Situational Analysis: Community Care for Survivors of Stroke and Suggestions for Improving the Provision of Care.

This descriptive qualitative study aimed to analyze the community care situation for survivors of stroke and provide suggestions for improving care. The study was conducted in a district of Chiang Mai Province. Purposive sampling was employed based on inclusion criteria to select 51 key informants comprised of 1) three health personnel, 2) 13 community leaders, 3) three local government officers, 4) 13 village health volunteers, and 5) 13 caregivers who took care of survivors of stroke. The data collection consisted of in-depth interviews and focus group discussions, based on the Expanded Chronic Care Model. Data were analyzed by content analysis. The results revealed that community care for survivors of stroke is mainly provided by family members. As well, our analysis revealed for survivors: 1) inadequate personal skills among caregivers and volunteers; 2) inefficient health services; 3) the lack of support for a caring system; 4) incomplete clinical information system; 5) no healthy public policy; and 6) lack of a supportive environment. We suggest that, to improve the care available to survivors of stroke, there needs to be: 1) development of supportive policies at both national and local government levels; 2) development and provision of guidelines for the care; and 3) a supportive caring system that includes health personnel, caregivers, and rehabilitation facilities, as well as support for the home and community-based environment. These results and suggestions will be useful to community nurses and stakeholders who are responsible to design caring for survivors of stroke.

A nursing intervention to enhance the self-care capacity of nondisclosed persons living with HIV in Thailand.

Significant numbers of nondisclosed persons living with HIV (NPLWH) who are aware of their status do not enter care and must rely on their own abilities to maintain their health. This study shows how these individuals can be reached through nongovernmental organizations and assisted to improve their self-care capacity through an intensive nursing intervention. NPLWH in Chiang Mai, Thailand, were assessed using a 31-item self-care capacity questionnaire (range = 0-62) at baseline and monthly for 6 months. The nursing intervention used reflective questioning to assist PLWH to find ways to improve their self-care capacity. At baseline, the mean self-care capacity score was 31.4. After 3 months of intervention, the score increased to 54 and was maintained at this level for the next 3 months. This study demonstrates that nurses can reach out to NPLWH who are not in care and help to improve self-care capacity.

Implementation of the World Health Organization surgical safety checklist at a university hospital in Thailand.

BACKGROUND: Compliance with the World Health Organization (WHO) surgical safety checklist may reduce preventable adverse events. However, compliance may be difficult to implement in Thailand. This study was conducted to examine compliance with the WHO checklist at a Thai university hospital. METHODS: A descriptive study was conducted among 4,340 patients undergoing surgery in nine departments from March to August 2009. The compliance rates were computed. RESULTS: The highest compliance rate (91.4%) during the sign-in period was with patients' confirmation of their identity, operative site, procedure, and consent. However, only 19.4% of the surgical sites were marked. In the time-out period, surgical teams had introduced themselves by name and role in 79% of the operations; and in 95.7% of the cases, the patient's name, the incision site, and the procedure had been confirmed. Antibiotic prophylaxis had been given within 60 min before the incision in 71% of the cases. For 83% of the operations, the surgeons reviewed crucial events whereas only 78.4% were reviewed by the anesthetists. Sterility had been confirmed by the operating room nurses for every patient, but the essential imaging was displayed at a rate of only 64.4%. In the sign-out period, nurses correctly confirmed the name of the procedure orally in 99.5% of the cases. Instrument, sponge, and needle counts were completed and the specimen was labeled in most cases, 96.8% and 97.6%, respectively. Equipment-related problems were identified in 4.4% of the cases, and 100% of them were addressed. The surgeon, anesthetist, and nurse reviewed the key concerns for recovery and management of the patient at the rate of 85.1%. CONCLUSIONS: The WHO checklist can be implemented in a developing country. However, compliance with some items was extremely low, reflecting different work patterns and cultural norms. Additional education and enforcement of checklist use is needed to improve compliance.

HIV positive but not in care: a follow-up study from Thailand.

Twenty-two persons in Northern Thailand who knew of their HIV positivity but were not in care were identified. They had significant medical, economic, behavioral, and family problems. A nurse researcher carried out a 6-month intervention with them to (1) assess whether they would remain in contact with the researcher for 6 months and (2) assess whether they would make positive changes in their lives. All 22 participants remained in contact for 6 months. A 5-step intervention process resulted in substantial improvements in their lives. Eleven patients entered care. Five needed immediate antiretroviral therapy (ART) and improved their CD4 counts. Six others established primary care relationships for non-HIV care. Twelve obtained legal, full-, or part-time employment. Eight disclosed to family members. Nine participants and/or family members entered counseling. Twelve persons publicly disclosed themselves. Twelve reported reducing or stopping substance abuse. Of 4 sex workers, 2 ceased engaging in that work.

Development of a theory-based sexual and reproductive health promotion and HIV prevention program for Chinese early adolescents.

