evaluation on the development of an emergency medical ... community health nursing model, namely,...

Journal of Public Health, September-December 2007 Vol. 37 No. 3

Evaluation on the Development of an EmergencyMedical Service System in Nakhon Ratchasima

Province, Fiscal Year 2002-2005

Warunyu Sattayawongthip * Chirapa Popattanachai *Sutat Tolang * Sirisak Prachsripum *

ABSTRACT

Nakhon Ratchasima Province is a transportation hub of the northeast region, and has a high

death rate from traffic accidents with approximately 30 deaths per 100,000 population. The major

problems for the emergency medical care service (EMS) system in the initial period were inadequate

emergency medical supplies, inadequate communication technology systems, improper first aid skills,

lack of emergency medical care teams, and an improper referral system. The present study aimed

to evaluate the EMS system developed under the “Quick & Run” policy (meet the incident alarm)

in order to further their development and improvement. Samples were taken from 350 officers in

the EMS call center and collaboration center, and from 300 EMS clients. The instruments used for

data collection were questionnaires that were quality tested with the reliable alpha coefficient value

at 0.89, 0.94. The guidelines included focus group discussion and secondary data. The statistics used

for the analyzing were percentage and means. Results revealed 81.24% (for the Basic Life Support

unit) and 98.02% (for the Advance Life Support unit), of “on site” EMS improvement with proper

skills and technique. The death rate decreased from 27.68 in 2004 to 22.92 per 100,000 pop in 2005.

High satisfaction with the EMS system in the officers’ and client samples accounted for 67.71% and

81.33%, respectively. Therefore, it is necessary for policy makers to make a comprehensive job

description of the EMS system. In addition, developing an appropriate collaboration network and

making communication technology available for 24 hours are also important.

Key words: Emergency Medical Service System (EMS), evaluation research, CIPP model,

Nakhon Ratchasima Province

Correspondence: Captain Dr. Warunyu Sattayawongthip, 255 Moo 11, Tambon Kokkruat, Nakhon Ratchasima 30280, Thailand

* Nakhon Ratchasima Provincial Public Health Offices

J Public Health 2007; 37(3): 201-215.

Journal of Public Health, September-December 2007 Vol. 37 No. 3

Concept Mapping of Doctoral Dissertation inPublic Health Nursing During the Years 1985-2005

Pimpan Silpasuwan * Chukiat Viwatwongkasem †

Siriluk Phuangkaew *

ABSTRACT

Few dissertation reports have been fully utilized in Public Health Nursing because of the

lack of content mapping, to help create a comprehensible body of existing knowledge. The main

purpose of the present study was to explore and classify a profile of doctoral dissertations completed

in Faculty of Public Health, specialty area of Public Health Nursing, at Mahidol University, Bangkok,

Thailand, in terms of research issues, designs and area and boundaries of nursing roles and functions.

The population and sample was twenty-four dissertation reports that were presented from 1985 to

2005. Data were collected by using sorting record cards. The data were analyzed using concept

mapping, meta analysis, and integrative review. Results showed that dissertations were conducted to

cover factors relevant to public health nursing roles and functions, health promotion, disease

prevention, primary care and rehabilitation. The investigations focused on individual, family and

community levels. Research designs focusing on a quantitative approach were the most frequent

pattern of investigation. Qualitative research and mixed approach were used only in a few reports.

As for meta analysis, it was found that 2 research projects had qualification to meet the required

criteria namely, the model of self-care for patients with hypertensions as the effective model to reduce

risk in hypertension. These findings suggest that content mapping of dissertations of Public Health

Nursing could facilitate and improve the nursing leader’s attention to and utilization of the results

to direct and change the nursing curriculum in order to achieve an increase in the academic excellence

of the nursing paradigm.

Key words: Dissertation, Public Health Nursing, concept mapping, integrative review, meta analysis.

Correspondence: Associate Professor Dr. Pimpan Silpasuwan, Department of Public Health Nursing, Faculty of Public Health,

Mahidol University 420/1 Rajavithi Road, Ratchathewi District, Bangkok 10400, Thailand

* Department of Public Health Nursing, Faculty of Public Health, Mahidol University†

Department of Biostatistics, Faculty of Public Health, Mahidol University

J Public Health 2007; 37(3): 216-227.

