Evidence remains limited regarding how a context-adapted hypoglycemia management guideline can be implemented in routine inpatient practice and whether such an implementation can improve care processes and patient outcomes. This quasi-experimental study evaluated the implementation of an adapted clinical practice guideline for hypoglycemia management at a tertiary care hospital in northeast Thailand. The study included a retrospective three-month pre-implementation baseline period (January-March 2024), a one-month nurse training and preparation phase (May 2025), and a three-month post-implementation period (June-August 2025). Participants included 245 hospitalized patients with at least one hypoglycemic episode (pre-implementation, n = 138; post-implementation, n = 107) and 137 nurses who implemented the guideline. The guideline was adapted from the Diabetes Association of Thailand's 2023 Clinical Practice Guideline to align with the local hospital's resources, care processes, and practice environment. Implementation included structured preparation, dissemination of resource materials, nurse training, guided practice using the guideline manual, competency assessment, and integration into routine clinical care. Effectiveness was evaluated by comparing hypoglycemia-related clinical indicators, appropriateness of management, treatment-related costs, and nurse satisfaction before and after implementation. Following implementation, the incidence of severe hypoglycemia (blood glucose < 54 mg/dL) signif icantly decreased from 7.1 to 2.8 episodes per 1,000 patient-days. Mean blood glucose at detection signif icantly increased from 58.6 to 62.9 mg/dL, indicating earlier recognition. Appropriate hypoglycemia management increased from 7.3% to 47.1%, and overtreatment with excessive carbohydrate decreased from 40.8% to 23.0%. The average cost of hypoglycemia treatment per episode decreased from 8.35 to 4.26 Thai baht (0.25 USD to 0.13 USD). Nurses demonstrated 100% adherence to hypoglycemia surveillance among high-risk patients, and 70.1% reported high satisfaction with the guideline. In conclusion, implementation of the adapted hypoglycemia management guideline improved the quality and safety of inpatient care. Further multicenter studies are needed to evaluate implementation in other hospital settings.
The Buddhist monastic discipline includes regulations regarding monks' consumption of food and drinks. Even in cases of health problems and with exceptions allowed, most monks still adhere to the practice of eating one to two meals per day. This limits their ability to obtain sufficient nutrients, increasing the risk of malnutrition. Malnutrition and protein-energy wasting commonly occur in people undergoing hemodialysis and may be of intense concern for Buddhist monks. This quasi-experimental study, a one-group pre-posttest with repeated measures, aimed to examine the effects of the Protein and Energy Intake Self-Care Support Program on knowledge, self-care behavior, and clinical outcomes among 30 monks undergoing hemodialysis at the Priest Hospital in Bangkok, Thailand. The participants received an intervention for twelve weeks. The instruments used were a Personal and Health Information Form, the Knowledge of Protein and Energy Intake Questionnaire, and a 24-Hour Dietary Recall Record Form to evaluate dietary behaviors as self-care behaviors. Descriptive statistics and one-way repeated-measures ANOVA were used to analyze data. The program led to a significant increase in mean scores for knowledge, dietary behaviors, and clinical outcomes (serum albumin and protein catabolic rate). Repeated measures analysis showed that knowledge significantly improved across three evaluation time points. Dietary behaviors and clinical outcomes significantly improved across all four evaluation time points. These findings suggest that the intervention effectively promotes long-term enhancements in both nutritional status and clinical outcomes in monks undergoing hemodialysis. Nurses can apply this intervention in nursing practice. However, further testing of this intervention is needed through a randomized controlled trial in a multi-site study.
