The association between advanced practice nursing roles and outcomes in adults following cardiac surgery: A systematic review of randomized controlled trials.

BACKGROUND: Empirical findings have shown significant and non-significant effects of advanced practice nursing roles within postoperative cardiac settings. The inconsistencies of the current literature preclude the identification of a significant effect of advanced practice nursing roles on patient and organizational outcomes. OBJECTIVE: 1) identify patient and organizational outcomes of advanced practice nursing roles in postoperative cardiac surgery and 2) synthesize the evidence of current roles of advanced practice nurses in postoperative cardiac surgery to provide the best quality of care for patients. METHOD: A systematic review of randomized controlled trials was conducted in six electronic databases, including Medline, CINHAL, Embase, Cochrane Database, Joanna Briggs Database and Web of Science, and the grey literature. Randomized controlled trials published after 1999 were included if they examined advanced practice nursing roles and recruited patients who underwent cardiac surgery. The study selection was performed by two independent reviewers, and consensus was achieved with a third reviewer. Data extraction was conducted by one reviewer and revised by a second reviewer. The methodological quality of the included studies was assessed with the Evidence Project risk of bias tool by two independent reviewers and revised by a third reviewer. A narrative synthesis of the available evidence was completed. No meta-analysis technique was attempted because of the high heterogeneity of the included studies. RESULTS: Among 4,448 retrieved papers, ten randomized controlled trials and three secondary analyses were included in this review. The methodological quality of the included studies was moderate. All studies included a comparison group and the majority of the studies collected data using a blinded researcher. However, all studies were based on small sample sizes and failed to randomly recruit participants. Five studies implemented nurse practitioner roles and five studies implemented clinical nurse specialist roles. The advanced practice nursing care included health condition management, lifestyle promotion and coping strategies with patients. A total of 22 outcomes were identified, including 13 patient outcomes (e.g., depressive symptoms) and nine organizational outcomes (e.g., rehospitalization after discharge). Each outcome was examined in one to five studies. All of the included outcomes were associated with inconsistent findings. CONCLUSION: The findings from existing literature remain inconsistent. The high risk of bias and the small sample sizes could potentially explain the non-significant findings. Avenues for future research should focus on the development of methodologically high-quality studies with larger sample sizes to enhance our understanding of the effectiveness of advanced practice nursing roles.

Viii. Attachment and sleep among toddlers: disentangling attachment security and dependency.

Many scholars have proposed that parent-child attachment security should favor child sleep. Research has yet, however, to provide convincing support for this hypothesis. The current study used objective measures of sleep and attachment to assess the longitudinal links between mother-child attachment security and subsequent sleep, controlling for child dependency. Sixty-two middle-class families (30 girls) were met twice, when children were 15 months (Wave 1; W1) and 2 years of age (Wave 2; W2). At W1, mother-child attachment was assessed with the observer version of the Attachment Q-Sort. At W2, children wore an actigraph monitor for 72 hr. Results indicated that children more securely attached to their mothers subsequently slept more at night and had higher sleep efficiency, and these predictions were not confounded by child dependency. These findings suggest a unique role for secure attachment relationships in the development of young children's sleep regulation, while addressing methodological issues that have long precluded consensus in this literature.

Mothers, fathers, and toddlers: parental psychosocial functioning as a context for young children's sleep.

The aim of this study was to investigate the prospective relations between parental psychosocial functioning and toddlers' sleep consolidation. Investigators met with 85 families 3 times, when children were 15 months (Time 1 [T1]), 18 months (T2), and 2 years of age (T3). Mothers and fathers completed questionnaires pertaining to their parenting stress, marital satisfaction, and perceived social support at T1 or T2, and mothers completed child sleep diaries at T2 and T3. Results indicated that fathers' parenting stress and marital satisfaction, as well as mothers' perceived social support, were related in expected directions to children's subsequent sleep consolidation (T3), with or without controlling for prior sleep consolidation (T2). In addition, all these relations were moderated by family socioeconomic status (SES), such that links were stronger in lower SES homes.

Maternal sensitivity and children's behavior problems: examining the moderating role of infant sleep duration.

The current study aimed to examine infant sleep duration as a moderator of the relations between maternal sensitivity and child externalizing and internalizing symptoms, in a prospective longitudinal design. Fifty-five Caucasian infants (33 girls) took part in 2 assessments, at 1 and 4 years. Maternal sensitivity was rated at 1 year, based on observations performed throughout a home visit. Infant sleep duration (i.e., nighttime sleep duration and 24-hr sleep duration) was assessed at 1 year as well, using a sleep diary completed by mothers. At 4 years, mothers completed the Child Behavior Checklist to assess children's internalizing and externalizing symptoms. Results indicated that maternal sensitivity interacted with infant nighttime sleep duration, such that there were negative relations between sensitivity and subsequent internalizing and externalizing symptoms only for children who slept more at night. Interactions using 24-hr sleep duration as the moderator were not significant. These findings add to an emerging literature on the importance of sleep for children's daytime functioning by suggesting that inadequate or insufficient sleep in infancy can interfere with the normal developmental process linking early maternal sensitivity to child subsequent emotional and behavioral adjustment.

Longitudinal associations between the quality of parent-child interactions and children's sleep at preschool age.

This study aimed to examine the prospective longitudinal links between the quality of mother-child and father-child interactions and preschoolers' sleep. Three dimensions of maternal interactive behavior were considered using 70 mother-child dyads, while the quality of father-child interactions was assessed using 41 of these families. Maternal mind-mindedness was assessed at 12 months during a mother-infant free-play sequence, maternal sensitivity was rated at 12 months based on observations performed throughout a home visit, maternal autonomy support was assessed at 15 months with a 10-min problem-solving situation, and the quality of father-child interactions was scored at 18 months, during father-child free play. Children's sleep was assessed at 3 and 4 years using a sleep diary completed by mothers during 3 consecutive days. Results indicated that, after controlling for family socioeconomic status and daycare attendance, the quality of both mother-infant and father-infant interactions was positively related to children's percentage of night-time sleep at preschool age. These findings add to previous literature in suggesting that early caregiving behavior by both mothers and fathers is related to subsequent child sleep.

Relations between physiological and cognitive regulatory systems: infant sleep regulation and subsequent executive functioning.

The aim of this report was to investigate the prospective links between infant sleep regulation and subsequent executive functioning (EF). The authors assessed sleep regulation through a parent sleep diary when children were 12 and 18 months old (N = 60). Child EF was assessed at 18 and 26 months of age. Higher proportions of total sleep occurring at night time, at both 12 and 18 months, were related to better performance on executive tasks, especially those involving a strong impulse control component. Most relations held above family socioeconomic status, prior mental development and concurrent verbal ability. These findings add to previous results with school-age children in suggesting that sleep favors the development of higher order cognitive functions requiring prefrontal cortex involvement.

Validation of a short version of the maternal behavior Q-set applied to a brief video record of mother-infant interaction.

A 25 item version of the maternal behavior Q-set (MBQS) was validated with 40 adolescent mother-infant dyads. Observations were made from 10 min play interactions when infants were 10 months old. Results show that the short MBQS is reliable (r(i)=.94), is related to assessments using the full MBQS at 6 months (r=.35), to cognitive development at 10 and 15 months (r=.48), and attachment security at 15 months (r=.34), indicating appropriate psychometric characteristics.