Assessing the feasibility and acceptability of a diabetes-specific nurse-led multicomponent smoking cessation intervention in diabetes education: study protocol for an open-label pragmatic randomised controlled trial.

INTRODUCTION: Smoking cessation is an essential, but often overlooked aspect of diabetes management. Despite the need for tailored smoking cessation support for individuals with diabetes, evidence of effective interventions for this cohort is limited. Additionally, individuals with diabetes do not easily adopt such interventions, resulting in low uptake and abstinence rates. This protocol describes a study that aims to assess the feasibility and acceptability of a unique smoking cessation intervention, based on the best evidence, theory and the needs of individuals with diabetes, among patients and service providers, the diabetes nurse educators. METHODS AND ANALYSIS: This is an open-label pragmatic randomised controlled trial. Between 80 and 100 individuals with type 1 or type 2 diabetes who smoke will be recruited from the diabetes outpatients at the main acute public hospital in Malta, starting in August 2023. Participants will be randomly assigned (1:1 ratio) to the intervention or control arm for 12 weeks. The experimental intervention will consist of three to four smoking cessation behavioural support sessions based on the 5As (Ask, Advise, Assess, Assist and Arrange) algorithm, and a 6-week supply of nicotine replacement therapy. The control intervention will consist of an active referral to the Maltese National Health Service's one-to-one smoking cessation support service, which is based on motivational interviewing. The primary feasibility and acceptability outcomes include the recruitment and participation rates, resources used, problems identified by the nurses, the nurses' perceived challenges and facilitators to implementation and the nurses' and patients' acceptability of the study intervention. Data analyses will be descriptive, with quantitative feasibility and acceptability outcomes reported with 95% confidence intervals. ETHICS AND DISSEMINATION: Ethical clearance was obtained from the Faculty of Health Sciences Research Ethics Committee, University of Malta. The study results will be disseminated through conference presentations and a publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT05920096.

Influence of quitting smoking on diabetes-related complications: A scoping review with a systematic search strategy.

INTRODUCTION: Smoking in people with diabetes markedly elevates their risk of developing complications and increases the likelihood of cardiovascular mortality. This review is the first to specifically provide evidence-based analysis about the influence of quitting smoking on diabetes-related complications in people with type 2 diabetes. METHOD: The present review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. All human clinical studies assessing the effects of stopping smoking cessation on diabetes-related complications were included. PubMed and Embase were screened until January 2024. References of primary studies and principal peer-reviewed scientific journals in the field were manually screened. RESULTS: We identified a total of 1023 studies. Only 26 met the criteria for eligibility. In general quitting smoking is associated with decreased risks of myocardial infarction and ischemic stroke. Regarding microvascular complications, the strongest evidence for the beneficial effects of smoking cessation is observed in diabetic nephropathy. However, the relationship between smoking cessation and retinopathy, neuropathy, diabetic foot complications and diabetic-related erectile dysfunction, is poorly investigated. CONCLUSION: Quitting smoking offers significant advantages in managing diabetes-related complications, significantly lowering the risks of myocardial infarction, ischemic stroke, and diabetic nephropathy. This underscores the importance of cessation. Providing evidence-based information on the benefits of stopping smoking for people with type 2 diabetes who smoke, can bolster smoking cessation efforts in the context of diabetes management.

Behavioral Therapy for People With Diabetes Who Smoke: A Scoping Review.

