Royal Thai Navy Medical Journal

Medical Corps Non-Commissioned Officer Course

Suwapak Vesamavibool — 2024-12-17

None

The Effect of a Digital Note-taking Using Cornell Method on English Listening Comprehension of Nursing Students at the Royal Thai Navy College of Nursing

Kittima Sadhuwong — 2024-12-03

The recent Royal Thai Navy College of Nursing (RTNCN) English training program was unsuccessful in improving the students’ listening comprehension to meet Thailand Higher Education Policy requirements. The Cornell digital note-taking method was found to be compatible with the cognitive process of listening comprehension for English as a Second Language (ESL) instruction. The research objectives were to investigate the effectiveness of the training program applying the Cornell digital note-taking method to the listening comprehension of RTNCN nursing students.
The quasi-experiment and pretest-posttest control group design was conducted with 42 first-year nursing students of academic year B.E. 2564. Purposive sampling based on the students’ pre-determined criteria and matching of students’ English performances was conducted to allocate students for the experimental and control groups with 21 students each. The experimental group participated in training program by taking the digital note with the Cornell note format while listening. The training phases consisted of preparation, listening, and evaluation. The program was developed by the researcher and verified by a panel of expert. In contrast, the control group completed the notes on paper in an unstructured format. The 1-hour training sessions were conducted for both groups each week over a 12-week period. The TOEIC Model Test was used to assess students’ pretest listening comprehension, and the Official TOEIC Listening Test was used for posttest.
The results found that the listening comprehension score of the experimental group was significantly higher in the posttest than in pretest (Mean = 222.62 ± 35.20 vs. Mean = 181.19 ± 39.99, t(20) = -9.09, p = .000) and the posttest score of the control group respectively (Mean = 222.62 ± 35.20 vs. Mean = 186.43 ± 47.96, t(40) = 2.79, p = .008).
In conclusion, digital note-taking using the Cornell note-taking format can improve the listening comprehension scores, with a focus on preparing students for listening comprehension. This includes taking notes of short texts or sentences, writing down keywords and questions, summarizing, reflecting, reciting, and reviewing.

The Development of Anesthesia Care Management Model for Aging Patients undergoing Total Hip Arthroplasty through Applying Enhanced Recovery After Surgery Model in Krabi Hospital

Supawadee Thinnongjig — 2024-12-03

          This research and development aimed to study the situation, develop a model, and examine the effectiveness of anesthesia care management model among older adults undergoing total hip arthroplasty by applying recovery enhancement program after surgery in Krabi hospital. The implementation process had 3 stages. Stage 1 was study the situation by analyzing documents and using qualitative method. The informants were 15 nurse anesthetists. Data were analyzed using content analysis. Stage 2 was development of a model by using research results from stage 1 before drafting a model which was validated by a panel of 3 experts. Stage 3 was study the effectiveness of developed model by using one group pretest and posttest quasi-experimental research. The sample were 15 nurse anesthetists and 50 patients. Data were analyzed using descriptive statistics, one sample t-test, Wilcoxon signed-rank test and repeated measure ANOVA. The research results were as follows:
          1. For the situation, it was found that patients undergoing total hip arthroplasty had physical deterioration and co-morbidities which resulted in late recovery after surgery, caused complications and nurse anesthetists lacked training of rapid recovery.
          2. The model of anesthesia care management among older adults undergoing total hip arthroplasty consisted of 3 phases including pre-anesthesia, peri-anesthesia and post- anesthesia. The model emphasized patient preparation by a multidisciplinary team from the preoperative phase to ensure safety, prevent complications, and promote faster recovery, as well as information transfer and post-discharge follow-up.
          3. After using the model, nurse anesthetists at Krabi hospital had significantly higher knowledge and satisfaction of using the model (p = .001). Whereas older adults undergoing total hip arthroplasty with anesthesia had significantly lower mean pain scores. The average pain scores tended to decrease from the first 24 hours after surgery, and all elderly patients had pain scores not exceeding 3 at 72 hours and before discharge, which was statistically significant (F = 27.26, p < .001). The patients could perform the same activities of daily living after 1 week of discharge (88%) and had significantly higher satisfaction of using the model more than 80% of criteria (p = .001).

