Ramathibodi Nursing Journal
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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 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 Relationships of Family Support and Friend Support to Life Satisfaction of Older Adults in Rural Areas(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2010-10-06) Porntip Malathum; Jiraporn Kongiem; Prakong IntarasombatAbstract:Keywords:Perceived giving support, Perceived family support, Perceived friend support, Life satisfaction, Older adults The aim of this descriptive correlational study was to explore the relationship of perceived giving support of family, perceived family support, and perceived friend support of older adults to life satisfaction of older adults. The concept of social support was used to guide this study. The research participants consisted of 60 dyads of family members and older adults who lived in Chacheongsao Province. The participants were recruited by simple random sampling using a random table. The eight instruments used in the study were the Set Test, the Demographic Questionnaire, the Modified Barthel ADL Index, the Chula ADL Index, the Family APGAR Questionnaire, the Friend APGAR Questionnaire, the Giving Support Questionnaire, and the Life Satisfaction Questionnaire. The data were analyzed using descriptive statistics and Pearson’s product moment correlation. The results revealed that the mean scores of perceived giving support of family and perceived family support of older adults were categorized as high; perceived friend support of older adults was categorized as moderate. The mean score of life satisfaction of older adults was moderate. Perceived family support was moderately and positively correlated with life satisfaction. Perceived friend support was weakly and positively correlated with life satisfaction. However, perceived giving support of family was not correlated with life satisfaction of older adults. Surprisingly, giving support perceived by family was not significantly correlated with family support perceived by older adults. It could be concluded that family support and friend support perceived by older adults contribute to their life satisfaction. Nevertheless, high giving support perceived by the family may not necessarily contribute to older adults’ life satisfaction if the older adults do not perceive it as such. This study suggests that nurses and other health professionals should maintain and promote social support of older adults from various sources, especially from families and friends, to increase life satisfaction of older adults.Item Relationships between Selected Factors and Length of Hospital Stay of Older Patients Undergoing Orthopedic Surgery(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2010-07-09) Amornta Archapitak; Suparb Aree-Ue; Porntip MalathumAbstract: The length of a patient’s hospital stay has been used as an indicator ofthe quality of care. Prolonged hospitalization has an impact on patients, theirrelatives, and hospitals. The purpose of this descriptive study was to investigate therelationship between selected factors (i.e. serum albumin level, functional ability atadmission, pain reduction, acute confusional state, number of complications, andnumber of co-morbidity) and the length of hospital stay for older patientsundergoing orthopedic surgery. Purposive sampling was used to recruit a sample of99 patients, aged 60 years and older, who were admitted to hospital for orthopedicsurgery of the spine, hip, and knee during a period from January to May 2008.Data collection procedures were conducted after approval by the Ethics Committeeof Rajavithi Hospital. The data were analyzed using descriptive statistics, andSpearman rank order correlation. Findings indicated that the length of the hospitalstay ranged from 7 to 81 days with a mean of 21.16 days. Serum albumin leveland functional ability at admission had a significant negative correlation with thelength of hospital stay in older patients undergoing orthopedic surgery, while acuteconfusional state and the number of complications were significantly, positivelycorrelated with the length of hospital stay. In conclusion, promotion of nutritionalstatus, maintenance of functional ability at admission, and prevention of complicationand acute confusional state had a correlation with the shortening of the length ofhospital stay in older patients undergoing orthopedic surgery. Findings of this studymay be used as basic information for enabling older patients who have undergoneorthopedic surgery to recover from the sickness and return home faster.Keywords: Functional ability, Complications, Acute confusional state, Length ofhospital stay, Older patients, Orthopedic surgeryItem The Relationship between Spouseûs Social Support, Perception of Breastfeeding, and Maternal Newborn Attachment in Postpartum Mothers(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2010-10-08) Pol.Lt.Col. Pornphan Bhoosahas; Pol.Lt.Col. Kanjana PanyanontwatAbstract:\ \ Keywords:\ \ Spouse๛s social support, Perception, Breastfeeding, Maternal-newbornattachmentThe purpose of this descriptive research was to investigate the