BACKGROUND: Tobacco smoking exacerbates diabetes-related complications; its prevalence is notwithstanding substantial. Persons with diabetes face a number of barriers and challenges to quitting such as multiple lifestyle restrictions; tailored interventions are required for smoking cessation. OBJECTIVE: To identify research on behavioral interventions for smoking cessation in diabetes. METHODS: Studies had to be randomized controlled trials, quasiexperimental or systematic reviews. The behavioral interventions included were: the 5As, Cognitive-Behavioral Therapy, Motivational Interviewing, Contingency Management, Health Coaching and Counselling, as compared to standard care. The outcomes were self-reported and/or biochemically verified smoking cessation. CINAHL Complete, MEDLINE Complete, the Cochrane databases of systematic reviews and randomized controlled trials, PsychInfo and PubMed Central were searched until July, 2023. Keywords used included diabetes, smoking cessation and each of the behavioral interventions included. RESULTS: 1615 papers were identified. Three studies on the 5As/brief advice, 4 on Motivational Intervention and 1 on counseling were retained. The results on the 5As and Motivational Interviewing were conflicting. More intensive interventions appear to be more successful in achieving smoking cessation in smokers with diabetes. CONCLUSIONS: Future research should focus on the continued development and evaluation of structured smoking cessation interventions based on the 5As, Motivational interviewing and Cognitive Behavioral Therapy.

Acceptability measures for evaluating smoking cessation interventions among individuals with diabetes.

Background: The literature indicates that individuals with diabetes do not easily adopt smoking cessation interventions. Given that the success of such interventions depends on patient involvement and attitudes, assessing intervention acceptability, including patient satisfaction and perceived usefulness, is crucial before implementing a smoking cessation intervention. This paper reports the preliminary validation of the satisfaction and perceived usefulness questionnaires for evaluating smoking cessation interventions among individuals with diabetes. Study design: Validity study. Methods: The satisfaction questionnaire contained eight statements while the perceived usefulness questionnaire had fourteen; both rated on a 5-point Likert scale. Content validation involved five tobacco cessation facilitators rating item relevance using a 4-point ordinal rating scale, suggesting improvements. The questionnaires were also translated into Maltese for local use and assessed for translation validity using a similar scale. Unanimous agreement among experts was required for item relevance and equivalence. Thirty-four individuals with type 1 or type 2 diabetes, attending a diabetes-specific smoking cessation intervention, received either the Maltese or English versions of the questionnaires. Internal consistency was measured using Cronbach's alpha. Results: After two rounds of content validation, the experts unanimously agreed on item relevance and conceptual equivalence. Fifteen and sixteen participants completed the Maltese and English versions of the questionnaires, respectively. Both questionnaires' versions were found to have a high internal consistency (>0.8). Conclusions: These findings provide the initial validation of these instruments for assessing the acceptability of smoking cessation interventions among individuals with diabetes. Further validation in different settings using a larger sample is suggested.

Exploring the smoking cessation needs of individuals with diabetes using the Information-Motivation-Behavior Skills model.

INTRODUCTION: Smoking cessation is an important aspect of diabetes management. Despite the increased risk for diabetes complications when smoking, evidence suggests that people living with type 1 and type 2 diabetes are less likely to quit smoking when compared to those without diabetes. Guided by the Information-Motivation-Behavioral Skills model, this study aimed to identify the needs of individuals living with type 1 and type 2 diabetes to quit smoking. METHODS: A qualitative descriptive design was adopted. Semi-structured telephone interviews were held between April and June 2021, with 20 former and current Maltese smokers living with type 1 or type 2 diabetes, recruited from the diabetic clinics within the two main acute public hospitals. The interview transcriptions were analyzed using applied thematic analysis. RESULTS: Individuals with diabetes need more information on the effects of smoking on diabetes to encourage cessation. Preventing diabetic complications was reported as a motivator to quit smoking. However, having diabetes was identified as a challenge to quitting. Participants welcomed the provision of health professional support for quitting smoking, identifying the need to provide smoking cessation support within diabetic clinics. The provision of information on tobacco-associated diabetic complications, by using video messages featuring former smokers' stories was also suggested. CONCLUSIONS: To promote smoking cessation among individuals with diabetes, they need to be informed about how smoking affects their condition. Utilizing video messages featuring real-life stories of former smokers with diabetes who experienced tobacco-associated diabetic complications may be influential. Additionally, providing diabetes-specific intensive smoking cessation support is crucial to help them quit.

The impact of COVID-19 on nursing students' lives and online learning: A cross-sectional survey.

