Digital Commons Network^™

Evaluating The Use Of A Diet Screening Tool For Diabetes And Weight Management In Primary Care, Christie Mcbride

DNP Projects

Background: Type 2 diabetes mellitus is a prominent disease and leading cause of death in the nation. Many complications can develop when glucose levels are poorly controlled. When patients receive education and support in diabetes self-management, including individualized dietary interventions, it leads to improved glycemic control.

Purpose: The purpose of this quality improvement (QI) project was to evaluate the incorporation of a diet recall tool, Starting the Conversation (STC), in the standard care for diabetic patients with abnormal body mass index (BMI). The study aimed to examine: (1) patient opinion of the intervention and (2) healthcare provider satisfaction with use …

Examining The Impact Of A Protein Intervention To Improve Outcomes In Frail Perioperative Candidates: A Feasibility Study, Anna M. Rose

DNP Projects

Background: Frailty is a syndrome or grouping of clinical characteristics that collectively increases one’s vulnerability to acute and external health stressors. Higher rates of frailty are present in oncology surgical patients and is a predictor of postoperative complications, as well as increased morbidity and mortality. Long- and short-term survival of surgical oncology patients is worse in frail patients than robust patients. Prehabilitation interventions during the planning phase of surgical intervention may serve to mitigate already known health concerns prior to inflicting the stressor that is surgical intervention.

Purpose: To measure the feasibility of an educational prehabilitative nutritional intervention aimed at …

Nursing Staff Education Project To Improve Diabetic Patients' Glycemic Control, Valerie R. Gaston

Walden Dissertations and Doctoral Studies

Diabetes is a chronic disease affecting more than 34.2 million people in the United States. The International Diabetes Federation predicted by the year 2045 an estimated 700 million people will have diabetes. In the clinic project site, the practice problem involved the increasing clinician’s knowledge about Type 2 diabetes mellitus (T2DM) with improved glycemic control through self-care management. The purpose of this project was to develop an educational training and intervention for staff to increase their knowledge of self-care management to improve glycemic control and have it validated by a panel of experts before dispersing it to the intended audience. …

An Educational Program For Standardization Of Care For The Acute Opioid Withdrawal, Jessica Ann Larson

Walden Dissertations and Doctoral Studies

Opioid addiction is a widespread chronic disease affecting millions of Americans each year, resulting in medical, social, financial, and societal detriments. Patients experiencing opioid withdrawal benefit from a standardized and evidence-based approach to care. The purpose of this doctoral nursing project was to provide inpatient nursing education for a standardized clinical practice approach to optimize patient outcomes. The research question examined the impact of an educational program for nurses presenting a new standardized opioid withdrawal clinical practice guideline inclusive of assessment, nursing interventions, a symptom triggered order set, and follow up plan of care in terms of knowledge gained and …

The Impact Of Dexmedetomidine Use In Patients Over The Age Of 60 Undergoing General Anesthesia On Postoperative Delirium Incidence, Elaina Branco

Nurse Anesthesia MSNA Student Capstones

Postoperative cognitive dysfunction (POCD) and postoperative delirium (POD) are of concern in the elderly population undergoing an anesthetic due to increased mortality and decreased quality of life that can ensue. Sui et al. (2021) reported a 15-50% incidence of POD in elderly surgical patients. Dexmedetomidine is a highly selective, alpha-2 agonist with sedative, analgesic, and anxiolytic properties that mimics a sleep-like state and causes bradycardia and hypotension but not respiratory depression. Dexmedetomidine has neuroprotective properties, including anti-apoptosis and anti-inflammation (Wu et al., 2019). A current review of the literature revealed that dexmedetomidine use can decrease POD incidence in the aged …

Development Of A Transition Program For Young Adults With Type 1 Diabetes Progressing From Pediatric To Adult Care – A Feasibility Study, Elizabeth Ann Minchau

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

Development of a Transition Program for Young Adults with Type 1 Diabetes Progressing from Pediatric to Adult Care – A Feasibility Study

Elizabeth A. Minchau

Background: Emerging adulthood requires a delicate balance of the competing social, educational, occupational, and financial demands typical of this developmental stage. This time period presents special challenges for adolescents with type 1 diabetes (T1D), who must also prioritize consistent medical follow-up and ongoing intensive self-care. Emerging adults with T1D struggle with glycemic control that is further exacerbated by an often-times disorganized transfer of care between pediatric and adult endocrinology practices. Substantial gaps in care …

