Knowledge, Attitude, and Practice in Preventing Infection Among Patients With Cancer Receiving Chemotherapy.

BACKGROUND: Oncology patients receiving chemotherapy are at a high risk for developing infections. Identifying factors that predict infection practices among these patients can help improve the quality of care provided. PURPOSE: The purpose of this study was to evaluate the knowledge, attitudes, and practices related to infection prevention in oncology patients receiving chemotherapy. METHODS: A cross-sectional study was conducted among 170 patients with cancer. RESULTS: The majority of participants had a low to moderate level of knowledge, with high levels of attitude and practice related to infection prevention. Knowledge was a significant predictor of attitude and practice, while attitude was a predictor of infection prevention practices. Knowledge and attitude emerged as mutual predictors, which could explain 23% of the variation in practice toward infection prevention (R2 = 0.230, P = .00). CONCLUSIONS: Findings indicated that both knowledge and attitude were powerful predictors of practice toward infection prevention.

Nurses' satisfaction with an educational web application to prevent transmission of multidrug-resistant organisms.

Multidrug-resistant organism infections are a serious health problem globally, and can result in patient mortality and morbidity. In this descriptive study, we produced the first web application for transmission prevention specific to the situation based on nursing experience, knowledge, and practice guidelines and to evaluate web application satisfaction among Thai nurses. The sample comprised 282 Thai registered nurses experienced in caring for patients with multidrug-resistant organisms in a tertiary hospital. A demographic form and knowledge test were completed anonymously online. Data were analyzed using descriptive statistics. The application emphasized crucial topics for which participants had low preliminary knowledge and included tutorial sessions, pictures, video clips, drills, and a post-test. The application was piloted with a random sample of 30 nurses, and an instrument tested their satisfaction with this. Results revealed that preliminary knowledge scores for preventing transmission were moderate, and participants were highly satisfied with the application. Findings suggest the application is suitable for Thai nurses and could be applied to nursing practice elsewhere. However, further testing is recommended before implementing it into nursing practice.

Impact of the COVID-19 pandemic on the Thai population: Delineating the effects of the pandemic and policy measures.

Objectives: This study aimed to determine the impacts of the COVID-19 pandemic and policy measures and delineate the impact of each on a cohort of Thai citizens. Methods: A cross-sectional study was conducted among 2,500 Thai people from October 2020 to January 2021. A questionnaire collecting demographic information and other data was sent to eligible subjects. Results: Overall, 51.6% and 49.5% of participants felt the impacts of COVID-19 and policy measures at the highest level, respectively. The study demonstrated that the weighted effect of the impact of the COVID-19 outbreak was statistically (p < .001) greater than that of policy measures on family (0.664 vs 0.618), education (0.562 vs 0.557), and the economy (0.643 vs 0.572). The weighted effect of the impact of policy measures was statistically (p < .001) greater than that of the COVID-19 pandemic on people's daily activities (0.675 vs 0.651), cultural/traditional or community way of life (0.769 vs 0.736), access to healthcare services and infection prevention supplies (0.410 vs 0.390), and mental health (0.625 vs 0.584). Conclusions: About half of the participants had a high level of impact from both the COVID-19 pandemic and policy measures. The results of this study suggest that policy measures need to be judged with caution, and the government should provide more comprehensive support to reduce the impact on people's lives.

A concept analysis of clinical judgment in undergraduate nursing students.

AIM: To offer a clear understanding of the definition, attributes, antecedents, and consequences of undergraduate nursing students' clinical judgment in the nursing education context. BACKGROUND: Clinical judgment is a concept with broad uses among healthcare professionals. Its definitions and attributes vary across contexts. There is no established understanding of clinical judgment in nursing students. DESIGN: This concept analysis was performed using the eight steps of Walker and Avant's framework. DATA SOURCES: A literature search was conducted using search engines and included peer-reviewed articles related to clinical judgment in nursing students. RESULTS: Clinical judgment in nursing students was defined as the cognitive process exhibited via a nursing action by observation, patient assessment, interpreting, and prioritizing data that lead to responding using the appropriate nursing practice with the patient. Reflection was used to evaluate nursing students' clinical judgment to revise nursing practice. Antecedents included nursing education curriculum, student's knowledge, previous clinical experience, critical thinking, and clinical reasoning. The consequences of clinical judgment were clinical judgment ability, safe nursing practice, nursing care quality, and patient safety. CONCLUSIONS: This concept analysis gives clear insights into the definition, attributes, antecedents, and consequences of undergraduate nursing student's clinical judgment.

Essential clinical skill components of new graduate nurses: A qualitative study.

