Conocimientos y actitudes de las enfermeras de Atención Primaria sobre el manejo del paciente con insomnio / Knowledge and attitudes of primary care nurses about the management of patients with insomnia

OBJETIVO: Describir los conocimientos, actitudes y actuación de las enfermeras en un área de Atención Primaria sobre la atención al paciente con insomnio. MÉTODOS: Estudio descriptivo. Se envió cuestionario online a todas las enfermeras de centros de salud del área sanitaria de Mallorca entre junio-julio de 2014. Variables: sociodemográficas, del profesional, formación, preferencias de manejo clínico del insomnio. RESULTADOS: Respondieron 138 enfermeras (47%). La mayoría mujeres (92,8%), media de edad 50,42 años (DE=8,9). La mayoría lo considera un problema importante de salud. Solo un 11% ha realizado alguna actividad formativa sobre trastornos del sueño en los últimos 5 años. Casi la mitad declara interrogar habitualmente sobre las repercusiones del insomnio en la vida laboral y sobre los hábitos que pueden alterar el sueño. El 79,7% valora posibles reacciones adversas de los medicamentos que toma el paciente para el insomnio y valora de forma diferente a los ancianos el 80,4%. Los tratamientos que declaran realizar habitualmente son medidas higiénicas (76%), fitoterapia (44,9%) y 22,4% terapia cognitivo-conductual. La terapia cognitivo-conductual es considerada efectiva y aplicable por las enfermeras (63,7%) y médicos (58%). Los profesionales que más se forman son los que practican de forma significativa terapia cognitivo-conductual con mayor frecuencia. CONCLUSIONES: Las enfermeras realizan una correcta anamnesis y evaluación del insomnio, sin embargo algunas terapias de demostrada efectividad son todavía escasamente utilizadas

OBJECTIVE: To describe the knowledge, attitudes, and performance of primary care nurses in the management of patients with insomnia. METHODS: Descriptive study. An online questionnaire was sent to all primary care nurses of the Majorca Primary Care Department between June-July 2014. Measurements: sociodemographic variables, professional characteristics, tuition, usual clinical practice in the management of patients with insomnia. RESULTS: 138 nurses answered the questionnaire (47%). Most of them were women (92.8%), 50.42 years old (DE=8.9). The majority considered insomnia an important health problem. Only 11% had received some formative activity on insomnia in the last 5 years. Nearly half declares to ask patients about consequences of insomnia in their jobs and about habits that alter their sleep quality.79.7% considered the possible adverse effects of insomnia drugs and take into consideration the age of patient (80.4%). The usual treatments were sleep hygiene (76%), phytotherapy (44.9%) and 22.4% cognitive behavioral therapy (CBT). This therapy is considered effective and applicable by nurses (63.7%) and doctors (58%). Those nurses who attended courses in the last 5 years apply CBT more frequently. CONCLUSIONS: Nurses conduct a correct anamnesis and evaluation of patients with insomnia. However some therapies of known effectiveness, such as CBT, are still scarcely applied

Experiences and insomnia-associated factors in Chinese breast cancer survivors: a qualitative study.

AIMS AND OBJECTIVES: This study aimed to explore the experiences and factors associated with insomnia in Chinese breast cancer survivors. BACKGROUND: Insomnia is a common and significant symptom in breast cancer survivors. Quantitative studies are unable to describe the experience of insomnia and the sleep-associated factors from a personal point of view. A profound understanding of the experience of insomnia in breast cancer survivors can provide information for health workers and caregivers to allow them to provide more effective support. DESIGN: A descriptive qualitative research was adopted. METHODS: In-depth interviews were conducted with 22 insomniac breast cancer survivors. A qualitative content analysis was used to analyse the data. RESULTS: Three themes emerged concerning the experiences of insomnia, including sleep neglect, insomnia perception and insomnia anxiety. Participants reported their own opinions on three insomnia-associated factors, including factors associated with hospitalisation, factors associated with breast cancer and the therapies and too much attention placed on sleep. CONCLUSIONS: Survivors would neglect their sleep problems in the early stage after diagnosis. When they became aware of their sleep problems, they were inclined to worry too much and sought help from traditional Chinese medicine. Anticipatory sleep anxiety, excessive negative cognitive activities and insomnia became a vicious circle for insomniac breast cancer survivors. RELEVANCE TO CLINICAL PRACTICE: The findings provide detailed information to help nurses understand the experiences of breast cancer survivors with insomnia. Nurses could provide proper care to help prevent insomnia or improve sleep.