AIMS: To explore the impact of COVID-19 on students' lives and their online learning experience. DESIGN: A cross-sectional survey design was used in this study. METHODS: A total of 44 nursing students who were enrolled in an undergraduate programme at a Canadian University participated in the study. The students were asked to fill out a 35-item survey that was developed by the European Students' Union and that was circulated across Europe in April 2020. RESULTS: The COVID-19 pandemic and subsequent lockdown affected students mentally, and emotionally. Findings also revealed that whilst most students had the privilege to study from home, many students did not have a desk, or a quiet place to study in their home and some had problems with Internet connectivity. Online lectures were delivered according to students' preferences; however, students were dissatisfied with the way their practice was organized. CONCLUSION: The similarities between this study and the European study provide common grounds for academics around the world to connect, collaborate and work on the challenges in providing nurse education in emergencies such as national disasters or pandemics to ensure preparedness for such future events. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. IMPACT: The commonalities experienced in nursing education across the globe should act as an impetus for globalized nursing action. Educators need to prepare and reinvent a role for students in the clinical area in the event of future disasters/pandemics. Policy makers and administrators need to ensure when switching to online education no student is underprivileged or marginalized in the process.

Effectiveness of intensive stand-alone smoking cessation interventions for individuals with diabetes: A systematic review and intervention component analysis.

INTRODUCTION: Tobacco smoking poses a significant threat to the health of individuals living with diabetes. Intensive stand-alone smoking cessation interventions, such as multiple or long (>20 minutes) behavioral support sessions focused solely on smoking cessation, with or without the use of pharmacotherapy, increase abstinence when compared to brief advice or usual care in the general population. However, there is limited evidence so far for recommending the use of such interventions amongst individuals with diabetes. This study aimed to assess the effectiveness of intensive stand-alone smoking cessation interventions for individuals living with diabetes and to identify their critical features. METHODS: A systematic review design with the addition of a pragmatic intervention component analysis using narrative methods was adopted. The key terms 'diabetes mellitus' and 'smoking cessation' and their synonyms were searched in 15 databases in May 2022. Randomized controlled trials which assessed the effectiveness of intensive stand-alone smoking cessation interventions by comparing them to controls, specifically amongst individuals with diabetes, were included. RESULTS: A total of 15 articles met the inclusion criteria. Generally, the identified studies reported on the delivery of a multi-component behavioral support smoking cessation intervention for individuals with type I and type II diabetes, providing biochemically verified smoking abstinence rates at follow-up at six months. The overall risk-of-bias of most studies was judged to be of some concern. Despite observing inconsistent findings across the identified studies, interventions consisting of three to four sessions, lasting more than 20 min each, were found to be more likely to be associated with smoking cessation success. The additional use of visual aids depicting diabetes-related complications may also be useful. CONCLUSIONS: This review provides evidence-based smoking cessation recommendations for use by individuals with diabetes. Nonetheless, given that the findings of some studies were found to be possibly at risk-of-bias, further research to establish the validity of the provided recommendations is suggested.

Helping smokers with diabetes quit: A scoping review of the interventions utilised, and the challenges and barriers to smoking cessation.

Tobacco smoking is recognised as a priority in diabetes management, yet many individuals with diabetes continue to smoke beyond diagnosis. This paper identifies the most promising smoking cessation strategies by reviewing the literature reporting interventions carried out amongst this study population, and the challenges and barriers to smoking cessation. Stand-alone smoking cessation interventions which included pharmacotherapy were found to be more successful in achieving abstinence than interventions which included smoking cessation as part of a broader intervention for improving diabetes management. Misconceptions about smoking and diabetes management were frequently reported, undervaluing smoking cessation. This emphasizes further the need to inform smokers with diabetes about the link between tobacco use and diabetes complications.

The effectiveness of skin traction in reducing pain in adults with a hip fracture: A systematic review.