Today it is a growing challenge for nursing schools to prepare students with quality education to provide them with essential clinical skills to practice as graduates. A number of studies report that graduate nurses feel underprepared with adequate skill levels to perform in the real world of clinical practice. In Thailand, these matters are of great concern, hence this first-time study on the topic. We report on the qualitative phase of a larger mixed methods study. A qualitative descriptive approach was used with the sample, 12 nursing educators, 24 registered nurses, 24 new graduate nurses, and four members of the Thailand Nursing and Midwifery Council committee. The participants were purposely selected for 12 semi-structured focus group discussions, and 12 were later invited for in-depth interviews. Using content analysis, four skills themes were extracted: fundamental, health promotion and disease prevention, rehabilitation, and skills in specialty areas. These skill components can be used to inform the development of a framework of essential clinical skills of graduate nurses for generating nursing practice to ensure patient safety and quality of care. Furthermore, these components can inform training guidelines for nursing student practice activities in subjects and policies to support nursing students in practice.

Factors influencing sexual risk behaviors among adolescents: A community-based participatory study.

Pregnancy rates and unprotected sex among Thai adolescents continue to increase. The aim of this community-based participatory study was to identify gender differences in sexual behaviors and sexual risk factors, and to examine factors associated with sexual risk behaviors among 397 adolescents in northern Thailand. Twenty two community researchers facilitated the data collection by using smart phones or tablet computers on a privacy basis. Ordinal and logistic regressions identified predictors influencing pre-coital behaviors and sexual behaviors. The results showed that males were more likely than females to engage in pre-coital and sexual behaviors. Significant predictors of higher pre-coital behaviors were age, sexual refusal self-efficacy, having boyfriends/girlfriends, authoritarian parenting style, parental approval of sex, and perceived peer norms. Pre-coital behaviors were positively correlated with sexual behaviors, and significant predictors of sexual behaviors were age, parent-adolescent communication, parental monitoring, perceived peer norms, and type of school. To better address the sexual risk behaviors of adolescents, we need to include key stakeholders to develop multi-modal culturally- and gender-specific sexual-prevention programs to account for information delivery, acceptability, and dealing with peer pressure.

Developing a program for enhancing youth HIV treatment adherence and risk reduction.

Youth living with HIV face difficult and challenging situations that decrease their adherence to antiretroviral medications. In this study, we developed a pilot program to enhance HIV treatment adherence and risk reduction among youth living with HIV based on collaboration with a community hospital involving a multi-disciplinary healthcare team. Participants were 25 youth living with HIV/AIDS, 18 caregivers, and 12 healthcare providers. The action research process comprised a preliminary stage and four phases of assessment, planning, implementation, and evaluation. This program used "edutainment", participatory learning, and multi-disciplinary collaboration to improve HIV treatment adherence and HIV risk behavior knowledge, motivation, and behavior. Education aimed to improve knowledge of antiretroviral drugs and HIV risk-taking behaviors. Motivation was directed at reframing beliefs and increasing positive attitudes of youth toward treatment adherence and raising awareness about safer sex behaviors. The behavioral skills focused on medication management in daily life activities, problem-solving, refusal and negotiation, and condom use. Findings provided preliminary evidence that the program was practical in a clinical context in a community hospital.

Factors Related to Sexual Self-Efficacy among Thai Youth Living with HIV/AIDS.

Studies of sexual behavior among HIV-infected Thai youth show conflicting results due to the different ages of the respondents. This study examined the relationships between sexual self-efficacy and risk behaviors among 92 HIV-positive Thai youth aged 14 to 21 years. A questionnaire previously validated in Thailand measured sexual self-efficacy. There were low levels of sexual activity with 13 respondents having sex in the last 6 months. The sexual self-efficacy scales were inversely related to the risk behaviors of having sex, having multiple partners, and drinking alcohol in the last 6 months. The scores of the sexual self-efficacy scale and its subscales were significantly lower in those aged 17 to 21 than in 14 to 16. Sexual risk behaviors were significantly higher in those aged 17 to 21 than in 14 to 16. These findings suggest that interventions to increase sexual self-efficacy should be emphasized as HIV-infected Thai youth reach late adolescence.

Effects of Internet-based instruction on HIV-prevention knowledge and practices among men who have sex with men.

HIV infection is increasing among men who have sex with men. In this study, the effects of Internet-based instruction on HIV-prevention knowledge were evaluated. The sample consisted of 162 men-who-have-sex-with-men volunteers in Thailand. The research instruments included a demographic data questionnaire, a knowledge test, and an HIV preventive practice questionnaire. The participants completed these instruments upon entry to the study and four months later. After entry to the study, the participants were given access to a previously-developed Internet-based instruction on HIV risk behaviors. Data were analyzed using descriptive statistics and paired t-test. After accessing the Internet-based instruction, the average score of HIV-prevention knowledge among the sample increased significantly, from 11.17 to 15.09 (maximum score of 20 points). The average score of practicing HIV prevention among the sample increased significantly, from 62.94 to 76.51 (maximum score of 99 points). This study demonstrated that Internet-based instruction was effective in improving HIV-prevention knowledge and practices among men who have sex with men. This suggests that Internet-based instruction could be developed for use in other countries and evaluated in a similar way.

Verifying quantitative stigma and medication adherence scales using qualitative methods among Thai youth living with HIV/AIDS.

