Benefits of the Modified Version of the Illness-Wellness Continuum Model for Nurse Education.

With rapid advancements in sciences and the expanding scope of nursing practice, faculty are challenged to connect the experiences of learners with abstract concepts of science and to cultivate clinical reasoning skills. Rationale for the adoption of the illness-wellness continuum model includes the following: (a) the relationships among illness, health, and the nursing process are relevant in many health situations, and (b) levels of wellness are steeped in holistic principles of self-care, which are consistent with educational and clinical goals. The modified version of the illness-wellness continuum model can serve as the groundwork that prepares nursing students in a constantly changing workplace.

Strategies to Strengthen Nursing PhD Enrollment: An Ecological Systems Perspective.

BACKGROUND: Nurses with a Doctor of Philosophy (PhD) degree are essential to developing nursing knowledge, promoting health outcomes, and educating the next generation of nurses. Declining enrollment in nursing PhD programs calls for purposeful action. Guided by Bronfenbrenner's Ecological Systems Framework, this article outlines barriers and facilitators, and offers strategies to increase PhD enrollment. METHOD: Extant literature and the authors' cumulative experiences in PhD education and research were reviewed to identify strategies to increase PhD enrollment. RESULTS: Multilevel influences impede or facilitate enrollment in PhD programs. Strategies addressing individual and interpersonal influences included intentional personalized recruiting and early outreach to students at various levels of education. Institutional and organizational strategies included research partnerships and programs, and financial and infrastructure support. Sociocultural strategies included image branding and a positive social media presence supporting nurse scientists. CONCLUSION: Strategies to enhance PhD enrollment across all levels can spark interest in nursing science and PhD enrollment. [J Nurs Educ. 2023;62(12):669-678.].

Cancer-Related Sleep Wake Disturbances.

OBJECTIVES: To review the evidence on sleep wake disturbance (SWD) in adults with cancer and provide an up-to-date review of the prevalence, impact, causes, risk factors, assessment, options for treatment, and emerging science and technology. DATA SOURCES: These include a synthesis of review articles and sources in electronic databases CONCLUSION: SWD is a prevalent and debilitating problem for millions of people living with cancer. If not addressed, SWD can negatively impact physical and psychological recovery from cancer. Multiple factors contribute to SWD among patients with cancer including a variety of physical symptoms related to cancer and its treatment including fatigue, anxiety, and other psychological symptoms. When SWD risk factors are predicted and clinical features evaluated, there are several treatment options and strategies available to help patients in a timely manner. There is a substantial body of evidence supporting the use of psychosocial interventions and behavioral treatments, such as cognitive behavioral therapy for insomnia (CBTI). Growing evidence supports exercise and mindfulness-based stress reduction to diminish SWD. Sleep needs to be prioritized in cancer care, but dedicated effort and resources are needed to address the patient, clinician, institutional, and societal barriers to routine sleep evaluation and effective delivery of SWD interventions. IMPLICATIONS FOR NURSING PRACTICE: It is important for oncology providers to be educated regarding both pharmacologic and nonpharmacological treatments. Strategies for management of SWD in the context of cancer care delivery and future research are discussed in the context of the predictive preventive and personalized medicine framework (PPPM).

Strategies to enhance the success of mid-career nurse scientists.

BACKGROUND: The mid-career nurse scientist, defined as an associate professor with/without tenure, is often faced with a multitude of challenges and opportunities PURPOSE: This paper shares strategies to assist mid-career scientists as they juggle required career demands and navigate the mid-career phase in pursuit of the rank of full professor. METHOD: A review of the literature was performed on mid-career nurse scientists. DISCUSSION: A combination of increased research responsibilities, increased institutional teaching and service demands, and dwindling support can result in a sense of overwhelm and burnout. The mid-career nurse scientist must balance several balls in the air at one time to remain successful. CONCLUSION: Strategies aligned with the Ecological Framework, focus on intrapersonal, interpersonal, institutional, organizational, and public policy domains to provide a wide scope of strategies that target the mid-career scientist and engage the larger nursing community.

Areas of satisfaction and challenges to success of mid-career nurse scientists in academia.

