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I Effects of the Integrated Concentration-Meditation Care i Effects of the Integrated Concentration-Meditation Care Program on Anxiety, Self-Breathing Control, and Weaning Outcomes in Patients with Difficult Weaning from Mechanical Ventilation: A Multi-Site Study Benjamard Thinhuatoey A Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in Nursing (International Program) Prince of Songkla University 2015 Copyright of Prince of Songkla University ii iii iv v ACKNOWLEDGEMENTS In recognition of my successful study, my deepest appreciation and thanks to Assoc. Prof. Dr. Praneed Songwathana, major advisor and Asst. Prof. Dr. Wongchan Petpichetchian, co-advisor; for their kindness and patience they have shown me. It has been a long journey. Due to the challenge of conducting smart nursing research, a good opportunity was referred upon me in which the Graduate School, Prince of Songkla University, gave me the visiting scholarship to conduct the research for this thesis. I had a valuable experience to work with Prof. Dr. Leanne Aitken and her research team at Nursing Faculty, Griffith University and Princess Alexandra Hospital, Nursing Practice Development Unit, Princess Alexandra Hospital, Australia. My grateful thanks are also given to all my teachers who have taught me and implanted in me to apply nursing philosophy and nursing theory into nursing practice. My grateful appreciation is extended to the dissertation committee. In a perspective vision of human resource development, I greatly appreciated Khun Tareetip Nuntarakchikul who was the Head Nurse of Surat thani Hospital at that moment in supporting me to be the Doctor of Philosophy in Nursing. I wish to acknowledge the director of Surat thani Hospital, Head Nurse, ICU Nurse Supervisor, Head of Medical-ICU for permission of granting leave for study. The biggest appreciation is given to my lovely parents who have always supported me in any situation. I cannot ignore to refer my heartfelt thanks to the ICU vi patients, their caregivers, and ICU nurses from Surat Thani Hospital, Maharat Nakorn Si Thamarat Hospital, and Songkhla Hospital; who participated in exploring the knowledge related to using the ICMCP in enhancing weaning success for difficult weaning from mechanical ventilation. Thanks are also given to my PhD friends for sharing their knowledge. Additional thanks are given to one special ICU patient, Mr. Allan Read and his family who have helped me in improving my academic writing. Benjamard Thinhuatoey vii CONTENTS PAGE ACKNOWLEDGEMENT...................................................................................... v CONTENTS…………………………………………....………………................. vii LIST OF TABLES………………………………………........………................... xi LIST OF FIGURES………………………………………………….................... xvi CHAPTER 1. INTRODUCTION Background and Significance of the Problem…………….......................... 1 Objectives of the Study…………………………………........…................. 6 Research Questions of the Study……………………….........…................. 7 Theoretical Framework of the Study………………………........................ 7 Research Hypotheses……………………………………........…................ 11 Definition of Terms………………………………………........................... 12 Significance of the Study…………………………….............…................. 15 viii CONTENTS (Continued) PAGE 2. LITERATURE REVIEW Overview of Caring for Patients with DWMV…….......……….................. 19 Weaning Process and Outcome…………………………............................ 23 Factors Associated with Successful Weaning............................................. 32 Weaning Approach and Theoretical Underpinning………......................... 37 Integrated Concentration-Meditation Care Program……............................ 44 3. RESEARCH METHODOLOGY Research Design…………………………………….......………................ 56 Variables……………………………………………….......……................ 58 Research Setting………………………………………….........….............. 58 Population/Sample………………………………………………............. 60 Instrumentation………………………………………….........…................ 64 Validity and Reliability of the Instruments……………………….............. 67 Human Rights Protection……………………………..............…................ 68 ix CONTENTS (Continued) PAGE Data Collection…………………………………………............................. 69 Data Analysis…………………………………………........……................ 82 Principle Analysis......................................................................................... 88 Controlling Threats to Validity..................................................................... 91 4. RESULT AND DISCUSSION Results.......................................................................................................... 92 Studied Variables......................................................................................... 98 Discussion.................................................................................................... 111 5. CONCLUSION AND RECOMMENDATION Conclusions of the Study.............................................................................. 118 Recommendations of the Study.................................................................... 119 Strengths and Limitations............................................................................. 120 Recommendation for Further Research........................................................ 122 REFERENCES....................................................................................................... 123 x CONTENTS (Continued) PAGE APPENDICES......................................................................................................... 143 Appendix A Instruments........................................................................ 144 Appendix B Ethical Consideration........................................................ 171 Appendix C Tables and Figures............................................................ 180 Appendix D Lists of Experts................................................................. 193 Appendix E Additional Data Analysis from Observation Record........ 195 VITAE...................................................................................................................... 219 xi LIST OF TABLES TABLES PAGE 1 The Accuracy of Weaning Parameters............................................................. 2 4 2 The Criteria of Failure to SBT based on Objective Measurements................. 27 3 Baseline Characteristics of Participants........................................................... 9 4 4 Baseline Characteristics of Participating Participants and Withdrawing Participants in the Experimental Group........................................................... 96 5 Actual Mean Scores of Anxiety at Baseline and Post-Intervention on Day 7 Afternoon in the Experimental Group and Control Group............................. 99 6 The Friedman's Test Comparing of Actual Mean Scores of Anxiety at Baseline and Post-Intervention from Day 1-7 Within the Experimental Group (N= 12) and Control Group (N=11).................................................... 100 7 The Wilcoxon Matched Pair Signed Rank Test on Actual Mean Scores of Anxiety in the Experimental Group between Baseline and Post-intervention on Day 3 Afternoon and Day 7 Afternoon....................................................... 100 8 The Mann-Whitney U-test on Actual Mean Scores of Anxiety Between the Experimental Group and Control group Post-intervention on Day 7 Afternoon......................................................................................................... 101 xii LIST OF TABLES (Continued) TABLES PAGE 9 Actual Mean Scores of Respiration Rate Minute Ventilation and Oxygen Saturation at Baseline and Post-Intervention on Day 7 Afternoon in the Experimental Group and Control Group.......................................................... 103 10 The Friedman's Test Comparison on Actual Mean Scores of Respiration Rate Minute Ventilation and Oxygen Saturation at Baseline and Post- Intervention from Day 1-7 Within the Experimental Group (N= 12) and Control Group (N=11)...................................................................................... 104 11 The Mann-Whitney U-test on Actual Mean Scores of Respiration Rate Minute Ventilation and Oxygen Saturation Between the Experimental Group (N=12) and Control Group (N=11) Post-intervention on Day 7 Afternoon......................................................................................................... 105 12 Numbers of Successful Weaning from Day 1-7 and the Chi-square Test Comparison on the Successful Weaning Rate over 7 Days between the Experimental Group (N = 18) and Control Group (N =23)............................. 107 13 Actual Mean Scores of Weaning Time and Ventilator Days over 7 Days between the Experimental Group (N = 18) and Control Group (N =24).......... 108 xiii LIST OF TABLES (Continued) TABLES PAGE 14 The Mann-Whitney U-test Comparison on Weaning Time and Ventilator Days over 7 Days between the Experimental Group (N=18) and Control Group (N=23)................................................................................................. 108 C1 Criteria of Readiness to Wean......................................................................... 181 C2 Actual Mean Scores of Anxiety at Baseline Pre-Intervention and Post- Intervention from Day 1 - 7 in the Experimental Group and Control Group...................................................................................................... 189 C3 Actual Mean Scores of Respiration Rate at Baseline
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