Utilizing role-play to support competency-based education in self-care management

BackgroundThe practice of taking medication as directed by a healthcare provider is known as medication adherence. Therefore, the application of a socio-ecological model to this study identifies multilevel factors on barriers of medication adherence on chronic non-communicable disease and provides information to develop scientific health communication interventional strategies to improve medication adherence.ObjectiveThis study aimed to explore barriers of medication adherence on non-communicable disease prevention and care among patients in North Wollo Zone public hospitals, northeast Ethiopia.MethodsA phenomenological study design was carried out between February 5 and February 30, 2023. The study participants were chosen using a heterogeneous purposive sampling technique. In-depth interviews and targeted focus groups were used to gather data. The focus group discussions and in-depth interviews were captured on audio, accurately transcribed, and translated into English. Atlas TI-7 was utilized to do the thematic analysis.ResultsFour main themes, intrapersonal, interpersonal, community level, and health care related, as well as seven subthemes, financial problems, lack of family support, poor communication with healthcare providers, effects of social ceremonies, remote healthcare facility, and drug scarcity, were identified by this study. In this study participants reported that lack of knowledge about the disease and drugs were the main barrier for medication adherence. The study revealed that financial problems for medication and transportation cost were the main factor for medication adherence for non-communicable disease patients.ConclusionThis study explored that lack of knowledge, financial problem, lack of family support, poor communication with healthcare providers, social ceremony effects, remote healthcare facility, and scarcity of drugs were barriers of medication adherence among non-communicable disease patients. In order to reduce morbidity and mortality from non-communicable diseases, it is advised that all relevant bodies look for ways to reduce medication adherence barriers for patients at every level of influence.

The American Association of Colleges of Nursing (AACN) Essentials (2021) and the National Organization of Nurse Practitioner Faculties (NONPF) Role Competencies (2022) outline professional nursing competencies, resulting in a shift toward Nurse Practitioner (NP) competency-based education. To evaluate the reliability and validity of the Nurse Practitioner Student Competency Assessment (NPSCA), a revised instrument measuring person-centered competencies established by AACN and NONPF. Fifty-three students from four NP programs in their first clinical experience participated in the study. Each student performed one simulation, which was video-recorded. Two faculty members reviewed and scored each student's video recording using the NPSCA and the Virginia Commonwealth University (VCU) Scale, an instrument similar to those used by NP programs. The faculty ratings were collected using an online survey program. The final version of the NPSCA has 17 items. Eight faculty members rated the items on a scale from 1 (not very relevant) to 4 (very relevant), with 100% agreement that the items were relevant or very relevant, indicating sufficient content validity. Internal consistency: α = 0.884-0.895. Correlations between the NPSCA and the VCU scale were r = 0.288, p = .036 and r = 0.589, p < .001, respectively. The evidence supports the reliability and validity of the NPSCA. Its internal consistency is excellent, and the content validity and criterion-related validity were sufficiently supported. With a shortage of reliable and valid tools to assess NP graduates, the NPSCA may play a role in evaluating and ensuring the readiness of NP graduates for practice.

The school health office is often used as a clinical site for prelicensure nursing students in their community/public health or pediatrics clinicals. School nurses who serve as preceptors often find themselves unprepared, in part due to curricular changes focusing on competency-based education, which were updated in 2021. This article provides guidance for the practicing school nurse to provide a clinical experience for nursing students that meets the competency-based education requirements of the undergraduate nursing program and aligns with the NASN School Nursing Practice Framework. A brief explanation of competency-based education is discussed. Utilizing the umbrella of the school nursing standards, the American Association of Colleges of Nursing (AACN) Essentials, along with the School Nursing Framework, a sample model of activities to meet these competencies is provided to support both the student and the precepting school nurse.

The American Association of Colleges of Nursing (AACN) is shifting the nursing education paradigm to competency-based education. Competency-based nursing education focuses on the nursing students' demonstration of knowledge. This shift in nursing education will rely on performance measures and data to determine success. Data and artificial intelligence can provide the nursing student with a targeted evaluation from the nursing faculty. Building on prior applications of "precision" and the use of data to drive precision medicine or precision nursing, nursing informatics is well-positioned for this paradigm shift to support data and artificial intelligence in nursing education. Little is understood about the concept of "precision nursing education" and its implications. We completed a concept analysis and defined the concept of "precision nursing education" as the use of data and artificial intelligence to measure student nurses' performance with competency-based nursing education.

