Indicators of community physical activity resources and opportunities and variation by community sociodemographic characteristics: A scoping review

Objective

This scoping review synthesizes studies examining community-level variability in physical activity resource (assets) and opportunity (organized group physical activity services) availability by community sociodemographic characteristics to describe methodologies for measuring resources/opportunities, indicators characterizing availability, and associations between community-level sociodemographic characteristics and availability.

Methods

A systematic search was conducted in MEDLINE, CINAHL, PsycINFO, and Scopus for literature through 2022. Eligible studies quantitatively examined measures of physical activity resource/opportunity availability by community-level racial, ethnic, and/or socioeconomic characteristics within geospatially defined communities. Extracted data included: community geospatial definitions, sociodemographic characteristics assessed, methodologies for measuring and indicators of community physical activity resource/opportunity availability, and study findings.

Results

Among the 46 included studies, community geospatial units were defined by 28 different community boundaries (e.g., town), and 13% of studies were conducted in rural areas. Nearly all (98%) studies measured community-level socioeconomic status, and 45% of studies measured race/ethnicity. A total of 41 indicators of physical activity resource/opportunity availability were identified. Most studies (91%) assessed built environment resources (e.g., parks), while 8.7% of studies assessed opportunities (e.g., programs). Of 141 associations/differences between community sociodemographic characteristics and resource/opportunity availability, 29.8% indicated greater availability in communities of higher socioeconomic status or lower prevalence of minority populations. The remaining findings were in the opposite direction (9.2%), non-significant (36.9%), or mixed (24.1%).

Conclusions

Variability in physical activity resources/opportunities by community sociodemographic characteristics was not consistently evident. However, the indicators synthesized may be useful for informing population health improvement efforts by illuminating the physical and social conditions impacting population physical activity outcomes.

Sociodemographic influences on youth sport participation and physical activity among children living within concentrated Hispanic/Latino rural communities

Introduction

Lack of physical activity (PA) among children living in rural communities is a documented public health problem. Although studies have examined community conditions defined by a rural-urban dichotomy, few have investigated rural community conditions with a concentration of Hispanic/Latino people. This cross-sectional study examined sociodemographic characteristics associated with youth sport (YS) participation and daily PA among children living within concentrated Hispanic/Latino rural U.S. Midwest communities.

Methods

During spring 2022, 97% of 3rd-6th grade children (n = 281, aged approximately 8-12 years) attending school in rural Midwestern communities (n = 2) with >50% concentration of Hispanic students participated in the Wellscapes Project, a community randomized trial. Participants completed the Youth Activity Profile and supplemental National Survey of Children's Health questions assessing PA behaviors and YS participation. Caregivers of a subsample of children (n = 215; males, n = 93; females, n = 122) consented to pair their child's survey results with school enrollment records (e.g., free/reduced lunch status and race and ethnicity). Mixed models with community as a random effect examined main and interaction effects of grade, sex, ethnoracial status, and family income on YS participation and these sociodemographic characteristics and YS participation on daily moderate-to-vigorous PA (MVPA).

Results

Approximately half of children participated in YS. Non-Hispanic White children (n = 82) were over five times more likely to participate in YS than Hispanic peers (n = 133) (OR = 5.54, 95% CI = 2.64-11.61, p < 0.001). YS participants accumulated 8.3 ± 2.3 more minutes of daily MVPA than non-participants (p < 0.001). Sixth graders, females, and Hispanic children reported lower daily MVPA than comparison groups (p < 0.05). Significant interaction effects on daily MVPA between grade and ethnoracial status (F(3, 204) = 3.04, p = 0.030) were also found.

Discussion

Disparities in sport participation and PA outcomes based on sociodemographic characteristics exist among children living in ethnoracially diverse rural communities. Strategies to promote YS participation, including community structural changes, may help reduce PA disparities. The research provides valuable insights for policymakers, public health professionals, and community members to address YS participation barriers, not limited to cost, while considering other PA-promotion efforts to improve child population health.

Performance of PROMIS Measures to Assess Fatigue and Sleep Symptom Severity Among African American Patients Newly Diagnosed With Obstructive Sleep Apnea

This pilot study examined the concurrent validity of Patient-Reported Outcomes Measurement Information System (PROMIS), Short Form, measures with the longer Multidimensional Fatigue Inventory among patients living with obstructive sleep apnea (OSA). A total of 26 African American patients living with prediabetes and newly diagnosed with OSA completed the six-item short form versions of PROMIS Fatigue and PROMIS Sleep Disturbance, and the longer 20-item Multidimensional Fatigue Inventory. Both PROMIS Fatigue and Sleep Disturbance scales demonstrated high reliability with Cronbach's α of .91 and .92, respectively. PROMIS Fatigue scores were significantly correlated with Multidimensional Fatigue Inventory scores (rs = .53; p = .006) and demonstrated concurrent validity. However, PROMIS Sleep Disturbance scores and Multidimensional Fatigue Inventory scores were not associated with one another. The brief PROMIS Fatigue scale is a useful, succinct approach to assess fatigue severity among diverse patient populations living with OSA. This study is among the first to evaluate the performance of PROMIS Fatigue in a sample living with OSA.