Organizational effectiveness is a critical component in sustaining healthcare service quality, workforce performance, and the adaptability of healthcare organizations within rapidly changing health systems. The increasing complexity of healthcare delivery and the growing demand for registered nurses underscore the importance of 21st century learning skills, including critical thinking and problem-solving; collaboration and teamwork with leadership; communication and information literacy; cross-cultural competence; digital and information and communication technology literacy; creativity and innovation; self-directed career and lifelong learning as essential competencies for contemporary nursing practice. However, empirical evidence regarding how these comprehensive skills influence organizational effectiveness remains limited, particularly within the highly competitive context of private hospitals in Northeastern Thailand. To address this research gap, this cross-sectional descriptive study aimed to examine the influence of 21st century learning skills on perceived organizational effectiveness among registered nurses working in four private hospitals in Northeastern Thailand. Data were collected from a sample of 230 registered nurses using three structured questionnaires: a Personal Characteristics Questionnaire, the 21st Century Learning Skills Questionnaire, and the Perceived Organizational Effectiveness Questionnaire. Data were subjected to statistical analysis, including descriptive statistics, Pearson's correlation coeficient, and stepwise multiple linear regression. The results revealed that the participants had both organizational effectiveness and overall 21st century learning skills at a high level. Pearson's correlation analysis demonstrated that all dimensions of 21st century learning skills were positively and significantly associated with perceived organizational effectiveness. Stepwise multiple regression analysis indicated that cross-cultural understanding skills, career and learning self-reliance skills, critical thinking and problem-solving skills, and collaboration, teamwork, and leadership skills were significant predictors of perceived organizational effectiveness, collectively explaining 76.5% of the variance. These findings highlight the importance of developing 21st century learning skills among registered nurses to enhance organizational effectiveness and support the efficient, sustainable operation of healthcare organizations.
Alcohol use disorder significantly increases morbidity and hospital utilization in Thailand. Coordinated, patient-centered transitional care bridges hospital and home settings to reduce post-discharge readmissions. This quasi-experimental study aimed to evaluate the effectiveness of a transitional care program in reducing alcohol consumption and hospital readmissions in people with alcohol use disorder, led by a nurse practitioner. Eighty-six people with alcohol use disorder were purposively recruited and randomly allocated to either the intervention (n = 43) or the comparison group (n = 43). The comparison group received only usual care, while the intervention group received the transitional care program in addition to usual care, which included hospital-based education, behavioral skills training, and post-discharge nurse consultations. Data were collected using a Demographic Data Sheet, the Time Line Follow Back, and a Hospital Readmission Record Form. A mixed-design analysis of variance was used to compare outcomes for alcohol consumption (heavy drinking days and abstinent days) and hospital readmissions, both within and between groups at baseline, 28 days, and 90 days post-discharge. At 28- and 90-day post-discharge, the intervention group showed a significant decrease in heavy drinking days and an increase in abstinent days compared with the comparison group. Additionally, hospital readmissions at both time points were significantly reduced in the intervention group. These findings support the effectiveness of the advanced practice nurse-led program in reducing alcohol consumption and hospital readmissions among individuals with alcohol use disorder. Therefore, nurses, particularly those with advanced practice competencies, should consider integrating this program into routine hospital care to reduce alcohol consumption among this population. However, rigorous testing in other settings with larger sample sizes is recommended.
University students are a vulnerable population for road traffic injuries, yet there is a limited comprehensive understanding of their road safety behaviors. In Thailand, where traffic-related mortality rates among young adults are high, research on university students' safety behaviors remains inadequate. This cross-sectional study aimed to describe protective and risk behaviors among 388 first-year student road users in Southern Thailand and compare these behavior scores by gender, faculty, licensure, driving frequency, and accident history. Data were collected using the Road Safety Behavior online questionnaire and analyzed using statistics and the Mann U test. Overall, safe road behaviors were common. However, pillion riders and vehicle passengers exhibited a moderate frequency of protective behaviors, highlighting key vulnerabilities. Primary protective behaviors included checking vehicle safety before travel, using helmets and seatbelts for all passengers, and walking facing traffic when there is no sidewalk. Main risk behaviors included using a mobile phone while travelling (highest risk), sleeping during vehicle transit, unsafe pillion riding, overloading the vehicle, distracting the driver, running a yellow traffic light, speeding, and crossing roads unsafely. Male students, frequent motorcycle users, experienced motorcycle riders, and those with a history of accidents while riding were more likely to engage in risk behaviors. License possession did not correlate with road safety behaviors. Male pedestrians exhibited both more protective and more risk-taking behaviors than females. The findings highlight a gap; the safety of pillion riders and vehicle passengers continues to be overlooked. Universities should include road safety in orientation programs, focusing on the primary issues identified in this study and running continuous campaigns. Nurses in university health services should screen risk behaviors and provide brief education. Health policy should prioritize safe passenger behavior when using vehicles.
