Much to be desired in self‐management of patients with adrenal insufficiency

We assessed self‐management in patients with adrenal insufficiency and patient‐related factors that affect self‐management. A self‐report questionnaire was developed to assess self‐management. The questionnaire contained three main topics, including: (i) medication adherence; (ii) anticipated measures; and (iii) dose adaptation during medical emergencies. Sixty per cent of the patients (n = 116) completed the questionnaire. The score for the medication adherence was 3.5 out of 4. The score for anticipated measures was 3.4 out of 5, and dose adaptation during medical emergencies was 1.9 out of 3. Older age was a positive predictor for all three self‐management topics. The female sex was a positive predictor for anticipated measures and dose adaptation during medical emergencies. High education level was associated with higher scores on dose adaptation during medical emergencies in women, not in men. Education level did not affect other self‐management aspects. There seems to be a need to improve self‐management in these patients. Self‐management might be improved by continuous education, and involvement of endocrine nurses and nurse practitioners is likely to be a key factor in the effectiveness of patient education.     

Capacity for care: meta‐ethnography of acute care nurses' experiences of the nurse‐patient relationship

Aims

To synthesize evidence and knowledge from published research about nurses' experiences of nurse‐patient relationships with adult patients in general, acute inpatient hospital settings.

Background

While primary research on nurses' experiences has been reported, it has not been previously synthesized.

Design

Meta‐ethnography.

Data sources

Published literature from Australia, Europe, and North America, written in English between January 1999–October 2009 was identified from databases: CINAHL, Medline, British Nursing Index and PsycINFO.

Review methods

Qualitative studies describing nurses' experiences of the nurse‐patient relationship in acute hospital settings were reviewed and synthesized using the meta‐ethnographic method.

Results

Sixteen primary studies (18 papers) were appraised as high quality and met the inclusion criteria. The findings show that while nurses aspire to develop therapeutic relationships with patients, the organizational setting at a unit level is strongly associated with nurses' capacity to build and sustain these relationships. The organizational conditions of critical care settings appear best suited to forming therapeutic relationships, while nurses working on general wards are more likely to report moral distress resulting from delivering unsatisfactory care. General ward nurses can then withdraw from attempting to emotionally engage with patients.

Conclusion

The findings of this meta‐ethnography draw together the evidence from several qualitative studies and articulate how the organizational setting at a unit level can strongly influence nurses' capacity to build and sustain therapeutic relationships with patients. Service improvements need to focus on how to optimize the organizational conditions that support nurses in their relational work with patients.     

Effect of simulation on knowledge,self‐confidence,and skill performance in the USA: A quasi‐experimental study

In health care, high‐fidelity simulation has been shown to result in increased student learning outcomes when compared to low‐fidelity simulation. With educational facilities investing significant amounts of money into purchasing high‐fidelity simulators, it is imperative to identify if the midlevel simulator, which is less costly, will result in the same learning outcomes. In this study, we examined the effect of midlevel‐fidelity simulation versus low‐fidelity simulation on Bachelor of Science in Nursing nursing students' knowledge, self‐confidence, and skill performance. A quasi‐experimental design examined the effects of midlevel‐fidelity simulation (n = 37) versus low‐fidelity simulation (case study) (n = 37) in junior‐level nursing students. There was a significant difference for both groups in knowledge and skill performance (measured with a mini Objective Structured Clinical Examination), but not between the groups. Unexpectedly, the case‐study group had a higher level of self‐confidence (self‐reported). The results of this study indicate that further research is needed to support faculties' selection of learning strategies with the lowest cost and highest effectiveness in achieving the desired learning outcomes.