HIV/AIDS-related stigma has been linked to poor adherence resulting in drug resistance and the failure to control HIV. This study used both quantitative and qualitative methods to examine stigma and its relationship to adherence in 30 HIV-infected Thai youth aged 14 to 21 years. Stigma was measured using the HIV stigma scale and its 4 subscales, and adherence was measured using a visual analog scale. Stigma and adherence were also examined by in-depth interviews. The interviews were to determine whether verbal responses would match the scale's results. The mean score of stigma perception from the overall scale and its 4 subscales ranged from 2.14 to 2.45 on a scale of 1 to 4, indicating moderate levels of stigma. The mean adherence score was .74. The stigma scale and its subscales did not correlate with the adherence. Totally, 17 of the respondents were interviewed. Contrary to the quantitative results, the interviewees reported that the stigma led to poor adherence because the fear of disclosure often caused them to miss medication doses. The differences between the quantitative and the qualitative results highlight the importance of validating psychometric scales when they are translated and used in other cultures.

Developing a web site for human immunodeficiency virus prevention in a middle income country: a pilot study from Thailand.

The Internet has often been used to reach men who have sex with men (MSMs) in developed countries. However, its use has not been as widespread in middle income countries because of a perceived lack of access to the web by residents of these countries. However, over half of the Internet users in the world now live in middle income countries. This article describes the development of web-based human immunodeficiency virus (HIV) prevention program that can serve as a model for middle income countries. Thai nursing faculty worked with MSMs to create and evaluate a Web site that provided HIV prevention messages directed toward MSMs. The steps for creating the site are described. Forty-one MSMs used the site and provided feedback to the site developers. The group was young (median=19 years), low income (median income was ∼170 US$ per month). The users demonstrated that they had access to the Internet and that they could utilize the site. They also reported moderate-to-high levels of satisfaction with site design, content, ease of use, information obtained, and benefits obtained from using the site. A previous article in the Thai language also showed that they reduced risk behaviors. They also made many useful suggestions for improving the content of the site. In conclusion, the study showed that the combination of nurses and MSMs from a middle income country could develop a usable HIV prevention Web site that instructed and changed behavior.

Thai nursing students' adaption to problem-based learning: a qualitative study.

Student-centred forms of learning have gained favour internationally over the last few decades including problem based learning, an approach now incorporated in medicine, nursing and other disciplines' education in many countries. However, it is still new in Thailand and being piloted to try to offset traditional forms of didactic, teacher-centred forms of teaching. In this qualitative study, 25 undergraduate nursing students in northern Thailand were interviewed about their experiences with problem-based learning in a health promotion subject. Content analysis was used to interrogate interview data, which revealed four categories: adapting, seeking assistance, self-development, and thinking process development. Initially participants had mixed emotions of confusion, negativity or boredom in the adaption process, but expressed satisfaction with creativity in learning, group work, and leadership development. They described increased abilities to problem solve and think critically, but struggled to develop questioning behaviours in learning. Socio-culturally in Thai education, students have great respect for teachers, but rarely question or challenge them or their learning. We conclude that problem-based learning has great potential in Thai nursing education, but educators and systems need to systematically prepare appropriate learning environments, their staff and students, to incorporate this within curricula.

Role model behaviors of nursing faculty members in Thailand.

Being a role model is very important in order for nurse teachers to promote students' competence and confidence. This descriptive study aimed at exploring the role model behavior of nursing faculty members in Thailand. The Self-Evaluation Scale on Role Model Behaviors for Nursing Faculty (Thai version) was used to collect data from 320 nursing faculty members in eight schools of nursing, four university nursing schools, one college under the Ministry of Public Health, one under the Bangkok Metropolitan Administration, and two private schools of nursing. The results revealed that the mean score of the overall items in the role model behaviors of nursing faculty members in Thailand, as perceived by themselves, was at a high level. The scores on each subscale of the role model behaviors also were high and related to respect for students, enthusiastic and high-quality teaching activities, showing the value of nursing practice and the nursing profession, social appropriateness, and ongoing professional development. The results can be used to further develop nurse professionals and to improve the effectiveness of clinical teaching in Thailand.

Readiness for self-directed learning among nursing students in Thailand.

This study took place in Thailand where didactic and lecture-driven teaching styles are beginning to transform into student-centered methods. At Chiang Mai University Faculty of Nursing in Thailand, the readiness of 272 undergraduate students to undertake self-directed learning was investigated using two instruments: a demographic data questionnaire and Guglielmino's Self Directed Learning Readiness Scale. The study found that the overall self-directed learning readiness of participants was at a high level in the categories of openness to learning opportunities, self-concept as an effective learner, initiative and independence in learning, informed acceptance of responsibility for one's own learning, creativity, and the ability to use basic study and problem-solving skills. The findings provide encouragement to nurse educators to further apply self-directed learning in nursing courses, to improve teaching and learning methods, and promote life-long learning for nurses within Thailand and elsewhere.