Structural validity of nursing diagnosis insomnia in older adults of a community center.

PURPOSE: Insomnia is an important sleep disorder in older persons. Conceptual analysis studies on this nursing diagnosis have been developed, but the diagnostic accuracy has not been verified. This study aimed to verify the diagnostic accuracy of the nursing diagnosis of Insomnia (00095) in older adults in a community center in Brazil. METHODS: A validation study for diagnostic accuracy of the defining characteristics of the nursing diagnosis Insomnia. Data were collected through telephone interviews with 90 participants. Latent class analysis was used to verify the sensitivity and specificity of the defining characteristics. Poisson regression was used to assess the prevalence of the association of factors related to the nursing diagnosis of insomnia. FINDINGS: A 47.42% prevalence of insomnia in the sample was identified. Defining characteristics such as expresses dissatisfaction with sleep and nonrestorative sleep-wake cycle showed the best accuracy values for insomnia, with a specificity of 0.92 (0.78-1.00) and 0.89 (0.74-1.00), respectively. Related factors such as stressors and frequent naps during the day were more likely to develop insomnia in individuals. CONCLUSIONS: This study indicates diagnostic accuracy of nursing diagnosis of insomnia in community-dwelling older people from a community center. The findings highlighted the importance of the defining characteristics of nursing diagnosis insomnia and its main related factors contributing to accurate diagnostic identification. IMPLICATIONS FOR NURSING PRACTICE: This study can contribute to providing objective clinical indicators of insomnia in the older population to guide nurses in early diagnostic confirmation for the selection of health interventions. In addition, it can be a consistent contribution to theoretical and conceptual reviews of this diagnosis.

OBJETIVO: A insônia é um importante distúrbio do sono em pessoas idosas. Foram desenvolvidos estudos de análise conceitual sobre esse diagnóstico de enfermagem, mas a precisão diagnóstica não foi verificada. Este estudo teve como objetivo verificar a acurácia diagnóstica do diagnóstico de enfermagem Insônia (00095) em idosos frequentadores de um centro de convivência no Brasil. MÉTODOS: Um estudo de validação de acurácia diagnóstica das características definidoras do diagnóstico de enfermagem Insônia. Os dados foram coletados por meio de entrevistas telefônicas com 90 participantes. Foi utilizada a Análise de Classe Latente para verificar a sensibilidade e especificidade das características definidoras. A regressão de Poisson foi usada para avaliar a prevalência da associação dos fatores relacionados ao diagnóstico de enfermagem insônia. RESULTADOS: Foi identificada uma prevalência de 47,42% de insônia na amostra. Características definidoras, como expressa insatisfação com o sono e ciclo sono-vigília não restaurador, apresentaram os melhores valores de precisão para a insônia, com especificidade de 0,92 (0,78-1,00) e 0,89 (0,74-1,00), respectivamente. Fatores relacionados, como estressores e cochilos frequentes durante o dia, aumentaram a probabilidade de desenvolver insônia em idosos do centro de convivência. CONCLUSÕES: Este estudo indica a precisão diagnóstica do diagnóstico de enfermagem de insônia em idosos que vivem em comunidade, frequentadores de um centro comunitário. Os resultados destacaram a importância das características definidoras do diagnóstico de enfermagem de insônia e seus principais fatores relacionados que contribuem para a identificação precisa do diagnóstico. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Este estudo pode contribuir fornecendo indicadores clínicos objetivos da insônia na população idosa para orientar os enfermeiros na confirmação precoce do diagnóstico para a seleção de intervenções de saúde. Além disso, pode ser uma contribuição consistente para revisões teóricas e conceituais desse diagnóstico. DESCRITORES: Distúrbios do Início e da Manutenção do Sono; Idoso; Estudo de Validação; Diagnóstico de Enfermagem; Transtornos Cronobiológicos.

Prevalência e fatores de risco associados ao delirium em uma unidade de terapia intensiva / Prevalencia y factores de riesgo asociados al delirium en una unidad de cuidados intensivos / Prevalence and risk factors associated with delirium at a critical care unit

Resumo Objetivo Identificar a prevalência e os fatores de risco associados ao delirium em pacientes internados em uma unidade de terapia intensiva no nordeste do Brasil. Métodos Estudo transversal realizado entre julho de 2017 e abril de 2018 com 316 pacientes hospitalizados por pelo menos 48h, ≥18 anos, com Richmond Agitation-Sedation Scale ≥ -3. A análise estatística incluiu análise univariada e multivariada; um modelo log-binomial foi utilizado para razões de prevalência ajustadas. Resultados A análise univariada indicou uma prevalência de delirium em 45,9%, meia idade (49,8 ± 17,4 vs. 44,0 ± 17,6, p=0,003) e neurocirurgia (62,5% vs. 26,1%, p<0,001). A contenção física (81,3% vs. 40,9%, p<0,001), alimentação por sonda nasoenteral (85,9% vs. 57,6%, p<0,001) e ventilação mecânica (50,0% vs. 29,2%, p<0,001) foram associadas à prevalência de delirium. Conclusão Idade, contenção física, alimentação por sonda e uso de anticonvulsivantes aumentaram a prevalência de delirium em nossa amostra.

