Royal Thai Navy Medical Journal

Extramedullary Hematopoiesis Mimicking as an Adrenal Incidentaloma: A Case Report

Apanaree Bhekasuta — 2025-08-28

We report on a case of extramedullary hematopoiesis in a male in his 50s who presented with right adrenal incidentaloma from CT scan for right ureteric calculi. The patient denied having any symptoms of mass effect or functioning of adrenal tumor. The CT scan revealed a heterogeneous fatty density mass with minimal enhancement in the right adrenal region, measuring 9.9 x 8.8 x 10.7 cm. Open adrenalectomy was performed after exclusion of a functioning tumor. The pathology report confirmed massive extramedullary hematopoiesis in the fat tissue surrounding the normal adrenal gland. A hematologist was consulted to assess the cause of extramedullary hematopoiesis in this case, and no abnormal hematologic cause was found. This case highlights the need to consider extramedullary hematopoiesis as a rare differential diagnosis for adrenal masses, even in the absence of hematologic abnormalities, to guide accurate diagnosis and management.

Editorial

Wannaporn Thongsangchan — 2025-08-28

None

Breath-hold Diving and Its Potential Health Risks

Poonsak Jittanonta — 2025-10-23

          Breath-hold diving is the oldest form of diving, practiced commercially, competitively and recreationally. Recently, there has been a surge in its popularity in a wide range of the population, but the potential health risks are somewhat overlooked.
          This article provides an overview of the physiological changes that occur during breath-hold diving, and how these changes can affect a diver’s well-being. Multiple organs are affected by the changes in pressures causing injury to a diver such as barotraumas, and in rare cases, “Taravara Syndrome”. Breath-hold divers are also exposed to the elements of nature which can be dangerous to the diver, capable of injuries and fatalities. These include strong and unpredictable currents, dangerous rocky terrains, and marine animals.
          The objective of this article is to raise awareness among breath-hold divers, especially those who are new and inexperienced. As breath-hold diving is becoming more and more popular, knowledge of hazards and physiological change can be beneficial and key to the prevention of potential injuries and fatalities.

Voice Hygiene Programs to Prevent Voice Disorders in Teachers

Chonnipa Pradit — 2025-10-23

Voice disorders are a significant issue in the teaching profession due to the continuous and prolonged use of the voice. Therefore, voice hygiene programs play a crucial role in preventing and mitigating this problem. This academic article focuses on reviewing the prevalence and causes of voice disorders among teachers, as well as effective strategies for maintaining vocal health and implementing voice hygiene programs. It analyzes approaches to reducing the risk of voice disorders, which include providing knowledge on voice care, modifying behaviors, and utilizing teaching technologies such as classroom voice amplification systems. Additionally, the article presents supplementary measures, such as limiting teaching hours and scheduling vocal rest periods during lessons, to allow teachers to recover their voices and reduce the long-term risk of voice-related health issues. Several studies have demonstrated that voice hygiene programs can significantly reduce symptoms of voice disorders and improve teachers' vocal quality. Thus, promoting voice hygiene training for teachers before they begin their professional careers is an essential strategy to ensure that they develop a foundational understanding of vocal health and can effectively prevent future problems. Furthermore, the article discusses the role of school administrators in supporting policies that promote teachers' vocal health, highlighting this as a key measure that should be further implemented to ensure the long-term well-being of teachers' voices.

Diving Medical Officer Course

Suwapak Vesamavibool — 2025-08-28

None

The Effect of Clinical Nursing Practice Guidelines for Prevention of Aspiration in Stroke Patients with Dysphagia at Somdech Phra Pinklao Hospital

