Thai Journal of Nursing Council https://www.tci-thaijo.org/index.php/TJONC 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 Application of the Growth Mindset to Registered Nurses’ Professional Development in the Thailand 4.0 Reformation https://www.tci-thaijo.org/index.php/TJONC/article/view/172448 <p>The Growth Mindset is a conceptual framework based on the belief that each individual’s capacity and potential can change at any time. Positive changes can be induced by the process of self-learning and self-training to address problems constructively and to concentrate more on the process than on the product. Such development plays an important part in enabling registered nurses to adjust to and keep abreast with current changes.</p> <p>This article focuses on building a knowledge and understanding of the Growth Mindset and how it can contribute to registered nurses’ professional development. The article also offers an exchange of academic fndings and empirical evidence, both of which are applicable to the patient care process, along with feedback between healthcare teams. The scope of this article covers the conceptual framework of the Growth Mindset, its signifcance to registered nurses’ professional development in the Thailand 4.0 Reformation, its further development, and its developmental application to the nursing profession.</p> นครินทร์ สุวรรณแสง ภราดร ยิ่งยวด ขวัญนภา ขวัญสถาพรกุล ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/4.0 2019-06-28 2019-06-28 34 3 5 14 Caring Process for Acute Stroke Patients https://www.tci-thaijo.org/index.php/TJONC/article/view/154122 <p>A stroke is a serious cerebrovascular syndrome that may result in death or paralysis, with severe consequences on the patient’s physical, intellectual, cognitive and psychosocial conditions. Economically, strokes affect not only the patients’ families but also the country. Stroke patients may suffer permanent paralysis, resulting in total dependency caused by their inability to work or support themselves.</p> <p>When an acute stroke occurs, the brain suffers a suddenly decreased supply of blood. During this stage, the brain matters are still not permanently damaged, and the patient has a good chance of recovering if appropriate and timely treatment is provided. As the initial phase of an acute stroke is critical, specialised care by an interdisciplinary team plays a crucial part in saving the patient’s life, reducing the severity of paralysis or disability and minimising complications. Nurses play a pivotal part in every stage of stroke patient treatment, particularly during the frst 72 hours. Excellent nursing care can help stroke patients achieve positive treatment outcomes.</p> <p>This article presents a set of guidelines and roles for nurses caring for acute stroke patients. Developed using empirical evidence, these guidelines and roles pertain to the following areas: neurological assessment, intracranial pressure control, blood pressure management, body temperature management, blood glucose management, oxygen therapy, body positioning, hydration, feeding, swallowing, bladder and bowel management, body movement, prevention of deep vein thrombosis, and depression management. The information presented herein can be applied to designing an appropriate caregiving practice and developing an effcient caregiving programme for acute stroke patients.</p> นิภาพร บุตรสิงห์ ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/4.0 2019-06-28 2019-06-28 34 3 15 29 The Effect of Motivation Program on Stroke Rehabilitation Motivation in Older Patients with Stroke https://www.tci-thaijo.org/index.php/TJONC/article/view/168297 <p style="margin: 0px; text-align: justify; text-indent: 2cm; text-justify: inter-cluster;">Objective: To study the effects of a rehabilitation motivation program on older stroke patients.</p> <p style="margin: 0px; text-align: justify; text-indent: 2cm; text-justify: inter-cluster;">Design: Two-group experimental research with one pre-test and two post-tests (in the frst and second weeks after the experiment).</p> <p style="margin: 0px; text-align: justify; text-indent: 2cm; text-justify: inter-cluster;">Methodology: The sample was 44 older stroke patients selected based on the inclusion criteria from two tertiary hospitals. The patients were paired by age and then divided into a control group and an experimental group, so that both groups had as similar conditions as possible. The experimental group was given a two-week motivation-building programme in addition to standard care, whilst the control group received only standard care. Data were collected consecutively from the control group and then from the experimental group, using personal information interviews and a stroke rehabilitation motivation scale. The patients’ rehabilitation motivation was measured three times: before the experiment, one week after the experiment and two weeks after the experiment. The data were analysed using descriptive statistics, Chi Square, Mann-Whitney U Test, and Repeated Measure one-way ANOVA.