BACKGROUND: Femoral fractures are associated with high mortality and morbidity, including pain. Skin traction may be used pre-operatively as an adjunct to analgesia to decrease pain. OBJECTIVE: To evaluate the effects on pain of the use of pre-operative skin traction in adults with a fracture of the proximal femur. RESEARCH QUESTION: Is the use of pre-operative skin traction effective in reducing pain in adults with proximal femoral fractures? METHOD: A systematic review was conducted based on a search of PubMed, CINAHL Complete, MEDLINE Complete, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews. The keywords 'preoperative', 'skin traction', 'hip fractures' and 'pain' were used. Randomised controlled trials published in English between April 2011 and November 2020 were included and appraised using the Cochrane Risk of Bias tool. RESULTS: Five articles met the inclusion criteria; all were randomised controlled trials. The results confirm those of earlier reviews: skin traction does not significantly decrease pain and analgesia use. The quality of the evidence available is weak. CONCLUSION: There is no strong evidence for the routine pre-operative use of skin traction in adults with a hip fracture. As the quality of the evidence is weak, further high-quality research on this topic is warranted.

Strategies to improve response rates to web surveys: A literature review.

BACKGROUND: The development of the web survey has led to significant strides in questionnaire survey methodology, including its potential to substantially increase sample sizes at minimal costs. Despite its advantages, web surveys typically achieve lower response rates from participants compared to more conventional survey methods. OBJECTIVE: The aim of this review was to evaluate strategies to increase the response rate to web surveys. METHODS: CINAHL (EBSCO), MEDLINE Complete, the Cochrane database of systematic reviews, the Cochrane central register of controlled trials and Psych Info were searched, from inception to the 24th of June, 2021. The Boolean search phrase (Ti: Web survey* OR online survey* OR internet survey*) AND (Ti: response rate* OR nonresponse* or participation rate*) was used. This was supplemented by a secondary search of the reference lists. To be eligible for inclusion in the review, papers had to evaluate one or more strategies to improve response rates to web surveys. Experimental and quasi experimental studies were included in the review. RESULTS: A total of 159 papers were identified. Following removal of duplicates, and further screening by two independent reviewers, 45 papers met the inclusion and exclusion criteria, and were included in the final review. The use of e-mail pre-notification, email invitation and two reminders were found to increase response rates to web surveys as do the use of a semi-automatic log-in, a simple design and a short survey which takes around 10 min to complete. Incentives, including entry into a prize draw with a cash prize considered to be of value to the participants also increase response rates. CONCLUSION: Research studies are needed to explore whether the different strategies used by researchers with the intent to improve response rates are acceptable to potential participants and to evaluate the potential synergistic effect of combinations of several strategies identified in this review. Tweetable abstract: Email prenotification, email invitation, 2 reminders, simple 10 min design and lottery incentives improve response rates to web surveys.

Distributed leadership and nurses' job satisfaction: a survey.

PURPOSE: The purpose of this paper is to explore the relationship between perceived distributed leadership and job satisfaction among nurses. Leadership is central to improving quality care. Reports following investigations of poor care standards, identified inadequate leadership as a contributory factor and called for a new kind of leadership. One alternative is distributed leadership. Evidence suggests associations between leadership and job satisfaction but, there is a paucity of research examining associations between distributed leadership and job satisfaction: the purpose of this study was to address this gap. DESIGN/METHODOLOGY/APPROACH: A cross-sectional survey design was used and data collected via questionnaires. Using census sampling, 350 nurses in a hospital in Malta were selected. A response rate of 50% (n = 176) was achieved. Data were analysed using Spearman's correlation coefficient and multiple regression. Ethical approval was obtained from relevant committees/individuals. FINDINGS: Results indicated a moderate application of perceived distributed leadership and application of all components of distributed leadership could be improved. Nurses were neither satisfied nor dissatisfied with their jobs. Correlation analysis showed a positive relationship between distributed leadership and job satisfaction. Multiple regression showed that commitment and participative decision-making were major predictors of job satisfaction while supervision by managers had a negative effect. PRACTICAL IMPLICATIONS: Improving distributed leadership is a priority in the nursing profession. ORIGINALITY/VALUE: To the best of the authors' knowledge, this study is the first to show that distributed leadership has a positive effect on job satisfaction among nurses. Supervision, a constituent of distributed leadership, was associated with reduced job satisfaction, therefore reducing this is paramount.