relationshipbetween spouse๛s social support, perception of breastfeeding, and maternal newbornattachment in postpartum mothers. The sample, consisting of 180 mothers who camefor postpartum follow-up from April to July, 2005 at Police General Hospital, wasselected by purposive sampling. Data were collected by using four questionnaires,which assessed the demographic data, spouse๛s social support, perception ofbreastfeeding and maternal newborn attachment. The data were analyzed by descriptivestatistics (percentage, range, mean, standard deviation), Pearson๛s product momentcorrelation coefficient, and multiple regression with the ๙Enter๛ method. The resultsrevealed positive by significant correlations between: 1) spouse๛s social support andmaternal newborn attachment; 2) perception of breastfeeding and maternal newbornattachment; and 3) spouse๛s social support and perception of breastfeeding.When spouse๛s social support and perception of breastfeeding were entered into theregression model, both of them could jointly explain 14 % of the variance inmaternal-newborn attachment in the postpartum period. Thus, health care professionsshould promote participation of spouse in breastfeeding of postpartum mothers forfamily relationsItem Impacts of the Unrest Situation on Nurses Practicing in the Three Southern Border Provinces(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2010-07-09) Sunee Kraonual; Urai Hatthaki; Umaporn BoonyasopuABSTRACT: Keyword: Impacts, Unrest situation, Nurse, Three southern border provincesThis qualitative study aimed to describe and explain impacts of theunrest situation on nurses, practice in the three southern border provinces. Theinformants were 11 registered nurses who had been working in the unrest situationin that region. The data were collected by in-depth interview using an interviewguide developed by the researchers, from December 2006 to May 2007. The datawere analyzed using general qualitative analytic methods. Working in the unrestsituation in the three border provinces impacted the nurses’ personal life and work.The impacts on personal life could be classified into five themes: 1) difficulty infinding food, 2) difficulty in traveling due to unsafe public transportation, 3)inconvenience in staying overnight in the hospital after work, 4) having less timefor family, and 5) being unable to take vacation as requested. The impacts on workcould be classified into two themes: 1) in the hospital: excessive workload due toinadequacy of nurses, and 2) outside the hospital: (a) at risk of being injured, and(b) reduction in community-based health services. The problems of working in theunrest situation could be classified into three themes: 1) inappropriateness of thereferral system, 2) inadequacy of medical equipment, and 3) inadequacy ofincentives for nurses who work in an unsafe situation. The problems had beensolved in seven ways: 1) readjusting the referral system according to the situation,2) cancellation of postmortem investigation on-site, 3) improvement of safescreening measures for emergent care on-site, 4) having safety practice guidelines,5) strengthening of the security system, 6) ensuring the adequacy of medicalequipment, and 7) readiness for emergency and implementation of the emergencyscheme. This study provides an understanding of the impacts of the unrest situationon nurses, practice in the three southern border provinces. The knowledge gainedfrom this study should be beneficial in guiding nurses, practice.Item Using Evidence-Based for Developing of Clinical Nursing Practice Guideline to Prevent and Relieve Oral Mucositis in Head and Neck Cancer Patients Received Chemotherapy and Radiotherapy on Admission(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2010-10-08) Supinya Sansrichan; Wanida Likitsinsopon; Suwimon Suntisuktana; Sermsukh PunmungdeangAbstract: Keywords: Clinical nursing practice guideline, Oral mucositis, Head and neck cancer,Chemotherapy, RadiotherapyThe purpose of the article is to review how to prevent and soothe mucositisin head and neck cancer after being treated with chemotherapy and radiotherapy,using nine research reports for clinical nursing practice guideline as bases of theevidence. The guideline was tested with 15 clients admitted in three EENT wards byregistered and practice nurses. The results showed that eleven of fifteen clients werefree from mucositis. Two of them had mucositis with severity of level 1 after leavingthe hospital. One client had mucositis but the clinical manifestation was better. Onlyone of the fifteen clients suffered with mucositis and was admitted to the hospital.In conclusion, the clinical nursing guideline established was useful and can beprevented clients with head and neck cancer from mucositis after being treated withchemotherapy and radiotherapy.Item Pain Management and Satisfaction with Pain Management in Patients Undergoing Total Abdominal Hysterectomy(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2010-10-06) Somporn Chinnoros; Mayuree Jirapinyo; Kwanjit PunphoAbstract: Keywords: Pain, Pain Management, Satisfaction with pain management, Totalabdominal hysterectomyThis descriptive research aimed to explore 1) pain