The Health Service Model for Promoting Good Death in Critically Ill End-of-Life Patients in the Emergency Department: A Qualitative Study.

Good death is one of the important outcomes of end-of-life care service delivery. The initial management of critically ill patients in the Emergency Department (ED) for promoting good death often challenging since it requires a focus on human dignity and equity at the end of life. A qualitative approach was used included eight bereaved family members who loss of their loved one in the ED and 25 emergency staff, including 11 emergency physicians and 14 emergency nurses of a super tertiary hospital in Thailand. Semi-structured, face-to-face interviews were conducted from February to August 2021. All the interviews were transcribed verbatim for content analysis. The result identified four distinct scenarios and seven core themes of end-of-life patient characteristics in the ED. To promote a good death in the ED, health care provider should consider the unique service deliver for each critically end-of-life patients and their family members.

Evaluation of antenatal simulation-based learning on satisfaction and self-confidence levels among Thai undergraduate nursing students during the COVID-19 pandemic: a mixed-method study.

BACKGROUND: During the COVID-19 pandemic, simulation-based learning (SBL) serves as an alternative teaching strategy for nursing students facing restricted access to antenatal clinical practicum. However, the factors predicting nursing students' satisfaction, self-confidence, and their learning experiences remain unclear. OBJECTIVE: To identify factors predict satisfaction and self-confidence and explore the learning experiences of antenatal SBL. METHODS: A Mixed methods research of the cross-sectional study design and descriptive qualitative research was conducted. A total of 100 third year nursing students who finished the Maternity-Newborn Nursing and Midwifery Practice course using antenatal simulation-based learning were invited to complete the online questionnaires. A total of seven questionnaires were administered, including a demographic questionnaire, the Attitude Scale toward Simulation-Based Education (SBE), the Professional Identity Scale for Nursing Students, the Perceived Stress Scale, the Evaluation of Teaching Competencies Scale, the Simulation Design Scale: Student Version, and the Student Satisfaction and Self-Confidence in Learning. The 20 nursing students who completed survey were asked to participate a qualitative focus group discussion. Multiple regression analysis was performed to investigate predictors, while qualitative data were analyzed using content analysis. RESULTS: The quantitative results showed high levels of satisfaction (mean = 20.55, SD = 3.17) and self-confidence (mean = 32.44, SD = 4.76) after completing the antenatal SBL. In regression analysis, attitude toward SBE (Beta = 0.473, t = 5.376, p < 0.001) and attitude toward antenatal care simulation design (Beta = 0.338, t = 2.611, p < 0.011) were significantly associated with a high level of satisfaction with antenatal SBL, which accounted for 44.0% of the variance explained in satisfaction. Only attitude toward SBE was significantly associated with a high level of self-confidence in antenatal SBL (Beta = 0.331, t = 3.773, p < 0.001), which accounted for 45.0% of the variance explained in self-confidence. The qualitative results generated four themes: (1) positive attitude toward antenatal simulation; (2) turning reassurance into confidence; (3) I am really happy to learn; and (4) being a good nurse motivates and stresses me. CONCLUSIONS: Antenatal SBL is an effective teaching strategy that can support nursing students to build clinical confidence. Creating a positive learning environment allows students to have a positive attitude and experience with simulations.

Contributing factors of birth asphyxia in Thailand: a case-control study.

BACKGROUND: Birth asphyxia is of significant concern because it impacts newborn health from low to severe levels. In Thailand, birth asphyxia remains a leading cause of delayed developmental health in children under 5 years old. The study aimed to determine the maternal, fetal and health service factors contributing to birth asphyxia. METHODS: A case-control design was conducted on a sample of 4256 intrapartum chart records. The samples were selected based on their Apgar scores in the first minute of life. A low Apgar score (≤ 7) was chosen for the case group (852) and a high Apgar score (> 7) for the control group (3408). In addition, a systematic random technique was performed to select 23 hospitals, including university, advanced and secondary, in eight health administration areas in Thailand for evaluating the intrapartum care service. Data analysis was conducted using SPSS statistical software. RESULTS: The odds of birth asphyxia increases in the university and advanced hospitals but the university hospitals had the highest quality of care. The advanced and secondary hospitals had average nurse work-hours per week of more than 40 h. Multivariable logistic regression analysis found that intrapartum care services and maternal-fetal factors contributed to birth asphyxia. The odd of birth asphyxia increases significantly in late-preterm, late-term pregnancies, low-birth weight, and macrosomia. Furthermore, maternal comorbidity, non-reassuring, and obstetric emergency conditions significantly increase the odd of birth asphyxia. In addition, an excellent quality of intrapartum care, a combined nursing model, low nurse work-hours, and obstetrician-conducted delivery significantly reduced birth asphyxia. CONCLUSION: Birth asphyxia problems may be resolved in the health service management offered by reducing the nurse work-hours. Excellent quality of care required the primary nursing care model combined with a team nursing care model. However, careful evaluation and monitoring are needed in cases of comorbidity, late-preterm, late-term pregnancies, low-birth weight, and macrosomia. Furthermore, increasing the obstetrician availability in obstetric emergencies and non-reassuring fetal status is important.