Nurses’ Perceptions Of Their Role Utilizing Eat, Sleep, Console, In The Management Of Neonatal Abstinence Syndrome, Cerys Eldred

Honors Theses and Capstones

Background: There is a rising prominence of infants being born and diagnosed with Neonatal Abstinence Syndrome (NAS) in the United States. In recent years, a new non-pharmacological method of managing these infants called Eat, Sleep, Console (ESC) has emerged. While there is mounting evidence demonstrating the positive outcomes for infants treated with this method, there is limited research regarding nurses’ perceptions of this new intervention. This study seeks to understand the nurse’s experience and role during caring for infants with NAS utilizing the ESC method in comparison to the past practices.

Methods: This study used a qualitative descriptive design to …

An Extreme Preterm Infant With Multiple Complications: A Case Study, Yashoda Sathish

Manipal Journal of Nursing and Health Sciences

Extreme preterm birth is the most critical risk factor, which leads to adverse effects on medical and developmental outcomes. We report a case of an extremely preterm infant admitted to NICU and had a prolonged period of non-invasive ventilation. The neonate had hepatosplenomegaly and antibiotic, antifungal, and antiviral treatment. She was recovered and shown significant improvement in her health status and growth and development were assessed until five years of corrected age.

Improving Advance Care Planning Among Native Americans, Jasjit Kaur Pataria

Walden Dissertations and Doctoral Studies

A staff education project was created in a tribal health system of primary care clinics to improve advance care planning (ACP) conversations between care providers and Native American tribal patients. ACP conversations and advance directive documentation occurrences were found to be low or negligible in the project site despite primary care clinics being an ideal place to start these conversations. The purpose of the staff education project was to improve the knowledge and attitudes of providers toward initiating ACP conversations in a rural underserved community of Native Americans. The knowledge-to-action model was used to frame the project. Pretests and posttests …

Use Of Evidence-Based Clinical Practice Guidelines In Obesity Management In Women, Chizimako Margaret Eze

Walden Dissertations and Doctoral Studies

AbstractObesity is one of the Healthy People 2020 high-priority public health issue. Obesity is of importance due to the troubling higher prevalence in women because of the close link that exists between body weight and reproductive health in females from menarche to menopause and beyond. The identification of guidelines to improve or manage the care of female patients can alleviate the burden and complications from being overweight or obese. This project guided by the ADDIE (analyze, design, develop, implement, and evaluate) model was conducted in a family primary care clinic to address a gap in practice, the lack of knowledge …

An Educational Program To Enhance Knowledge And Communication For Nursing Staff Who Care For Dementia Patients, Behnaz Mohammadi

Walden Dissertations and Doctoral Studies

AbstractDementia is a progressive chronic disease that requires skilled nursing care. Staff at a skilled nursing facility were not using best practices to prevent and manage the psychological and behavioral symptoms of dementia. The purpose of this DNP project was to implement a dementia care education to address this gap in knowledge. The question for the evidence-based educational project was whether the program increased knowledge, promoted positive attitudes, and increased confidence in dementia care staff. A 5-hour workshop was presented in person, twice in two weeks. The person-centered care model served as a framework for the project. Nursing staff (N …

Improving The Patient Repositioning Process: A Quality Improvement Project, Sydney Elizabeth Mcgough

Master's Theses and Capstones

Background: Research has shown that visual turn reminders can improve patient repositioning to prevent pressure injuries. The aim of this quality improvement project was to improve adherence to repositioning by increasing the perceived usefulness of the visual turn reminder.

Methods: A pre-intervention survey was distributed to 70 staff members with 22 responses. Staff were given the opportunity to recommend changes to the visual reminders and were informed that feedback would lead to the identification of common themes. Based on feedback, high visibility turn reminders were developed and implemented on the unit. A post-intervention survey was distributed to the same 70 …

Documenting Body Mass Index And Lifestyle Counseling For Pediatric Patients: A Quality Improvement Project At A Federally Qualified Healthcare Facility, Taylor R. Graziano

Master's Theses and Capstones

Background: Screening and monitoring growth throughout childhood and adolescence, as well as providing the necessary education on positive lifestyle choices is vital in combating the childhood obesity epidemic. Counseling children on the importance of nutrition and physical activity also helps to prevent numerous comorbid conditions associated with obesity. The United States. Preventive Services Task Force recommends that healthcare workers screen for obesity at least annually in all patients 3-17 years of age, as well as offer lifestyle counseling regardless of Body Mass Index ranking.

