Princess of Naradhiwas University Journal

Effects of Preanesthesia Preparation Application on Knowledge, Anxiety of Preanesthesia Preparation, and Self-management of Pain among Clients Underwent One Day Surgery without Prior Anesthesia Experience from Anesthesia Team

Kuntalee Chaikate, Woralak Chanphong, Punika Aonthong — Wed, 15 Jan 2025 00:00:00 +0700

This research was quasi-experiment with a two-group pretest-posttest design aimed to study effects of preanesthesia preparation application on knowledge, anxiety of preanesthesia preparation, and self-management of pain among clients underwent one day surgery without prior anesthesia experience from anesthesia team. Simple random sampling was used to choose the samples, which were split into 30 members of the control group and 30 members of the experimental group. The created application of the trial instrument was validated by three experts. The contents of the data collection instruments, which included a personal data questionnaire, a knowledge measurement before to anesthesia, and an anxiety questionnaire were validated by five experts equaled to 0.86 and 0.92. The reliability was assessed using the Kuder-Richardson formula, which equaled 0.72, and the reliability were tested by using the Kuder-Richardson formula equaled 0.72 and the Alpha Cronbach coefficient was determined to be 0.86.

According to the results after applying the application of the preanesthesia preparation, the experimental group's average scores were statistically significantly higher than those of the control group (p <0.001) and their average anxiety scores were statistically significantly lower than those of the control group (p <0.001).

Effects of Using the Bilangual (Thai - Malayu) Cartoon Animation on Knowledge and Attitudes Towards Vaccination among Caregivers of Children’ Delayed Vaccination Schedules in Narathiwas Province

Wanisa Hayeese, Hamdee mayae — Wed, 15 Jan 2025 00:00:00 +0700

The quasi-experimental research aimed to investigate the effects of using bilangual (Thai-Malayu) cartoon animation on knowledge and attitudes towards age-appropriate vaccinations as well as cartoon animation satisfaction. Samples were 32 parents of children aged zero to five years old who postponed their children's immunization schedules and resided in the Narathiwas province. The design thinking method of: 1) empathizing; 2) defining the problem; 3) ideating; 4) prototyping; and 5) testing was used to develop the bilingual (Thai-Malayu) cartoon animation that served as the trial's instruments. The instruments used to collect the data included a knowledge measurement, and an attitude questionnaire. Data were analyzed by using average, standard deviation, Pair t-test and satisfaction questionnaire.

The results showed that samples' average scores of knowledges and attitude toward vaccination were statistically significantly higher after using the program (t = 1.26, t = 1.87, p<0.05, respectively), and they were highly satisfied with the use of the bilingual (Thai-Malayu) cartoon animation (M = 4.54, SD = 1.02). According to the study's findings, caregivers may find it particularly enjoyable to learn from bilingual (Thai-Malayu) cartoon animation since it tells a true story that they can employ in their everyday lives. Additionally, it uses a language that is acceptable for the people living in the three southern border provinces.

Factors Associated with Suicidal Ideation among Junior High School Students in Mueang District, Nakhon Ratchasima Province

Wed, 15 Jan 2025 00:00:00 +0700

The purpose of this predictive regression analysis study was to investigate the factors associated with suicidal ideation in junior high school students. A multi-stage random sampling was used to recruit samples of 280 junior high school students in Mueang district, Nakhon Ratchasima province. The following research tools were used: 1) a questionnaire about stressful life events; 2) a measure of adolescents' coping strategies; and 3) an assessment of suicide ideation. The results of reliability indexes of these instruments were 0.91, 0.71, and 086, respectively. Data were analyzed by using frequency, percentage, average, standard deviation, range, and multiple regression analysis.

The findings showed that: 1) The three most stressful events in their lives were students' problems with their study course, study limitations, and friends, with scores of 90.00, 85.40, and 83.90, respectively; 2)The three coping strategies that students used the most were self-competency, other support resources, and problem avoidance (81.10, 64.30, and 44.60, respectively); 3) students' suicidal ideation was low, high, and very high (79.30, 12.10, and 8.60, respectively); 4) There were five factors linked to suicidal ideation in students: coping strategies by avoiding problems, coping strategies by using other resources for support, stressful life events involving study course problems, problems with teachers, and problems with lovers (β =.291, -.279, .131, .126, and .126, respectively) .Suicidal ideation among students was predicted by these characteristics in 29.10% (R2=.291, p<.05). The results can be used to reduce suicide ideation in students by reducing stressful events and encouraging students to use appropriate coping strategies.

