Thai Journal of Nursing Research

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Participative Model of Child Protection in Northern Thailand
(The Thailand Nursing Council, 2009-10-05) Naruemon Auemaneekul; Faculty of Nursing, Chiang Mai University, Thailand.; Wilawan Senaratana; Associate Professor, Department of Public Health Nursing, Faculty of Nursing, Chiang Mai University, Thailand.; Yuwayong Juntarawijit; Assistant Professor, Department of Public Health Nursing, Faculty of Nursing, Chiang Mai University, Thailand.; Kasara Sripichyakan; Associate Professor, Department of Pediatric Nursing, Faculty of Nursing, Chiang Mai University, Thailand.; Barbara J. Ensign; Associate Professor, Department of Psychosocial \& Community Health, School of Nursing, University of Washington, Seattle, WA, USA.
Abstract: This community-based, participatory research was undertaken with the aim to develop a model for promoting child protection in Northern Thailand. Semistructured interviews, focus group discussions, participant activities and observations,group meetings and brainstorming were conducted among children, parents, villagers and key community leaders of one rural community in Chiang Mai province,Thailand. Content analysis was utilized for analyzing qualitative data. The model demonstrated three levels of protective factors for child protection. At the individual level, both children and parents needed to be equipped with the skills and knowledge of child protection. At the family level, the focus was onpromoting family warmth and applying sufficient economy. At the community level, the emphasis was on promoting public awareness, encouraging a child protection network, and developing a community child protection master plan. Community mobilization supported the sense of belonging and sustainability of the project. The participation evaluation indicated change outcomes in terms of more network interest, raising public awareness, improving capacity, disseminating knowledge, and committing and implementing community child protection policy.The study outlines implications for nursing research, education and practice regarding child protection. Culturally appropriate activities and programs also were encouraged.
Relationship among Maternal Depressive Symptoms, Gender Differences and Depressive Symptoms in Thai Adolescents
(The Thailand Nursing Council, 2009-10-05) Nopporn Vongsirimas; Faculty of Nursing, Mahidol University, Bangkok, Thailand.; Yajai Sitthimongkol; Associate Professor, Faculty of Nursing, Mahidol University, Bangkok, Thailand.; Linda S. Beeber; Professor, School of Nursing University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.; Nonglak Wiratchai; Professor Emeritus, Chulalongkorn University, Bangkok, Thailand.; Sopin Sangon; Assistant Professor, Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Abstract: To examine the pattern of relationships among factors related to depressive symptoms in adolescents of mothers with depressive symptoms, the structural equation model of adolescent depressive symptoms was tested. The conceptual framework, for this study, drew on the Interpersonal Theory of Depression. Through use of stratified sampling, 460 Thai adolescents, and respective mother, were selectedfor participation. All adolescents completed the: Demographic Data Questionnaire; Center for Epidemiologic Studies Depression Scale; Rosenberg’s Self-esteem Scale; Multidimensional Scale of Perceived Social Support; Maternal Supportive BehaviorsQuestionnaire; Negative Event Scale; and, Parental Bonding Instrument. Each mother completed the: Demographic Data Questionnaire; and, Center for Epidemiologic Studies Depression Scale. Data were analyzed using LISREL. A goodness of fit wasobtained with the model. The adolescents’ depressive symptoms accounted for over 60% of the variance.A strong effect of maternal depressive symptoms on depressive symptoms among Thai adolescents, as well as on mediation by intervening variables, was found. The results also enhanced understanding of how to develop and target nursing interventions to prevent development of depressive symptoms, and optimize mental health, among Thai adolescents, when their mother suffers from depressive symptoms.
