A composite measure of sleep health is associated with glycaemic target achievement in young adults with type 1 diabetes.

We investigated whether sleep health (each individual dimension and a composite measure) was associated with better glycaemia among a cohort of young adults with type 1 diabetes (mean age 21.5 years, mean body mass index 24.55 kg m-2 ). Multiple validated self-report questionnaires were completed, and raw continuous glucose monitor data were shared. One self-reported sleep characteristic for each of the five sleep health dimensions was selected. A composite score was calculated by summing the number of "good" sleep health dimensions. We evaluated the associations between sleep health and glycaemia, and whether covariates, including age, type 1 diabetes duration and sleep apnea risk, influenced the relationships among the study variables using multivariable linear regression. Individual dimensions of sleep satisfaction (ß = 0.380, p = 0.019; ß = -0.414, p = 0.010), timing (ß = 0.392, p = 0.015; ß = -0.393, p = 0.015) and sleep efficiency (ß = 0.428, p = 0.007) were associated with higher achievement of glycaemic targets (J-index and time in range); however, these associations did not persist after considering covariates. A better Sleep Health Composite score was associated with higher achievement of glycaemic targets even after considering covariates. Using a multidimensional framework can guide future research on causal pathways between sleep and diabetes health, interventions to target sleep health profiles, and may improve sleep screening in routine diabetes care.

Resilience as a moderator of role overload and sleep disturbance among caregivers of persons with dementia.

The purpose of this study was to examine if resilience moderates the association between role overload and sleep disturbance among caregivers of persons with dementia. This was a secondary analysis of data on 437 informal caregivers (mean age=61.77 years, SD=13.69) of persons with dementia in the United States. Data from the 2017 wave of the National Study of Caregiving were analyzed using multiple regression with interaction terms to evaluate the moderation effect of resilience, while controlling for caregivers' age, race, gender, education, self-rated health, caregiving hours, and primary caregiving status. Higher role overload was associated with greater sleep disturbance and this association was attenuated among caregivers with higher levels of resilience. Our findings highlight the stress-buffering effects of resilience in the context of sleep disturbance in dementia caregivers. Interventions to improve caregivers' ability to recover, resist, and rebound during challenging situations may mitigate role overload and optimize sleep health.

Racial and Ethnic Cardiometabolic Risk Disparities in the Type 1 Diabetes Exchange Clinic Registry Cohort.

OBJECTIVE: To determine whether individuals from a historically underrepresented racial group have a higher cardiometabolic risk than historically represented individuals with type 1 diabetes (T1D) considering socioeconomic deprivation. METHODS: We used the multivariable logistic and linear regression models to examine socioeconomic deprivation (upper 10th percentile) by race/ethnicity interaction for each cardiometabolic risk factor and cardiometabolic risk burden score, respectively, across 6320 zip code tabulation areas. We also determined the age-adjusted prevalence of low, moderate, and high cardiometabolic risks defined as 0, 1 to 2, and 3 or more risk factors for hypertension, obesity, dyslipidemia, and off-target glycemia for non-Hispanic White (n = 15 746), non-Hispanic Black (n = 1019), Hispanic (n = 1115), and other (n = 887), respectively. RESULTS: The sample comprised 18 767 adolescents and adults with T1D. Those identifying as non-Hispanic Black were more likely to have a high cardiometabolic risk profile, including a 4.5-fold increase in the odds of off-target glycemia, a twofold increase in the odds of systolic hypertension, and 0.29 (unadjusted) and 0.46 (adjusted) increases in a higher cardiometabolic risk burden compared with non-Hispanic White individuals (P < .01). Those identifying as Hispanic had a 3.4-fold increase in the odds of off-target glycemia but were less likely to be overweight/obese or have systolic hypertension compared with non-Hispanic White. However, the lower likelihood of overweight/obesity and hypertension did not persist after considering covariates. CONCLUSION: There is a need to investigate additional determinants of racially/ethnically underrepresented cardiometabolic health, including structural racism and implicit bias in cardiometabolic care for individuals with T1D.

"Feeling Anxious about Catching COVID": Facilitators and Barriers of Sleep Health among Young Adults with Type 1 Diabetes.

