Ramathibodi Nursing Journal
Permanent URI for this collection
Browse
Browsing Ramathibodi Nursing Journal by Issue Date
Now showing 1 - 20 of 87
Results Per Page
Sort Options
Item Long-Term Care: Comparative Analysis for Policy Recommendation(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2009-09-21) Kanitta Bundhamcharoen; Senior Researcher, International Health Policy Program, Thailand; Siriphan Sasat; Assistant Professor, Faculty of Nursing, Chulalongkorn UniversityAbstract: A comparative analysis study of long-term care system from 10 countries was carried out for policy development and policy planning recommendation forappropriate long-term care services in the Thai context. The result of this study found that the government had difference levels of roles in conceptualizing anddeveloping long-term care provision system depending on social background of each countries. The services included personal care needs and institutional andcommunity care. In addition, there were cash benefits and financial support for family caregivers. The financial systems came from general taxation, third party payers, and out-of-pocket payment and the cost control such as co-payment was often found. For the issue of management, the care receiver was assessed for their dependency level and duration of caring needs. Various financial support models for the family and informal network in each country were found, for example, services provisioning, cash benefit for family, tax relief for co-residential children, benefit of working leave, and basic pension benefit. The recommendation for developing long-term care in Thailand was that the system development must be appropriate for cultural and value of Thai context. The services should be emphasized on family’s role in caring, while the government provides support, education, supervision, and monitoring on quality control. In addition, there should be a safety net available for the family that is unable to provide this kind of care.Item Occupational Exposures to Blood and Body Fluids among Healthcare Workers(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2009-09-21) Siriluk Apivanich; Instruc tor, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Thanomvong Muntajit; Infection Control Nurse, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Somporn Somsakul; Infection Control Nurse, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Pranee Kehachindawat; Infection Control Nurse, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Kumthorn Malathum; ssistant Professor, Division of Infectious Disease, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol UniversityAbstract: The purpose of this descriptive study was to determine the incidence and characteristies of occupational exposure to blood and body fluid and infectious consequence among healthcare workers (HCWs) and to predict the type of HCWs at risk of occupational hazard in Ramathibodi Hospital from January 1, 2004 through December 31, 2006. Throughout the 3-year surveillance, there were 448blood and body fluid exposures. Of these 448 accurrences 331 (73.9%) were women. The average age was 27.64 years. Most of them (79.0%) were between the ages of 19-30 years. The majority of them were nursing staff (29.5%) and medical students (22.5%). Medical wards were the most common places where HCWs exposed to blood and body fluid by accident. Concerning working experience, 66.7% had less than 5-year experiences. The blood and body fluidincidence rate per 100 HCWs was 8.2 for medical students, 5.4 for residents and 1.7 for nursing students. Medical students had the highest risk to have an accident, considering the nursing students as the reference group. Regarding the activities undertaken at the time of injury, 231 accidents (51.6%) happened in the process of using sharp devices, and 42.4% were needle stick. Sources of infection were patients who had positive results for anti-HIV (15%) and HBsAg (4.2%). However, a 3-year sureillance found that none of the HCWs had positive results of these diseases. Education of occupational infection with bloodborne pathogens should be a priority of the hospital program for infection control. Training of HCWs on safe handling and disposal of needles and sharps devices and hepatitis B vaccination of all HCWs are required to reduce transmission.Item The Effect of Music Therapy on Anxiety, Physiological Responses, and Weaning Parameters in Patients during Weaning from Mechanical Ventilation(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2009-09-21) Jiraporn Chontichachalalauk; Instructor, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Porntip Malathum; Assistant Professor, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Somchit Hanucharurnkul; Professor, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Charn Kredboonsri; Assistant Professor, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol Universitywhich, in turn, may induce physiological responses. From a literature review, music therapy has shown to decrease anxiety and increase relaxation in variouspopulations. However, these effects have not been examined in patients during weaning