ªï∑’Ë 37 ©∫—∫∑’Ë 3 ª√–®”‡¥◊Õπ°—π¬“¬π-∏—π«“§¡ 2550 217

IntroductionScientific integrity and progress of nursing

knowledge are extended both by graduated nurses

practices and relevant research or dissertations.

The exercise of documenting dissertations provides

an opportunity for the nurse or public health nurse

researcher to access these useful documents to

reflect on each study and to guide current work

and future direction of nursing curriculum and

organization.

The advanced Doctor of Public Health

Curriculum, Major in Public Health Nursing

degree, has been in operation since 1985 as the

first doctoral degree program of nursing in

Thailand. The aim of this course focuses on

producing public health nursing leaders in

education, administration research, and health

care services. Measures of success include

graduates making significant contributions that

have a crucial positive impact on Thai’s people

health outcomes as well as the advancement in

academic achievement of the public health nursing

profession.

Although public health nursing curriculum

developers have investigated doctoral students

alumni in order to develop and improve update

curriculum, very little attention has been given

to dissertation innovation and their effect on

development of nursing education or research.

Nursing dissertations are vital components of

nursing education and practices. Nursing educators

have to recognize that the successful dissertation

topic should be established as a vital factor in

the expanding body of knowledge in nursing.

The main purpose of the present study was

to use integrative reviews and concept mapping

to explore and classify a profile of doctoral

dissertations completed in the faculty of Public

Health, specialty area of Public Health Nursing,

at Mahidol University, Bangkok, Thailand, in

terms of research issues, designs and area and

boundaries of nursing roles and functions.

Concept mapping represents a reality, or is a

primarily suggestive device which might stimulate

new ways to look at our past experiences. This

study, therefore aims to analyze and synthesize

the dissertations of doctoral students in the area

of public health nursing using concept mapping,

meta analysis, and integrative reviews were

applied in order to reflect our stand points till the

present time and to guide a direction for achieving

a satisfactory educational and researchable focus

for public health nursing disciplines in the future.

Materials and MethodsDocument researches were designed for

analyzing dissertations using integrative review

and meta analysis. Concept mapping and meta

analysis were employed when the data met the

inclusion criteria of each method.

Population and sample

Twenty-four dissertation projects1-24

were used. They represent the total number of

dissertations published in Public Health Nursing,

Faculty of Public Health, Department of Public

Health Nursing, Mahidol University, Bangkok

in during year 1985-2005.

Data collection and extraction for integrative

reviews

Data-base searches involved using library

catalogues and final reported dissertations.

Structure and keywords for data analysis were

from both conceptual model development and

methodologies and including substantive

characteristics such as type of design, number

of samples, sampling techniques, dependent

variables, independent variables, setting,

218 «“√ “√ “∏“√≥ ÿ¢»“ µ√å

theoretical base and target population. The aims

of the study and information from each study was

identified, coded, and mixed and matched into

pattern. The information was classified and

extraction of these patterns was done manually.

As an example of meta analysis: from the

24 dissertation projects concerning self care of

hypertension. It only two projects focused on

patients with mild-moderate hypertension who

were specifically treated for hypertension in a

health care center. The research design to examine

these two research titles was a quasi-experimental

model using a two group pre- and post-testing.

Data analysis

To classify general characteristics of the

dissertation projects, descriptive statistics such

as percentage, integrative reviews and concept

mapping were used, as well as meta analysis for

the same intervention program of self care of

hypertension in the two different research studies.

Moreover, meta analysis goes beyond

critique and integration and conducts secondary

statistical analysis of the outcomes of similar

studies.25 The outcomes are measured as the mean

difference, between the treatment and control

groups in the 2 studies.

The test statistic quality (Q) is used to

determine whether to use the homogeneity of

mean differences or, equivalently, the fixed effect

against the random effect model (REM). If as

mean difference we accept the Ho and the fixed

effect model is used for homogeneity of di for

the two studied. Under the fixed effect model,

the inverse-variance (INV) and the Cochran-

Mantel-Haenszel (CMH) weights are used to

combine several mean differences from the two

studies into a summary mean difference.

In this study, the result of quality (Q)

showed heterogeneity of mean difference for all

outcomes (knowledge, practice, and behavior);

therefore, the pooling mean differences under the

random effect model was more appropriate than

the inverse-variance and the Cochran-Mantel-

Haenszel methods.

