Princess of Naradhiwas University Journal

Effectiveness of a Massive Open Online Course in Paediatric Nursing for Undergraduate Nursing Students

Siriporn Vetcho — 2026-08-18

Background and Objective Massive Open Online Courses (MOOCs) represent a flexible and accessible mode of learning, with a strong emphasis on learner-centered approaches. ThaiMOOC is Thailand’s national MOOC platform that provides open online courses for higher education and lifelong learning. This study aimed to evaluate the effectiveness of the ThaiMOOC-based paediatric nursing course in enhancing knowledge, learning behaviours, and satisfaction among undergraduate nursing students from networked institutions.

Methods A quasi-experimental one-group pretest–posttest design was employed with a sample of 210 nursing students from five institutions. This course consisted of 14 modules with a total learning time of nine hours. The intervention was delivered through the ThaiMOOC online learning platform. The research instruments included a demographic questionnaire, a knowledge assessment test, a learning behavior questionnaire, and a satisfaction questionnaire. Data were analyzed using descriptive statistics and a paired t-test.

Result The finding revealed that students’ knowledge scores significantly increased from pretest (M = 22.06, S.D. = 7.667) to posttest (M = 36.12, S.D. = 5.213), p < .001. Learning behaviours were reported at a “frequent” level (M = 4.12, S.D. = 0.519), while satisfaction with both course content and course design was rated as “very high” (M = 4.19, S.D. = 0.272).

Conclusion and Recommendations The ThaiMOOC-based paediatric nursing course was associated with significant improvements in nursing students’ knowledge, learning behaviours, and satisfaction, demonstrating the value of well-designed MOOC instruction in nursing education. By structuring learning into smaller modules and adopting a learner-centred approach, it can effectively promote flexible learning and support educational equity.

Caregiver’s Factors Influencing Time to Access an Emergency Department among Older Persons with Acute Ischemic Stroke

Keerati Nitipuwadol — 2026-08-18

Background and Objectives Caregivers play a crucial role in deciding to transfer patients with symptoms of acute ischemic stroke for treatment within 4.5 hours or 270 minutes. This study aimed to investigate 1) the emergency department length of stay of older adults with prodromal symptoms of acute ischemic stroke, and 2) caregiver factors influencing the emergency department length of stay of older adults with acute ischemic stroke.

Methods Predictive research. The sample consisted of 100 caregivers or individuals who brought older adults to the emergency department. Data were collected at the emergency department and stroke ward of a central hospital in Samut Sakhon Province. The instruments used for data collection included 1) a general information questionnaire, 2) a knowledge questionnaire about stroke prodromal symptoms, 3) a disease severity perception assessment, 4) a symptom management questionnaire, and 5) a hospital arrival method questionnaire. These instruments had validated content validity with scores of 1.00, .96, .90, .94, and 1.00, respectively. The reliability analysis of questionnaires number 2, 3, 4, and 5 yielded scores of .70, .63, .94, and 1.00, respectively. Data were analyzed using descriptive statistics and multiple regression analysis.

Results The emergency department length of stay for older adults with acute ischemic stroke was 399 minutes. Factors related to knowledge about the prodromal symptoms of acute ischemic stroke and the management of symptoms by caregivers or transporters influenced the emergency department length of stay by 14.5% (adjusted R² = .14, p<.001).

Conclusion and Recommendation The study results provide foundational information for educating caregivers or individuals who encounter elderly patients suspected of having acute ischemic stroke about the prodromal symptoms and symptom management, ensuring that the elderly patients receive timely treatment in the emergency department.

Predicting Factors of Executive Function Development among Preschoolers in Orhanages

Pennapa Phummai — 2026-08-18

Background and Objectives Executive function development is a fundamental foundation for learning, emotional regulation, and behavioral control in children. Preschool children with well-developed executive functions can engage in analytical thinking, planning, problem-solving, impulse control, and social adaptation in the future. This study aimed to examine factors predicting executive function development among preschool children living in orphanages.

Methods This study employed a predictive correlational research design. The simple random sampling of 85 preschool children aged 3- 6 years residing in three government orphanages in Bangkok and its surrounding areas. Samples were selected using a multistage random sampling. The research instruments consisted of four questionnaires: a general information; Child’s Sleeping Habits: Thai version (abridged version); a preschool language development; and the Executive Function Development for Early Childhood. The second and fourth questionnaires demonstrated Cronbach’s alpha reliability coefficients of 0.78 and 0.96, respectively. The language development questionnaires showed a sensitivity of 41.70% and a specificity of 75.50%. Data were analyzed using descriptive statistics and stepwise multiple regression analysis.