Buddhist Mothers’ Experience of Suffering and Healing After the Accidental Death of a Child
(The Thailand Nursing Council, 2009-10-05) Kallaya Wiriya; Faculty of Nursing, Prince of Songkla University, Hat Yai, Songkhla,; Urai Hatthakit; Assistant Professor, Faculty of Nursing, Prince of Songkla University, Hat Yai, Songkhla, Thailand.; Wantanee Wiroonpanich; Assistant Professor, Faculty of Nursing, Prince of Songkla University, Hat Yai, Songkhla, Thailand.; Lee Smith-Battle; Professor, School of Nursing, Saint Louis University, St. Louis, MO, USA
Abstract: Numerous nursing studies have examined suffering, but none have addressed the suffering and healing Buddhist mothers experience after the accidental death of a child. The purpose of this study was to gain understanding of the meaning of sufferingand the practices of healing and suffering, among Buddhist mothers after such a loss. Buddhist concepts provided the philosophical framework, and Gadamerian hermeneutic phenomenology provided the methodological framework, for this investigation.Ten Buddhist mothers were recruited from a government hospital in Songkhla province, Thailand. In-depth interviews were conducted and data were analyzed using hermeneutics. Five themes that reflected the meaning of suffering amongBuddhist mothers, after the accidental death of a child, were identified. They included: the mother’s heart was torn into pieces; the mother’s body was frozen andshe was uncertain she would survive; happiness in the mother’s life was missing; the mother’s anger and rage at self and others; and, the mother worried and wondered about the next life of her deceased child. The mothers were found to heal their suffering by: transforming their relationship with the deceased child; elevating the deceased child to be a very good child capable of going to heaven; making merit in order to pass the benefit to the deceased child; self-healing through understanding and mind cultivation; and, seeking support. The findings promote the understanding of the suffering and coping of Buddhist mothers whose child accidentally died.
Writing an Appropriate Methods Section for a Research Article: Design, Ethical Considerations and Sample
(The Thailand Nursing Council, 2009-10-05) Vickie A. Lambert; Clinton E. Lambert
Over the years, while editing numerous manuscripts, we have noted a consistent problem exists regarding the manner in which the method section, of research articles, is written. All too often crucial content is missing and, thus, the reader is unable to truly understand what the researcher did. If the method section of the article is poorly written, not only will the reader not understand what was done, but no one can replicate the researcher’s work, since no one will know what actually had been done.In general, the method section, of a research article, needs to contain the following elements: design, ethical considerations, sample, procedure, instruments or measurements, and data analysis. Each of these elements will be discussed, over the next two issues of the Thai Journal of Nursing Research. In this issue, we will focus on what needs to be included in the: design, ethical considerations and sample components of the method section of a research article.
Cognitive Performance after a Transient Ischemic Attack: Attention, Working Memory, and Learning and Memory
(The Thailand Nursing Council, 2009-10-05) Vishuda Charoenkitkarn; Faculty of Nursing, Mahidol University, Bangkok, Thailand.; Saipin Kasemkitwattana; Associate Professor, School of Nursing, Mae Fah Luang University, Chiang Rai, Thailand.; Barbara Therrien; Associate Professor, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA.; Orapan Thosingha; Assistant Professor, Faculty of Nursing, Mahidol University, Bangkok, Thailand.; Thavatchai Vorapongsathorn; Associate Professor, Faculty of Public Health, Mahidol University, Bangkok, Thailand.
Abstract: This prospective study aimed to explore the three main areas of cognitive function (attention; working memory; and, learning and memory) among individuals who had experienced a transient ischemic attack (TIA). Convenience sampling wasused to recruit 52 individuals, who had experienced a TIA, from outpatient and emergency departments in three tertiary hospitals, in Bangkok, and one tertiaryhospital in Ayutthaya province, Thailand; as well as 52 persons, who had experienced minor surgery and served as matched control subjects, from the outpatient department at a tertiary hospital in Thailand. Subjects were assessed, 3, 10 and 30days after experiencing a TIA or having minor surgery, using the Necker Cube Pattern Control Test, Trial Making A Test, Digit Span Forward and Backward Test, Barratt Impulsiveness Scale, Irritability Assessment Scale, Digit Symbol Substitution Test, and Hopkins Verbal Learning Test. A repeated-measures-within-and-across-subjects design was used to analyze the results. Findings indicate that those who had a TIA continued to experience attention, working memory, and learning and memory changes, but not irritability changes, for over 30 days after symptom occurrence. Three days after symptom occurrence, those who had a TIA showed less ability in the 3 main cognitive erformances than did the control group. Their performance ability became worse at day 10, but improved at day 30. All performances among those with a TIA were lower than the control group, at all three time points. Thus, nurses should be concerned about the cognitive ability of those who have had a TIA, as well as their respective families, and provide information to both about the effects of a TIA, particularly 10 days after symptom occurrence.
