Thai Journal of Nursing Council วารสารสภาการพยาบาลเป็นวารสารทางวิชาการที่มีการประเมินบทความและงานวิจัย โดยผู้ทรงคุณวุฒิที่มีความเชี่ยวชาญเฉพาะสาขา (peer review) กำหนดออกรายสามเดือน ปีละ 4 ฉบับ จัดทำโดยสภาการพยาบาล เพื่อเป็นแหล่งในการเผยแพร่ผลงานวิชาการ ทั้งด้านการพยาบาลทางคลินิกและชุมชน การศึกษาพยาบาล การบริหารการพยาบาล Thailand Nursing and Midwifery Council en-US Thai Journal of Nursing Council 1513-1262 Improvement of Discharge Planning and Continuing Care for Vascular Surgery Patients: A Case Study <p>Vascular surgery patients are prone to developing complications, which could result in high mortality risks. For this reason, such patients need to be treated in tertiary hospitals, where specialists and well-trained nurses play primary roles in planning their discharges and continuing care. It is necessary that the medical staff assess the patients’ conditions, provide them with proper care and plan their discharges with their family caregivers, to enable the patients to perform specifc self-care activities, such as caring for their surgical wounds or foot ischaemia, preventing disease-specifc risks and observing any abnormalities that would require urgent visits to the physicians. Without thorough planning and post-discharge follow-ups, the patients would have no reliable self-care consultants and could employ improper self-care methods, which<br>might result in escalating pain or even death.<br>&nbsp; &nbsp;&nbsp; Improvement to discharge and continuing care planning is, therefore, of critical importance, as it leads to additional channels for post-discharge monitoring. Through these channels, nurses are able to advise the patients and address their self-care problems in a timely manner, thereby minimising negative effects on the patients. This study has helped the researcher build a better knowledge of common post-discharge self-care<br>problems, which could be applied to improving a more comprehensive self-care system for other patients.<br>&nbsp; &nbsp;&nbsp; This article presents concepts related to nurses’ roles in discharge and continuing care planning, two important processes that could be contribute to positive outcomes in the treatment of vascular surgery patients.</p> รัตนาภรณ์ ประยูรเต็ม นงลักษณ์ ว่องวิษณุพงศ์ ประณีต ส่งวัฒนา ##submission.copyrightStatement## 2019-04-22 2019-04-22 34 2 5 17 Nursing Management in Transitional Care Model: A Case Study of Patients with Peripheral Arterial Disease <p>&nbsp; &nbsp;&nbsp; Peripheral arterial disease, a common circulatory disorder characterised by arterial atresia, can be caused by a number of factors, such as atherosclerosis and polycythemia. This disease impedes blood circulation to peripheral organs, causing necrosis and risk of amputation.<br>&nbsp; &nbsp;&nbsp; This article presents a case study of patients with peripheral arterial disease caused by polycythemia during the critical stage of their chronic illnesses. Due to their complications, the patients were treated using a specially managed nursing care model closely supervised by advanced practice nurses. Customised to suit individual patients’ needs, this caregiving model integrated various competencies to provide transitional<br>care for the patients, from their admission, transfer, critical stage, long-term rehabilitation, to palliative care.<br>&nbsp; &nbsp;&nbsp; Subjected to thorough problem evaluation and conducted based on empirical evidence, this model was expected to be capable of inducing changes, multidisciplinary collaboration, ethical decision-making and family empowerment. These factors could improve the entire caregiving process and produce desirable outcomes, enabling patients and their families to cope with the illness-induced changes, adjust to their fnal<br>stage and be ready to pass away peacefully.</p> กัลปังหา โชสิวสกุล ##submission.copyrightStatement## 2019-04-23 2019-04-23 34 2 18 29 The Effect of Group Reminiscence Program on Self-Esteem among Institutionalized Older Adults <p>&nbsp; &nbsp;&nbsp; Objective: To examine the impacts that a group-implemented reminiscence programme could have on Institutionalized older adults.<br>&nbsp; &nbsp;&nbsp; Design: Experimental research with a pre-test and an immediate post-test, and a two-week follow-up.<br>&nbsp; &nbsp;&nbsp; Methodology: The subjects were 44 purposively sampled Institutionalized older adults, assigned equally to an experimental group and a control group. The experimental group participated in the group-implemented reminiscence programme once a week for fve weeks, whilst the control received standard care. Data were collected twice, immediately after the experiment and two weeks after the experiment, through a Selfesteem Questionnaire for Older Adults. The data were analysed using Fisher’s exact test, Independent T-test, ANCOVA and Repeated Measures ANOVA.