after total abdominalhysterectomy in the first 3 days, 2) pain management methods, 3) the relationship ofpain and activities of daily living, and 4) satisfaction of patients with pain management.Symptom management was used as conceptual framework. The sample consisted ofpatients admitted in the gynecological ward and private obstetrics ward at RamathibodiHospital from October to November 2006. There were 110 participants chosen bypurposive sampling. Data were collected using the Demographic Questionnaire, thePain Questionnaire, which was modified by the researchers from the Patient Questionnaireof the American Pain Society Quality of Care Committee, and the Pain ManagementQuestionnaire developed by the researchers on the basis of literature review. Theresults revealed that: 1) on postoperative Day 1, the participants had an average ofthe highest pain in high level, while there was a low level on postoperative Day 2 andDay 3; 2) most pain management methods used in the participants included turningtheir position for comfort, while pain management methods that doctors and nursesused most included paying attention to and asked about patients’ pain. For pharmacologicalpain management, it was found that on postoperative Day 1, in the participantsreceived pethidine and Dynastat® injection, they perceived that those medicationscould relieve their pain with the high level; 3) pain disturbed their activities of dailyliving after surgery in relation to coughing and deep breathing, movement, sleep,emotion, other activities, relationship with other persons at a low level; and 4)patients had satisfaction with the pain management that they received from doctors,nurses and over all at a high level. This study provides basic information for healthcareproviders to find ways to relieve pain in patients undergoing total abdominal hysterectomy.Item Management of Insomnia in Hospitalized Older Adults: A Systematic Review(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2010-07-09) Maytharat Yaowa; Panwadee Putwatana; Supreeda MonkongAbstract: Keywords: Management, Insomnia, Older adultsThe purposes of this study were to analyze and synthesize researchevidence on management of insomnia in hospitalized older adults. Throughsearching electronic databases, 11 relevant research studies published between1990 and 2007 were selected for study. Of the research studies, six wereclassified as level A having high reliability, and five as level B having goodreliability. The findings indicated that management of insomnia in older adultscould be categorized into three areas as follows: 1) management of insomnia inhospitalized older adults with pharmacological treatment, 2) management ofinsomnia in hospitalized older adults with non-pharmacological treatment, such as,music therapy, light exposure, acupuncture therapy, and the use of relaxationtechnique in coordination with imagination, and 3) management of insomnia inhospitalized older adults with multi-factorial interventions. The findings revealedvarious methods, which would reduce insomnia in older adults and might be usedin hospitalized patients. In addition, they could be used as guidelines for atreatment management system and implementation enabling older adults to obtaingood quality of sleep. Besides, it would also help them recover from diseases at afaster pace as well as to obtain a good quality of life.Item Using Evidence-Based Strategies for Development of Clinical Nursing Practice Guidelines for Patients Undergoing Breast Cancer Surgery(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2010-10-08) Suwaluck Wongjunlongsin; Jirapee Soonthornkul Na Chonburi; Saiporn RatanaruengwatanaAbstract\ \ Keywords\ \ : Clinical nursing practice guidelines, Breast cancer surgery, Evidencebasedstrategies: The objective of this article was to present the development of clinicalnursing practice guidelines (CNPGs) for patients undergoing breast cancer surgeryby using evidence-based strategies. Thirty-three staff nurses of seven surgical wardsat Ramathibodi Hospital were asked to read, use, and evaluate the CNPGs. Findingsrevealed that two-thirds of the staff nurses reported that the language use, contents,applicability, and usefulness of the CNPGs are good. In addition, the CNPGs werehelpful to strengthen nurses๛ confidence in nursing practice. However, the CNPGshad some limitations and made it not feasible for some cases. Because the CNPGshave been newly developed, it needs more time for nurses to understand themthoroughly.Item Surgical Delay in Older Patients with Hip Fracture: A Clinical Challenge for Management(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2010-07-09) Monrudee Petlamul; Suparb Aree-UeAbstract: Keywords: Surgical delay, Hip fracture, Older patientsHip fracture is one of the most common health problems in olderpatients. Hip surgery is a good option and might be necessary for them. Preparationof patients’ readiness, medical device, operation room, and health care team isneeded in order to decrease risk and danger that might happen with older patientsadmitted to the hospital. Recovery in patients with old age and concomitantdiseases tends to be delayed. When the hip surgery is