The Effect of Clinical Nursing Practice Guidelines on Delirium Prevention among Patients Undergoing Treatment in Cardiac Intensive Care Unit at Somdej Pranangchaosirikit Hospital

Warunthorn Phromsont — 2024-12-03

The purpose of this quasi-experimental research was to study the effect of clinical nursing practice guidelines on delirium prevention among patients undergoing treatment in the cardiac intensive care unit at Somdej Pranangchaosirikit hospital. The sample group consisted of 44 patients, divided into a control group and an experimental group with 22 patients per group who were matched by sex, age, and Modified Early Warning Score (MEWS). The control group received routine nursing care, while the experimental group followed a clinical nursing practice guideline for delirium prevention. The research tools included: (1) clinical nursing practice guidelines for delirium prevention, which were evaluated by 5 experts and had a content validity of 1; (2) personal information record form; and (3) Confusion Assessment Method of the ICU (CAM-ICU). Data were analyzed using descriptive statistics and Fisher’s exact test. The findings revealed that the acute delirium occurrences between experimental group and control group had no statistical significant difference (p = .412).

Development of a Self-care Program Focusing on Breathing Exercise by Blowing Balloon for School Age Children with Obstructive Sleep Apnea

Adisa Panith — 2024-12-03

Obstructive Sleep Apnea (OSA) is a common breathing disorder during sleep that significantly impacts the quality of life in children. This research aimed to develop a self-care program focusing on breathing exercise by blowing balloon for school age children with obstructive sleep apnea and to test the program's quality by five experts and implement it over a two-month period with 30 school-aged children (6 - 12 years) diagnosed with OSA.
The research findings indicated that the self-care program focusing on breathing exercise by blowing balloon for school age children with OSA consists of four steps, in line with the four concepts of Orem's Self-Care Theory (2001): 1) decision-making in self-care 2) setting goals and planning self-care 3) implementing self-care through the LINE Official Account application named "Good Sleep" 4) maintaining continuous self-care practices. The total duration of the program is five weeks. The program was reviewed by five experts, who unanimously agreed that the content and steps of the program were highly appropriate and aligned with the objectives, being comprehensive and accurate (100% agreement). For the consistency with the terminology and concepts used, the experts strongly agreed with 80% agreement.
When tested with 30 school-aged children with OSA, the program received an 83.33% satisfaction rate. This study presents an alternative approach to improving the quality of life for school-aged children with OSA through effective self-care practices.

Factors related to Healthy Lifestyle Behaviors of People in Selected Community, Thonburi District

Vacharaporn Choeisuwan — 2024-12-03

The purposes of this research were to study health literacy, healthy lifestyle behaviors and factors related to healthy lifestyle behaviors in selected community, Thonburi District. The sample consisted of 169 people living in selected community, Thonburi District, aged 20 years and over. The research tools included health literacy and healthy lifestyle behavior questionnaires. The Cronbach’s alpha coefficient were 0.94 and 0.88, respectively. Data were analyzed using descriptive statistics, Chi-square test and Pearson product moment correlation coefficient. The results showed that: (1) The sample group had healthy lifestyle behaviors at high level (37.28%), followed by the highest level (28.40%); (2) Health literacy in total was high level (29.59%), followed by the highest level (27.40%); and (3) Factors related to healthy lifestyle behaviors with statistical significance at .05 level included income sufficiency, marital status, occupation, and underlying disease having low positive relationship (Cramer’s V = 0.243, 0.225, 0.225, and 0.216, respectively). While the sample aged 60 years and over had a very low negative relationship (r = -.195), and health literacy was positively related to healthy lifestyle behaviors at moderate level (r = .617). The results of this study are beneficial to further strengthen health literacy and healthy lifestyle behaviors of people in community.

The Active Aging Promoting Model of the Elderly by Social Learning Innovation from the New Normal toward the Next Normal Era

Mujjalin Pangsiri — 2024-12-03

This study is an advanced mixed method research with explanatory sequential design (convergent parallel design) was divided into 3 phases: (1) Quantitative research to study the factors affecting the empowerment of the elderly; (2) Qualitative research to develop a model for empowering the elderly with social learning innovation from the new way to the next way; and (3) Quantitative research to evaluate the results of using the model for empowering the elderly with social learning innovation from the new normal toward the next normal era, and compare the behavior for empowering the elderly before and after using the model. The sample consisted of 295 elderly people aged 60 years and over. Data were collected by questionnaire according to the framework of the active aging concept and social learning as well as stimulating the learning skills of the elderly by Appreciation Influence Control (AIC). Data were analyzed using descriptive statistics, multiple regression analysis (Stepwise), and content analysis then model creation and testing and compared the mean scores of the behavior for empowering the elderly before and after using the model with paired sample t-test.
The research results found that elderly behavior under active aging from the new normal toward the next normal era, the average of participation in all 3 areas were at the high level (Mean = 3.70, SD = 0.44). The factors affecting the strengthening of the elderly's behavior were participation in planning and decision making, participation in practice, and participation in receiving benefits. Health promotion behavior to become active elderly (good health and participation in society), and occupation (pensioners or retired person) were predicted jointly at 54.5 percent. The active aging promoting model of the elderly by social learning innovation from the new normal toward the next normal era had 4 components including: (1) health knowledge in all dimensions; (2) perception of themselves before and after enhancement; (3) protection from social network threats and online media; and (4) network partners, caregivers and elderly coordinator under the name “Wiangthakan Aui Model”. After the trial of the model, it was found that the elderly had good health behaviors, participated in activities under the school club for the elderly, and had more security and stability for living in the next normal era of life.