Environment for Scholarship and Journal Impact Factor in Thailand
(The Thailand Nursing Council, 2009-10-05) Shaké Ketefian; Profess or and Director of International Affairs University of Michigan, School of Nursing, 400 North Ingalls, Ann Arbor, MI 48109, USA.; Somchit Hanucharurnkul; Professor, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
An increasing number of institutions, internationally, are requiring their faculties publish in journals with high impact factors (IF), and providing various types of rewards to motivate scholars to do so. The literature describes appropriate and inappropriate uses of such policies. Thus, this study, as part of a five country study, aimed to explore, in Thailand: (a) the extent to which institutions are requiring faculty to publish in high impact journals, and (b) how the pressure of publishing in high impact journals influences a nurse scientist’s choice of topic for investigation, and the development of nursing science. The design was qualitative, using a questionnaire designed to obtain respondent views. One senior faculty member, from each of the seven nursing doctoral programs in the country, was invited to participate; five did so. Objective responses were summarized and descriptively presented. Contentanalysis was used for narrative responses. Results indicate that faculties were expected to publish in high IF journals. The faculties stated this led to: competition instead of cooperation; and, authors wanting to publish in journals of other countries, so as to bring prestige to their institutions. However, they felt this does not contribute to resolving health problems of thecountry, and further enumerated the hurdles and positive outcomes of the policy. They said Thai scholars study health problems of the country, and frame the practical applications of their work, in terms that might be of interest to their country, as wellas to other countries. Results were discussed and interpreted in view of current realities in Thailand.
Quality of Diabetes Care in PCUs in Central Thailand
(The Thailand Nursing Council, 2009-10-05) Rukchanok Koshakri; Faculty of Nursing, Mahidol University, Thailand.; Nantawon Suwonnaroop; Assistant Professor, Faculty of Nursing, Mahidol University, Thailand.; Kobkul Phancharoenworakul; Associate Professor, Faculty of Nursing, Mahidol University, Thailand.; Chanvit Tharathep; Bureau of Health Service System Development, Ministry of Public Health, Nonthaburi, Thailand.; Noel Chrisman; Professor, School of Nursing, University of Washington, USA.
Abstract: This descriptive study, using a mixed method design, sought to describe, within Central Thailand, the quality of diabetes care in terms of the structure ofPrimary Care Units (PCUs), care processes for diabetics and outcomes of diabetic care; and the relationships among these factors. Three hundred health care providers from 300 PCUs completed a researcher-designed questionnaire which sought information regarding the structure and care processes, used in the PCUs, with diabetics. Outcomes of diabetic care were assessed using fasting plasma glucose reports obtained from the PCUs. In addition, 9 care providers, who completed the questionnaire, served as key informants, for in-depth interviews, which validated andfurther explained the quantitative data. Quantitative data were analyzed using descriptive statistics and Pearson’s product moment correlation, while qualitative data were examined by way of content analysis.Almost one-quarter of the PCUs met all components of structure, based upon PCU standards. Results revealed the structure of most PCUs were sufficient in termsof facility, financing and networking. Although the majority of staff consisted of nurses, the PCUs were considered insufficiently staffed, and 825 demonstrated improper preventive care. However, 43% of the diabetics, being cared for in the PCUs, showed sound glycemic control. Good PCU structure suggested an increase in the likelihood of appropriate care processes and corresponding positive outcomes. In addition, the presence of well- trained health volunteers provided assistance to the PCU staff, particularly when professional staffing levels were low. Thus, a need for an increase in the number ofprofessional staff in PCUs, enhanced training for health care volunteers and revision of the standards of diabetic care was evident.