</p> <p style="margin: 0px; text-align: justify; text-indent: 2cm; text-justify: inter-cluster;">Results: A signifcant difference in rehabilitation motivation levels between the experimental group and the control group at week two after the experiment was evident (p &lt; .05). Within the experimental group, the patients’ rehabilitation motivation levels differed signifcantly (p &lt; .05) between before the experiment and one week after the experiment, whilst no signifcant difference was found between the frst-week and second-week post-experimental measures.</p> <p style="margin: 0px; text-align: justify; text-indent: 2cm; text-justify: inter-cluster;">Recommendations: This programme had a positive impact on older stroke patients’ rehabilitation motivation. It is recommended that nurses apply it to older stroke patients in the process of rehabilitation.</p> ศิริลักษณ์ ผมขาว นารีรัตน์ จิตรมนตรี วิราพรรณ วิโรจน์รัตน์ ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/4.0 2019-06-28 2019-06-28 34 3 30 42 Application of a Nursing Process Record Form for a Nursing Practicum and Its Contribution to Fostering Favourable Graduates Characteristics https://www.tci-thaijo.org/index.php/TJONC/article/view/176808 <p>Objective: To study how a nursing process record form for a nursing practicum contributed to fostering favourable graduate characteristics<br>Design: Descriptive qualitative study.<br>Methodology: The subjects were 36 purposively sampled third-year nursing students doing a practicum in the gastro-intestinal surgery ward. In the frst week, the subjects used the standard record form in the process of caring for the assigned patients. In the second week, the subjects switched to the Nursing Student-Nursing Process record form (NS-NPR), which was employed along with 1) the Nursing Student-Instruction Manual for Nursing Process record (NS-IM NPR), and 2) the Nursing Student-Reflection Record Sheet (NS-RRS). The process record form, the manual and the reflection sheet were all developed by the researcher.</p> <p>Content analysis was used to analyse the data obtained through the NS-RRS, designed according to 1) this study’s conceptual framework, which conformed to Mahidol University’s core values of ‘Being Good, Being Wise, Bringing Joy’; 2) the expected educational skills for the twenty-frst century; and 3) Thailand Quality Framework for Higher Education (TQF-HEd), BE 2555-2559 and 2560 (2012-2016 and 2017), which was consistent with the Faculty of Nursing’s core values and favourable graduate characteristics.</p> <p>Results: After applying the nursing process record forms for a nursing practicum, the subjects reflected all aspects of the favourable graduate characteristics as required by the university. The subjects fulflled the main core values, displayed twenty-frst-century educational skills and satisfed all aspects of Thailand Quality Framework for Higher Education. In response to<br>Mahidol University’s core values, the subjects’ reflection was more evident in the ‘Being Good’ aspect than in the ‘Being Wise’ and the ‘Bringing Joy’ aspects.</p> <p>Recommendations: The nursing process record form and manual were effective in fostering the university’s favourable graduate characteristics in the participating nursing students. However, it is recommended that the form be adjusted so that it would foster the ‘Being Wise’ and the ‘Bringing Joy’ aspects as effectively as it does the ‘Being Good’ aspect.</p> สกุลรัตน์ เตียววานิช ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/4.0 2019-06-28 2019-06-28 34 3 43 59 Factors Predicting Shock in Emergency Patients https://www.tci-thaijo.org/index.php/TJONC/article/view/173801 <p>Objective: To study the factors of age, comorbidity, time spent on transporting patients to hospital, type of transport service and emergency severity, and their power to predict shock in emergency patients.</p> <p>Design: Correlational predictive design.</p> <p>Methodology: The sample was 200 patients with physical illnesses or injuries treated at two suburban tertiary hospitals. Six instruments were used to collect data: 1) a personal information questionnaire; 2) an illness/injury form; 3) a form recording the transport time, transport service type and treatment/care given during transport; 4) a comorbidity assessment form; 5) the Emergency Severity Index (ESI); and 6) the Shock Index (SI). The data were analysed using chi-square and binary logistic regression analysis, with the statistical signifcance level determined at 0.05.</p> <p>Results: The patients’ average age was 52.04 years (SD = 21.78; range = 18-93 years). Sixty-three percent of the patients were treated for illnesses, and over half (54%) had comorbid diseases. In nearly half of the cases (48.5%), the patients had been transported to hospital by their friends or relatives. In three-fourths of the cases (75.5%), the transporting time had exceeded 60 minutes, and the patients (76.5%) had not received medical treatment or care during transportation. More than half (53.5%) suffered from shock; of these, 43% (SI &gt; 0.8) were already in shock upon admission.