BACKGROUND: Mid-career nurse scientists in academia face many challenges that can lead to burnout and exiting the profession. Finding ways to increase satisfaction and support will help retain these critical faculty in research positions. PURPOSE: Describe areas of satisfaction and challenges to success in the faculty role for mid-career nurse scientists in academia. METHOD: Cross-sectional, descriptive. A total of 65 self-identified mid-career nurse scientists completed an online survey. FINDINGS: Mid-career nurse scientists were most satisfied with their role at their organization, least satisfied with time for research and opportunities to receive mentoring. They felt moderately supported by colleagues and deans, least supported by their ADR. Differences in satisfaction among nurse scientists in different levels of research institutions were noted. DISCUSSION: Challenges to success in mid-career nurse scientists exist. Loss of nurse scientists at mid-career threatens to undermine the knowledge base of the individuals who mentor the next generation of scientists. The discipline must support mid-career scientists in their efforts to be successful in research.

The perceived reality and environment of the mid-career nurse scientist.

BACKGROUND/PURPOSE: A qualitative study was designed to explore facilitators and barriers to success from the perspectives of self-identified mid-career nurse scientists. METHODS: Data were collected from 84 respondents using open-ended items as part of an electronic survey of self-identified mid-career nurse scientists who were members of regional nursing research societies. DISCUSSION/CONCLUSION: Two main themes emerged: "Perceived Realities" and "What's Needed to Achieve Career Success." Mid-career nurse scientists experience both joy from teaching and research roles and dissatisfaction with research support; difficulty balancing heavy teaching workload, administrative responsibilities, and research, and ineffective mentoring. Based on the challenges in their environment, respondents identified numerous ways to enhance career success including (1) increasing or enhancing release time for research activities, (2) formal infrastructure to support research activities, and (3) targeted, effective mentoring by senior scientists.

Call to action to support the success of midcareer nurse scientists.

Mid-career nurse scientists in academia are at risk for burnout and departing scientific careers, particularly those in research-intensive academic settings. With the shortage of nursing faculty and the public health need for high-quality nursing research, it is critical to retain current research-focused individuals in nursing. In this paper, we discuss definitions and expectations of mid-career scientists, challenges and barriers faced by mid-career scientists, and opportunities for mid-career scientists, informed by both nursing and non-nursing literature. Finally, we focus on definitions and expectations, challenges, and opportunities specifically related to mid-career nurse scientists in research-intensive academic settings.

Implementing Advance Care Planning: Barriers and Facilitators.

An article by Izumi et al. (2019) in the current issue describes the effect of a brief educational intervention for nurses to increase confidence in their knowledge of advance care planning (ACP). The description of this project offers a useful exemplar for those wishing to implement ACP interventions. This commentary raises questions about the role of nurses in ACP and the design of effective, sustainable ACP programs within complex health systems.

Feasibility of a Telemedicine-Delivered Cognitive Behavioral Therapy for Insomnia in Rural Breast Cancer Survivors.

OBJECTIVES: To evaluate a nurse-led, telemedicine-delivered cognitive behavioral therapy for insomnia (CBTI) in rural breast cancer survivors (BCSs). SAMPLE & SETTING: 18 BCSs diagnosed with stage I-III breast cancer in the rural western United States. METHODS & VARIABLES: In this prospective, pre-/post-test, quasiexperimental feasibility pilot trial, BCSs attended six weekly sessions of CBTI via Internet videoconference. Feasibility was assessed using recruitment and acceptability of the intervention. Primary outcomes were diary-based sleep efficiency (SE), sleep latency (SL), total sleep time, wake after sleep onset, and number of nightly awakenings; secondary outcomes included quality of life (QOL), mental health, and daily functioning. RESULTS: Following the intervention, participants reported improvements in sleep outcomes, including SE and SL. QOL and daily functioning improved, but anxiety and depression did not. IMPLICATIONS FOR NURSING: Nurse-led, telemedicine-delivered CBTI for rural BCSs is feasible and may be effective in managing insomnia. Additional research is needed to determine widespread effectiveness and best practices for dissemination and implementation.

Effects of Exercise on Sleep in Women with Breast Cancer: A Systematic Review.

Sleep deficiency is common and distressing for women with breast cancer throughout the care continuum. This article describes the scope and quality of evidence related to exercise interventions to improve sleep in women with breast cancer. Fifteen studies met the criteria and 12 were judged to be excellent quality. The most frequent intervention was walking, primarily during the time of chemotherapy. Eleven studies reported postintervention improvement in sleep deficiency. Most yoga, qigong, and dance intervention studies reported no differences between groups. Emerging evidence exists for the effectiveness of aerobic exercise to improve various sleep outcomes in women with breast cancer.

