<![CDATA[A Sequential Explanatory Mixed Methods Evaluation of a Clinical Nursing Practice Guideline for Intracranial Pressure Management Background: Increased intracranial pressure (IICP) is a life-threatening complication of traumatic brain injury (TBI). Previous studies in Thailand have not evaluated the effectiveness of a structured clinical nursing practice guideline (CNPG) in improving nurses’ knowledge, skills, and confidence, highlighting the need for a rigorously developed and evaluated CNPG.Purpose: This study aimed to evaluate the effectiveness of a CNPG in improving nurses’ knowledge, skills, and confidence in managing IICP among patients with TBI and to explore nurses’ perceptions of its feasibility, optimality, and benefits.Methods: A sequential explanatory mixed methods design was employed. The quantitative phase used a pre–post design and was conducted from February to September 2024. The intervention involved implementing an IICP CNPG among 45 registered nurses in two neurological wards at a tertiary hospital in eastern Thailand. Data were collected using four validated instruments: the Nurses’ Knowledge on IICP Questionnaire, Clinical Skills Observation Checklist, Self-Confidence Scale for IICP Care, and Nurses’ Perception of CNPG Questionnaire. In the qualitative phase, 20 nurses participated in two focus group discussions, which were analyzed using conventional content analysis.Results: Nurses showed statistically significant improvements in knowledge, clinical skills, and self-confidence following CNPG implementation (all p < .001). Perceptions of the CNPG in terms of feasibility, optimality, and benefits significantly exceeded the standard benchmark (all p < .001). Eight qualitative themes were identified, highlighting the roles of evidence-based knowledge, repeated training, structured protocols, interprofessional collaboration, and refresher training in enhancing the consistency, confidence, and quality of IICP care.Conclusion: The CNPG was feasible, effective, and well accepted among nurses, leading to significant improvements in knowledge, clinical skills, and self-confidence in IICP management. Future research should examine its long-term impact and effectiveness across diverse clinical settings. Background: Diabetic peripheral neuropathy (DPN) is associated with older age and an abnormal ankle-brachial index (ABI). However, no previous study has investigated the synergistic interaction between older age and an abnormal ABI in relation to DPN.Purpose: This study aimed to investigate the independent associations and synergistic interaction of older age and an abnormal ABI in relation to DPN.Methods: This analytical cross-sectional study included 416 individuals with type 2 diabetes mellitus in Jakarta, Indonesia. Older age was defined as age >64 years. DPN was assessed using a combination of sensory testing with a 10-g Semmes-Weinstein monofilament and vibration testing with a 128-Hz tuning fork, with the diagnosis validated by a physician. ABI was assessed using continuous-wave Doppler ultrasound. Chi-square tests, independent t-tests, and multivariable logistic regression were performed with a significance level of p < .05.Results: DPN was identified in 34.9% (n = 145) of participants. Older age (adjusted odds ratio [AOR] = 1.74) and an abnormal ABI (AOR = 2.04) were independently associated with DPN. Older participants with an abnormal ABI were 4.03 times more likely to have DPN than adult participants with a normal ABI (p < .001). A positive synergistic interaction between older age and an abnormal ABI in relation to DPN was identified (AOR = 4.03; relative excess risk due to interaction [RERI] = 2.20; attributable proportion [AP] = 0.55; synergy index [SI] = 3.65).Conclusion: Older age and an abnormal ABI were independently associated with DPN, with their co-occurrence showing a positive synergistic interaction in relation to DPN. Further longitudinal studies with larger samples and relevant clinical factors are needed to confirm these findings. ]]>
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