Effect of auricular acupressure for postpartum insomnia: an uncontrolled clinical trial.

AIMS AND OBJECTIVES: This study examined the effects of auricular acupressure therapy on women with postpartum insomnia. BACKGROUND: Postpartum women generally have poor sleep quality because of frequent night-time breastfeeding during the first month after giving birth. DESIGN: A one-group pretest/post-test quasi-experiment was conducted. METHODS: A convenience sampling method was used to recruit participants at a postpartum centre (doing-the-month centre) in Northern Taiwan, from January 2014-July 2014. Thirty women with postpartum insomnia received auricular acupressure therapy on one auricular point (Shenmen point pressing) four times a day for 14 days. The Chinese version of the Pittsburgh Sleep Quality Index was used to assess sleep quality before and after the 14-day treatment. RESULTS: After the 14-day auricular acupressure treatment, the Pittsburgh Sleep Quality Index total scores of the women decreased from 8·7 (pretest) to 5·57 (post-test, 36% reduction). Scores on the subscales of the Pittsburgh Sleep Quality Index, including sleep quality, sleep latency, sleep duration and sleep disturbance, also statistically improved (p < 0·05). CONCLUSIONS: Hormone changes and frequent breastfeeding were identified as characteristics that may exacerbate poor sleep quality of postpartum women, for whom the auricular acupressure intervention may effectively improve sleep quality. RELEVANCE TO CLINICAL PRACTICE: Auricular acupressure can be an alternative complementary therapy to aid postpartum women with insomnia in improving sleep quality.

Randomised controlled trial of the effectiveness of using back massage to improve sleep quality among Taiwanese insomnia postpartumwomen.

OBJECTIVE: to examine the effectiveness of using back massage to improve sleep quality in postpartum women. DESIGN AND SETTING: randomised controlled trial, conducted at a postpartum centre in Northern Taiwan. PARTICIPANTS: sixty postpartum women reporting poor quality of sleep were recruited from February 2012 to May 2012. INTERVENTIONS: participants were assigned randomly to either an intervention or a control group. Participants in both groups received the same care except for back massage therapy. The intervention group received a single 20-minutes back massage session at the same time each evening for 5 consecutive days. Sessions were administered by a certified massage therapist. MEASURES AND FINDING: the outcome measure was the Pittsburgh Sleep Quality Index (PSQI), which was administered pre- and post-test. Using a generalised estimation equation to control several confounding variables, the changes in mean PSQI were significantly lower in the intervention group (B=-3.97, standard error=0.43, p<0.001) than in the control group. CONCLUSIONS: an intervention involving back massage in the postnatal period significantly improved the quality of sleep. IMPLICATIONS FOR PRACTICE: midwives should evaluate maternal sleep quality and design early intervention programs to improve the quality of sleep, to increase maternal health. Midwives interested in complementary therapies should be encouraged to obtain training in back massage and to apply it in postpartumcare.

Optimal timing for initiation of biofeedback-assisted relaxation training in hospitalized coronary heart disease patients with sleep disturbances.

