RESUMO
Obstructive sleep apnea (OSA) is a sleep disorder affecting 18 million Americans. The prevalence of OSA is increasing due to an epidemic rise in obesity, which is a major contributing factor. The primary treatment for OSA is continuous positive airway pressure, designed to maintain a patent airway for unobstructed breathing. OSA patients may experience postoperative hypoventilation due to residual anesthetic, analgesic requirements, and other comorbidities. Postoperative health care providers must be prepared to assess for hypoventilation and intervene using evidence-based interventions to improve outcomes. It is incumbent that the PACU nurse be aware of and implement evidence-based clinical guidelines for patients with OSA. Therefore, the purpose of this manuscript is to (1) describe the physiology, comorbidities, diagnosis, and treatment of OSA; (2) identify the effects of anesthesia in persons with OSA; (3) discuss clinical guidelines; and (4) describe implications for care in an effort to improve health outcomes in persons with OSA during the perianesthesia period.
Assuntos
Pessoal de Saúde , Enfermagem em Pós-Anestésico , Apneia Obstrutiva do Sono/cirurgia , HumanosRESUMO
BACKGROUND: Restless legs syndrome (RLS) is a movement disorder treated with dopamine agonists. RLS is often diagnosed as a comorbid condition with psychiatric disorders, which are treated with dopamine antagonists or antidepressants resulting in onset or exacerbation of RLS symptoms. OBJECTIVES: The objectives of this article are to provide a review of the literature to (a) describe the comorbidity of psychiatric disorders associated with RLS, (b) identify the treatment of psychiatric disorders that cause or exacerbate symptoms of RLS, and (c) provide clinical recommendations for psychiatric health care providers. DESIGN: A review of the literature of English articles included the databases of Medline, Pubmed, PsychINFO, and CINAHL for "Restless Legs Syndrome" with major psychiatric disorders including mood disorders (depression and bipolar), schizophrenia, and anxiety disorders (anxiety, panic disorder, obsessive compulsive disorder). The PRISMA guidelines were used to improve the reporting of the review of the literature. RESULTS: There were 61 articles that met the inclusion and exclusion criteria identified for the review of the literature, including RLS with mood disorders (n = 36), schizophrenia (n = 9), and anxiety disorders (n = 16). CONCLUSIONS: Clinical trials are lacking on the best treatment for persons with RLS and psychiatric disorders; the most rigorous research found in the literature related to depression and anxiety. Studies lack evidence to document the best practice for persons with RLS and comorbid psychiatric disorders. Psychiatric health care providers should be aware of RLS, which is influenced by psychiatric medications.
Assuntos
Agonistas de Dopamina/uso terapêutico , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Síndrome das Pernas Inquietas/tratamento farmacológico , Síndrome das Pernas Inquietas/epidemiologia , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Benzodiazepinas/uso terapêutico , Comorbidade , Humanos , Transtornos Mentais/psicologia , Psicofarmacologia/métodos , Síndrome das Pernas Inquietas/psicologiaRESUMO
Introduction: Peru has experienced one of the highest rates of COVID-19 with only 27% of the population vaccinated. College students must make decisions on vaccination based on their belief and knowledge about immunizations. The purpose of this study was to describe COVID-19 behaviors and beliefs toward immunization among college students in Lima, Peru. Methods: Undergraduate students from Universidad Maria Auxiliadora (UMA) participated in this descriptive study. The CDC National 2009 H1N1 Flu Survey was adapted to measure behaviors and beliefs about immunizations of COVID-19. Results: 818 students participated in the study during the 2020 academic year. Significant differences were identified about taking vaccine when it was available by age (p = .02), gender (p < .001), marital status (p = .004), and income (p = .002). Significant associations were found between participants' ethnicity and location of last vaccination (p < .001) and race and reason to not receive the COVID-19 vaccine (p < .001). Conclusions: Peruvian students under the age of 32 are not eligible for the COVID-19 at this time. Findings can prepare academic institutions to promote education about the vaccine in this age group who have unique barriers in receiving health care and vaccinations.
Assuntos
COVID-19 , Vírus da Influenza A Subtipo H1N1 , Vacinas contra COVID-19 , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Peru , SARS-CoV-2 , Estudantes , Inquéritos e Questionários , VacinaçãoRESUMO
Introduction: Race and ethnicity along with social determinants of health have been identified as risk factors for COVID-19. The purpose of this clinical paper is to provide an overview of the National Coalition of Ethnic Minority Nurse Associations (NCEMNA), present COVID-19 epidemiological data on five racial-ethnic groups, identify culturally congruent health care strategies for each group, and provide directions for practice and research. Method: NCEMNA collaborated to provide a clinical paper that addresses information about COVID-19 and culturally congruent health care in five racial-ethnic groups. Results: Every organization presented common themes across the different groups and unique perspectives that each group is faced with during this challenge. Discussion: This article provides an introduction to the issues that minority groups are facing. It is imperative that data are collected to determine the extent of the impact of COVID-19 in diverse communities in the country.
