Society of Anesthesia and Sleep Medicine Position Paper on Patient Sleep During Hospitalization.

This article addresses the issue of patient sleep during hospitalization, which the Society of Anesthesia and Sleep Medicine believes merits wider consideration by health authorities than it has received to date. Adequate sleep is fundamental to health and well-being, and insufficiencies in its duration, quality, or timing have adverse effects that are acutely evident. These include cardiovascular dysfunction, impaired ventilatory function, cognitive impairment, increased pain perception, psychomotor disturbance (including increased fall risk), psychological disturbance (including anxiety and depression), metabolic dysfunction (including increased insulin resistance and catabolic propensity), and immune dysfunction and proinflammatory effects (increasing infection risk and pain generation). All these changes negatively impact health status and are counterproductive to recovery from illness and operation. Hospitalization challenges sleep in a variety of ways. These challenges include environmental factors such as noise, bright light, and overnight awakenings for observations, interventions, and transfers; physiological factors such as pain, dyspnea, bowel or urinary dysfunction, or discomfort from therapeutic devices; psychological factors such as stress and anxiety; care-related factors including medications or medication withdrawal; and preexisting sleep disorders that may not be recognized or adequately managed. Many of these challenges appear readily addressable. The key to doing so is to give sleep greater priority, with attention directed at ensuring that patients' sleep needs are recognized and met, both within the hospital and beyond. Requirements include staff education, creation of protocols to enhance the prospect of sleep needs being addressed, and improvement in hospital design to mitigate environmental disturbances. Hospitals and health care providers have a duty to provide, to the greatest extent possible, appropriate preconditions for healing. Accumulating evidence suggests that these preconditions include adequate patient sleep duration and quality. The Society of Anesthesia and Sleep Medicine calls for systematic changes in the approach of hospital leadership and staff to this issue. Measures required include incorporation of optimization of patient sleep into the objectives of perioperative and general patient care guidelines. These steps should be complemented by further research into the impact of hospitalization on sleep, the effects of poor sleep on health outcomes after hospitalization, and assessment of interventions to improve it.

Reducing Central Line Utilization by Peripherally Infusing Vasopressors.

BACKGROUND: Central line-associated bloodstream infection is a preventable contributor to excess death and excess cost in the health care system. Vasopressor infusion is one of the primary reasons for central line placement. In the medical intensive care unit (MICU) at an academic medical center, there was no standard practice for peripheral versus central infusion of vasopressors. OBJECTIVE: The objective of this quality improvement project was to implement an evidence-based, nurse-driven protocol to guide the peripheral infusion of vasopressors. The goal was to reduce central line utilization by 10%. METHODS: Education on the protocol was provided to the MICU nurses, MICU residents, and crisis nurses, followed by a 16-week implementation period. Nursing staff were also surveyed preimplementation and postimplementation of the protocol. RESULTS: Central line utilization was reduced by 37.9%, and there were no central line-associated bloodstream infections recorded during project implementation. Most of the nursing staff indicated that use of the protocol increased their confidence in administering vasopressors without a central line. No significant extravasation events occurred. DISCUSSION: Although a causal link between implementation of this protocol and reduction of central line utilization cannot be established, the reduction is clinically meaningful given the known risks of central lines. Increased nursing staff confidence also provides support for continued use of the protocol. CONCLUSION: A nurse-driven protocol to guide the peripheral infusion of vasopressors can be effectively implemented into nursing practice.

A Mentoring Workgroup for Academic Role Transition Among Clinical-Track Nursing Faculty.

BACKGROUND: With the current ongoing nurse faculty shortage, mentorship can aid in career advancement, promotion, and retention for clinical assistant professors (CAPs) when hiring clinical-track faculty. METHOD: The organization, experiences, and outcomes of a CAP mentorship workgroup within a multi-campus research-intensive college of nursing are described. RESULTS: The CAP mentorship workgroup was guided by senior faculty and met monthly to provide CAPs with a better understanding of the promotion process, motivation to pursue scholarship, and peer support. Through this workgroup, seven CAPs have completed their probationary review process, two CAPs are in the process of being promoted to clinical associate professors, and more than 90% of CAPs have been retained. CONCLUSION: Mentorship for clinical-track faculty can positively influence faculty productivity and aid in CAP retention, which contributes to the success of nursing programs. [J Nurs Educ. 2023;62(3):183-186.].

Bloom's Taxonomy: Framing Virtual Simulations During the COVID-19 Pandemic.

The COVID-19 pandemic required a significant pivot in nursing education, whereby in-person simulations moved to an online format. Kaplan's i-Human Patients was a virtual simulation platform utilized at a large Midwestern university for student nurses. This online virtual simulation platform helped evaluate students' clinical knowledge and understanding using the Bloom's taxonomy framework to scaffold cases. In addition, the five phases of professional development was incorporated to aid faculty instruction.

