Wichit Srisuphan

Impact of Nurse Work Environment and Staffing on Hospital Nurse and Quality of Care in Thailand

PURPOSEnTo determine the impact of nurse work environment and staffing on nurse outcomes, including job satisfaction and burnout, and on quality of nursing care.nnnDESIGNnSecondary data analysis of the 2007 Thai Nurse Survey.nnnMETHODSnThe sample consisted of 5,247 nurses who provided direct care for patients across 39 public hospitals in Thailand. Multivariate logistic regression was used to estimate the impact of nurse work environment and staffing on nurse outcomes and quality of care.nnnFINDINGSnNurses cared for an average of 10 patients each. Forty-one percent of nurses had a high burnout score as measured by the Maslach Burnout Inventory; 28% of nurses were dissatisfied with their job; and 27% rated quality of nursing care as fair or poor. At the hospital level, after controlling for nurse characteristics (age, years in unit), the addition of each patient to a nurses workload was associated with a 2% increase in the odds on nurses reporting high emotional exhaustion (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.00-1.03; p < .05). Nurses who reported favorable work environments were about 30% less likely to report fair to poor care quality (OR 0.69; 95% CI 0.48-0.98; p < .05) compared with nurses who reported unfavorable work environments. The addition of each patient to a nurses workload was associated with a 4% increase in the odds on nurses reporting quality of nursing care as fair or poor (OR 1.04; 95% CI 1.02-1.05; p < .001).nnnCONCLUSIONSnImproving nurse work environments and nurse staffing in Thai hospitals holds promise for reducing nurse burnout, thus improving nurse retention at the hospital bedside as well as potentially improving the quality of care.nnnCLINICAL RELEVANCEnNurses should work with management and policymakers to achieve safe staffing levels and good work environments in hospitals throughout the world.

Role conflict and rapid socio-economic change: breastfeeding among employed women in Thailand.

Conflicts between womens productive and reproductive roles are intensified by rapid development and social change. Women have a right to offer optimum nutrition to their babies through breastfeeding; they also are entitled to seek gainful employment. For many, furthermore, employment is essential to the economic survival of their families. This article derives from a combined qualitative and quantitative study conducted in Chiang Mai, Thailand. Interviews were carried out with 313 women to investigate the experiences of those who resumed employment within six months after delivery. The findings demonstrate that urban women in the modern workplace face many obstacles in their efforts to maintain lactation while simultaneously undertaking paid work. Current public policies do not address these obstacles effectively, which is of particular concern in todays volatile economic climate.

Born female: The development of nursing in Thailand

Nursing was the first education-based occupational field for women in Thailand. In the brief span of 90 years since its beginning in hospital bedside care, it has become a professional field that has one of the greatest concentrations of women with doctoral degrees in the nation (n = 23). The academic evolution of nursing was instigated by the decisive contributions of two rich and powerful interests, the monarchy and private U.S.A.-based foundations. A cadre of doctorally prepared nurses has emerged. They, like members of other professions in Thailand, are predominantly from the urban privileged sector of society. The majority of todays nurses have followed a different course starting from petty bourgeoisie origins in towns and moving laterally through provincial bureaucratic channels. To date, lack of basic education has denied the poor and minority ethnic groups from the hill areas access to nursing. We describe the development of the nursing profession in three phases: the beginning of nurse training, 1896-1926; the creation of a small elite of nurses, 1926-1956; and the development of academic nursing, 1956 to the present. The future depends upon how the current polarization between the minority elite of university-prepared nurses and the majority lower middle class nurses proceeds. Since each group is governed and educated by separate government Ministries, and since women do not have access to higher government positions, nursing may have little control over its own development unless its new leaders take new leadership. One strategy is to recruit men into university nursing.

Multimedia computer-assisted instruction for carers on exercise for older people: development and testing

AIMnThis paper is a report of a study conducted to develop a multimedia computer-assisted instruction for informal carers and test its content validity, user difficulty and user satisfaction.nnnBACKGROUNDnHealthy ageing is an increasingly important public health target globally. Changes in technology offer the opportunity for e-health promotion as a means of educating populations and healthcare staff to meet public health targets.nnnMETHODSnComputer-assisted instruction was developed and tested systematically in four phases during 2008, and these are outlined. Phase 1 consisted of topic and content identification using a literature review. Phase 2 comprised refinement of the content using an academic panel of experts. Phase 3 was the production of computer-assisted instruction comprising problem clarification, algorithm designing with reference to a cognitive theory of multimedia learning and program coding. Phase 4 consisted of testing for content validity, and writing a computer-assisted instruction manual and testing it for user difficulty and satisfaction.nnnRESULTSnThe data from each phase informed the development and refinement of the computer-assisted instruction. Content validity was confirmed and test users reported few difficulties in its use and high satisfaction.nnnCONCLUSIONnThis e-health promotion initiative is an example of how computer-assisted instruction may be developed to teach carers of older people.

Effects of a cognitive adjustment program for Thai parents

Child physical abuse is recognized as a major public health problem that affects children and is likely to become increasingly common. The objective of this study was to examine the effects of a cognitive adjustment program on parental attitudes toward child rearing and the potential for this abuse. Child-care centers were randomly allocated to either the intervention or the control group. The sample included 116 Thai parents of children aged 1-6 years. The intervention group attended the cognitive adjustment program while the control group received the usual services. The results showed that, after program completion, the intervention group had statistically significantly better parental attitudes toward child rearing, but not a significantly lower potential for CPA than the control group. We concluded that the cognitive adjustment program was effective in altering parental attitudes toward child rearing. However, in order to enhance its efficacy, the program should be modified to be more intensive and it should be studied further for its effect on the potential for abuse.