Accounting for study quality: Poor quality

studies may lead to biases in combined study

results. To improve the pooling estimates from

the various mean differences, adjusted weighs by

the quality scores (QS) was used. The quality of

the projects used in this study was scored by two

reviewers.

Results

Integrative review

A total of 24 doctoral dissertations were

retrieved. They consisted of 15 quantitative studies,

7 qualitative studies and 2 mixed research designs

from 1985 to 2005. As for the quantitative research

studies, there are 6 descriptive designs and 6

quasi-experimental design. Qualitative research

and mixed design studies are illustrated in

Diagram 1.

ªï∑’Ë 37 ©∫—∫∑’Ë 3 ª√–®”‡¥◊Õπ°—π¬“¬π-∏—π«“§¡ 2550 219

As shown in Diagram 1, a total number

of 24 dissertation projects were reported from

1987-2005 and most were of quantitative research

design (9 of 24 are quantitative descriptive

research design and 6 of quasi-experimental

design).

Figure 1 illustrates that research issues

covered in the dissertations included nursing

services, administration, education and research.

In nursing services, clustered health promotion,

health risk prevention and primary care concepts

were cared. Some of the studies had applied

nursing theory-based-intervention. Four projects

were guided by three grand nursing theories and

one community health nursing model, namely,

Orem’s self care Theory, Roy’s Adaptation model,

and Watson’s caring model, and the OMAHA

System Frame work.

Diagram 1 Number of Doctoral Dissertations in Public Health Nursing during the years 1987-

2005, classified by research design

220 «“√ “√ “∏“√≥ ÿ¢»“ µ√å

Fig

ure

1C

once

pt m

appi

ng o

f D

octo

ral

Dis

sert

atio

ns i

n P

ublic

Hea

lth N

ursi

ng s

peci

fic f

or r

ole

of n

ursi

ng a

nd f

unct

ion.

ªï∑’Ë 37 ©∫—∫∑’Ë 3 ª√–®”‡¥◊Õπ°—π¬“¬π-∏—π«“§¡ 2550 221

Figure 2 shows that doctoral dissertations

in Public Health Nursing studied health promo-

tion. They can be divided into five clusters, namely

“Capacity Building”, “Healthy Setting”,

“Community Participation”, “Health Promotion

Initiative” and “Leadership development”. Each

cluster used many concepts or variables that had

been studied on various group of the individuals.

Figure 2 Concept mapping of Doctoral Dissertations in Public Health Nursing classified by

health promotion.

222 «“√ “√ “∏“√≥ ÿ¢»“ µ√å

Meta analysis

Meta analysis of the two research projects

with patients with mild-moderate hypertension

associated with a specific behavioral modification

program (k = 2) showed treatment caused their

knowledge, attitude, and practice regarding

hypertension to be changed in positive way.

Results after adjusting for project quality:

Table 1 present the 95% confidence for know-

ledge, practice, and behavior of patients with

mild-moderate hypertension who underwent a

self care intervention program.

Table 1 The effect of a self care intervention program on patients with mild-moderate

hypertension with respect to change in their behavior after adjusting for study quality

Study QSi W’ i -INV W’ i -CMH W’ i -RNM

1 17 124.3601 272.0000 3.7944

2 27 1086.9552 1086.6960 6.1803

The 95% confidence interval for mean differences between treatment and control groups

calculate as = 1.2380 ± 1.96 × 1.5250 = (-1.7510, 4.2270)

Note: Table 2 from 2 research projects.

DiscussionThis study is focused on the current status

of the doctoral dissertations in public health

nursing conducted during the years 1985-2005.

The results have been illustrated in terms of

integrative reviews, meta analysis and concept

mapping. The profiles or concept maps shown in

this paper do not necessarily constitute theories,

because a theory postulates a relationship (usually

causal) between two or more concepts. The concept

mapping has provided a framework within which

a theory might be stated in under the conditions

of each concept.26 This study has looked for

matching patterns of concepts and their relationship

among identical or similar projects in order to

develop new awareness of pattern combinations

emerging as follows.

