Motivational training improves self-efficacy but not short-term adherence with asthma self-management: a randomized controlled trial.

BACKGROUND: Adherence to self-management in asthma is poor. AIM: To investigate the effect of disease-unspecific motivational training on self-management adherence in addition to asthma-specific patient education. METHODS: We randomized patients with partly controlled asthma to asthma education, with or without the Zurich Resource Model (ZRM) training. Main elements of the ZRM training are development of action-oriented personal goals and activation of resources to achieve and practice them in daily life. The primary outcome was adherence to self-monitoring and to a written personal action plan during three months. Secondary outcomes included patient-reported self-efficacy. RESULTS: As control patients (n=30) were younger, mostly male and had better asthma control compared with the intervention group (n=30), we adjusted the analyses for these imbalances. Both groups showed excellent adherence to self-monitoring over three months [27 patients (90.0%) in intervention and 25 patients (83.3%) in control group, adjusted odds ratio: 1.28 (0.24-6.78), P=0.78)]. Patients in the ZRM group tended to adjust their medication more often [median 36% days with action (IQR 11-62%)] than control patients [9% (0-43), P=0.18]. In both groups, actions were rarely in accordance with the action plan [median 20% of actions appropriate (IQR 0-37) in intervention and 11% (IQR 0-56) in control group, P=0.92]. After three months, self-efficacy was significantly better with ZRM (adjusted difference on self-efficacy scale 2.31, 95% CI 0.31-4.31, P=0.02). CONCLUSION: Unspecific self-management training had no short-term effect on self-management adherence in asthma patients. Self-efficacy improved, but it is uncertain whether this translates into better long-term outcomes.

[Ideas about a "good death" in Palliative Care Nursing]. / Ein "Gutes Sterben" und ein "Guter Tod": zum Verständnis des Sterbeideals und seiner Bedeutung für Hospiz und Palliative Care.

In the modern hospice movement and in Palliative Care, helping severely ill and dying patients to have a "good end of life" and a "good death" has high priority. The concept of a "good death" reflects the corresponding ideal of a "good dying". This concept analy-sis aimed at clarifying the current understanding of the characteristics of a "good death" as well as at presenting a coherent theoretical and ideational basis. The meaning of an ideal death as a point of reference and leitmotif in structuring palliative and hospice care, the theoretical background, and the components of a "good death" will be described in this article.