BACKGROUND: Clinical studies have shown that biofeedback-assisted relaxation positively influences the treatment outcomes of sleep disturbance. However, there are only few studies reporting the timing of relaxation training initiation, and the relationships between the timing of initiation and the effectiveness of relaxation remain unclear. OBJECTIVES: The aim of this study was to determine the optimal timing for initiating nurse-led biofeedback-assisted relaxation on hospitalized coronary heart disease patients with sleep disturbance. METHODS: An experimental pretest and repeated posttest design was used to compare the effectiveness of nurse-led biofeedback-assisted relaxation. A total of 128 patients with coronary heart disease were randomly assigned to 1 of 4 groups: morning group, night group, morning-night group, or control group. Outcome measures included self-report of sleep-related indicators, the scores of the Pittsburgh Sleep Quality Index (PSQI) and the Zung's Self-rating Anxiety Scale (SAS), and the dosage of sleep medication used. A 2-way analysis of variance and a simple effect test were used to analyze the differences among the 4 groups. RESULTS: No significant differences could be detected at baseline. Compared with the control group, the nurse-led biofeedback-assisted relaxation yielded a greater benefit for patients in the 3 intervention groups. Group and time factors (pretest-protest) could explain the variation in the effectiveness of this program (main effect P < .01). There were statistical differences among the groups: patients in the night group (FSOL = 33.15, P < .001; FTST = 17.99, P < .001; FSE = 10.26, P = .002; FPSQI = 27.38, P < .001; FSAS = 54.39, P < .001, respectively) and in the morning-night group (FSOL = 33.62, P < .001; FTST = 34.13, P < .001; FSE = 24.04, P < .001; FPSQI = 31.26, P < .001; FSAS = 73.93, P < .001, respectively) had slightly shorter sleep latency, experienced fewer awakenings, reported higher sleep quality, and used significantly fewer sleep medications than the morning group did (F = 32.97, P < .001). CONCLUSIONS: The timing of the initiation of nurse-led biofeedback-assisted relaxation was 1 of the factors affecting the effectiveness of relaxation. Relaxation training either at night or in the morning-night combination could effectively enhance sleep quality and decrease the need for of sleep medications in hospitalized patients with sleep disturbance.

Mind-body therapies for sleep disturbances in women at midlife.

Multiple factors contribute to sleep disturbances in women at midlife. Poor sleep is a common occurrence in women transitioning through midlife and is associated with significant morbidity. Factors that are known to disturb sleep in women at midlife include vasomotor symptoms, nocturia, sleep apnea, and stress. Stress in particular has a significant impact on sleep. Various treatments, pharmacologic and nonpharmacologic, are available to treat sleep disturbances. One nonpharmacologic option includes mind-body medicine, which encompasses several therapies. Practices within this realm have been shown to moderate the experience of stress and help restore sleep quality. Each woman's experience of disturbed sleep and transition through midlife is unique. By having a broad awareness of all evidence-based therapeutics, the clinician is able to present a diverse set of options for women at midlife who are affected by poor sleep.

The experience of a diagnosis of advanced lung cancer: sleep is not a priority when living my life.

PURPOSE/OBJECTIVES: To describe common practices and shared meanings of sleep-wake disturbances in individuals with newly diagnosed non-small cell lung cancer (NSCLC) before treatment and evaluate their preexisting sleep disturbances. RESEARCH APPROACH: Open-ended interviews of patients newly diagnosed with lung cancer. SETTING: A Veterans Administration hospital and a comprehensive cancer center in the northeastern United States. PARTICIPANTS: 26 patients newly diagnosed with NSCLC who chose chemotherapy treatment. METHODOLOGIC APPROACH: Interpretive phenomenology based on Heideggarian hermeneutics. MAIN RESEARCH VARIABLES: Meaning of diagnosis on life experiences and sleep practices. FINDINGS: Participants described four related themes: (a) the diagnosis as devastating yet not surprising, (b) treatment as hope for more time, (c) keeping life normal, and (d) sleep patterns as long lived. CONCLUSIONS: Although participants did not complain about sleep difficulties, they described a history of sleep disturbances and poor sleep hygiene. Participants focused their trust on the treatment, giving them more time to follow their priorities and ignoring the effects of sleep deprivation on their quality of life. INTERPRETATION: Healthcare professionals may design interventions to encourage keeping life as normal as possible, focusing on improving sleep, which may ultimately prolong patients' lives.

Clinical subgroups of a psychoneurologic symptom cluster in women receiving treatment for breast cancer: a secondary analysis.