Utumporn Rubleak — 2025-10-23

This one-group pretest-posttest quasi-experimental study aimed to: (1) compare the mean swallowing ability scores of stroke patients with dysphagia before and after the implementation of a clinical nursing practice guideline for aspiration prevention; and (2) compare the mean aspiration scores of stroke patients with dysphagia before and after the implementation of the same guideline. The sample consisted of 30 stroke patients with dysphagia who received treatment at Somdech Phra Pinklao Hospital. Participants were purposively selected based on inclusion criteria. The research instruments included: (1) a clinical nursing practice guideline for aspiration prevention in stroke patients with dysphagia; (2) a personal and health information questionnaire, which demonstrated good item-objective congruence (IOC) indices of 0.82 and 1.00, respectively; (3) the Gugging Swallowing Screen, which demonstrated good interrater reliability (k = 0.835); and (4) an aspiration assessment form. The content validity index (CVI) for these instruments was 0.80, and the Cronbach’s alpha coefficient was 0.94. Data were analyzed using descriptive statistics and the paired t-test. The results of the study revealed that the mean swallowing ability score of the participants after implementing the clinical nursing practice guideline was significantly higher than before (t = -6.28, p < .001). Additionally, the aspiration score of the participants after implementing the clinical nursing practice guideline was significantly lower than before (t = 5.93, p < .001). The findings of this study indicate that the clinical nursing practice guideline improves swallowing ability and reduces the risk of aspiration in stroke patients with dysphagia. Therefore, it should be implemented as a standard nursing practice to prevent aspiration in this population.

Factors Predicting Role Strain in Family Caregivers of Dependent Older Adults Living at Home

Khwanthida Phimphakarn — 2025-08-28

The objectives of this predictive research were to examine the role strain of family caregivers of dependent older adults living at home and to investigate the predictive power of the factors: resilience, and the level of dependency of older adults on the role strain of family caregivers. The sample consisted of 100 primary family caregivers caring for dependent older adults living at home. Data were collected using a personal data record form, the Role Strain Scale, and the Resilience Scale for both family caregivers and the dependent older adults. The data were analyzed by descriptive statistics and multiple linear regression analysis. The research results found that the role strain score of family caregivers for the dependent older adults was at a low level (Mean = 33.08, SD = 7.87). The factors that could predict the role strain of family caregivers of dependent older adults were resilience and the level of dependency of older adults, which could jointly predict the role strain of family caregivers for the dependent older adults by 25.1% (R² = 0.251, p < .05). The results of the study suggest that nurses and health personnel should organize programs to promote the resilience of the family caregivers and improve health status of the dependent older adults to reduce dependency

Prevalence and Associated Factors of Sea Sickness in Thai Naval Personnel

Leelawadee Pengsut — 2025-10-23

This cross-sectional descriptive research aimed to study the prevalence of and analyze the relationships between personal factors, work factors, and environmental factors with motion sickness among Royal Thai Navy personnel. The sample consisted of 360 naval personnel from the Royal Thai Fleet, selected through multi-stage random sampling. Data were collected using questionnaires designed to assess motion sickness-related factors and Motion Sickness Susceptibility Questionnaire, with a content validity index of 0.67 - 1. and reliability of 0.91. Data were analyzed using descriptive statistics, and relationships were tested using Chi-square and Fisher's exact tests.
The study revealed a sea sickness prevalence of 40.8% among the sample population. Personal factors significantly associated with sea sickness included the use of anti-motion sickness medication (χ² = 24.22) and motion sickness susceptibility scores above 11.3 (χ² = 17.17). Regarding work and environmental factors, ship size (χ² = 27.03), average daily working hours (χ² = 4.75), sleeping quarter location (χ² = 13.08), and encountering storms during navigation (χ² = 10.67) showed statistically significant relationships with motion sickness (p < .05).
Therefore, it is recommended to establish screening policies and sea sickness risk assessment for personnel before duty, provide regular training on sea sickness prevention and management, and improve shipboard environmental conditions to reduce triggering factors. These measures aim to enhance the effectiveness of sea sickness prevention and management among Royal Thai Navy personnel.