from mechanical ventilation. The purpose of this study was to examine the effect of music therapy on anxiety, physiological responses, and weaning parameters in patients during weaning from mechanical ventilation. The sampleconsisted of 20 patients during weaning from mechanical ventilation at three intensive care units of a university hospital, Bangkok, Thailand. Purposivesampling was used to recruit the sample. A crossover experimental design was used to compare the mean changes in anxiety, physiological responses, and weaning parameters between the subjects in an intervention period—a period when the patients received 30 minutes of music—and in a control period without music. The sequence of these periods for each subject was randomly assigned by drawing lots.For both periods, the anxiety level was assessed, and physiological responses (heart rate, respiratory rate, and blood pressure) and weaning parameters (oxygensaturation, tidal volume, and rapid shallow breathing index) were measured. The tests showed that the anxiety level, respiratory rate, and mean arterial pressure during the music therapy period were decreased more than during the control periodover time, while there was no significant difference as regards other physiological responses and the weaning parameters. In conclusion, this study showed that music therapy can help in the process of weaning patients from mechanical ventilation because it reduces anxiety level and some physiologic responses. These outcomes indicate that music therapy can promote relaxation responses in patients during weaning from mechanical ventilation, which in turn, may help the patients to conserve their energy and topromote their recovery.Item Health Promotion in Urban Community under the Standards of Primary Care System(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2009-09-21) Supunnee Thrakul; Assistant Professor, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Anchalee Naulclai; Assistant Professor, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Kannika Kongtong; Assistant Professor, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Karn Chaladthanyagid; Lecturer, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol Universityhealth care in the urban community under the standards of primary care system in the health insurance project. The population was people aged 15 years and older who registered in the health insurance project and used the Universal Health Care Coverage Scheme for the treatment at the specified health care centers. The sample was selected by simple random sampling and divided into two groups: 1) Pradit-Thorakarn community and 2) Soi Phaholyothin 45 community with health benefits for government workers. The data were collected in January 2003. The variables for comparing the access to health promotion included health education, service activities outside health centers, basic knowledge for self care, basic skills for emergency care and screening. One hundred and twenty-seven participants were interviewed using questionnaires. Data analysis was performed in descriptive statistics and tested the difference by the Chi-square. Findings showed that there were 67 and 60 subjects for the first and second groups, respectively. The first group (73.1%) had been educated for health promotion about appropriate eating but the second group (63.3%) had appropriate exercise. Both groups had support from health care providers for primary health care (83.6% and 61.7%), gained basic knowledge for self care when getting fever and common cold (89.6% and 70.0%), had basic skills for emergency care when experiencing epistaxis (79.1%and 53.3%), and had screening for hypertension (59.7% and 36.7%) and diabetes (38.8% and 35.0%), respectively. The difference between both groupsin support from health care providers in primary health care, basic skills for emergency care, and screening was statistically significant. The results of the studysuggested that the standards of primary care system in the health insurance project could improve the increase of the access to health promotion and community nurses play an important role for health promotion programs that lead to a good quality of life.Item Central Venous Catheter Care in Children(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2009-09-21) Somtawin Sirireung; Registered Nurse (Haematology-Oncology Unit), Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol UniversityMedications and nutritions are generally given to patients via the intestinal tract. When oral administration is not possible, the venous system is an alternative route which comprises peripheral and central veins. The selection of either peripheral or central venous route depends on the purpose of usage. With advances in medical technology, many kinds of long-term venous access devices have been developed for central venous use in children such as Hickman catheter, Broviac catheter, and Subcutaneous port for long-term uses, depending on the patient’s necessity and suitability. Catheter related complications are particularly related to age, development, and type of catheter in pediatric patients. Nurses