BACKGROUND: The COVID-19 pandemic has imposed pervasive stress and significant disruptions in sleep health in young adults. The purpose of this study was to describe the perceived facilitators and barriers of sleep health among young adults with type 1 diabetes during the COVID-19 pandemic. PARTICIPANTS: Thirty-two young adults with T1D (87.5% female; mean age = 21.5, SD = 2.0) participated in an online survey between January and July 2021. Young adults between the ages of 18-25 years with T1D for at least 6 months were eligible to participate, while those who had a previous OSA diagnosis, were currently pregnant, or worked the night shift were not eligible to participate. METHODS: A qualitative descriptive approach was used to explore the perceived facilitators and barriers to sleep among a convenience sample. Qualitative content was analyzed and coded for themes using qualitative content analysis. Responses were coded using an in vivo approach. RESULTS: Young adults with T1D identified changes in facilitators and barriers of sufficient sleep from before the COVID-19 pandemic to during the pandemic. Three overarching barriers and facilitators were identified: (1) general, (2) diabetes-specific, and (3) COVID-19 specific. CONCLUSIONS: Our findings can inform future educational and cognitive-behavioral interventions to promote sleep health in young adults with T1D and other complex chronic conditions. When designing sleep-promoting interventions for young adults with T1D in the COVID-19 pandemic and post-pandemic, researchers should consider T1D as well as COVID-specific barriers and facilitators.

Negative marital interaction, purpose in life, and depressive symptoms among middle-aged and older couples: evidence from the Health and Retirement Study.

OBJECTIVE: Negative marital interaction and purpose in life have been associated with depressive symptoms. Yet, these associations have not been fully explored in a dyadic context. This study examines the actor (intra-individual) and partner (cross-spousal) effects of negative marital interaction on depressive symptoms in couples and the potential mediating role of purpose in life. METHODS: Data came from 1186 heterosexual married couples who participated in the 2016 (T1) and 2018 (T2) waves of the Health and Retirement Study and completed the psychosocial questionnaire in 2016. Structural equation modeling was used to estimate the direct and indirect associations among T1 negative marital interaction, T1 purpose in life, and T2 depressive symptoms at the actor and partner levels. Models controlled for age, race, educational level, self-rated health, and length of marriage. RESULTS: At the actor level, a greater negative marital interaction was associated with significantly lower levels of purpose in life for husbands and wives. Negative marital interaction was also associated with depressive symptoms for wives. Purpose in life mediated the relationship between negative marital interaction and depressive symptoms. At the partner level, wives' negative marital interaction was negatively associated with husbands' purpose in life, independent of husbands' own effects. CONCLUSION: The findings support the dominant marital discord model of depression and highlight gender differences in the cross-spousal effects of negative marital interaction on purpose in life. Positive psychology interventions can be beneficial to promote purpose in life and subsequently improve mental health outcomes among couples.

Decision fatigue among clinical nurses during the COVID-19 pandemic.

AIMS AND OBJECTIVES: The purpose of this study was to report the psychometric properties, including validity and reliability, of the decision fatigue scale (DFS). BACKGROUND: Decision fatigue may impair nurses' ability to make sound clinical decisions and negatively impact patient care. Given the negative impact of the COVID-19 pandemic on psychological well-being and the workplace environment, decision fatigue may be even more apparent among clinical nurses. Valid assessment of this condition among clinical nurses may inform supportive interventions to mitigate the negative sequelae associated with states of decision fatigue. DESIGN: This study was a secondary analysis of a parent study using a cross-sectional descriptive design. METHODS: A convenience sample of 160 staff nurses was recruited online from across the United States. Participants completed a demographic questionnaire and subjective measures of decision fatigue, nursing practice environment scale and traumatic stress. Exploratory factor analysis (EFA), correlation coefficients and internal consistency reliability coefficients were computed to examine the DFS's validity and reliability within this sample. RESULTS: The EFA yielded a single factor, 9-item version of the DFS. The DFS scores were strongly correlated with traumatic stress and moderately correlated with the nursing practice environment, and the scale displayed appropriate internal consistency. CONCLUSIONS: This is the first known study to provide evidence of the DFS's validity and reliability in a sample of registered nurses working during the COVID-19 pandemic. The results of this study provide evidence of a reliable and valid assessment instrument for decision fatigue that can be used to measure the burden of decision-making among registered nurses. RELEVANCE TO CLINICAL PRACTICE: Given the relationship between traumatic stress and the nursing work environment, decision fatigue may be a modifiable target for interventions that can enhance the quality of decision-making among clinical nurses.