Coping Behaviors and Family Well-Being of Urban Thai Families
(The Thailand Nursing Council, 2010-03-25) Sunee Lagampan; Sawitree Buranakarn; Punyarat Lapvongwatana; Patchaporn Kerdmongkol
This study investigates the relationships between coping behaviors and family well-being of urban Thai families. A descriptive correlational study was guided by the theory of Lazarusû stress and coping. Samples of 100 families residing in an urban area of one district in Bangkok were recruited by purposive sampling. Data collection was carried out by using interview forms consisting of items on sociodemographics, Coping Behavior Scales, and Family Well-being Assessment (FWA). The findings reveal that the husbands and wives reported similar coping behaviors and family well-being. There were significant correlations between coping behavior and family well-being for both husbands and wives (r = 0.35 and r = 0.30 at p \< .01, respectively). When sociodemographics factors were adjusted, both problem-focused coping and emotional-focused coping could account for the family well-being of the husbands (R²=0.270, F=17.792, p \< .001). Similarly, problem-focused coping, emotional-focused coping, and sufficient family income could account for the family well-being of the wives (R²= .182, F=7.142, p \< .001). The study suggests that family should be counseled and educated to use appropriate coping behaviors when faced with stressful life events for enhancing their family well-being.
Development of the Body Image Self-Schema Scale and the Body Image Possible Selves Scale for Thai Middle-Aged Women
(The Thailand Nursing Council, 2010-03-25) Parichart Rangkakulnuwat; Linchong Pothiban; Bonnie L. Metzger; Sujitra Tiansawad; Somchai Teaukul
Body image is related to various health behaviors and psychological status. Nowadays the number of obese Thai middle-aged women is rising and body image is the primary concern for people who seek to reduce their weight. Cognitive measures related to body image of Thai women have not been found. This study was designed to develop and examine the psychometric properties of two scales: The Body Image Self-Schema Scale (BISSS) which is used for assessing the current thoughts about the body and the importance individuals place on it and the Body Image Possible Selves Scale (BIPSS) which is used for assessing the future thoughts of the body, hopes and fears. An instrument development design was used. Convenience sampling was employed to recruit 507 Thai women aged 40-60 years with different weights working in both public and private sectors to participate in this study. Seven steps of the instrument development process included identifying the body image concept, generating the items, determining the format, reviewing the items by six experts, testing of face validity, construct validity, concurrent validity, and reliability. The BISSS is a 27-item 7-point semantic differential (evaluative part) and 5-point Likert scale (important part), while the BIPSS is a 27-item 5-point Likert scale and composed of Hoped for and Feared subscales. Both scales comprise eight dimensions, namely feelings about the body, size estimation, facial features, attractive looks, physical fitness, weight regulation, general appearance, and body shape. The new scales demonstrate an acceptable content validity index and construct validity. Their concurrent validity with the Body Esteem Scale for Adolescents and Adults developed by Mendelson, White, and Mendelson, and the Figure Rating Scale developed by Collins, was also reported. The BISSS and the BIPSS developed in this study can be used as research and clinical tools regarding body image of Thai middle-aged women.
The Effects of Tai Chi on Sleep Quality, Well-Being and Physical Performances among Older Adults
(The Thailand Nursing Council, 2010-03-25) Sunuttra Taboonpong; Napatharin Puthsri; Wipawee Kong-In; Aimorn Saejew
The elderly face physiological decline leading to problems such as chronic illness, poor physical performance and emotional disturbance. Thepractice of Tai Chi is generally considered psychologically and physiologically beneficial for older adults but scientific reports on its benefits are still limited. This quasi-experimental study, a pre-post test with control group design investigated the effects of low intensity and short term Tai Chi practice on sleep quality, general well-being and physical performance. The subjects were purposefully selected from elders who lived in residential care facilities in accordance with the study inclusion criteria. There were 25 elders in each experimental and control group. The experimental group engaged in 22 minutes Tai Chi training at least three times a week for 12 weeks. The control group engaged in their usual activities, without Tai Chi. The Pittsberg Sleep Quality Index (PSQI) and General Well-Being Scale (GWBS) questionnaires were used to assess the subjects’ sleep quality and well-being. The physical performances including 2 minutes step test, lung capacity, and sit and reach test were measured by a professional staff from a Provincial Sport Authority. These measures were taken at the first and fourteenth weeks of the study. Independent and paired t-tests were used in data analysis. The two groups had no difference in personal characteristics and baseline outcome measures. The experimental group showed significantly greater change score of the PSQI (p \< .01) and step test (p \< .05). The change scores of the GWBS, lung capacity, and sit and reach test between the two groups showed no differences. The results indicated that a low intensity Tai Chi exercise for 12 weeks could improve sleep quality and physical performance on balance and flexibility of legs in older adults.