Spiritual coping strategies and quality of life in older adults who have sustained a hip fracture: A cross-sectional survey.

AIMS: To investigate the relationship between spiritual coping strategies and quality of life in persons with a hip fracture. DESIGN: A correlational, cross-sectional survey design. METHODS: The total population of Maltese-speaking adults over 65 years (N = 299), with a hip fracture receiving treatment in a public hospital in Malta in 2015, were invited. The WHOQOL-BREF questionnaire and the Spiritual Coping Strategies Scale were used. RESULTS: A response rate of 51% (n = 147) was achieved. The poorest quality of life was for the physical and psychological domains. Spiritual coping strategies were associated with better quality of life with the exception of physical quality of life. Non-religious coping strategies were the stronger predictor of quality of life compared with religious coping strategies. The former predicted physical, psychological, environmental, social and overall quality of life. CONCLUSION: Hip fractures have serious implications on quality of life which could be improved by promoting non-religious spiritual coping strategies.

The effect of gum chewing on postoperative ileus in open colorectal surgery patients: A review.

BACKGROUND: Postoperative ileus is a common complication of abdominal surgery, leading to prolonged hospital stay and associated costs. Gum chewing may be a safe, cheap intervention to reduce postoperative ileus. METHODS: The aim was to investigate the effect of gum chewing on postoperative ileus in open colorectal surgery patients. A literature search was conducted between December 2018 and March 2019 on CINAHL, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews, MEDLINE, Academic Search Complete, PubMed, Scopus and Google Scholar. The keywords used included 'ileus', 'chewing gum', 'mastication' and 'sham feeding'. Papers had to include adults undergoing open colorectal surgery. The studies were appraised using Critical Appraisal Skills Programme tools and the results summarised using a narrative review. RESULTS: A total of three systematic reviews and three randomised controlled trials were included in the study. The studies show a significant to highly significant effect of gum chewing on postoperative ileus-related outcomes. The trials however in general utilised a weak design. CONCLUSIONS: Gum chewing decreases postoperative ileus following colorectal surgery. More robust trials are required to confirm these findings. Due to the low risk of harm and cost of using gum chewing, its use is recommended even in the interim.

Formal caregivers' perceptions and experiences of using pet robots for persons living with dementia in long-term care: A meta-ethnography.

AIM: To explore the formal caregivers' perceptions and experiences of using pet robots for persons living with dementia residing in long-term care settings and the factors influencing their perceptions by evaluating, integrating, and synthesizing findings from relevant international research articles using a meta-ethnography. DESIGN: Noblit and Hare's interpretative meta-ethnography. DATA SOURCES: Eight articles, published between 2013-2018, were identified following a systematic search of four databases (Scopus, ProQuest Central, EBSCO, and Google Scholar) between June 2019-February 2020. REVIEW METHODS: Two researchers independently appraised the selected articles. Noblit and Hare's seven steps and a meta-ethnography reporting guidance were used. Reciprocal translation was used to obtain a line of argument synthesis. RESULTS: Three overarching themes were identified: a beneficial tool but not for everybody, a tool that has limitations but could be overcome, and a positive experience if appropriately introduced and sustained. CONCLUSION: This meta-ethnography contributes to the understanding of current potential benefits and limitations of pet robots for persons living with dementia residing in long-term settings. It also identifies several factors, as perceived by caregivers, that may influence their acceptability, adoption, and routine use in practice. IMPACT: Although for the past two decades pet robots have been used as a psychosocial intervention for persons living with dementia in long-term care settings, there is a dearth of literature on the perception of formal caregivers and their experience of such interventions. While pet robots can have emotional, social, behavioural, and practical benefits, there are several technological, organizational, and contextual challenges and limitations that constrain their routine use. The solutions synthesized in this review can be of benefit to robot designers, facility managers, policy makers, and other health care professionals interested in introducing pet robots in long-term care settings.

Brief tobacco cessation interventions: Practices, opinions, and attitudes of healthcare professionals.

