Journal of Nurses Association of Thailand Northern Office

Quality Improvement of Palliative Care in Stroke Patients, Acute Stroke Unit, Maharaj Nakorn Chiang Mai

Kanungnit Kladsuk — 2025-06-30

This developmental study aimed to improve the quality of palliative care for stroke patients in the acute stroke unit at Maharaj Nakorn Chiang Mai Hospital using the FOCUS PDCA continuous quality improvement process. The population in this study was 13 professional nurses. Three of them were in the developmental team, and ten were in the practical team. The study tools consisted of a personal information questionnaire, focus group interview instructions, an observation and inspection form regarding the following palliative care guidelines for stroke patients, and a form for documenting the patient outcome index in palliative care for stroke patients. All data was analyzed through descriptive statistics consisting of frequency and percentage.

The results showed that ten nurses in the practical team used the guidelines correctly in 24 patients, accounting for 87.5%. Additionally, the study of patient indicators from the twenty-four patients found that 100% of the patients received assessments for pain, anxiety, and satisfaction. Furthermore, pain, and anxiety management were provided, and both patients and their families expressed satisfaction with the palliative care provided.

The findings of this study can be used as a guideline to improve the quality of palliative care for stroke patients in other healthcare settings.

The Needs of Family Members of Patients with Traumatic Brain Injuries Admitted to the Critical Care Unit in a Tertiary Hospital

Janchai Kanchai — 2025-06-30

This cross-sectional descriptive study aimed to explore the needs of family members of patients with traumatic brain injuries admitted to critical care units in a tertiary hospital. It is also aimed to compare the needs of family members of patients with mild, moderate, and severe traumatic brain injuries. Data were collected between February 2023 and January 2024. The samples included 205 purposively selected participants. They were either blood relatives, legal guardians, or close kin who served as primary caregivers of the patients who’s hospitalized in surgical trauma critical care unit, neurosurgical critical care unit, or neurosurgical intensive care unit for at least 24 hours. The research instruments included a general demographic questionnaire for traumatic brain injuries patients, a general demographic questionnaire for family members, and a needs assessment questionnaire specifically designed for family members. Data were analyzed using descriptive statistics and the Mann–Whitney U test.

The findings revealed that family members had an overall need at a high level (x ˉ = 3.5, SD = 0.28). Specific dimensions of needs were also rated as high level, including informational needs (x ˉ = 3.7, SD = 0.26), psychosocial needs (x ˉ = 3.62, SD = 0.35), and spiritual needs (x ˉ = 3.43, SD = 0.49), while physical needs were rated at a moderate level (x ˉ = 3.25, SD = 0.55). Furthermore, no significant differences were observed between the needs of family members of mild and moderate to severe traumatic brain injuries patients (p>.05).

The findings of this study support the development of a spiritual health care system to promote interpersonal healings among healthcare providers, patients, and families. Additionally, critical care nurses should provide accurate and timely information that aligns with the highest specific needs of patients' family members.

The Development of A Nursing Care Model for Patients with New Colostomy in Lamphun Province

Sasithorn Pichaipong — 2025-06-30

This developmental study aimed to develop a nursing care model for patients with new colostomy in Lamphun Province and to evaluate its effects on the incidence of peristomal skin excoriation, hospital re-admission rates due to colostomy-related complications, return rates for repeated colostomy care education, and patients’ knowledge and correct practices in colostomy care. The research was conducted in three phases. In the developmental phase, key issues were identified through literature review and similar-context studies, and a draft model was created. This model was appraised by experts using the AGREE II instrument, achieving a quality score of 70.67%. In the pilot phase, the model was implemented with 56 colostomy patients—both newly operated and those referred from other hospitals—using a sample size determined by Cochran’s formula. Data were collected between 4 July 2022 and 26 June 2023. In the evaluation phase, the outcomes were analyzed using descriptive statistics, paired t-tests, and independent t-tests.

The finalized nursing model comprised six components: (1) establishment of an ostomy clinic; (2) a structured service system encompassing pre-operative nursing, and post-operative nursing, discharge planning, and continuous follow-up; (3) development of clinical guidelines and provisioning of specialized equipment for colostomy care; (4) implementation of an information system for patient data management; (5) health education and discharge planning delivered by a stoma nurse ; and (6) a referral network to facilitate patients’ reintegration into the implementation of the model in community led to significant improvements. The mean of peristomal excoriation rates fell from 0.14 to 0.04 (p < .05), the readmission rates for colostomy complications dropped from 0.44 to 0.00 (p < .05), and repeat education return rates decreased from 0.89 to 0.00 (p < .05). Additionally, patients’ knowledge and correct practices regarding ostomy equipment use, diet, appliance management, physical activity, and recognition of abnormal symptoms increased significantly (p < .01). These findings demonstrate that the developed nursing model effectively enhances clinical outcomes and supports a continuous, structured care approach for new ostomates.

It is suggested that this study is highly specific in nature, with its primary users being specialized nurses in colostomy care. Therefore, it is recommended that guidelines should be developed to facilitate the use of the nursing model by general professional nurses. This can be achieved by establishing consultation channels where general nurses can receive guidance on the application of the colostomy care model from specialized nurses. Incorporating information technology to support communication can further enhance the convenience and efficiency of nursing practice.