The Result of a Cognitive Behavioral Therapy Program on Depression among Practical Nurses in a Chonburi Province Hospital

Pattarapon Jammin — 2024-12-06

This research is a quasi-experimental study using a one-group pretest-posttest design that assesses the effectiveness of a Cognitive Behavioral Therapy (CBT) program on depressive symptoms among 27 practical nurses (PN) at one hospital in Chonburi province. The research instruments included the CBT program and the Depression Anxiety Stress Scale-21 (DASS-21). The IOC for all items was greater than 0.5, and the Cronbach’s alpha coefficient for the overall DASS-21 was 0.90, with a value of 0.72 for the depression subscale. Data were analyzed using descriptive statistics and the Wilcoxon signed-rank test for inferential statistics.
The study participants were predominantly female (96.3%), with an average age of 36.15 years and an average work experience of 11.26 years. Most participants (85.2%) had no chronic illnesses. Regarding education, 48.1% had completed high school. Marital status showed that 55.6% were single. The majority (63%) reported insufficient income, and 85.2% worked in rotating shifts, with an average of 23 shifts per month. Comparisons of depression levels before and after the intervention at weeks 2 and 4 showed a significant reduction in depressive symptoms, with statistical significance at the .001 level (z = -3.443 and - 4.298, respectively). Therefore, this study concludes that the CBT program effectively reduces depressive symptoms.

Factors Influencing the Adherence to Rehabilitation in Stroke Patients

Supapun Kanjanabunyong — 2024-12-06

This predictive research aimed to assess the adherence to rehabilitation and its influencing factors in stroke patients, including perceived self-efficacy, modified Rankin scale (mRS), social support, fear of falling, and anxiety in COVID-19. The sample consisted of patients with ischemic or hemorrhagic stroke within the first three months after diagnosis, who came for follow-up at four selected hospitals. A total of 109 participants were selected through simple random sampling. Research instruments included demographic data, perceived self-efficacy, mRS, social support, fear of falling, anxiety in COVID-19, and adherence to rehabilitation. Data were analyzed using descriptive statistics and multiple regression analysis.
The results showed that the mean score for the adherence to rehabilitation was 83.78 (SD = 16.26). Perceived self-efficacy and social support together predicted 56% of the variance in the adherence to rehabilitation (adj. R² = 0.56, p < .01). Perceived self-efficacy was the most predictive variable for the adherence to rehabilitation (β = 0.70, p < .01), followed by social support (β = 0.39, p < .01). Therefore, promoting the adherence to rehabilitation should focus on enhancing self-efficacy alongside providing social support.

Positive Aspects of Caregivers Caring for Older Adults with Dependency and Its Associated Factors

Kwanchanok Yotkhamlue — 2024-12-06

This predictive correlational study aimed to investigate the positive aspect and its predicting factors among caregivers of older adults with dependency. The participants were 114 caregivers of older adults with dependency in Saraburi province who were recruited based on multi-stage cluster sampling. Data was collected by using 1) the demographic data questionnaire, 2) relationships between caregiver and older adult questionnaire, 3) perceived self-efficacy questionnaire, 4) social support questionnaire, 5) perceived caregiving burden questionnaire, and 6) positive aspect of caregiving questionnaire. The questionnaires no. 2 - 6 yielded Cronbach’s alpha of 0.86, 0.92, 0.89, 0.88 and 0.94 respectively. Descriptive statistics, percentage, mean, and standard deviation, and stepwise multiple regression were employed to analyze the data.
The results revealed that caregivers of older adults with dependency have high levels of positive aspect (Mean = 4.40, SD = 0.45). Stepwise multiple regression analysis demonstrated that social support, perceived self-efficacy, relationships between caregiver and older adult, and perceived caregiving burden together could explain 82.60% of the variance in positive aspect among caregivers of older adults with dependency (R² = .826, F = 129.289, p < .001). The most significant predicting factor was social support (b = .416, p < .01), followed by perceived self-efficacy (b = .255, p < .001), relationships between caregiver and older adult (b = .172, p < .01), and perceived caregiving burden (b = -.170, p < .05).
The results from this study provide useful information for relevant healthcare providers to create activities aimed at promoting positive aspect among caregivers of older adults with dependency by enhancing their social support, perceived self-efficacy, relationships between caregiver and older adult, and reduce the perceived burden.