Key populations still experience stigma, privacy concerns, and limited access to HIV testing. Digital counseling and HIV self-testing offer a safer alternative. This systematic review synthesized evidence on the effectiveness of technology-based counseling and testing services in improving self-testing acceptability, uptake among key populations and linkage to care. A literature search was conducted (July–September 2025) in five databases, including studies published between 2017 and 2024, in accordance with PRISMA guidelines. This review protocol was registered with PROSPERO (CRD420251084235). Inclusion criteria comprised adult key populations receiving technology-based interventions in randomised controlled trials, cohort, or quasi-experimental designs that reported outcomes on acceptance, uptake, and/or linkage to care. Risk of bias was evaluated using the Joanna Briggs Institute tools, and results were synthesized narratively. Twelve studies from middle and high-income countries (n = 8,328) were included. The most consistently effective interventions were models that integrated HIV self-testing with structured digital counselling, including pre-and post-test education and direct referral systems to healthcare services. These services increased HIV testing frequency compared to standard care, were well accepted, and successfully reached many first-time testers. However, challenges remain, including disparities in digital access, sustainability of self-testing kit supply, and variability in intervention components. In this context, nurses play a critical role as digital care navigators by providing digital pre- and post-test counseling through smartphone-based platforms, such as widely used applications like WeChat, while also ensuring digital health literacy, addressing technical barriers, and coordinating referrals for confirmatory testing.
Type 2 diabetes mellitus with diabetic peripheral neuropathy often leads to impaired self-management and poor glycemic control. Psychological stress, limited family support, and insuficient behavioral guidance may weaken motivation to maintain effective diabetes care. An integrated intervention was developed by combining Bandura's self-efficacy construct and Orem's self-care theory to strengthen diabetes self-management. The quasi-experimental study took place at community health centers in Kendari City, Indonesia. People with type 2 diabetes and diabetic peripheral neuropathy were recruited using consecutive sampling and randomly allocated to an intervention group (n = 45) or a control group (n = 47). The 12-week intervention consisted of six structured sessions that integrated diabetes coaching, mindfulness practices, family participation, and scheduled home visits. Primary outcomes were diabetes self-eficacy, measured at baseline, 3 months, and 6 months, and HbA1c, measured at baseline and 6 months after the intervention. Data were collected using a demographic questionnaire, the Holistic Diabetes Self-Eficacy Scale, and HbA1c testing. Analyses included descriptive statistics, paired t-tests, independent t-tests, and generalized estimating equations. Post-intervention analysis demonstrated that the intervention group had significantly higher total and domain-specific self-efficacy scores than the control group at both 3 and 6 months, and also showed greater improvement in HbA1c over time. Self-efficacy and glycemic control were improved through this integrated intervention among people with type 2 diabetes mellitus and diabetic peripheral neuropathy. Nurses can apply this intervention to practice. However, further multi-site randomized controlled trials are needed before wider implementation.