The Effects of Educative Program Using Multimedia Learning on Success in Exclusive Breastfeeding for 6 Months in Postpartum Muslim Mothers

Manusmeen Jehnok — 2025-10-23

This quasi-experimental research aimed to compare the success of exclusive breastfeeding for 6 months in postpartum Muslim mothers between the group receiving the educative program using multimedia learning and the group receiving standard nursing care. The sample comprised postpartum Muslim mothers who gave birth at Kapho Hospital in Pattani Province. A random selection was used to recruit a sample of 52 Muslim postpartum mothers. They were assigned to a control group and an experimental group with 26 Muslim postpartum mothers each. The control group received conventional nursing care, while the experimental group received a multimedia application program for 6 months. Research instruments for data collection included demographic questionnaires, questionnaires assessing knowledge, and breastfeeding assessment skills. The validity index of research tools was 0.67 - 1, the knowledge questionnaire demonstrated a KR-20 reliability coefficient of 0.94 and the Cronbach's alpha coefficient of breastfeeding assessment skills was 0.95. Data were analyzed using frequency, percentage, independent t-test, paired t-test, and Chi-square test. The results showed that: (1) The average scores of the knowledge and exclusive breastfeeding skills after receiving the multimedia application program increased than before the intervention, at a statistically significant level (p < .05); (2) The average scores of the knowledge and exclusive breastfeeding skills after receiving the multimedia application program were higher than those in the control group, at a statistically significant level (p < .05); and (3) The experimental group was more successful in exclusive breastfeeding than the control group after receiving the multimedia application program, at a statistically significant level (p < .05). These findings suggest that the educative program using multimedia learning should be implemented in maternal nursing care during labor and postpartum periods to increase knowledge, cultivate positive attitudes, and increase skills for exclusive breastfeeding for 6 months.

The Development of Clinical Nursing Practice Guidelines for Weaning from Mechanical Ventilator Support in General Wards at Somdech Phra Pinklao Hospital

Chalermsri Songhong — 2025-10-23

This research and development aimed to develop clinical nursing practice guidelines and examine the effects of implementing these guidelines for weaning from mechanical ventilator support in general wards at Somdech Phra Pinklao Hospital. The guidelines were developed by applying Soukup’s four-step evidence-based approach: identifying and analyzing clinical problems, searching for evidence, trial and evaluation of the practice guidelines, and implementing and evaluating the guidelines in practice. The weaning process was divided into three phases: pre-weaning, weaning, and post-weaning. The sample included two groups: 24 professional nurses and 30 patients diagnosed with respiratory failure who were treated with intubation and mechanical ventilation in male and female general medical wards at Somdech Phra Pinklao Hospital from March to June 2024. The research instruments were clinical nursing practice guidelines for ventilator weaning in general wards, a knowledge assessment form on ventilator weaning, a satisfaction questionnaire on the use of the guidelines, a readiness assessment form for ventilator weaning, a weaning phase record, and an evaluation of the weaning outcomes. The content validity index (CVI) values were 0.83, 0.80, 0.80, and 1, respectively. The reliability of the knowledge assessment on ventilator weaning was 0.92, while the reliability of the satisfaction questionnaire on the use of the guidelines was 0.71. Data were analyzed using descriptive statistics, and knowledge scores were compared using the t-test.
The results showed that the average knowledge scores after training were significantly higher than those before training at the .05 level. Overall, the nurses’s satisfaction with the guidelines was high (Mean = 4.10, SD = 0.74), with the highest satisfaction in the aspect of enhancing nurses' knowledge and confidence in caring for patients undergoing ventilator weaning (Mean = 4.54, SD = 0.50). Regarding clinical outcomes, the success rate of weaning from mechanical ventilation increased from 58.67% to 90.00%. The average weaning time was 38 hours, and the average duration of mechanical ventilation was 3.87 days.

Pregnancy-Specific Stress, Social Support, and Coping among Women of Advanced Maternal Age

