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PURPOSE: The specific aim of the study was to determine whether there was an increased time in target glucose range for individuals with type 1 diabetes mellitus who were permitted to self-manage their insulin plan while hospitalized. DESIGN: A retrospective chart review was conducted of 60 inpatients with type 1 diabetes mellitus who met the criteria to self-manage their diabetes care with the use of their continuous subcutaneous insulin infusion pump or a multiple daily injection insulin regimen. A comparison of the 2 groups was examined to assess differences in glucose outcomes and glycemic stability. RESULTS: Seven hundred fifty-three glucose results were examined. The total number of hypoglycemic events in both groups was 37. The number of glucose values labeled as stable was 405, and the remaining 311 glucose values were categorized as hyperglycemic. There were no statistically significant differences in glucose levels between the 2 groups. CONCLUSION: No patients experienced severe hypoglycemia leading to cognitive impairment or severe hyperglycemia leading to diabetic ketoacidosis. The outcomes of this study suggest that diabetes self-management practices in select individuals hospitalized with type 1 diabetes mellitus can contribute to greater glucose stability and time in targeted glucose range.

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In the pandemic of coronavirus disease 2019, virtual visits have become the primary means of delivering efficient, high-quality, and safe health care while Americans are instructed to stay at home until the rapid transmission of the virus abates. An important variable in the quality of any patient-clinician interaction, including virtual visits, is how adroit the clinician is at forming a relationship. This article offers a review of the research that exists on forming a relationship in a virtual visit and the outcomes of a quality improvement project which resulted in the refinement of a "Communication Tip Sheet" that can be used with virtual visits. It also offers several communication strategies predicated on the R.E.D.E. to Communicate model that can be used when providing care virtually.

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Pain is personal, subjective, and best treated when the patient's experience is fully understood. Hospitalization contributes to the physical and psychological complications of acute and chronic pain experienced by patients with inflammatory bowel disease (IBD). The purpose of this qualitative phenomenological study was to develop an understanding of the unique experience of pain in hospitalized patients with an admitting diagnosis of IBD and related care or surgery. Following institutional review board approval, purposeful sampling was used to recruit 16 patients (11 female, 5 male, mean age 41.8 years) from two 36-bed colorectal units of a large academic medical center in the Midwest. Individual, audio-recorded interviews were conducted by a researcher at each participant's bedside. Recordings and transcripts were systematically reviewed by the research team using Van Manen's approach to qualitative analysis. Subsequently, 5 major themes were identified among the data: feeling discredited and misunderstood, desire to dispel the stigma, frustration with constant pain, need for caregiver knowledge and understanding, and nurse as connector between patient and physician. Hospitalized patients with IBD have common issues with pain care. Nurses caring for them can provide better pain management when they understand these issues/themes. Further research into the themes discovered here is recommended.

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OBJECTIVE: The Leadership Education and Development (LEAD) Program was designed to transform care at the bedside by empowering clinical nurses as leaders. BACKGROUND: The heart of LEAD was enhancing communication skills of clinical nurses with clinical colleagues and, most importantly, patients and families. Key concepts of leadership/management were included: personal awareness, personal leadership skills/abilities, leading change, leading others individually and in teams, enhancing the patient/provider experience, and the leadership role in outcomes management. METHODS: A quantitative, longitudinal, survey design was used with 2 cohorts. The program consisted of six 4-hour sessions for 3 to 6 months. Leadership practices were measured before program implementation, at the end of the program, and 3 months after program completion. RESULTS: There were significant increases in leadership practices sustained 3 months after program completion. A range of other outcome measures was included. CONCLUSIONS: There is a need for additional leadership development programs for clinical nurses.