The Development of Immersive Interactive 3D Learning Materials Using Virtual Reality Technology to Enhance the Skills of SIEVE, SORT, and START Triage (VR-SSST) in Mass Casualty Situations

Kritsada Chumvanichaya — 2024-12-06

Triage training is an essential component of emergency medical services and disaster response, where healthcare professionals are trained to assess and prioritize patients quickly and efficiently. This study aimed to develop immersive, interactive 3D learning materials using virtual reality technology to enhance the skills of sieve, sort, and start triage (VR-SSST) in mass casualty situations, and to test its feasibility. This study employs a research and development design composed of three phases: (1) content development and scenario design; (2) technical development and platform selection; and (3) pilot testing to gather feedback on feasibility. Thirty 2nd-year emergency medical technician students in academic year 2024 from the Naval Operational Medicine School, Naval Medical Department, Royal Thai Navy were recruited for testing VR-SSST. Data were collected using a questionnaire. Data analysis included calculating the content validity index, mean, and standard deviation.
The results show that the VR-SSST is a triage program that includes sieve, sort, and start triages, leveraging virtual reality technology to create a highly immersive and engaging learning experience. It involves the use of 3D simulations and environments to facilitate learning, allowing users to interact with and explore triage content. The content validity index was highly acceptable (CVI = 1). The feasibility of VR-SSST was rated at a high level (M = 4.49, SD = 0.88). The VR-SSST is a valuable tool with good content validity and high feasibility. Trainers can use VR-SSST as a tool for the triage training.

Effects of the Health Literacy Promotion Program on Health Literacy and Behaviors for Preventing Cannabis Use among Upper Primary School Children in Pathum Thani Province

Wikanda Wiriyanupappong — 2024-12-17

This quasi-experimental study used a two-group pretest-posttest design and aimed to compare the school-aged children's health literacy and the prevention behaviors for cannabis use between the experimental group who attended the health literacy program and the control group who attended the usual program. The sample consisted of 58 students studying in grades 3 - 6 from a school in Patum Thani province. The multi-stage sample method was implemented for sample selection. The samples were divided into two groups using a simple random sampling method, with 29 students per group and were matched to have equal qualifications in grade level, gender, age, academic performance, and history of cannabis use. The research instruments for the experimental process consisted of: (1) The health literacy promotion program; and (2) The use of animation clip about “Interesting Facts of Cannabis”. The research instruments for data collection process consisted of: (1) The health literacy questionnaire in preventing cannabis use; and (2) The behaviors for preventing cannabis use. Three experts checked the content validity of the two instruments. The index of Item-Objective Congruence (IOC) of both questionnaires was 1. The instrument reliability was examined using Cronbach's alpha coefficient, which was 0.82 and 0.77, respectively. The differences in health literacy scores in preventing cannabis use and preventive behaviors before and after the experiment were compared using a paired t-test and between the experimental and control groups using an independent t-test.
The results revealed that the health literacy and the preventing behaviors scores of the experimental group during the posttest were significantly higher than the pretest (p < .05).
Based on these findings, it is suggested that the health literacy promotion program could be integrated to the health and physical education program or the school and community health promotion program to prevent and solve the inappropriate cannabis use of the school-aged children.

Development of Fall Prevention Model in the Geriatric Clinic of Sapphaya Hospital, Chainat Province