A systematic review of sleep deprivation and neurobehavioral function in young adults.

AIM: To examine the effect of sleep deprivation (total and partial) on neurobehavioral function compared to a healthy sleep opportunity (7-9 h) in young adults 18-30 years. BACKGROUND: More than one-third of young adults are sleep deprived, which negatively affects a range of neurobehavioral functions, including psychomotor vigilance performance (cognitive), affect, and daytime sleepiness. METHODS: A systematic review of randomized controlled trials (RCTs) on sleep deprivation and neurobehavioral function. Multiple electronic databases (Cochrane Central Registry of Controlled Trials [CENTRAL], PubMed, PsycINFO, CINAHL, and Web of Science) were searched for relevant RCTs published in English from the establishment of each database to December 31, 2020. RESULTS: Nineteen RCTs were selected (N = 766, mean age = 23.7 ± 3.1 years; 44.8% female). Seven were between-person (5 were parallel-group designs and 2 had multiple arms), and 12 were within-person designs (9 were cross over and 3 used a Latin square approach). Total sleep deprivation had the strongest detrimental effect on psychomotor vigilance performance, with the largest effects on vigilance tasks in young adults in the included studies. CONCLUSION: Acute sleep deprivation degrades multiple dimensions of neurobehavioral function including psychomotor vigilance performance, affect, and daytime sleepiness in young adults. The effect of chronic sleep deprivation on the developing brain and associated neurobehavioral functions in young adults remains unclear.

Early symptom recognition and symptom management among exacerbation COPD patients: A qualitative study.

BACKGROUND: An acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the most cause of deaths in COPD patient. It induces COPD patients often end in unexpected or unpredictable death. OBJECTIVES: The purposes were to explore the lived experiences of symptom recognition and to explain the pattern of symptom management successfully among exacerbation COPD patients. DESIGN: A Heideggerian hermeneutic phenomenology approach. SETTING: The interviews took place in participants' home by using android or iOS (iPhone) phone. PARTICIPANTS: Twenty participants were recruited until saturation by purposive sampling technique. METHODS: The semi-structured interview was used to capture detailed experiences verbatim. Data analysis based on a seven-stage hermeneutical process. RESULTS: Two constitutive patterns with relational themes were identified. First, symptom recognition, consisted of four themes: meaning of AECOPD, pattern of AECOPD, warning signs and prodromal symptoms, and risk factors of AECOPD. Second, symptom management, consisted of four themes: methods of symptom management (during AECOPD state), methods of symptom management (during stable COPD state for helping to prevent AECOPD state), knowledge source of symptom management, and factors influencing symptom recognition and symptom management. CONCLUSIONS: The use of a Heideggerian hermeneutic phenomenology as a research methodology fulfilled the aims of this study. It will enable healthcare professionals to select and advise the strategies or methods that will be the most likely to appropriate within the limits set by individual capabilities for promoting the best quality of life in COPD patients.

Inclusive leadership to guide nursing's response to improving health equity.

The purpose of this manuscript is to examine traditional models of leadership in nursing, and to provide a roadmap and specific recommendations for nurses at all levels to lead our profession through the next decade in achieving health equity. We examine current leadership frameworks in nursing and discuss ways to contemporize these frameworks to more explicitly center the expertise of clinicians and communities from historically marginalized backgrounds. Next, we examine the racial, gender, and able-bodied biases that impact nurses, and call upon nurses to examine and dismantle these biases. We discuss the roles of health systems and academic organizations in developing inclusive leaders, including through community engagement and true service-learning partnerships. Finally, we provide a set of recommendations for all nursing leaders across career stages to embrace inclusivity as they work to improve health equity.

A psychometric evaluation of the Family Decision-Making Self-Efficacy Scale among surrogate decision-makers of the critically ill.