Understanding Mothers of Children with Type 1 Diabetes: An Investigation of Perspective and Management
(The Thailand Nursing Council, 2010-03-25) Somsiri Athaseri; Fongcum Tilokskulchai; Autchareeya Patoomwan; Margaret Grey; Kathleen Knafl; Chittiwat Suprasongsin
Families with children with type 1 diabetes (T1D) encounter many stressful experiences. The mother is a significant person in taking care of a child’s diabetes. However, little is known about the experiences of mothers living with a child with T1D in Thailand. This study aimed to describe mothers’ definition of their predicament, management behaviors and consequences of having a child with T1D. A descriptive qualitative approach was used, and data were elicited from interviewing 22 mothers living with a child aged 6-12 with T1D. Content analysis was used for data analysis. It is found that both mothers who perceived T1D was a non-life threatening and serious disease could manage their disease. The meaning of having a child with T1D was either part of life or as a situation beset with dukkha (the Buddhist concept of suffering). Most mothers could manage the disease even though some perceived that they were burdened by it. Major activities included diabetes management activities and day to day management activities. The difficulty of balance family relationships, social life, lifestyle and finances was found in some families. The findings indicated that understanding of mothers’ response to the illness situation was a crucial guideline for supporting the family and lead to further clinical exploration and research.
Experiences of Early Motherhood among Thai Adolescents: Perceiving Conflict Between Needs as a Mother and an Adolescent
(The Thailand Nursing Council, 2010-03-25) Rudee Pungbangkadee; Sukanya Parisunyakul; Kannika Kantaruksa; Kasara Sripichyakarn; Susan Kools
Adolescent mothers are considered to be at high risk of becoming mothers because of psychological immaturity, and their own normal development needs that may conflict with the needs of their child. Adolescents’ perception and meaning of motherhood determine their strategies to live with conflicting needs. The purpose of this qualitative study was to understand the experiences of early motherhood among Thai adolescents who had a child ages less than 6 months. Participants were 21 adolescent mothers who attended at well baby clinics of the Health Centers 49, Taksin Hospital, and Siriraj Hospital. Data collection and analysis were guided by grounded theory approach. The data collection and analysis occurred simultaneously during August 2004 to December 2005. Data were collected by multiple in-depth interviews and participant observation. The findings demonstrated that “living with conflict between needs as a mother and an adolescent,” was a core category of the process in developing early motherhood. Four ‘perceiving conflicting needs’ which included perceiving conflict between focusing on the child and the self, perceiving conflict between taking care of the child and desiring to go to school or work, perceiving conflict between concerning maternal images and self-images, and perceiving conflict between interdependence with family and independence from family, was emerged and identified as the causal condition that led adolescent mothers to use strategies for living with conflicting needs. These findings recommended that health care providers need to be more sensitive to adolescents’ perceiving conflicting needs in order to promote using appropriate strategies leading to positive experience of motherhood and positive mother-child outcomes.