Assuntos
Betacoronavirus , Infecções por Coronavirus/etnologia , Etnicidade/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Grupos Minoritários/estatística & dados numéricos , Pneumonia Viral/etnologia , COVID-19 , Infecções por Coronavirus/prevenção & controle , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , SARS-CoV-2 , Fatores Socioeconômicos , Estados UnidosRESUMO
OBJECTIVE: To compare the effects of 800 mg of valerian with a placebo on sleep quality and symptom severity in people with restless legs syndrome (RLS). METHODS: A prospective, triple-blinded, randomized, placebo-controlled, parallel design was used to compare the efficacy of valerian with placebo on sleep quality and symptom severity in patients with RLS. Thirty-seven participants were randomly assigned to receive 800 mg of valerian or placebo for 8 weeks. The primary outcome of sleep was sleep quality with secondary outcomes including sleepiness and RLS symptom severity. RESULTS: Data were collected at baseline and 8 weeks comparing use of valerian and placebo on sleep disturbances (Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale) and severity of RLS symptoms (International RLS Symptom Severity Scale) from 37 participants aged 36 to 65 years. Both groups reported improvement in RLS symptom severity and sleep. In a nested analysis comparing sleepy vs nonsleepy participants who received 800 mg ofvalerian (n=17), significant differences before and after treatment were found in sleepiness (P=.01) and RLS symptoms (P=.02). A strong positive association between changes in sleepiness and RLS symptom severity was found (P=.006). CONCLUSIONS: The results of this study suggest that the use of 800 mg of valerian for 8 weeks improves symptoms of RLS and decreases daytime sleepiness in patients that report an Epworth Sleepiness Scale (ESS) score of 10 or greater. Valerian may be an alternative treatment for the symptom management ofRLS with positive health outcomes and improved quality of life.
Assuntos
Hipnóticos e Sedativos/administração & dosagem , Fitoterapia , Síndrome das Pernas Inquietas/tratamento farmacológico , Índice de Gravidade de Doença , Valeriana , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Extratos Vegetais/administração & dosagem , Psicometria , Qualidade de Vida , Síndrome das Pernas Inquietas/prevenção & controle , Fases do Sono/efeitos dos fármacos , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
INTRODUCTION: Since 2010, more than 75 rural hospitals have closed in the USA and more than one-third are at risk of closure due to lower patient volumes, lower funding levels, decreased hospital revenue and lower physician employment pools. Telemedicine can provide new models of care delivery that maintain quality and reduce cost of healthcare in rural populations. The purpose of this project was to evaluate a cross-organizational pilot program by comparing a NP/telemedicine physician hospitalist programme with a traditional physician hospitalist model to assess effects on length of patient stay, mortality rates, readmission rate, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings of provider communication, and total hospital costs. METHODS: The Standard for Quality Improvement Reporting Excellence (SQUIRE) guidelines were followed. Using a one-year retrospective chart review, average length of stay, mortality rates, 30-day readmission rates and provider communication ratings were compared between hospitalists that were nurse practitioners working with physicians through telemedicine support and physicians alone. RESULTS: There was no statistically significant variance in average length of stay, mortality rates, 30-day readmission rates, or provider communication ratings on HCAHPS surveys compared to the NP or physician hospitalist. DISCUSSION: This new model of care demonstrates that telemedicine can be used to provide safe and efficient physician support from a regional hub medical centre to nurse practitioners practising as hospitalists in rural Critical Access Hospitals at up to 58% cost savings while maintaining quality of care and increasing access to community-based physicians.
Assuntos
Médicos Hospitalares/estatística & dados numéricos , Profissionais de Enfermagem/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Serviços Urbanos de Saúde/organização & administração , Feminino , Custos Hospitalares/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Estudos RetrospectivosRESUMO
PURPOSE: The purpose of this study was to provide a background of restless legs syndrome (RLS), present the prevalence and demographic findings of a descriptive study of type 2 diabetes with RLS, and provide implications to diabetes educators on the management and education of RLS. METHODS: Participants with type 2 diabetes who met the diagnostic criteria for RLS based on the International RLS Study Group Criteria were recruited from the PENN Rodebaugh Diabetes Center from July 2005 through September 2006. Participants who met inclusion and exclusion criteria were mailed a survey to collect data. RESULTS: Of 121 patients with type 2 diabetes, 54 (45%) of the screened sample met the 4 diagnostic criteria for RLS. Of those who met the inclusion and exclusion criteria of the primary study, 18 patients with type 2 diabetes with RLS participated in this study. Along with diabetes, the participants had a variety of comorbid health conditions including hypertension, neuropathies, rheumatoid arthritis, renal failure, and irritable bowel syndrome. Only one third of the participants were being treated for RLS. Thirty-nine percent of the participants with type 2 diabetes were using insulin to manage their diabetes with other oral agents. CONCLUSIONS: RLS is a sleep disorder that may affect the management of type 2 diabetes. Diabetes educators must know that sleep disorders can affect long-term health outcomes, and RLS is frequently seen in this cohort of patients.