PURPOSE/OBJECTIVES: To investigate clinical subgroups using an empirically identified psychoneurologic symptom cluster (depressed mood, cognitive disturbance, fatigue, insomnia, and pain) and to examine the differences among subgroups in the selected demographic and clinical variables, as well as in patient outcome (i.e., functional performance). DESIGN: Secondary analysis. SETTING: A university health science center in Salt Lake City, UT, and a National Cancer Institute-designated comprehensive cancer center in Philadelphia, PA. SAMPLE: 282 patients with breast cancer undergoing chemotherapy or radiotherapy. METHODS: Cluster analyses were conducted to identify subgroups. Multinomial logistic regression and one-way analyses of variance were used to examine the differences among subgroups. MAIN RESEARCH VARIABLES: Depressed mood, cognitive disturbance, fatigue, insomnia, pain, and functional performance. FINDINGS: Patients were classified into four distinct subgroups based on their symptom cluster experience: all low symptom, high fatigue and low pain, high pain, and all high symptom. Such patient classification patterns were consistent across the treatment trajectory, although group memberships were inconsistent. After initiating treatment, two additional subgroups emerged: high depressed mood and cognitive disturbance, and high fatigue and insomnia. Subgroups differed in physical performance status at baseline, symptom burden, and treatment modality in a relatively consistent pattern across time points. Patients in the all-high-symptom subgroup experienced the most serious limitations in activities across all time points. CONCLUSIONS: Patient subgroups exist that share the unique experience of psychoneurologic symptoms. IMPLICATIONS FOR NURSING: Findings are useful to determine who needs more intensive symptom management during cancer treatment. Future studies should examine whether specific symptom management strategies are more efficient for certain subgroups.

The role of emotional brain processing during sleep in depression.

ACCESSIBLE SUMMARY: • Explores current research illuminating the physiological mechanisms contributing the relationship of sleep dysfunction and depression. • Investigates the crucial role of sleep in the affective modulation of brain functioning. • Describes the relationship between emotional brain processing during rapid eye movement and depression. • Points to the use of multi-therapeutic approaches for treatment with emphasis on positive behavioural imagery therapies. ABSTRACT: This review synthesizes some of the most current investigative research to illuminate the physiological mechanisms contributing to the relationship between sleep dysfunction and depression. Major depression has consistently been linked to sleep abnormalities and insomnia is a robust risk factor in the initiating and development of depression. Recent neurobiological findings indicate the crucial role of sleep in the affective modulation of brain functioning. Studies have demonstrated that sleep in major depression is characterized by a reduction in slow wave sleep, interruptions in sleep continuity, longer periods of rapid eye movement (REM) sleep including a shortening of REM latency (i.e. the time between sleep onset and the occurrence of the first REM period), as well as an increase in REM density. The failure of sleep dependant emotional brain processing in REM sleep that seems to occur in depression, support the development and fostering of clinical depression. How depression likely interplays with these sleep processes points to the use of multi-therapeutic approaches for treatment with emphasis on positive behavioural imagery therapies.

[Literature review of back massage and similar techniques to promote sleep in elderly people]. / Rückenmassage und verwandte Techniken zur Förderung des Schlafes bei älteren Menschen: Eine Literaturanalyse.

Insomnia is a frequent problem among elderly people. As a consequence, sedative hypnotic drugs are prescribed very often that can lead to problematic effects. As an alternative to sedative hypnotic drugs nurses use relaxing interventions to promote sleep. One of these techniques, the back massage, is very popular because of the expected relaxing effect of touch. Against this background, this review includes 16 surveys of the international nursing literature and the German literature until the year 2004, that analyse the most common intervention in Germany, the "Atemstimulierende Einreibung" (similar to Effleurage). These studies are presented and evaluated. The results indicate that these interventions promote relaxation and sleep and that they are perceived as very pleasant by the elderly. However; they do not explain in detail the reasons for effects these and the role of touch. This review shows that further research (RCTs) is necessary to determine the effects of back massage and "Atemstimulierende Einreibung" on relaxation and sleep.

The Sh-h-h-h Project: nonpharmacological interventions.

Promoting rest and sleep is integral to the profession of nursing. The Sh-h-h-h Project, a nonpharmacological program designed to enhance rest and sleep, was implemented on a hospital medical unit. Nursing assistants provided patients with various modalities to improve sleep, including back rubs, warm drinks, blankets warmed in a blanket warmer, aromatherapy, relaxation music, and earplugs. Additional interventions were taken to reduce noise. The outcomes of the Sh-h-h-h Project are reported here, with patients indicating improved sleep quality and quantity.