have important roles in catheter care. They must have knowledge of the type, size, indication, advantage, and disadvantage of each catheter type. To fulfill these important roles, they must have adequate experiences and proficiency in catheter care in basis to maintain these devices as long as they are needed.Item Effectiveness of Music Therapy on Anxiety, Physiological Responses, Vital Capacity, and Oxygen Saturation in Mechanically Ventilated Patients(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2009-09-21) Sumolchat Duangbubpha; Instructor, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Somchit Hanucharurnkul; Professor, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Charn Kiatboonsri; Assistant Professor, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol UniversityAbstract: This experimental research was designed to test the effectiveness of music therapy in reducing anxiety levels, promoting physiological responses by decreasing heart rate, respiratory rate, blood pressure, and increasing oxygen saturation and vital capacity in patients with respiratory failure using a mechanical ventilator. The sample consisted of thirty patients receiving mechanical ventilation. The study was conducted from July 2000 to January 2001 in three settings: the medical intensive care unit, the coronary care unit, and the intermediate care unit, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand. Subjects were purposively selected according to pre-determined criteria. A change-over design was used in this research study to compare the changes in anxiety level, vital capacity, physiological responses, and oxygen saturation among the same patients during two periods: the music therapy and no music therapy period. Subjects assessed their music preference and received a chance to select natural music from the collection. In the experimental period,the subjects listened to their chosen music through headphones via portable compact disk player for 30 minutes while receiving mechanical ventilation. In the control period, all subjects received no music therapy, but silent headphones were put on. The results of thestudy indicate that during the music therapy period, anxiety level, heart rate, respiratory rate, and mean arterial pressure and systolic blood pressure of the subjects decreased significantly more than in the control period. Vital capacity and oxygen saturationof the subjects during the music therapy period increased significantly more than in the control period. There was no statistically significant difference in the change in diastolic blood pressure between the music therapy and the no music therapy period. The application of music therapy is convenient and inexpensive for patients receiving mechanical ventilation. Music therapy provides an effective and inexpensive means for anxiety reduction and promotes relaxation in mechanically ventilated patients.Item Factors Predicting Hyperglycemic Preventive Behaviors among Older Persons with Uncontrolled Type 2 Diabetes Mellitus(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2009-09-21) Nattaya Prasertampisakul; Graduate Student in Master Degree of Nursing Science (Family Nurse Practitioner), Faculty of Nursing, Thammasat Univ; Kaysorn Sumpowthong; Assistant Professor, Faculty of Nursing, Thammasat University (Current workplace: Faculty of Public Health, Thammasat University); Chodchoi Wattana; Instructor, Faculty of Nursing, Thammasat UniversityAbstract: The purpose of this study was to examine the power of selected factors to jointly predict hyperglycemic preventive behaviors among older persons with uncontrolled type 2 diabetes mellitus. The sample of this study consisted of 140 older persons with type 2 diabetes drawn from a name list using multi-stage cluster sampling. The inclusion criteria included persons with type 2 diabetes aged 60 years or older who had fasting plasma glucose higher than 140 mg/dl for two times within 6 months prior to the data collection. Data analysis employed frequencies, percentages, means, standard deviations and a multiple linear regression analysis. The results showed that the overall selected factors accounted for 25.9% of the variance in hyperglycemic preventive behaviors. Three selected factors (cues to action, perceived benefits of hyperglycemic preventive behaviors, and income) significantly predicted hyperglycemic preventive behaviors. However, gender, marital status, perceived susceptibility, and perceived barrier could notsignificantly explain hyperglycemic preventive behaviors. The findings suggest that health care services for older patients with uncontrolled diabetes mellitus should be modified to help them to gain the perceived benefits of hyperglycemic preventive behaviors and also to support them by organizing follow-up appointments continuously and practically. Health care providers should pay more attention onproviding care with good relationships, and on encouraging families to support persons with type 2 diabetes in performing hyperglycemic preventive behaviors congruent with their socio-cultural context.Item Glycemic Control in Persons with Diabetes after