Journal of Nurses Association of Thailand Northern Office

Enhancing Competency in Primary Care Services through Participatory Interactive Learning through Action (PILA): A Case Study of Takuang subdistrict, Saraphi District, Chiang Mai

Wilawan Senaratana — 2025-12-30

Primary care services are the foundation of the health system. Enhancing competency in primary care services is therefore essential to ensuring equitable, accessible, and high-quality health services for all citizens. It also promotes appropriate health behaviors and reduces preventable diseases. Enhancing the capacity in primary care services requires a comprehensive systems approach, particularly through the development of human resources in health using a contextbased learning process.

This academic article aims to describe the enhancement of primary care service competency through a participatory interactive learning through actions among health teams, family physicians and community network representatives. The learning activities focused on the development of human brain utilization, deep listening, teamwork, contextual health issue learning, and systemic reflective learning in community settings.

The results revealed that participants experienced changes at personal, family, and organizational levels. Improvements were observed in listening skills, emotional control, and positive thinking. Participants also developed appropriate health behaviors and enhanced competencies in teamwork, communication, and change leadership.

The case study indicates that the Participatory Interactive Learning through Action (PILA) is a crucial learning approach that enhances the competencies required for primary care service delivery. It also fosters sustainable collaboration among community partners and networks, facilitating the development and advancement of primary care services within the community.

The Relationship Between Health Literacy and Self-Management among Hypertensive Patients in Mae La Noi District, Mae Hong Son Province

Praveeda Kamdaeng — 2025-12-30

This descriptive correlational research aimed to explore the levels of health literacy, selfmanagement, and the relationship between these two variables among hypertensive patients in Mae La Noi District, Mae Hong Son Province. The samples consisted of 343 hypertensive patients receiving treatment at public health facilities in Mae La Noi District, Mae Hong Son Province, selected by using systematic random sampling. Patients were chosen at regular intervals from the registry list based on the population-to-sample ratio, and all provided informed consent. Research instruments included a personal information questionnaire, a health literacy questionnaire, and a self-management questionnaire for patients with hypertension. Data were analyzed using descriptive statistics including frequency, percentage, mean, standard deviation, and Pearson's correlation coefficient.

The findings revealed that the majority of the sample were female (73.76%), aged 60 years or older (51.02%), and had no formal education (63.84%). Patients in Mae La Noi District had a moderate level of overall health literacy (Mean=3.22, S.D.=.81) and a moderate level of overall self-management (Mean=3.36, S.D.=.73). Correlation analysis showed a statistically significant moderate positive relationship between health literacy and self-management among hypertensive patients (r=.52, p < .01).

These findings suggest that enhancing health literacy plays a crucial role in improving selfmanagement among patients with hypertension. Healthcare-professionals should design health promotion programs that specifically target skills in asking for reliable health information and adjusting health behaviors according to individual conditions, thereby improving blood pressure control and preventing complications.

Perceptions and Self - Management for Serum Phosphate Control among End-Stage Renal Disease Patients Undergoing Hemodialysis

Sudawan Khuntamitr — 2025-12-30

Hemodialysis is an indispensable intervention, as it is the principal modality for the removal of excrement form the body, thereby prolonging both the lifespan and quality of life of patients. This descriptive study aimed to: (1) examine the perceived susceptibility to hyperphosphatemia, perceived severity of hyperphosphatemia, perceived benefits of phosphate-control behaviors, and self-management behaviors for phosphate control among patients with end-stage renal disease (ESRD) patients undergoing hemodialysis; and (2) investigate the relationships between demographic, perceived the susceptibility to hyperphosphatemia, perceived severity of hyperphosphatemia, perceived benefits of phosphate-control behaviors and self-management behaviors for phosphate control. The participants comprised 94 ESRD patients who undergoing hemodialysis at the Veterans General Hospital between April 29th and May 17th, 2025. The research instrument was a questionnaire developed by the researcher. Data were analyzed using descriptive statistics, Spearman’s correlation (p), Pearson’s correlation coefficient (r) and the chi-square test (X²).

The findings revealed that participants had high levels of perceived susceptibility to hyperphosphatemia (Mean=27.02, S.D.=2.69), perceived severity of hyperphosphatemia (Mean=23.67, S.D.=3.20), perceived benefits of phosphate-control behaviors (Mean=22.47, S.D.=2.28) and self-management behaviors for phosphate control (Mean=55.33, S.D.=4.30). Occupation (X²= 156.04), perceived severity of hyperphosphatemia (p=.29) and perceived benefits of phosphate-control behaviors (p=.21) were positively correlated with self-management behaviors for phosphate control at a low level, with statistical significance at the .05 level.

This study highlights that perceived severity of hyperphosphatemia, perceived benefits of phosphate-control behaviors and occupation are important factors influencing self-management. However, they are not the sole determinants of health behavior change. Further research should investigate additional factors that may contribute to effective self-management of serum phosphate levels in ESRD patients undergoing hemodialysis.

