Interpreting measures of risk: Translating evidence into practice.

Advanced practice registered nurses must have a working knowledge of statistical principles in order to provide high-quality, evidence-based care. This article presents basic concepts of risk indexes and case study examples illustrating how these measures can inform practice.

Participants' views of telephone interviews within a grounded theory study.

AIM: To offer a unique contribution to the evolving debate around the use of the telephone during semistructured interview by drawing on interviewees' reflections on telephone interview during a grounded theory study. BACKGROUND: The accepted norm for qualitative interviews is to conduct them face-to-face. It is typical to consider collecting qualitative data via telephone only when face-to-face interview is not possible. During a grounded theory study, exploring users' experiences with overnight mask ventilation for sleep apnoea, the authors selected the telephone to conduct interviews. This article reports participants' views on semistructured interview by telephone. DESIGN: An inductive thematic analysis was conducted on data pertaining to the use of the telephone interview in a grounded theory study. METHODS: The data were collected during 4 months of 2011 and 6 months in 2014. The article presents an inductive thematic analysis of sixteen participants' opinions about telephone interviewing and discusses these in relation to existing literature reporting the use of telephone interviews in grounded theory studies. FINDINGS: Overall, participants reported a positive experience of telephone interviewing. From each participants reports we identified four themes from the data: being 'phone savvy; concentrating on voice instead of your face; easy rapport; and not being judged or feeling inhibited. CONCLUSION: By drawing on these data, we argue that the telephone as a data collection tool in grounded theory research and other qualitative methodologies need not be relegated to second best status. Rather, researchers can consider telephone interview a valuable first choice option.

Sexuality and chronic illness.

Sexual function is often affected in individuals living with chronic illness and their partners, and multiple comorbidities increase the likelihood of sexual dysfunction. This review focuses on the areas of cardiovascular disease, respiratory conditions, and cancer, all areas for which there are practical, evidence-based strategies to guide sexual counseling. Although nurses have been reluctant to address the topic of sexuality in practice, a growing number of studies suggest that patients want nurses to address their concerns and provide resources to them. Thus, nurses must be proactive in initiating conversations on sexual issues to fill this gap in practice.

Relationship of chronic pain and opioid use with respiratory disturbance during sleep.

This research assessed: 1) whether patients thought to have sleep disordered breathing would have more severe symptoms if they were taking opioids; 2) whether severity of sleep disordered breathing was associated with class or dose of opioid; and 3) whether pain intensity was associated with sleep disordered breathing. A descriptive cross-sectional study of patients referred for assessment of sleep disorders was conducted. Data were collected on a total of 419 subjects (no pain [n = 171], chronic pain without opioid treatment [n = 187], and chronic pain with opioid treatment [n = 61]). The findings suggest that regardless of opioid drug or dose, the management of chronic pain with opioids is not likely to exacerbate obstructive sleep apnea at stable doses. However, central sleep apnea was associated with opioid use. Patients with chronic pain taking opioids had a mean of 5 ± 13 central apneic events per hour compared with 1.6 ± 7 events per hour in patients without pain and not taking opioids. Oxygen saturation mean nadir 83.5% (opioid group) versus 82.9% (no pain, pain without opioid) was not significantly different. The clinical relevance of the effect is unknown, so the potential for marginal respiratory disturbance (an increase of 2.8 central events per hour for every 100 mg morphine-equivalent opioid dose) must be weighed against the therapeutic value of pain management with opioids.

Overcoming barriers to implementing evidence-based practice: a collaboration between academics and practice.

This article describes two collaborative paired student-preceptor efforts. One project resulted in the implementation of a hospital-wide oral care protocol, and the second enhanced the admission assessment process for adult patients at risk for respiratory compromise after sedation and/or receipt of narcotic analgesia. Recommendations for staff development are addressed.

An integrated approach to managing sleep disordered breathing and cardiovascular disease.

Despite its prevalence, most cases of sleep disordered breathing (SDB) go unrecognized by the medical community, creating a mismatch between disease pervasiveness and medical appreciation of its impact. Of particular importance is that 30% of those with cardiovascular disease (CVD) have some type of sleep disorder. One explanation for this lack of recognition and under-appreciation is that common symptoms seen with SDB are non-specific and are present in many acute and chronic conditions. This article will present a brief review of current processes used to diagnose and treat SDB, followed by a discussion of the overlap that exists between CVD and SDB, and present an argument that these chronic conditions should not be considered and managed as separate entities.