Hypertension is a significant public health burden, and cultural factors influence the perception and management of hypertension in Southeast Asia. However, regional synthesis of evidence remains limited, hindering the development of culturally appropriate and scalable interventions. This study examined how cultural beliefs and practices influence hypertension self-care behaviors among adults with hypertension in selected Southeast Asia countries. Five electronic databases (PubMed, Scopus, Web of Science, ProQuest, and SAGE Journals) were searched in 2025 for studies published from 1 January 2015 to 31 March 2025. Eligible studies included adults (≥18 years) with hypertension in Southeast Asia settings and reported cultural influences on self-care. Two reviewers conducted a narrative synthesis with thematic coding (third-party adjudication for disagreements), and methodological quality was assessed using the critical evaluation tools from the Joanna Briggs Institute. Twelve studies involving 2,252 participants were included, and the protocol was registered in PROSPERO (CRD420250656487). Five themes emerged: illness perceptions, traditional and spiritual self-care practices, dietary traditions, sociocultural barriers to engagement with biomedical care, and community-based approaches. Examples included preferences for natural or spiritual practices in Malaysia, herbal and spiritual rituals that delay biomedical engagement in Indonesia, and the illness metaphor malapot na dugo (“thick blood”) that shapes treatment decisions in the Philippines. Communal dietary practices and collective decision-making also influenced the negotiation of self-care within families and communities. Hypertension self-care in Southeast Asia is embedded in collectivist and culturally specific contexts. For community nursing practice, culturally responsive assessment, communication, and family–community engagement are essential to support adherence and integrate cultural practices with evidence-based care. Policy should support culturally safe care; further research in underrepresented settings is needed.
Due to the burden of diseases and adverse reactions to treatment, people with hematologic malignancies usually experience frailty. This study determined the risk factors associated with frailty in people with hematologic malignancies. A thorough examination of the literature was conducted across nine databases following the PRISMA guidelines, including PubMed, Web of Science Core Collection, Embase, CINAHL, CNKI, Wanfang Data, CBM, VIP Database, and SinoMed, covering the period from 2001 to July 26, 2024. The Newcastle-Ottawa Scale was used to assess the quality of the included studies, in conjunction with evaluation tools from the Agency for Healthcare Research and Quality. The analysis included 23 studies, encompassing 13,849 participants. A high prevalence of frailty was observed in this study, affecting 27.1% of the participants involved. Several risk factors for frailty were identified, including demographic traits (gender, age), clinical features (hand grip strength, physical activity, comorbidities, advanced disease stages, neurological symptoms), biochemical markers (albumin levels, interleukin-6), and mental state (anaemia, depressive symptoms). Our analysis suggests that frailty is common among people with hematologic malignancies. Nurses should pay attention to individuals who exhibit the above-mentioned influencing factors in clinical practice, prevent the occurrence and progression of frailty, and engage in multidisciplinary collaboration and multi-targeted interventions to better manage individuals with frailty.
Hip fractures are common health issues among older adults, and many require surgery to restore mobility and alleviate pain. However, post-surgical recovery can take months and requires intensive care and rehabilitation at home, which is linked to better health outcomes. Family-based care interventions with optimal management have been advocated to support good recovery and improve health outcomes, but their effectiveness remains inconsistent across studies. This systematic review aimed to critically synthesize evidence on the effects of family-based care interventions in improving health outcomes in older adults undergoing hip fracture surgery. The review was conducted on November 1, 2024, by searching databases PubMed, Science Direct, Web of Science, Scopus, ThaiJo, and other sources from Google Scholar from 2014 to 2024. The inclusion criteria were people aged 60 and older with hip fractures, and the articles related to family interventions that affect physical or psychological health outcomes. The review used the Joanna Briggs Institute approach and is reported here in accordance with PRISMA. The PROSPERO registration was CRD42024625893. Six of 521 articles met the criteria: three randomized controlled trials, a secondary data analysis of such trials, and two quasi-experimental studies. A meta-analysis was not conducted because the studies differed in their characteristics. Therefore, a narrative synthesis was used. Results show that interventions using various components are mostly provided during the pre-discharge phase. The main components were assessment and consultation, a team-based approach, health education, patient and caregiver training/coaching, rehabilitation, motivational intervention, and follow-up. Physical outcomes were a primary health outcome measured in all studies that showed positive trends using mobile innovation and self-management programs. Psychological outcomes such as stress, fear of falling, depression, and burden were also improved. The review underscores the potential of the family-based care intervention in improving health outcomes of older adults who underwent hip fracture surgery. The intervention consists of multiple components that improve physical and psychological outcomes. A comprehensive hospital-to-home-based intervention and the use of technology during care transitions appear to help both community nurses and families achieve successful care. However, these require a more comprehensive assessment of their cost-effectiveness in terms of patient outcomes.