OBJECTIVES: The purpose of this study was to report the psychometric properties, in terms of validity and reliability, of the Unconscious Version of the Family Decision-Making Self-Efficacy Scale (FDMSE). METHODS: A convenience sample of 215 surrogate decision-makers for critically ill patients undergoing mechanical ventilation was recruited from four intensive care units at a tertiary hospital. Cross-sectional data were collected from participants between days 3 and 7 of a decisionally impaired patient's exposure to acute mechanical ventilation. Participants completed a self-report demographic form and subjective measures of family decision-making self-efficacy, preparation for decision-making, and decisional fatigue. Exploratory factor analyses, correlation coefficients, and internal consistency reliability estimates were computed to evaluate the FDMSE's validity and reliability in surrogate decision-makers of critically ill patients. RESULTS: The exploratory factor analyses revealed a two-factor, 11-item version of the FDMSE was the most parsimonious in this sample. Furthermore, modified 11-item FDMSE demonstrated discriminant validity with the measures of fatigue and preparation for decision-making and demonstrated acceptable internal consistency reliability estimates. SIGNIFICANCE OF RESULTS: This is the first known study to provide evidence for a two-factor structure for a modified, 11-item FDMSE. These dimensions represent treatment and palliation-related domains of family decision-making self-efficacy. The modified FDMSE is a valid and reliable instrument that can be used to measure family decision-making self-efficacy among surrogate decision-makers of the critically ill.

The Contribution of Living Arrangements, Social Support, and Self-efficacy to Self-management Behaviors Among Individuals With Heart Failure: A Path Analysis.

BACKGROUND: Living arrangements, social support, and self-efficacy have significant implications for self-management science. Despite the theoretical linkages among the 3 concepts, there is limited empirical evidence about their interplay and the subsequent influence on heart failure (HF) self-management. OBJECTIVE: The aim of this study was to validate components of the Individual and Family Self-management Theory among individuals with HF. METHODS: This is a secondary analysis of cross-sectional data generated from a sample of 370 individuals with HF. A path analysis was conducted to examine the indirect and direct associations among social environment (living arrangements), social facilitation (social support) and belief (self-efficacy) processes, and self-management behaviors (HF self-care maintenance) while accounting for individual and condition-specific factors (age, sex, race, and HF disease severity). RESULTS: Three contextual factors (living arrangements, age, and HF disease severity) had direct associations with perceived social support and self-efficacy, which in turn were positively associated with HF self-management behaviors. Living alone (ß = -.164, P = .001) was associated with lower perceived social support, whereas being an older person (ß = .145, P = .004) was associated with better support. Moderate to severe HF status (ß = -.145, P = .004) or higher levels of perceived social support (ß = .153, P = .003) were associated with self-efficacy. CONCLUSIONS: Our results support the Individual and Family Self-management Theory, highlighting the importance of social support and self-efficacy to foster self-management behaviors for individuals with HF. Future research is needed to further explore relationships among living arrangements, perceived and received social support, self-efficacy, and HF self-management.

Comparing cognitive load levels among family members of the critically ill exposed to electronic decision aids.

Cognitive load predicts one's ability to process information and learn from decision support interventions. The present study compared intrinsic and extraneous cognitive load levels resulting from exposure to two different electronic decision aids. A convenience sample of ninety-seven surrogate decision makers for critically ill patients were randomly assigned to receive either a single dose of a video-based or avatar-based decision aid. Intrinsic and extraneous cognitive load levels among recipients of the video-based decision support resource were lower than recipients of the avatar-based decision support resource. After controlling for age, the observed differences in intrinsic cognitive load were not significantly different, whereas the observed differences in extraneous cognitive load remained. Extraneous cognitive load is a modifiable factor to consider for future developers of decision support interventions that may determine the efficacy of efforts to support patients and family members with decision making.

A preliminary psychometric evaluation of the eight-item cognitive load scale.