Effects of Home-Based Care Program on Symptom Alleviation and Well-Being Among Persons with Chronic Heart Failure
(The Thailand Nursing Council, 2010-03-25) Apinya Wongpiriyayothar; Linchong Pothiban; Patricia Liehr; Wilawan Senaratana; Khanokporn Sucumvang
Chronic heart failure (CHF) often requires a long period of recuperative care to address physical, psychological and social functions. CHF patients need a home-based care program to alleviate symptoms and improve well-being. This study was a randomized clinical trial aimed to examine the effects of a home-based care program on the alleviation of symptoms and improvement of well-being of CHF patients. The study framework included a symptom management model and coaching strategies. A sample of 96 participants who met the inclusion criteria were randomly assigned into control and experimental groups. The experimental group intervention consisted of two home visits for coaching and at least two weekly telephone contacts to assure regular performance of self-monitoring and symptom management activities. The control group received usual care. Data were collected before the intervention and after the intervention at week-8 and week-12. Collection instruments were the Chronic Heart Failure Symptom Severity Scale and the Medical Outcomes Study Short Form Health Survey Version 2 (SF-36 V2) to measure well-being. The results show that a home-based care program can significantly alleviate the severity and increase the well-being of CHF patients. The findings provide nurses with guidelines for taking care of CHF patients at home. In order to generalize the findings, further study must be carried out in different patient groups with various severity levels so that the finding can be generalized to the whole CHF population.
Premenstrual Syndrome among Thai Nurses: Prevalence, Impact and Self-management Strategies
(The Thailand Nursing Council, 2010-03-30) Benjamaporn Butsripoom; Somchit Hanucharurnkul; Manee Arpanantikul; Wicharn Choktanasiri; Thavatchai Vorapongsathorn; Nittaya Sinsuksai
Premenstrual syndrome (PMS) is a common health problem among reproductive women, and may adversely affect female nurses experiencing stress from their occupation, due to its interference with one’s endocrine function. The purposes of this descriptive prospective study were to: (a) explore the occurrence, intensity and impact of PMS, and (b) describe the type and effectiveness of PMS self-management strategies used by participants. One hundred and sixty-one, 20-45 year old, Thai nurses were recruited from four hospitals in Bangkok. Data related to the occurrence, intensity and impact of PMS were obtained, for two consecutive menstrual cycles, through the use of the Women’s Daily Health Diary (DHD), the General Data Record (GDR) and the Negative Impact section of the Daily Record of Severity of Problems (DRSP). The type and effectiveness of PMS self-management strategies used by the participants were obtained, by way of a telephone interview, using the researcher created Self-Management Measures Questionnaire (SMMQ). Results revealed the prevalence of PMS to be 16.8%, with the most common symptoms being irritability, fatigue, painful or tender breasts, anger, bloating or swelling of abdomen, tension and rapid mood change. The highest intensity of PMS symptoms included: increased appetite, craving for specific food or tastes, painful or tender breasts, irritability and feeling out of control. Although, interference with relationships was a commonly reported impact symptom of PMS, the most disturbing symptom reported was irritability. The most common self-management technique used to alleviate irritability was to decrease time spent with others. The findings suggest symptom prevalence, intensity and impact were dependent on the individual’s perceptions at the time. In addition, no one particular strategy or self-management was found to be most effective in managing any given disturbing symptom, as symptoms were managed with a variety of strategies and self-management techniques.
Perspectives on Wisdom-Health of Thai Buddhist Nurses through Meditation
(The Thailand Nursing Council, 2010-03-30) Sirilak Kitsripisarn; Warunee Fongkaew; Chawapornpan Chanprasit; Sally H. Rankin
The purpose of this qualitative study was to explore Thai nurses’ perspectives regarding the meaning of wisdom-health, the characteristics of persons who have wisdom-health, and the importance of wisdom-health to Thai people’s overall general health. Purposive and snowball sampling were used to recruit twelve Thai registered nurses who regularly practice meditation. Data were collected through in-depth interviews along with observation and ethnographic records. Data were analyzed using Spradley’s method of content analysis. The main findings illustrated that the meaning of wisdom-health based on the perspective of Thai nurses is defined as having mindfulness (satti) and clear comprehension (sampajanna). Mindfulness focuses on being aware of, and reminding oneself to know and concentrate on the present moment, while clear comprehension means thinking reflectively on cause and effect. Both mindfulness and clear comprehension enable one to understand the nature of truth or “wisdom” so as to live with happiness. The characteristics of persons who have wisdom-health include 1) using wisdom to live their lives, 2) applying morality and ethical behavior to their lives, and 3) having inner peacefulness. Further, wisdom-health is crucial to the overall general health of Thai people because it helps them attain well-being by way of choosing the right means to solve their health problems both physically and mentally. Realizing the nature of truth leads people to be compassionate toward themselves, their fellow human beings and the environment, which, in turn, can contribute to a peaceful society. The results of this study provide an understanding of wisdom-health from the perspectives of Thai nurses who practice meditation. Also, these findings could provide a foundation for developing guidelines, regarding assessment and nursing care related to wisdom-health, that lead to holistic care of clients.