The accelerating global shift toward ageing populations has become one of the most urgent challenges for 21st-century health systems and nursing education. As nations strive to prepare digitally competent health workforces, technologies such as simulation-based learning, virtual reality, artificial intelligence, and ambient assisted living (AAL) are redefining what it means to care for older adults with independence, dignity, and safety. AAL refers to intelligent environments and systems designed to support disability-free and independent living while enhancing the well-being of older users. Yet, the promise of AAL remains unevenly realized. While high-income countries have incorporated gerontechnology into curricula and practice, many middle-income nations, including Thailand, still rely on traditional pedagogy, leaving graduates underprepared for the realities of digital health. This editorial argues that integrating AAL into nursing education is no longer optional but essential. It calls for a paradigm shift that positions AAL as a global core competency aligned with the United Nations Sustainable Development Goals Goal 3 (Good Health and Well-being) and Goal 4 (Quality Education) and the Universal Health Coverage (UHC) principles of efficiency, equity, and effectiveness. The readiness of today’s nursing education to embrace AAL in curricula, teaching-learning, and digital infrastructure will determine not only how well future nurses are prepared for geriatric care but also how effectively health systems keep pace with the global, gerontechnology-driven transformation.
Global mental health has been markedly disrupted following the COVID-19 pandemic, and Thailand has similarly faced considerable psychological consequences among its communities. This embedded mixed-methods study was conducted in Bueng Yi Tho sub-district, Pathum Thani province, central Thailand. For the quantitative strand, 115 community dwellers aged 18-59 years were recruited via proportionate stratified random sampling. They completed validated questionnaires measuring stress (Thai Perceived Stress Scale-10) and mental well-being (Scales of Psychological Well-Being). For the qualitative strand, 45 participants with moderate-to-high stress were purposively selected from the quantitative sample and participated in five focus group discussions. Qualitative data were analyzed using hermeneutic phenomenological analysis. The study is reported here following the STROBE and COREQ guidelines. Quantitative findings revealed that the majority experienced moderate-to-high stress, with insuficient income, chronic disease, education level, occupation, and female sex as key sociodemographic predictors. Mental well-being was inversely correlated with stress levels. Qualitative findings yielded two themes: 1) stress experiences and management in the post-pandemic context; and 2) mental well-being promotion through hybrid support systems. Integration of findings confirmed that economic insecurity was the predominant stressor, with qualitative data revealing specific mechanisms such as the inability to support children's education and fear of economic collapse. Effective coping integrated traditional Thai practices (herbal medicine, Buddhist principles, suficiency economy philosophy) with modern approaches. Community support through village health volunteers and structured activities buffered the impact of stress. These integrated findings provide evidence for developing culturally appropriate, multi-level mental health interventions for post-pandemic Thai communities.