The Effects of Health Education Program using applied Self- Efficacy Theory on Self- Care Behaviors in Diabetic Patients

Surin Makmaitree — 2025-06-30

This quasi-experimental research aimed to study the effects of a health education program by applying self-efficacy theory on self-care behaviors of diabetic patients. The sample group was type 2 diabetic patients who received services at Lam Luk Ka Subdistrict Health Promotion Hospital. The samples were selected by simple random sampling with lottery to selected the villages and patients. There were 30 experimental patients and 30 control patients. The experimental group received a health education program. The research instruments consisted of 2 parts 1) the experimental instrument was a health education program applying the self-efficacy theory developed by the researcher from the self-efficacy perception research. 2) the data collection instrument was a questionnaire on general information, self-efficacy perception and self-care behavior of diabetic patients. The reliability values were .88 and .83 respectively. Data were analyze using descriptive statistics and t-test.

The results found that, the mean score of self-efficacy perception (ˉx= 83.56, S.D. = 4.43) and the mean score of self-care behavior (ˉx= 62.30, S.D. = 4.68) in the experimental group were significantly higher than the control group. The mean score of self-care behaviors also increased significantly than before the implementation of the health education program at p < .001. The results of this study showed that the health education program by applying the self-efficacy theory resulted in more correct self- care behaviors among type 2 diabetic patients. This health education program should be studied and tested with other group of diabetic patients.

The effects of Health Coaching Program on Hemoglobin A1c Levels Among Uncontrolled Type 2 Diabetes Patients

Bumnet Saengrut — 2025-06-30

Health coaching is an effective strategy for enhancing knowledge and skills through a patient-centered approach. This study aimed to examine the effects of a health coaching program on patients with uncontrolled type 2 diabetes. A quasi-experimental study with a two-group pretest-posttest design was employed. The samples comprised 76 patients with type 2 diabetes admitted to a medical ward between January and May 2020. They were divided into an experimental group (n=38) and a control group (n=38). The research instruments included the health coaching program, a self-care knowledge scale, educational materials, a self-care manual for diabetic patients, hospital discharge readiness scale, personal information survey, and an HbA1c analyzer. The instruments were validated for content validity by three experts and tested for reliability. Data were analyzed using the Mann-Whitney U test and the Wilcoxon Signed Rank test.

The findings revealed that, after participating in the program, the HbA1c levels of the experimental group were statistically significant lower than the control group (Z = –2.41, p=.016). Additionally, after the program participation, the HbA1c levels of the experimental group, were statistically significant lower than baseline levels (Z = -3.33, p=.001).

Therefore, the health coaching program was statistically effective in reducing HbA1c levels among uncontrolled type 2 diabetes. Thus, this program should be implemented in healthcare settings to promote diabetes management in this group of patients.

Health Literacy, Personalities, and Health Behaviors for Prevention of COVID-19 Virus Disease among Students at Kasem Bundit University

Jarussri Intarasomwang — 2025-06-30

This survey research aimed to explore the levels and relationships of health literacy, personalities and health behaviors among students at Kasembundit University in prevention of COVID-19 disease during the COVID-19 outbreak. The samples consisted of 400 students from all faculties, 1^st to 4^th year, who studied in regular programs in the first semester of academic year 2022, They were selected using systematic random sampling. The data collection tools were questionnaires for general information, health literacy, personalities and health behaviors. Data were analyzed using frequency, percentage, mean, standard deviation, and Pearson's Product Moment Correlation Coefficient.

The results found that 61.2% of the samples were female, 76.25% of them aged 15–20. They were domiciled in Bangkok and its vicinity 54.50%, and 61.80% of them lived outside the university. They had a high level of health literacy (mean=3.84, S.D.=.51) personality was at a high level (mean =3.70, S.D.=.57), health behavior was at a very good level (mean= 3.62, S.D.=.54). There was significant positive relationship between health literacy and health behaviors in prevention of COVID-19 disease (r=.375) There was significant positive relationship between personalities and health behaviors in prevention of COVID-19 disease (r=.387)

This research can be applied to develop teachers and students in teaching and learning management by continuously developing and keeping up with the changing situations of the world. It is a guideline for students to develop continuously, learning, experimenting, editing, improving to make teaching and learning more advanced and beneficial to students.

The Effects of Promoting Nursing Practice Guidelines to Prevent Ventilator-Associated Pneumonia in Newborns in the Pediatric and Neonatal Intensive Care Unit Nan Hospital

Wasinee Thiwannalak — 2025-06-30

This participatory action research aimed to explore the effects of using nursing practice guidelines to prevent ventilator-associated pneumonia in newborns on the levels of knowledge and practices in professional nurses regarding the prevention and the incidence of ventilator-associated pneumonia among newborns in the Pediatric and Neonatal Intensive Care Units, Nan Hospital. The study comprised 4 stages; planning, implementation, observation, and reflection. The samples were 13 professional nurses and 70 newborns. Data were collected from September 2024 to March 2025. The research instruments were the intervention instruments and the data collection instruments. Data were analyzed using descriptive statistics, independent t-tests, and chi-square tests.

The results demonstrated that after using the nursing practice guidelines for the prevention of ventilator-associated pneumonia, the average score of nurses’ knowledge regarding the prevention of ventilator-associated pneumonia in newborns was statistically significant higher than before using the nursing practice guidelines (t=7.104, p<.001). The nurses also performed a higher correct practice (X² =251.682, p<.001). The incidence of ventilator-associated pneumonia in newborns decreased statistically and significant decreased from 11.24 to 3.46 episodes per 1,000 days of intubation (X²=3.231, p=.036).

Therefore, using the nursing practice guidelines regarding the prevention of ventilator-associated pneumonia in newborn enhanced the knowledge and practices among professional nurses and reduced the incidence of ventilator-associated pneumonia among newborns.