Uthumpon Sumakon — 2024-12-17

This study was a research and development aimed to develop fall prevention model in the geriatric clinic of Sapphaya Hospital, Chainat Province. It was divided into 3 phases. Phase 1 was the situation assessment, data collection from focus group discussions to discover the problems related to fall prevention behavior. The data was analyzed by content analysis. Phase 2 was the model development phase, including: (1) planning; (2) activity implementation according to the plan; (3) monitoring and evaluation during implementation; and (4) reflection of model development results and lessons learned. The sample group which selected purposively was divided into 2 groups: 25 elderly people from the geriatric clinic at Sapphaya hospital, Sapphaya district, Chai Nat province, and 35 community stakeholders. Phase 3 was the evaluation including single group activity outcome measurement, pre- and post-measurement, and data analysis using Paired t-test statistics.
The results of the study in Phase 1 found that the factors affecting fall behavior were as follows: (1) knowledge of fall risk factors and fall prevention methods; (2) motivation and awareness of fall prevention; (3) support from family and community; and (4) impact and severity of fall. Phase 2 found that there were processes as follows: (1) using participation to analyze and find the solutions; (2) planning joint actions; (3) training workshops on fall in the elderly and testing the use of the fall prevention model with Pender's health promotion model; and (4) evaluating the continuous implementation results, which resulted in an appropriate fall prevention model in the geriatric clinic. Phase 3 found that the mean scores of fall prevention behavior after participating in the experiment was significantly higher than before participating in the experiment (p < .01). The mean scores of testings with the Time Up and Go Test (TUGT) and Five Times Sit to Stand Test (FTSST) was significantly better (p < .01).

Editorial

Wannaporn Thongsangchan — 2024-12-16

None

Women’s Health and Diving

Chatpiwat Ramjuan — 2024-12-17

Diving activities among female divers are becoming increasingly popular. With the current trend of people being more health-conscious and seeking medical advice regarding diving-related risks, there has been a continuous increase in inquiries for medical recommendations. Upon examining anatomical factors, physiological changes, and individual factors that might affect the performance and risks associated with diving for female divers, it has been found that there is no significant difference in the risk of decompression sickness between female and male divers. However, it is noted that immersion pulmonary edema may be more prevalent in females than in males. Diving during menstruation or while using contraceptives or hormones is generally safe. Female divers who are planning to become pregnant or are currently pregnant should avoid diving. Postpartum women should refrain from diving until surgical wounds are fully healed and there is no risk of infection. Breastfeeding women can safely engage in diving activities since nitrogen does not dissolve in breast milk. Women who are post-menopausal can dive if they do not have any pre-existing health conditions that contraindicate diving or severe osteoporosis of the spine. Additionally, it has been observed that women with breast implants do not have an increased risk of decompression sickness. Therefore, if female divers are well-informed about the potential risks and impacts of diving, they can mitigate dangers and enhance their diving performance. This knowledge and understanding will help female divers to dive more safely and effectively.

Hyperbaric Oxygen Therapy for Athletes: from Basic Principle to Clinical Application

Naruebade Rungrattanawilai — 2024-12-17

Hyperbaric oxygen therapy (HBO₂T) is indicated for the treatment of diving injuries and other medical problems. HBO₂T’s principal mechanism to treat such conditions is the benefit of increased systemic oxygenation under pressure. Theoretically, this mechanism could have positive effect to athletes in promoting recovery after injuries and enhancing exercise performance. Although recent studies were unable to clinically demonstrate this advantages, many professional athletes and sports authorities applied HBO₂T in their practice. This review of published literature both basic sciences and clinical studies aimed to reveal the concept of HBO₂T used in athletes for proper and most beneficial application. Moreover, further study of HBO₂T in professional athletes during competitive events is required to prove the therapeutic effect in this specific population. Even minimal effect from this modality may be enough to act as a game changer in the final competition.

Psychology of Submariners

Wichian Sripootorn — 2024-12-17

Mental health problems in submariners are a critical concern within the field of submarine medicine due to the high-risk nature of submarine operations. The unique conditions in which submarines operate increase their susceptibility to developing mental health problems. Compounding this issue is the limited access to medical services, particularly psychiatric treatment, while submerged. The presence of mental health problems or disorders during submarine missions inevitably compromises the safety of both submariners and submarine assets. Therefore, conducting thorough psychological evaluations is of paramount importance in submarine medicine. These evaluations aid in the selection of individuals with specific characteristics suitable for underwater operations, thereby preventing or reducing the risk of mental health problems that may arise. A comprehensive assessment of the factors that may impact submarine mental health is essential in all dimensions. Such assessments provide valuable information for formulating policies on psychological assessments, procuring or developing psychological tests for submariners, and preparing for the mental health needs of submarines. Additionally, these assessments offer important concepts that can be utilized to design programs aimed at enhancing mental performance in a tangible way. These programs promote mental resilience within submarines and equip personnel with the skills necessary to effectively manage stress in high-pressure underwater situations. Ultimately, these efforts contribute to the successful execution of submarine missions and the achievement of the Royal Thai Navy goals.