Experiences of Older Adults During COVID-19: Loss, Boredom, Uncertainty, Worry, and Resilience.

The coronavirus disease 2019 (COVID-19) pandemic and resulting instructions to stay home and social distance enhanced concerns of the impact of social isolation on the physical and mental well-being of older adults. Eighteen community-dwelling older adults participated in interviews describing their experiences early in the COVID-19 pandemic. Participants experienced loss of activities, routines, and social connection, and feelings of worry and uncertainty. Nevertheless, participants were hopeful about the future and demonstrated resilience in overcoming boredom as they became intentional in finding new activities and using technology to maintain connection with others. Older adults may need support in such situations to manage boredom and uncertainty and avoid social isolation. [Journal of Gerontological Nursing, 49(6), 27-32.].

COMFORT communication in the ICU: Pilot test of a nurse-led communication intervention for surrogates.

AIM: This study was designed to investigate the feasibility, acceptability, and preliminary efficacy of a nurse-led communication intervention among surrogates in the intensive care unit (ICU) guided by the COMFORT (Connect; Options; Making meaning; Family caregivers; Openings; Relating; Team) communication model. BACKGROUND: As frontline communicators, nurses experience communication difficulties with surrogates who face complex informational and emotional barriers when making decisions for critically ill patients in the ICU. However, research on effective nurse communication focusing on both curative and end-of-life (EOL) care is lacking in the literature. DESIGN: A single-centre two-group pretest-posttest quasi-experiment. METHOD: The total sample included 41 surrogates of adult ventilated patients. Twenty participants were allocated to the intervention group who received a daily 20-min telephone call with content based on the COMFORT communication model. Twenty-one participants comprised the control group who received usual care. Participants completed a questionnaire before and after the study measuring satisfaction, anxiety and depression, decisional conflict, and quality of communication. The Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) checklist was followed for nonrandomised controlled trials. RESULT: The intervention was feasible, with 19 of 20 surrogates completing the follow-up surveys, and 48 telephone conversations completed (48% of the planned phone calls). Surrogates' satisfaction was higher in the intervention group than in the control group after adjusting for the selected covariates (25.43 and 24.15, respectively; p = .512). Preliminary efficacy outcomes favouring the intervention included quality of communication with healthcare providers, but not surrogates' perceived depression/anxiety and decisional conflicts. CONCLUSION: Implementation of the intervention is feasible, acceptable, and favourable among surrogates to improve quality of communication with healthcare providers in the ICU. Further research is needed to determine whether the intervention could be implemented by nurses to improve surrogates' outcomes in other ICUs.

Circadian rhythm and quality of life in older adults.

Sleep is critical to physical and mental health for people of all ages, but older adults are particularly vulnerable to the consequences of poor sleep health. The purpose of this pilot study was to explore patterns of sleep and the relationships between circadian rhythm disorders and quantity of life in 34 community-dwelling older adults. Participants were primarily female, and single. Of participants, 44% reported poor sleep quality, and 29% had a circadian rhythm disorder. Those with circadian rhythm disorders had lower physical health quality of life score than other participants although this was not significant. No differences were seen in mental health quality of life scores. Further research is needed to explore sleep and circadian rhythm disorders in this population to target interventions to improve sleep quality.

Fatigue in Family Caregivers of Individuals With Dementia: Associations of Sleep, Depression, and Care Recipients' Functionality.

The current study examined factors related to fatigue in family caregivers of individuals with dementia using a cross-sectional design to collect subjective and objective data. Findings indicated that caregivers' sleep quality, difficulty falling asleep, and depression, as well as care-recipients' functionality, were associated with family caregivers' fatigue. Regression analysis indicated that only sleep quality significantly predicted caregivers' fatigue. Study findings suggest fatigue is common among family caregivers of individuals with dementia and may be related to sleep quality. The level of fatigue identified in the current study warrants further study with larger and more diverse samples. [Journal of Gerontological Nursing, 46(9), 14-18.].

Perceived stress, physiological stress reactivity, and exit exam performance in a prelicensure Bachelor of Science nursing program.

Objectives High-stakes exams are a source of chronic stress that may adversely affect nursing students' thinking, behavior, and overall health. The purpose of this study was to explore the relationships of perceived stress, physiological stress reactivity, and exit exam performance. Methods A within-subjects design allowed measurement of perceived stress, salivary cortisol, and salivary alpha amylase in pre-licensure nursing students under two different conditions: a high-stakes exit exam and a low-stakes homework assignment. Results Perceived stress and salivary alpha amylase were significantly higher after the high-stakes exam compared to the homework condition. Perceived stress after the exam was correlated with lower exam score. Conclusion Study findings suggest that in response to a high-stakes exam, prelicensure nursing students experience high levels of perceived stress coupled with sympathetic activation but not activation of the hypothalamic-pituitary adrenal axis.