<br>&nbsp; &nbsp;&nbsp; Results: The study revealed a signifcant difference in the average self-esteem scores achieved by the experimental group and control group immediately after the experiment (p &lt; .05); nonetheless, no signifcant difference was found at the end of the two-week follow-up (p &gt; .05). In the experimental group, the average self-esteem scores at the three stages (before, immediately after and two weeks after the experiment)<br>were signifcantly different (p &lt; .05), whereas the control group displayed no such differences.<br>&nbsp; &nbsp; &nbsp; Recommendations: The group-implemented reminiscence programme helped increase the self-esteem of the Institutionalized older adults studied, but such increased self-esteem is still not sustainable. It is suggested, therefore, that the programme be further tested and modifed, so that it can heighten self-esteem in a sustainable manner.</p> ญานิศา ดวงเดือน นารีรัตน์ จิตรมนตรี วิราพรรณ วิโรจน์รัตน์ ##submission.copyrightStatement## 2019-04-23 2019-04-23 34 2 30 43 Prevention of Metabolic Syndrome for School Adolescents: Participatory Action Research <p>&nbsp; &nbsp;&nbsp; Objective: To develop a programme for the prevention of metabolic syndrome in adolescent schoolchildren through a participatory process, and to compare the adolescents’ nutritional conditions, waist circumferences, fasting blood sugar levels, triglyceride levels and cholesterol levels before and after participating in the programme.<br>&nbsp; &nbsp;&nbsp; Design: Participatory action research (PAR).<br>&nbsp; &nbsp;&nbsp; Methodology: The subjects in this study consisted of 40 students, 12 parents, 13 teachers/school administrators and 10 shopkeepers. Through participatory action, the subjects developed a programme to prevent metabolic syndrome in adolescents. Qualitative data were analysed using content analysis. Quantitative data were compared using paired T-test and Wilcoxon signed rank test.<br>&nbsp; &nbsp; &nbsp; Results: The PAR-developed metabolic syndrome programme was operated in four stages. In the frst stage, causes of the syndrome were identifed, namely, overconsumption; inappropriate food consumption habits; easy access to food; lack of environments conducive to exercise; and obstacles to behaviour change. The second stage engaged the adolescents, their families and school in planning the syndrome-preventing programme. The third stage, which was the implementation of the programme, required the adolescents to make self-inspired changes with support by their families and their school’s clear policy. The fnal stage was for regular self-monitoring and follow-ups. From the study, the participating adolescents’ post-experiment<br>fasting blood sugar levels were signifcantly lower than their pre-experiment levels (Z = -3.01, p &lt; .001). However, no signifcant differences in their nutritional conditions, waist circumferences, triglyceride levels and cholesterol levels were found (p &gt; .05).<br>&nbsp; &nbsp; &nbsp; Recommendations: In this study, the participatory process involving adolescents families, friends and school personnel enabled the subjects to change their behaviour, which could help prevent metabolic syndrome and lower their blood sugar levels. It was also found that clear communication and coordination led to stakeholders’ cooperation, which was a key factor in effectively preventing metabolic syndrome in adolescents.</p> อาภาวรรณ หนูคง วนิดา เสนะสุทธิพันธุ์ ##submission.copyrightStatement## 2019-04-23 2019-04-23 34 2 44 61 Stress and Stress-Coping Behaviour in Caregivers of Older Adults Having Parkinson’s Disease <p>&nbsp; &nbsp;&nbsp; Objective: To study stress levels and stress-coping behaviour of caregivers of older adults having Parkinson’s disease (PD), and to examine the relationship between disease stages, stress and coping behaviour.<br>&nbsp; &nbsp;&nbsp; Design: Cross-sectional descriptive correlational research.<br>&nbsp; &nbsp;&nbsp; Methodology: This study was conducted on a sample of 100 caregivers of older Parkinson’s disease patients treated at the Neurological Clinic of Maharaj Nakorn Chiang Mai Hospital between October 2017 and March 2018. All of the recruited caregivers met the inclusion criteria. Data were collected through 3 questionnaires, namely, 1) the Perceived Stress Scale; 2) the Jalowiec Stress-Coping Scale; and 3) the personal<br>information form for PD patients and their caregivers. Analysis of stress levels and stress-coping behaviour was performed using descriptive statistics, Spearman’s correlation and Pearson’s correlation.