Themes of dissertations

Public health research in Thailand has

generally been focused on reducing toxicity in the

environment, health surveillance of communicable

disease, self-reliance development of individual

health, family and community, impacts due to

health system research and health promotion in

various Thai subpopulations, especially in out-

reach or vulnerable groups in communities

both in urban and rural areas.27 The published

dissertations have generally also focused on

these areas. The total number of 24 dissertations

studied reflected mainly interesting issues of

public health nursing work within the health

services system and the public health nursing

field. As shown in Figures 1 and 2, dissertations

examining the nursing roles and functions focused

ªï∑’Ë 37 ©∫—∫∑’Ë 3 ª√–®”‡¥◊Õπ°—π¬“¬π-∏—π«“§¡ 2550 223

on health promotion, health risk prevention and

health behavior change in the individual, families,

and at the community level.

Research design

As can be seen in Table 1, there has been

a slow change in research design from quantitative

to qualitative to mixed design in public health

nursing research during the last 20 years. However,

the independent and dependent variables of all

the studies actually overlay and correspond well

with nursing practices for health and illness in

school, family, hospital and wider communities.

With respect to the dissertations, the

quantitative approach has been the most imple-

mented design, consisted of 6 quasi-experimental

and 6 descriptive studies. As for the 7 qualitative

studies, there has been 1 ethnological study, 2

phenomenological study, 2 action research and 2

participatory action research studies. Mixed design

involved using both qualitative and quantitative

approaches or using action research, then

application, in a mixed pattern of qualitative and

quantitative combination.

The origin of conceptual framework

This investigation found that only three

grand nursing theories derived from nursing

theory were applied in the projects as conceptual

framework-Orem’s theory of self-care, Watson’s

caring-suffering, and Roy’s adaptation model.

Other conceptual frameworks had been derived

from community health nursing models, public

health nursing concepts and related principles

theories.

Many health or public issues of P.H.

nursing research are able to be examined using

theory from other disciplines, such as robust public

health policy, health alliance team development

or empowerment process projects,28 and thus,

many styles of conceptual models were addressed

in the dissertations. Some formed theoretical

frameworks by combining or selecting some

related concepts from 2 theories or more. They

often applied a framework of public health

concepts or nursing theories related to the

investigated concepts or variables without

connecting the concepts of the theory’s proposition

and variables in the objectives or hypothesis of

the dissertation in terms of empirical deductive

relationship or the logical deductive relationship

between the concepts or variables (that had been

derived) from the same theory. Moreover, the

operative definition of a variable frequently was

not consistent with the nursing theory’s concept

or with the research instruments that were

designed to measure the variables derived from

the relevant nursing theory. As a consequence

the data missed verifying nursing theory

concepts. This could be a weakness in the

expanding body of knowledge in nursing or

public health nursing, either because of limitation

or lack of verification of the concepts in each

nursing theory or from evidence-base practice in

Thai society.

The research directions of the Public

Health paradigms are centered in several

diversified issues in human health and environment

from the micro to the macro level. The complexity

of public health system must be examined through

a holistic approach focusing on both the well-

being of the total Thai population and their

environment (or impact on) health policy. A few

of the dissertation projects in this study examined

primarily particular health determinants of many

groups of people and their families, and

communities.

Where as meta analysis showed that a

review of 24 dissertations, two projects were

identified as having sufficient research data to

224 «“√ “√ “∏“√≥ ÿ¢»“ µ√å

meet criteria for a meta analysis to be conducted.

The results of meta analysis indicated that a self

care intervention program to reduce risk in

hypertension among mild-moderate patients is

effective at positively changing patient knowledge,

practice, and health behavior.

Weaknesses of the results are (1) there

were a small number of research dissertations

used, and (2) there is no adjustment made for

publication bias of the two studies.

Conclusion and RecommendationThe present study confirmed the concepts

and principle of concept mapping as a tool for

assessing or evaluating public health nursing

dissertations. In this investigation, concept

mapping was used to develop the framework for

constructing schemata of the evolution of public

health nursing dissertation over 20 years. Our study

demonstrated that public health nursing

interventions, using either health promotion or

health risk prevention, are the crucial issues of

investigation.

Concept mapping is generally used in

science and mathematics.29 It is proposed here

that it can be applied to all areas of nursing. This

study has demonstrated that the analysis of the

intricacies of a few published research reports is

meaningful for enlarging and strengthening the

insight offered through the holistic viewing of

dissertation projects for the purpose of guiding

future directions in several disciplines, mainly in

health education research and theory.