Home Monitoring to Track Activity and Sleep Patterns Among Older Adults: A Feasibility Study.

Measuring changes in activity and sleep over time is important for research and practice. While commercially available home monitoring systems passively track these parameters, the feasibility, acceptability, and usefulness of new products need to be evaluated. We tested a commercially available system for providing long-term data on activity and sleep with 10 single women (mean age, 86.5 years) who were monitored in their homes. Motion detectors, a bed sensor, door sensor, and chair sensor were installed for 3 months to collect data. Other measures, objective actigraphy data from 1 week and self-report, provided data for comparison. Sleep and activity data were similar across measures; the most active participant had the highest scores on all activity measures including sensor data. Participants were generally positive about the monitoring system, but participants varied in their awareness levels of the presence of the equipment. Use of the sensor system was feasible in this pilot study and acceptable to participants. The study also illustrates challenges researchers can encounter when working with a commercial company.

Ethical dilemmas in nursing: An integrative review.

AIMS: To identify themes and gaps in the literature to stimulate researchers to develop strategies to guide decision-making among clinical nurses faced with ethical dilemmas. BACKGROUND: The concept of ethical dilemmas has been well explored in nursing because of the frequency of ethical dilemmas in practice and the toll these dilemmas can take on nurses. Although ethical dilemmas are prevalent in nursing practice, frequently leading to moral distress, there is little guidance in the literature to help nurses resolve them. DESIGN: This study is an integrative review of published research from 2000 to 2017. METHODS: The keywords ethics, ethical dilemmas and nurs* were searched in CINAHL, PubMed, OVID and SCOPUS. Exclusion criteria were sources not available in English, not in acute care, and without an available abstract. Seventy-two studies were screened; 35 were retained. Garrard's matrix was utilised to analyse and synthesise the studies. RESULTS: Ethical dilemmas arose from end-of-life issues, conflict with physicians or families, patient privacy concerns and organisational constraints. Differences were found in study location, and yet international research confirms that ethical dilemmas are universally prevalent and must be addressed globally to protect patients and nurses. CONCLUSIONS: This review offers an analysis of the available evidence regarding ethical dilemmas in acute care, identifying themes, limitations and gaps in the literature. The gaps in quantitative intervention work, US paucity of research, and lack of comparisons across practice settings/nursing roles must be addressed. Further exploration is warranted in the relationship between ethical dilemmas and moral distress, the significance patient physical appearance plays on nurse determination of futility, and strategies for pain management and honesty. RELEVANCE TO NURSING PRACTICE: Understanding and addressing gaps in research is essential to develop strategies to help nurses resolve ethical dilemmas and to avoid moral distress and burnout.

A methodological review of qualitative longitudinal research in nursing.

Qualitative longitudinal research (QLR) provides temporal understanding of the human response to health, illness, and the life course. However, little guidance is available for conducting QLR in the nursing literature. The purpose of this review is to describe the methodological status of QLR in nursing. With the assistance of a medical librarian, we conducted a thorough search circumscribed to qualitative, longitudinal nursing studies of patients' and care-givers' experiences published between 2006 and 2016. The methodological quality of the 74 reviewed studies varied tremendously; many reports lacked sufficient detail in reporting on sampling and attrition, retention strategies, and data collection and analysis, making it difficult for readers to evaluate the credibility and transferability of study findings. Based on the strengths and limitations of the studies reviewed and findings in the literature, we provide recommendations for enhancing the reporting of the research process as a supplement to the standards for qualitative research more broadly. These recommendations are offered in the spirit of encouraging dialogue among colleagues and assisting journal reviewers and editors in their evaluation of QLR.

The relationship between sleep and physical function in community-dwelling adults: a pilot study.

More than 50% of community-dwelling adults have sleep complaints. Because aging is associated with decline in physical function, coexistent sleep difficulties may exacerbate functional decline. This pilot study explored the relationships between sleep, age, chronic disease burden, and physical function among 50 community-dwelling older adults. Findings revealed significant relationships between total sleep time and preclinical disability (r = -0.33, P ≤ .05) and mobility difficulty (r = -0.36, P ≤ .05). A regression analysis showed that total sleep time was significantly associated with mobility difficulty and preclinical disability, even after controlling for chronic disease burden. These findings suggest that total sleep time may be a catalyst for functional decline.

