Nursing graduates' perceptions of their undergraduate clinical placement.

Student clinical practice is a significant and essential part of nursing education. Accordingly, clinical placements need to be positive and valuable. The purpose of this study was to describe newly-graduated nurses' perceptions of their student clinical intersession placements and how these placements impacted their functioning as graduate nurses. Inductive semantic analysis of the data revealed four themes: developing nursing skills and knowledge; preparing for future employment; experiencing supportive relationships; and experiencing realities of work-life. Educators must ensure that clinical placements are in an environment that is conducive to learning and promotes the personal and professional development of nursing students. Positive clinical experiences are more likely related to how valued and supported students feel than the physical aspects of a placement; thus, it is imperative educators assess and focus on providing placements that offer a supportive learning environment.

Predictors of selecting atomoxetine therapy for children with attention-deficit-hyperactivity disorder.

STUDY OBJECTIVE: To investigate predictors of beginning treatment with atomoxetine, a new attention-deficit-hyperactivity disorder (ADHD) drug, shortly after it was introduced into the marketplace compared with well-established stimulants for children in a managed care setting. DESIGN: Retrospective cohort analysis. DATA SOURCE: Managed care claims database. PATIENTS: A total of 45,144 patients aged 18 years or younger who filled a prescription for an ADHD-specific drug. MEASUREMENTS AND MAIN RESULTS: For each patient, the most recent start of therapy between April 1 and December 31, 2003, was categorized by drug: atomoxetine; any stimulant; or short-, intermediate-, or long-acting stimulant. The categories were based on the first use of the drug without use of a drug in that same category in the previous 3 months. Logistic regression analysis of past-year administrative claims was applied to determine predictors of the start of specific pharmacotherapy. Patients with a claim of ADHD with hyperactivity were 1.50 times more likely to begin therapy with atomoxetine than with any stimulant (95% confidence interval [CI] 1.42-1.58). Patients with a history of tics (odds ratio [OR] 3.11, 95% CI 2.54-3.82), anxiety (OR 1.35, 95% CI 1.24-1.48), pervasive developmental disorders (OR 2.00, 95% CI 1.69-2.37), or frequent use of behavioral care services (OR 1.34, 95% CI 1.21-1.48) were predisposed to starting treatment with atomoxetine relative to any stimulant, but patients with obesity were not (OR 0.68, 95% CI 0.53-0.87). A short-acting stimulant was specifically preferred for patients with narcolepsy or hypersomnolence (OR 0.33, 95% CI 0.20-0.56). Alcohol dependence, but not drug dependence or drug abuse, was predictive of the selection of atomoxetine over a short-acting stimulant (OR 2.98, 95% CI 1.25-7.09). CONCLUSION: Atomoxetine therapy was systematically preferred for patients with psychiatric comorbidities, contraindications to stimulants, or relatively heavy use of behavioral health care.