Prevalence and related factors of inappropriate gestational weight gain among pregnant women with overweight/ obesity in Thailand.

BACKGROUND: An inappropriate gestational weight gain (GWG) among pregnant women with overweight/obesity is a crucial health problem. Its prevalence remains high worldwide, particularly in urban areas. The prevalence and predicting factors in Thailand are lack of evidence. This study aimed to investigate prevalence rates, antenatal care (ANC) service arrangement, predictive factors, and impacts of inappropriate GWG among pregnant women with overweight/obesity in Bangkok and its surrounding metropolitan area. METHODS: This cross-sectional, retrospective study used four sets of questionnaires investigating 685 pregnant women with overweight/obesity and 51 nurse-midwives (NMs) from July to December 2019 in ten tertiary hospitals. Multinomial logistic regression identified predictive factors with a 95% confidence interval (CI). RESULT: The prevalence rates of excessive and inadequate GWG were 62.34% and 12.99%. Weight management for pregnant women with overweight/obesity are unavailable in tertiary cares. Over three-fourths of NMs have never received weight management training for this particular group. ANC service factors, i.e., GWG counseling by ANC providers, quality of general ANC service at an excellent and good level, NMs' positive attitudes toward GWG control, significantly decreased the adjusted odds ratio (AOR) of inadequate GWG by 0.03, 0.01, 0.02, 0.20, times, respectively. While maternal factors, sufficient income, and easy access to low-fat foods reduce AOR of inadequate GWG by 0.49, and 0.31 times. In contrast, adequate maternal GWG knowledge statistically increased the AOR of inadequate GWG 1.81 times. Meanwhile, easy access to low-fat foods and internal weight locus of control (WLOC) decreased the AOR of excessive GWG by 0.29 and 0.57 times. Finally, excessive GWG significantly increased the risk of primary C/S, fetal LGA, and macrosomia 1.65, 1.60, and 5.84 times, respectively, while inadequate GWG was not associated with adverse outcomes. CONCLUSION: Prevalence rates of inappropriate GWG, especially excessive GWG remained high and affected adverse outcomes. The quality of ANC service provision and appropriate GWG counseling from ANC providers are significant health service factors. Thus, NMs should receive gestational weight counseling and management training to improve women's knowledge and practice for gestational weight (GW) control.

"Because it eases my Childbirth Plan": a qualitative study on factors contributing to preferences for caesarean section in Thailand.

BACKGROUND: Although caesarean section (CS) rates have increased rapidly in Thailand, the upward trend is not supported by significant maternal or perinatal health benefits. The appropriate use of CS through QUALIty DECision-making by women and providers (QUALI-DEC project) aims to design and implement a strategy to optimize the use of CS through non-clinical interventions. This study aimed to explore the factors influencing women's and health professionals' preferences for CS delivery in Thailand. METHODS: We conducted a formative qualitative study by using semi-structured in-depth interviews with pregnant and postpartum women, and healthcare staff. Purposive sampling was used to recruit participants from eight hospitals across four regions of Thailand. Content analysis was used to develop the main themes. RESULTS: There were 78 participants, including 27 pregnant and 25 postpartum women, 8 administrators, 13 obstetricians, and 5 interns. We identified three main themes and seven sub-themes of women and healthcare providers' perceptions on CS: (1) avoiding the negative experiences from vaginal birth (the pain of labor and childbirth, uncertainty during the labor period); (2) CS is a safer mode of birth (guarantees the baby's safety, a protective shield for doctors); and (3) CS facilitates time management (baby's destiny at an auspicious time, family's management, manage my work/time). CONCLUSIONS: Women mentioned negative experiences and beliefs about vaginal delivery, labor pain, and uncertain delivery outcomes as important factors influencing CS preferences. On the other hand, CS is safer for babies and facilitates multiple tasks in women's lives. From health professionals' perspectives, CS is the easier and safer method for patients and them. Interventions to reduce unnecessary CS, including QUALI-DEC, should be designed and implemented, taking into consideration the perceptions of both women and healthcare providers.