Observation-based nocturnal sleep inventory: screening tool for sleep apnea in elderly people.

OBJECTIVES: To measure the ability of the Observation-based Nocturnal Sleep Inventory (ONSI) to detect the presence or absence of sleep apnea syndrome (SAS) in older adults. DESIGN: Cross-sectional blinded study. SETTING: University hospital-based geriatric sleep center. PARTICIPANTS: All participants aged 70 and older were referred by physicians for suspicion of SAS. MEASUREMENTS: ONSI performed by nurses; overnight polysomnography. SAS was defined as an apnea-hypopnea index of 15 events or more per hour of sleep. RESULTS: A total of 121 consecutive patients were evaluated for study participation. Six were excluded because of technical difficulties with polysomnography or too-frequent awakenings related to medical conditions. One hundred eleven patients completed the validation process. Polysomnography identified 68 patients as having SAS and 43 patients as not having SAS. The nurse-administered ONSI demonstrated good levels of sensitivity (90%), specificity (81%), positive predictive value (88%), and negative predictive value (83%) in screening older adults for SAS. CONCLUSION: The ONSI is the first valid SAS screening tool proposed for older persons in hospitals and nursing homes. This study demonstrates that the ONSI provides accurate information; is a simple, easy-to-use bed-side tool; and is highly sensitive and specific in screening SAS when compared with overnight polysomnography results.

Prevalence of sleep apnea in a population of adults with type 2 diabetes mellitus.

OBJECTIVE: To assess the prevalence of sleep apnea (SA) in adults with type 2 diabetes mellitus (T2DM) and examine whether demographics and comorbid factors were associated with SA in this population. METHODS: This study enrolled 330 consecutive adults with T2DM referred to a diabetes clinic, 279 of whom completed the study. Evaluation of the presence of SA was performed with use of a single-channel recording device that measures disordered breathing events from a nasal cannula airflow signal. The device was worn by the study participants in their home, after instruction in appropriate use by clinical staff at the diabetes center. The presence and severity of SA were determined by use of an apnea-hypopnea index (AHI), reflecting periods of diminished and absent breathing. Demographic and medical information data were collected to detect factors associated with SA in this study population. In addition, a time and cost analysis was conducted regarding the screening process for SA by clinical staff at the diabetes center. RESULTS: The results show a high prevalence of SA in adults with T2DM, ranging from 48% (AHI level of >or=10 events/h) to 29% (AHI level of >or=20 events/h). At an AHI cutoff value of >or=15 events/h, the overall prevalence rate was 36% (49% in male and 21% in female participants). The following variables were associated with SA: age >or=62 years, male sex, body mass index >or=30 kg/m2, snoring, and reports of stopping breathing during sleep. The time and cost analysis showed that the screening device involved minimal setup time, was simple to use, and was a cost-effective method to screen for SA. CONCLUSION: SA is a common disorder associated with major morbid conditions, including hypertension, obesity, cardiovascular disease, and insulin resistance. Predisposing factors for SA and T2DM are similar. This study showed that SA has a high prevalence in adults with T2DM and identified factors that may be associated with its presence in this population. Assessment for SA can be easily performed in an outpatient setting with a portable recording device such as the one used in this study. Screening for SA should be considered in the T2DM population.

Sleep disturbances in patients with chronic heart failure and their holistic consequences-what different care actions can be implemented?

BACKGROUND: Sleep disturbances are prevalent among elderly, especially among those with chronic heart failure (CHF) and can affect all dimensions of quality of life (QOL) negatively. AIM: To describe the most common causes leading to sleep disturbances in patients with CHF, their consequences from a holistic perspective and different care actions that can be implemented. METHODS: MEDLINE and CINAHL databases were searched from 1989 to July 2004. FINDINGS: Sleep disordered breathing (SDB), and insomnia were the most common causes for sleep disturbances and occurs in 45--82% (SDB) and one-third (insomnia) of all patients with CHF. SDB cause a disturbed sleep structure with frequent awakenings, as well as several adverse effects on the cardiovascular system causing increased morbidity and mortality. Insomnia, caused by anxiety, an unknown life situation in relation to the debut of CHF, or symptoms/deteriorations of CHF can lead to negative effects on all aspects of QOL, as well as daytime sleepiness. CONCLUSION: The high prevalence of sleep disturbances and their holistic consequences should be taken into account when nurses asses and plan the care for patients with CHF. Randomized studies with large sample sizes evaluating non-pharmacological nursing interventions that improve sleep are needed.