Sleep deficiency among Native Hawaiian/Pacific Islander, Black, and White Americans and the association with cardiometabolic diseases: analysis of the National Health Interview Survey Data.

PURPOSE: Examine sleep deficiency, factors, and associations with cardiometabolic diseases in United States Native Hawaiian/Pacific Islanders (NHPI), Blacks, and Whites. DESIGN: Data from the 2014 National Health Interview Survey and NHPI National Health Interview Survey household interviews of adults were analyzed. PARTICIPANTS: Of 31,724 participants, 7% were NHPI, 14% were Black, and 79% were White. METHODS: Habitual sleep duration and quality, sociodemographic/economic covariates, health behaviors, psychological distress, and chronic diseases were self-reported. Sleep duration was coded as very short (VSS; <5 hours), short (SS; 5-6 hours), long (LS; >8 hours), or healthy (7-8 hours). Using multivariate logistic regressions, the association between sleep duration and diseases was assessed after adjusting for covariates. RESULTS: NHPI were more likely to report sleep <7 hours compared to Whites (40.2% NHPI, 29.3% White) and less LS than Blacks (7% NHPI, 9.2% Black), report poor sleep quality, and use fewer sleep medications. VSS was related to smoking and psychological distress in NHPI men. VSS was associated with hypertension and SS with diabetes in NHPI, even in adjusted models. The relationship between SS and diabetes was higher in NHPI (risk ratio [RR]: 1.40, 95% confidence interval [CI]: 1.03-1.90) than Whites (RR: 1.01, 95% CI: 0.90-1.14, P = .027) and Blacks (RR: 1.02, 95% CI: 0.85-1.23, P = .043) even after adjusting for other covariates. CONCLUSIONS: NHPI reported suboptimal sleep duration that was linked to hypertension and diabetes even after controlling for covariates. Additional prospective studies in NHPI are needed to understand biological, behavioral, and psychological factors of sleep deficiency and its impact on chronic diseases.

Agenda for Sleep Research in Older Adults With Cancer: A Conference Report.

BACKGROUND: Sleep problems are common but often neglected in older adults, particularly in the context of cancer. Underlying mechanisms are poorly understood and interventions frequently lack a clear scientific basis. OBJECTIVE: The objective of this report was to examine scientific content presented at a National Institutes of Health-sponsored U13 "Bedside to Bench" conference using a qualitative and iterative review procedure. Analysis of current scientific issues regarding sleep in older adults with cancer is needed to direct nurse scientists and clinicians toward research opportunities. METHODS: A multistep review procedure for the analysis/synthesis of knowledge gaps and research opportunities was undertaken by oncology nurse scientists in attendance. RESULTS: Conceptual problems in this area include the lack of standard sleep terminology and absence of an overarching conceptual model. Methodological problems are inconsistent sleep/napping measurement and complex operational challenges in designing comprehensive yet feasible studies in older adults. Knowledge gaps in basic and clinical science relate to cellular and molecular mechanisms that underlie sleep and circadian rhythm disturbances, contribution of sleep to adverse outcomes, and impact of disturbed sleep during hospitalization and the transition from hospital to home. CONCLUSIONS: Focused and interdisciplinary research that advances conceptual and operational understanding of biological and behavioral determinants of sleep health in the aging cancer population can lead to more effective, safe, and targeted interventions for those with cancer-related sleep-circadian disturbances. IMPLICATIONS FOR PRACTICE: Research that addresses current conceptual, methodological, and physiological issues can lead to more effective, safe, and targeted care for older adults with cancer-related sleep-circadian disturbances.

Management of Sleep-Wake Disturbances Comorbid With Cancer.

It is critical that clinicians and healthcare systems adopt routine screening and affordable interventions to reduce chronic insomnia and improve the quality of life in cancer patients and survivors. We provide expert clinical advice on how to manage sleep-wake disturbances that occur comorbidly with cancer. Our discussion focuses on the etiology, screening, and assessment of sleep-wake disturbances, and on both nonpharmacologic and pharmacologic interventions to manage sleep disturbances, insomnia, and sleep-related breathing disorders. We share a simplified sleep management algorithm based on evidence-based guidelines and resources from the National Cancer Institute, National Comprehensive Cancer Network, and Oncology Nursing Society, as well as case studies that illustrate how oncology professionals can use the algorithm. Finally, we describe ways to strengthen the partnership between clinicians and patients in the management of sleep-wake disorders and related symptoms.

