Community Health Care System Development Process: 14 Case Studies of Communities in Central Region
Penchan Sittipreechachan Panudda Priyatruk

ABSTRACT
The purposes of this lessons learned study was to explore implementing process of community health care system as well as the developmental process for sustainable community health care system. Focus groups were conducted with 36 participants who were nurse researchers conducting 14 case studies in 12 sub-districts. Data were analyzed using content analysis and themes were emerged. The results revealed that government policies and the needs of local people are the key mechanism for community health care system. 14 case studies showed that community social capitals and resources including human resources, financial resources, and enabling environment are crucial to driven the process of community health care system. Community health need assessment to identify health care demand of the people included several methods and involvement of community participation. When designing and implementing community health programs, there is a need to focus on human capacity and direct practical experience in finding community health solutions that should based on problems and needs of the local people as well as community lifestyle. Development of local public policies generates from incorporating community health projects in community development plan and using platforms to communicate among people in the community. Development of sustainable community health care system requires community volunteers, community solutions response to the needs of local people, and supporting system at local policies. The findings suggest that community health nurses should incorporate community social capital, community needs assessment, and community participation involvement with other health care professions and organizations to create public policies in response to the needs of local people encouraging successful and sustainable community health care system.

Keywords: Community health care processes/ Sustainable health community

Performance Assessment of Village Health Volunteer Working in District Health Network,Pompiram district, Phitsanolok Province
Phudit Tejativaddhana Nithra Kitreerawutiwong

ABSTRACT
Village health volunteer (VHV) had been recognized for attaining population coverage with essential health care. With their unique capability to provide bridges between the community and health care service. However, district health network, Pompiram district has a limited documentation about the performance of VHV. The purposes of this study are to 1) assess the performance of VHV and 2) study the association between demographic data and the performance of VHV in district health network, Pompiram district, Phitsanulok province. A sample of 171 VHVs in district health network, Pompiram district, Phitsanulok province, which determined using the Cochran (WHO, 1977) were selected by simple random sampling. The questionnaire was developed from the study of Komart Jonesatherinsup and Paranut Suksit (2550) including 3 parts as follow: 1) Demographic data, 2) the performance of VHV and 3) the knowledge of VHV. The average item-content validity index (I-CVI) was 1. The overall value of Cronbach's alpha coefficient part 2 was 0.84 and the value of KR-20 part 3 was 0.78. Data were analyzed to obtain frequency, mean, standard deviation, chi square and Cramer's V values. Findings showed that mostly 65.6% of VHV in district health network, Pompiram district had a fair level on their performance (X = 22.34, SD = 4.21) and 28.4% had a good level on their performance (X = 32.47, SD = 2.87). Furthermore, there was a significant relationship, at low level, 2Xbetween having the other societal positions in community ( = 4.268, Cramer's V = .161) and 2Xknowledge ( = 3.884, Cramer's V = .223), at the level of .05. Based on the result, health manager should be improved coordination skill consistent with having other societal positions in community and continuous supported activities to improve knowledge of village health volunteers. Moreover, the training should be designed in relation to VHV's functions in community.

Keywords: Performance/ Village Health Volunteer/ District Health Network.

Factors Related to Quality of Work Life of Nurses Working in Primary Health Care units in the Central Region of Thailand
Suwaree Pethtang Wonpen Kaewpan Surintorn Kalampakorn Jutatip Sillabutra