delayed longer than 48hours, it might lead to complications: infection, delay of recovery, prolongedlength of hospital stay, or death. This article discusses factors related to surgicaldelay in four older patients who underwent operations longer than 48 hours andmanagement strategies, which address how to prevent potential complications andpromote recovery in a timely manner among older patients with hip fracture.Item The Effect of Using Clinical Nursing Practice Guideline for Preventing Neonatal Hypothermia on Body Temperature of Full-Term Newborns(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2010-10-06) Nitaya Rotjananirunkit; Piyaporn PunyavachiraAbstract: The purpose of this study was to compare body temperature of newborns between the group using clinical nursing practice guideline for prevention of neonatal hypothermia and the group receiving usual nursing care. The sample consisted of 60 normal newborns who were born at the delivery room, Ramathibodi Hospital in October 2007. The sample was assigned into the control group and the experimental group. The control group consisted of 30 newborns receiving usual nursing care and the experimental group consisted of 30 newborns receiving nursing care based on clinical nursing practice guideline for preventing neonatal hypothermia. The results showed that the mean body temperature measured by a rectal thermometer in the experimental group at 10, 30, 60, 90, and 120 minutes after birth were in normal limits and significantly higher than those of the control group. However, the mean body temperature in each group was significantly different over time. The mean body temperature of each group slightly decreased at 10 minutes after birth, however, in the control group, the body temperature was subnormal at 30 and 60 minutes after birth, while in the experimental group, subnormal temperature at those points of time was not found. Then, the mean body temperature of each group slightly increased until closed to that at 10 minutes after birth when 120 minutes elapsed. This study suggests that the CNPG is helpful for nurse-midwives to prevent hypothermia in newborns. However, this CNPG may be adjusted to suit the context appropriately. Keywords: Clinical nursing practice guideline, Body temperature, Hypothermia, Full-term newbornsItem Ramathibodi Intracoronary Shunt (Rama ICS)(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2010-10-08) Wipaporn Pummangura; Suchart ChaiyarojAbstract:\ \ Keywords:\ \ Ramathibodi intracoronary shunt, Coronary artery bypass graftRamathibodi Intracoronary Shunt (Rama ICS) is a device used toinsert into the coronary artery via arteriotomy while performing distal anastomosisduring the ็off pump coronary artery bypass graft้ (OPCABG) procedure. The RamaICS is modified and invented from the material simply found in the operating room.The inventing process is simple and inexpensive. A set of the Rama ICS consisted ofa silicone tube, a titanium haemostatic clip, and silk. There are four sizes of transversediameter (0.94, 1.2, 1.65, and 2.0 millimeter) and three sizes in length (20, 30,and 40 millimeter) matching with the diameter of each coronary artery and the lengthof arteriotomy respectively. The Rama ICS has better characteristics over thecommercially imported shunt in terms of better elasticity, transparency, shape fittingto the artery, variety in length, and lower cost. These characteristics can improve thesurgical techniques. In clinical use with 170 patients who underwent the OPCABGprocedure at the Faculty of Medicine, Ramathibodi Hospital, no shunt-relatedcomplication has been found from November 2003 to July 2005 when the datarecord was conducted. In addition, the cost is inexpensive as compared to the oneimported. The application of the Rama ICS demonstrates its cost effectiveness,which conforms to policy of the hospital.Item A Follow-Up Study of Health Status in Patients with Chronic Low Back Pain before and after Spinal Surgery(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2010-10-06) Inthira Roopsawang; Suparb Aree-Ue; Panwadee PutwatanaAbstract: Keywords: Health status, Chronic low back pain, Spinal surgeryThe objective of this prospective descriptive research was to compare healthstatus in patients with chronic low back pain before and after spinal surgery at a 6-weekfollow-up. The conceptual framework of this study was based on Smith’s idea of ahealth model. This study comprised 69 patients who were 20 years of age and older,and were diagnosed with low pack pain with degenerative spinal diseases, andreceived spinal surgery as the primary treatment. Data were obtained by interviewingpatients admitted to orthopaedic wards at three government tertiary care hospitals inBangkok, from February to August 2008. The types of data collected in this studywere: 1) the Demographic Data Form; 2) the Short-Form Health Survey-Thaiversion; and 3) the Modified Oswestry Low Back Pain Disability Questionnaire-Thaiversion. Statistical analysis was performed using descriptive statistics and paired t-test.Findings of this study revealed that the means score of overall health status weresignificantly improved postoperatively. Approximately 