Aim: The aim of this quality improvement project was to improve the current percentage of pediatric …

The Effect Of Virtual Learning As A Result Of Covid-19, Ann Redle Ms., Joel Mcmullen

Williams Honors College, Honors Research Projects

In the early spring of 2020, the United States began to experience the effects of the question-inspiring, novel COVID-19 viral illness, with the onset of massive business, school, and entertainment closures, initiating a shift towards virtual learning, communication, and professional interactions. This paper is intended to identify the common experiences of two nursing students throughout the COVID-19 pandemic by utilizing a personal narrative, or autoethnographic approach, coupled with reviews of previously published literature relating to shared themes of the authors, including the rapid changes to an online environment from traditional classroom settings, the stressors that were experienced as a result …

Bachelor Of Science In Nursing First Professional Degree & Second Degree Accelerated Student Guide, 2022-2023 Edition, Dr. Susan L. Davis, Rn & Richard J. Henley College Of Nursing

News, Magazines and Reports

The Nursing Student Guide is the official student handbook and provides essential DHCON policies and procedures for academic progression and graduation. This guide is intended to supplement the University Catalog and provide information specific to the nursing programs.

Consent To Research In Madagascar: Challenges, Strategies, And Priorities For Future Research A Scoping Review Of Interprofessional, Elysée Nouvet, Simon Grandjean Lapierre, Astrid Knoblauch, Laurence Baril, Andry Andriamiadanarivo, Mihaja Raberahona, Chiarella Mattern, Lorie Donelle Phd, Rn, Fcan, Faan, Jean Rubis Andriantsoa

Publications

The ethical conduct of research in any setting hinges on the voluntary and informed consent of research participants. Working towards consent that is truly voluntary and informed, however, is far from straightforward, and requires attention to contextual factors that may complicate achievement of this ideal in specific research settings. This paper is based on Madagascar’s first “Consent complexities in health research in Madagascar” workshop, held in Antananarivo, Madagascar, in October 2018. It identifies a number of challenges encountered by individuals responsible for the conduct or oversight of health research in Madagascar related to informed and voluntary consent. Key challenges identified …

Qualitative Evidence For Improved Caring, Feeding And Food Production Practices After Nutrition-Sensitive Agriculture Interventions In Rural Vietnam, Dai Dinh Nguyen, Sabina Di Prima, Reint Huijzendveld, E Pamela Wright Phd, Ms, Med, Rn, Cen, Dirk Essink, Jacqueline E. Broerse

Publications

BACKGROUND:

Research on nutrition-sensitive agriculture (NSA) has mostly been aimed at demonstrating its impact on nutrition and explicating underlying pathways, and more rarely at understanding processes and lessons learnt from them. This study aimed to gain insights into the processes that influence behaviour change, contributing to improved caring, feeding and food production practices, using a program theory perspective. It also investigated perceived challenges to the sustainability of interventions and potential solutions, in the context of an NSA program in rural Vietnam. Using a participatory approach, data were gathered on impact pathways and perceived outcomes, on elements of program theory that …

Creating A Pre-Illness Covid-19 Action Plan: A Web-Based Public Education Initiative, Brian S. Hustad

DNP Research Projects

Abstract

Background: The COVID-19 pandemic took the world by storm in the beginning stages of 2020. Public health agencies were overwhelmed, undermanned, and therefore slow to respond. Information began to flow at an unprecedented rate. Yet, very limited resources were put into place to present this information or to instruct the public on evidence-based prevention, treatment, or care at home during active infection.

