Sleep-Related Cognitive/Behavioral Predictors of Sleep Quality and Relapse in Individuals with Alcohol Use Disorder.

BACKGROUND: Little is known about cognitive and behavioral predictors of sleep quality and relapse among individuals with alcohol use disorder (AUD). Using the social cognitive theory (SCT), we assessed sleep-related behaviors and cognitions, sleep quality, and relapse to drinking among individuals with AUD transitioning from inpatient to outpatient settings. METHOD: Individuals (n = 149) seeking treatment for AUD were recruited during their inpatient stay. Self-efficacy for sleep, dysfunctional beliefs about sleep, sleep-related behaviors, sleep quality, and relapse were assessed. Objective (actigraphy) assessment of sleep efficiency and duration was measured using actigraphy. Multiple logistic regression models tested whether self-reported sleep quality or sleep-related beliefs/behavior predicted relapse. Repeated measures linear mixed modeling tested whether there was a change over time in sleep quality as well as the relationships between self-efficacy, sleep-related beliefs, sleep behaviors, sleep quality, and relapse. RESULTS: In our sample, self-efficacy for sleep, dysfunctional beliefs about sleep, and sleep-related behavior were all significantly associated with both sleep quality and relapse. Controlling for pre-discharge sleep-related behaviors (SRBQ) and actigraphy-recorded average sleep time during the first week post-discharge, married participants had lower odds of relapse compared with non-married patients (p = 0.048, OR = 0.119, 95% CI 0.015-0.983). Patients with lower self-efficacy for sleep (SES) scores (p < 0.001) and higher CPRS anxiety scores (p < 0.001) had higher PSQI scores. CONCLUSION: Our results highlight the importance of self-efficacy and dysfunctional beliefs about sleep as predictors of sleep quality and relapse among individuals with AUD and the utility of the SCT as a sleep research framework.

Results of a national survey of certified nurse coaches with implications for advanced practice nurses.

BACKGROUND AND PURPOSE: Evidence suggests that nurse-coaching can improve health outcomes, but application of this skill is not well understood. The purpose of this study is to describe the practices of nurse coaches including their work settings, clients/health conditions, motivations behind becoming certified as coaches, and the personal benefits experienced by nurse coaches. METHODS: A cross-sectional online survey was emailed to certified nurse coaches (n = 315); 164 completed the survey, including 68 (41.5%) advanced practice nurses. CONCLUSIONS: The most frequent conditions seen by coaches included the following: anxiety/stress (n = 39, 27.1%), cardiometabolic conditions (n = 24, 16.7%), and pain (n = 20, 13.9%). Coaching varied in frequency, method (individual versus group), and mode (in-person, by phone, or electronically). Participants became coaches to gain skills for enhancing their practice, deliver care that fits with their values and philosophy, meet personal needs (starting a private practice and improve their own self-care), attain credentials/validation, and empower others. The majority agreed/strongly agreed that since becoming a nurse coach, their own interpersonal relationships (80.3%), health/health behaviors (84.8%), and job satisfaction (70.7%) improved. IMPLICATIONS FOR PRACTICE: Nurse practitioners may be strategically situated to provide coaching and have the knowledge and skills needed to intervene with medically complex, at-risk populations.

Engaging Community Leaders in the Development of a Cardiovascular Health Behavior Survey Using Focus Group-Based Cognitive Interviewing.

Establishing the validity of health behavior surveys used in community-based participatory research (CBPR) in diverse populations is often overlooked. A novel, group-based cognitive interviewing method was used to obtain qualitative data for tailoring a survey instrument designed to identify barriers to improved cardiovascular health in at-risk populations in Washington, DC. A focus group-based cognitive interview was conducted to assess item comprehension, recall, and interpretation and to establish the initial content validity of the survey. Thematic analysis of verbatim transcripts yielded 5 main themes for which participants (n = 8) suggested survey modifications, including survey item improvements, suggestions for additional items, community-specific issues, changes in the skip logic of the survey items, and the identification of typographical errors. Population-specific modifications were made, including the development of more culturally appropriate questions relevant to the community. Group-based cognitive interviewing provided an efficient and effective method for piloting a cardiovascular health survey instrument using CBPR.

Critical Transitions: A Mixed Methods Examination of Sleep from Inpatient Alcohol Rehabilitation Treatment to the Community.

AIMS: This prospective, repeated measures study utilized a convergent parallel mixed methods approach to assess sleep experiences among individuals who were alcohol-dependent undergoing inpatient detoxification and treatment at a clinical research facility across the transition periods associated with the rehabilitation process: the initial adjustment to becoming an inpatient and the transition from inpatient to outpatient status. METHODS: This study included individual semi-structured interviews and quantitative measures relating to psychological distress, sleep quality, daytime sleepiness, and sleep-related beliefs and behavior (n = 33; 66.7% male). Interviews were conducted and questionnaires were administered within one week of participants' scheduled discharge date and again four to six weeks post-discharge when they returned for a follow-up visit (or via phone). RESULTS: Participants self-reported significant sleep disturbances at both study time points. Of those participants with valid data at both time points (n = 28), there were no significant changes in mean scores from pre- to post-discharge with the exception of self-efficacy for sleep (SE-S) being significantly higher post-discharge. Preliminary qualitative findings suggested differences between those with ongoing sleep disturbances, those whose sleep disturbances had resolved, and those with no sleep disturbances at either time point. CONCLUSIONS: This analysis highlights individual variation in sleep throughout the process of inpatient treatment and transition to outpatient aftercare in individuals with alcohol dependence. Collecting quantitative and qualitative data concurrently and combining emerging themes from qualitative data with quantitative analyses allowed for a more thorough examination of this relatively novel area of research and provided information that can be utilized to inform future behavioral sleep interventions.