Attending a Group Educational Program for Diabetes Self-Management(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2009-09-21) Boonchan Wongsunopparat; Advanced Practice Nurse (Medical-Surgical Nursing: Diabetes), Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Chardpra-orn Ngarmukos; Assistant Professor, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Nampeth Saibuathong; Registered Nurse, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol UniversityAbstract: The purpose of this retrospective research study was to examine glycemic control in persons who attended a group educational program for diabetes selfmanagement (GEDSM). The sample consisted of 45 persons with diabetes who came to follow-up at the Medical Out-patient Clinic, Ramathibodi Hospital. The data assessment included: 1) the demographic data, 2) fasting plasma glucose (FPG), and 3) glycosylated hemoglobin (HbA1C). The sample after attending a group educational program for diabetes self-management instructed by a multidisciplinary team on different topics for one year. The FPG and HbA1C data were retrieved from the patients’ medical records before attending the GEDSM and the other five times during a one-year period of follow-up after attending the GEDSM. The results revealed that the mean scores of the FPG and HbA1C of the first four times of follow-up after attending the GEDSM decreased from the baseline over time; however, those in the fifth time of follow-up tended to slightly increase. Analysis of variance showed that the mean scores of the FPG and HbA1C in persons with diabetes before attending the GEDSM was significantly different from those five times of follow-up after attending the GEDSM. Post hoc comparisons with Scheffe’s test revealed that: 1) the FPG before attending the GEDSM was significantly higher than that at the fourth time of follow-up; 2) the HbA1C before attending the GEDSM was significantly higher than that at the third and the fourth times of follow-up; 3) no significant differences between those before attending the GEDSM and the rest were found. The findings indicated that the GEDSM run by a multidisciplinary team is helpful for glycemic control in persons with diabetes. However, according to the trend of a higher plasma glucose level in a few months before the ending of a one-year period of follow-up, an additional session of the educational program should be planned for persons with diabetes for improving glycemic control.Item The Use of Warfarin in Older Adults: A Case Study and Caring(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2009-09-21) Sukoldee Choicharnchaikul; Registered Nurse, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Porntip Malathum; Assistant Professor, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Supanee Karnchanachari; Assistant Professor, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol UniversityAbstract: Warfarin is an oral anticoagulant, which is frequently used to control and prevent thromboembolic disorders. Older adults have a great risk forthromboembolic disease. Thus, the use of anticoagulant therapy is expanding among older adults, particularly because of the increasing prevalence of atrial fibrillation. Warfarin has been proven to be the most effective antithrombotic agentfor the primary or secondary prevention of stroke in clients with atrial fibrillation. However, the therapeutic range for warfarin is narrow; an international normalized ratio (INR) of less than two increases the risk of thromboembolism, and an INR ofmore than three increases the risk of major bleeding in older adults. Individuals older than 65 years are at a particular risk for thromboembolic events as well asanticoagulant-related complications. Numerous considerations for the use of warfarin include the complex pharmacokinetics of warfarin, the need for continuous monitoring and dose adjustments, bleeding events, non-adherence, good patient communication, drug–drug interactions, drug–food interactions or drug–disease interactions, and old age, which requires a careful management. The purpose of thisarticle is to describe basic knowledge and mechanism of action of warfarin, factors influencing the effectiveness of warfarin therapy, adverse drug reactions, contraindications, monitoring, management of warfarin therapy and its complications, and special instructions for in clients and their caregivers. Also, acase study is presented to analyze warfarin therapy in an older client. This knowledge is expected to be useful for health care providers, particularly nurses, tocare for older adults receiving warfarin therapy appropriately, thereby enhancing the effectiveness of warfarin therapy, reducing its complications, and reducing hospitalization.Item Clinical Nursing Practice Guideline for Successful Weaning from Mechanical Ventilation(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2009-09-21) Yupha Wongrostrai; Lecturer, Department of Medical-Surgical Nursing, Kuakarun Nursing College; Orasa Panpakdee; Associate Professor, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Supreeda Monkong; Assistant Professor, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol