Chronic illness causes the majority of disease burden and health costs in developed countries; however, this could be substantially reduced by optimal patient self-management. This study examined the levels of self-management in patients (n = 300) with chronic illness (chronic heart failure, chronic respiratory disease, Parkinson's disease and chronic schizophrenia) of moderate severity who had experienced an illness exacerbation in the last month. Patient's perceptions of self-efficacy in relation to their self-management and their sense of coherence were also assessed at baseline and 1 month later. No changes occurred in self-perceptions or self-management from baseline to follow-up. Patients at risk of poor self-management included people with low self-efficacy, poor sense of coherence, older age and a primary diagnosis of chronic schizophrenia. As self-efficacy is the only predictor known to be amenable to intervention, self-efficacy enhancing support should be promoted.

In contrast to other studies, experience and educational level were not found to influence decision-making strongly, the value of role was the most significant predictor. The model developed, however, only accounted for a low amount of variability in decision-making. The findings indicate that there are other factors affecting clinical decision-making that still require identification.

No abstract

Increasing retirement age may retain older nurses in the workforce, however, the impact on the health of older nurses is not known, nor is the impact for employers of older nurses continuing to work known. Employers must facilitate workplace changes to accommodate older nurses.

Many patients have moderate anxiety before coronary angiography and PCI; therefore, routine assessment and management of anxiety are justified. The FAS is not as useful as the SAI for this purpose.