Resumen Objetivo Identificar la prevalencia y los factores de riesgo asociados al delirium en pacientes internados en una unidad de cuidados intensivos en el nordeste de Brasil. Métodos Estudio transversal realizado entre julio de 2017 y abril de 2018 con 316 pacientes hospitalizados por al menos 48 horas, ≥18 años, con Richmond Agitation-Sedation Scale ≥ -3. El análisis estadístico incluyó análisis univariado y multivariado. Se utilizó un modelo log-binomial para razones de prevalencia ajustadas. Resultados El análisis univariado indicó una prevalencia de delirium en el 45,9 %, mediana edad (49,8 ± 17,4 vs. 44,0 ± 17,6, p=0,003) y neurocirugía (62,5 % vs. 26,1 %, p<0,001). La contención física (81,3 % vs. 40,9 %, p<0,001), alimentación por sonda nasoenteral (85,9 % vs. 57,6 %, p<0,001) y ventilación mecánica (50,0 % vs. 29,2 %, p<0,001) fueron factores asociados a la prevalencia de delirium. Conclusión Edad, contención física, alimentación por sonda y uso de anticonvulsivos aumentaron la prevalencia de delirium en nuestra muestra.

Abstract Objective Identify the prevalence and risk factors associated with delirium in patients in a critical care unit in northeastern Brazil. Methods A cross-sectional study that enrolled 316 patients with at least 48h of hospitalization, ≥18 years old, with Richmond Agitation-Sedation Scale ≥ -3, between July 2017 and April 2018. Statistical analysis included univariate and multivariate analysis, we employed a log-binomial model for adjusted prevalence ratios. Results Univariate analysis indicated that delirium was prevalent among 45.9%, middle age (49.8 ± 17.4 vs. 44.0 ± 17.6, p=0.003) and neurosurgery (62.5% vs. 26.1%, p<0.001). Physical restraining (81.3% vs. 40.9%, p<0.001), nasoenteral tube feeding (85.9% vs. 57.6%, p<0.001) and mechanical ventilation (50.0% vs. 29.2%, p<0.001) was associated with prevalence of delirium . Conclusion Age, physical restraint, tube feeding, and the use of anticonvulsants increase the prevalence of delirium in our sample.

Association between community-based and workplace violence and the sleep quality of health professionals: a cross-sectional study. / Associação entre a violência comunitária e no local de trabalho e a qualidade do sono de profissionais da saúde: estudo transversal.

Community-based and workplace violence against health professionals has caused feelings of vulnerability, emotional exhaustion, and psychological changes, reflecting on sleep quality disorders. Thus, we aimed to analyze the association between community and workplace violence and the sleep quality of health professionals working in primary health care. The study was conducted with 286 health professionals who worked in PHC in one of the largest cities in Brazil. The primary outcome was sleep quality as assessed by the Pittsburgh Sleep Quality Index. Most of the participants (69.2%/p=0.074) were classified as "bad sleepers", and nurses (73.3%/p=0.049) showed the worst sleep quality. Additionally, most professionals suffered some type of violence at work (p<0.001), which impaired professional activities (p=0.010), forcing them to change their behavior (p<0.001) and consider changing the workplace location (p=0.051). The results showed that professionals have been experiencing moments of fear, anxiety, and stress associated with workplace and community violence. This highlights the need for public policies geared to occupational health.