Research priorities to reduce risks from work hours and fatigue in the healthcare and social assistance sector

BACKGROUND

The services of Healthcare and Social Assistance (HCSA) workers are needed by society around the clock. As a result, these workers are exposed to shift work and long work hours. The combination of demanding work schedules and other hazards in the HCSA work environment increases the health and safety risks to these workers, as well as to their patients/clients and the public.

METHODS

This paper has three aims: (1) provide an overview of the burden of shift work, long hours, and related sleep and fatigue problems in this sector; (2) suggest research priorities that would improve these; and (3) discuss potential positive impacts of addressing these research priorities for the health and safety of workers and the public. The authors used a modified Delphi approach to anonymously rank-order priorities for improving HCSA worker health and safety and public safety. Input was also obtained from attendees at the 2019 National Institute for Occupational Safety and Health (NIOSH) Work Hours, Sleep, and Fatigue Forum.

RESULTS

The highest rated research priorities were developing better designs for work schedules, and improving the HCSA culture and leadership approaches to shift work and long work hours. Additional priorities are identified.

CONCLUSION

Research in these priority areas has the potential to benefit HCSA workers as well as their patients/clients, employers, and society.

Preliminary evidence of insulin resistance in young adults with impaired sleep

Objective: Impaired sleep is associated with insulin resistance (IR), a precursor to type 2 diabetes mellitus (T2DM), but is poorly understood in young adults. This cross-sectional study examined sleep characteristics, risk factors for T2DM, and IR in college students. Participants: Thirty-two college students (18-25 years) with either short sleep or poor quality sleep were assessed. Methods: Participants completed self-report measures of sleep and T2DM risk factors. One week of objective sleep was measured with wrist actigraphy. IR was calculated from fasting serum glucose and insulin concentrations. Results: The sample slept on average 6.6 hours/night, and over half had IR. Of those with IR, 44.4% had normal body mass index (BMI), 72% had normal fasting glucose concentrations, and all but one had T2DM risk test score indicating they were not at risk. Conclusions: IR was found in over half of participants; however, many typical T2DM risk factors were not present in those with IR.

CE: Nurses Are More Exhausted Than Ever: What Should We Do About It?

ABSTRACT

For nurses, the challenges posed by demanding work environments and schedules often lead to fatigue, and this can be exacerbated during crises like the COVID-19 pandemic. In this article, the authors discuss causes and challenges of nurse fatigue and consider several evidence-based strategies and solutions for individual nurses and organizations. Barriers to implementation, including a negative workplace culture and inadequate staffing, are also described, and several resources are presented.

Shiftwork, functional bowel symptoms, and the microbiome

BACKGROUND

There are about 15 million Americans working full-time on evening, night, or rotating shifts. Between 48% and 81.9% of those working rotating or night shifts report abdominal pain, constipation, diarrhea and other symptoms of functional bowel disorders. The basis for this high prevalence of functional bowel disorders, including irritable bowel syndrome (IBS), among shift workers is unknown. Animal studies, however, suggest that circadian disruption, similar to that in shift workers, may contribute to the development of GI complaints among shift workers by altering the composition and normal diurnal rhythmicity of the resident intestinal microbes. Therefore, the present study was designed to determine if there were differences in (1) composition and diversity of the microbiome of night shift workers compared to day shift workers; and (2) the composition and diversity of the microbiome among shift workers experiencing functional bowel symptoms compared to shift workers who did not experience functional bowel symptoms.

METHODS

Fifty-one full time staff nurses who worked either 12-hour day or night shifts completed demographic information, and the Rome III IBS module. They also collected two samples of gut microbiota before the beginning and at the end of their last work shift on day 14, using validated field-tested methods consistent with the Human Microbiome Project. After DNA extraction, 16S rRNA sequencing and assignment to the genus level was completed, samples were then compared to determine if there were (1) differences in the diversity and profile of the microbiome by shift type; (2) if there were differences in the microbiome by time of day for collection; and (3) whether there were differences in the diversity and profile of the microbiome of nurses with IBS and those without IBS.

RESULTS

There were no differences in alpha or beta diversity of gut microbiota when specimens from day and night shift nurses were compared. There were however marginal differences in beta diversity when specimens collected at the beginning and end of the shifts were compared, with seven OTUs being differentially abundant when collected from day shift workers in the evening. There were also three OTUs to be differentially abundant in participants reporting IBS symptoms.

Consecutive nursing shifts and the risk of hypoglycemia in critically ill patients who are receiving intravenous insulin: a multicenter study

STUDY OBJECTIVES

Intensive care unit nurses commonly work multiple consecutive 12-hour shifts that leave little time for sleep between work shifts. Working multiple consecutive shifts could compromise vigilance and patient care, especially with respect to managing high-risk medications such as insulin infusions. We hypothesized that as the number of consecutive shifts worked by nurses increases, the rate of hypoglycemia in patients who are receiving an insulin infusion would also increase.

