[Nursing skill levels and implementation of Advanced Nursing Practice in Austria: A cross-sectional study]. / Pflegerische Qualifikationsniveaus und Umsetzung von Aufgaben für eine Advanced Nursing Practice in Österreich.

Nursing skill levels and implementation of Advanced Nursing Practice in Austria: A cross-sectional study Abstract: Background: New fields of practice are emerging under the concept of "Advanced Nursing Practice" (ANP) that offer specialised care provided by nurses who hold master's degrees. In Austria, nurses are currently being trained as Advanced Practice Nurses (APN). Aim: The project aimed to investigate which advanced nursing practice tasks according to the Hamric model are undertaken by nurses at different levels of qualification in Austria. Methods: Certified nurses did participate in a cross-sectional survey through an online questionnaire based on the Role Delineation Model and tailored to the Austrian context. The tasks were assigned based on the Hamric model and were tested and evaluated descriptively according to the qualification level through factor analysis. Results: Completed data was available from 105 participants, among them 80% with undergraduate education, 20% with a master's degree. A tendency in the results showed that the level of qualification was related to the activities carried out. The higher the academic degree, the more activities were performed in the field of leadership. The central ANP-competencies, research and education, are rather weak among all respondents. Conclusion: The results show that activities corresponding to the competencies of an ANP are performed by a heterogeneous group of nurses. Conditions and a standardized understanding of ANP need to be established in order to offer a professional practice that matches the competency profile.

The test-retest reliability of the respiratory-related evoked potential.

The respiratory-related evoked potential (RREP) is an established technique to study the neural processing of respiratory sensations. We examined the test-retest reliability of the RREP during an unloaded baseline condition (no dyspnea) and an inspiratory resistive loaded breathing condition (dyspnea) over a one-week period. RREPs were evoked by short inspiratory occlusions (150 ms) while EEG was continuously measured. The mean amplitudes of the RREP components Nf, P1, N1, P2, and P3 were studied. For the no dyspnea condition, moderate test-retest reliability for Nf (intraclass correlation coefficient ICC: 0.73) and P1 (ICC: 0.74), good test-retest reliability for N1 (ICC: 0.89) and P3 (ICC: 0.76), and excellent test-retest reliability for P2 (ICC: 0.92) was demonstrated. For the dyspnea condition, moderate test-retest reliability was found for Nf (ICC: 0.69) and P1 (ICC: 0.57) and good test-retest reliability for N1 (ICC: 0.77), P2 (ICC: 0.84), and P3 (ICC: 0.77). This indicates that the RREP components Nf, P1, N1, P2, and P3, elicited by inspiratory occlusions, show adequate reliability in a test-retest study design with or without parallel sustained resistive load-induced dyspnea.

The impact of unpredictability of dyspnea offset on dyspnea perception, fear, and respiratory neural gating.

Dyspnea is a debilitating and threatening symptom in various diseases. Affected patients often report the unpredictability of dyspnea episodes being particularly anxiety-provoking and amplifying the perception of dyspnea. Experimental studies testing dyspnea unpredictability together with related neural processes, physiological fear responses, and dyspnea-related personality traits are sparse. Therefore, we investigated the impact of unpredictability of dyspnea offset on dyspnea perception and fear ratings, respiratory neural gating and physiological fear indices, as well as the influence of interindividual differences in fear of suffocation (FoS). Forty healthy participants underwent a task manipulating the offset predictability of resistive load-induced dyspnea including one unloaded safety condition. Respiratory variables, self-reports of dyspnea intensity, dyspnea unpleasantness, and fear were recorded. Moreover, respiratory neural gating was measured in a paired inspiratory occlusion paradigm using electroencephalography, while electrodermal activity, startle eyeblink, and startle probe N100 were assessed as physiological fear indices. Participants reported higher dyspnea unpleasantness and fear when dyspnea offset was unpredictable compared to being predictable. Individuals with high levels of FoS showed the greatest increase in fear and overall higher levels of fear and physiological arousal across all conditions. Respiratory neural gating, startle eyeblink, and startle probe N100 showed general reductions during dyspnea conditions but no difference between unpredictable and predictable dyspnea conditions. Together, the current results suggest that the unpredictable offset of dyspnea amplifies dyspnea perception and fear, especially in individuals with high levels of FoS. These effects were unrelated to respiratory neural gating or physiological fear responses, requiring future studies on underlying mechanisms.

The effect of dyspnea on recognition memory.

