Experiences of Older Adults During COVID-19: Loss, Boredom, Uncertainty, Worry, and Resilience.

The coronavirus disease 2019 (COVID-19) pandemic and resulting instructions to stay home and social distance enhanced concerns of the impact of social isolation on the physical and mental well-being of older adults. Eighteen community-dwelling older adults participated in interviews describing their experiences early in the COVID-19 pandemic. Participants experienced loss of activities, routines, and social connection, and feelings of worry and uncertainty. Nevertheless, participants were hopeful about the future and demonstrated resilience in overcoming boredom as they became intentional in finding new activities and using technology to maintain connection with others. Older adults may need support in such situations to manage boredom and uncertainty and avoid social isolation. [Journal of Gerontological Nursing, 49(6), 27-32.].

Circadian rhythm and quality of life in older adults.

Sleep is critical to physical and mental health for people of all ages, but older adults are particularly vulnerable to the consequences of poor sleep health. The purpose of this pilot study was to explore patterns of sleep and the relationships between circadian rhythm disorders and quantity of life in 34 community-dwelling older adults. Participants were primarily female, and single. Of participants, 44% reported poor sleep quality, and 29% had a circadian rhythm disorder. Those with circadian rhythm disorders had lower physical health quality of life score than other participants although this was not significant. No differences were seen in mental health quality of life scores. Further research is needed to explore sleep and circadian rhythm disorders in this population to target interventions to improve sleep quality.

COMFORT communication in the ICU: Pilot test of a nurse-led communication intervention for surrogates.

AIM: This study was designed to investigate the feasibility, acceptability, and preliminary efficacy of a nurse-led communication intervention among surrogates in the intensive care unit (ICU) guided by the COMFORT (Connect; Options; Making meaning; Family caregivers; Openings; Relating; Team) communication model. BACKGROUND: As frontline communicators, nurses experience communication difficulties with surrogates who face complex informational and emotional barriers when making decisions for critically ill patients in the ICU. However, research on effective nurse communication focusing on both curative and end-of-life (EOL) care is lacking in the literature. DESIGN: A single-centre two-group pretest-posttest quasi-experiment. METHOD: The total sample included 41 surrogates of adult ventilated patients. Twenty participants were allocated to the intervention group who received a daily 20-min telephone call with content based on the COMFORT communication model. Twenty-one participants comprised the control group who received usual care. Participants completed a questionnaire before and after the study measuring satisfaction, anxiety and depression, decisional conflict, and quality of communication. The Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) checklist was followed for nonrandomised controlled trials. RESULT: The intervention was feasible, with 19 of 20 surrogates completing the follow-up surveys, and 48 telephone conversations completed (48% of the planned phone calls). Surrogates' satisfaction was higher in the intervention group than in the control group after adjusting for the selected covariates (25.43 and 24.15, respectively; p = .512). Preliminary efficacy outcomes favouring the intervention included quality of communication with healthcare providers, but not surrogates' perceived depression/anxiety and decisional conflicts. CONCLUSION: Implementation of the intervention is feasible, acceptable, and favourable among surrogates to improve quality of communication with healthcare providers in the ICU. Further research is needed to determine whether the intervention could be implemented by nurses to improve surrogates' outcomes in other ICUs.

Barriers and Facilitators to Engagement in Rehabilitation Among Stroke Survivors: An Integrative Review.

BACKGROUND: Approximately 795,000 Americans experience a new or recurrent stroke every year, and it remains one of the leading causes of disability worldwide. Patient engagement in rehabilitation and physical activity has been associated with improvements in functional outcomes during inpatient rehabilitation. There is limited knowledge of the barriers and facilitators to patients' engagement in stroke rehabilitation. METHODS: An integrative review with a systematic approach was conducted to explore the current available literature on barriers and facilitators to patient engagement in stroke inpatient rehabilitation. RESULTS: Twenty-five studies were included in the final review. Four major themes described the identified barriers and facilitators: (1) stroke impact, (2) self-efficacy, (3) therapeutic relationship, and (4) motivating factors. Individualized patient-centered goal setting was a commonly studied intervention found to successfully increase engagement. CONCLUSION: Engagement in stroke rehabilitation is associated with improved patient outcomes. Using the identified themes from this review, nurses can develop focused interventions aimed at reducing barriers and increasing stroke patient engagement.