Advanced practice nursing roles are being developed in Morocco to address growing demands on emergency departments, yet physicians' perceptions of these roles remain poorly understood. The international literature highlights that contextual factors are crucial to the success of advanced practice nursing integration, with physicians as key stakeholders whose collaboration and support are considered essential. A qualitative descriptive study was conducted between June and September 2025, using semi-structured interviews with emergency physicians at a university hospital in Morocco. Participants were selected through purposive sampling, and interviews were audio-recorded, transcribed verbatim, and analyzed using an inductive thematic analysis approach. Nine physicians participated in the study and analysis generated five main themes: 1) The concept of advanced practice nursing: integrating autonomy, technical expertise, and standardized care; 2) Optimizing patient care through the advanced practice nurses: the clinical and organizational pivot; 3) The multidimensional challenge of implementing advanced practices; 4) Prerequisites for successful integration of advanced practices; and 5) The strategic path: the catalytic national context. Overall, physicians recognized the potential of advanced practice nurses to optimize emergency care delivery while highlighting substantial legal, organizational, and cultural barriers to their implementation. These findings require Moroccan emergency nurses to undertake three measures: advocate for a clear regulatory framework that defines the advanced practice nurse's scope of practice and legal protections; strengthen educational programs to build physicians' confidence through interprofessional collaboration; and capitalize on opportunities within the Moroccan context to advance the nursing profession. By taking these actions, nurses can ensure safe, efective, and sustainable integration of advanced practice nursing roles in Moroccan emergency departments.
Being overweight or obese pre-pregnancy or during pregnancy is a significant risk factor affecting maternal and fetal health. Therefore, pregnant women in this group require specific care to prevent adverse outcomes. A quasi-experimental study was conducted to evaluate the impact of a Health Literacy Program on health behaviors and gestational weight gain among pregnant women who were overweight or obese, which was delivered via a LINE official account. The sample consisted of such women attending an antenatal clinic of a general hospital in southern Thailand. The experimental group received the health literacy program in addition to routine nursing care for eight weeks (n = 30), while the control group received only routine nursing care (n = 30). The study was conducted in the control group first, followed by the experimental group. Data were collected using a General Information Questionnaire and the Health Behavior Assessment Tool for Overweight or Obese Pregnant Women. Data analysis was conducted using descriptive statistics, independent t-test, paired t-test, and chi-square test. The findings indicated that, following the intervention, the experimental group demonstrated significantly higher mean health behavior scores than at baseline, whereas the control group showed no change. In addition, the proportion of pregnant women who were overweight or obese who achieved gestational weight gain according to standard criteria was significantly greater in the experimental group compared with the control group. Therefore, the program is recommended as a guideline for antenatal care in this population, with further evaluation warranted in larger and more diverse settings.
The rising incidence of cancer in Thailand, the poor prognosis of people with advanced-stage disease, and cultural barriers to discussions about death all contribute to insufficient awareness of the advance care planning process among the Thai population. This cross-sectional study examined factors influencing the intention to participate in advance care planning among people with cancer in a university hospital seting. A total of 155 people with cancer were recruited through simple random sampling from the oncology outpatient unit of a university hospital in Bangkok, Thailand, during November 2024 and February 2025. The following instruments were employed: the Mini-Cog assessment for cognitive screening, the Personal and Health-Related Information Questionnaire, and the Advance Care Planning Questionnaire, which comprises measures of knowledge, attitudes, subjective norms, and intention to participate regarding care planning. The data were examined through descriptive statistics and multiple regression analysis. The results indicate that knowledge, attitudes, subjective norms, and covariates collectively and significantly predicted intention to participate in the advance care planning process among people with cancer, accounting for 42.1% of variance. Attitudes towards advance care planning were the strongest predictor, followed by subjective norms and knowledge. The findings highlight the need to cultivate positive attitudes, strengthen understanding, and actively involve key influencers to improve participation in advance care planning within this population. In particular, nursing practice should prioritize early assessment of patients' attitudes and engage family influencers in advance care planning discussions, ensuring alignment with Thai cultural values and promoting greater engagement among individuals with cancer.