Dyspnea is a debilitating symptom in various prevalent diseases. Previous research demonstrated several cognitive impairments in dyspneic patients including an impairment in recognition memory. Even though some factors contributing to these impairments have already been identified (e.g., smoking, medication), the relevance of dyspnea as one of those contributing factors is still unclear. Thus, the goal of the current study was to investigate whether acute dyspnea impairs recognition memory in a picture recognition task as indexed by reduced accuracy and a reduced old-new effect in event-related potentials (ERPs) in the electroencephalogram (EEG). Fifty healthy participants underwent a passive encoding phase without dyspnea induction, followed by the picture recognition task performed during an unloaded baseline and a resistive load induced dyspnea condition while EEG was continuously measured. Results indicated comparable accuracy during the baseline and dyspnea condition. A reduced fronto-central old-new effect during dyspnea compared to baseline was found for ERPs in the latency ranges 350-500, 500-800, 800-1100, and 1110-1400 ms. These findings suggest that dyspnea influences the process of familiarity (350-500 ms) and recollection (500-800 ms) as well as post-retrieval processes (800-1100 and 1100-1400 ms), highlighting a potential impairing effect of acute dyspnea on recognition memory.

The Effects of Repeated Dyspnea Exposure on Response Inhibition.

In order to treat dyspnea (=breathlessness) successfully, response inhibition (RI) as a major form of self-regulation is a premise. This is supported by research showing that self-regulation is associated with beneficial behavioral changes supporting treatment success in patients. Recent research showed that dyspnea has an impairing effect on RI, but the effects of repeated dyspnea exposure on RI remain unknown. Therefore, the present study tested the effects of repeated resistive load-induced dyspnea on RI over a 5-day period. Healthy volunteers (n = 34) performed the standard version of the Stroop task during baseline and dyspnea conditions on the first and fifth testing day and underwent an additional dyspnea exposure phase on each testing day. Variables of interest to investigate RI were reaction time, accuracy as well as the event-related potentials late positive complex (LPC) and N400 in the electroencephalogram. Reduced accuracy for incongruent compared to congruent stimuli during the dyspnea condition on the first testing day were found (p < 0.001). This was paralleled by a reduced LPC and an increased N400 for incongruent stimuli during the induction of dyspnea (p < 0.05). After undergoing dyspnea exposure, habituation of dyspnea intensity was evident. Importantly, on the fifth testing day, no differences between baseline, and dyspnea conditions were found for behavioral and electrophysiological measures of RI. These findings demonstrate that the impairing effect of dyspnea on RI disappeared after repeated dyspnea exposure in healthy participants. Translated to a clinical sample, it might cautiously be suggested that dyspnea exposure such as dyspnea perceived during physical exercise could reduce the impairing effect of dyspnea on RI which might have the potential to help increase self-regulation abilities and subsequent treatment efforts in dyspneic patients.

The presence of others reduces dyspnea and cortical neural processing of respiratory sensations.

Dyspnea is a threatening symptom frequently experienced by patients within social contexts such as in the presence of family members, health professionals, or other patients. However, the effects of social presence on perceived dyspnea remain unknown. Therefore, this study examined the effects of social presence on dyspnea perception and cortical neural processing of respiratory sensations using respiratory-related evoked potentials (RREPs) in the electroencephalogram while additionally investigating the impact of dyspnea-specific fear. Thirty-one healthy females underwent four experimental conditions while RREPs were induced by inspiratory occlusions: (1)observer present/no dyspnea, (2)observer present/dyspnea, (3)alone/no dyspnea, (4)alone/dyspnea. The observer presence reduced ratings of perceived dyspnea during dyspnea conditions either significantly or at trend level. Additionally, reduced amplitudes at trend level of RREP component P2 in conditions with an observer present were found. No associations with dyspnea-specific fear were found. Findings suggest that social presence might have beneficial effects for individuals experiencing dyspnea.

The impact of dyspnea and threat of dyspnea on error processing.

Dyspnea (breathlessness) is a threatening and aversive bodily sensation and a major symptom of various diseases. It has been suggested to impair several aspects of functioning in affected patients, but experimental proof for this assumption is widely absent. Error processing is an important domain of functioning and has intensively been studied using electrophysiological measures. Specifically, the error-related negativity (ERN) has been suggested to reflect early performance monitoring and error detection, while the error positivity (Pe) has been linked to subsequent error awareness. So far, little is known about the effects of anticipated or perceived dyspnea on error processing. Therefore, in 49 healthy participants, we studied the effects of experimentally induced dyspnea and threat of dyspnea on the ERN/Pe and behavioral task performance. Participants performed the arrowhead version of the flanker task during three experimental conditions: an unloaded baseline condition, a dyspnea condition, and a threat of dyspnea condition. Dyspnea was induced by breathing through inspiratory resistive loads, while high-density EEG was continuously measured. No differences in task performance (reaction times, error rates) and ERN mean amplitudes were found between conditions. However, mean amplitudes for the Pe differed between conditions with smaller Pe amplitudes during threat of dyspnea compared to baseline and dyspnea conditions, with the latter two conditions showing no difference. These results may suggest that threat of dyspnea, but not dyspnea itself, reduces error awareness, while both seem to have no impact on early error processing and related behavioral performance.