The Experiences of Family Members of Ventilated COVID-19 Patients in the Intensive Care Unit: A Qualitative Study.

BACKGROUND: Visitor restrictions caused challenges for family members when their loved ones had coronavirus disease (COVID-19) and were ventilated. Limited studies have reported on family members' experiences and support needs. AIM: To explore the experiences and support needs of family members of ventilated COVID-19 patients in the intensive care unit (ICU). DESIGN: Exploratory, qualitative design, using in-depth individual telephone interviews, and analyzed using thematic analysis. SETTING/PARTICIPANTS: Ten family members of adult COVID-19 patients in the ICU. RESULT: Seven key themes represented family members' experiences: (a) reactions to the COVID-19 diagnosis, (b) COVID-19 as a destabilizing force on the family unit, (c) COVID-19's effects on bereavement outcomes, (d) desperately seeking information, (e) family member needs, (f) conflicting feelings about video calls, and (g) appreciation of care. Family members' feelings about the patient's diagnosis and how the virus was contracted exacerbated their stress and anxiety. They struggled to feel informed about care that they could not witness and had difficulty understanding information. Family members reported that video calls were unhelpful. While these experiences made them question the quality of care, they expressed their appreciation of the frontline healthcare providers taking care of their loved ones. CONCLUSION: The stress and uncertainty of family members of critically ill patients with COVID-19 were influenced by their inability to feel connected to the patient and informed about care. Healthcare providers should assess each individual family's burden and preferences, and this should include establishing structured, timely, and consistent communication regarding patient care during the pandemic including early referral to palliative care.

The Experience of Participating in an 8-Week Mindfulness Based Stress Reduction plus Sleep Retraining Course among Women Living with Multiple Sclerosis.

Adult women with multiple sclerosis (MS) can benefit from innovative mindfulness-based interventions designed and structured with understanding and consideration of the multifaceted challenges these women face on a daily basis. The purpose of this qualitative descriptive study was to explore the experience of participating in an online or traditional onsite 8-week, once a week, Mind Body Stress Reduction combined with Sleep Retraining course among women living with MS to establish online course acceptability. Braun and Clarke's Reflexive Thematic Analysis method was used to analyze focus group interview data. Time and length for both courses was found acceptable, camaraderie and interconnectedness were essential, having choice regarding course delivery format was important, and being provided with organized learning materials at the course start in a binder or packet was considered imperative. Acceptability was established for both the online and onsite formats.

Improving Sleep among Adults with Multiple Sclerosis using Mindfulness plus Sleep Education.

We explored the feasibility of a mindfulness plus sleep education intervention, SleepWell!, delivered via videoconference compared to onsite among adults with MS. A non-randomized wait-list control design was used. Participants wore actigraphy watches and kept sleep diaries for seven days pre- and post intervention. Questionnaires were completed pre-intervention, post-intervention, and three months post-intervention. One group was conducted onsite. Three groups participated via videoconference. Attrition among videoconference groups was 23% compared to 57% in the onsite group. Within group analysis showed moderate-to-large effect sizes on sleep efficiency (d=0.78) and total sleep time (d=0.54) in the videoconference groups. One-way repeated measures ANOVA post-hoc analysis suggested small-to-medium effect over three months on sleep quality (ηp2 =0.28), physical health quality of life (ηp2 =0.42), mental health quality of life (ηp2 =0.13), and mindfulness (ηp2 =0.29). Results indicate feasibility of providing our intervention via videoconferencing. Preliminary analysis suggests that SleepWell! improves sleep and mindfulness among adults with MS.