The purpose of this study was to develop a theory-based program for Chinese early adolescents in order to promote their sexual and reproductive health and to prevent HIV infection. The program was designed based on the Information-Motivation-Behavioral skills model and a needs assessment among the stakeholders. A technical collaborative action research approach was applied. The study's participants were 102 early adolescents in a public middle school in mainland China, with the involvement of other key stakeholders, including 15 teachers and 12 parents. The results revealed a statistically significant improvement in the scores of sexual and reproductive health promotion and HIV prevention information, motivation, and behavioral skills after the program's implementation. Meanwhile, qualitative data from the early adolescents' reflection indicated that the content was useful and comprehensive, the trainers were friendly and knowledgeable, and participatory learning with an "edutainment" style was especially impressive. Additionally, the early adolescents expressed that they could apply the knowledge and skills in their daily life, which would benefit themselves and their family and peers. The Information-Motivation-Behavioral skills model could be explored in a non-Western context and the program was shown to be acceptable for use in a Chinese middle school setting.

Nursing values in China: the expectations of registered nurses.

Abstract The purpose of this study was to identify the essential professional values of Chinese nurses and their manifestations in the current health-care environment. Data were collected from 29 nurse experts by semi-structured individual interviews or focus groups in Beijing and Shanghai, China. Thematic analysis was used to analyze the data. Seven themes were identified: altruism, caring, trustworthiness, dignity, responsibility for the development of the profession, autonomy, and justice. On the whole, these values were in accordance with the codes of the International Council of Nurses and the Chinese Nursing Association. Additionally, culture and socioeconomic trends were found to have an influence on nurses' understanding and explanation of professional values. The findings of this study provided insight into Chinese nurses' professional values and might contribute to the future development of a culturally sensitive scale to measure nursing values in China.

Known to be positive but not in care: a pilot study from Thailand.

This study was designed to describe persons with HIV/ AIDS (PWHAs) in Thailand who have not disclosed their HIV status to the government HIV clinics to receive medical care. Objectives were to (1) demonstrate a way to access these persons, and (2) describe their characteristics, HIV status, reasons for nondisclosure, and problems related to their self-care. Two nongovernmental organizations (NGOs) serving the nonmedical needs of PWHAs were used. In all, 22 PWHAs participated. Approximately 80% have known their HIV status for more than 1 year and 30% for more than 5 years. Almost 60% currently used recreational drugs. Reasons for not disclosing their HIV status included that they were still healthy (81.8%) and worried about stigma (77.3%). Two thirds will disclose when a serious problem occurs. This study demonstrates that this population can be accessed and studied through NGOs and that this population differs slightly from PWHAs in Thailand studied at initiation of medical care.

Development of competency inventory for registered nurses in the People's Republic of China: scale development.

BACKGROUND: Literature review indicated there is no existing nursing competency framework or instrument for Chinese registered nurses. By virtue of its global leadership role in nursing, the International Council of Nurses (ICN) developed an ICN Framework of Competencies for the Generalist Nurses in 2003. On the basis of the ICN's framework, a qualitative study was conducted to explore the expectations of Chinese nurse professionals on nursing competency in the previous study. A competency framework for Chinese registered nurses was formed. This paper describes the development and testing of the Competency Inventory for Registered Nurses (CIRN). METHODS: A methodological study design was used, consisting of two phases with six steps. A review of literature generated 112 items, which were evaluated by six experts followed by field testing in a purposive sample of 815 Chinese clinical registered nurses. Factor analysis and item analysis were applied to establish the scale's construct validity and reliability. RESULTS: The final scale consists of seven dimensions with 58 items. The overall scale reliability had a Cronbach's alpha of 0.89; the dimensions Cronbach's alpha ranged from 0.79 to 0.86. In addition, evidence for two other kinds of validity was obtained, which included criterion-related validity (r=0.44, p=0.04) and contrasted-group validity (p<0.001). CONCLUSION: The CIRN has demonstrated evidence of internal consistency reliability, content validity, and construct validity, and it provides an objective tool for assessing registered nurse competencies in the various areas of clinical practice.

Roles of infection control nurses in university hospitals.

OBJECTIVE: To evaluate the roles of infection control nurses (ICNs) in university hospitals. MATERIAL AND METHOD: Interviewing 23 ICNs in 6 university hospitals applying for hospital accreditation during March and April 2002. RESULTS: The ICNs had an average work experience of 11.3 years. The roles relatively well carried out by the ICNs were: administration, outbreak investigation, personnel health, education, consultation. Better performance was needed in the roles of presenting surveillance data to infection control committee, research and analyzing the needs and expectation of patients related to IC. CONCLUSION: Infection control nurses in university hospitals could perform their roles relatively well. However, better roles in surveillance, research and quality improvement need to be developed.

Reduction of the incidence of pressure sores by an education program on nursing care.

OBJECTIVES: To determine whether an education and campaign program would reduce the incidence of pressure sores. MATERIAL AND METHOD: The study was performed in a 1,400-bed teaching hospital in Thailand with a total number of 697patients from 47 wards for a point prevalence study; 1,201 and 1,268 patients from 12 wards to determine whether reduction of pressure sore occurrence would be obtained by an education program. RESULTS: The point prevalence of pressure sores was 10.8%. The significant risk factors were age older than 60 years, fecal incontinence, and history of diarrhea. The occurrence of pressure sores was significantly reduced after the educational program from 9.91% to 5. 76%. The education on patient care aiming at reduction of the occurrence of pressure sores could be adopted nation-wide in order to reduce the morbidity, mortality and expenses. CONCLUSION: The education program was effective in reducing the incidence of pressure sores.