<br>&nbsp; &nbsp;&nbsp; Results: Caregivers of older PD patients displayed moderate levels of stress and stress-coping behaviour. Regarding means of coping with stress, the subjects made moderate use of problem confrontation and problem alleviation methods, and displayed a low level of emotion management. Stress was found to be in negative relationships with overall stress-coping behaviour (r = -.251, p &lt; .05), problem confrontation (r =<br>-.352, p &lt; .01) and problem alleviation (r = -.270, p &lt; .05), but not in any signifcant relationship with emotion management. Disease stages, on the other hand, were not found to be in any signifcant relationship with the caregivers’ stress and stress-coping behaviour.<br>&nbsp; &nbsp;&nbsp; Recommendations: It is recommended that healthcare personnel working with older PD patients assess their caregivers’ stress and stress-coping behaviour and plan a proper intervention to enable them to manage their stress and develop appropriate stress-coping methods.</p> ลินจง โปธิบาล ทศพร คำผลศิริ นรัชพร ศศิวงศากุล ##submission.copyrightStatement## 2019-04-23 2019-04-23 34 2 62 75 Continuing Hospital-to-Home Palliative Care: A Southern Thai Context <p>&nbsp; &nbsp;&nbsp; Objective: To describe 1) continuing hospital-to-home palliative care services in southern Thailand; and 2) supportive factors for, and obstacles to, provision of continuing hospital-to-home palliative care in southern Thailand.<br>&nbsp; &nbsp; &nbsp; Design: Qualitative multiple-case study. &nbsp;&nbsp;<br>&nbsp; &nbsp;&nbsp; Methodology: The research sites were purposively selected, based on these criteria, namely, 1) being tertiary care centres or regional hospitals; 2) providing continuing hospital-to-home palliative care services; and 3) serving as healthcare centres with links to secondary care hospitals, primary care units or sub-district health-promoting hospitals. In total, four regional or tertiary hospitals were selected. The participants were (1) terminal patients and their family caregivers and (2) stakeholders involved in palliative care services, totalling 92. Interviews, focus-group discussions, and observation were data collection methods. The data were analysed using content analysis.<br>&nbsp; &nbsp;&nbsp; Results: Three models of continuing hospital-to-home palliative care were identifed in the southern Thai context: (1) hospital-based palliative care; (2) integrated community-based palliative care; and (3) volunteer-supported palliative care. Voluntary assistance, support from organisations’ administrators, and collaborative community networking were identifed as major supporting factors. Limited access to the use of analgesics, compartmentalisation without coordination, lack of knowledge and skills , insuffciency and workload of palliative care personnel and shortage of medical equipment were identifed as major obstacles.<br>&nbsp; &nbsp;&nbsp; Recommendations: To provide patients and their families with continuing services and improve their quality of life, it is necessary that healthcare organisation administrators actively integrate palliative care as one major healthcare service provided by each hospital, support healthcare personnel at all levels and in all felds of specialisation to optimise their palliative care expertise, promote coordination through effcient communication to ensure uninterrupted flow of information, and systematically improve medication and medical equipment management at all levels of service. Also, further research on effects of different palliative care models is recommended.</p> กิตติกร นิลมานัต มลธิรา อุดชุมพิสัย ภัทรสิริ พจมานพงศ์ นิภา นิยมไทย ##submission.copyrightStatement## 2019-04-23 2019-04-23 34 2 76 93 Factors Predicting Systemic Inflammatory Response Syndrome in Cranial Surgery Patients <p>&nbsp; &nbsp;&nbsp; Objective: To study the predicting power of age, comorbidity, blood glucose and types of surgery on cranial surgery patients systemic inflammatory response syndrome (SIRS).<br>&nbsp; &nbsp;&nbsp; Design: Predictive correlational research.<br>&nbsp; &nbsp;&nbsp; Methodology: The sample consisted of 164 cranial surgery patients in the intensive care unit of a tertiary hospital. The study was conducted within the frst 24 hours after their operations. The research instruments were 1) a personal information form; 2) a comorbidity assessment form; and 3) a systemic inflammatory response syndrome (SIRS) scoring form. Binary Logistic Regression Analysis was employed for data analysis, with the level of statistical signifcance set at .05.<br>&nbsp; &nbsp;&nbsp; Results: The incidence of SIRS was found in 49.4% of the patients. Age and blood glucose levels were identifed as signifcant factors capable of predicting 24% of SIRS incidence (at .05, Nagelkerke R2 = .24, p &lt; .01). Comorbidity and surgery types, on the other hand, were incapable of signifcantly predicting SIRS.