Results The overall executive function development of preschool children in orphanages was at a moderate level, with a mean score of 81.61 (S.D. = 25.20, range = 14-127) and a mean T-score of 51. Gender was identified as only significant predictor, explaining 33.40% of the variance in executive function development (R² = .334, p < .001). Boys showed significantly lower executive function development than girls (β = -.578, p < .001).

Conclusion and Recommendations Gender significantly predicts executive function development among preschool children living in orphanages. Pediatric nurses and child caregivers are encouraged to develop appropriate strategies to enhance executive function skills, particularly among boys.

Development of a Health Literacy Management Model to Delay Kidney Deterioration in Patients with Type 2 Diabetes with Complications of Chronic Kidney Disease stage 3 in the Wang Wiset District Network, Trang Province

Jiravadee Sinchai — 2026-08-18

Background and Objectives Diabetes is a chronic disease caused by abnormalities in the production or response to the body's insulin hormone, leading to inefficient use of sugar and high blood sugar levels and resulting in chronic kidney complications. Health literacy is therefore a factor that can delay kidney deterioration in diabetic patients and reduce blood sugar levels. This research and development aimed to create a health literacy management model designed to delay kidney deterioration and evaluate the effectiveness of this model in patients with type 2 diabetes who have chronic kidney disease stage 3 complications within the Wang Wiset district network in Trang Province.

Methods The research was conducted using a research and development approach from March 2024 to May 2025 at the chronic diabetes and chronic kidney disease clinic, Wang Wiset Hospital, Trang Province. The sample consisted of 30 patients with type 2 diabetes with complications of chronic kidney disease stage 3. The research process included four phases: 1) Situational analysis and problem identification, 2) Development of a health literacy management model, 3) Implementation of the model for managing health literacy, and 4) Evaluation of the outcomes of using the health literacy management model. Research tools included in-depth interviews, feasibility questionnaires for the model, health literacy questionnaires for patients with diabetes, and satisfaction questionnaire for service providers using the health literacy management model. The research tools were validated by five experts. Data were analyzed using descriptive statistics, T-test, and content analysis.

Results Research results revealed that 1) the situational analysis identified the existing healthcare service model as reactive, lacking a complete interdisciplinary team. The sample group exhibited inappropriate behavioral outcomes, and their kidney filtration rates and blood sugar levels could not be controlled within the standard parameters. 2) The development of a health literacy management model to delay kidney deterioration utilized health literacy theory, and 3) the evaluation of the outcomes of using the health literacy management model to delay kidney deterioration showed that the average estimated glomerular filtration rate (eGFR) (M = 51.03, S.D. = 12.40) increased before using the health literacy management model (M = 44.95, S.D. = 7.91) and the average blood sugar level (HbA1c) (M = 7.15, S.D. = 0.93) decreased before using the health literacy management model (M = 7.83, S.D. = 1.39) significantly (p<0.05).

Conclusion and Recommendation This research indicates that the developed health literacy management model to delay kidney deterioration in patients with type 2 diabetes can effectively enhance nursing quality and clinical outcomes.

Factors Associated with Serum 25-Hydroxyvitamin D Levels in Muslim Women in Narathiwat Province: A Cross-Sectional Analytical Study

Davis Muhammaddawood WamaeWamae — 2026-08-21

Background and Objectives This analytical cross-sectional study aimed to compare serum 25-hydroxyvitamin D [25(OH)D] levels between Muslim women who wear a headscarf and those who do not in Narathiwat Province, Thailand, while analyzing factors associated with vitamin D levels after controlling for physiological confounders.

Methods A total of 100 female participants were equally divided into two groups: headscarf-wearing (n=50) and non-headscarf-wearing (n=50). Serum vitamin D levels were measured as total serum 25(OH)D using Chemiluminescent Microparticle Immunoassay (CMIA) at an ISO 15189:2012-certified laboratory. Data were analyzed using descriptive statistics, independent t-test, multiple linear regression, and logistic regression analysis.

Results The mean vitamin D level in the headscarf group (18.92 ± 7.34 ng/mL) was significantly lower than that in the non-headscarf group (25.22 ± 8.77 ng/mL) (p < 0.001), with a large effect size (Cohen’s d = 0.776). Multiple linear regression revealed that headscarf wearing was the only statistically significant predictor of vitamin D levels (B = -6.05, 95% CI: -9.16 to -2.95, p < 0.001), after adjusting for age, BMI, and eGFR (R² = 0.231). Furthermore, logistic regression showed that headscarf-wearing women had 7.16 times higher odds of vitamin D deficiency (95 % CI: 2.72 –18.90, p < 0.001). None of the headscarf-wearing participants achieved the optimal vitamin D level (≥ 40 ng/mL)

Conclusion and Recommendation The findings of this study indicated that Headscarf wearing is a significant independent predictor of lower serum vitamin D levels. Clothing-related physical barriers reduce UVB-exposed skin surface area, substantially limiting cutaneous vitamin D synthesis. These findings support targeted vitamin D screening and supplementation strategies for this high-risk population, while respecting their cultural and religious practices. Future studies should incorporate quantitative sun exposure assessment, dietary vitamin D intake, and genetic polymorphisms to more comprehensively explain the remaining variance.