UniversityAbstract: The objectives of this study were to establish clinical nursing practice guideline (CNPG) using a research utilization process to promote the successfulweaning the patients from mechanical ventilation. This CNPG could help the healthcare providers, especially nurses, to perform the effective weaning frommechanical ventilation. Moreover, the CNPG would be useful in promoting the communications within the healthcare team, and providing necessary informationfor nurses and physicians. This information could be used to achieve the best decision in giving proper treatment and care for ventilated patients to ensuresuccessful weaning. The development of CNPG was done from analysis and synthesis of 42 relevant studies and was approved by three experts. The results of the CNPG development consisted of the nursing intervention in three phases including: pre-weaning phase, weaning phase, and post-weaning phase. Inaddition, the CNPG focused on the assessment of the readiness weaning, the monitoring the patients’ weaning abilities and the evaluation of the outcome in each phase of weaning. In addition, the CNPG was reviewed by experts in terms of content validity and feasibility of clinical practice. The investigator recommended that the CNPG should be implemented in the clinical setting to evaluate its feasibility for practice and develop acare model for patients who required mechanical ventilation. Furthermore, a pilot study should be conducted in clinical setting to evaluate the effective of the CNPG and outcomes. In addition, the CNPG should be improved continuously for the quality of nursing care.Item Nursing Care of Patients Undergoing Mastectomy with Immediate Latissimus Dorsi Flap Reconstruction(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2009-09-23) Suwaluck Wongjunlongsin; Advanced Practice Nurse, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Prakasit Chirappapha Prakasit Chirappapha; Instructor, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Permrudee Pongmongkol; Head Nurse, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University.Abtstract: Mastectomy with immediate latissimus dorsi (LD) flap reconstruction is the operation that dissecting the LD muscle and fatty tissue overlying the musclewith the skin paddle to create a new breast after mastectomy. Immediate LD flap reconstruction is an acceptable procedure due to safety and early recovery. This article describes the procedure, surgical method, indications and contraindications, complications, and nursing care plan for pre- and post-operation. A case study was also presented.Item Using the RAMA EVD Set in Pediatric Patients with Renal Failure(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2009-09-23) Natthacha Chiannilkulchai; Instructor, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol UniversityAbstract: Pediatric patients with renal failure who need peritoneal dialysis which is a method of removing waste products and water from the body by using dialysate. In the traditional method, the bag of dialysate is weighed before releasing the dialysate to the patient’ s peritoneal wall and again after the process of dialysate diffusion ended in each cycle. Then, the weight of the dialysate in the bag before releasing to the peritoneum and after ending the process of dialysate diffusion in each cycle is compared. However, this traditional method is not able to estimate the exact volume and it might delay and burden staff nurses’ work. Thus, the Renal Unit of Ramathibodi Hospital has applied the “Ramathibodi External Ventricular Drainage” (EVD) set to estimate the volume of the dialysate which is accurate and convenient. A set of RAMA EVD is composed of a three-way stopcock, an extension tube, and a urinary bag. The results of applying the RAMA EVD set to 15 pediatric patients with renal failure showed the accuracy of estimating the volume of the dialysate. Additionally, applying the RAMA EVD set has saved time and decreased staff nurses’ workloads and is more convenient than the traditional method. Importantly, this innovative set can prevent complications from an excessive or insufficient releaseof the dialysate.Item The Predictability of Personal Factors, Social Support, and Uncertainty on Stress and Coping Behavior of First-time Fathers Dealing with Spouse’s High Risk Pregnancy(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2009-09-23) Areerat Naewchalee; Lecturer, Department of Obstetric Nursing, Phrapokklao Nursing College; Srisamorn Phumonsakul; Assistant Professor, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital; Orapin Chareonpol; Associate Professor, Department of Nursing, Faculty of Medicine, Ramathibodi HospitalAbstract: The present research was a descriptive study which aimed at investigating the predictability of personal factors, social support, and uncertainty on stress and coping behavior of first-time fathers dealing with spouse’s high-risk pregnancy. The Stress, appraisal, and coping model of Lazarus and Folkman (1984) was used as the conceptual framework of the study. The sample of the study consisted of first-time fathers