We must insure that the concept mapping

in this study provides insight into the challenges

of leading public health nurses in the first

established doctoral program in Thailand in order

that they may become the best practitioners of

health research and development. The directions

and needed themes for future research study of

the program should be conducted so that these

will fill the gap between policy and advance

practice in many areas, especially in health policy

research, as well as expand the body of knowledge

in nursing education, practice and research through

increasing nursing theory application more

concisely and covering the whole model.30

Moreover, research design should be strengthened

through creating an environment which encourages

innovation for both public health nursing education

and administration. In addition, using integrative

review and concept mapping for creating new

schema28 in regard to assessing evaluating multiple

research reports is recommended, in order to

provide a clear vision and guidelines which will

contribute to strengthened research and

development in nursing research and promote the

service of education needs.

AcknowledgementThe authors wished to express our gratitude

to all of the contributors of the dissertation projects

and the Department of Public Health Nursing for

giving us the splendid opportunity to conduct this

research.

References1. Padumanonda S. Health locus of control,

selected population characteristics and

effectiveness of acute-natal teaching of

maternal and child health on self care. Doctor

of Public Health, Faculty of Graduate Studies,

Mahidol University, 1989.

2. Kompayak J. The effects of public health

nursing’s approach to the compliance of

essential hypertension patients. Doctor of

Public Health, Faculty of Graduate Studies,


ªï∑’Ë 37 ©∫—∫∑’Ë 3 ª√–®”‡¥◊Õπ°—π¬“¬π-∏—π«“§¡ 2550 225

3. Sattayut P. The effects of intensive antenatal

care to high risk pregnancy on maternal

behavior changes and infant birth weight.

Doctor of Public Health, Faculty of Graduate

Studies, Mahidol University, 1990.

4. Panichacheewakul P. Development of a

multidimensional quality of life instrument

for the rural elderly. Doctor of Public Health,

Faculty of Graduate Studies, Mahidol

University, 1994.

5. Junprasert S. Factors related to the intention

and behavior of insured persons concerning

choice for main contractor hospitals,

Bangpakong District, Chacheongsao

Province. Doctor of Public Health, Faculty

of Graduate Studies, Mahidol University,

1995.

6. Keyuranon P. Home health care models

within the next decade for hospitals under

the jurisdiction of the rural hospital division,

Ministry of Public Health (1996-2006).



7. Saminpanya P. Decision-making behaviors

of the head nurses in the government hos-

pitals in Bangkok Metropolitan. Doctor of



8. Jaikaew S. Effects of family support

programme on adaptation to AIDS of HIV

seropositive persons. Doctor of Public Health,


University, 1997.

9. Chawapong W. A comparative study of

management of non-protractiled nipples

and breastfeeding practice. Doctor of Public

Health, Faculty of Graduate Studies, Mahidol

University, 1997.

10. Nimit-Arnun N. The process of symptom

management among Thai climacteric women

in a department of the Ministry of Defense.



11. Suwanpatikorn K. Family health promoting

behavior scale: development and psycho-

metric analysis. Doctor of Public Health,


University, 2001.

12. Neeskul N. Development of the service

model for amphetamine addicted youths in

Thanyarak Hospital. Doctor of Public


University, 2001.

13. Krobthong V. The effects of the empower-

ment process on the self-esteem development

for hypertension control. Doctor of Public


University, 2001.

14. Tongvichean S. Effects of the family nursing

diagnosis manual on nursing diagnoses

among family nurses in Bangkok Metropolis.



15. Tanchai M. Herbal steam bath services and

the user’s body physiological responses.



16. Changtong A. Self care of blind people in

Bangkok Metropolis: An Ethnographic study.



17. Vajamun P. A model of eye care for the

elderly by community-based nursing in

Pakthongchai District, Nakhon Ratchasima.



18. Thiangtham W. A phenomenological

approach in the lived experiences of Thai

women who’re suffering with HIV positive

pregnancy. Doctor of Public Health, Faculty

226 «“√ “√ “∏“√≥ ÿ¢»“ µ√å

of Graduate Studies, Mahidol University,

2003.