The Situation of Mental Disorders in San Sai District, Chiang Mai Province

Warunee Pongpaew — 2025-12-30

This retrospective descriptive study aimed to examine the situations and distributions of mental disorders according to personal, geographical, and temporal factors in San Sai District, Chiang Mai Province, during the fiscal years 2019–2021. The study found a total of 20,633 cumulative service visits and 4,048 new cases. The highest number of service visits occurred in 2021, while the highest number of new cases was reported in 2019. Nong Han Subdistrict had the highest number of patients, whereas San Pa Pao Subdistrict had the lowest one. The five most common diagnostic groups were mood [affective] disorders (F30–F39); mental and behavioural disorders due to psychoactive substance use (F10–F19); schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders (F20–F29); neurotic, stress-related, and somatoform disorders (F40–F48); and organic, including symptomatic, mental disorders (F00–F09), respectively. Male patients outnumbered females, with mental and behavioural disorders due to psychoactive substance use being the most prevalent among males, and mood [affective] disorders being the most common among females. Age-specific distribution revealed that children aged 0–5 and 6–14 years had similar proportions of disorders of psychological development (F80–F89) and behavioural and emotional disorders with onset usually occurring in childhood and adolescence (F90–F98). Mood [affective] disorders were most common in the 15–24 age group; mental and behavioural disorders due to psychoactive substance use predominated among those aged 25–59 years; and organic, including symptomatic, mental disorders were most frequent in individuals aged 60 years and older. The findings indicate an increasing trend of mental disorders in San Sai District, especially during the COVID-19 pandemic, consistent with patterns observed at the provincial and national levels. Mood [affective] disorders and mental and behavioural disorders due to psychoactive substance use were identified as the primary conditions requiring targeted surveillance.

Quality of Life and Related Factors among Children with Cleft Lip and/or Palate in a University Hospital in Northern Thailand

Phitchawan Laochaicharoenphon — 2025-12-30

Cleft lip and/or cleft palate are common congenital anomalies that affect children’s physical, psychological, and social well-being, imposes economic burdens on families, and influences the quality of life of both children and caregivers. This cross-sectional descriptive study aimed to examine the level of quality of life and its related factors among children with cleft lip and/or cleft palate in a university hospital in northern Thailand.

Participants were 66 parents of children with cleft lip and/or cleft palate age 0–6 years who were purposively selected according to inclusion criteria. All children had been diagnosed with Cleft lip and/or cleft palate and had completed surgical treatment. Data were collected between August 2024 and February 2025 using a general information questionnaire and the validated THAICLEFT QoL Questionnaire. Data were analyzed using descriptive statistics and the Chi-square test to identify associated factors, with a significance level at .05.

The results revealed that the overall quality of life of children was at a high level. The highest mean score was found among children aged 0–1 year old (Mean=4.25, S.D.=.22; 95% CI:4.11–4.39), whereas the lowest was among those aged 3–6 years (Mean=3.93, S.D.=.53; 95% CI:3.75–4.11). Although the quality of life of children was high but tended to decline in relations to psychosocial satisfaction and family impact domains. Parental education level was significantly associated with children’s QoL (χ² =14.14, df=3, p=.03), while sex, age, cleft type, income, and health insurance were not significantly related (p > .05).

These findings highlight the important role of family, especially parents with higher education levels, in promoting children’s quality of life through better access to health information, understanding of the condition, and appropriate psychosocial support. The results provide essential evidence for developing comprehensive family-centered care strategies that enhance parental knowledge, psychosocial support, and continuity of care to improve the long-termquality of life of children with cleft lip and/or cleft palate.

Competencies of Palliative Care Nurses, Maharaj Nakorn Chiang Mai Hospital

Panadda Suwan — 2025-12-30

This descriptive research aimed to examine the palliative care competencies of professional nurses at Maharaj Nakorn Chiang Mai Hospital and to compare these competencies among nurses at different experience levels. The sample consisted of 271 professional nurses, selected through purposive sampling, all of whom had worked in wards providing palliative care for at least 3 months. The research instruments included a personal information questionnaire and the Palliative Care Competency Assessment Tool, developed by the Nursing Division, Office of the Permanent Secretary, Ministry of Public Health. Data were analyzed using descriptive statistics, the KruskalWallis test, and the Mann-Whitney U test.

The results revealed that 47.9% of professional nurses demonstrated overall palliative care competency at the level of requiring improvement, whereas 31.4% were at the standard level and 20.7% exceeded the standard level. Professional nurses with 1-3 years of experience showed the highest proportion (37.3%) of competencies above the standard level. In addition, professional nurses with more than 10 years of experience and those with 0-1 years of experience required the improvement at 68.3% and 52.4%, respectively. Furthermore, statistically significant differences (p < .05) were found forcompetencies in managing end-of-life care for patients and their families among professional nurses with different years of experience.