Breaking Bad News via Telehealth: Simulation Training for Nurse Practitioner Students.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic demonstrated educators must consider students' future practice will involve patient communication via telehealth, including breaking bad news. METHOD: This mixed-methods analysis was conducted among 33 nurse practitioner (NP) students at two universities. Questionnaires were analyzed before and after a simulation training session with standardized patients to determine students' perceptions, learning satisfaction, confidence, and self-rated preparedness for delivering bad news via telehealth. RESULTS: Students' self-rated levels of preparedness for delivering bad news were higher after participating in the simulation. Students found the teaching methods to be effective, enjoyable, motivating, and suitable to individual learning styles. Two themes emerged that described students' perceptions of the experience: valuable simulation processes and multifaceted learning applicable to future NP practice. CONCLUSION: Breaking bad news via virtual platforms is new and challenging. Findings suggest this simulation experience provided a valuable tool for augmenting didactic training for NP students. [J Nurs Educ. 2022;61(9):528-532.].

Association of continuous positive airway pressure adherence with complications in patients with type 2 diabetes and obstructive sleep apnea.

STUDY OBJECTIVES: To explore the association of continuous positive airway pressure (CPAP) adherence with clinical outcomes in patients with type 2 diabetes and obstructive sleep apnea in a real-world setting. METHODS: This was a retrospective study of patients with type 2 diabetes diagnosed with obstructive sleep apnea between 2010 and 2017. CPAP adherence (usage for ≥ 4 h/night for ≥ 70% of nights) was determined from the first CPAP report following the polysomnography. Data including estimated glomerular filtration rate, hemoglobin A1c, systolic and diastolic blood pressure, lipid panel, and incident cardiovascular/peripheral vascular/cerebrovascular events were extracted from medical records. Mixed-effects linear regression modeling of longitudinal repeated measures within patients was utilized for continuous outcomes, and logistic regression modeling was used for binary outcomes. Models were controlled for age, sex, body mass index, medications, and baseline levels of outcomes. RESULTS: Of the 1,295 patients, 260 (20.7%) were CPAP adherent, 318 (24.5%) were CPAP nonadherent, and 717 (55.3%) had insufficient data. The follow-up period was, on average, 2.5 (1.7) years. Compared to those who were CPAP nonadherent, those who were adherent had a significantly lower systolic blood pressure (ß = -1.95 mm Hg, P = .001) and diastolic blood pressure (ß = -2.33 mm Hg, P < .0001). Among the patients who were CPAP adherent, a 17% greater CPAP adherence was associated with a 2 mm Hg lower systolic blood pressure. Lipids, hemoglobin A1c, estimated glomerular filtration rate, and incident cardiovascular/peripheral vascular/cerebrovascular events were not different between the 2 groups. CONCLUSIONS: Achieving CPAP adherence in patients with type 2 diabetes and obstructive sleep apnea was associated with significantly lower blood pressure. Greater CPAP use within patients who were adherent was associated with lower systolic blood pressure. CITATION: Sheth U, Monson RS, Prasad B, et al. Association of continuous positive airway pressure adherence with complications in patients with type 2 diabetes and obstructive sleep apnea. J Clin Sleep Med. 2021;17(8):1563-1569.

Management Of Excessive Sleepiness In Patients With Narcolepsy And OSA: Current Challenges And Future Prospects.

Excessive daytime sleepiness (EDS) can be caused by insufficient sleep but is also a manifestation of medical or sleep disorders and a side effect of medications. It impacts quality of life and creates safety concerns in the home, at work, and on the roads. Screening questionnaires can be used to estimate EDS, but further evaluation is necessary. EDS is a common symptom of both narcolepsy and obstructive sleep apnea (OSA). Polysomnography and multiple sleep latency testing are used to diagnose these disorders. However, isolating the primary etiology of EDS can be challenging and may be multifactorial. Untreated OSA can show polysomnographic findings that are similar to narcolepsy. The effects of sleep deprivation and certain medications can also affect the polysomnographic results. These challenges can lead to misdiagnosis. In addition, narcolepsy and OSA can occur as comorbid disorders. If EDS persists despite adequate treatment for either disorder, a comorbid diagnosis should be sought. Thus, despite advances in clinical practice, appropriate management of these patients can be challenging. This review is focused on EDS due to OSA and narcolepsy and addresses some of the challenges with managing this patient population.

Effective management of ARDS.

Acute respiratory distress syndrome is a serious complication of critical illness that is associated with high morbidity and mortality. There are no effective treatment options, so prevention, early recognition, and appropriate supportive care are essential to improve outcomes. This article provides an overview of the disorder, including current treatment considerations.

Poor sleep, hazardous breathing: an overview of obstructive sleep apnea.

Obstructive sleep apnea is a chronic disorder resulting from upper airway collapse during sleep. It is linked to a variety of health and safety risks but can often be effectively treated. This article provides an overview of the disorder, including an evidence-based approach to diagnosis and management.

Implementation of an interprofessional educational model.

Despite literature that supports the benefits of interprofessional collaboration among healthcare practitioners, such as better patient outcomes and more efficient use of resources, many education programs continue to educate in silos, leading to a lack of awareness of the role of other disciplines. The nurse practitioner role, as example, requires positive collaboration with other healthcare providers, including physicians. The authors describe the development, implementation, and evaluation of an innovative interprofessional clinical educational model that was integrated into a nurse practitioner curriculum, as well as lessons learned during the first 2 years this program has been in place.

Implementing team-based learning in a nurse practitioner curriculum.

Team-based learning (TBL) is an innovative, learner-centered teaching strategy that promotes active learning. The authors describe their experience with implementing TBL in an adult-gerontology acute and primary care course for nurse practitioners as well as their evaluation of student outcomes.