Stress, Sleep, and Resilience Among Rural BSN Students in a New Nursing Program.

BACKGROUND: Nursing students experience stress that may impact their sleep and resilience, especially those attending rural campuses that may have potentially limited access to resources. PURPOSE: The purpose of this study was to examine relationships among perceived stress, sleep quality, resilience, and demographics and predictors of resilience among senior BSN students. METHODS: In this cross-sectional study, perceived stress, sleep quality, resilience, and demographic data were collected from a senior student cohort attending a new baccalaureate nursing program on a rural Appalachian campus (N = 16). Data were analyzed using descriptive, bivariate, and multiple regression analyses. RESULTS: Perceived stress significantly associated with sleep quality, resilience, and gender. Perceived stress, sleep quality, and gender significantly explained 61% of the variance in resilience, with perceived stress as the strongest predictor. CONCLUSIONS: Early collaborative assessment and intervention focused on mitigating stress may promote improved sleep and resilience. Availability of resources for students attending small rural campuses is essential.

Homesickness among rural Appalachian university students.

Objective: Homesickness among university students may impact their wellbeing and academic success. The study purpose was to examine homesickness and self-reported outcomes/university life events among students on a rural Appalachian campus. Methods: A descriptive study (N = 91) using electronic questionnaires was conducted. Results: Most participants (65%) reported homesickness, especially around move-in time, with several events making it better/worse; and were more likely to reside in-state, be at the sophomore level or above, and live in an apartment/dormitory. There were significant associations between homesickness and self-reported outcomes (anxiety, depression, wanting to drop out). Conclusions: Homesickness is prevalent among rural Appalachian students. Interprofessional collaboration to identify and mitigate effects on students' wellbeing and academic success is key. Tailoring campus life, including food options and on-campus activities, to meet student needs may promote a sense of comfort and decrease homesickness. Educational intervention to improve homesickness among university students is warranted.

Living Through COVID-19: A Family Experience.

Through qualitative inquiry grounded in story theory, this study described the impact of COVID-19 on a 5-member family. Using conventional content analysis, 8 themes were abstracted and organized around the story plot of being exposed, facing the challenge, and moving to resolution. Findings offer an approach for holistic nursing practice.

Impact of Sleep Apnea, Daytime Sleepiness, Comorbidities, and Depression on Patients' Heart Failure Health Status.

There is a gap in current research on common factors that impact patients with advanced heart failure (HF). The purpose of this secondary data analysis was to explore associations of those factors with three empirically verified measures of HF-related clinical, physical, and mental health status. Baseline data of 198 advanced systolic HF (EF < 40%) patients were analyzed. Patients were 61.6% male, with a mean age of 62.3 (SD = 13.2) years. The multivariable general linear modeling results indicated that patients who had poorer scores on HF-related clinical status were those who had sleep apnea (ß = -6.6, p < .05), daytime sleepiness (ß = -9.4, p < .01), four or more comorbidities (ß = -11.8, p < .001), and depression (ß = -18.7, p < .001). Depression was associated with all three measures of HF-related health status. These findings alert nurses to assess for sleep apnea and to use known screening measures for daytime sleepiness, depression, and comorbidities.

CPAP-SAVER follow-up study to determine long-term adherence and associated factors.

BACKGROUND: Many factors contribute to continuous positive airway pressure (CPAP) nonadherence, affecting health care burden. The original CPAP-SAVER study enrolled 66 CPAP-naive participants and showed high 1-month adherence and significantly higher apnea beliefs and CPAP attitude for the intervention group. PURPOSE AND METHODS: Thirty-three participants from the original CPAP-SAVER study were recruited for a 3-year follow-up to determine adherence, examine the intervention effect, and identify adherence-associated factors. RESULTS: Adherence rates dropped to 54.5% at 3 years, with a significant decrease in CPAP use hours (t = -2.37, p = .024) and nights (t = -4.05, p < .001). Group differences in beliefs and attitude were not sustained; however, beliefs (r = 0.57) and attitude (r = 0.44) were significant factors associated with adherence. Life satisfaction was significantly higher at present compared with before wearing CPAP (t = 5.17, p < .001). IMPLICATIONS FOR PRACTICE: The authors recommend intervention with a focus on apnea beliefs, CPAP attitude, and long-term support to promote CPAP adherence. Focus on CPAP attitude and beliefs and enhanced support early in the obstructive sleep apnea (OSA) treatment trajectory may promote long-term adherence and subsequently reduce the health care burden of OSA disease.