Fatigue in Family Caregivers of Individuals With Dementia: Associations of Sleep, Depression, and Care Recipients' Functionality.

The current study examined factors related to fatigue in family caregivers of individuals with dementia using a cross-sectional design to collect subjective and objective data. Findings indicated that caregivers' sleep quality, difficulty falling asleep, and depression, as well as care-recipients' functionality, were associated with family caregivers' fatigue. Regression analysis indicated that only sleep quality significantly predicted caregivers' fatigue. Study findings suggest fatigue is common among family caregivers of individuals with dementia and may be related to sleep quality. The level of fatigue identified in the current study warrants further study with larger and more diverse samples. [Journal of Gerontological Nursing, 46(9), 14-18.].

Home Monitoring to Track Activity and Sleep Patterns Among Older Adults: A Feasibility Study.

Measuring changes in activity and sleep over time is important for research and practice. While commercially available home monitoring systems passively track these parameters, the feasibility, acceptability, and usefulness of new products need to be evaluated. We tested a commercially available system for providing long-term data on activity and sleep with 10 single women (mean age, 86.5 years) who were monitored in their homes. Motion detectors, a bed sensor, door sensor, and chair sensor were installed for 3 months to collect data. Other measures, objective actigraphy data from 1 week and self-report, provided data for comparison. Sleep and activity data were similar across measures; the most active participant had the highest scores on all activity measures including sensor data. Participants were generally positive about the monitoring system, but participants varied in their awareness levels of the presence of the equipment. Use of the sensor system was feasible in this pilot study and acceptable to participants. The study also illustrates challenges researchers can encounter when working with a commercial company.

The Relationship Among Multiple Sclerosis-Related Symptoms, Sleep Quality, and Sleep Hygiene Behaviors.

AIMS AND OBJECTIVES: The aim of this study was to examine the relationships among multiple sclerosis (MS)-related symptoms, sleep hygiene behaviors, and sleep quality in adults with MS who self-report fatigue. BACKGROUND: Fatigue is a frequent, prevalent symptom among adults with MS. Few studies have examined the relationship among fatigue and other symptoms with sleep quality and sleep behaviors. DESIGN: This is a descriptive correlational study. METHODS: A convenience sample of 39 adults with MS were recruited for the study. Instruments used included the revised MS Related Symptom Scale and the Pittsburgh Sleep Quality Index. Correlations examined the relationships among fatigue and other MS symptoms with sleep quality and sleep hygiene behaviors. RESULTS: The frequency of several symptoms correlated with poor sleep quality, and fatigue frequency was higher in those who used electronic devices and practiced poor sleep hygiene behaviors. NURSING IMPLICATIONS: Nurses should incorporate interventions for symptoms that impact sleep quality. These findings suggest that sleep hygiene education should be a part of routine clinical care. CONCLUSION: Adults with MS experience the burden of many symptoms that impact sleep quality. Interventions that include education to improve symptoms, sleep hygiene behaviors, and sleep quality are needed.

Factors associated with sleep in family caregivers of individuals with dementia.

PURPOSE: The study aimed to identify factors related to family caregivers' sleep. DESIGN AND METHODS: The study used a cross-sectional design with objective and subjective methods to measure sleep in the home setting over a 7-day period. FINDINGS: Findings indicated that poor sleep quality was found in 91.7% of the caregiver participants. Depression, sleep hygiene, burden, and care-recipients' sleep were significant predictors of various dimensions of caregivers' sleep. PRACTICE IMPLICATIONS: Our study suggests that sleep quality for family caregivers of individuals with dementia varies considerably from night to night. Understanding the complex interrelationships among caregivers' sleep and other contributing variables is an important first step toward the development of individualized and effective treatment strategies.

Ethical dilemmas in nursing: An integrative review.