INTRODUCTION: Although brief smoking cessation interventions that follow the 5As algorithm (Ask, Advise, Assess, Assist, Arrange) can trigger smokers to quit, routine delivery remains low in Europe. This study aimed to identify the extent of smoking cessation practices of healthcare professionals interested in tobacco cessation, and their opinions and attitudes. METHODS: A quantitative, cross-sectional survey design was adopted. Healthcare professionals (n=133) who attended one of ten training sessions on brief interventions for smoking cessation, held every month between September 2018 and June 2019 in Malta, were recruited. Univariate logistic regression and non-parametric tests were carried out to identify associations by participants' characteristics. Potential confounders were ruled out following multivariate analyses. RESULTS: Most participants were female nurses who had never smoked. While most professionals reportedly asked (76.3%), advised (83.5%) and assessed (70.5%) patients for cessation, fewer provided assistance (40.9%) and arranged followup (24.2%). Compared to other participants, doctors were more likely to have counselled patients over the previous week. Most professionals were favourably disposed towards counselling patients to quit, however, they claimed they had insufficient time to do so. Although most found it difficult to get clients to quit, former smokers were more likely to disagree when compared to those who never smoked (OR=6.86; 95% CI: 2.17-21.71; p=0.001). CONCLUSIONS: While more initiatives to train healthcare professionals in providing smoking cessation interventions are recommended, lack of sufficient time, being an organisational barrier, requires healthcare management exploration and action. Given that former smokers were more confident in helping patients quit, engaging them in training activities would be of added value.

Exploring the knowledge, attitudes and perceived learning needs of formal carers of people with dementia.

BACKGROUND: An appropriate level of knowledge, a positive attitude and awareness of learning needs are essential to provide high-quality care to people living with dementia. AIM: To explore the knowledge, attitudes and perceived learning needs of formal carers of residents living with dementia in one long-term care facility. METHOD: Questionnaires were sent to nurses and nursing assistants working in one long-term care facility in Malta. A total of 207 completed responses were received from these formal carers. The questionnaire comprised scales: the Alzheimer's Disease Knowledge Scale, the Dementia Attitude Scale and the Dementia Learning Needs Assessment tool. RESULTS: Formal carers' knowledge about dementia was satisfactory. Increased knowledge was associated with being a nurse and working on a specialist dementia unit. Overall, formal carers' attitudes towards people with dementia were positive. Nurses identified managing behaviour that challenges as the most important learning need, while for nursing assistants it was how to assist family caregivers in coping with Alzheimer's disease. Nurses and nursing assistants considered learning about the use of technology to be the least important learning need. Being a nurse and working in a specialist dementia unit were predictors of better knowledge. Working in specialist dementia units was also a predictor of positive attitudes towards people with dementia. CONCLUSION: Policymakers should be aware that continued investment in specialist dementia units should be an intermediate and long-term goal because of the projected increase in the number of people living with dementia and the need to ensure these individuals receive optimum care.

Nurses' and nurse managers' perceived transformational leadership behavioural practices: a survey.

PURPOSE: The purpose of this paper is to compare the perceived transformational leadership practices of charge and staff nurses. Transformational leadership is effective in promoting change in organisations, with the leader guiding followers towards a common vision. DESIGN/METHODOLOGY/APPROACH: A quantitative, descriptive, comparative survey design was used. All charge nurses (N = 151) and staff nurses (N = 1,950) in six health entities in Malta were included. A mixed mode survey design was used. Data were collected using the Leadership Practices Inventory and analysed using ANOVA and the Kruskal-Wallis test. FINDINGS: An overall response rate of 15% (n = 315) was achieved. Both staff and charge nurses perceived transformational leadership to be practiced. Charge nurses scored consistently higher than staff nurses. In long-term care environments, charge nurses are more likely to "model the way", while in acute settings, they were more likely to "enable others to act". RESEARCH LIMITATIONS/IMPLICATIONS: Transformational leadership appears to be applied by charge nurses in Malta. The response rate achieved was low and may limit the generalisability of the results of the study. PRACTICAL IMPLICATIONS: Nurse managers need to adapt their transformational leadership style based on the context in which they work. ORIGINALITY/VALUE: Regular feedback from nursing staff should be sought for charge nurses to be aware of the extent to which they are implementing transformational leadership.