Sleep Disturbances in Acutely Ill Patients with Cancer.

Intensive care units may place acutely ill patients with cancer at additional risk for sleep loss and associated negative effects. Research suggests that communication about sleep in patients with cancer is suboptimal and sleep problems are not regularly assessed or adequately treated throughout the cancer trajectory. However, many sleep problems and fatigue can be managed effectively. This article synthesizes the current literature regarding the prevalence, cause, and risk factors that contribute to sleep disturbance in the context of acute cancer care. It describes the consequences of poor sleep and discusses appropriate assessment and treatment options.

A Qualitative Study of Sleep-Wake Disturbance Among Veterans With Post-Acute Moderate to Severe Traumatic Brain Injury.

OBJECTIVE: Examine sleep-wake disturbance (SWD) characteristics, factors, consequences, and management strategies from the perspective of veterans with chronic stage, moderate/severe traumatic brain injury (TBI). SETTING: VA Medical Center, Rocky Mountain. US PARTICIPANTS: Nineteen male veterans with post-acute TBI and SWD in the VA Health Administration. DESIGN: Qualitative descriptive. MEASURES: Semistructured interviews, Ohio State University TBI-Identification Method, Insomnia Severity Index. RESULTS: Two main dimensions emerged: "Messed up sleep" and Surviving and Managing SWD. Sleep-wake disturbance has long-term multidimensional features, etiology, consequences, and practice implications. Although SWD may not be consistently discussed with providers, the problem appears to be pervasive in many aspects of the lives of the informants. Difficulty falling asleep, frequent awakenings, and poor sleep quality were common symptoms that were described as intrusive, isolating, and difficult to self-manage. Veterans discussed a host of physical symptoms, mental health issues, environmental, and behavioral factors that contributed to SWD. Medications, sleep apnea treatment, and self-imposed isolation were frequent management strategies. Veterans expressed a willingness to try new approaches and work with providers. CONCLUSION: Sleep-wake disturbance among veterans with chronic stage TBI is a multidimensional phenomenon with interplay between comorbidities, contributing factors, effects on functioning, and sleep management strategies. Implications for practice include early and routine evaluation, monitoring, and treatment of SWD. Research is needed to test interventions that address SWD and common TBI comorbidities.

Actigraphic and Sleep Diary Measures in Veterans With Traumatic Brain Injury: Discrepancy in Selected Sleep Parameters.

OBJECTIVE: To examine the discrepancy between sleep diary and actigraphic measures of sleep in Veterans with moderate-severe post-acute traumatic brain injury (TBI) and to explore whether these discrepancies vary according to participant characteristics. SETTING: VA Medical Center in the Rocky Mountain United States. PARTICIPANTS: Nineteen males with moderate-severe post-acute TBI and insomnia symptoms as measured by the Insomnia Severity Index. DESIGN: Descriptive, cross-sectional. MAIN MEASURES: Sleep diary, wrist actigraphy, Ohio State University TBI-Identification Method, Insomnia Severity Index, and Hospital Anxiety and Depression Scale. RESULTS: There was poor agreement between actigraphic and sleep diary measurements of (1) total sleep time, (2) wake after sleep onset, and (3) sleep onset latency. On average, actigraphy measured greater duration of all 3 sleep parameters. Discrepancies were not found to be associated with specific TBI characteristics or mood-related symptoms. CONCLUSION: When measuring sleep-related outcomes among Veterans with moderate-severe post-acute TBI, notable mismatches were found between actigraphic and self-reported sleep diary data. Knowledge regarding measure-related limitations is important for both clinical and research practices among those with moderate-severe post-acute TBI.

Characterization of Childhood Obesity and Behavioral Factors.

INTRODUCTION: Childhood obesity is a major public health threat in the United States. Recent data indicate that 34.2% of children ages 6 to 11 years are overweight or obese. The purpose of this study is to describe childhood obesity levels and identify risk behaviors in two school-based health centers in Michigan, one urban and one rural. METHODS: This study is a secondary data analysis from a multicenter comparative effectiveness trial. Multiple logistic regression was used to examine behavioral factors associated with overweight/obesity in children. RESULTS: In this sample (n = 105), 41.9% were obese and 16.2% were overweight. The duration of sleep per night (p = .04) and the frequency of eating breakfast (p = .04) were significant predictors of being overweight/obese. DISCUSSION: Health care providers in school-based health centers must be comfortable assessing, preventing, and treating childhood obesity in this high-risk group of patients. Interventions should encourage children to eat breakfast daily and to get adequate sleep.