Use of sleep studies in the neonatal intensive care unit.

Although early hospital discharge of infants can be both cost-effective and better for developmental care and parent-infant bonding, neonatal caregivers need to ensure infant safety. One of the concerns of early discharge is the risk that premature babies may continue to have apnea, bradycardia, and oxygen desaturation after discharge and that these events can be serious enough to increase morbidity and mortality. The discharging provider bears the responsibility of assessing each infant's risk for persistent apnea and providing the care and monitoring appropriate for his presumed risk level. Presently there is no universally accepted testing method that can accurately predict which infants will experience significant apnea. Neonatal sleep studies are one of the objective methods being evaluated to identify infants at risk for persistent apnea. This article addresses arguments for and against the use of sleep studies to determine the risk of apnea in neonates about to be discharged, types of sleep studies and what they test, and how sleep studies can be useful in determining infant care.

Assisting patients using positive airway pressure therapy.

The number of patients with sleep apnea treated by home care nurses is increasing. The most common treatment is with at-home positive airway pressure (PAP). This article presents an overview of PAP, including its purpose, correct application, and hints for assisting patients when they experience problems. Additionally, resources for further information on this therapy for sleep apnea are provided.

Obstructive sleep apnea syndrome in ambulatory surgical patients.

Obstructive sleep apnea in the ambulatory surgery setting has become a more significant concern in recent years because its Identification and recognition are a critical part of preoperative patients' risk assessment. The types of surgeries that can be performed on an outpatient basis have increased and include many specialty procedures that previously were performed on an inpatient basis only. Ambulatory surgery has proven to be a cost-effective alternative for patients and physicians; however, patients in this setting often have complex surgical histories. Perioperative nurses must provide a more integrated approach to patient assessment to recognize, identify, plan, and implement a course of safe care for patients with obstructive sleep apnea. Reviewing patients' histories can help nurses identify symptoms of obstructive sleep apnea, allowing them to alert the surgical team of special requirements. Ambulatory patients with identified obstructive sleep apnea will require a planned course of care. Ambulatory care facilities should have a policy in place to ensure that safe care will be provided to patients for the entire perioperative course.

Uso del CAP: un desafío de enfermería / Use of the Continuos Positive Airway Pressure: a challenge to nursing

El síndrome de apnea onstructiva del sueño (SAOS) afecta al 4 por ciento de hombres y al 2 por ciento de mujeres (Capa, Fernández & Moreno, 1998; Chokroverty, 1999; Strohl & Redline, 1996), el tratamiento de elección es un dispositivo que ejerce una presión continua positiva de aire (CPAP), que evita colapso de la vía aérea superior. Se realizó una investigación de tipo descriptiva, retrospectiva y transversal cuyo objetivo es conocer cuáles son los factores que influyen en el uso del CPAP, percibidos por las personas con diagnóstico de SAOS que acuden al Centro Medico del Sueño de la Pontificia Universidad Católica de Chile (CEMS) entre mayo 1998 a septiembre del 2000. El universo estuvo constituido por 375 personas requirientes de CPAP, conformándose una muestra de 130 personas contactadas por vía telefónica. En términos generales el uso del CPAP es aceptado por la población en estudio, sin embargo,ésta posee necesidades educativas que requieren ser satisfechas para lograr un mayor uso del CPAP, las que deben ser cubiertas por un equipo multidisciplinario donde la enfermera cobra un rol importante

Assessing children for obstructive sleep apnea.

The incidence of obstructive sleep apnea (OSA) in children has only recently been appreciated. Early identification of this disorder is extremely important to minimize neurologic, cardiac, and/or developmental complications that may occur as a result of the syndrome. This article presents an overview of OSA syndrome, pediatric risk factors for sleep apnea, symptoms common in children with OSA, and assessment information to guide the health practitioner in identifying children whose sleep patterns require further evaluation.