The effectiveness of virtual simulation in improving student nurses' knowledge and performance during patient deterioration: A pre and post test design.

BACKGROUND: Preparing nursing students to perform competently in complex emergency situations, such as during rapid patient deterioration, is challenging. Students' active engagement in such scenarios cannot be ensured, due to the unexpected nature of such infrequent events. Many students may consequently not experience and integrate the management of patient deterioration into their knowledge and practical competency by the end of their studies, making them unprepared to manage such situations as practicing nurses. This study investigated the effectiveness of virtual simulation in improving performance during rapid patient deterioration. OBJECTIVE: To investigate the effectiveness of virtual simulation in improving student nurses' knowledge and performance during rapid patient deterioration. DESIGN: A pre- and post-test design was used. SETTING: Nursing students at a university in Malta were invited to participate in a virtual simulation program named FIRST2ACTWeb™, using their own computer devices. PARTICIPANTS: A total of 166 (response rate=50%) second and third year diploma and degree nursing students participated in the study. METHODS: The simulation included three scenarios (Cardiac-Shock-Respiratory) portraying deteriorating patients. Performance feedback was provided at the end of each scenario. Students completed pre- and post-scenario knowledge tests and performance during each scenario was recorded automatically on a database. RESULTS: Findings showed a significant improvement in the students' post-scenario knowledge (z=-6.506, p<0.001). Highest mean performance scores were obtained in the last scenario (M=19.7, median: 20.0, s.d. 3.41) indicating a learning effect. Knowledge was not a predictor of students' performance in the scenarios. CONCLUSIONS: This study supports virtual simulation as an effective learning tool for pre-registration nursing students in different programs. Simulation improves both knowledge about and performance during patient deterioration. Virtual simulation of rare events should be a key component of undergraduate nurse education, to prepare students to manage complex situations as practicing nurses.

An exploratory study of predictors of self-care behaviour in persons with type 2 diabetes.

BACKGROUND: Type 2 diabetes constitutes a growing public health concern due to the risk of long-term complications. Control of blood glucose and other preventative measures are known to decrease this risk. Since prevention depends on the individual's behaviour, this study sought to identify factors related to self-care behaviour of persons with type 2 diabetes. The theory of planned behaviour provided the theoretical framework. OBJECTIVES: The objectives were to explore the relationship between attitudes towards self-care behaviour, subjective norms, behavioural control, behavioural intentions and actual self-care behaviour. DESIGN: A two-stage, descriptive survey design was used; data was collected at two time points, 1 week apart. SETTINGS: Participants were recruited by telephone. Data collection was carried out in participants' homes and over the phone. PARTICIPANTS: Participants were Maltese, over 50 years, diagnosed with type 2 diabetes at least 6 months beforehand. A random sample of 200 individuals was selected from a database of persons registered at a diabetes clinic in Malta. METHODS: In the first stage, data on factors which may predict self-care behaviour was collected by means of a structured interview. This included four subscales consisting of items rated on a seven point Likert Scale, constructed to measure the independent variables of attitudes to self-care behaviour, subjective norm, behavioural control and the independent variable of intent to perform the self-care behaviour. In the second stage, a structured telephone interview, including a revised version of the Summary of Diabetes Self-Care Activities, was used to measure the independent variable of self-care behaviour. RESULTS: A 50% (n=100) response rate was achieved. All participants were on insulin and/or hypoglycaemic agents. Attitude to self-care behaviour, subjective norms and behavioural control all predicted behavioural intent. Of these, perceived behavioural control was the most predictive and was also predictive of actual self-care behaviour. Participants reported high perceived behavioural control in relation to medication taking, but low perceived control in relation to exercise and dietary behaviour. CONCLUSIONS: Strategies to improve self-care behaviour in relation to type 2 diabetes should focus on improving the individual's perception of behavioural control, especially with regards to exercise and diet.