Wipada Kunaviktikul

Moral Competence in Nursing Practice

This article presents the derivation of moral competence in nursing practice by identifying its attributes founded on Thai culture. In this process moral competence is formed and based on the Thai nursing value system, including personal, social and professional values. It is then defined and its three dimensions (moral perception, judgment and behavior) are also identified. Additionally, eight attributes as indicators of moral competence are identified and selected from three basic values. The eight attributes are loving kindness, compassion, sympathetic joy, equanimity, responsibility, discipline, honesty, and respect for human values, dignity and rights. All attributes are discussed by addressing the three moral dimensions in order to present how to deal with ethical issues in nursing practice. As a summary, a model of moral competence is presented to demonstrate moral competence in nursing practice in Thailand.

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

PURPOSE To determine the impact of nurse work environment and staffing on nurse outcomes, including job satisfaction and burnout, and on quality of nursing care. DESIGN Secondary data analysis of the 2007 Thai Nurse Survey. METHODS The 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. FINDINGS Nurses 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). CONCLUSIONS Improving 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. CLINICAL RELEVANCE Nurses should work with management and policymakers to achieve safe staffing levels and good work environments in hospitals throughout the world.

Factors influencing fatigue in Chinese nurses

Factors predicting fatigue in Chinese nurses were examined in a descriptive, correlational study. The participants were 581 nurses working in general hospitals in Chengdu City, China. The study instruments included the Occupational Fatigue Exhaustion Recovery Scale, the Job Content Questionnaire, the Exposure to Hazards in Hospital Work Environments Scale, the Pittsburgh Sleep Quality Index, the Job Dissatisfaction Scale, the Beck Anxiety Inventory, and the Beck Depression Inventory. The data were analyzed by using descriptive statistics, Pearsons correlation, F statistics, and multiple regression. The findings revealed that 61.7% of the variance in chronic fatigue and 54.9% of the variance in acute fatigue were explained by the independent variables. Intershift recovery was the most important variable in the explanation of acute fatigue, while acute fatigue was the most important variable in the explanation of chronic fatigue. Different intervention strategies should be implemented regarding the different influencing factors of acute and chronic fatigue.

Nurse Burnout, Nurse-Reported Quality of Care, and Patient Outcomes in Thai Hospitals.

PURPOSE The purpose of this study was to investigate the effect of nurse burnout on nurse-reported quality of care and patient adverse events and outcomes in Thai hospitals. METHODS Cross-sectional analysis of data from 2,084 registered nurses working in 94 community hospitals across Thailand. Data were collected through survey questionnaire, including the Maslach Burnout Inventory (MBI), which measures of nurse perceived quality of care and patient outcomes. Multiple logistic regression modeling was performed to explore associations between nurse burnout on quality of care and patient outcomes. FINDINGS Thirty-two percent of nurses reported high emotional exhaustion, 18% high depersonalization, and 35% low personal accomplishment. In addition, 16% of nurses rated quality of care on their work unit as fair or poor, 5% reported patient falls, 11% reported medication errors, and 14% reported infections. All three subscales of the MBI were associated with increased reporting of fair or poor quality of care, patient falls, medication errors, and infections. Every unit of increasing emotional exhaustion score was associated with a 2.63 times rise in reporting fair or poor quality of care, a 30% increase in patient falls, a 47% increase in medication errors, and a 32% increase in infection. CONCLUSIONS Findings clearly indicate that nurse burnout is associated with increased odds of reporting negative patient outcomes. Implementing interventions to reduce nurse burnout is critical to improving patient care in Thai hospitals. CLINICAL RELEVANCE Hospital administrators, nurse managers, and health leaders urgently need to create favorable work environments supporting nursing practice in order to reduce burnout and improve quality of care.

Effects of nurse work environment on job dissatisfaction, burnout, intention to leave

BACKGROUND The nursing shortage is a critical issue in many countries. High turnover rates among nurses is contributing to the shortage, and job dissatisfaction, intention to leave, and burnout have been identified as some of the predictors of nurse turnover. A well-established body of evidence demonstrates that the work environment for nurses influences nurse job dissatisfaction, intention to leave, and burnout, but there never has been a study undertaken in Thailand to investigate this relationship. OBJECTIVES To investigate how work environment affects job dissatisfaction, burnout, and intention to leave among nurses in Thailand. METHODS The study used a cross-sectional survey to collect data from 1351 nurses working in 43 inpatient units in five university hospitals across Thailand. The participants completed the Practice Environment Scale of the Nursing Work Index, the Maslach Burnout Inventory, and measures of job dissatisfaction and intention to leave. Logistical regression models assessed the association between work environment and nurse-reported job dissatisfaction, burnout, and intent to leave. RESULTS Nurses working in university hospitals with better work environments had significantly less job dissatisfaction, intention to leave, and burnout. CONCLUSION The nurse work environment is a significant feature contributing to nurse retention in Thai university hospitals. IMPLICATIONS FOR NURSING AND HEALTH POLICY Improving the work environment for nurses may lead to lower levels of job dissatisfaction, intention to leave, and burnout. Focusing on these nurse outcomes can be used as a strategy to retain nurses in the healthcare system. Addressing the challenges of poor work environments requires coordinated action from policymakers and health managers.