Assuntos
Diabetes Mellitus Tipo 2/complicações , Educação de Pacientes como Assunto , Síndrome das Pernas Inquietas/etiologia , Idoso , Estudos Transversais , Diabetes Mellitus Tipo 2/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome das Pernas Inquietas/classificação , Síndrome das Pernas Inquietas/prevenção & controle , Transtornos do Sono-Vigília/etiologiaRESUMO
Mindfulness meditation (MfM) is a mind-body therapy identified by the National Center for Complementary and Alternative Medicine. Initially taught in a formal classroom setting, MfM is a sustainable intervention with minimal costs that can be used over time. For veterans, after mastery, this technique shows promise in improving health outcomes and quality of life. This article describes MfM, discusses the conceptual framework and evidence-based research for MfM, and identifies the implications of MfM use by health care providers who are caring for war veterans.
Assuntos
Meditação , Enfermagem do Trabalho/organização & administração , Veteranos , Adaptação Psicológica , Medicina Baseada em Evidências , Nível de Saúde , Humanos , Meditação/métodos , Meditação/psicologia , Relações Metafísicas Mente-Corpo , Modelos Biológicos , Modelos Psicológicos , Papel do Profissional de Enfermagem , Educação de Pacientes como Assunto , Psiconeuroimunologia , Psicofisiologia , Qualidade de Vida/psicologia , Fatores de Risco , Autocuidado/métodos , Autocuidado/psicologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/prevenção & controle , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/educação , Veteranos/psicologiaRESUMO
OBJECTIVES: To compare differences in sleep quality, sleepiness, fatigue, depression, and quality of life according to severity of symptoms of restless legs syndrome (RLS) in older adults. DESIGN: Descriptive, comparative study; cross-sectional design. SETTING: Penn Sleep Center at the University of Pennsylvania and RLS support groups in Philadelphia. PARTICIPANTS: Thirty-nine adults, aged 65 and older, diagnosed with RLS with symptoms at least 3 nights per week. Participants were stratified according to symptom severity based on scores from the RLS Symptom Severity Scale. Exclusion criteria were dementia, cognitive impairments, and sleep disorders other than RLS. MEASUREMENTS: Sleep quality, measured using the Pittsburgh Sleep Quality Index (PSQI), was the primary outcome. Secondary outcomes were sleepiness, fatigue, depression, and quality of life measured using the Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), Center for Epidemiological Studies--Depression Scale (CES-D), and RLS Quality of Life Instrument (RLS-QLI), respectively. RESULTS: Significant differences were found in subjective sleep quality (P=.007) and sleep duration (P=.04), as well as in PSQI global score (P=.007). RLS-QLI sleep quality (beta=-0.12, 95% confidence interval (CI)=-0.18 to -0.06, P<.001) and sleepiness (beta=0.35, 95% CI=0.09-0.61, P=.01) were significantly related to PSQI global score. Subjects with severe symptoms were five times as likely to use medication to treat RLS (OR=5.3, 95% CI=1.2-22.2). CONCLUSION: The severity of RLS symptoms in older adults affects not only sleep quality but also many aspects of quality of life, including social functioning, daily functioning, and emotional well-being.
Assuntos
Depressão/complicações , Fadiga/complicações , Qualidade de Vida , Síndrome das Pernas Inquietas/psicologia , Sono/fisiologia , Idoso , Estudos Transversais , Depressão/psicologia , Fadiga/psicologia , Feminino , Humanos , Incidência , Masculino , Prognóstico , Síndrome das Pernas Inquietas/complicações , Síndrome das Pernas Inquietas/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Estados Unidos/epidemiologiaRESUMO
One of the blueprints used by health care organizations for attaining and sustaining nursing excellence is the American Nurses' Credentialing Center's (ANCC) Magnet designation. The ANCC requires organizations to identify a Magnet program director (MPD), who serves as the contact and communication point through the process of application, designation, and maintenance of the credential. The MPD role is complex, has a wide variety of necessary skills and competencies, and can be challenging and overwhelming to undertake. Literature reveals no guidelines nor recommendations regarding educational preparation for assuming the role. Chief nursing officers (CNOs) support "program director" as a potential employment option for doctor of nursing practice (DNP) graduates. Given the complexity of the MPD, would DNP education provide elements that would help new MPDs prepare for the position? The purpose of this project was to determine if MPDs recommend concepts within DNP program Essentials as preparation for their roles. A mixed methods design was used, with qualitative data obtained from a focus group and quantitative, nonexperimental data obtained through a cross-sectional survey. Data were collected from current MPDs. The concepts of DNP Essentials presented in the survey were all recommended as preparation for the MPD role, making DNP education a relevant option.