Development of Self-Management Support Program Integrated with a Mobile Application for Patients with Uncontrolled Hypertension

Aminee Saroeng — 2026-09-17

Background and Objectives The World Health Organization (WHO) identifies cardiovascular disease as the leading cause of death worldwide, with hypertension being a major risk factor. In Thailand, the prevalence of hypertension has risen from 25.4% to 29.5%, escalating patients' risk of life-threatening complications, including stroke, ischemic heart disease, heart failure, chronic kidney disease, cognitive impairment, and dementia. Although lifestyle modification is a cornerstone of long-term management, Pattani Province consistently fails to meet hypertension control targets. This challenge is primarily driven by self-management support models and health policies that lack effective health data-recording systems to stimulate patient self-management behaviors actively. This study, therefore, aims to develop and evaluate the effectiveness of a mobile application-based self-management support program for patients with uncontrolled hypertension

Methods This research and development (R&D) study was conducted in two phases: Phase 1 focused on developing the program model, and Phase 2 involved quality validation and pilot testing. The sample consisted of 5 registered nurses from the outpatient chronic disease clinic and 25 purposively selected patients with hypertension. The research instruments included the newly developed self-management support program combined with a mobile application, a hypertension knowledge assessment, an appropriate health behaviors questionnaire, a perceived self-management self-efficacy scale, a feasibility evaluation form, and a user satisfaction questionnaire. Data were analyzed using descriptive statistics and paired t-tests.

Results The program consisted of three components: 1) a program implementation manual, 2) a self-management support activity plan, and 3) a mobile application user guide for logging health behavior modifications. Following the pilot testing with patients, the post-test mean scores for hypertension knowledge, appropriate health behaviors knowledge, and perceived self-management self-efficacy were significantly higher than the pre-test scores (p < .001). Regarding program feasibility, the registered nurses unanimously agreed that the program was user-friendly and practical. For the patient group, the post-test mean score for feasibility was at a moderate level (48%, M=41.44, SD=3.15), while their mean satisfaction score was at a high level (40 %, M = 21.16, S.D. = 2.15)

Conclusion and Recommendations The developed program effectively increased the mean scores for hypertension knowledge, appropriate health behaviors knowledge, and perceived self-management self-efficacy, with statistically significant improvements at the .001 level. Therefore, future studies should evaluate the effectiveness of the program using a quasi-experimental research design with a larger sample size.

Effects of Pain Assessment and Management Models on Caregivers' Knowledge and the Nurses' Practices in Pediatric Patients After Appendectomy

Rawadee Kongdee — 2026-09-17

Background and Objectives: Pain in pediatric patients after appendectomy is an acute condition that causes discomfort both physically and mentally, especially in preschool children aged 3-6 years who cannot communicate their needs. If nurses do not assess and manage pain consistently, it can lead to complications. This study aimed to 1) investigate the effect of the knowledge media "Application PAIN ASSESSMENT KIT TO KID" via QR Code on the knowledge of pain assessment and management among caregivers of children aged 3-6 years who have undergone appendectomy, comparing before and after the experiment between the experimental group and the control group, and 2) compare the average nursing practice scores and the satisfaction of professional nurses in using nursing practice guidelines for pain assessment and management against the specified criteria

Methods A quasi-experimental study with a pre-test and post-test design. The sample consisted of caregivers of children aged 3-6 years undergoing appendectomy, who were divided into experimental and control groups, each consisting of 35 individuals, along with 16 professional nurses working in the pediatric ward. The tools used in the experiment included the knowledge media "Application PAIN ASSESSMENT KIT TO KID" via QR code for caregivers and nursing practice guidelines for pain assessment and management for professional nurses, which had an IOC value of 0.67-1.00. The tools used for data collection included a caregiver knowledge assessment with an IOC value of 0.67-1.00 and a KR-20 value of 0.72, a nursing practice questionnaire, and a nurse satisfaction questionnaire regarding the use of nursing practice guidelines, both with an IOC value of 0.67-1.00. Cronbach’s alpha coefficients were 0.83 and 0.76, respectively. Data analysis used descriptive statistics, including percentage, mean, and standard deviation; the Wilcoxon Signed Ranks Test; the Mann-Whitney U test, one-sample t-test, and One-sample Wilcoxon Signed Rank Test.