A violência comunitária e no local de trabalho contra os profissionais de saúde tem causado sentimentos de vulnerabilidade, desgaste emocional e alterações psicológicas, refletindo em distúrbios na qualidade do sono. Assim, buscou-se analisar a associação entre violência comunitária e no local de trabalho e a qualidade do sono de profissionais de saúde que atuam na atenção primária à saúde. O estudo foi realizado com 286 profissionais de saúde que atuavam na atenção primária à saúde, em uma das maiores cidades do Brasil. O desfecho primário foi a qualidade do sono, avaliada pelo Índice de Qualidade do Sono de Pittsburgh. A maioria dos participantes (69,2%/p=0,074) foi classificada como "maus dormidores", sendo os enfermeiros (73,3%/p=0,049) os que apresentaram a pior qualidade de sono. Ademais, grande parte dos profissionais sofreram algum tipo de violência durante o trabalho (p<0,001), que prejudicou as atividades profissionais (p=0,010), obrigando-os a mudar de conduta (p<0,001), e a cogitar mudança do local de trabalho (p=0,051). Os resultados mostraram que os profissionais têm apresentado episódios de medo, ansiedade e estresse, relacionados à violência no local de trabalho. Isso evidencia a necessidade de políticas públicas voltadas à saúde ocupacional.

Análise simultânea dos conceitos de ansiedade e medo: contribuições para os diagnósticos de enfermagem / Análisis simultáneo de los conceptos de ansiedad y temor: contribuciones a los diagnósticos de enfermería / Simultaneous analysis of the concepts of anxiety and fear: contributions to nursing diagnoses

Resumo Objetivos Realizar a análise simultânea dos conceitos de ansiedade e medo. Método Análise simultânea de conceitos com base nas nove etapas propostas por Haase, Leidy, Coward, Britt e Penn. Resultados 43 artigos foram incluídos a partir de uma busca em cinco bases de dados. 51 atributos, 26 antecedentes e 10 consequentes foram identificados a partir da análise destes conceitos. Esta análise revelou que a ansiedade e o medo são conceitos subjetivos, multidimensionais e com altos graus de abstração. Conclusão A análise simultânea da ansiedade e do medo possibilitou o refinamento destes diagnósticos e a proposição de modificações em seus componentes. Implicações para a prática A análise destes conceitos possibilitará a identificação precisa destes fenômenos na prática clínica, proporcionando maior acurácia diagnóstica.

Resumen Objetivos Realizar un análisis simultáneo de los conceptos de ansiedad y miedo. Método Análisis simultáneo de conceptos basado en los nueve pasos propuestos por Haase, Leidy, Coward, Britt y Penn. Resultados Se incluyeron 43 artículos de una búsqueda en cinco bases de datos. Del análisis de estos conceptos se identificaron 51 atributos, 26 antecedentes y 10 consecuencias. Este análisis reveló que la ansiedad y el miedo son conceptos subjetivos y multidimensionales con altos grados de abstracción. Conclusión El análisis simultáneo de la ansiedad y del miedo permitió refinar estos diagnósticos y proponer cambios en sus componentes. Implicaciones para la práctica el análisis de estos conceptos permitirá la identificación precisa de estos fenómenos en la práctica clínica, proporcionando una mayor precisión diagnóstica.

Abstract Objectives To make a simultaneous analysis on the concepts of anxiety and fear. Method Simultaneous concept analysis with nine steps proposed by Haase, Leidy, Coward, Britt, and Penn. Results A total of 43 articles were included from a search in five literature databases. 51 attributes, 26 antecedents, and 10 consequents were identified from the analysis of these concepts. This analysis revealed that anxiety and fear are subjective, multidimensional concepts with high abstraction degrees. Conclusion The simultaneous analysis of anxiety and fear is useful to refine these diagnoses and propose changes in their components. Implications for practice The analysis of these concepts enables the precise identification of these effects in the clinical practice, applying greater diagnostic accuracy.

Vitamin D Insufficiency Reduces Grip Strength, Grip Endurance and Increases Frailty in Aged C57Bl/6J Mice.

Low 25-OH serum vitamin D (VitD) is pervasive in older adults and linked to functional decline and progression of frailty. We have previously shown that chronic VitD insufficiency in "middle-aged" mice results in impaired anaerobic exercise capacity, decreased lean mass, and increased adiposity. Here, we examine if VitD insufficiency results in similar deficits and greater frailty progression in old-aged (24 to 28 months of age) mice. Similar to what we report in younger mice, older mice exhibit a rapid and sustained response in serum 25-OH VitD levels to differential supplementation, including insufficient (125 IU/kg chow), sufficient (1000 IU/kg chow), and hypersufficient (8000 IU/kg chow) groups. During the 4-month time course, mice were assessed for body composition (DEXA), physical performance, and frailty using a Fried physical phenotype-based assessment tool. The 125 IU mice exhibited worse grip strength (p = 0.002) and inverted grip hang time (p = 0.003) at endpoint and the 8000 IU mice transiently displayed greater rotarod performance after 3 months (p = 0.012), yet other aspects including treadmill performance and gait speed were unaffected. However, 125 and 1000 IU mice exhibited greater frailty compared to baseline (p = 0.001 and p = 0.038, respectively), whereas 8000 IU mice did not (p = 0.341). These data indicate targeting higher serum 25-OH vitamin D levels may attenuate frailty progression during aging.