Many young transplant patients (≤11 years old) struggle to take their immunosuppressive and co-medications correctly, yet it remains unclear which factors positively or negatively affect medication adherence. Research studies on determinants in this age group are scarce, have methodological flaws, and focus exclusively on immunosuppressants or on barriers rather than on facilitators. This study used a consecutive mixed-methods (qualitative + quantitative) design. Semistructured interviews with parents of 10 pediatric liver or kidney transplant recipients 2 to 11 years old on adherence facilitators and barriers were conducted, complemented by quantification of adherence to the immunosuppressants and co-medications, and completion of the "immunosuppressive medication adherence barriers" self-report instrument. A median of 19 (range, 10-29) barriers was reported: the most commonly encountered were forgetfulness (70%), vomiting (70%), bad taste (60%), and interruptions in routine (60%). Parents reported a median of 15 facilitators (range, 6-26), including using practical aids (100%), having medication with you at all times (100%), having to take fewer medications (80%), and experiencing fewer regimen changes over time (80%). No clear distinction between immunosuppressants or co-medications was made. This study provides several new insights based on peer experience to support future patients and their parents in medication adherence.

Background: Diabetes mellitus (DM) is a highly prevalent chronic disease in Pakistan, ranking third globally concerning diabetes prevalence, with more than 33 million adults affected. The effective management of Diabetes management is essential for regulating blood glucose levels, mitigating complications, and improving patient outcomes. quality of life. Self-care practices include medication adherence, dietary changes, regular physical activity, and blood glucose monitoring, are all integral parts of good diabetes management. management However, there is a scarcity of research examining the self-care behaviors of Pakistani DM patients, which impedes the development of targeted interventions to improve patient outcomes.PurposeThis study aims to assess the self-care management practices among patients with diabetes mellitus in a tertiary care hospital in Karachi, Pakistan. Specifically, it seeks to evaluate the self-perceived importance of various self-care activities, identify socio-demographic factors influencing these practices, and highlight strengths and areas for improvement in current self-care behaviors. The ultimate goal is to inform healthcare providers and policymakers to develop culturally tailored strategies that promote effective diabetes self-management.MethodAn analytical cross-sectional design was employed to evaluate self-care management practices among DM patients. A convenient sample of 258 participants was recruited from inpatient and outpatient services at Aga Khan University Hospital in Karachi. Data were collected using the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire, which assesses various domains of self-care, including diet, exercise, medication adherence, blood glucose monitoring, and foot care. Socio-demographic information was also gathered through structured interviews. Data analysis was performed using SPSS version 26, utilizing both descriptive and inferential statistics to identify socio-demographic predictors of self-care management scores.FindingsThe study revealed that while a significant proportion of DM patients demonstrated satisfactory self-care practices in medication adherence and blood glucose monitoring, practices related to diet and physical activity were less consistently maintained. The most important self-care activity identified was medication adherence, followed by regular blood glucose monitoring. Socio-demographic factors such as age, gender, marital status, education level, relationship with the patient, duration of hospital stay, and distance from home to the hospital were significant predictors of self-care management scores. Additionally, cultural beliefs and socio-economic status were identified as key barriers to effective self-care practices.ConclusionThere is a pressing need for a patient- and family-centered approach for the health-care system of Pakistan. Interventions considering socio-demographic and cultural variables are also important in improving self-management behaviors among the patients with diabetes mellitus. Recommendations include patient education, improved access to health services, flexible visiting hours, and culturally sensitive interventions that improve diet and exercise adherence. These will eventually result in improvement in the health trend and decrease the rate of diabetes in Karachi, Pakistan.

Background Medication nonadherence and suboptimal self-care are common in inflammatory bowel disease (IBD), and are associated with increased relapse rates, unplanned health care use, and reduced quality of life. However, the psychological mechanisms underpinning these behaviors are still poorly understood. This study examined whether self-efficacy mediates the relationship between medication adherence and self-care behaviors in adults with IBD. Methods We conducted a multicenter cross-sectional secondary analysis of 453 clinically stable outpatients with Crohn’s disease or ulcerative colitis, consecutively enrolled from nine Italian hospitals. Sociodemographic and clinical data were collected through medical records and patient interview. Medication adherence, self-efficacy, and self-care (maintenance, monitoring, management) were assessed using the Morisky Medication Adherence Scale-8, the Self-Care Self-Efficacy Scale, and the Self-Care of Chronic Illness Inventory. Descriptive statistics, Pearson correlations, and mediation analysis (PROCESS model 4 with 5000 bootstrap samples) were used to explore associations and the mediating effect of self-efficacy, adjusting for relevant covariates. Results Only 10.1% of patients reported high medication adherence, while 89.9% had low or medium adherence. Self-efficacy levels were moderate overall and significantly higher in patients with high adherence. Medication adherence correlated positively with self-care maintenance (r = 0.12, p = 0.011) and self-efficacy (r = 0.11, p = 0.015), but not with self-care monitoring or management. Self-efficacy was associated with self-care maintenance and significantly mediated the relationship between medication adherence and self-care maintenance (indirect effect = 0.25, 95% CI 0.05–0.50), explaining 9.3% of the variance in maintenance behaviors, while no significant mediation emerged for monitoring or management. Conclusion In adults with IBD, medication adherence is closely linked to self-care maintenance, and this relationship is partially explained by patients’ self-efficacy. These findings support the systematic assessment of adherence and self-efficacy in routine care, and the development of tailored educational and digital interventions explicitly aimed at strengthening patients’ confidence in managing their condition. Targeting self-efficacy may represent a feasible strategy to simultaneously improve medication adherence and self-care, with potential benefits on long-term clinical and patient-reported outcomes.