Parichat Wunchooserm — 2025-10-23

          Coping strategies among women with advanced maternal age are important for the health of pregnant women, their fetuses and their newborns. The purpose of this descriptive research was to investigate pregnancy-specific stress, social support, coping strategies and to explore the relationships between pregnancy-specific stress, social support, and coping among women of advanced maternal age, using the model of coping by Hamilton and Lobel as a framework. The coping strategies were categorized into three types: planning-preparation, spiritual-positive, and avoidance. The purposive sample consisted of 85 women of advanced maternal age who received services from the antenatal care department at Mahasarakham Hospital between June to October 2023. They were selected according to specific qualifications. The research instruments were: (1) a patient general information form; (2) the Revised Prenatal Coping Inventory form; (3) the Revised Prenatal Distress Questionnaire form; and (4) the Social Support of High-Risk Pregnant Women form. The reliability of the questionnaires was tested using Cronbach’s alpha coefficient, yielding values of 0.88, 0.85 and 0.89, respectively. Data were analyzed by using descriptive statistics and Pearson’s correlation coefficient.
          The results of the study showed that pregnancy-specific stress was at a low level (Mean = 11.52, SD = 4.60), social support was at a high level (Mean = 139.16, SD = 10.01), and coping strategies with 3 models were as follows: coping by planning-preparation was at a high level (Mean = 49.60, SD = 5.26, 77.50%), coping by spiritual-positive was at a high level (Mean = 27.95, SD = 4.33, 63.52%), and coping by avoidance was at a low level (Mean = 6.54, SD = 4.56, 27.56%). The findings indicated that pregnancy-specific stress had a low positive correlation with both planning-preparation coping (r = .270, p < .05) and spiritual-positive coping (r = .241, p < .05). However, social support was not significantly correlated with any of the coping strategies.
          This study indicates that appropriate coping strategies for women of advanced maternal age involves promoting low levels of pregnancy-specific stress. Nurses should therefore pay attention to managing the levels of pregnancy-specific stress, in order to plan appropriate coping strategies for women of advanced maternal age.

Social Capital and Its Related Factors in Caring for Elderly People Living Alone

Uthaitip Chanpen — 2025-10-23

This research employed a mixed-method approach with the following objectives: (1) to study the social capital in elderly care as perceived by elderly individuals living alone; and (2) to examine the relationship between various factors and social capital in elderly care. The sample comprised 180 elderly individuals living alone and 60 community network members. The research tools used were: (1) a personal information interview form; (2) a social capital measurement scale for the elderly; (3) a social capital measurement scale for the community network; and (4) a satisfaction scale for participation in the care of elderly individuals living alone. Quantitative data were analyzed using statistics, including means, standard deviations, frequencies, percentages, Pearson’s correlation, Spearman's rank correlation, and Chi-square tests. Qualitative data were analyzed through content analysis.
The study results were as follows: (1) The average score of social capital perception among elderly people living alone was 66.33 (SD = 13.79); (2) The average score of social capital perception among the community network was 20.30 (SD = 2.47); and (3) The average score of satisfaction with participation in elderly care was 106.68 (SD = 9.29). The analysis results showed that gender (χ² = 4.37), income (r_s = 0.157), education level (r_s = 0.224), satisfaction with quality of life (r_s = 0.251), and housing (χ² = 5.203) had a statistically significant positive relationship with social capital in the care of elderly people living alone at the .05 level. These research results indicated that community networks should become familiar with the elderly people living alone, especially elderly males, to build trust, and try to reach out to those with low income, particularly in urban areas in order to ensure comprehensive social capital for elderly people living alone.

Caring Experience for a Good Death at Home by Family Members of Terminally Ill Cancer Patients

Wipa Wiseso — 2025-08-28

          This qualitative research aimed to explore the caring experience for a good death at home, as perceived by family members of terminally ill cancer patients. A purposive sampling method was employed to select 15 family members of terminally ill cancer patients, who had at least one month of caring experience at home, lived with the patients, and were either related by blood or legal relationship. Data were collected through in-depth interviews with family members and analyzed using the framework outlined by Cohen, Kahn, and Steeves. Heidegger’s concept, which emphasizes that individuals derive meaning from phenomena based on their personal feelings and thoughts, was applied as the conceptual framework.
          The findings demonstrated that the caring experience for a good death at home, as perceived by family members of terminally ill cancer patients, included the following: (1) caring for the patients to feel comfortable in their final stages of life and pass away peacefully, which involved maintaining daily routines, offering emotional support and encouragement to help the patients cope with the suffering caused by illness, providing compassionate and attentive care, alleviating pain and suffering, and facilitating a connection to religion to calm the mind and prepare for death; (2) family collaboration in caregiving, where family members collaborated in caring for the patients by collectively accepting the reality of death, making shared decisions about treatment, fulfilling the patients’ wishes, sharing caregiving responsibilities, and providing emotional support to each other; (3) caring with love and attachment, which was an opportunity to give back and the key component of caring for a good death.
          The research findings can be used as foundational information to explain the caring experience for a good death at home, as perceived by family members of terminally ill cancer patients, which will deepen the understanding of the family’s role in such care. The findings can also contribute to the development of the Thai family service system for terminally ill cancer patients by coordinating with the healthcare team, including physicians, social workers, home care services and specialists in end-of-life care, to assess the needs of the patients and their families, provide information, as well as manage symptoms and other discomforts, along with offering psychological and spiritual care. Additionally, it can help promote the well-being of Thai families in caring for terminally ill cancer patients to ensure a good death at home.