Predicting Factors of Symptoms among Persons Suspected of Acute Coronary Syndrome in Emergency Department, Secondary Hospital

Wed, 15 Jan 2025 00:00:00 +0700

This predictive correlational study aimed to identify factors that predict patient-reported symptoms of acute coronary syndrome (ACS) individuals presenting with suspected ACS at the emergency department of secondary hospital, A purposive sample of 419 individuals aged 35 years and older with suspected ACS was selected. Data were collected through interviews using a questionnaire, which included demographic information, a 15-symptom checklist, and a clinical data form. Descriptive statistics, Chi-Square, and binary logistic regression were employed for data analysis.

The results revealed that 62.53% of the participants developed ACS. Chest pain (OR=1.924, 95% CI 1.196–3.096, p=.007), shortness of breath (OR=2.237, 95% CI 1.229–4.072, p=.008), upper xiphoid and abdominal pain (OR=0.275, 95% CI 0.133–0.567, p<.001), and weakness or dizziness (OR=2.650, 95% CI 1.367–5.140, p=.004). Collectively, these factors predicted ACS with statistical significance at p <.05 and predicted the occurrence of ACS by 66.80%.

The findings suggest that healthcare providers should have prioritized early screening and monitoring of ACS, particularly in patients presenting with chest pain, shortness of breath, abdominal discomfort, and weakness or dizziness, to facilitate timely diagnosis, enhance treatment outcomes, and lower the risk of complications from delayed recognition.

Incidence and Predicting Factors Associated with Complications in Patients with Stroke in Rehabilitation Phase at Thung Khoa Luang Hospital in Roi-Et Province

Wuttichai Somgit, Pitchaon Nampeng — Wed, 15 Jan 2025 00:00:00 +0700

This descriptive retrospective analysis research aimed to study incidence and predicting factors associated with complications in patients with stroke in rehabilitation phase at Thung Khoa Luang Hospital in Roi-Et Province. Samples were 136 patients with stroke in rehabilitation phase who were admitted in inpatient ward at Thung Khoa Luang Hospital between January 1, 2018, and December 31, 2022, and who met the inclusion criteria. Data were collected from medical records by using a data record form with a content validity of 1. Sample data were analyzed by using descriptive statistics and multiple logistic regression statistics.

The findings showed that from 136 samples had complications (58.09%), which were divided among pneumonia (44.30%), pressure sores (32.91%), urinary tract infections (13.92%), and joint stiffness and muscular atrophy (8.86%). Predicting factors associated with complications in patients with stroke in rehabilitation phase at Thung Khoa Luang Hospital were male (OR Adj 3.56; 95 %
CI = 1.33, 9.54; p = 0.012), those with Activity Daily Living scores between 25 and 45 (OR Adj 7.38; 95% CI = 1.48, 36.89; p = 0.015), those with Activity Daily Living score between 75 and 90 (OR Adj 4.64; 95 % CI = 1.08, 19.86; p = 0.039), dysphagia issues (OR Adj 9.06; 95 % CI = 2.66, 30.85; p < 0.001), and urine and bowel incontinence (OR Adj 9.35; 95 % CI = 1.41, 61.86; p = 0.020).

Development of Nursing Service System for Critical Ill Patients, Mahasarakham Hospital Network

Wed, 15 Jan 2025 00:00:00 +0700

This research and development aimed to develop and evaluate the implementation of a Critical Care Nursing Service System in the Mahasarakham Hospital Network. The study consisted of 4 phases: 1) situation analysis, problem identification, and needs assessment; 2) development of the critical care nursing service system, quality verification, and pilot study; 3) implementation of the critical care nursing service system to examine its effectiveness with 240 critical patients and 116 professional nurses, and 4) evaluation, improvement, and system quality confirmation. Research instruments included in-depth interview forms, nursing outcome records, critical care nursing service system structure assessment forms, knowledge tests, nursing practice evaluation forms, satisfaction assessment forms, and focus group discussion guidelines. Five experts validated all instruments. The research was conducted between October 2022 and April 2024. Data were analyzed using descriptive statistics, chi-square test, and content analysis.