Impact of personal and environmental factors affecting exclusive breastfeeding practices in the first six months during the COVID-19 pandemic in Thailand: a mixed-methods approach.

BACKGROUND: Exclusive breastfeeding (EBF) for six months is recommended as one of the most important ways to support child health and survival, particularly during the COVID-19 pandemic. However, breastfeeding women encountered several obstacles during the pandemic. The purpose of this study was to conduct a survey to document breastfeeding practices, EBF rates and associated factors with six month exclusive breastfeeding during the second wave of the coronavirus outbreak in Thailand. METHODS: A mixed-methods design that included a cross-sectional survey (n = 390) and semi-structured in-depth interviews (n = 15) was carried out between August and November 2021. Participants were women aged ≥ 15 years who had given birth within 6-12 months before data collection and delivered in three public hospitals in the top three provinces with the most severe COVID-19 outbreaks. RESULTS: The median duration of EBF was four months (interquartile range, IQR: 1-6 months) and 37.4% of women exclusively breastfed for six months. From binary logistic regression models, several personal factors were associated with exclusive breastfeeding for six months including being a housewife (AOR 2.848; 95% CI 1.512, 5.367), perceived sufficiency of family income (AOR 2.502; 95% CI 1.362, 4.594), working from home/business (AOR 2.071; 95% CI 1.074, 3.995), breastfeeding intention (AOR 1.162; 95% CI 1.116, 1.210), and maternal age (AOR 0.932; 95% CI 0.882, 0.986). From qualitative interviews, women who were able to exclusively breastfed during the outbreak explained five themes that were a protective shield; I have to save money, I could spend all my time with my baby and breastfeed, spousal support is valuable, and opportunity to avoid the obstructed beliefs about exclusive breastfeeding. CONCLUSIONS: Mothers with higher socioeconomic status and who were unemployed/worked from home and had support structures in place were able to successfully EBF during the COVID-19 outbreak. Healthcare providers can better support breastfeeding if they provide informational support and allow family members to participate in breastfeeding programs, especially spouses who provided key emotional and tangible support during pandemic.

Factors influencing the implementation of labour companionship: formative qualitative research in Thailand.

INTRODUCTION: WHO recommends that all women have the option to have a companion of their choice throughout labour and childbirth. Despite clear benefits of labour companionship, including better birth experiences and reduced caesarean section, labour companionship is not universally implemented. In Thailand, there are no policies for public hospitals to support companionship. This study aims to understand factors affecting implementation of labour companionship in Thailand. METHODS: This is formative qualitative research to inform the 'Appropriate use of caesarean section through QUALIty DECision-making by women and providers' (QUALI-DEC) study, to design, adapt and implement a strategy to optimise use of caesarean section. We use in-depth interviews and readiness assessments to explore perceptions of healthcare providers, women and potential companions about labour companionship in eight Thai public hospitals. Qualitative data were analysed using thematic analysis, and narrative summaries of the readiness assessment were generated. Factors potentially affecting implementation were mapped to the Capability, Opportunity, and Motivation behaviour change model (COM-B). RESULTS: 127 qualitative interviews and eight readiness assessments are included in this analysis. The qualitative findings were grouped in four themes: benefits of labour companions, roles of labour companions, training for labour companions and factors affecting implementation. The findings showed that healthcare providers, women and their relatives all had positive attitudes towards having labour companions. The readiness assessment highlighted implementation challenges related to training the companion, physical space constraints, overcrowding and facility policies, reiterated by the qualitative reports. DISCUSSION: If labour companions are well-trained on how to best support women, help them to manage pain and engage with healthcare teams, it may be a feasible intervention to implement in Thailand. However, key barriers to introducing labour companionship must be addressed to maximise the likelihood of success mainly related to training and space. These findings will be integrated into the QUALI-DEC implementation strategies.