The impairing effect of dyspnea on response inhibition.

Dyspnea (=breathlessness) is an aversive and threatening symptom in various prevalent diseases. Established treatment procedures aim for behavioral changes in dyspneic patients in order to treat dyspnea successfully. To achieve these behavioral changes, response inhibition as one key executive function for goal-directed behavior is an important prerequisite. However, the impact of dyspnea on response inhibition is widely unknown. Therefore, the present study aimed at testing whether experimentally induced dyspnea would impair response inhibition. Thirty-six healthy participants performed the color-word Stroop task during an unloaded baseline and a resistive load-induced dyspnea condition. Response inhibition was investigated using behavioral measures (reaction time, accuracy) and, based on literature, the late positive complex (LPC) in the electroencephalogram. Furthermore, the N400 was investigated in an exploratory analysis. The results showed significantly reduced accuracy for incongruent compared to congruent color-words in the Stroop task during the dyspnea condition (p < .001) which was paralleled by a smaller LPC and a more negative centro-parietal N400 for incongruent color-words during the dyspnea compared to the baseline condition (p < .05). Possibly, during dyspnea more neural resources are allocated towards the semantic processing of incongruent color-words indexed as the N400 which are then not available for the partly overlapping LPC as an index for response inhibition. These findings demonstrate that resistive load-induced dyspnea has an impairing effect on response inhibition in healthy participants, both in terms of behavioral performance and respective neural processing. This might impair treatment efforts aimed at behavioral changes in patients suffering from dyspnea.

Observing dyspnoea in others elicits dyspnoea, negative affect and brain responses.

Dyspnoea is usually caused by diagnosable cardiorespiratory mechanisms. However, frequently dyspnoea relates only weakly or not at all to cardiorespiratory functioning, suggesting that additional neuropsychosocial processes contribute to its experience. We tested whether the mere observation of dyspnoea in others constitutes such a process and would elicit dyspnoea, negative affect and increased brain responses in the observer.In three studies, series of pictures and videos were presented, which either depicted persons suffering from dyspnoea or nondyspnoeic control stimuli. Self-reports of dyspnoea and affective state were obtained in all studies. Additionally, respiratory variables and brain responses during picture viewing (late positive potentials in electroencephalograms) were measured in one study.In all studies, dyspnoea-related pictures and videos elicited mild-to-moderate dyspnoea and increased negative affect compared to control stimuli. This was paralleled by increased late positive potentials for dyspnoea-related pictures while respiratory variables did not change. Moreover, increased dyspnoea correlated modestly with higher levels of empathy in observers.The present results demonstrate that observing dyspnoea in others elicits mild-to-moderate dyspnoea, negative affect, and increased brain responses in the absence of respiratory changes. This vicarious dyspnoea has clinical relevance, as it might increase suffering in the family and medical caregivers of dyspnoeic patients.

The effect of mindfulness on extinction and behavioral resurgence.

In the present experiments, we investigated the effects of mindfulness on behavioral extinction and resurgence. Participants received instrumental training; either they received FI training (Experiment 1), or they were trained to emit high rates and low rates of response via exposure to a multiple VR yoked-VI schedule prior to exposure to a multiple FI FI schedule in order to alter their rates of responding learned during Experiment 2. Participants were then exposed to either a focused- (mindfulness) or an unfocused-attention induction task. All participants were finally exposed to an extinction schedule in order to determine whether a mindfulness induction task presented immediately prior to extinction training affected extinction (Experiment 1) and behavioral resurgence (Experiment 2). During the extinction phase, the rates of responding were higher in the control group than in the mindfulness group, indicating that the mindfulness group was more sensitive to the contingencies and, thus, their prior performance extinguished more readily (Experiment 1). Moreover, rates of response in the extinction components less precisely reflected previous training in the mindfulness group, suggesting less resurgence of past behaviors after the mindfulness induction (Experiment 2).