The results showed that the developed critical care nursing service system aligned with the context and practitioners' needs, comprising 3 aspects: 1) Structure, including policies, facilities, personnel, and medical equipment; 2) Process, including professional nurse competency development in critical care units, nursing communication and supervision, nursing practice guidelines, and task assignment and medical equipment readiness, and 3) Outcomes, including service recipients, service providers, and organization. After implementing the developed system, critical care nursing outcomes showed improvement trends and met the indicators. Professional nurses received competency development and increased participation in specialized critical care nursing training programs. This indicates that the developed nursing service system can effectively and efficiently enhance nursing quality. However, continuous monitoring and supervision of the system should be maintained.

Factors Related to Nutritional Status among Preschool Children in Three Southern Border Provinces

Pramote Thapchan, Nethong Namprom, Jutamas Chotibang — Wed, 15 Jan 2025 00:00:00 +0700

Nutritional status among preschool children is an indicator of both their general health and the fundamental elements necessary for healthy growth. The objectives of this study were to: 1) examine the state of nutritional status among preschool children in three southern border provinces; and 2) investigate relationship between caregiver and child characteristics and nutritional status among preschool children in three southern border provinces. Samples were 96 caregivers of preschool children. Data were collected between January and May, 2024 with validated instruments comprised of: 1) a questionnaire for the personal information of preschool children and caregiver; 2) a record form for the nutritional status of preschool children; 3) a questionnaire for the consuming behavior of preschool children; 4) a measurement of the caregiver's knowledge regarding the nutritional status of preschool children; 5) a questionnaire for the preparation of food for preschool children; and 6) a questionnaire regarding the caregiver's attitude toward consuming. The reliability index values of these instruments were 0.80, 0.90, 0.80, and 0.82. Data were analyzed by using descriptive statistics and point biserial correlation coefficients.

The results found that 64.6% of preschool children had normal nutritional status. Consuming food behavior of children, caregiver’s nutritional status knowledge, and caregivers' food preparation behavior had statistically significant positive correlations with children's nutritional status (rpb =.378, p < .01; rpb = .226, rpb = .203, p < .05). However, there was a statistically significant negative association between the caregiver's attitude regarding consumption and the children's nutritional status. (rpb = -.207, p < .05).

It is necessary to encourage the caregiver's food consuming behavior, provide health education regarding nutritional status to the caregiver, encourage proper food preparation behaviors for the children, and encourage a positive attitude toward caregiver consumption to achieve normal nutritional status for preschool children.

The Development of A Nursing Supervision Model to Improve the Quality of Nursing in Critical Care

Wed, 15 Jan 2025 00:00:00 +0700

This research and development aimed to develop a nursing supervision model to improve the quality of nursing in critical care and assess the outcomes of utilizing the model. Samples were 90 participants including the head nurse, the vice head nurse, and nurses with experience caring for critically ill patients and 100 clients who used Saun Hospital's services. There were three phases of the research methodology: 1) Study nurse supervision issues; 2) Create a model for nursing supervision; and 3) Test and assess the results of using a model. The following were the research tools: 1) three parts of a nursing supervision model that the researcher developed, including the manual guidelines of a nursing supervision model, the adult learning program, and the practicum manual of critical care;
2) questionnaires that the researchers developed were validated by three experts with indexes equaled to 0.93, 0.93, 0.95, 0.8, and 0.7 and relied values equaled to 0.96, 0.96, 0.93, 0.93, and 0.93. The findings showed that: 1) the average scores of service quality and client satisfaction were at a high level; 2) the average scores of client opinion and contentment with a nursing supervision model were at a high level. The average knowledge score was statistically significantly higher after using the model than it was before; 3) nursing administration outcomes, nursing quality, sleep duration, and guideline practice after using the model were all equaled with the clinical outcomes standard after using the model. The prevalence of ventilator-associated pneumonia, high-risk medication errors, pressure sores, and fewer unplanned extubation.