Development of Age-Friendly Primary Health Care: Case Study of One Primary Care Unit
(The Thailand Nursing Council, 2010-03-30) Duangporn Hoontrakul; Wanapa Sritanyarat; Khanitta Nuntaboot; Amorn Premgamone
This mutually collaborative action research aimed to develop age-friendly primary health care (AFPHC) for older people at one primary care unit (PCU), under the supervision of the university hospital, Khon Kaen province, Thailand. The participants were older people and their family members, nurses, the staff of the primary care unit, community health volunteers (CHVs), and community leaders. Data were collected by participatory observations, natural interviews, in-depth interviews, focus group discussions, and document reviews. Qualitative data were analyzed by content analysis. Quantitative data were analyzed by using frequencies and percentages.The findings of six concepts of AFPHC: Respect, direct services, equity in elders group, good death, family care, and age-friendly environment, led to the process of developing age-friendly primary health care for the elders in four phases. These were: 1) awareness of AFPHC concepts, 2) changes in health service behaviors and age-friendly environments, 3) developing age-friendly services and activities, and 4) building age-friendly service networks. The results of this study suggested that age-friendly primary care comprised of three components: age-friendly behaviors, age-friendly services, and an age-friendly environment.Factors contributing to the development of AFPHC were: 1) positive thinking of participants, 2) management for mutual benefits, 3) social capital of local stakeholders, and 4) input from gerontological advanced practice nurses in the community. Barriers to the development of AFPHC were: 1) the changed policies of the PCU administration, 2) the personnel outcome evaluation system that focused more on individual than groups or project based.
Living with the Differences: Thai Adolescents' Experiences of Living with Transfusion-dependent Thalassemia
(The Thailand Nursing Council, 2010-03-30) Ratanachadawan Yunak; Ratanawadee Chontawan; Kasara Sripichayakan; Areewan Klunklin; Pamela Jordan
Although transfusion-dependent thalassemia causes physical and psychosocial impacts, little is known about adolescents’ experience in living with the disease. The knowledge of how adolescents live with their illness is expected to benefit patient focused nursing interventions to promote adolescents’ well-being. The purpose of this study was to understand and explain Thai adolescents’ experience of living with transfusion-dependent thalassemia. Grounded theory methodology was employed to generate a substantive theory to capture that experience. Data were gathered from thirteen Thai adolescents through in-depth interviews and analyzed concurrently through constant comparative analysis to generate a substantive theory. The adolescents were recruited by purposive and theoretical sampling. Theoretical saturation was a criterion to finish data collection. Living with the differences emerged as a core category of the substantive theory, and consists of four related categories: illness understanding; a sense of differences; emotional experiences; and, managing the differences. The findings provide better understanding of the experiences of Thai adolescents attempting to meet social expectations of normalcy in living with transfusion-dependent thalassemia. This understanding adds to prior knowledge of the disease and other chronic illnesses, and contributes to the development of nursing interventions to support adolescents to achieve well-being as they navigate life.