AIMS: To identify themes and gaps in the literature to stimulate researchers to develop strategies to guide decision-making among clinical nurses faced with ethical dilemmas. BACKGROUND: The concept of ethical dilemmas has been well explored in nursing because of the frequency of ethical dilemmas in practice and the toll these dilemmas can take on nurses. Although ethical dilemmas are prevalent in nursing practice, frequently leading to moral distress, there is little guidance in the literature to help nurses resolve them. DESIGN: This study is an integrative review of published research from 2000 to 2017. METHODS: The keywords ethics, ethical dilemmas and nurs* were searched in CINAHL, PubMed, OVID and SCOPUS. Exclusion criteria were sources not available in English, not in acute care, and without an available abstract. Seventy-two studies were screened; 35 were retained. Garrard's matrix was utilised to analyse and synthesise the studies. RESULTS: Ethical dilemmas arose from end-of-life issues, conflict with physicians or families, patient privacy concerns and organisational constraints. Differences were found in study location, and yet international research confirms that ethical dilemmas are universally prevalent and must be addressed globally to protect patients and nurses. CONCLUSIONS: This review offers an analysis of the available evidence regarding ethical dilemmas in acute care, identifying themes, limitations and gaps in the literature. The gaps in quantitative intervention work, US paucity of research, and lack of comparisons across practice settings/nursing roles must be addressed. Further exploration is warranted in the relationship between ethical dilemmas and moral distress, the significance patient physical appearance plays on nurse determination of futility, and strategies for pain management and honesty. RELEVANCE TO NURSING PRACTICE: Understanding and addressing gaps in research is essential to develop strategies to help nurses resolve ethical dilemmas and to avoid moral distress and burnout.

Evaluating the Needs of Patients Living With Solid Tumor Cancer: A Survey Design.

PURPOSE: To describe the unmet needs of adult patients living with solid tumor cancer. DESIGN: Survey design. METHOD: Adult patients living with solid tumor cancer from two outpatient clinics were mailed the Sheffield Profile for Assessment and Referral to Care, a holistic screening questionnaire for assessing palliative care needs, and a demographics questionnaire. One hundred fifteen patients returned the instruments, corresponding to a 62% response rate. FINDINGS: There were no significant differences by cancer type (breast, non-breast) or gender. However, Caucasians reported significantly more psychological issues, such as anxiety, than non-Caucasians ([ n = 101 (87.8%)] and [ n = 14 (12.2%)], respectively, p = .032). Older patients reported more concerns about loss of independence/activity ( p = .012) compared with younger age groups. Patients living with Stage III/IV cancer reported more distressed about independence/activity ( p = .034), family/social issues ( p = .007), and treatment side effects ( p = .027) than patients living with Stage I/II cancer. CONCLUSION: Patients living with solid tumor cancer have a myriad of unmet needs regardless of age, gender, cancer type, or cancer stage. There appears to be important differences by cancer stage. The Sheffield Profile for Assessment and Referral to Care questionnaire provides a holistic approach for nurses to identify unmet needs and concerns. Future research should explore the preferred methods of receiving support and information.

Sleep Quality in Family Caregivers of Individuals With Dementia: A Concept Analysis.

Poor sleep quality in family caregivers may impact their health status and cause quality of life to decline. Nurses are conducting an increasing number of studies that use sleep quality or related concepts as a main indicator to assess caregiver's sleep. Therefore, a clear understanding of sleep quality and how it is different from other relevant sleep domains is essential. This article aimed to analyze the concept of sleep quality using the steps outlined by Walker and Avant. Findings include (a) attributes of sleep quality including subjective perception of sleep, sleep hours, and evaluation of activity after awaking; (b) antecedents of sleep quality including the ability to get naturally into the sleep cycle and status of conscious state; and (c) consequences of sleep quality including bio-psycho-social and global dimensions of health. This article intends to help clinicians and researchers better understand and define sleep quality in dementia caregivers.

The Effect of a Comprehensive Provider and Patient Intervention to Improve Blood Pressure Control.