whose wife was diagnosed with high-risk pregnancy who sought prenatal care from PrapokklaoHospital, Chantaburi Province, from February to April, 2007. A total of 100 subjects were recruited by means of purposive sampling, and data were elicited using demographic characteristics questionnaire, social support questionnaire, uncertainty in parturitionquestionnaire, stress questionnaire, and stress coping behavior questionnaire. The findings revealed that uncertainty in parturition, social support, and educational background could together significantly explain 21 % of variance in stress of first-time fathers dealing with spouse’s high-risk pregnancy (R2 = .21, p \< .05). In addition, social support could explain5 % in coping behavior of first-time fathers dealing with spouse’s high-risk pregnancy in terms of confrontive coping behavior (R2 = .05, p \< .05), uncertainty in parturition and stress could together significantly explain 26 % in coping behavior of first-time fathersdealing with spouse’s high-risk pregnancy in terms of emotional coping behavior (R2 = .26, p \< .05), and stress, uncertainty in parturition, and age could together significantly explain 22 % in coping behavior of first-time fathers dealing with spouse’s high-riskpregnancy in terms of palliative coping behavior (R2 = .22, p \< .05). Based on the findings of the study, it is recommended that fathers’ stress and related factors such as educational background, social support, and uncertainty in parturition should be assessed to enhance nurses to provide more effective nursing care for first–time fathers who deal with highrisk pregnancy.Item A Synthesis of Research on Management of Urinary Incontinence in Persons with Stroke*(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2009-09-23) Sukoldee Choicharnchaikul; Graduate Student in Master Degree of Nursing Science (Adult Nursing), Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Porntip Malathum; Assistant Professor, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Prakong Intarasombat; Associate Professor, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol UniversityAbstract: Urinary incontinence is a common health problem which can be found after the occurrence of stroke. It impacts a person’s quality of life and also increases the demand for health care services. The purposes of this study were to gather, review, analyze, and synthesize research evidence on the management of urinary incontinence in persons with stroke. Seventeen relevant research studies published between 1985 and 2008 were selected for the study. They were evaluated based on the criteria in evaluating research reports of the Royal College of Physicians of Thailand. Of these research studies, eight were classified as Level A; five were classified as Level B; and four were classified as Level C. The findings were thus divided into three parts. Firstly, assessment, including a historyand physical examination as well as post voiding residual urine and laboratory test was completed. Although the urodynamic study indicated that it could identify the physiologic abnormality of lower urinary tract, it should not be used as the first-line ssessment.Secondly, interventions such as behavioral interventions (pelvic floor muscle exercise andbiofeedback) were shown to significantly reduce the rate of urinary incontinence if they were combined with other scheduling regimens, such as lifestyle modifications, environmental modifications, or pharmacological management. Unfortunately, empirical evidence regarding the effectiveness of transcutaneous electrical nerve stimulation on urinary control was yetinsufficient. Additionally, clamping of the catheter for the urethral sphincter’s training appeared to be an ineffective method. Finally, the establishment of a urinary incontinence management system in persons with stroke increased continence and the clients’ andhealthcare providers’ satisfaction. The findings of the present study shed light on guidance of the evidence-based approach for nursing practice. However, the number of research studies on the management of urinary incontinence in persons with stroke is relativelysmall. Thus further study should be conducted particularly. Besides, the context issue of studies also needs to be considered for research utilization.Item A Clinical Innovation in Nursing: A Pouch Collecting an External Part of Nasogastric Tube(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2009-09-23) Sauwana Piyapisut; Clinical Nurse Expert, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University.Abstract: A pouch for collecting an external part of nasogastric tube is a nursing innovation. The pouch is designed to collect an external part of nasogastric tube, which is out of the nasal cavity. It is simple and practical to use. When using this tube pouch, the patient can perform daily activities conveniently. Without the pouch, the tip of the nasogastric tube may swing freely, resulting in pain and discomfort of the patient. In addition, the tube pouch can reduce the chance to be contaminated by surrounding organisms; thereby preventing infection and can reduce the