PurposeMedication disposal knowledge is a key component of safe pharmaceutical management, while medication adherence remains essential for achieving optimal treatment outcomes among patients with chronic conditions. However, poor adherence may contribute to medication accumulation and waste, which, if not disposed of properly, can pose risks to environmental and public health. Therefore, this study aimed to assess medication disposal knowledge, policy awareness and satisfaction, as well as medication adherence among chronic disease patients, and to examine how these outcomes differed across demographic and clinical subgroups.Patients and MethodsA cross-sectional design was employed, collecting data from 273 chronic disease patients with long term medication usages at a hospital in Taipei, Taiwan. The questionnaire covered knowledge of medication disposal, medication adherence, clarity of the disposal policy and satisfaction with the disposal policy promotional strategies, and socio-demographics. Independent samples t-tests were used to assess the influence of demographic characteristics on knowledge and adherence. Pearson correlation coefficients were applied to evaluate the relationship between knowledge of medication disposal and medication adherence.ResultsYounger age and higher education were associated with better medication disposal knowledge. Medication adherence was significantly higher among patients over 65, lower education, who lived alone and those taking five or more medications. The medication disposal knowledge was not significantly different between good or poor adherence. Although most respondents were unaware of the recycling label on medication bags, those who knew the location of disposal stations scored higher knowledge of medication disposal, clarity in the disposal policy and satisfaction with the disposal policy promotional strategies.ConclusionMedication disposal competency plays an important role in reducing environmental harm, especially in people with poor adherence. Improving knowledge of medication disposal and adherence remains a key objective for medication safety and health issues.

BackgroundPresently, 6.5 million Americans are living with heart failure (HF). These patients are expected to follow a complex self-management regimen at home. Several demographic and psychosocial factors limit patients with HF in following the prescribed self-management recommendations at home. Poor self-care is associated with increased hospital readmissions. Under the Affordable Care Act, there are financial implications related to hospital readmissions for hospitals and programs such as the Program of All-Inclusive Care for the Elderly (PACE) in Pinellas County, Florida. Previous studies and systematic reviews demonstrated improvement in self-management and quality of life (QoL) in patients with HF with structured telephone support (STS) and SMS text messaging.ObjectiveThis study aimed to evaluate the effects of STS and SMS on self-care, knowledge, medication adherence, and QoL of patients with HF.MethodsA prospective quality improvement project using a pre-post design was implemented. Data were collected at baseline, 30 days, and 3 months from 51 patients with HF who were enrolled in PACE in Pinellas County, Florida. All participants received STS and SMS for 30 days. The feasibility and sustained benefit of using STS and SMS was assessed at a 3-month follow-up.ResultsA paired t test was used to compare the mean difference in HF outcomes at the baseline and 30-day follow-up, which demonstrated improved HF self-care maintenance (t49=0.66; P=.01), HF knowledge (t49=0.71; P=.01), medication adherence (t49=0.92; P=.01), and physical and mental health measured using Short-Form-12 (SF-12; t49=0.81; P=.01). The results also demonstrated the sustained benefit with improved HF self-care maintenance, self-care management, self-care confidence, knowledge, medication adherence, and physical and mental health (SF-12) at 3 months with P<.05 for all outcomes. Living status and social support had a strong correlation with HF outcomes. Younger participants (aged less than 65 years) performed extremely well compared with older adults.ConclusionsSTS and SMS were feasible to use among PACE participants with sustained benefits at 3 months. Implementing STS and SMS may serve as viable options to improve HF outcomes. Improving outcomes with HF affects hospital systems and the agencies that monitor and provide care for outpatients and those in independent or assisted-living facilities. Investigating viable options and support for implementation will improve outcomes.