Clinical internship is a core component in nursing education, during which students are often exposed to high emotional stress and potentially traumatic events. Although the adverse psychological efects of these experiences have been widely recognized, it remains unclear whether and how such traumatic experiences can foster personal and professional growth among Chinese nursing students. This qualitative descriptive study aimed to explore the traumatic experiences of nursing students during an internship conducted at a college in eastern China. Purposive sampling techniques were used to recruit 15 undergraduate nursing students who were engaged in their pre-graduation clinical practicum. Data were collected through in-depth, semi-structured interviews and supplemented by their original drawings. Following each interview, participants were invited to depict their traumatic experiences or reflections using colored pencils on A4 paper, without restrictions on time or artistic skill. The Braun and Clarke topic analysis method was employed. Three main themes emerged: 1) confronting painful experiences during practicum, encompassing unprepared exposure to death and suffering, hidden harm within power structures, and activation of personal unfinished business; 2) coping with emotional pain, including emotional labor overload, feelings of empathy but powerlessness, and defensive emotional isolation; and 3) transformation from pain to personal and professional growth, involving pulling strength from supportive resources to develop coping strategies, reshaping personal views on life, nursing, and boundaries, and reaffirmation of professional identity and personal growth. This study reveals a unique experience of trauma-to-growth trajectory among nursing students, "Facing-Coping-Transformation." It identifies the core mechanisms underlying this positive transformation: using internal and external supportive resources as the foundation, internal cognitive restructuring as the core driving force, and reafirmation of professional values and meaning as a key link, ultimately leading to dual growth in personal maturity and professional advancement. It is suggested that trauma-informed growth experiences be integrated into undergraduate nursing curricula to cultivate such adaptive capacities and transformative skills in clinical practice, with adequate support.
The COVID-19 pandemic exacerbated family distress during end-of-life care, especially in the intensive care unit. Resource constraints, limited hospital capacity, and increased economic strain hindered timely access to care while amplifying public fear and social isolation. While some studies have investigated family experiences across regions worldwide, little is known about these experiences within Asian cultural contexts, particularly in Southeast Asia. This q qualitative study, g grounded in Husserl's descriptive phenomenology, explored the experiences of Thai family members of patients with COVID-19 who died in intensive care units. Ten bereaved family members were recruited via snowball sampling on online platforms through a digital poster. Participants who met the eligibility criteria were video recorded during semi-structured online interviews. Data were analyzed using Colaizzi's seven-step phenomenological method, which provides a systematic process for moving from significant statements to formulated meanings, theme clusters, and an essential structure of the phenomenon. This approach enabled an in-depth understanding of Thai family members' lived experiences of the death and dying of a loved one to COVID-19 in the ICU, with rigor ensured in accordance with Guba and Lincoln's criteria. The analysis revealed six themes: 1) broken and disrupted communication; 2) living with uncertainty; 3) striving for involvement in patient care amid powerlessness; 4) eternal separation without a final g goodbye goodbye; 5) disrupted funeral rituals and cultural practices; and 6) the journey toward healing after loss. The findings underscore the need for clear communication, flexible family involvement supported by technology, and early mental health monitoring to strengthen family-centered and bereavement care in epidemic ICU contexts. Nurses play a key role in providing timely and consistent information, coordinating family engagement through digital contact, and offering compassionate support during restricted visitation. The findings also highlight the importance of culturally and spiritually responsive nursing care aligned with Thai beliefs and practices. In addition, nurses should screen for psychological distress, provide bereavement support, and facilitate timely referrals to prevent complicated g grief. Collectively, these implications support the development of flexible, family-centered nursing protocols that can be effectively implemented during pandemics and other infectious disease crises.
