A causal model of factors influencing the quality of nursing care in psychiatric and substance abuse wards in hospitals under the Office of the Permanent Secretary, Ministry of Public Health, Thailand
Year: 2026
Type: article
Study design: Observational Study
Abstract: The quality of nursing care in psychiatric and substance abuse wards directly affects patient outcomes. The objective of this study was to examine the causal factors affecting the quality of nursing care in psychiatric and substance abuse wards in Thailand. A multi-site cross-sectional study was employed among 480 registered nurses with at least a Bachelor’s degree and experience in psychiatric and substance abuse care. Participants were purposively and conveniently sampled from 130 Ministry of Public Health hospitals across Thailand. Data were collected by an online survey using validated instruments, including the Practice Environment Scale of the Nursing Work Index (PES-NWI), a Nurses’ Clinical Competency Scale, a Work Engagement Scale, a Burnout Assessment Tool, and a Quality Nursing Care Scale. Structural Equation Modeling (SEM) was applied to test the hypothesized model, assessing both direct and indirect effects of study variables. The final model demonstrated a good fit (χ²/df = 2.67, RMSEA = 0.06, GFI = 0.96, TLI = 0.95, SRMR = 0.05). Nurses’ clinical competency had the strongest direct effect on the quality of nursing care (β = 0.63, p < 0.001), followed by work engagement (β = 0.16, p < 0.05). Burnout negatively influenced the quality of nursing care both directly (β = -0.09, p < 0.05) and indirectly through work engagement. Job satisfaction had an indirect effect on the quality of nursing care, whereas the nursing practice environment had no significant direct effect. Overall, the model explained 61% of the variance in the quality of nursing care. The findings suggested that improving nursing care quality in psychiatric and substance abuse settings requires enhancing clinical competency, work engagement, and reducing burnout. Implementation efforts should focus on training and burnout prevention, while future studies should examine the long-term effects and include diverse hospital settings.
Institutions: Ministry of Public Health, Maharat Nakhon Ratchasima Hospital
Language: English
Subfield: Research and Theory
Field: Nursing
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7160919717