kaunas). 2025;61(5).
Johnson S, Dalton-Locke C, Baker J, Hanlon C, Salisbury TT, Fossey M, et al. Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care. World Psychiatry. 2022;21(2):220-36.
Ross LE, Vigod S, Wishart J, Waese M, Spence JD, Oliver J, et al. Barriers and facilitators to primary care for people with mental health and/or substance use issues: a qualitative study. BMC Fam Pract. 2015;16(1):135.
Division of Nursing. Policy Driven to Increase Accessibility of Psychiatric and Drug Abuse Nursing Services in General Hospitals, Ministry of Public Health, Thailand. Nonthaburi: Division of Nursing, Ministry of Public Health, Thailand.; 2024.
Aekwarangkoon S, Noonil N, Negarandeh R. Understanding Thai Community Nurses' Experiences of Caring for Psychiatric Patients in Primary Care Units: A Phenomenological Study. Int J Community Based Nurs Midwifery. 2024;12(3):150-61.
Pillon SC, Luis MA, Laranjeira R. Nurses' training on dealing with alcohol and drug abuse: a question of necessity. Rev Hosp Clin Fac Med Sao Paulo. 2003;58(2):119-24.
Juanamasta IG, Aungsuroch Y, Gunawan J. A Concept Analysis of Quality Nursing Care. J Korean Acad Nurs. 2021;51(4): 430-41.
Wolf EJ, Harrington KM, Clark SL, Miller MW. Sample Size Requirements for Structural Equation Models: An Evaluation of Power, Bias, and Solution Propriety. Educ Psychol Meas. 2013;76(6):913-34.
Christopher Westland J. Lower bounds on sample size in structural equation modeling. Electron Commer Res App. 2010;9(6):476-87.
Schaufeli WB, Bakker AB, Salanova M. The Measurement of Work Engagement With a Short Questionnaire:A Cross-National Study. Educ Psychol Meas. 2006;66(4):701-16.
Wongcharoen W, Singchungchai P, Wongkhomthong J, Meehanpong P. The Structural Equation Model of Leadership of In-Patient Unit Head Nurses as Perceived by Professional Nurses, Nurses’ Work Engagement, and Job Performance of Professional Nurses in Community Hospitals. J Royal Thai Army Nurs. 2018;19(3):97-106.
Khaowphong W. Factors Predicting Job Satisfaction and Intent to stay of Professional Nurses in Private Hospitals of the Eastern region. Chonburi: Burapha University; 2013.
McCarthy G, Tyrrell MP, Lehane E. Intention to’leave’or’stay’in nursing. J Nurs Manage. 2007;15(3):248-55.
Stamps PL, Piedmonte EB. Nurses and Work Satisfaction: An Index for Measurement: Health Administration Press Perspectives; 1986.
Mueller CW, Mccloskey JC. Nurses' job satisfaction: A proposed measure. Nursing research. 1990;39(2):113-6.
Posai V. A causal model of factors affecting intention to turnover among registered nurses: a longitudinal study. Hat Yai: Prince of Songkla University.; dissertation in progress.
Schaufeli WB, Desart S, De Witte H. Burnout Assessment Tool (BAT)—development, validity, and reliability. Int. J. Environ. Res. Public Health. 2020;17(24):9495.
Redelinghuys K, Morgan B. Psychometric properties of the Burnout Assessment Tool across four countries. BMC Public Health. 2023;23(1):824.
Lake ET, Gil J, Moronski L, McHugh MD, Aiken LH, Lasater KB. Validation of a short form of the practice environment scale of the nursing work index: The PES-5. Res Nurs Health. 2024;47(4):450-9.
Funakoshi A, Miyamoto Y, Tsuchiya T, Tsunoda A. Development of the clinical competency assessment scale in child and adolescent mental health nursing. J Psychiatr Ment Health Nurs. 2024;31(4): 583-95.
Mrayyan MT, Abunab HY, Abu Khait A, Rababa MJ, Al-Rawashdeh S, Algunmeeyn A, et al. Competency in nursing practice: a concept analysis. BMJ Open. 2023;13(6): e067352.
Liu Y, Aungsuroch Y, Gunawan J, Sha L, Shi T. Development and psychometric evaluation of a quality nursing care scale from nurses' perspective. Nurs Open. 2021;8(4):1741-54.
Karaca A, Kaya L, Kaya G, Harmanci Seren AK. Psychometric properties of the quality nursing care scale-turkish version: a methodological study. BMC Nurs. 2022;21(1):370.