</p> <p>The patients’ shock was found to be correlated with the factors of age, comorbidity, type of transport and symptomatic severity. In addition, emergency severity level 1 (critical) and level 2 (high-risk) displayed signifcant shock-predicting powers, at Nagelkerke R2 = .296 (OR = 35.198, 95% CI = 7.726-160.351, p &lt; 0.01; and OR = 4.545, 95% CI = 1.498-13.786, p &lt; 0.05, respectively).</p> <p>Recommendations: It is recommended that emergency unit nurses apply the ESI and SI to assessing trauma patients’ emergency severity to prevent shock in patients with physical illnesses and injuries.</p> นันทพร หาสาสน์ศรี วัลย์ลดา ฉันท์เรืองวณิชย์ อรพรรณ โตสิงห์ ศรัทธา ริยาพันธ์ ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/4.0 2019-06-28 2019-06-28 34 3 60 75 Factors Influencing Acute Exacerbations in Patients with Chronic Obstructive Pulmonary Disease: A Prospective Study https://www.tci-thaijo.org/index.php/TJONC/article/view/176837 <p>Abstract:<br>Objective: To determine the influence of disease severity perception, depression, inhaler technique, and influenza and pneumococcal vaccinations, on acute exacerbations in patients with chronic obstructive pulmonary disease (COPD).</p> <p>Design: Predictive correlational research design, with a prospective three-month follow-up.</p> <p>Methodology: The subjects, selected based on a pre-set criteria, were 147 patients diagnosed with chronic obstructive pulmonary disease and receiving treatment at a tertiary hospital in Bangkok. Data were collected using 1) a personal information questionnaire; 2) an overall disease severity perception questionnaire; 3) a depression assessment questionnaire; 4) an inhaler use checklist; and a daily exacerbation symptom and management recording form. Data were analysed using descriptive statistics and enter method logistic regression statistics.</p> <p>Results: Most of the subjects were males (93.3%) with an average age of 73.38 years. According to their diagnosis results, the subjects had COPD for an average of 8.53 years.About one-fourth of the subjects had experienced acute COPD exacerbations, and showed symptoms of depression (24.5% and 27.9%, respectively), whilst one-third (38.1%) displayed a moderate level of disease severity perception. The majority of the subjects (87.8%) had received influenza vaccination, but a very small number (4.1%) had received both influenza and pneumococcal vaccinations. More than half of the subjects (59.9%) practiced the inhaler technique correctly. The aforementioned factors were able to jointly predict acute COPD exacerbations at 26.7 % (Nagelkerke R2 = .267). High and highest perception of disease severity (OR 5.11, 95% CI 1.67-15.66, p = .004) and depression (OR 3.31, 95% CI 1.36-8.05, p = .008) were also capable of predicting COPD exacerbations.</p> <p>Recommendations: It is suggested that nurses assess AE-COPD patients’ perception of disease severity and depression as part of risk factor evaluation. Health education is recommended for patients with high levels of disease severity perception and depression, to ensure early detection of the disease. Action plans for prevention and alleviation of acute exacerbations in COPD patients are also advised.</p> วิภาณี คงทน ดวงรัตน์ วัฒนกิจไกรเลิศ คนึงนิจ พงศ์ถาวรกมล นัฐพล ฤทธิ์ทยมัย ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/4.0 2019-06-28 2019-06-28 34 3 76 90 Bangkok Residents’ Attitudes towards Breastfeeding in Public https://www.tci-thaijo.org/index.php/TJONC/article/view/183217 <p>Abstract:<br>Objective: To study and compare Bangkok residents’ attitudes towards breastfeeding in public, based on their genders, educational levels, ages, and numbers of children.</p> <p>Design: Cross-sectional survey research.</p> <p>Methodology: The study was conducted on 400 conveniently sampled male and female residents of Bangkok. The subjects had to be 18 years old or more and able to speak, read and write Thai. A questionnaire on attitudes towards breastfeeding in public was used for data collection. Descriptive statistics, independent t-test and one-way ANOVA were used for data analysis.</p> <p>Results: The results showed that 70.2% of the sample supported breastfeeding in public. Around three-fourths (75.5%) considered breastfeeding in public acceptable; however, only 31% of the subjects found breastfeeding in public acceptable even without using breast covers. Ninety-fve percent of the subjects supported the provision of breastfeeding rooms in public places. An average attitude score was 55.14 (SD = 8.59), from a range between 26 and 75.</p> <p>According to the comparative study, no signifcant difference in the attitude scores was found between genders (t(398) = -.969, p &gt; .05), and ages (F(2, 397) = 1.476, p &gt; .05). However, signifcant differences in the attitude scores were found between subjects with different educational levels (F(2, 397) = 3.185, p &lt; .05), and between subjects with children and those without children (t(398) = -2.563, p &lt; .05).