Sleep disturbances in patients with chronic heart failure and their holistic consequences-what different care actions can be implemented?

BACKGROUND: Sleep disturbances are prevalent among elderly, especially among those with chronic heart failure (CHF) and can affect all dimensions of quality of life (QOL) negatively. AIM: To describe the most common causes leading to sleep disturbances in patients with CHF, their consequences from a holistic perspective and different care actions that can be implemented. METHODS: MEDLINE and CINAHL databases were searched from 1989 to July 2004. FINDINGS: Sleep disordered breathing (SDB), and insomnia were the most common causes for sleep disturbances and occurs in 45--82% (SDB) and one-third (insomnia) of all patients with CHF. SDB cause a disturbed sleep structure with frequent awakenings, as well as several adverse effects on the cardiovascular system causing increased morbidity and mortality. Insomnia, caused by anxiety, an unknown life situation in relation to the debut of CHF, or symptoms/deteriorations of CHF can lead to negative effects on all aspects of QOL, as well as daytime sleepiness. CONCLUSION: The high prevalence of sleep disturbances and their holistic consequences should be taken into account when nurses asses and plan the care for patients with CHF. Randomized studies with large sample sizes evaluating non-pharmacological nursing interventions that improve sleep are needed.

[The effects of foot reflexology on fatigue and insomnia in patients suffering from coal workers' pneumoconiosis].

PURPOSE: The purpose of this study was to determine the effects of foot reflexology on fatigue and insomnia in patients suffering from coal workers' pneumoconiosis. METHOD: This study was a quasi-experimental study of pre-test and post-test design in a non-equivalent control group. The subjects of this study consisted of both the experimental group of twenty-nine and the control group of thirty coal workers' pneumoconiosis patients. Data was collected from December 10, 2002 to February 15, 2003. Foot reflexology was performed for 60 minutes twice a week through five weeks in the experimental group, but none in the control group. To evaluate the effects of foot reflexology, the scores of fatigue and insomnia were measured before and after the experiment in both groups. Fatigue was evaluated by Fatigue Symptoms Inventory. Insomnia was measured with the visual analogue scale (VAS). Data of this experiment was analyzed by Chi-square test, t-test, unpaired t-test and Repeated Measures ANOVA with the SAS Program. RESULTS: The scores of fatigue and insomnia decreased in the experimental group but not in the control group. There was a significant difference of fatigue and insomnia between the two groups. CONCLUSION: It is suggested that foot reflexology might have beneficial effects on reducing fatigue and insomnia in patients suffering from coal workers' pneumoconiosis, and can be recommended as a nursing intervention program for patients with coal workers' pneumoconiosis.

A study on the experience of insomnia in a psychiatric inpatient population.

Complaints of insomnia among psychiatric inpatients are high. Many technical studies about insomnia are available in the literature, but few make reference to individual experience. This study examines the subjective experience of insomnia for psychiatric patients in one mental health unit. A random purposive sample of seven subjects was selected from the population of patients complaining of insomnia. Subjective experience was examined using a tape-recorded semistructured interview. The data were analysed using Burnard's content analysis framework. Ten categories were identified: control, wants and desires, holistic, assessment, individualisms, beliefs, conflict, communication, resignation and sleep signatures. Biographical data, and data from clinical notes about sleep were also collected. Results show that the impact of insomnia should not be underestimated and that attention to this aspect of a patient's experience could have a general effect on their mental health and well-being.

Management of chronic insomnia in the elderly.

Insomnia is a common complaint in the elderly. It is not a disease in and of itself, but a symptom of an underlying problem with the potential for medical, psychological, and functional complications. Approximately one half the persons aged 65 years and older experience insomnia. However, few mention their sleep problems to their primary care providers. Because of the prevalence of insomnia in the elderly and the potential for complications, it is important for primary health care providers to understand the cause, assessment, and management of chronic insomnia. Both pharmacologic and behavioral therapies are effective in the treatment of insomnia. Early recognition and treatment may increase the quality of life for the elderly insomniac.