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OBJECTIVE: The aim of this study was to examine the effectiveness of a subcutaneous insulin double-checking preparation intervention on insulin administration errors. BACKGROUND: Insulin accounts for 3.5% of medication-related errors. The Joint Commission and Institute for Safe Medication Practices recommend a 2-nurse double-checking procedure when preparing insulin. METHODS: This study used a randomized, controlled, nonblinded, intent-to-treat methodology. RESULTS: In total, 266 patients were enrolled, and over 4 weeks of data collection, there were 5238 opportunities for insulin administration. Overall, 3151 insulin administration opportunities had no errors; the double-checking group had more no-error periods than usual care. Of error types, wrong time was predominant, but less prevalent in the double-checking group. Omission errors were uncommon and occurred less in the double-checking group. CONCLUSIONS: The subcutaneous insulin double-checking preparation procedure led to less insulin administration errors; however, timing errors were most prevalent and are not resolved with double-checking interventions.

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BACKGROUND: Nurses are responsible for critical aspects of diabetes care. PURPOSE: The purpose of this study was to examine nurses' knowledge of inpatient diabetes management principles before and after a structured diabetes education program. METHODS: In this descriptive, correlation study, 2250 registered nurses working in a quaternary health care center completed a 20 question assessment. The assessment was administered pre and post attendance at a 4hour diabetes management course. FINDINGS: Nurses' knowledge of inpatient diabetes management principles was low. There was no correlation between knowledge scores and age, education, employment status, years of experience or clinical specialty. CONCLUSIONS: In general, our findings suggest that nurses do not feel comfortable and are not adequately prepared to make patient care decisions or provide survival skill education for patients with diabetes in the hospital.

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In the United States it is estimated that over 30% of the population suffers from some form of chronic pain (Institute of Medicine of the National Academies Report, 2011). Therefore, it is likely that 30% of patients who are admitted to the hospital for acute care needs also have an underlying chronic pain issue. When patients are admitted for concerns that are not related to their chronic pain, the chronic pain may be overlooked in deference to acute medical issues. Nurses dealing with pain in the acute care setting may limit their assessment and management of pain to acute pain. Although there is a significant body of research related to the management of acute pain (Bell & Duffy, 2009; Brennen, Obs, Carr, & Cousins, 2007; Dihle, Bjolseth, & Helseth, 2006; McDonnell, Nicholl, & Read, 2003; Wang & Tsai, 2010) and the management of chronic pain (Bruckenthal, 2010; Clarke & Iphofen, 2005; Kaasalainen et al., 2011; Matthews & Malcom, 2007; Papaleontiou et al., 2010, Reid et al., 2008), few studies were found that explained how nurses care for patients with pre-existing chronic pain in the acute care setting. The purpose of this study was to develop a theoretical understanding of nurses' assessment and decision-making behaviors related to the care of patients with chronic pain in the acute care setting.

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CARING BEHAVIORS: Perceptions of acute care nurses and hospitalized patients with diabetes. PURPOSE: The purpose of this study was to examine the perceptions of caring behaviors that influence the patient experience in acute care nurses and hospitalized patients with diabetes. BACKGROUND: Nurses are the caregivers who render most of the direct care patients receive while they are hospitalized. Understanding what patients perceive as caring behaviors is essential in tailoring nursing interventions to meet patient needs. DATA SOURCES: Data collection occurred at a 1,200 bed, nonprofit academic medical center located in the Midwest. DESCRIPTION: Sixty-four nurses and 54 patients with diabetes were queried about their experience with diabetes caring behaviors. CONCLUSION: Nurses consistently reported providing caring behaviors more frequently than patients reported receiving them. IMPLICATIONS: This study has implications for understanding the patient experience in the hospital setting specifically related to patient education. Providing patient education is an important caring intervention that directly affects the patient experience. However, none of the patients in this study identified this as a caring behavior used by nurses.

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Patients on continuous subcutaneous insulin infusion, or insulin pumps, are increasingly seen in hospitals. Inpatient providers need to have a working knowledge of insulin pumps to be able to decide, in conjunction with the patient whenever feasible, whether or not pump use is to be continued in the hospital, to assist patients in adjusting insulin doses via continuous subcutaneous insulin infusion, to transition patients to multiple daily subcutaneous insulin dosing as appropriate, and to prevent or manage problems that might arise from improper handling of the insulin pump. Clinical vignettes with key points and strategies for patient care are discussed in this article.

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