Intervention: A project website was created and accessed through a QR code on the project flyer or by entering the URL into any browser. Participants were able to access three evidence- based video modules, which introduced the …

Enhancing Hospitalists' Knowledge In Relation To Palliative Care, Herline Raphael

DNP Research Projects

Abstract

Palliative care was not the specialty of many hospitalists; thus, communication was hindered regarding ELC and advanced directives. Despite healthcare utilization in the United States, inadequate treatment of serious illnesses continues due to the lack of provider education and understanding of ELC (palliative and hospice care). Hospitalists are not formally or informally trained to care for patients that need palliative or hospice care. A quantitative, quasi- experimental and qualitative approach was utilized to determine if hospitalists who received educational training on palliative care communication and collaboration improved knowledge, skills, and collaboration when caring for end-of-life or critically ill patients. …

The Rhythm Of Your Life: The Effects Of Daily Routine On Mental Health, Kristen Brown

Graduate Research Projects

No abstract provided.

The Effects Of 465nm Blue Light On Sleepiness & Fatigue, Mark E. Childress

DNP Research Projects

Abstract

Background: Exhaustion is now accepted in nursing culture. Staff suffering from sleepiness and fatigue are more likely to commit medical errors and sentinel events. Emergency department nurses have the greatest risk of committing these errors. Currently, there is no relief provided to shift workers beyond a single 30-minute meal break within a 12-hour period. Other researched mitigation strategies have either failed or are unrealistic in this environment.

Local Problem: Emergency Department nurses at Parkridge Medical Center in Chattanooga, TN suffer from chronic sleepiness and fatigue that is exacerbated by shift duration, excessive workload, a stressful environment, and lack of …

Improving Nutrition Literacy In Primary Care, Kami D. Dykes

DNP Research Projects

Abstract

By the year 2030, nearly one in every two adults will have obesity (Body Mass Index [BMI] ≥30 kg/m².), and one in four adults will have severe obesity (BMI ≥35 kg/m²) (Ward et al., 2019). Equally troubling is that obesity poses a threat to the health of individuals, decreases the quality of life, shortens life expectancy, causes and worsens comorbidities, and increases all- cause mortality (Abdelaal et al., 2017). Studies have shown a link between BMI, nutritional knowledge, and dietary practices. Nutrition literacy is a newer term that refers to the complex relationship between nutrition …

Effect Of Naloxegol On Opioid-Induced Esophageal Motility Disorder, Crista Ulteig, Kristin Ciezki, Megan Jacobson, Maharaj Singh, Tarun Sharma

College of Nursing Faculty Research and Publications

Opioid effects on lower gastrointestinal motility are well documented, and increasing attention is being paid to their effect on esophageal motility. Naloxegol is a µ-opioid receptor antagonist that is used for opioid-induced constipation, but its impact on esophageal motility has not been well documented. We report a case series of 3 patients with coexisting esophageal dysmotility and constipation on chronic opioids that improved both symptoms after starting naloxegol. Based on these observational studies, we propose that formal studies be conducted to assess the effect of naloxegol on opioid-induced esophageal dysmotility.

ผลของโปรแกรมการจัดการตนเองที่เน้นการออกกำลังกายแบบแกว่งแขนต่อระดับฮีโมโกลบินเอวันซีของผู้ป่วยโรคเบาหวานเข้าจอประสาทตา, ลินดา อ่องนก, สุรีพร ธนศิลป์

Journal of Nursing Research, Innovation, and Health

วัตถุประสงค์: ศึกษาผลของโปรแกรมการจัดการตนเองที่เน้นการออกกำลังกายแบบแกว่งแขนต่อระดับฮีโมโกลบินเอวันซี ของผู้ป่วยโรคเบาหวานเข้าจอประสาทตา

รูปแบบการวิจัย: การวิจัยกึ่งทดลอง

วิธีดำเนินการวิจัย: กลุ่มตัวอย่างคือ ผู้ป่วยโรคเบาหวานเข้าจอประสาทตา ที่มารับการรักษาที่โรงพยาบาลเมตตาประชารักษ์ (วัดไร่ขิง) จังหวัดนครปฐม คัดเลือกกลุ่มตัวอย่าง โดยการสุ่มแบบเจาะจง ตามเกณฑ์ที่กำหนด จำนวน 44 คน แบ่งเป็นกลุ่มทดลองและกลุ่มควบคุมกลุ่มละ  22 คนโดย กลุ่มทดลองได้รับโปรแกรมการจัดการตนเองที่เน้นการออกกำลังกายแบบแกว่งแขน และกลุ่มควบคุมได้รับโปรแกรมตามปกติ เครื่องมือในการทดลอง คือ โปรแกรมการจัดการตนเองที่เน้นการออกกำลังกายแบบแกว่งแขน เครื่องมือวิจัยในการเก็บรวบรวมข้อมูล คือแบบบันทึกข้อมูลส่วนบุคคล และเครื่องตรวจระดับฮีโมโกลบินเอวันซี วิเคราะห์ข้อมูลโดยใช้สถิติ ร้อยละ ค่าเฉลี่ย ส่วนเบี่ยงเบนมาตรฐาน และการทดสอบที (t-test )