Does dance-based therapy increase gait speed in older adults with chronic lower extremity pain: a feasibility study.

A decreased gait speed in older adults can lead to dependency when the individuals are no longer able to participate in activities or do things for themselves. Thirty-seven senior apartment residents (31 females; Mean age=80.6 years; SD=8.9) with lower extremity pain/stiffness participated in a feasibility and preliminary efficacy study of 12 weeks (24 sessions). Healthy-Steps dance therapy compared to a wait-list control group. Small improvements in gait speed ([ES]=0.33) were noted for participants completing 19-24 dance sessions. Improvements in gait speed measured by a 10 Meter Walk Test (0.0517 m/s) exceeded 0.05 m/s, a value deemed to be meaningful in community dwelling older adults. These feasibility study findings support the need for additional research using dance-based therapy for older adults with lower extremity pain.

Sleep Quality and Associated Factors Among Survivors of Breast Cancer: From Diagnosis to One Year Postdiagnosis.

OBJECTIVES: To examine sleep quality and self-reported causes of sleep disturbance among patients with breast cancer at diagnosis and one year later. SAMPLE & SETTING: 486 of 606 patients with histologically confirmed breast cancer completed a Pittsburgh Quality Sleep Index (PSQI) survey at the time of diagnosis and again one year later. METHODS & VARIABLES: In this secondary data analysis, descriptive statistics were computed for seven PSQI components and its global score. Wilcoxon signed-rank tests and McNemar's tests were used. Self-reported reasons for sleep disturbances were summarized. RESULTS: PSQI scores significantly increased from baseline (mean = 6.75) to one-year follow-up (mean= 7.12), indicating worsened sleep. Sleep disturbance and onset latency scores increased, whereas sleep efficiency decreased. The two most frequently reported reasons for sleep disturbance were waking up late in the night or early in the morning (more than 50%) and needing to use the bathroom (49%). Feeling too hot and experiencing pain three or more times per week were reported by participants at baseline and one year later. IMPLICATIONS FOR NURSING: Results can aid in monitoring patient response to treatment methods and formulating benchmarks to manage sleep problems.

Treatment Modalities for Insomnia in Adults Aged 55 and Older: A Systematic Review of Literature from 2018 to 2023.

Purpose of Review: Insomnia is the most common sleep disorder experienced by older adults. There is a wide range of pharmacological and non-pharmacological treatment options in existing literature. The purpose of this systematic review was to synthesize randomized controlled trials of insomnia treatment modalities for adults aged 55 and older over the last 5 years. We searched four databases, and after screening, there were 34 full-text manuscripts that met the inclusion/exclusion criteria. Recent Findings: We found non-pharmacological interventions, including exercise and behavioral/psychoeducational therapies, remain effective and favorable. Complementary and alternative therapies ranged across studies and warrant further testing in larger, more diverse samples. Dual orexin receptor antagonist medications were tested in a few studies with positive benefits for sleep and minimal side effects. Finally, measures of insomnia/sleep disturbance outcomes varied among the studies, with the Pittsburgh Sleep Quality Index being used most frequently. Summary: Non-pharmacological interventions for insomnia in older adults are effective, and some newer medications may be safer, with less side effects, at managing insomnia in this population.

Listening with care: using narrative methods to cultivate nurses' responsive relationships in a home visiting intervention with teen mothers.

Effective public health nursing relies on the development of responsive and collaborative relationships with families. While nurse-family relationships are endorsed by home visitation programs, training nurses to follow visit-to-visit protocols may unintentionally undermine these relationships and may also obscure nurses' clinical understanding and situated knowledge. With these issues in mind, we designed a home-visiting intervention, titled Listening with Care, to cultivate nurses' relationships with teen mothers and nurses' clinical judgment and reasoning. Rather than using protocols, the training for the intervention introduced nurses to narrative methods and therapeutic tools. This mixed-method pilot study included a quasi-experimental design to examine the effect of the intervention on teen mothers' depressive symptoms, self-silencing, repeat pregnancy, and educational progress compared to teens who received usual care. Qualitative data were collected from the nurses to evaluate the feasibility and acceptability of the intervention and therapeutic tools. The nurses endorsed the therapeutic tools and expected to continue using them in their practice. Despite the lack of statistically significant differences in outcomes between groups, findings suggest that further study of the intervention is warranted. Future studies may have implications for strengthening hidden aspects of nursing that make a difference in the lives of teen mothers.