Conceptual Structure of Primary Care Competency for Thai Primary Care Unit (PCU) Nurses
(The Thailand Nursing Council, 2010-03-30) Orratai Nontapet; Sang-arun Isaramalai; Wongchan Petpichatchain; Constance Wilhelmine Brooks
Since the introduction of universal healthcare coverage in 2001, professional nurses have worked in primary care units throughout Thailand. Although they did not have practical primary care experience, Thai nurses, initially were expected to delivery primary care services like in hospitals where they worked. In order to meet the increased need for primary care competency, many of the nurses received additional training as nurse practitioners. However, the concept and framework for primary care competency, for Thai primary care unit (PCU) nurses, has not been clearly defined. Therefore, the purpose of this investigation was to explore the concept and structure of primary care competency for Thai PCU nurses. The investigation was carried out using a two-step approach, which consisted of: a) an integrated systematic review of national and international publications and b) interviews of nursing experts, primary care authorities, primary care nurses and public health staff. From the data, the concept of primary care competency was placed into four domains. The first, interpersonal relationship consisted of communication, coordination, team work, social involvement, collaboration, and facilitation. The second, care management included service system management, resource management, quality management, information management, and environmental health management. The third, integrated healthcare service consisted of health promotion, disease prevention, treatment/prescription, rehabilitation, continuous care, and holistic care. The last, professional accountability consisted of moral sensitivity, patient rights respectability, code of ethics, patient advocacy, professional development, and self-development. The conceptual structure created, as result of this research, can serve as a framework for guiding future research, facilitating the creation of specific and detailed job descriptions, and developing a competency assessment instrument.
Health Meanings and Practices among Midlife Professional Thai Women
(The Thailand Nursing Council, 2010-03-30) Jantararat Chareonsanti; Sujitra Tiansawad; Chawapornpan Chanprasit; Christine V. Newburn–Cook; Kaysi Eastlick Kushner
Midlife professional women face many challenges including changes in physical functions, chronic illness and increasing demands from both professional and family roles. Understanding women’s health meanings and health care practices within their sociocultural context is important. A qualitative research design, informed by general principles of feminist inquiry, was used to explore the experiences of professional women regarding their health meanings and health care practices. Twenty midlife professional Thai women, working as teachers and nurses in northern Thailand, were recruited purposively between May 2005 and February 2006. In-depth individual interviews were conducted and data were processed based on Morse and Richards’ analysis guide. Results included the themes: “being able to maintain normality,” as the meaning of health; and, “rearranging my way of life,” as the health care practices. “Being able to maintain normality” was found to be the women’s ability to manage multiple roles productively and capability of having a normal state of physical functioning and emotional stability. “Rearranging my way of life” was evidenced through the women’s readjustment of their eating styles, initiation of consumption of nutrients and vitamin supplements, effort to have more exercise, precautionary accident risk activities and modification of known ways of reducing stress. Findings have significant implications for policy-makers and health care professionals to provide health promotion programs which consider the meaning of health and health care practices for women.
Social Networks and Social Support Influncing Health-Promoting Behaviors among Thai Community-Dwelling Elderly
(The Thailand Nursing Council, 2010-03-30) Kattika Thanakwang
This study aimed to examine whether a proposed conceptual model can explain mechanisms by which social networks and social support influence health-promoting behaviors among Thai community-dwelling elderly. Four hundred and sixty-nine elders from Nan Province, Thailand, were recruited by multi-stage random sampling. Berkman’s work on social relations related to health provided the theoretical framework of this study. Structural equation modeling, using LISREL, was used to examine the causal relationships in the hypothesized model. The results suggesting the final model had a good fit with the data and could explain 74% of the variance in health-promoting behaviors. Kinship networks, through kinship support and sense of well-being, were found to have indirect effects on health-promoting behaviors. Kinship support, through a sense of well-being, also was found to have an indirect influence on health-promoting behaviors. Friendship networks and friendship support demonstrated both direct and indirect influences on health-promoting behaviors. Interestingly, friendship networks and support were found to influence support for the elderly person by family members. Elderly persons’ sense of well-being demonstrated a strong positive direct effect on health-promoting practices. The findings indicated that kinship support had a clear direct influence on the elderly person’s sense of well-being, whereas friendship networks had a noticeable effect on health-promoting behaviors. To enhance the elderly person’s health-promoting behaviors, nurses and multidisciplinary healthcare providers should design intervention programs to foster social relations, especially by promoting familial support and the elderly person’s psychological well-being. This should also be done by facilitating friendship network activities in communities.

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