20% of the sample perceivedmoderate or severe disability during the 6-week follow-up, while 80% perceived severedisability at the baseline assessment. For implications of this study, subjectiveevaluation tools, which provide the benefits of general health status and specific healthstatus related to spinal problems may help identify patients who are likely to benefit fromsurgical treatment. Although postoperative disability seems to be decreased at a 6-weekfollow-up, the provision of continual care to the adult and older adult patients withchronic low back pain is needed in order to restore the functional ability and improvetheir health status, which has a major influence on patients’ quality of life.Item Pain Assessmentûs Tools and Pain Management System in Ramathibodi Hospital(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2010-10-08) Jantip Vongsvivut; Supanee Senadisai; Suteera Chukkul Luengsukcharoen; Podjanee Rodjinda; Pattra Nicrotha; Nuntana Suksomnirundorn; Sositta KongkuyAbstract:\ \ Keywords:\ \ Pain assessment๛s tool, Pain management, Patient๛s knowledge, Painsatisfaction, Work instructionPain is a significant indicator of the quality of care of health care organizations.Patients suffering from pain basically expect that their pain would be alleviated whilehospitalized. However, pain is a complicated phenomenon because it involves subjectivefeeling that is difficult to quantify. When providing care for patients suffering frompain, nurses have to understand the pain in order to respond to patients๛ needsappropriately. In the past, although nurses had recognized the pain problem ofpatients, pain assessment and management were not performed systematically.Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, realizes thatdevelopment of a pain management system is essential for quality of care. Thus,a committee working on development of a pain scale, an indicator for assessing painleading to set up a pain management system, has been pointed since 2003. During theyear 2003-2006, a pain management program has been developed and tested in apilot study, then disseminated to utilize in nursing practice for patients sufferingfrom pain at all wards in Ramathibodi Hospital. Therefore, the targeted goal for็Best Practice้ of pain management has been established in 2005, according to thestrategic plan of organization. It has been found that the patients๛ outcomes met theobjectives assessed by quality indicators including patients๛ knowledge about painmanagement, ability to perform activities of daily living, sleep quality, interactionwith others, and satisfaction with pain management by nurses. Also, work instruction(WI) on pain management has been developed and used as a standard guideline inDepartment of Nursing Ramathibodi Hospital.Item A Comparison of Using Polyethylene Bag and Radiant Warmer on Body Temperature of Full-Term Newborns*(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2010-10-06) Piyaporn Punyavachira; Nitaya RotjananirunkitAbstract:\ \ temperature was controlled at 26 ํC or higher. The results revealed that the mean bodytemperature of the newborns between two groups were normal during the first 2 hoursafter birth. However, the mean changes of body temperature in the radiant warmergroup from baseline (1 minute after birth) to 30 minutes and to 60 minutes after birthdecreased significantlyless than those in the polyethylene bag group. This findingindicates that the group placed under the radiant warmer could keep temperatureslightly better than that using the polyethylene bag with blanket. However, theybecame not significantly different between both groups at 90 minutes and 120minutes after birth. The finding of the study suggested that when the radiant warmer isunavailable, nurses can keep the newborn warm by using a polyethylene bag withblanket at least 2 hours after birth in order to prevent heat loss and should control thelabor room temperature at higher than 26 ํC.Keywords:\ \ Polyethylene Bag, Radiant warmer, Body temperature, Full-term newbornsThe purpose of this quasi experimental research was to compare the bodytemperature of newborns between keeping warm by using a polyethylene bag withblanket and by placing newborns under a radiant warmer. Random sampling was usedto select 60 full-term newborns in the labor room at Ramathibodi Hospital. Thesubjects were equally, randomly assigned into two groups. The first group was keptwarm by being wrapped with a polyethylene bag and covered with a blanket in thecrib, while the second group was placed under a radiant warmer. The labor roomItem The Effect of an Interpersonal Communication Skill Training Program on Teamwork of Nursing Personnel at Eye Clinic(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2010-10-08) Bangorn Yuvavitayapanich; Police Major Paungphen ChoonhapranAbstract:\ \ Keywords:\ \ Interpersonal communication, TeamworkThe purpose of this one group, pre-test/ post-test design was to comparethe teamwork of nursing personnel before and after using the InterpersonalCommunication Skill Training Program and to compare the mean difference of nursingpersonnel teamwork score between the duration of time of using the InterpersonalCommunication