AIM: The aim of this article is to report the psychometric properties of the eight-item cognitive load scale. BACKGROUND: According to cognitive load theory, the formatting and delivery of healthcare education influences the degree to which patients and/or family members can engage their working memory systems for learning. However, despite its relevance, cognitive load has not yet been evaluated among surrogate decision makers exposed to electronic decision support for healthcare decisions. To date, no psychometric analyses of instruments evaluating cognitive load have been reported within healthcare settings. METHODS: A convenience sample of 62 surrogate decision makers for critically ill patients were exposed to one of two healthcare decision support interventions were recruited from four intensive care units at a tertiary medical center in Northeast Ohio. Participants were administered a battery of psychosocial instruments and the eight-item cognitive load scale (CLS). RESULTS: The CLS demonstrated a bidimensional factor structure with acceptable discriminant validity and internal consistency reliability (Cronbach's α = 0.75 and 0.89). CONCLUSIONS: The CLS is a psychometrically sound instrument that may be used in the evaluation of decision support among surrogate decision makers of the critically ill. The authors recommend application of the cognitive load scale in the evaluation and development of healthcare education and interventions.

Response of Flight Nurses in a Simulated Helicopter Environment.

OBJECTIVE: The purpose of this study was to determine if a helicopter flight simulator could provide a useful educational platform by creating experiences similar to those encountered by actual flight nurses. METHODS: Flight nurse (FN) and non-FN participants completed a simulated emergency scenario in a flight simulator. Physiologic and psychological stress during the simulation was measured using heart rate and perceived stress scores. A questionnaire was then administered to assess the realism of the flight simulator. RESULTS: Subjects reported that the overall experience in the flight simulator was comparable with a real helicopter. Sounds, communications, vibrations, and movements in the simulator most approximated those of a real-life helicopter environment. Perceived stress levels of all participants increased significantly from 27 (on a 0-100 scale) before simulation to 51 at the peak of the simulation and declined thereafter to 28 (P < .001). Perceived stress levels of FNs increased significantly from 25 before simulation to 54 at the peak of the simulation and declined thereafter to 30 (P < .001). Perceived stress levels of non-FNs increased significantly from 31 before simulation to 49 at the peak of the simulation and declined thereafter to 25 (P < .001). There were no significant differences in perceived stress levels between FNs and non-FNs before (P = .58), during (P = .63), or after (P = .55) simulation. FNs' heart rates increased significantly from 77 before simulation to 100 at the peak of the simulation and declined thereafter to 72 (P < .001). CONCLUSION: The results of this study suggest that simulation of a critical care scenario in a high-fidelity helicopter flight simulator can provide a realistic helicopter transport experience and create physiologic and psychological stress for participants.

Leveraging the lived experience of surrogate decision makers of the seriously ill to develop a decision support intervention.

BACKGROUND: Surrogate decision makers of seriously ill patients are frequently asked to make healthcare decisions without evidence-based decision support. AIMS: To describe the lived experiences of surrogate decision makers who have made advance care decisions and identify relevant features of a decision support intervention from their perspectives. METHODS: A convenience sample of surrogate decision makers (n=10) of seriously ill patients discharged to an extended care facility within the past 6 months participated in focus group discussions. Data were analyzed using content analysis. RESULTS: Three salient themes were identified: (1) limited preparation, (2) decisional and emotional burden, and (3) content and features of a decision support intervention. CONCLUSIONS: Surrogate decision makers of the seriously ill are not prepared for their new role, and experience decisional and emotional burden. Effective decision support interventions must address the decisional and emotional needs of surrogate decision makers to enhance the quality of their decisions.

CREATING A SERIOUS GAME FOR HEALTH.

The prevalence of chronic illnesses continues to increase as does the cost of such care. Teaching self-management skills is more effective than solely providing information and teaching technical skills at improving health outcomes. Serious games for health provide an opportunity to support learning and health-related behavior change using messages and experiences in an engaging and entertaining format. We developed eSMART-HD with the intention of improving interactions between patients with chronic disorders and their health care providers. This paper describes the factors that we considered when creating eSMART-HD, a serious game for health.

IMPACT OF A SERIOUS GAME FOR HEALTH ON CHRONIC DISEASE SELF-MANAGEMENT: PRELIMINARY EFFICACY AMONG COMMUNITY DWELLING ADULTS WITH HYPERTENSION.