<br>&nbsp; &nbsp;&nbsp; Recommendations: It is recommended that nurses apply the data on every cranial surgery patients age, blood glucose level and SIRS score to assessing their post-operative condition, as part of the process of monitoring all the risk-group patients for clinical signs of inflammation and alleviating their systemic inflammation.</p> เบญจกาย ตรีถูกแบบ วัลย์ลดา ฉันท์เรืองวณิชย์ อรพรรณ โตสิงห์ ธีรพล วิทธิเวช ##submission.copyrightStatement## 2019-04-23 2019-04-23 34 2 94 111 Social Support and Health Status among Community Dwelling Older People Living Alone with Chronic Diseases <p>&nbsp; &nbsp;&nbsp; Objective: 1) To describe personal factors, social support, and health status, and 2) To examine relationships among personal factors and social support with health status among community dwelling older people living alone with chronic disease.<br>&nbsp; &nbsp;&nbsp; Design: Descriptive Correlational Research.<br>&nbsp; &nbsp;&nbsp; Procedure: The participants were 262 older people living alone with chronic disease in a province of northeastern region were recruited. Data were collected using demographic characteristics and a set of instruments designed to assess happiness in life, social support, perceived health status, depressive symptom, and death acceptance. Descriptive statistics, Biserial correlation, and Spearman’s Rank Correlation were used to analyze the data.<br>&nbsp; &nbsp;&nbsp; Results: The mean age of the sample was 71.20 ± 7.53 years. They had social support at a moderate level (66.8 %), perceived physical health at a fair level (47.7%), depression at a beginning level (80.5 %), happiness at a high level (52.7 %), and death acceptance at a mild level (57.6 %). Correlation analysis revealed that income was correlated with the perceived physical health (r= .181, p= .003) and happiness (r= .136,p= .028). Social support was correlated with perceived physical health (r= .148, p= .016) and happiness (r= .489,p&lt; .001).<br>&nbsp; &nbsp;&nbsp; Recommendations: The four dimensions of health should be enhanced among older people living alone with chronic disease, particularly those with low income and lack of social support. Their access to healthcare and social services should be promoted and provided and vocational activities should be organized for them to earn income to sustain their health and self-esteem. Community activities should be promoted consistently integrated in their beliefs and culture to preserve their faith, beliefs, and mental attachment.</p> รัตนา บุญพา ผจงจิต ไกรถาวร นพวรรณ เปียซื่อ ##submission.copyrightStatement## 2019-04-23 2019-04-23 34 2 112 126 Factors Predicting Quality of Life of Hepatocellular Carcinoma Patients Undergoing Transarterial Chemoembolisation <p>&nbsp; &nbsp;&nbsp; Objective: To study predictive correlations between fatigue, insomnia and anorexia,and the quality of life of hepatocellular carcinoma (HCC) patients during four to eight weeks after undergoing transarterial chemoembolisation (TACE).<br>&nbsp; &nbsp;&nbsp; Design: Predictive correlational research.<br>&nbsp; &nbsp;&nbsp; Methodology: The subjects were 77 HCC patients receiving monitoring check-ups in an out-patient ward during 4 to 8 weeks after undergoing transarterial chemoembolisation. Data were collected through a set of questionnaires: 1) a general information questionnaire; 2) the Fatigue Symptom Inventory; 3) the Insomnia Severity Index; 4) the Council on Nutrition Appetite Questionnaire; and 5) the Functional Assessment of Cancer Therapy-Hepatobiliary. The data were analysed using descriptive statistics and stepwise multiple regression analysis.<br>&nbsp; &nbsp; &nbsp; Results: Based on the results, the participants displayed mild fatigue ( = 19.31,SD = 27.09), no insomnia ( = 6.39, SD = 7.74), moderate anorexia ( = 17.25, SD = 5.55)and good quality of life ( = 138.36, SD = 22.99). The most influential factor affecting the quality of life was fatigue (ß = -.49, p &lt; .001), followed by anorexia (ß = -.38,p &lt; .001) and insomnia (ß = -.18, p &lt; .001). These three factors were capable of predicting the patients’ quality of life by up to 80% (R2 = .80, F = 96.03, p &lt; .001).<br>&nbsp; &nbsp;&nbsp; Recommendations: Thorough evaluation of the severity of fatigue, anorexia and insomnia in hepatocellular carcinoma patients after TACE treatment is instrumental in successfully controlling or alleviating their symptoms, or preventing such symptoms from escalating and affecting the patients’ quality of life.</p> อรุณ นิลเลิศ ผ่องศรี ศรีมรกต เกศศิริ วงษ์คงคำ สมราช ธรรมธรวัฒน์ ##submission.copyrightStatement## 2019-04-23 2019-04-23 34 2 127 140