Mortality Predictors and Associated Factors in Patients in the Intensive Care Unit: A Cross-Sectional Study.

BACKGROUND: Mortality in the intensive care unit (ICU) has been associated to an array of risk factors. Identification of risk factors potentially contribute to predict and reduce mortality rates in the ICU. The objectives of the study were to determine the prevalence and the factors associated with the mortality and to analyze the survival. METHOD: A cross-sectional study conducted in two clinical and surgical ICU in the state of Sergipe, northeastern Brazil. We enrolled 316 patients with at least 48 h of hospitalization, minimum age of 18 years old, sedated or weaned, with RASS ≥ -3, between July 2017 and April 2018. We categorized data in (1) age and gender, (2) clinical condition, and (3) prevalence of delirium. Data from enrolled patients were collected from enrollment until death or ICU discharge. Patients' outcomes were categorized in (1) death and (2) nondeath (discharge). RESULTS: Twenty-one percent of participants died. Age (53 ± 17 years vs. 45 ± 18 years, p < 0.01), electrolyte disturbance (30.3% vs 18.1%, p=0.029), glycemic index (33.3% vs 18.2%, p=0.008), tube feeding (83.3% vs 67.1%, p=0.01), mechanical ventilation (50% vs 35.7%, p=0.035), sedation with fentanyl (24.2 vs 13.6, p=0.035), use of insulin (33.8% vs 21.7%, p=0.042), and higher Charlson score (2.61 vs 2.17, p=0.041) were significantly associated with death on the adjusted model. However, the regression model indicated that patients admitted from the emergency (HR = 0.40, p=0.006) and glycemic index alterations (HR = 1.68, p=0.047) were associated with mortality. There was no statistically significant difference (p=0.540) in survival between patients with and without delirium, based on the survival analysis and length of hospitalization. CONCLUSION: The prevalence of death was 21%, and age, electrolyte disturbance, glycemic index, tube feeding, mechanical ventilation, sedation with fentanyl, use of insulin, and higher Charlson score were associated with mortality.

Nurse-Delivered Brief Behavioral Treatment for Insomnia in Lung Cancer Survivors: A Pilot RCT.

Objective/Background: Insomnia occurs in 50 to 80% of lung cancer survivors. Cognitive behavioral therapy is the standard treatment for insomnia (CBTI); however, treatment length and lack of psychologists trained in CBTI limits access. Brief Behavioral Treatment for Insomnia (BBTI), a nurse-delivered modified CBTI, is proposed. This feasibility pilot study sought to compare the BBTI intervention to attention control Healthy Eating Program (HEP) for insomnia in lung cancer survivors. Participants: The participants comprised adults, 21 years of age or older with insomnia and stage I/II non-small cell lung cancer, more than 6 weeks from surgery and living in Western NY. Methods: Participants (n = 40) were randomly assigned to an experimental (BBTI) or attention control condition (Healthy Eating Program). Thirty participants completed the study. Results: Participants were 66 years of age (± 7.6; range 53-82), 40% (n = 16) male, 87.5% (n = 35) Caucasian, 50% (n = 20) married, BMI 27.7 (± 5.8), and 12% (n = 5) never smokers. Baseline sleep diary sleep efficiency, ISI and other baseline covariates were balanced between the groups. Sleep efficiency improved ≥85% in BBTI group (p = .02), but not in HEP control group (p = 1.00). Mean ISI for BBTI and attention control were 6.40 ± 4.98 and 14.10 ± 4.48 (p = .001) respectively. In addition, BBTI group mean total FACT-L score improved by 6.66 points from baseline while HEP group score worsened (p = .049). Conclusions: BBTI is a practical, evidence-based, clinically relevant intervention that improved sleep and quality of life in lung cancer survivors with insomnia. Additional research to evaluate efficacy, duration, and implementation strategies are essential.

Impaired Sleep: A Multifaceted Geriatric Syndrome.

Impaired sleep increases in prevalence in older adults, with multiple possible causes that can interact with each other and can lead to poor health outcomes. This article describes normal changes in sleep with aging, sleep disorders that increase in prevalence in older adults, medications and sleep, and medical conditions and psychosocial conditions associated with impaired sleep. In addition, a brief assessment that nurses could use to assess for impaired sleep and nonpharmacologic interventions to improve sleep are discussed.