Skill Training Program and the duration of time of conventional practice.The subjects were 32 nursing personnel including professional nurses, practical nurses,and ward clerks who worked at the eye clinic, Ramathibodi Hospital. The researchinstruments were the Interpersonal Communication Skill Training Program, theTeamwork of Nursing Personnel questionnaire, the Interpersonal Communication LessonPlan and Manual. The program and the questionnaire were tested for their contentvalidity. The Cronbach๛s alpha coefficient of the questionnaire was .90. The datawere analyzed using mean, standard deviation and dependent t-test.The major findings of the study were as follows: 1. The mean score of nursingpersonnel teamwork after using the Interpersonal Communication Skill TrainingProgram was significantly higher than before using the Interpersonal CommunicationSkill Training Program at a level of .05. and 2. The mean difference of nursingpersonnel teamwork score between the duration of time of using the InterpersonalCommunication Skill Training Program was significantly higher than that ofconventional practice at a level of .05.Item The Effect of Using Multimedia on Expectation and Satisfaction with the Teaching-Learning Approach in Operating Rooms among Nursing Students(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2010-10-06) Kieratikan Payngulume; Sriwiengkaew TengkiattrakulAbstract: Keywords: Multimedia for learning, ExPARS model, Expectation, Satisfaction,Operating rooms, Nursing studentsThis quasi-experimental study aimed to compare the expectation andsatisfaction of students toward using multimedia for learning in the operating room. Atotal of 60 third-year nursing students in academic year 2005 were recruited in thestudy. They were assigned into two groups: the control group receiving conventionallecture and demonstration for learning, while the experimental group receivingmultimedia tools for learning using the ExPARS model (Exploring needs, Planning,Activity, Reflecting, and Synthesizing). Data were collected from May 2005 toFebruary 2006 using the Expectation and Satisfaction toward Learning Model inOperating Room Questionnaires. Data were analyzed using descriptive statistics andindependent t-test statistics. Results revealed that expectation with learning for bothoverall and subscale scores between the experimental group and the control group wasnot significantly different. However, satisfaction with learning for both overall andsubscale scores in the experimental group was significantly higher than that in thecontrol group. The suggestion from this study is that nurse instructors in the operatingroom should pay more attention to establish strategies to improve nursing students’learning by using educational technology to support effective learning. This may solvethe problem of having insufficient learning experiences in the operating room, whilethe number of nursing students is creasing with a limited resource.Item Evaluation of Acute Pain Management at Ramathibodi Hospital(Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2010-10-06) Jirapee Soonthornkul Na Chonburi; Suteera Chukkul LuengsukcharoenAbstract: Keywords: Quality indicators, Pain management, Pain assessment, Measurementoutcome, Patient satisfactionThis article presents an evaluation of quality of pain management bothprocess and outcome in post operative patients at Ramathibodi Hospital by the PainManagement Committee. The Pain Management Committee has been establishedsince B.E. 2546. They are responsible for setting the pain management systemincluding developing work instruction and pain quality indicators. The objective ofthis descriptive study was to evaluate quality of pain management using both processand outcome indicators in postoperative patients admitted to Ramathibodi Hospital.One hundred and sixty nine patients from 11 wards were recruited in the study. Theinstruments used in this study were 1) the Demographic Questionnaire, 2) the PainManagement Process Indicators, and 3) the Pain Management Outcome Indicators.Data analysis was performed using descriptive statistics. The result of this studyshowed that most nurses used the numerical rating pain scale and pain document,which met the goal of pain management process. However, they did not continueassessing pain. In addition, most of the patients received pain medication managementonly when needed rather than around-the-clock. Regarding non-pharmacologicalmanagement, positioning was most used by these patients. For outcome indicators,mean scores of worst pain, and disturbance of functional activity and sleep were inthe moderate level. Of the total sample, 13.6% did not receive information about sideeffect of analgesics, but their satisfaction levels with pain management were good andvery good. Recommendations from this study are that nurses should pay more attention on thecontinuity of pain assessment and management, as well as develop the non-pharmacologicalpain management program combined with analgesics to alleviate pain. These mayresult in decreasing pain intensity, and disturbance of functional activity and sleep.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.