19. Ampunsiriratana A. A palliated suffering

model for HIV-infected patients: a combi-

nation of the four foundations of mindfulness

and Watson’s caring. Doctor of Public Health,


University, 2003.

20. Chitthathairatt S. Cognitive-behavioral

approach and Buddhist practice in amphe-

tamine prevention among adolescents. Doctor



21. Kumsuchat S. The development of alliances

for health promotion among the older persons

in an urban community in Bangkok. Doctor



22. Rassmeapong S. Development of primary

care model in the community. Doctor of



23. Nakatong P. Development of a community

health nursing practice model: Community

empowerment for narcotic prevention,

Lampang Province. Doctor of Public Health,


University, 2004.

24. Durongritichai V. Caregiver self-help group

development in preschooler home injury

prevention: An action research perspective.



25. Reith CH, Malone DC. Understanding the

fundamental concepts for interpreting or

conduction meta-analysis formulary; Aug

2001. Vol. 36, issue 8, p. 594. Available at

http://web6.epnet.com, accessed March 7,

2006.

26. Burke JG, Geeh GC, Compo OP, et al. An

introduction to concept mapping as a

participatory public health research method.

Qualitative health research; Dec 2005.

Vol. 15, issue 10. Available at http://web19.

epnet.com, accessed March 14, 2006.

27. Social Sciences Research Association.

“Concepts and misconcepts in Educational

Statistics” in 108 Questions, Social Science

Institute publications, Thailand, 1996.

28. Norma JS. An integrative nursing theoretical

frame work. J Advance Nursing 1990; 15:

463-7.

29. Trochim WM. Concept mapping: Soft

science or hard art?. Cornell University.

Available at http://trochim.human.cornell.

edu/research/epp2, accessed January 21,

2003.

30. Nantaboot K. Identification of essential

national research themes for nursing: The

process. Faculty of Nursing, Khon Kaen

University, 2003.

«“√ “√ “∏“√≥ ÿ¢»“ µ√å ª√–®”‡¥◊Õπ°—π¬“¬π-∏—π«“§¡ 2550 ªï∑’Ë 37 ©∫—∫∑’Ë 3

°“√ √â“ß·ºπ∑’Ë·π«§‘¥√«∫¬Õ¥¢Õß¥ÿ…Æ’π‘æπ∏å¢ÕßºŸâ ”‡√Á®°“√»÷°…“æ¬“∫“≈ “∏“√≥ ÿ¢ „πªï æ.». 2528-2548