Factors Affecting Recurrence among Patients with Stroke, La-ngu District, Satun Province

Paleeya Jaranai, Kittiporn Nawsuwan — Wed, 15 Jan 2025 00:00:00 +0700

This descriptive research using case control study aimed to determine factors affecting recurrence among patients with stroke, La-ngu district, Satun province. Sample were 128, divided into 64 of cases (recurrent stroke) and 64 of controls (post stroke) admitted to inpatient department of La-ngu hospital, Satun province. Research instruments consisted of demographic recording form and a set of questionnaires including knowledge of warning signs, perceived susceptibility, food consumption behavior, exercise, medication adherence, follow-up and alcohol drinking and cigarette smoking. IOC ranged from .67 to 1.00 and Cronbach alpha coefficient reliability of each of questionnaire was .710, .738, .773, .722, .748, .711 and .745 respectively. Data were analyzed using descriptive statistics and multiple logistic regression analysis. Research results were found as follows;

Factors affecting recurrence among patients with stroke La-ngu district, Satun province at significance levels of .01 and .001 included duration of stroke (OR_adj=71.09, 95%CI: 10.74-471.72), knowledge of warning signs (OR_adj=8.27, 95%CI: 1.90-35.95), perceived susceptibility of recurrence (OR_adj=87.95, 95%CI: 1.73-36.61) and appropriate food consumption (OR_adj=26.76, 95%CI: 5.51-130.01).

Hence, to reduce the chance of recurrent stroke, activities promoting knowledge of warning signs and perceived susceptibility of recurrence should be provided to patients as well as promoting food consumption behavior and continuous monitoring in those who had more than 1 year of disease duration.

Relationship Between Food and Nutrition Literacy and Caring Behavior about Food and Nutrition among Caregivers of Children Aged 3-5 Years

Wed, 15 Jan 2025 00:00:00 +0700

This descriptive research study aimed to examine the relationship between food and nutrition literacy and caring behavior about food and nutrition among caregivers of children aged 3-5 years. Samples were 174 caregivers of children aged 3-5 years in Tha Ruea subdistrict, Mueang district, Nakhon Si Thammarat province by using simple random sampling. Instruments were a food and nutrition literacy questionnaire and a questionnaire assessing caring behavior about food and nutrition among caregivers. The content validity indices were 0.95 and 0.86, respectively. Data were analyzed by using frequency, percentage, average, standard deviation, and Pearson’s Correlation Coefficient.

The findings showed that food and nutrition literacy was at a suitable level (36.2%), caring behavior about food and nutrition was at a moderate level (52.3%). There was a strong statistically significant positive correlation between food and nutrition literacy and caring behavior about food and nutrition among caregivers of children aged 3 - 5 years at .01 (r = .516 p = .00). Regarding the component, it was discovered that accessing information about food and nutrition, developing an understanding of that information, asking for information about food and nutrition, making decisions about food and nutrition, and bringing food and nutrition literacy to apply had statistically significant relationships with caring behavior about food and nutrition at 0.1 (r = 0.379, 0.503, 0.436, 0.493, 0.439,
p = 0.00), respectively.

The caregiver is a crucial person in caring about food and nutrition for children. As a result, this research should serve as a guideline for raising food and nutrition literacy in order to encourage responsible behavior that leads to healthy nutrition for children.

Factors Associated with Self - care behaviors of Patients with Chronic Schizophrenia

Wed, 15 Jan 2025 00:00:00 +0700

The descriptive study aimed to determine relationship among knowledge of the disease and drug-assisted treatment, social support, self-efficacy, and family function in relation to self-care behaviors of 90 patients with chronic schizophrenia who were treated with medication or monitored at a psychiatric clinic in Kalasin province using a purposive sample technique. The questionnaires used to collect the data were: 1) Personal information questionnaire; 2) Self-care behavior assessment; 3) Knowledge of the disease and drug-assisted treatment measurement; 4) Social support measurement; 5) Self-efficacy measurement; and 6) Family function measurement. The reliability indexes for parts 2, 3, 4, 5, and 6 were 0.87, 0.92, 0.80, 0.80, and 0.88, respectively. The data were analyzed by using descriptive statistics and Pearson correlation analysis.

According to the results, the majority of patients with chronic schizophrenia were male, and they exhibited good self-care behaviors (x ̅ = 132.73, S.D. = 6.47). Knowledge of the disease and drug-assisted treatment, social support, and self-efficacy, all had statistically significant moderately positive relationships with self-care behaviors at the 0.5 level (r =.497, p =.000; r =.498, p =.000; r =.573, p =.000, respectively). However, there was no statistically significant negative association between self-care behaviors and family function (r = -.028, p =.795).

The study's findings may serve as baseline information to enhance recommendations for encouraging self-care behaviors.