chance of unintentional dislodgment of the tube. Therefore, this innovative pouch is useful for the patient who uses the nasogastric tube for their onvenience, comfort, and safety, which in turn, promotes quality of daily living.Item A Survey of Knowledge, Preventive Behavior, and Risk of Osteoporosis on Breast Cancer Survivors(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2009-09-23) Suparb Aree-Ue; Assistant professor, Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University; Montha Limthongkul; Assistant professor, Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversiityAbstract: Breast cancer is the second in frequency cancer diagnosed among Thai women. Although new therapeutic modalities have increased survival rate for patients, the wider use of adjuvant chemotherapy and antiestrogens is a common long-term side effect causing bone loss. The aim of this descriptive survey study was therefore to examine knowledge, preventive behavior, and risk of osteoporosis on breast cancer survivors. Purposive sampling was used to recruit a sample with the inclusion criteria as follows: 1) being a group of breast cancer patients completely treated withchemotherapy and adjuvant treatment for 5 years; and 2) being members of a self help group for breast cancer patients at a university hospital. The sample consisted of 95 women with breast cancer. Their age ranged from 34 to 67 years with a mean of 51.31 (SD = 7.3) years. Tools used in the study included: the Osteoporosis Knowledge Test consisting of 24 questions, and the Osteoporosis Preventive BehaviorQuestionnaire consisting of 10 questions with a multiple-choice format requiring a correct response. Additionally, the Osteoporosis Self-Assessment Tool was employed to investigate the risk of osteoporosis. Results indicate that breast cancer survivors havehad moderate knowledge about osteoporosis. With regard to osteoporosis preventive behavior, 42.9% of the participants did osteoporosis preventive behavior. For the risk of osteoporosis, 32.3% of the participants had a moderate risk of osteoporosis. This result suggests that further study needs to emphasize what interventions increase osteoporosis knowledge as well as promote osteoporosis preventive behavior amongbreast cancer survivors. Additionally, bone mass should be monitored for evaluating the risk of osteoporotic fractures in this population.Item The Effects of a Program to Promote Spouse Involvement in Pregnancy and Birth on Marital Relationships, Perception of Childbirth Experience, Maternal-Infant Attachment, and Paternal- Infant Attachment(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2009-09-23) Navaporn Mamark; Professional Nurse, Bangbor Hospital, Samutprakarn Province; Srisamorn Phumonsakul; Assistant Professor, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Orapin Chareonpol; Associate Professor, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol UniversityAbstract: The present study was quasi-experimental research which aimed at investigating the effects of a program to promote involvement of the spouse in pregnancy and birth on marital relationships, perception of childbirth experience, maternal-infant attachment, and paternal-infant attachment in first-time mothers and fathers. The sample consisted of 60 pregnant women and their husbands who were purposively selected from the obstetric department, Bangbor Hospital, and who were divided into control and experimental groups. The control group received the usual care from nursing staff, while the experimental group received the usual care plus the program promoting spouse involvement in pregnancy and birth from the researcher. This study was carried out between March and August 2007. Data were collected by using the perception of childbirth experience questionnaire, the dyadic adjustment scale, the maternal attachment inventory, and the affectional relationship questionnaire. Data were statistically analyzed by means of independent t-test. The results of this study showed that the mothers in the experimental group had a statistically significanthigher mean score of childbirth experience than that of the mothers in the control group (p \< .001). As for paternal-infant attachment, the experimental group had a statistically significant higher mean score than that of the control group (p \< .05). However, themean scores of maternal-infant attachment and marital relationship of the mothers and the fathers in the experimental group were not statistically significant higher than those of the mothers and fathers in the control group (p \> .05). The findings of this study haveled to the conclusion that the program to promote spouse involvement in pregnancy and the birth should be implemented by nursing staff in order to promote marital relationship, perception of childbirth experience, and parent-infant attachment among first-time mothers and fathers as well as to further develop the quality of nursing services.Item Symptom Experiences, Management Strategies, and Quality of Life of Females with Overactive Bladder(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2009-09-23) Somporn Chinnoros; Associate