</p> <p>Recommendations: It is suggested that nurses develop intervention activities to promote and develop positive attitudes towards breastfeeding in public amongst individuals, groups, and communities, particularly amongst school children. Advocacy of mothers’ and infants’ right to public breastfeeding facilities should also be supported.</p> เยาวเรศ บุญเลอร์ ทัศนี ประสบกิตติคุณ พรรณรัตน์ แสงเพิ่ม ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/4.0 2019-06-28 2019-06-28 34 3 91 104 Factors Predicting Trauma Patients’ Discharge Destinations https://www.tci-thaijo.org/index.php/TJONC/article/view/173389 <p>Objective: To study the predictive power of the factors of age, comorbidity,<br>physiological deterioration and pain on trauma patients’ discharge destinations.</p> <p>Design: Predictive correlational design.</p> <p>Methodology: This study was conducted on a sample of 300 trauma patients treated at the trauma unit of a campus hospital between January and June 2018. The research instruments consisted of 1) a personal information form; 2) the Modifed Early Warning Sign (MEWS) scale; 3) the Critical-Care Pain Observation Tool<br>(CPOT); 4) a comorbidity form; and 5) a discharge destination record form. The data were analysed using Point-Biserial Correlation and Logistic Regression Analysis.</p> <p>Results: More than half of the subjects (58%) were males. The subjects’ average age was 48.58 years (SD = 19.86), about one-third (30.67%) of whom were injured in traffc accidents. Almost 75% of the subjects showed minor physiological deterioration, at an average of 2.01 (SD = 1.54) on the MEWS scale, and an average score of 2.47 (SD = 1.63) on the CPOT. Nearly half of the subjects (47.33%) had comorbidity conditions.<br>A predictive analysis showed that physiological deterioration and increase in pain frequency signifcantly raised the likelihood of the patients’ needing prolonged hospitalisation (.05 (OR = 2.23, 95% CI: 1.69-2.94; OR = 1.25, 95% CI: 1.06-1.49, respectively). These two factors were jointly capable of predicting 31.00% (Nagelkerke R2 = .31, p &lt; .05) of the cases.</p> <p>Recommendations: It is suggested that nurses and healthcare personnel apply physiological deterioration and pain data to the process of determining whether a patient needs continued intensive care or can be transferred to an in-patient ward.</p> วรานุช ศรรักษ์ วัลย์ลดา ฉันท์เรืองวณิชย์ อรพรรณ โตสิงห์ กฤษณ์ แก้วโรจน์ ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/4.0 2019-06-28 2019-06-28 34 3 105 122 Organisational Change Perception Induced by the Project for Propelling the Nursing Profession towards Health Promotion in Northern Thailand https://www.tci-thaijo.org/index.php/TJONC/article/view/151458 <p>Objective: To describe effects of implementing the project for driving the nursing profession towards health promotion on changes to units/organisations in Northern Thailand.</p> <p>Design: Descriptive research.</p> <p>Methodology: This was a project assessment study that applied research methodology to the assessment process. The study was conducted on 178 subjects, consisting of hospital and nursing administrators of units/organisations that served as learning centres for nursing innovations for health promotion. The instrument was a questionnaire designed to obtain data on fve aspects of unit/organisation change, namely, 1) personnel’s potential; 2) information system and knowledge management; 3) operational methods and work direction; 4) collaboration with networks; and 5) organisational policies and planning. Data were analysed using descriptive statistics.</p> <p>Results: After the implementation of the project for driving the nursing profession towards health promotion, the administrators’ perception of unit/organisation change was as follows.<br>1. Overall, the administrators’ perception of all aspects of unit/organisation change<br>was moderate (µ = 3.11-3.38; SD = .90-.98).<br>2. The administrators displayed a high level of perception of the personnel’s potential,operational methods and work direction, and organisational policies and planning aspects of unit/organisation change, with the highest percentage for every item asked (35.40-44.90%). They also showed a high level of perception of the information system and knowledge management aspect, scoring the highest on all items (38.20%) except the item on research for health promotion (36.00%). Finally, the administrators’ perception of the collaboration with networks aspect ranged from moderate to high (33.10-3.20%).</p> <p>Recommendations: It is recommended that administrators and registered nurses of local nursing units, organisations and institutions conduct joint studies to address research- and network collaboration-related problems and obstacles, and work out possible solutions. Also, Thailand Nursing and Midwifery Council should perform follow-ups on units/organisations serving as learning centres, to enhance their effciency and sustainability.</p> สมใจ ศิระกมล ธานี แก้วธรรมานุกูล อรอนงค์ วิชัยคำ วิภาดา คุณาวิกติกุล ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/4.0 2019-06-28 2019-06-28 34 3 123 141