Impact of Simulation and Clinical Experience on Self-efficacy in Nursing Students: Intervention Study.

This study compared the effect of simulation and clinical experience timing on self-confidence/self-efficacy for the nursing process. Using a randomized, double-crossover design, self-efficacy was measured 3 times. Although self-efficacy was significantly higher at time 1 for students who had clinical experience, there was no difference between the groups at the end of the course (time 2). Thus, simulation increased self-confidence/self-efficacy equivalently if placed either before or after clinical experience.

My first preceptor.

A patient emergency alters the dynamic of a less-than-nurturing relationship.

Implementing a dedicated education unit: a practice partnership with oncology nurses.

An urgent need exists to identify innovative and evidence-based educational methods to help oncology nurses provide safe and high-quality patient care. One promising solution is the dedicated education unit (DEU) educational model, which partners nursing faculty and skilled nursing clinicians to facilitate the clinical experience of undergraduate baccalaureate nursing students. This article describes the collaborative DEU initiative developed between a university school of nursing and a tertiary cancer center to provide senior nursing students with an innovative method to develop their competencies in oncology nursing practice and care.

Obstructive sleep apnea: a risk factor for cardiovascular disease.

Obstructive sleep apnea (OSA) is a condition in which the upper airway becomes constricted or occluded during sleep, leading to decreased or absent airflow, hypoxia, and sympathetic activation. This chain of events, occurring dozens of times an hour, can contribute to the development of hypertension, coronary artery disease, heart failure, and stroke. This article discusses the epidemiology of comorbid OSA and cardiovascular disease, the pathophysiology of OSA, how it acts as a risk factor for cardiovascular problems, and how appropriate treatment of OSA ameliorates the consequences. The importance of having a high suspicion for OSA in people with risk factors (including obesity, middle age, male or postmenopausal female) or symptoms (snoring, excessive daytime sleepiness, difficulty concentrating) is pointed out. The article concludes with clinical and research implications.

Outcome of CPAP treatment on intimate and sexual relationships in men with obstructive sleep apnea.

STUDY OBJECTIVES: To examine intimate and sexual relationships in patients with obstructive sleep apnea (OSA), the association with daytime sleepiness, and the change in these outcomes with continuous positive airway pressure treatment (CPAP). DESIGN: Pre-post test, quasi-experimental study. SETTING: Seven sleep disorders centers in the U.S. and Canada. PARTICIPANTS: 123 males with OSA (AHI > or =20), aged 21 to 60 years. INTERVENTIONS: Nasal CPAP for > or =3 months. MEASUREMENTS AND RESULTS: Compared to normal values, at baseline patients were significantly sleepier, as measured by the Multiple Sleep Latency Test and Epworth Sleepiness Scale. They were also more impaired in intimate and sexual relationships, as measured by the Intimate and Sexual Relationships subscale of the Functional Outcomes of Sleep Questionnaire. Neither race nor marital status was significantly associated with impaired intimate and sexual relationships. Following treatment, patients were significantly more alert and had reported improved intimate and sexual relationships, with the greatest change occurring in those with the most disease severity. CONCLUSIONS: OSA has an adverse impact on intimate and sexual relationships that is related to subjective sleepiness and improved with CPAP treatment.

Sleepiness and relationships in obstructive sleep apnea.

This is a qualitative analysis of data from a multisite study of 156 participants with Obstructive Sleep Apnea (OSA). Participants completed a battery of tests, including the Functional Outcomes of Sleep Questionnaire (FOSQ) that contains an item assessing the impact of OSA on relationships. Approximately one third of participants wrote comments; they were predominately male, mean age 44.7, with severe OSA. Interpersonal themes expressed included work and marital problems and social life restriction. Intrapersonal themes included embarrassment and poor mood. This report adds specific details to previous reports of impaired relationships in OSA, and stresses the importance of assessing this critical area.

Sleep in mechanically ventilated patients.

People dependent on mechanical ventilation in an intensive care unit sleep poorly. Less than half of their sleep occurs at night. Sleep architecture is abnormal, with occasional disappearance of some stages of sleep, and there are frequent arousals and awakenings. Because most arousals are associated with caregiving activities or noise, caregivers should consolidate care and decrease environmental noise. More research is needed on sleep and sleep promotion in mechanically ventilated patients.

Relationship between symptoms and functional performance in COPD.

We studied the relationships among functional performance and three symptoms--dyspnea, fatigue, and sleep difficulty--in a sample of 100 people with chronic obstructive pulmonary disease (COPD). All participants had an FEV(1) 60% or less of the predicted level for age, sex, and height. Consistent with the Theory of Unpleasant Symptoms, dyspnea correlated with both fatigue and sleep difficulty. Dyspnea and fatigue both had moderate negative correlations with functional performance, while sleep difficulty had a small nonsignificant negative correlation with functional performance. After controlling for age and oxygen use, dyspnea was the only symptom to predict variance in functional performance significantly. Of the three symptoms studied, only dyspnea was related to both the other symptoms and to functional performance. Focusing on dyspnea may be the best way to improve both symptom experience and functional performance in people with COPD.