The Relationship between Personal Factors, Digital Literacy, Surrounding Factors, and Digital Competency in Nursing Students

Monrudee Petlamul — 2025-10-23

The rapid advancement of medical and public health technologies has led to the widespread integration of digital technologies in health service delivery, known as digital health. Consequently, it is essential for health professionals, including nursing students, to develop digital competencies to effectively perform their roles. Studying the digital competence of nursing students who will soon become part of the public health workforce, is therefore crucial for preparing them to meet future healthcare challenges. This study aimed to examine the relationship between environmental factors, digital literacy, and digital competency among 169 nursing students. Data were collected using a personal factors questionnaire and a digital literacy assessment form, which yielded a Kuder-Richardson value of 0.71 and Cronbach’s alpha coefficients of 0.85 and 0.97, respectively. The research results revealed that 69.24% of the participants agreed that having digital and information technology skills is important for the nursing profession. The average score for digital literacy was 14.34 points (SD = 2.77), representing 71.70% of the total possible score. The average score for environmental factors was 24.99 points (SD = 4.39), accounting for 83.80% of the full score. The average score for overall digital competence was 103.53 points (SD = 18.47), corresponding to 82.82% of the maximum score. The correlation analysis using Pearson’s correlation coefficient revealed that opinions on digital skills, information technology, digital literacy, and environmental factors were significantly associated with digital competence at the .05 significance level. These findings provide insights into the factors related to digital competence, which can inform targeted planning and development efforts aimed at enhancing the digital competence of nursing students.

Occupational Health Literacy among Aircraft Maintenance Mechanics in Private Aircraft Maintenance Repair and Overhaul Facilities in Thailand

Punyisa Pholphantin — 2025-10-23

This cross-sectional study aimed to assess occupational health literacy (OHL) and related factors among aircraft maintenance mechanics in private aircraft maintenance repair and overhaul facilities in Thailand. The sample consisted of 691 mechanics. Data were collected using an OHL self-administered questionnaire, covering 6 domains, which was validated for content validity and reliability. The data were analysed using multiple linear regression statistics. The results revealed that the average OHL score among the sample was 143.56 ± 10.54 points, corresponding to 89.72% of the total score, categorized as high level of OHL. The predictor variables that significantly explained the overall OHL score at a 0.05 significance level accounted for 57.74% of the variance (R² = 0.5774) included gender, departments, years of work experience, being aware of occupational health and safety policies, and support from the organization regarding health surveillance and disease prevention. Factors associated with OHL, statistically significant at the .05 level, included being male gender, having 11 years or more of work experience, working in the hangar department, and being aware of occupational health and safety policies. Based on the findings, enhancing OHL among aircraft maintenance mechanics should focus on improving media literacy and increasing awareness of occupational health and safety policies, ensuring that mechanics understand and align with these policies and the guidelines, which will further improve their OHL levels.