ผลการวิจัย 1) ฮีโมโกลบินเอวันซีของผู้ป่วยโรคเบาหวานเข้าจอประสาทตาในกลุ่มทดลองหลังได้รับโปรแกรมฯ (  = 8.30  ± 1.55 ) มีค่าต่ำกว่าก่อนการทดลอง (  = 9.14 ± 1.46  ) อย่างมีนัยสำคัญทางสถิติ (t= 3.23, p <05)  2) ผลต่างของฮีโมโกลบินเอวันซีก่อนและหลังเข้าร่วมวิจัยของกลุ่มทดลอง (= 0.84 ± 1.21) มากกว่ากลุ่มควบคุม (= 0.13 ±  0.85) อย่างมีนัยสำคัญทางสถิติ (t= 2.24 , p < .05 )

สรุป :โปรแกรมการจัดการตนเองที่เน้นการออกกำลังกายแบบแกว่งแขนสามารถลดระดับฮีโมโกลบินในผู้ป่วยเบาหวานเข้าจอประสาทตาได้อย่างมีประสิทธิภาพ

An Investigation Of Registered Nurses’ Knowledge And Decision-Making Processes In Relation To The Management Of Adults With Diabetic Ketoacidosis, Megan Alice Westphalen

Theses

Introduction: Diabetic ketoacidosis (DKA) is an acute complication of diabetes. Registered nurses (RNs) knowledge with regard to DKA has never been investigated in any depth, nor has their decision making ever been examined in this specific context.

Research Significance: Nursing research literature acknowledges that nurses have an important role in the management of patient with DKA. However, there is very little empirical evidence available to support this claim. The purpose of this study is to provide evidence of the level of knowledge, the decision-making processes and the factors that influence nurses’ decision making whilst managing patients with DKA.

Methodology: A …

Increasing Staff Compliance With Routine Hcv Screening And Improving Linkage To Care Among Patients Testing Hepatitis C Positive In The Emergency Department, Carson G. Swartz

DNP Projects

Background: Hepatitis C virus (HCV) is a blood-borne pathogen that can cause severe liver disease, cancer, and death and is a significant source of morbidity and mortality in the United States. Several academic medical centers including University of Kentucky Healthcare have implemented routine HCV screening for patients presenting to the emergency department (ED) and have discovered a large viral burden amongst patients who are often symptomatic.

Purpose: The purpose of this doctoral project is to increase staff compliance, confidence, and education regarding the HCV screening process in an urban, Level I emergency department, as well as to evaluate whether an …

Nurses' Knowledge Of Delirium In The Icu, Sara Hancock

DNP Projects

Abstract

Background: Delirium costs the healthcare system $38 to $152 billion dollars annually. Nurses have a unique opportunity as healthcare providers to assess for and identify delirium, but often fail to recognize delirium.

Purpose: The purpose of this DNP project was to determine the effect of implementing an educational intervention regarding delirium risk factors, symptoms, prevention strategies, and treatments, on the knowledge of nurses working in an intensive care unit.

Methods: This DNP project used a quasi-experimental pre-test post-test design. Participants completed a pre-test (Appendix A), an educational intervention (Appendix C & D), and a post-test (Appendix B). Pre-test …

Effect Of Anticipatory Guidance On Parental Knowledge And Anxiety Prior To Discharge Of Infant From The Neonatal Intensive Care Unit To Home, Stephanie Kelty

DNP Projects

Background: Lack of adequate parental education and discharge readiness from the Neonatal Intensive Care Unit (NICU) increases the risk for poor infant outcomes, hospital readmissions, postpartum depression, parental anxiety, and post-traumatic stress disorder. One component of parental readiness at discharge is receiving anticipatory guidance from a trusted healthcare provider prior to discharge.