Professor, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Sujinda Chaiparyorm; Professional Nurse, Samutsakhon Hospital; Wachira Kochakarn; Professor, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol UniversityAbstract: This descriptive research aimed to investigate 1) symptom experiences of females with overactive bladder, 2) symptom management strategies of females with overactive bladder and of doctors and nurses, and 3) quality of life of females withoveractive bladder. The study group consisted of 110 females with overactive bladder who sought treatment at the outpatient unit of the urology clinic, urodynamics room, and urogynecology clinic, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, and at the outpatient unit of the urology clinic, Rajavithi Hospital. The sample was recruited with purposive sampling based on the inclusion criteria. Data were collectedusing self-administered questionnaires covering the Demographic Questionnaire, the Symptom Experience Questionnaire, the Symptom Management Strategy Questionnaire, and the Quality of Life Questionnaire. According to the study findings, the most frequently found symptom experiences of overactive bladders in females was going to the restroom at the night. The most frequently found symptom management strategies of overactive bladder was going to the restroom before going to bed, going out, or traveling. Regarding symptom management strategies, doctors administered nonpharmacological strategies or behavior therapy and prescribed medications while nurses not only administered medications according to treatment plans, but also advised nonpharmacologicalstrategies or behavior therapy. Subjects’ overall quality of life were moderate. The findings of this study might be helpful for health care providers to understand symptom experiences, symptom management strategies, and quality of life in females with overactive bladder, and to promote their self-care management when they experience overactive bladder symptoms.Item Scleroderma: Illness Trajectory and Self-Care Experiences(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2009-09-23) Promjit Hornboonherm; Associate Professor, Faculty of Nursing, Mahasarakham UniversityAbstract This article aims to present the author’s lived experiences with scleroderma for 17 years. The focuses are about the illness trajectory and self-care practicesalong with each phase of illness based on the Chronic Illness Trajectory framework of Corbin and Strauss and Orem’s self-care theory. Living with scleroderma foralong time makes the author deeply realize that it makes the patients very suffer from physical, mental, emotional, and psychosocial health deviation. The patient has to face with pain, digital ulcers, fatigue, limitation of body movement, disability, and severe body image loss. Because the severity of this chronic disease progresses continuously along with a timing period, it forces the patient to develop self-careagency to meet the continuing therapeutic self-care demands. Fortunately, the author is a nurse and self-care agent with high motivation to practice self-care, then, the outcome is surviving during the crisis phase. In addition, understanding, “what isthe reason to be alive?,” is a crucial thing that encourages the author’s will to live and practice self-care for promoting well-being potentially.Item Perioperative Nurses’ Caring Behaviors Perceived by Perioperative Patients at Ramathibodi Hospital(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2009-09-23) Pisamai Orathai; Lecturer, Division of Fundamental Nursing, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital; Sriwiengkaew Tengkiattrakul; Assistant Professor, Division of Perioperative Nursing, Department of Nursing, Faculty of Medicine, Ramathibodi HospitalAbstract: The purposes of this research study were to examine perioperative patients’ perceptions towards perioperative nurses’ caring behaviors at Ramathibodi Hospital and to compare the mean scores of perioperative patients’ perceptions towards perioperative nurses’ caring behaviors among differences in patients’ gender, age, career, income,and perioperative experiences. One hundred and sixty patients with short stay visits were approached from five operative rooms at Ramathibodi Hospital. ll patients were asked to respond to questionnaire developed by Swanson’s Caring ProfessionalScale and translated into Thai language by Kusuma Piyasiripan. Descriptive statistics, independent t-test, and one-way ANOVA were used for analysis. Results showed that all patients from all operative rooms perceived perioperative nurses’ caring behaviorsat a high level. However, there were no differences among perioperative patients’ perceptions towards perioperative nurses’ caring behaviors according to gender, age, career, income, and perioperative experiences. The findings suggested that thedirectors of the operative rooms should promote perioperative nurses to maintain their caring behaviors at a high level and develop a system to continuously assess caring behaviors for perioperative nurses for sustaining standards of care quality of operative nursing services.