Results

The knowledge of caregivers of children aged 3-6 years undergoing appendectomy in assessing and managing pain after using the education media "Application PAIN ASSESSMENT KIT TO KID" through QR Code showed that caregivers had significantly increased knowledge (p-value < 0.001, z-value = -4.82) compared to the control group, with a statistically significant difference (p-value < 0.001).
The average nursing practice score in pain assessment and management was higher than the specified criteria (mean > 4.00), with a statistically significant difference (p-value < 0.001).
The average satisfaction score of nurses in using nursing practices is higher than the specified criteria (mean > 3.50), with a statistically significant difference (p-value < 0.001).

Conclusion and Recommendations The research findings on the pain assessment and management model after appendectomy can be applied in nursing practice. This enables pediatric caregivers to gain knowledge and nurses to have continuous nursing practices for pain assessment and management, thereby reducing postoperative complications.

Effects of Injectable Medication Label Development on Medication Errors, Adverse Drug Events, and Medication Wastage Costs at Sungaikolok Hospital

Tatchai Tanchaitechawut — 2026-09-25

Background and Objectives Medication errors and adverse drug events associated with injectable medications are important patient safety concerns, particularly during medication compounding, preparation, and administration. Labels that do not adequately support clinical workflows may increase the risk of errors. This study aimed to evaluate the effects of redesigning injectable medication labels based on Human Factors Engineering (HFE) principles on medication errors, adverse drug events, and medication wastage costs at Sungaikolok Hospital.

Methods A quasi-experimental study with an uncontrolled before-and-after design was conducted. Incident reports from the HRMS were compared between the pre-intervention period (May 1, 2024, to February 28, 2025) and the post-intervention period (March 1 to December 31, 2025). Eligible incident reports involving medication errors or adverse drug events associated with injectable medications were included. The labels were redesigned to support nursing workflows and provide information on routes of administration, drug stability, compatibility, pH, and osmolarity, together with safety warning symbols.

Results The number of reported incidents was lower in the post-intervention period than in the pre-intervention period. The distribution of incident severity levels differed significantly between the two periods (p = 0.025). No level C incidents were reported after the intervention, and the number of level D incident reports decreased from 12 to 8. Reported errors involving medication compounding and preparation, as well as the handling of multiple-dose medications, also decreased. Medication wastage costs decreased from THB 2,662.01 to THB 806.00.

Conclusions and Recommendations Implementation of injectable medication labels development using HFE principles was associated with fewer reported incidents and lower medication wastage costs. These findings suggest that user-centered label design may support medication safety. However, the absence of a control group precludes attributing the observed changes solely to the redesigned labels.

Factors Affecting the Enhancement and Service Quality Development of Premium Thai Massage Establishments in Uttaradit Province

Jaruwan Koedphon — 2026-09-30

Background and Objectives: Premium Thai massage has the potential to promote wellness tourism in secondary cities, but there is still a lack of empirical evidence regarding mechanisms to enhance service quality. This research aimed to analyze the influences of factors such as personnel, facilities, management, and innovation on service quality and to propose prioritized development strategies for premium Thai massage establishments in Uttaradit Province.

Methods: A sequential explanatory mixed-methods design (QUAN → qual) was used. Quantitative data were collected from a sample of 609 individuals, including 45 entrepreneurs, 180 personnel, and 384 customers. Data were analyzed using descriptive statistics, Pearson correlation, multiple regression and subgroup analysis. Common method bias was checked using Harman's Single Factor Test (first component = 28.43%, below the 50% threshold). Qualitative data were collected through in-depth interviews with 20 key informants. Data were analyzed using content analysis, and credibility was verified according to Lincoln and Guba's (1985) criteria through triangulation and member checking.

Results: Results showed that all four factors significantly influenced service quality (p < .01) and together predict service quality at 68.40% (R² = .684). The personnel factor had the highest influence (β = .342, f² = .224), followed by management (β = .276, f² = .128), facilities (β = .198, f² = .079), and innovation (β = .156, f² = .049). The subgroup analysis confirmed the model's consistency in the entrepreneur group (R² = .621), personnel group (R² = .671), and customer group (R² = .612). Customers expressed high satisfaction (M = 4.12), with 87.50% intending to use the service again. Qualitative results confirmed that personnel and management were the main mechanisms for enhancing service quality, while retaining skilled personnel and controlling costs were significant constraints.

Conclusion and Recommendations: The quality of services should be enhanced and prioritized, starting with the development of a human resources and management standard system (3–6 months), followed by facility upgrades (6–12 months), and the gradual implementation of digital innovations in the long term. The strategy should leverage the province's potential as a transit point for 1,100,382 tourists annually, who have a lower overnight stay rate than the northern region average, to develop the identity of a wellness stopover in line with the stopover tourism concept, which indicates that secondary cities can sustainably create value by being transit points.