Purpose: To examine the comprehensive provider and patient intervention (CPPI) compared to usual care (UC) on blood pressure control among newly diagnosed hypertensive patients treated in a nurse practitioner practice. Data Sources: CPPI included provider and patient education, electronic health record messages about the guidelines of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, Treatment of High Blood Pressure (JNC-7), and patient counseling. Blood pressure control (intervention group; CPPI) was assessed and compared to levels of newly diagnosed patients prior to the intervention (usual care group; UC). One-way analysis of variance (ANOVA) tested for between-group differences and independent samples t test tested for within-group differences in blood pressure readings measured at initial visit and 12-week follow-up visit. Conclusions: There were no significant differences between the groups for mean blood pressure on Weeks 1 and 12. Patients in CPPI showed slightly greater improvement in blood pressure classification compared to UC. Follow-up phone calls allowed for identification of barriers for adherence with follow-up appointments. Implications for Practice: JNC-7 provides an evidence-based approach to diagnosis and management of hypertension. Understanding patient barriers to adherence with treatment may lead to more effective programs that address individual patient needs.

A model of risk reduction for older adults vulnerable to nursing home placement.

Because of the cost of nursing home care and desire of older adults to stay in their homes, it is important for health care providers to understand the factors that place older adults at risk for nursing home placement. This integrative review of 12 years of research, as published in 148 articles, explores the risk factors for nursing home placement of older adults. Using the framework of the vulnerable populations conceptual model developed by Flaskerud and Winslow (1998), we explored factors related to resource availability, relative risks, and health status. Important factors include socioeconomic status, having a caregiver, the availability and use of home- and community-based support services, race, acute illness particularly if hospitalization is required, medications, dementia, multiple chronic conditions, functional disability, and falls. Few intervention studies were identified. Development of evidence-based interventions and creation of policies to address modifiable risk factors are important next steps.

Does dance-based therapy increase gait speed in older adults with chronic lower extremity pain: a feasibility study.

A decreased gait speed in older adults can lead to dependency when the individuals are no longer able to participate in activities or do things for themselves. Thirty-seven senior apartment residents (31 females; Mean age=80.6 years; SD=8.9) with lower extremity pain/stiffness participated in a feasibility and preliminary efficacy study of 12 weeks (24 sessions). Healthy-Steps dance therapy compared to a wait-list control group. Small improvements in gait speed ([ES]=0.33) were noted for participants completing 19-24 dance sessions. Improvements in gait speed measured by a 10 Meter Walk Test (0.0517 m/s) exceeded 0.05 m/s, a value deemed to be meaningful in community dwelling older adults. These feasibility study findings support the need for additional research using dance-based therapy for older adults with lower extremity pain.

Aging muscles and joints: mobilization.

Critical illness can impose immobility in older patients, resulting in loss of strength and functional ability. Many factors contribute to immobility, including patients' medical conditions, medical devices and equipment, nutrition, use of restraint, and staff priorities. Early mobilization reduces the impact of immobility and improves outcomes for older patients. Several important components make up successful mobility programs, including good patient assessment, a core set of interventions, and use of the interprofessional health care team. Nurses can lead in improving the mobilization of older critical care patients, thus reducing clinical risk in this vulnerable population.

A retrospective review of leg wound complications after coronary artery bypass surgery.

Little research or attention has been paid to finding out whether wound closure with sutures or staples attains the best outcomes after saphenous vein harvest for coronary artery bypass grafting. We undertook a quality improvement project to compare the prevalence of leg wound complications (eg, infection, seroma, hematoma, dehiscence) between two types of skin closure (ie, staples, subcuticular sutures) after conventional open surgery with bridging between incisions and vein harvesting during coronary revascularization to determine the need for practice changes. We found no significant differences between patients with wound complications and those without. However, in this project, the risk for infections was greater for patients with diabetes whose wounds were closed by using subcuticular sutures. These findings have led to practice changes for reducing leg wound complications within our institution: clinicians now assess patients for increased risk of leg wound complications preoperatively and opt to close wounds with staples for patients who have diabetes.