The Effect of Medication Reconciliation Process on Medication Errors at Medical Ward in Sungai Kolok Hospital

Kanchana Keawmang — Wed, 15 Jan 2025 00:00:00 +0700

The objectives of this retrospective descriptive study were to examine the effect of the medication reconciliation process, the quantity, nature, and degree of severity of medication errors, as well as the correlation between medication reconciliation and the type and magnitude of medication errors that occurred in the medical ward. Patients with past medication histories who were admitted to the medical ward at Sungai Kolok hospital between October 1, 2022, and September 30, 2023, served as samples of this study. Data was gathered from the hospital data-based system and the medication reconciliation form. Based on inclusion and exclusion criteria, the results showed that 1360 samples of 2760 patients had a history of medical usage prior to admission. The majority of 1008 patients had either hypertension alone or hypertension in conjunction with another illness. Pharmacists discovered medication errors in 324 patients throughout the admission period and 134 patients during the hospital discharge procedure. The three highest levels of medication errors were ordering medications that were not on the hospital list, making omission errors, and changing the dosage and mode of medication use. Only medication errors in severity levels B and C were discovered. Analyzing the relationship between medication reconciliation and the type and magnitude of medication errors revealed that there were statistically significant relationships between medication reconciliation and medication errors found in each severity level (p < 0.001) and the medication reconciliation process had statistically significant relationships with the type of medication errors regarding commission errors (P-value = 0.042). However, in this study no statistically significant relationship was found between the medication reconciliation process with other types of medication errors.

Analysis of Legal Factors Related to Drug Security in Thailand: Scoping Review

Wed, 15 Jan 2025 00:00:00 +0700

The United Nations Sustainable Development Goals (SDGs) related to health and well-being are closely connected to drug security, which in this study refers to “available when in need” for both normal and emergencies. This study was secondary research, employing a scoping review methodology to gather data on the legal factors affecting drug security issues in Thailand from January 1, 2000 to August 31, 2024. The data was gathered from academic databases and evaluated using the PRISMA-Scr Flow Diagram, alongside an exploration of legal awareness related to drug security through the Newscenter X news database. This study identified that the main issues affecting drug security in Thailand include reliance on imported pharmaceutical raw materials, inefficient management of the drug supply chain, the complexity of laws related to patents, trade competition, and international trade, which obstruct the production and access to generic drugs. Additionally, the system for procuring and supplying medicines during emergencies has proven inadequate in meeting demand promptly. Existing laws and measures require improvement to ensure drug security. The key recommendations from this study include the development of a new legal framework to support domestic drug production, procurement systems efficiency for greater flexibility and speed, and implementing compulsory licenses under patent laws when necessary to enhance access to affordable medicines for the people.

Self-care Experiences of Older adults with Diabetes Mellitus Following Limb Amputation Living in Rural Areas

Panida Yowapui, natthawut suriya, Nutjariya Phimpha, Keskanok Deeprom — Wed, 15 Jan 2025 00:00:00 +0700

This research article aimed to examine the self-care experiences of older adults with diabetes mellitus following limb amputation used a phenomenological qualitative research methodology. Key informants were twelve older adults with diabetes mellitus following lower limb amputation living in rural areas, Muang district, Maha Sarakham province. The period of data collection was February 2022–April 2022. Research instruments were an in-depth interview questionnaire, observations, field notes, and tape recordings. The Data were transcribed verbatim and analyzed by using thematic analysis.

The findings revealed that three primary themes emerged from key informants' definitions of self-care after limb amputation due to diabetes mellitus: 1) mental care, which included two subthemes: feeling of living with an incomplete organ and burdened by others; 2) physical part, which included two subthemes: losing one's ability to work and changing one's role in the family; and 3) stress coping strategies, which included three subthemes: self-consolation, limb amputation due to past karma, and dependence on others. Experiences of older adults with diabetes mellitus after limb amputation can serve as a basis information for preparing plans for their self-care after limb amputation to promote further appropriate treatment.