Purpose/Objectives: This study aimed to evaluate the effectiveness of provider-led anticipatory guidance to enhance parents’ knowledge regarding high-risk infant behaviors and decrease anxiety related to caring for their high-risk infant after NICU discharge. Additionally, this study aimed to assess parental opinions about the value of anticipatory guidance sessions. …

A Path Analysis Model Of Mobility Among Persons With Hip Fracture After Surgery, Chanipa Yoryuenyong

Chulalongkorn University Theses and Dissertations (Chula ETD)

This correlational study aimed to 1) investigate mobility and 2) examine direct and indirect paths of relationships among comorbidity, cognitive function, social support, pain, fatigue, and sleep quality on mobility among persons with hip fracture after surgery. The hypothesized model was constructed based on the theory of unpleasant symptoms and the literature reviewed. A three-stage random sampling approach was utilized to recruit 260 persons with hip fracture after surgery aged 50 years old and older who visited four hospitals in three health regions of Thailand. Research measurements consisted of the demographic data form, Charlson Comorbidity Index, General Practitioner Assessment of …

ปัจจัยคัดสรรที่สัมพันธ์กับพฤติกรรมการรับประทานอาหารของผู้ป่วยกลุ่มอาการภาวะกล้ามเนื้อหัวใจขาดเลือดเฉียบพลัน, รัชฎาพร บุญสนอง

Chulalongkorn University Theses and Dissertations (Chula ETD)

การวิจัยครั้งนี้เป็นการศึกษาความสัมพันธ์เชิงบรรยายเพื่อศึกษาปัจจัยคัดสรรที่สัมพันธ์กับพฤติกรรมการรับประทานอาหารของผู้ป่วยกลุ่มอาการภาวะกล้ามเนื้อหัวใจขาดเลือดเฉียบพลัน กลุ่มตัวอย่าง คือ ผู้ป่วยกลุ่มอาการภาวะกล้ามเนื้อหัวใจขาดเลือดเฉียบพลัน จำนวน 195 คน คัดเลือกกลุ่มตัวอย่างด้วยวิธีการสุ่มแบบหลายขั้นตอน จากผู้ป่วยที่มารับบริการ ณ แผนกผู้ป่วยนอกระบบหัวใจและหลอดเลือด โรงพยาบาลจุฬาลงกรณ์ สภากาชาดไทย โรงพยาบาลตำรวจ และโรงพยาบาลศิริราช เก็บข้อมูลโดยใช้แบบสอบถามทั้งหมด 7 ส่วน คือ 1) แบบบันทึกข้อมูลส่วนบุคคล 2) แบบสอบถามความรู้เรื่องโรคหัวใจขาดเลือด 3) แบบสอบถามการรับรู้การเจ็บป่วย 4) แบบสอบถามแรงจูงใจ 5) แบบสอบถามการสนับสนุนทางสังคม 6) แบบสอบถามการรับรู้สมรรถนะแห่งตน และ 7) แบบสอบถามพฤติกรรมการรับประทานอาหาร ตรวจสอบความตรงตามเนื้อหาโดยผู้ทรงคุณวุฒิ 5 คน มีค่าดัชนีความตรงตามเนื้อหาเท่ากับ 0.94, 1.0, 1.0, 0.97, 1.0 และ 0.95 ตามลำดับ และตรวจสอบความเที่ยงของเครื่องมือเท่ากับ .76, .80, .73, .91, .96 และ .87 ตามลำดับ วิเคราะห์ข้อมูลโดยใช้วิธีการทดสอบค่าสัมประสิทธิ์สหสัมพันธ์เพียร์สัน ผลการวิจัยสรุปได้ดังนี้ 1. ผู้ป่วยกลุ่มอาการภาวะกล้ามเนื้อหัวใจขาดเลือดเฉียบพลันมีคะแนนเฉลี่ยพฤติกรรมการรับประทานอาหารเฉพาะโรค ความรู้ แรงจูงใจ การสนับสนุนทางสังคม และการรับรู้สมรรถนะแห่งตนอยู่ในระดับสูง (Mean = 100.98 SD = 12.39, Mean = 16.48 SD = 2.16, Mean = 76.03 SD = 8.63, Mean = 67.43 SD = 9.09 และ Mean = 25.73 SD = 3.79 ตามลำดับ) และมีคะแนนการรับรู้การเจ็บป่วยระดับปานกลาง (Mean = 49.81 SD …