Patients' Assessment of the Convenience of Fentanyl HCl Iontophoretic Transdermal System (ITS) Versus Morphine Intravenous Patient-Controlled Analgesia (IV PCA) in the Management of Postoperative Pain After Major Surgery

The patient-controlled fentanyl HCl iontophoretic transdermal system (ITS) is a compact, self-contained, needle-free system that has been approved for acute postoperative pain management in hospitalized adults. The objective of the present analysis was to evaluate patients' assessment of fentanyl ITS and morphine intravenous patient-controlled analgesia (IV PCA) convenience on 7 different subscales, using a validated patient ease of care (EOC) questionnaire in 2 prospective, open-label, randomized, phase IIIb clinical trials. Patients received fentanyl ITS or morphine IV PCA (N = 1,305) for up to 72 h after total hip replacement surgery (THR study) or abdominal or pelvic surgery (APS study). For the majority of items on the patient EOC questionnaire, trends suggest that greater percentages of patients reported the most positive response for fentanyl ITS than they did for morphine IV PCA in both studies; differences were particularly noteworthy for items on the Movement subscale. In the THR study, more patients in the fentanyl ITS group were responders compared with those in the morphine IV PCA group for the subscales Confidence with Device, Pain Control, Knowledge/Understanding, and Satisfaction. In the APS study, responder rates for these subscales did not differ between treatment groups. These findings indicate that patients assessed the EOC associated with fentanyl ITS higher compared with morphine IV PCA for the management of acute postoperative pain and suggest that fentanyl ITS has the potential to improve acute postoperative pain care for patients and nurses.     

Use of strategies to improve antihypertensive medication adherence within United States outpatient health care practices,DocStyles 2015‐2016

Patients’ adherence to antihypertensive medications is key to controlling high blood pressure. Evidence‐based strategies to improve adherence exist, but their use, individually and in combination, has not been described. 2015‐2016 DocStyles data were analyzed to describe health care professionals’ and their practices’ use of 10 strategies to improve antihypertensive medication adherence across 3 categories: prescribing, education, and tracking/encouragement. Among 1590 respondents, a mean of using 5 strategies was reported, with individual strategy use ranging from 17.2% (providing patients adherence‐related rewards) to 69.4% (prescribing once‐daily regimens). Those with higher odds of using ≥7 strategies and strategies across all 3 categories included: (1) nurse practitioners compared to family practitioners/internists and (2) health care professionals in practices with standardized hypertension treatment protocols who routinely recommend home blood pressure monitor use compared to respondents without those characteristics. Despite using an array of evidence‐based adherence‐promoting strategies, additional opportunities exist for health care professionals to provide adherence support among hypertensive patients.     

An e‐health intervention for increasing diabetes knowledge in African Americans

An evidence‐based e‐health program, eCare We Care, was developed to disseminate information on diabetes management through web‐based interactive tutorials. This study examined the effect of the eCare We Care program on diabetes knowledge development in African American adults with low diabetes literacy. Forty‐six African American adults with type 1 or type 2 diabetes and low diabetes literacy were recruited from two health‐care centres in eastern Winston Salem, North Carolina. The eCare We Care program included four weekly sessions: introduction to diabetes; eye complications; foot care; and meal planning. Significant differences in scores on the diabetes knowledge survey were demonstrated between the eCare We Care program participants and the comparison group. Study findings indicate the eCare We Care program is more effective in improving diabetes knowledge of African American adults with low diabetes literacy than paper‐based, text‐only tutorials. The eCare We Care program can be an effective educational strategy for improving diabetes knowledge and decreasing diabetes disparities among African American adults.     

Self‐determined motivation and exercise behaviour in COPD patients

The purpose of this study was to evaluate the self‐determined motivation predictors of exercise behaviour following pulmonary rehabilitation in COPD recipients. This cross‐sectional study was conducted with 135 COPD patients. A demographic questionnaire, clinical factors, behavioural regulations in exercise questionnaire, and leisure time exercise questionnaire were used to collect data. A logistic regression model was used to identify the predictors associated with demographics and self‐determined motivation types regarding physical activity. Education level, episodes of acute exacerbation within 2 years, and identified regulation were significant predictors of executing physical activities with high metabolic equivalents. The results of this study imply that healthcare providers need to be aware of the importance of exercise motivation among COPD patients.     

Nursing Diagnoses in Wellness Childbearing Settings

Although most nurses recognize the benefits of nursing diagnoses, difficulties surrounding clinical application of the NANDA system have often occurred. Many nurses feel that the NANDA system focuses mainly on illness or problem diagnoses, which makes application to healthy processes and areas such as childbearing more difficult. Examples of the flexibility of the NANDA system for stating diagnoses involving healthy processes as well as illness/problem diagnoses for postpartum clients are cited to illustrate that with simple modifications and in combination with a conceptual framework, this system can be used to formulate individualized diagnoses in childbearing settings.