æ‘¡æåæ√√≥ »‘≈ª– ÿ«√√≥* ™Ÿ‡°’¬√µ‘ «‘«—≤πå«ß»å‡°…¡† »‘√‘≈—°…≥å æ«ß·°â«*

∫∑§—¥¬àÕ

¥ÿ…Æ’π‘æπ∏å¢ÕßºŸâ ”‡√Á®°“√»÷°…“∑“ß°“√æ¬“∫“≈ “∏“√≥ ÿ¢‰¥â„™âª√–‚¬™πåπâÕ¬¡“° ‡π◊ËÕß®“°¢“¥°“√®—¥ √â“ßº≈ß“π∑’Ëºà“π¡“„Àâ‡¢â“„®∂÷ß¿“æ√«¡¢ÕßÕß§å§«“¡√Ÿâ∑’Ë¡’Õ¬Ÿà ß“π«‘®—¬π’È¡’«—µ∂ÿª√– ß§å‡æ◊ËÕ«‘‡§√“–Àå·≈–®—¥ √â“ß·ºπ¿“æ∑“ß§«“¡§‘¥¢Õß¥ÿ…Æ’π‘æπ∏å¢Õßπ—°»÷°…“ª√‘≠≠“‡Õ° ºŸâ ”‡√Á®°“√»÷°…“®“°¿“§«‘™“°“√æ¬“∫“≈ “∏“√≥ ÿ¢„π√Õ∫ 20 ªï ¢Õß§≥– “∏“√≥ ÿ¢»“ µ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈ ”À√—∫ª√–‡¥Áπ«‘®—¬∑’Ëπ”¡“»÷°…“ °“√ÕÕ°·∫∫ √–‡∫’¬∫«‘∏’∑’Ë„™â·≈–‡π◊ÈÕÀ“ “√– ª√–™“°√·≈–µ—«Õ¬à“ß ‰¥â·°à √“¬ß“π¥ÿ…Æ’π‘æπ∏å ∑—ÈßÀ¡¥®”π«π 24 ‡√◊ËÕß ¢ÕßºŸâ ”‡√Á®°“√»÷°…“µ—Èß·µàªï æ.». 2528-2548 °“√‡°Á∫√«∫√«¡¢âÕ¡Ÿ≈®“°√“¬ß“π¥ÿ…Æ’π‘æπ∏å∑—ÈßÀ¡¥‡ªìπ∞“π¢âÕ¡Ÿ≈°“√«‘‡§√“–Àå „™â°“√∑∫∑«π«√√≥°√√¡·∫∫‡™‘ß√–∫∫ (Integrative review) ·∫∫º ¡º “π§«∫§Ÿà°—∫°“√«‘‡§√“–Àå‡™‘ßÕ¿‘¡“π (Meta analysis) „™â«‘∏’≈ß√À— ‡®“–∫—µ√¥â«¬¡◊Õ º≈°“√«‘®—¬ æ∫«à“¥ÿ…Æ’π‘æπ∏å∑—ÈßÀ¡¥‰¥â§√Õ∫§≈ÿ¡·π«§‘¥√«∫¬Õ¥∑’Ë ”§—≠„πß“πæ¬“∫“≈ “∏“√≥ ÿ¢¥â“π∫∑∫“∑Àπâ“∑’Ë„πß“π √â“ß‡ √‘¡ ÿ¢¿“æ·≈–°“√ªÑÕß°—π§«“¡‡ ’Ë¬ß √«¡∂÷ß°“√¥Ÿ·≈√—°…“‡∫◊ÈÕßµâπ „π√–¥—∫∫ÿ§§≈ §√Õ∫§√—« ·≈–™ÿ¡™π ”À√—∫√Ÿª·∫∫°“√«‘®—¬ à«π¡“°‡ªìπ°“√«‘®—¬‡™‘ßª√‘¡“≥ ¡’«‘®—¬°÷Ëß∑¥≈Õß 2 ‡√◊ËÕß ∑’Ë “¡“√∂π”¡“«‘‡§√“–Àå‡™‘ßÕ¿‘¡“π æ∫«à“‚§√ß°“√°“√¥Ÿ·≈µπ‡Õß¢ÕßºŸâªÉ«¬∑’Ë¡’¿“«–§«“¡¥—π‚≈À‘µ Ÿß “¡“√∂™à«¬≈¥§«“¡‡ ’Ë¬ß∑“ß ÿ¢¿“æ‰¥â ®÷ß¡’¢âÕ‡ πÕ·π–„ÀâºŸâπ”∑“ß°“√»÷°…“æ¬“∫“≈‰¥â„™âª√–‚¬™πå®“°°“√∑”·ºπ∑’Ë‡™‘ß·π«§‘¥√«∫¬Õ¥ ¡“„™â«“ß·ºπ·≈–ª√—∫ª√ÿß∑‘»∑“ß°“√æ—≤π“À≈—° Ÿµ√ ‚¥¬‡©æ“–°“√∑”¥ÿ…Æ’π‘æπ∏å„Àâπ”‰ª Ÿà°“√‡ªìπ‡≈‘»∑“ß«‘™“°“√„π√–∫∫°“√æ¬“∫“≈ “∏“√≥ ÿ¢

§” ”§—≠: ¥ÿ…Æ’π‘æπ∏å, °“√æ¬“∫“≈ “∏“√≥ ÿ¢, °“√«“ß·ºπ∑’Ë·π«§‘¥√«∫¬Õ¥, °“√∑∫∑«π«√√≥°√√¡·∫∫∫Ÿ√≥°“√, °“√«‘‡§√“–Àå·∫∫Õ¿‘¡“π

* ¿“§«‘™“°“√æ¬“∫“≈ “∏“√≥ ÿ¢ §≥– “∏“√≥ ÿ¢»“ µ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈† ¿“§«‘™“™’« ∂‘µ‘ §≥– “∏“√≥ ÿ¢»“ µ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈

«“√ “√ “∏“√≥ ÿ¢»“ µ√å 2550; 37(3): 216-227.

evaluation on the development of an emergency medical ... community health nursing model, namely,...

Documents