The findings suggest that both novice nurses who had 0-3 years of experience and senior nurses who had over 10 years of experience, require improvement in palliative care competencies. Therefore, healthcare administrators should focus on developing competency-building initiatives for both novice and senior nurses. This should include establishing training systems, mentorship programs, knowledge exchange platforms, and strengthening areas of deficiency to ensure that palliative care is of high quality, comprehensive, and more responsive to the needs of patients and their families.

The Analysis of Risk Management Situation in Male Medical Ward at A Tertiary Hospital

Tadsanee Khueankaeo — 2025-12-30

Risk management is a critical component of patient safety and healthcare quality. This descriptive qualitative study aimed to examine the current state of risk management and propose strategies for improvement in the male medical ward at a tertiary hospital. Data were collected from relevant documents, in-depth interviews with five physicians and professional nurses from the ward’s risk management leadership team, and focus group discussions with 24 nursing personnel working in the ward, consisting of registered nurses, nursing assistants, and nurse aides. A semi-structured interview guideline was developed based on Donabedian's conceptual framework for quality assessment (structure, process, and outcome) and validated by three experts. Data were analyzed using content analysis.

The findings are as follows; Structure: Several structural factors limited work efficiency. Although the ward had a complete risk management committee in accordance with hospital policy, the implementation of the policies into practice was found insufficient. In terms of human resource management, staffing levels were inadequate. The nursing personnel demonstrated varying levels of knowledge and competence in risk management. Limitations in tools, budget, environmental conditions, and supervision further impeded implementation. Strengthening the structural dimensions of policy, human resources, and support systems is essential to enhance service quality and patient safety.

Process: Risk management was performed using the Healthcare Accreditation Institute Framework of identification, assessment, management, and evaluation. However, risk identification lacked continuity and engagement, reporting was delayed and incomplete, and management remained largely reactive. Evaluation results were not fully aligned with actual ward risks or effectively utilized for improvement. Promoting proactive risk identification, timely reporting, and systematic data use is recommended.

Outcome: The findings indicated that the indicators related to clinical and non-clinical risks, as well as patient and family satisfaction and complaints, did not meet the targets, with certain complaints showing a rising trend. Recurrent incidents and limited use of outcome data were also noted. These results highlight the need for an in-depth analysis of contributing structural and process factors. The insights can be used to support nursing administrators in designing effective risk-management structures, processes, and outcome monitoring to ensure continuous improvement.

Predictive Factors of Alcohol Drinking Prevention Behaviors among Junior High School Students in Urban Chiang Mai

Muntanavadee Maytapattana — 2025-12-30

Alcohol drinking affects significantly among youth in terms of physical development, mental health, and social behaviors. This predictive correlational research aimed to 1) investigate the relationships between personal factors, family factors, social factors, and self-efficacy in preventing alcohol consumption affecting alcohol drinking prevention behaviors among junior high school students in an urban Chiang Mai, and 2) identify the predictors of alcohol drinking prevention behaviors among these students. The samples were 430 junior high school students attending urban community schools in Chiang Mai Province recruited by multi-stage random sampling. The research instruments included 1) the Alcohol Knowledge Questionnaire, 2) the Opinions on Family Factors Questionnaire, 3) the Opinions on Social Factors Questionnaire, 4) the Self-Efficacy in Alcohol Drinking Prevention Questionnaire, and 5) the Alcohol Drinking Prevention Behaviors Questionnaire. The content validity indexes of 5 research instruments were .97, .97, 1.0, 1.0, and .97, respectively. The reliability value of the Alcohol Knowledge Test, using Kuder-Richardson 20 (KR-20), was .76. Cronbach’s Alpha Coefficients of research instruments 2-5 were .72, .80, .85, and .73, respectively. The statistics used for data analysis were percentage, mean, standard deviation, Pearson’s correlation coefficient, and Stepwise Multiple Regression Analysis.

Findings of this study revealed that the students had mean scores 7.9 (S.D.=1.1) on alcohol knowledge at a high level. The mean scores for overall of the family support, social support, selfefficacy in preventing alcohol consumption, and alcohol drinking prevention behaviors were at a high level namely 31.0 (S.D.=5.6), 47.6 (S.D.=8.0), 40.8 (S.D.=7.5), and 38.7 (S.D.=6.9), respectively. In addition, the factors predicting alcohol drinking prevention behaviors (p<.05) were self-efficacy (X1), social factors in the aspect of school supports (X2), and peers (X3) which collectively accounted for 49.6% of the variance in prevention behaviors (R2=.496, Adjusted R2=.486). The resulting regression equation was Y = 6.522 + 0.499(X1) + 0.239(X2) + 0.236(X3).

The research findings can be used as a baseline for schools and related networks to plan for projects or activities to promote effective alcohol drinking prevention behaviors among students. Schools and relevant networks should implement programs that foster, particularly, refusal skills and life skills within schools, along with building positive peer networks and family involvement for proper supervision.