Factors Affecting Thai Workers' Use of Hearing Protection

This study used an ecological model to examine Thai workers beliefs and attitudes toward using occupational hearing protection. Data collection involved focus group sessions with 28 noise-exposed workers at four factories in Chiang Mai Province and an interview with a safety officer at each organization. Detailed content analysis resulted in the identification of three types of factors influencing the use of hearing protection: intrapersonal, including preventing impaired hearing, noise annoyance, personal discomfort, and interference with communication; interpersonal, including coworker modeling, supervisor support, and supervisor modeling; and organizational, including organizational rules and regulations, provision of hearing protection devices, dissemination of knowledge and information, noise monitoring, and hearing testing. Effective hearing protection programs depend on knowledge of all of these factors. Strategies to promote workers use of hearing protection should include the complete range of factors having the potential to affect workers hearing.

From Women in White to Scholarship: The New Nurse Leaders in Thailand

The nature of nursing in Thailand has changed dramatically since World War II. The field is now led by a cadre of women who make nursing one of the largest occupational concentrations of women who hold doctoral degrees in the country. In this article reflections of these nurses on their profession, on their reasons for entering it, and on their contributions to its development are discussed. The findings are derived from a survey of 16 nurses with doctoral degrees and from participant observation. The women and their parents who guided their choice of a career were attracted to nursing by ideals of social service and family obligations. They were also attracted to nursing by its cultural definition as a female career and by the pragmatics of university entrance examinations. Most of the informants attributed their career success to hard work, family support, a strong sense of responsibility and commitment, self-sacrifice for the common good, and a calm demeanor. A minority of informants stressed new values of scholarship and management skills such as long-range planning and independent thinking. The emergence of these new values suggests that nursing in Thailand is on the verge of a new stage in its rapid evolution.

Analysis of a government policy to address nursing shortage and nursing education quality

BACKGROUNDnA well-educated, sufficient nursing workforce improves population health and standards of nursing care. Analysing workforce policies assists nurses to learn from the past and develop better future policies.nnnAIMnDescribe policy-making processes in the first Thai government plan to increase nursing capacity and improve nursing education quality.nnnDESIGNnA qualitative study employing Longests model to examine policy-making processes.nnnMETHODSnData were obtained from 28 in-depth interviews with key informants, who had been committee members and former deans of nursing involved with the policy processes in the 1990s. Both qualitative and quantitative data were extracted from relevant documents, and content analysis employed with all data.nnnFINDINGSnThree policy phases were identified. Policy formulation, where three streams of problems, politics and policy resulted in identification of nursing shortage, changes of government incumbents and needing to increase nurse production; Policy implementation included creating methods of implementation, appointing responsible people and committees, creating operational plans, producing more nurses and faculty development projects and Policy modification which incorporated implementing the first Thai international doctoral degree in English, a collaborative programme between universities.nnnSTUDY LIMITATIONSnNot all key informants could be accessed due to the passage of time. Findings are unique to Thailand but inform internationally of nurses abilities and need to be involved in policy.nnnCONCLUSIONnNurses were involved in all policy phases. While the policy produced positive developments in growing nursing capacity and education in the past, nursing shortages remained and are now acute in Thailand.nnnIMPLICATIONS FOR NURSING/HEALTH POLICYnLessons learned from this policy analysis help explain why the nursing education and nursing shortage policy was legislated through the government agenda, and the active involvement of Thai nurses in this process. Nurses globally need to be at the policy-making table to try to reduce nursing shortages, and enhance practice and education environments.

Preferred choice of work setting among nurses in Thailand: A discrete choice experiment.

The shortage of health personnel and nurses is an important issue in many developed and developing countries. Understanding preferred choice of work setting is an important strategy for retaining nurses in their work. The purpose of this study was to determine choices made by nurses in Thailand relative to their preferences for a work setting. A discrete choice experiment was conducted to elicit attributes and levels of job characteristics expected to contribute to work-place preferences. The sample included 921 nurses and was selected using stratified random sampling. A random effects probit model was used to identify factors contributing to work-setting preferences. The results showed that nurses first work-place preference was a high level of work setting. The second preference was to work in a hospital in the same province as their families. The results provide information for hospital and nurse administrators and policymakers seeking to address the nursing shortage.

Research Article: Effects of a cognitive adjustment program for Thai parents

Child physical abuse is recognized as a major public health problem that affects children and is likely to become increasingly common. The objective of this study was to examine the effects of a cognitive adjustment program on parental attitudes toward child rearing and the potential for this abuse. Child-care centers were randomly allocated to either the intervention or the control group. The sample included 116 Thai parents of children aged 1-6 years. The intervention group attended the cognitive adjustment program while the control group received the usual services. The results showed that, after program completion, the intervention group had statistically significantly better parental attitudes toward child rearing, but not a significantly lower potential for CPA than the control group. We concluded that the cognitive adjustment program was effective in altering parental attitudes toward child rearing. However, in order to enhance its efficacy, the program should be modified to be more intensive and it should be studied further for its effect on the potential for abuse.