The placebo puzzle: examining the discordant space between biomedical science and illness/healing.

The placebo response presents an enigma to biomedical science: how can 'inert' or 'sham' procedures reduce symptoms and produce physiological changes that are comparable to prescribed treatments? In this study, we examine this puzzle by explicating the discordant space between the prevailing biomedical paradigm, which focuses on a technical understanding of diagnosis and treatment, and a broader understanding of illness and healing as relational and embodied. Although biomedical achievements are impressive, the knowledge resulting from this paradigm is limited by its ontological and epistemological assumptions. When the body and world are objectified, illness meanings, therapeutic relationships, and healing practices are dismissed or distorted. In spite of a robust critique of the tenets of biomedicine for guiding practice, the biomedical paradigm retains a tenacious hold on evidence-based medicine and nursing, downplaying our clinical understanding of the sentient body, patients' life-worlds, and illness and healing. In reality, skilled nurses rely on multiple forms of knowledge in providing high-quality care to particular patients. Clinically wise nurses integrate their experience and knowledge of patients' priorities, fears, and illness trajectories along with biomedical findings to make astute judgments and promote health and healing.

Medication reconciliation: reducing risk for medication misadventure during transition from hospital to assisted living.

The discharge of older adults from hospital to home has been associated with poor outcomes. It is well documented that performing medication reconciliation at every transition point is critical to ensuring patient safety, preventing unnecessary rehospitalizations, and reducing the risk for medication misadventures. However, the medication reconciliation process is not well executed in numerous institutions and possibly not at all in many assisted living facilities (ALFs). Thus, the purpose of this study was to examine medication discrepancies that occur as a result of transitioning from hospitals to ALFs and to explore the role of nurses regarding medication reconciliation in ALFs. A comparison of medication records for 80 residents ages 65 and older revealed that 86.2% of resident records had at least one medication discrepancy. These results represent an opportunity for nurses to be involved with post-acute care communication and medication reconciliation to improve safe transitions for residents in ALFs.

Contraceptive Behavior in Appalachia: Exploring Use, Nonuse, and Contraceptive Attitudes.

Very little is known about contraceptive behavior in Appalachia, a large geographic region in the eastern United States where even basic prevalence estimates of contraceptive use/nonuse are lacking. This study characterizes contraceptive behavior among Appalachians, including contraceptive use, reasons for use, and methods used; contraceptive nonuse and reasons for nonuse; and attitudes about contraception, including acceptability. This is a secondary analysis of a subsample of survey data collected on sexual and reproductive health attitudes, behaviors, and needs among reproductive-age women (18-49 years) living in the Appalachian region (n = 332). Results identify rates of contraceptive use (66.6%) and nonuse (33.1%) among Appalachian residents. Methods used most frequently included those that did not require prescription (i.e., external condoms and natural family planning methods) though many reported the use of intrauterine devices (IUDs). Among nonusers, fear of side effects from contraception and ambivalence towards pregnancy were most commonly selected as the most important reason for not using contraception. Contraception was considered acceptable by this sample overall, and these acceptability attitudes were significantly associated with contraceptive behavior.

Examining the feasibility of adult quality-of-life measurement for obstructive sleep apnea in clinical settings: what is the path forward for sleep centers?

Quality of life (QoL) is one of the outcomes that can be measured as a component of the required standards for sleep facility accreditation by the American Academy of Sleep Medicine. Utilization of a psychometrically robust QoL instrument is recommended; however, clinicians face a challenge balancing psychometric properties with questionnaire completion and scoring characteristics. This article provides an overview of common QoL instruments as a reference for clinicians when selecting a QoL tool for use in the clinical setting for adult patients with obstructive sleep apnea. CITATION: Colvin L, Collop N, Lorenz R, Morgenthaler T, Weaver TE. Examining the feasibility of adult quality-of-life measurement for obstructive sleep apnea in clinical settings: what is the path forward for sleep centers? J Clin Sleep Med. 2023;19(6):1145-1155.

An Integrative Review of the Relationship Between Intrauterine Devices and Bacterial Vaginosis.