Effect of the CPAP-SAVER Intervention on Adherence.

Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing. Continuous positive airway pressure (CPAP) is the treatment of choice, but adherence is poor, contributing to a myriad of comorbidities that increase health burden. The study purpose was to examine the effect of the CPAP-SAVER intervention on adherence among adults with newly diagnosed OSA. Sixty-six participants were randomly assigned to intervention or standard care groups. Data were analyzed using chi-square, t-tests, and correlations. At one month, there was no significant difference in adherence between groups; CPAP beliefs and attitude were significantly higher and attitude significantly increased for the intervention group. Focus on CPAP beliefs and attitude by practitioners may impact CPAP adherence. With further research and replication of this study in larger samples to determine generalizability, the CPAP-SAVER intervention may provide underpinnings for the eventual development of an OSA-CPAP adherence management protocol.

Perceptions of Asthma Quality of Life in Children and Parent Dyads in Two Rural Counties in West Virginia.

This study examines perceived quality of life (QOL) in a convenience sample of children (aged 7-11) with asthma and their parents from two schools in rural West Virginia. Forty-nine child-parent dyads representing 25 males and 24 females completed the study. The PedsQL™ 3.0 Asthma Module was utilized to separately measure child and parent perceptions of various dimensions of pediatric, asthma-specific, health-related QOL. Dimensions of the tool were scored separately and included symptoms, treatment, worry, and communication. The mean module dimension scores for children ranged from 63.27 to 80.47 and for parents, the range was from 61.26 to 79.79, with higher scores indicating higher QOL. Parents of male children perceived their son's QOL to be higher than that of female children in the symptoms and treatment dimensions. Strong relationships occurred between the child's worry and the other three dimensions as well as between the symptoms and the treatment dimensions. For the dyads, the only significant relationship was between the child and the adult treatment dimensions. With the well-documented burden of asthma in school-aged populations, information regarding the QOL of child and parent dyads will enhance school nurses' ability to improve health and educational outcomes in schools.

OSA symptoms associated with and predictive of anxiety in middle-aged men: secondary analysis of NHANES data.

OBJECT: This population-based study examined obstructive sleep apnea (OSA) symptoms predictive of anxiety in middle-aged men. METHOD: Secondary analyses were conducted on the National Health and Nutrition Examination Survey (NHANES) 2007-2008 data using weighted samples and complex sample analysis techniques (unweighted N=1,217). FINDINGS: Nonrefreshing sleep (χ(2)=69.333, p<0.001), excessive daytime sleepiness (χ(2)=47.766, p<0.001), and sleep fragmentation (χ(2)=30.692, p<0.001) were significantly associated with anxiety. Nonrefreshing sleep (OR 3.582, p<0.001) and awakenings due to apneic episodes (OR 2.047, p=0.001) were predictive of anxiety. CONCLUSION: Comorbid anxiety and OSA symptoms are common and have implications for activities of daily living, social responsibilities, and quality of life. Screening for anxiety among men with OSA symptoms is recommended.

Anxiety in middle-aged men with obstructive sleep apnea: state of the science.

PURPOSE: This article presents the state of the science of anxiety in middle-aged men with obstructive sleep apnea (OSA). OSA affects 10% of men in this population. Psychological outcomes, especially anxiety, have a significant impact on quality of life, yet are essentially ignored. DATA SOURCES: Search of CINAHL, MEDLINE, PsycINFO, and PsycARTICLES, with the key words "sleep apnea" and "anxiety" and with age and gender limits, resulted in 107 articles. Based on established inclusion criteria, 71 studies were excluded. The resulting 36 studies were critically evaluated by sample characteristics, anxiety measurement, and results. CONCLUSIONS: Anxiety was noted in 34 of the 36 samples, most commonly measured using the Hospital Anxiety and Depression Scale, the State Trait Anxiety Inventory, and the Beck Anxiety Inventory. Effects of treatment on anxiety were significant. IMPLICATIONS FOR PRACTICE: Anxiety is common in middle-aged men with OSA, but is not adequately studied in this population. Psychological screening for anxiety at the time of OSA diagnosis is warranted, but is not encouraged in the clinical guidelines. More primary care attention is needed on psychological implications that impact OSA treatment adherence. Advanced practice nurses can be instrumental in ensuring comprehensive assessment of patients with OSA, especially psychological aspects of the disease.