Work empowerment and burnout among registered nurses in two tertiary general hospitals

AIMS AND OBJECTIVES To describe and explore the relationship between work empowerment and burnout as perceived by nurses in two tertiary general hospitals in China. BACKGROUND Studies conducted in Western countries show that work empowerment can negatively influence burnout. Review of literature indicates that currently, no study on the relationship between work empowerment and burnout has been conducted in China. DESIGN A correlational, cross-sectional design was adopted using questionnaires for data collection. METHODS This study used correlational and cross-sectional designs to collect and analyse data. The demographic data were analysed using frequency and percentage distributions. Work empowerment and burnout as perceived by registered nurses were analysed using means and standard deviation. The relationship between work empowerment and burnout was analysed using Spearmans rank-order coefficient after testing the normal distribution using the Kolmogorov-Smirnov test. RESULTS The registered nurses perceive work empowerment at a moderate level. Emotional exhaustion as determined in this study is higher than in other nursing studies. A negative correlation is indicated between work empowerment and emotional exhaustion. A statistically significant positive correlation is also indicated between work empowerment and personal accomplishment. CONCLUSION When the work environment provides empowerment, registered nurses are less likely to experience burnout. Nursing supervisors should empower staff nurses by giving them opportunities to study, actualise the hospitals vision and share information with other staff nurses. RELEVANCE TO CLINICAL PRACTICE Nurse administrators can use the results of this study to develop policies, improve work empowerment programmes and decrease burnout so that staff nurses can work more effectively.

Nurse staffing and cost of care in adult intensive care units in a university hospital in Thailand

Decisions about nurse staffing levels in intensive care units (ICUs) should be guided by research to ensure optimal outcomes. This descriptive correlational study in a large Thai hospital was designed to evaluate the effect of nurse staffing levels on the costs of care, in terms of medical care cost per patient day and health personnel cost per patient day, in ICUs. The costing data were collected prospectively from the records of 242 critically ill patients while the nurse staffing levels were extracted from hospital management reports. The findings showed that a nurse staffing model with a higher number of registered nurses (RNs) led to an increase in the health personnel cost per patient day. However, a greater number of RNs was associated with improved patient safety and efficiency, thereby reducing the length of stay and the costs of care in the long term. This study provides evidence to support decisions by hospital administrators concerning RN staffing levels.

Diagnostic indicators for peptic ulcer perforation at a tertiary care hospital in Thailand

Introduction Limited data currently exists regarding the diagnostic indicators of peptic ulcer perforation for early detection among patients in Thailand. Delayed diagnosis and treatment for an ulcer can be life-threatening, resulting in shock or death. Objective To determine the diagnostic indicators of peptic ulcer perforation. Material and methods A cohort study was conducted in a tertiary care hospital in Thailand from 2005 to 2009. Peptic ulcer patients aged 15 years and over admitted to the surgical department were included. The diagnostic indicators used criteria of the patients’ final diagnoses and operations, coded according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, which included patient profiles, gender, age, coexisting illnesses, personal habits, signs and symptoms, laboratory investigations, radiological finding, and treatment role. Exponential risk regression analyses to obtain relative risk (RR) estimates for diagnostic indicators were analyzed using Stata® statistical software package, version 11 (StataCorp LP, College Station, TX). Results The study included 1290 patients. Of these, 57% reported perforated peptic ulcer. Multivariate analysis showed five diagnostic indicators: signs and symptoms including intense abdominal pain (RR = 1.53, 95% confidence interval [CI] 1.14–2.06), tenderness (RR = 1.94, 95% CI 1.17–3.21), and guarding (RR = 1.52, 95% CI 1.05–2.20); X-ray with free air (RR = 2.80, 95% CI 2.08–3.77); and referral from other hospitals (RR = 1.37, 95% CI 1.03–1.82). Conclusion Five diagnostic indicators for peptic ulcer perforation monitoring were suggested from this study. Improving diagnostic indicators for medical care may improve the outcome of patients that have perforated peptic ulcer.

Development of a simplified diagnostic indicators scoring system and validation for peptic ulcer perforation in a developing country

Objective: To perform and confirm a simplified diagnostic indicators scoring system for predicting peptic ulcer perforation (PUP). Methods: A case–control study was conducted including 812 consecutive patients with PUP from retrospective medical records. Each diagnostic indicator measurable at the time of admittance was analyzed by a multiple regression. Stepwise logistic regression was applied with backward elimination of statistically significant predictors from the full model, with P ≥ 0.05 for exclusion. The item scores were transformed from regression coefficients and computed to a total score. The risk of PUP was interpreted using total scores as a simple predictor. This system was internally validated in 218 consecutive patients and compared to existing systems. Results: A PUP risk score was determined from the diagnostic indicators associated with PUP: gender, age, nonsteroidal antiinflammatory drugs used, history of peptic ulcer, intense abdominal pain, guarding, X-ray free air positive, and referral from other hospitals. Item scores ranged from 0–6.0 and the total score ranged from 0–34.0. The area under the receiver operating characteristic curve shows that there was 91.73% accuracy in the total scores predicting the likelihood of PUP. The likelihood of PUP among low risk (scores <10.5), moderate risk (scores 11–21), and high risk (scores ≥ 21.5) patients was 0.13, 11.44, and 1.95, respectively. Conclusion: This scoring system is an effective diagnostic indicator for identifying the complex cases of PUP. It is a simple system and can help guide clinicians, providing them with a more efficient way to accurately subgroup patients while also reducing potential biases.

Nursing Education on Women’s Health Care in Australia, Japan, South Korea, and Thailand

Only within the last 3 decades have a select number of countries addressed issues surrounding the all-inclusive health and well-being of women. This factor has had a major influence on nursing education within these countries and the subsequent development of curricula. Because the preparation of nurses is pivotal in shaping a society’s health care agenda, this article compares and contrasts demographic characteristics, curricular frameworks, the role of the nurse, quality control of nursing curricula, and the focus of nursing courses related to women’s health care among the countries of Australia, Japan, South Korea, and Thailand. Recommendations based on infant mortality rates, life expectancy, leading causes of death, and country-based health care issues are provided to inform and guide the future focus of nursing education courses on women’s healthcare within these countries.