Kwak S. Are Only p-Values Less Than 0.05 Significant? A p-Value Greater Than 0.05 Is Also Significant! J Lipid Atheroscler. 2023;12(2):89-95.
Andrade C. The P Value and Statistical Significance: Misunderstandings, Explanations, Challenges, and Alternatives. Indian J Psychol Med. 2019;41(3):210-5.
Kline RB. Principles and Practice of Structural Equation Modeling, Second Edition: Guilford Publications; 2005.
Hooper D, Coughlan J, Mullen M. Structural Equation Modelling: Guidelines for Determining Model Fit. Electron J Bus Res Methods. 2008;6:53-60.
Aiken LH, Sermeus W, Van den Heede K, Sloane DM, Busse R, McKee M, et al. Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. Bmj. 2012;344:e1717.
Maslach C, Leiter MP. Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry. 2016;15(2):103-11.
Laschinger HK, Finegan J, Shamian J, Wilk P. Impact of structural and psychological empowerment on job strain in nursing work settings: expanding Kanter's model. J Nurs Adm. 2001;31(5):260-72.
Donley J. The Impact of Work Environment on Job Satisfaction: Pre-COVID Research to Inform the Future. Nurse Lead. 2021;19(6):585-9.
Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber JH. Educational levels of hospital nurses and surgical patient mortality. Jama. 2003;290(12):1617-23.
Duffield C, Diers D, O'Brien-Pallas L, Aisbett C, Roche M, King M, et al. Nursing staffing, nursing workload, the work environment and patient outcomes. Appl Nurs Res. 2011;24(4):244-55.
Zaitoun RA, Said NB, de Tantillo L. Clinical nurse competence and its effect on patient safety culture: a systematic review. BMC Nurs. 2023;22(1):173.
Tai C, Chen D, Zhang Y, Teng Y, Li X, Ma C. Exploring the influencing factors of patient safety competency of clinical nurses: a cross-sectional study based on latent profile analysis. BMC Nurs. 2024; 23(1):154.
Ausman C, Almatar D, Kiepek N. Medical training to effectively support patients who use substances across practice settings: a scoping review of recommended competencies. Can Med Educ J. 2024; 15(3):73-96.
Bakker AB, Schaufeli WB, Leiter MP, Taris TW. Work engagement: An emerging concept in occupational health psychology. Work & Stress. 2008;22(3):187-200.
Salanova M, Schaufeli W, Martinez I, Breso E. How obstacles and facilitators predict academic performance: the mediating role of study burnout and engagement. Anxiety Stress Coping. 2010; 23(1):53-70.
Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52:397-422.
McHugh MD, Kutney-Lee A, Cimiotti JP, Sloane DM, Aiken LH. Nurses' widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care. Health Aff (Millwood). 2011;30(2):202-10.
Galanis P, Moisoglou I, Katsiroumpa A, Vraka I, Siskou O, Konstantakopoulou O, et al. Increased Job Burnout and Reduced Job Satisfaction for Nurses Compared to Other Healthcare Workers after the COVID-19 Pandemic. Nurs Rep. 2023; 13(3):1090-100.
Quesada-Puga C, Izquierdo-Espin FJ, Membrive-Jiménez MJ, Aguayo-Estremera R, Cañadas-De La Fuente GA, Romero-Béjar JL, et al. Job satisfaction and burnout syndrome among intensive-care unit nurses: A systematic review and meta-analysis. Intensive Crit Care Nurs. 2024;82:103660.
Foà C, Guarnieri MC, Bastoni G, Benini B, Giunti OM, Mazzotti M, et al. Job satisfaction, work engagement and stress/burnout of elderly care staff: a qualitative research. Acta Biomed. 2020;91(12-s):e2020014.
Dall'Ora C, Griffiths P, Ball J, Simon M, Aiken LH. Association of 12 h shifts and nurses' job satisfaction, burnout and intention to leave: findings from a cross-sectional study of 12 European countries. BMJ Open. 2015;5(9):e008331.
Laschinger HK, Wong CA, Cummings GG, Grau AL. Resonant leadership and workplace empowerment: the value of positive organizational cultures in reducing workplace incivility. Nurs Econ. 2014;32(1):5-15, 44; quiz 16.
Ditlopo P, Rispel LC, Van Bogaert P, Blaauw D. The impact of the nurse practice environment, workload, and professional support on job outcomes and standards of care at primary health care clinics in South Africa: A structural equation model approach. Int J Nurs Stud Adv. 2024;7:100241.
Boudreau C, Rhéaume A. Impact of the Work Environment on Nurse Outcomes: A Mediation Analysis. West J Nurs Res. 2024;46(3):210-8.