Maternal and health service predictors of postpartum hemorrhage across 14 district, general and regional hospitals in Thailand.

BACKGROUND: Postpartum hemorrhage (PPH) is a preventable complication, however, it remains being the leading cause of maternal mortality and morbidity worldwide including Thailand. METHODS: A case-control study to examine the risk factors associated with PPH across the hospitals under the Ministry of Public Health in Thailand, was conducted. A total of 1833 patient birth records and hospital profiles including human and physical resources from 14 hospitals were obtained. A multiple logistic regression was used identifing the factors that are significantly associated with PPH. RESULTS: The results show that the rate of PPH varied across the hospitals ranging from 1.4 to 10.6%. Women with past history of PPH were more likely to have increased risk of having PPH by 10.97 times (95% CI 2.27,53.05) compared to those who did not. The odds of PPH was higher in district and general hospitals by 14 (95% CI 3.95,50.04) and 7 (95% CI 2.27,23.27) times respectively, compared to regional hospitals. The hospitals which had inadequate nurse midwife to patient ratio (OR 2.31,95% CI 1.08,4.92), lacked nurse midwives with working experience of 6-10 years (OR 2.35, 95% CI 1.41,3.92), as well as inadequate equipment and supplies for emergency obstetric care (OR 6.47, 95% CI 1.93,21.63), had significantly higher incidence of having PPH, respectively. CONCLUSIONS: This study provides interesting information that the rate of PPH varies across the hospitals in Thailand, in particular where essential nurse midwives, equipment, and supplies are limited. Therefore, improving health care services by allocating sufficient human and physical resources would contribute to significantly reduce this complication.

Factors influencing the stages of breast cancer at the time of diagnosis in Thai women.

BACKGROUND: Early diagnosis of breast cancer leads to early treatment therefore improving women's health. However, most Thai women are diagnosed at a late stage. OBJECTIVE: This cross-sectional correlational study was designed to explore factors influencing the diagnosis of early stage breast cancer in Thai women. METHOD: Thai women (n = 400) newly diagnosed breast cancer at all clinical stages from public hospitals in Bangkok Metropolitan completed a questionnaire about knowledge of breast cancer and screening. The questionnaire addressed pre-diagnosis data about: (1) health care provider's recommendations to undertake breast screening, (2) health coverage for mammography (MM) costs and (3) regularity of breast screening behaviors in terms of breast self-examination (BSE), clinical breast examination (CBE) and MM including stage breast cancer at diagnosis. Data analysis was determined by PASW Statistics version 18 as univariate and multivariate logistic regression. RESULTS: Health coverage for MM costs and all three behaviors were significantly related to and could predict the early stages breast cancer at diagnosis (p < 0.05): health coverage for MM costs (OR = 0.32, 95% confidence interval [CI], 0.17-0.63), BSE (OR = 8.08, CI 95%, 3.93-16.63), CBE (OR = 12.54, CI 95%, 2.29-68.65) and MM (OR = 5.89, CL 95%, 1.13-30.73). CONCLUSIONS: All three behaviors are essential and related to one another. CBE on a regular basis is the best predictor for early stages breast cancer at diagnosis in Thai context. Nurses should provide information and teach including re-check the woman's skills to perform BSE regularly.

Trapped in circle of threats: violence against sex workers in Thailand.

Most researchers studying sex work have focused on the risks of sexually transmitted diseases, predominantly HIV, for sex workers, their clients, and subsequent partners. Violence against these women often goes undocumented and unnoticed. Consequently, few researchers have addressed violence against sex workers, and these few have generated limited evidence about the nature of violence from the sex-worker perspective--especially the street sex worker perspective. In this study, we used qualitative methods to explore characteristics of violence against street sex workers and how violence influences personal and societal health risks. The participants were 28 female street sex workers. The data were collected through in-depth interviews with 23 women, one focus group with 5 women, and observations of these women in their working and social environment. The results revealed that violence against sex workers can be clustered into three categories, threat to their life and health, threat to control of work and financial security, and finally, threat to humanity. Because they are disadvantaged, and engage in illegal employment, theses women were trapped in a circle of threats. To reduce violence, sex work should be decriminalized along with strategies to decrease poverty and social inequality. A special agency needs to be established to protect the rights and safety of sex workers.