Most Americans will acquire a chronic disease during their lifetime. One of the most prevalent chronic diseases that affect Americans is hypertension (HTN). Despite the known comorbidities and increased mortality rate associated with uncontrolled HTN, most community dwelling adults with HTN do not have sufficient blood pressure control Therefore, the aim of this article is to report the preliminary efficacy of a serious game for health to enhance blood pressure control among community dwelling adults with HTN. A nonprobability sample of 116 community dwelling adults with HTN participated in this nonblinded, randomized controlled trial. Participants were randomly assigned to: (1) an intervention arm that consisted of four exposures to a serious game for health known as eSMART-HD; or (2) an attentional control arm that compromised of four exposures to screen-based HTN education. The primary outcome measure for this trial was blood pressure reduction over a four month observational period. In this study, baseline characteristics and blood pressure measurements were similar between participants in each study arm. There was no significant between-group difference in blood pressure reduction over time. However, there were significant within-group reductions in systolic and diastolic blood pressures across time among favoring participants exposed to eSMART-HD. This study establishes the preliminary efficacy of eSMART-HD that can be easily administered to community dwelling adults and facilitate clinically significant reductions in systolic and diastolic blood pressures. Future studies should assess the influential components of this promising serious game for health (eSMART-HD) combined with medication management in larger and more diverse samples of community dwelling adults with HTN.

WAIT, WON'T! WANT: BARRIERS TO HEALTH CARE AS PERCEIVED BY MEDICALLY AND SOCIALLY DISENFRANCHISED COMMUNITIES.

OBJECTIVES: We explored barriers to healthcare as perceived by members of medically and socially disenfranchised communities. METHODS: We conducted focus groups with 28 women and 32 men from Northeast Ohio who identified themselves as African-American, Hispanic/Latino, lesbian/gay/bisexual/transgendered, and/or Russian immigrant. RESULTS: Participants described their experiences of waiting, things they won't tolerate, when they won't participate, and what they want from providers. They described behaviors, actions and relationship characteristics that they want from their providers and characteristics that they prefer in health systems. CONCLUSIONS: The themes of Wait, Won't, and Want have healthcare practice and policy implications. Patient-provider interactions are known to be significant determinants of healthcare outcomes and these exploratory findings suggest that they might also affect patient self-management strategies. Future efforts should focus on developing and testing patient-centered strategies that address the themes identified to increase engagement to increase self-management of health.

Advance directives lessen the decisional burden of surrogate decision-making for the chronically critically ill.

AIMS AND OBJECTIVES: To identify the relationships between advance directive status, demographic characteristics and decisional burden (role stress and depressive symptoms) of surrogate decision-makers (SDMs) of patients with chronic critical illness. BACKGROUND: Although the prevalence of advance directives among Americans has increased, SDMs are ultimately responsible for complex medical decisions of the chronically critically ill patient. Decisional burden has lasting psychological effects on SDMs. There is insufficient evidence on the influence of advance directives on the decisional burden of surrogate decision-makers of patients with chronic critical illness. DESIGN: The study was a secondary data analysis of cross-sectional data. Data were obtained from 489 surrogate decision-makers of chronically critically ill patients at two academic medical centres in Northeast Ohio, United States, between September 2005-May 2008. METHODS: Data were collected using demographic forms and questionnaires. A single-item measure of role stress and the Center for Epidemiological Studies Depression (CESD) scale were used to capture the SDM's decisional burden. Descriptive statistics, t-tests, chi-square and path analyses were performed. RESULTS: Surrogate decision-makers who were nonwhite, with low socioeconomic status and low education level were less likely to have advance directive documentation for their chronically critically ill patient. The presence of an advance directive mitigates the decisional burden by directly reducing the SDM's role stress and indirectly lessening the severity of depressive symptoms. CONCLUSIONS: Most SDMs of chronically critically ill patients will not have the benefit of knowing the patient's preferences for life-sustaining therapies and consequently be at risk of increased decisional burden. RELEVANCE TO CLINICAL PRACTICE: Study results are clinically useful for patient education on the influence of advance directives. Patients may be informed that SDMs without advance directives are at risk of increased decisional burden and will require decisional support to facilitate patient-centred decision-making.