Health Literacy with COVID - 19 Prevention Behavior among Informal Workers in The Post-pandemic Situation in Chumphon Province

Nirachon Chutipattana, nisarat haohan — Wed, 15 Jan 2025 00:00:00 +0700

This cross -sectional study aimed to examine the relationship between health literacy and prevention behaviors of COVID-19 among informal workers during the post pandemic period in Chumphon province. Data were collected from 427 samples by using multistage sampling. Instruments used in this study were closed-ended questionnaire that created by the researcher were validated content by five experts, including health care professionals, experts in health education and behavioral science, experts in epidemic control and prevention, and experts in health literacy. The content validity was good at 0.93. The content validity was high at 0.93, and the reliability index was tested using tools that were deemed suitable by experts to test with informal workers who shared characteristics with the samples. The reliability index was high at 0.92, the literacy portion equaled 0.89, and the behavior component equaled 0.90. Data were analyzed by using descriptive statistics including frequency, percentage, average, standard deviation, and Pearson’s Correlation Coefficient.

Results found that informal workers had health literacy in a moderate level ( = 121.91,S.D. = 18.69) and prevention behaviors of COVID-19 was also in a moderate level ( = 80.29,S.D. = 13.63). There was a statistically significant relationship between the healthcare facilities accessed and health literacy (P<0.05). The findings of this study can be applied to the design of behavioral modification strategies and the monitoring and prevention of emerging diseases among the working-age population in the future.

Health Seeking Behavior by Thai Herbal Consumption of Older Adults During COVID - 19 Pandemic Situation in Surat Thani Province

Panida Bunkongthong, Sasithorn Thanapop, Wanvisa Saisanan Na Ayudhaya — Wed, 15 Jan 2025 00:00:00 +0700

The descriptive study aimed to determine relationship related to predisposing, enabling, and reinforcing factors as well as health seeking behavior by Thai herbal consumption of older adults during COVID - 19 pandemic situation in Surat Thani province. Methods: a descriptive cross-sectional study, 367 community-dwelling older adults between April and June of 2023 provided data via a questionnaire whose content validated between 0.67 and 1.00 and its reliability was 0.89. Data was analyzed by using descriptive statistics and chi-square statistics. Results: The majority of older adults (63.76 %) were female, aged 60 - 69 years (57.76 %), had no underlying diseases (63.76 %), had completed primary school (63.21 %), were married (65.12), had used herbs (76.29 %), had a high level of knowledge about consuming Thai herbs (79.84 %), a moderate level of attitude (50.69 %),
a high level of perceived benefit (59.67 %), and a moderate level of health seeking behavior (46.05 %). Predisposing, enabling, and reinforcing factors were associated with the health seeking behavior of older adults who consumed Thai herbs. Based on the findings, families and community health care providers should educate people about the proper use of Thai herbs as a substitute for traditional medical care in the event that access to primary healthcare is restricted due to a pandemic of infectious diseases.

Empowerment for Patients with Depressive Disorders: Role of Psychiatric Nurses

Suparada Wongjumpa, pattarin thamduangsri — Wed, 15 Jan 2025 00:00:00 +0700

The purpose of this scholarly article was to provide information regarding empowerment for patients with depressive disorder. The researcher used the empowerment process to modify nursing care activities for patients with depressive disorder. The activity was created by focusing on problem-solving to address the current issue and improve the patients' sense of self-worth and develop appropriate behavior in order to improve the self-empowerment of patients with depressive disorder and enable them to live happily in society

Leadership of Nursing Innovation

Wed, 15 Jan 2025 00:00:00 +0700

The purpose of this article was to examine leadership of nursing innovation roles from literature reviews, the current state of the world with its rapidly changing technology, and the competition of the economy, society, and health in both internal and external organizations. These topics are crucial for organization leaders to comprehend and prepare for in order to develop strategies that align with the changes that affect the economy, society, and health in the so-called "VUCA World century." In the century of intense competition, the implementation of changes in the health care system would be essential to the organization's survival and ability to advance. Because science and technology are developing so quickly, the organization is unable to adjust. The trend of vital health change that would he occurred were good health maintenance, risk patient inquiry, illness prevention, and the initial stage of disease healing through the use of technology and innovation in diagnosing and curing patients.

Thus, the following were the primary responsibilities of nursing innovation leadership to improve the quality of patient care and improve the efficiency of nursing organization operations:
1) inspiring others; 2) honing leadership skills in nursing innovation; 3) facilitating change;
4) fostering innovation in the workplace culture; 5) integrating new technology with nursing in the digital century; 6) fostering collaboration; and 7) assessing and improving work processing of leadership in nursing innovation. In addition, the leader of nursing care services should be at the forefront of nursing innovation to play a critical role in administering and managing nursing resources that result in efficacy and balance for nursing management to achieve success for customer safety.