ABSTRACT
Quality of work life is very significant to work effectiveness of each individual. Public health nurses are the professional nurse working in primary care units. Their roles include health promotion as well as disease prevention and control at the community level. Various roles, over workload, and inadequate staff could have effects on their quality of work life .The objectives of this cross-sectional study were to study quality of work life of nurses working in primary care unit and its related factors. The sample were 336 public health nurses working in primary care units located in the central region of Thailand selected by multi stage sampling .Data were collected by mail questionnaire with the response rate of 73.19 %.Data were analyzed by using mean, standard deviation, and the relationships between personal factors, working factors, organizational factors and quality of work life were examined by the Chi-Square test, Peason 's Product Moment correlation coefficient and multiple regression analysis. This study showed that quality of working life was at good level (X = 2.82, S.D.= 0.23) team work was at moderate level (X = 2.95, S.D.= 0.36), organizational climate was at moderate level (X = 2.78, S.D.= 0.29), work stress was at moderate level (X = 2.66, S.D.=0.23) Multiple regression analysis showed that reward, norms of team, work conflict, work load, effort, and sense of belonging could altogether predict 19% of quality of working life. Findings suggest that quality of working life can be promoted by chief executive providing approapriate reward supporting effective team work, and improving workload. Development of organizational factor to enhance organization climate and sense of belonging improve quality of working life of public health nurses.

Keywords:Public Health Nursing/Quality of Working Life/Primary Health Care Units.

Development of Nursing Practice Guidelines for Major Trauma Patients in ChaophyaAbhaibhubejhr Hospital
Pensri Dumrongjitti Rossukon Srisanit Pornpen Doungdee

ABSTRACT
Saving life is the goal of major trauma patient care in emergency room. An effective nursing practice guideline could help trauma team to work effectively for assessment, management, and further treatment. The objective of this study was to develop a guideline based on evidencebased practice (Soukup, 2000), for major trauma patient care in emergency room at Chaophya Abhaibhubejhr hospital. This nursing practice guideline was developed through 4 phases as situation analysis (Evidence trigger phase), developing guideline (Evidence-supported phase), feasibility test (Evidence-observed phase) and evaluating the guideline (Evidence-based phase). The situation analysis process revealed that there were no nursing practice guideline, no clearly assignment, and the team function was conduction on the basis of individual knowledge and experience. An evidences showed that an effective guideline, composed of Advance trauma Life Support (ATLS) protocol, roles and function assignment, and appropriate equipments and environment preparation, is needed. After developing the nursing practice guideline and indicators, the feasibility test showed a better patients' clinical outcomes, a lessen duration in emergency room, and raise the trauma team satisfaction. However, the trauma team suggested a minimal revision. In the evidence-based phase, results showed a statistical significance improvement in clinical outcomes of trauma patients (oxygen saturation). The result also indicated that over 90% of the trauma team had high satisfaction on using the nursing practice guideline. This developed clinical nursing practice guideline based on evidence-based practice could be benefit a good outcome and high quality of care.

Keywords: Guidelines development/ major trauma patients/ emergency room/ clinical outcomes

Guidelines development/ major trauma patients/ emergency room/ clinical outcomes
Thanada Keatkor Naruemon Auemaneekul Sunee Lagampan Arpaporn Powwattana

ABSTRACT
This quasi- experimental research is designed to study the effectiveness of a life skills development program for sexual abuse prevention for teenagers at risk in Middle school, Muang district, Nakhon Ratchasima provinc. The subjects of the study comprised of 80 female teenagers at risk, aged 11-14 year. Participants were divided into experimental and comparison group, of 40 subjects each. The experimental group was assigned three activities plans of sexual abuse prevention by applying the life skill concepts of WHO and participatory learning technique. The research procedure lasted 3 weeks with a 4 weeks follow – up period. Scenario and group process were organized by using lecture, brainstorming, group discussion, game, role play. in order to develop decision making skills, critical thinking skills, communication skills , negotiation skills to protect themselves from sexual abuse. The data analysis was done by descriptive analysis, and repeated measure ANOVA, Independent t-test, with the p-value at 0.05. The study results revealed that after experiment and 4 week follow up , the experimental group had significantly higher scores of decision making skills, critical thinking skills, communication skills , negotiation skills, and sexual abuse prevention behavior, than prior to experimentation and higher than those of the comparison group (p-value < .001) In conclusion, The effects of sexual abuse prevention program for female teenager at risk could develop skills and sexual abuse prevention behavior.

Keywords: Sexual Abuse / Prevention / Female Teenagers at Risk