Quality of Life among Nursing Students in a VUCA World

Pornchula Sathutham — 2025-10-23

          This mixed-methods study aimed to examine the quality of life among naval nursing students in a VUCA world, and the relationship between the quality of life with learning at different year levels, GPAX, family status, and the adequacy of income. In the quantitative design, the sample consisted of 148 naval nursing students, from first to fourth year in the academic year 2024, who were recruited by using proportional stratified random sampling. The research instruments were questionnaires on quality of life and self-esteem (instruments validity = 0.67 - 1 and Cronbach’s alpha coefficient = 0.92, 0.96, respectively). The data were analyzed using descriptive statistics, including frequency, percentage, mean, standard deviation; and correlation analysis using one-way ANOVA, Chi-square and Pearson correlation coefficient. In the qualitative deign, 12 naval nursing students (3 from each year) were selected using purposive sampling. Data were collected through structured interviews and analyzed using content analysis. The findings were as follows:
          1. The overall quality of life among naval nursing students was at a moderate level (Mean score = 81.18). The first year had the highest quality of life at a moderate level, followed by the third-year, second-year, and fourth-year students, respectively (Mean scores = 79.30, 78.43, 76.41 and 73.05).
          2. The nursing students’ year level, GPAX, and self-esteem were significantly positively correlated with the quality of life at a moderate level (r_xy = .368, .307, .470, p < .01).
          3. The adequacy of income had a statistically significant negative relationship with the quality of life (p < .05).
          4. Factors contributing to the quality of life of the naval nursing students included the environment, opportunities to go outside of the school, having a place to exercise, getting at least 8 hours of sleep, having a relaxation corner for nursing students and good maintaining relationships among teachers, classmates, and other students with in the institution where they live together.

The Effects of an Applied Mindfulness-based Program on Psychological Well-being of Older Adults with Major Depressive Disorders

Phanassaphon Siringam — 2025-10-23

This quasi-experimental research aimed to examine the effect of an applied mindfulness-based program on the psychological well-being of older adults with major depressive disorders. The sample consisted of older adults with major depressive disorders who received treatment at the outpatient department of a psychiatric hospital. Participants were randomly assigned to the control group and the experimental group, with 22 participants in each group. The research instruments included: (1) an applied mindfulness-based program validated by three experts, and; (2) the psychological well-being questionnaire tested for reliability. Data were analyzed using descriptive statistics and t-test. The results were: (1) The mean score of psychological well-being in the experimental group after the intervention (Mean = 55.05, SD = 3.03) was significantly higher than before the intervention (Mean = 39.82, SD = 5.27, with statistical significance at the .05 level.; (2) The difference in mean scores before and after the intervention for the experimental group who received the applied mindfulness-based program (D̅₁ = 15.23, SD = 4.68) was significantly higher than the control group, who received usual care (D̅₂ = 1.46, SD = 5.57), with statistical significance at the .05 level. This study suggests that meditation and mindfulness training should be continued to enhance physical, mental, and emotional well being, leading to psychological well-being.

Establishment of Matrix Risk Assessment Tool for Combined Noise and Chemical Exposure Affecting Hearing Ability among Workers

Sanhathai Banchanurat — 2025-10-23

The objectives of this research were to: (1) develop a matrix-based risk assessment tool for the combined effects of noise exposure and chemical exposure on hearing ability; and (2) evaluate the quality and validity of this risk assessment tool. A cross-sectional study design was used, involving 21 experts, specifically certified professionals in preventive medicine with expertise in occupational health. These experts were tasked with reviewing and providing feedback on the quality and validity of the risk assessment tool using the Modified Delphi technique. The analysis focused on achieving a certain level of agreement, defined as the sum of proportions of levels 4 and 5 (indicating strong agreement) greater than 80%. The results showed that the level of agreement for the risk assessment tool assessing noise exposure alone ranged from 33.33% to 85.71% in the first round, and from 83.33% to 94.44% in the second round. For the combined risk assessment tool, considering both noise and chemical exposure on hearing ability, the agreement ranged from 61.90% to 90.47% in the first round, and from 83.33% to 100% in the second round. The matrix-based risk assessment tool, developed in the second round, considered both the risk level of chemical exposure and the noise exposure level. The matrix was designed to assess two separate risk factors: one for chemicals that affect hearing ability, based on the level of chemical exposure, and another for noise, based on the average noise level during an 8-hour workday (TWA₍₈₎). This tool uses a 3x3 matrix, with risk levels categorized as low, medium, or high. In addition to the risk assessment, the tool provides recommendations for risk management measures and health surveillance actions to protect workers' hearing. In conclusion, the risk assessment tool passed the evaluation in the second round, demonstrating its validity and reliability. The results confirm that the tool is capable of accurately measuring outcomes and can be relied upon to effectively assess risk, ensuring it aligns with the research objectives.