Actigraphy and Sleep Diary Measurements in Breast Cancer Survivors: Discrepancy in Selected Sleep Parameters.

This analysis examined the discrepancy between sleep diary and actigraphy measurements in breast cancer survivors (BCS) with insomnia. BCS from communities in Western U.S. provided demographic/medical information, insomnia, mood, and fatigue data at baseline. Averaged over 5 weeks, actigraphy measured 55.75 minutes (SD = 112.42) less total sleep time (TST), and 85.19 minutes (SD = 81.36) more wake after sleep onset (WASO) than diaries. Some women showed agreement between measures; others were more variable. There were no significant relationships between TST and WASO discrepancy and participant characteristics. There may be sleep differences in BCS that results in greater perceived TST and less WASO reported in diaries. Measurements discrepancy is a significant concern needing further evaluation of medical populations with insomnia.

Sleep in mother and child dyads during treatment for pediatric acute lymphoblastic leukemia.

PURPOSE/OBJECTIVES: To compare the sleep of children with acute lymphoblastic leukemia (ALL) during maintenance treatment with controls and to measure the effect on maternal sleep. DESIGN: Comparative, descriptive. SETTING: Pediatric oncology clinic and communities in Colorado. SAMPLE: 26 dyads of mothers and children with ALL and matched controls. METHODS: Mothers completed insomnia severity, mood, and stress questionnaires and wore a wrist actigraph, and mothers and children completed a seven-day sleep diary. MAIN RESEARCH VARIABLES: Mother and child sleep parameters (e.g., total sleep time, sleep latency, sleep efficiency, awakenings); maternal insomnia severity, mood, and stress; child sleep habits. FINDINGS: Mothers of children with ALL reported greater insomnia compared to controls, which was correlated with anxiety, depressive symptoms, and stress. Maternal groups did not differ on diary- and actigraph-measured sleep outcomes; both groups experienced sleep fragmentation. Children with ALL took longer to fall asleep and had more variable sleep patterns. CONCLUSIONS: Actigraph and sleep diary data indicated adequate maternal sleep duration and sleep latency. Self-reported insomnia severity in mothers of children with ALL suggested sleep fragmentation that may be undetected by these measures. IMPLICATIONS FOR NURSING: Oncology nurses are in a unique position to identify sleep problems in mothers and children with ALL, which may lead to recommendations for improved sleep and referrals for treatment.

Cognitive behavioral therapy for insomnia outcomes in women after primary breast cancer treatment: a randomized, controlled trial.

PURPOSE/OBJECTIVES: To examine the effect of cognitive-behavioral therapy for insomnia (CBTI) on sleep improvement, daytime symptoms, and quality of life (QOL) in breast cancer survivors (BCSs) after cancer treatment. DESIGN: A prospective, longitudinal, randomized, controlled trial. SETTING: Oncology clinics, breast cancer support groups, and communities in Colorado. SAMPLE: 56 middle-aged BCSs with chronic insomnia. METHODS: Women were randomly assigned to CBTI or behavioral placebo treatment (BPT) and completed measures of sleep, QOL, functioning, fatigue, and mood at baseline, postintervention, and at three- and six-month follow-ups. MAIN RESEARCH VARIABLES: Sleep outcomes (e.g., sleep efficiency, sleep latency, total sleep time, wake after sleep onset, number of nightly awakenings); secondary variables included sleep medication use, insomnia severity, QOL, physical function, cognitive function, fatigue, depression, anxiety, and sleep attitudes or knowledge. FINDINGS: Sleep efficiency and latency improved more in the CBTI group than the BPT group; this difference was maintained during follow-up. Women in the CBTI group had less subjective insomnia, greater improvements in physical and cognitive functioning, positive sleep attitudes, and increased sleep hygiene knowledge. No group differences in improvement were noted relative to QOL, fatigue, or mood. CONCLUSIONS: Nurse-delivered CBTI appears to be beneficial for BCSs' sleep latency/efficiency, insomnia severity, functioning, sleep knowledge, and attitudes more than active placebo, with sustained benefit over time. IMPLICATIONS FOR NURSING: Oncology nurses are in a unique position to identify insomnia in cancer survivors. When sleep disturbances become chronic, nurses need to make recommendations and referrals.