OBJECTIVE: To examine the relationship between intrauterine devices (IUDs) and bacterial vaginosis (BV) through an integrative review of the current literature. DATA SOURCES: CINAHL, MEDLINE, Health Source, Evidence-Based Medicine's Cochrane Central Registry of Controlled Trials, Embase, and Web of Science databases were searched. STUDY SELECTION: Cross-sectional, case-control, cohort, quasi-experimental, and randomized controlled trials examining copper (Cu-IUD) and levonorgestrel (LNG-IUD) use in reproductive- age users with BV occurrence confirmed with Amsel's criteria or Nugent scoring were included. Articles included were published in the past 10 years. DATA EXTRACTION: Fifteen studies met criteria, after an initial search identified 1,140 potential titles, and two reviewers assessed 62 full-text articles for inclusion. DATA SYNTHESIS: Data were categorized into three groups: retrospective descriptive cross-sectional studies identifying point prevalence of BV among IUD users; prospective analytic studies examining BV incidence and prevalence among Cu-IUD users; and prospective analytic studies examining BV incidence and prevalence among LNG-IUD users. CONCLUSION: Synthesis and comparison of studies were difficult because of disparate study designs, sample sizes, comparator groups, and inclusion criteria for individual studies. Synthesis of data from cross-sectional studies showed that all IUD users combined may have an increased point prevalence of BV compared with non-IUD users. These studies did not delineate LNG-IUDs from Cu-IUDs. Findings from cohort and experimental studies suggest a possible increase in BV occurrence among Cu-IUD users. Evidence is lacking to show an association between LNG-IUD use and BV.

Exercise and social activity improve everyday function in long-term care residents.

OBJECTIVES: This study examined the effects of high-intensity resistance strength training and walking (E), individualized social activity (SA), and resistance training and walking combined with social activity (ESA) on everyday function in long-term care (LTC) residents and explored the relationship between change in everyday function and change in sleep. DESIGN: The study used data from The Effect of Activities and Exercise on Sleep, a randomized controlled trial. SETTING: Residential LTC facilities. PARTICIPANTS: A total of 119 participants who had measures of everyday function and sleep at baseline and postintervention. INTERVENTIONS: The E group exercised 5 days a week. The SA group was involved in social activities 5 days a week. The ESA group received both E and SA interventions. The usual care (UC) control group participated in usual activities. MEASUREMENTS: Everyday function was measured by the Nursing Home Physical Performance Test. Nighttime sleep was measured by attended polysomnography. RESULTS: The UC and SA groups showed a decline in everyday function, whereas the E and ESA groups showed improvement. There were statistically significant differences between the groups, with pairwise comparisons showing significant improvements in the ESA group over the SA group (95% confidence interval, -3.94 to -0.97) and the UC group (95% confidence interval, -3.69 to -0.64). No relationship was found between change in everyday function and change in sleep. CONCLUSION: Seven weeks of high-intensity resistance strength training and walking, combined with individualized social activities (ESA), improved everyday function among LTC residents, independent of change in sleep.

Daily Sleep and Anxious and Depressive Symptoms Among Dementia Caregivers-The Mediation of Cortisol Total Output on High- and Low-Stress Days.

OBJECTIVES: Dementia family caregivers report poor sleep and mood, typically attributed to chronic stress and managing frequent daily stressors. Although many studies use global retrospective reports of these indicators, the current study examines mechanisms linking sleep, negative affect, stress biomarkers, and high-/low-stress contexts at the daily level, from the biopsychosocial perspective of stressor exposure and reactivity. METHOD: One hundred seventy-three caregivers (Mage = 61.97, SD = 10.66) were providing care at home and used adult day services (ADS) at least 2 days a week. Caregivers reported their bedtime, wake time, sleep quality, and nighttime problems of the person with dementia (PwD) daily for eight consecutive days, concurrently reporting noncare stressors, negative affect, and providing five salivary cortisol samples per day. We conducted multilevel analysis to examine whether caregiver sleep characteristics overnight (i.e., total time in bed, quality, and PwD sleep problems) were associated with their anxious and depressive symptoms on days where ADS were utilized versus non-ADS days (i.e., low stress vs. high stress), and whether cortisol daily total output as area under the curve (AUCg) mediated the direct associations, at the within- and between-person levels. RESULTS: On high-stress (i.e., non-ADS) days when caregivers had a longer time in bed than usual the night before, they were less anxious on the following day; the direct association was statistically mediated through lower cortisol AUCg during the day. DISCUSSION: Staying longer in bed than usual before an upcoming high-stress day may help dementia family caregivers better regulate cortisol stress reactivity and anxious symptoms.