Objective: Diabetes is a complex heterogeneous disorder with chronic multiple illness which needs continuous medical management. Along with the medication life style modifications (diet, exercise) and patient self-management education is necessary not only for glyceamic control but also for prevention and delay of acute and long term complications. In this regard an observational study was carried out among 167 type 2 diabetic patients using a self-administered questionnaire in tertiary care hospital, Guntur.&#x0D; Methods: Patients of both genders in the age of 30-89 with co morbidities were included in the study. Data regarding social habits, medication and adherence, duration of diabetes, co-morbidities, presence of diabetic complications along with the prevalence of complications while practicing regular diet, exercise with medical adherence was collected and evaluated.&#x0D; Results: Among 167 patients 64.64 % were male and 35.36% were female. 14.4% of the populations are with diabetes from more than 17years. 65.3% of the patients don’t have alcoholic and smoking habit. Only 51.5% of the population was adherent to the medications. Hypertension is major co-morbidity existing among them. 82% of the study population reported macro vascular complication. The periodic prevalence rate(1-5years) of complications in type 2 diabetic patients who are adherent to medications and life style modifications was found to be 11.4% and the periodic prevalence rate of complications in patients who are either non-adherent to medications or life style modifications was 88.6%.&#x0D; Conclusion: Medical and life style adherence is strongly recommended which also must be promoted by conducting awareness programme and health care camps with continuous supervision by the family members over patients for healthy society.

In this column on the humanbecoming teaching-learning model, the author explores creativity in nurse education as an alternative to routinized learning strategies. There is an explanation of the American Association of Colleges of Nursing (AACN) Essentials, domains, competencies, subcompetencies, concepts, and spheres of care, followed by an explanation of competency-based education. These topics are contrasted with the humanbecoming paradigm and the humanbecoming teaching-learning model. Infusing artforms in teaching-learning nursing is proposed as a way to preserve creativity. An assignment with first-semester pre-licensure students is explained and exemplars are provided to demonstrate the preservation of creativity while teaching-learning nurse students.

Social Support and Locus of Control as Predictors of Adherence to Antidepressant Medication in an Elderly Population

ABSTRACTBackground and AimsIn the elderly population, the prevalence of chronic diseases and the necessity for supportive and medication treatments are increasing, making medication adherence a crucial factor in enhancing their quality of life.MethodsThis study conducted a comprehensive descriptive‐analytical survey on older adults aged over 65 with chronic diseases, who were visiting a specialized diabetes clinic in YAZD in 2023. The clinic provides treatment for elderly diabetic patients as well as those with chronic diseases resulting from or concurrent with diabetes, managed by internal medicine specialists and endocrinologists. The participants had been taking medication for more than 6 months and were suffering from chronic conditions such as asthma, hypertension, diabetes, chronic cardiovascular disease, liver cirrhosis, stroke, and vascular heart disease, with normal cognitive function. Medication adherence was assessed to determine the level of adherence. Data were analyzed using SPSS version 20.0, utilizing logistic regression.ResultsA total of 196 participants took part in the study. The average medication knowledge score was 14.7 ± 3.5, the average depression score was 8.1 ± 2.4, the average health literacy score was 7.5 ± 1.6, and the average self‐efficacy score was 29.1 ± 5. Logistic regression analysis revealed that more than half of the participants (58.7%) lacked medication adherence. The analysis also indicated that the presence of a spouse had a significant effect on medication adherence (p‐value = 0.038), along with health literacy (p‐value = 0.002) and self‐efficacy (p‐value = 0.000), which had the most significant impact on medication adherence.ConclusionThe findings suggest that self‐efficacy, health literacy, and the presence of a spouse are crucial factors influencing medication adherence in older adults with chronic diseases. These factors can shape the beliefs, attitudes, and behaviors of older adults regarding medication adherence and affect their health outcomes and quality of life. Therefore, interventions aimed at improving medication adherence in this population should consider these factors and attention to the specific needs and preferences of older adults and their spouses or family members.

Medication adherence remains a significant challenge in healthcare, particularly in paediatric populations, where non-adherence has a substantial impact on therapeutic outcomes and contributes to increased healthcare costs. This manuscript emphasises the central role of drug formulations and delivery systems in shaping adherence behaviours in children. Given the unique pharmacokinetic characteristics of paediatric patients, formulation design has a critical impact on medication efficacy, safety and acceptability. By integrating pharmacological considerations with innovative formulation strategies and tailored care approaches, this work provides practical and evidence-informed pathways to enhance medication adherence and improve clinical outcomes in paediatric care.

Abstracts 8th PCNE working symposium ‘Navigating research on pharmaceutical care’. 11–12 February 2022, Lisbon, Portugal