A comprehensive understanding of the experiences of road traffic accident survivors remains limited, especially regarding their recovery processes and the ongoing challenges following injury. The impacts afect physical, psychological, and occupational aspects, making it difficult to return to their former way of living, while also leading to consequences that render survivors a burden to their families. The study aimed to 1) describe the adaptive perspectives of adult road trafic accident survivors in Northeast Thailand and 2) explore the caregiving roles and forms of support provided by spousal caregivers and healthcare team members of road traffic accident survivors. A qualitative descriptive study was conducted. In-depth interviews were conducted from November 2024 to July 2025 with 23 participants, including survivors, spousal caregivers, and an interdisciplinary healthcare team comprising nurses, physicians, physiotherapists, and social workers, representing diverse professional roles in the care and support of survivors. Data were analyzed using thematic analysis. Four key themes were identified: 1) Acceptance, belonging, and resilience; 2) Overcoming burden through the pursuit of independence; 3) Spousal encouragement for strength and healing; and 4) Acceptance, hope, and practical support as facilitators of adaptation. The study advances understanding of the adaptive journey of road trafic accident survivors, highlighting the development of acceptance, a sense of belonging, and resilience. Spousal caregivers and interdisciplinary healthcare teams, including nurses, play a central role in supporting survivors through coordinated, culturally sensitive, and family-oriented care, through sustained engagement, psychosocial support, and efective interdisciplinary communication.
Delayed access to healthcare services among people with rheumatoid arthritis remains a critical challenge, which may increase the risks of disability and reduce quality of life. Timely initiation of disease-modifying anti-rheumatic drugs within the first 12 weeks is the therapeutic window of opportunity essential for preventing long-term disease progression. However, evidence explaining the determinants of delayed access in Asian contexts remains limited. This study aimed to design and test a causal model of factors predicting delayed access to healthcare services among people who have rheumatoid arthritis in Northern Vietnam. A detailed cross-sectional study was conducted among 308 adults with rheumatoid arthritis between June and September 2023. Data were collected using the Demographic and Clinical Questionnaire, the Health Literacy Short Form-12 items (HL-SF12), the Brief Illness Perception Questionnaire (BIPQ), and the General Help-Seeking Questionnaire (GHSQ). Structural equation modeling was used to examine the relationships between variables and identify predictors of delayed access to care. Delayed access was highly prevalent, with 91% of participants experiencing delays of three months or longer before receiving treatment. The final model explained 9.6% of the variance in delayed access. Health literacy and help-seeking behaviors demonstrated small but statistically signif icant total efects in reducing delay. A strong negative relationship was observed between health literacy and help-seeking behaviors. The model's limited explanatory power highlights the need to enhance its predictive capabilities by adding more factors or variables before further testing. Nursing interventions and practice should broaden strategies beyond individual behaviors to address structural, cultural, and service barriers, thereby improving equity and the timeliness of care.
Women with ovarian cancer receiving chemotherapy commonly experience multiple distressing symptoms that adversely affect quality of life; however, empirical evidence on symptom experiences and management behaviors, and their influence on quality of life among this population in Thailand, remains limited. Thus, this cross-sectional study in Thailand aimed to describe these experiences and behaviors, to predict quality of life in women with ovarian cancer receiving chemotherapy. Ninety-six women with ovarian cancer receiving chemotherapy at a university hospital were recruited using purposive sampling. Instruments used were the M.D. Anderson Symptom Inventory-Ovarian Cancer, a Modified Self-Care Diary, and the Functional Assessment of Cancer Therapy-Ovarian. Data were analyzed using descriptive statistics, Spearman's rho correlation, and hierarchical multiple regression. Participants experienced multiple concurrent symptoms, with numbness/tingling and fatigue reported most frequently. Overall symptom severity and interference were mild; however, neuropathy and fatigue were perceived as the most severe symptoms. Symptom management effectiveness was moderate, with hair loss and nausea showing the greatest improvement, whereas neuropathy remained poorly managed. Overall quality of life was rated as good. Symptom experiences-occurrence, severity, and interference-were significantly associated with overall quality of life. However, the association between symptom management effectiveness and quality of life was not significant. Combined, symptom experiences and management efectiveness explained 28.6% of the variance in quality of life. Only symptom interference was a significant negative predictor of quality of life. These findings emphasize the need for nurses to conduct routine and comprehensive symptom assessments and implement targeted interventions, particularly to reduce symptom interference, neuropathy, and fatigue, to improve quality of life in women with ovarian cancer receiving chemotherapy.
