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The latest evidence for practice

Una Adderley
Specialist Nurse
Team Leader

Peer relationships among nursing home residents

Friendships and social networks are an essential part of being a healthy human being, but the establishment of such relationships can be particularly challenging for nursing home residents. People living in nursing homes may find themselves trying to make friends in a new strange environment with the added challenges of the impediments of old age such as hearing or sight deficits.

This Norwegian qualitative study used observation and interviews with 26 mentally lucid nursing home residents living in two nursing homes to explore the significance of peer relationships to thriving in nursing homes. Twelve residents had established a personal relationship with one or more other residents but not all saw such relationships as important. Some residents felt they already had sufficient relationships with friends or family outside the nursing home. Others had initially expected to socialise with the other residents but when they realised they could not interact with many of their peers, had reduced their expectations. Some others, although they regarded themselves as thriving, still wished for more and closer social contact with their peers. Organised activities offered limited opportunities for interaction but caregivers were identified as being particularly influential in facilitating such relationships.

A commentary notes that caregivers appear to have the potential to be instrumental in helping residents to develop relationships with other residents. However, since the study noted that not all residents felt that such peer relationships were important, caregivers need to be able to understand, respond and adapt to the different needs of individual residents to promote a positive nursing experience for their residents.

Reference
Bergland A, Kirkevold M. The significance of peer relationships for thriving in nursing homes. J Clin Nurs 2008;17:1295-302.

Commentary
Spilsbury K. Evid Base Nurs 2009;12:31.

Intensive glucose control for complications in type 2 diabetes

There is a well-established link between poorly controlled type 2 diabetes and complications, such as microvascular events (eg, retinopathy, nephropathy) and macrovascular events (eg, myocardial infarction, stroke). The ADVANCE trial sought to establish whether intensive glucose control prevented adverse events more than standard glucose control.

The ADVANCE randomised, controlled trial compared intensive glucose control using gliclazide and other non-sulfonylurea drugs as needed to achieve an HbA1c

A commentary notes that the UK Prospective Diabetes Study (UKPDS) had shown that tight glycaemic control in type 2 diabetes had reduced microvascular diabetes-related complications but found no reduction in macrovascular events. This trial supported the findings of the UKPDS and again serves as a reminder that type 2 diabetes is a vascular disease that affects both microvasculature and macrovasculature.

Reference
Murphy MH, Nevill AM, Murtagh EM, Holder RL. The effect of walking on fitness, fatness and resting blood pressure: a meta-analysis of randomised, controlled trials. Prev Med 2007;44:377–85.

Commentary
Maddison R. Evid Base Nurs 2008,11(1):15.