METHODS

We identified patients who had hypoglycemia (glucose ≤ 3.5 mmol/L, 63 mg/dL) between December 2008 and December 2009 in 3 intensive care units in Vancouver, British Columbia, Canada. For each hypoglycemic event, we counted the number of shifts worked on consecutive days during the previous 72 hours by the bedside nurse who was caring for the patient at the time of hypoglycemia (case shift). For each case shift, we identified up to 3 control shifts (24, 48, and 72 hours before the hypoglycemic event in the same patient when there were no hypoglycemic events) and counted the number of consecutive shifts worked by those nurses in the previous 72 hours. This analysis allowed us to control for patient-associated confounders. Conditional logistic regression was used to determine the association between number of consecutive shifts worked and occurrence of hypoglycemic events.

RESULTS

A total of 282 hypoglycemic events were identified in 259 patients. For 191 events, we were able to identify 1 or more control shifts. Compared with nurses who had not worked a shift in the preceding day, the odds ratio of a hypoglycemic event was 1.68 (95% confidence interval: 1.12-2.52), 2.16 (95% confidence interval:1.25-3.73), and 2.54 (95% confidence interval: 1.28-5.06) for nurses who were working their second, third, or fourth consecutive shift, respectively.

CONCLUSIONS

Working multiple consecutive nursing shifts is associated with increased risk of hypoglycemic events in patients in an intensive care unit.

0591 The Significance of Body Mass Index in Varying Sleep Apnea Levels for Men and Women

Introduction

A BMI increase, in men and women, is associated with an increased severity and progression of OSA. This study will examine the impact of BMI on varying levels of OSA severity and progression.

Methods

Participants, divided by sex, included 2728 (47%) men and 3076 (53%) women over the age of 40 that were in the Sleep Heart Health Study (SHHS). Participants were separated into 1 of 10 groups based on initial OSA levels at SHHS time point 1 (SHHS1) and ending OSA levels at SHHS time point 2 (SHHS2) as measured by RDI. A Kruskall-Wallis test examined the BMI median differences in the groups. Post-hoc tests, including pairwise comparisons and Wilcoxon rank sum test with Holm adjustment, were conducted to further examine results.

Results

Significant differences existed between certain groups (Men: Chi-Square=146.87, p&lt;.001, df=9; Women: Chi-Square=128.59, p&lt;.001, df=9). For men and women, those in the group with normal OSA levels at SHHS1 and SHHS2 had significant BMI differences compared to those in all 9 other groups where mild, moderate, or severe OSA levels exist at SHHS1 or SHHS2. Additionally, in men, BMI is significantly different for those with normal or mild OSA levels at SHHS2 compared to those with moderate or severe OSA levels at SHHS2. Also, a significant BMI difference exists in men maintaining mild OSA levels throughout SHHS compared to those maintaining severe OSA levels.

Conclusion

Although BMI is a known influential factor in OSA progression, this study demonstrated that those maintaining normal OSA levels over time have a significant BMI difference compared to those reaching even mild OSA levels over time. Additional implications were also found for men. These findings may coincide with recent research suggesting that one needs to progress only to moderate OSA levels to reach a tipping point of significantly increasing and impacting many health risks.

Support

Robert Wood Johnson Foundation Future of Nursing Scholars Program

Sleep, Lifestyle Behaviors, and Cardiometabolic Health Markers in Overweight/Obese Young Adults: A Pilot Study Using the SenseWear® Armband

AIM

This pilot study examined associations between sleep quality and metabolic risk profiles, underlying hormones, inflammatory markers, and behaviors in overweight and obese young adults, aged 18-29 years.

DESIGN

Cross-sectional, descriptive, correlational study design.

METHOD

A partial sample ( n = 29) was re-recruited from a parent study on screening for risk of early-onset diabetes. BodyMedia's SenseWear® armband was used to assess sleep quality. Based on the percentage of consolidated sleep days during the past week, participants were classified as poor, fair, or good sleepers. Multiple multivariate general linear models were used to examine group differences in study variables after adjusting for obesity impact.

RESULTS

There were no significant differences among groups in age (mean 23.5 ± 2.9 years) or body mass index (mean 38.0 ± 8.9 kg/m²). Good sleepers ( n = 12, 41.4%) showed the longest nocturnal sleep duration (7:53 ± 1:00 hr), followed by fair ( n = 12, 41.4%, 7:23 ± 1:34 hr) and poor sleepers ( n = 5, 17.2%, 5:34 ± 0:56 hr). Poor sleepers showed the highest plasma resistin (η² = .103) and ghrelin (η² = .205) levels and caloric (η² = .255) and sodium (η² = .156) intakes. No differences in clinical metabolic markers or serum leptin or adiponectin were observed.

CONCLUSIONS

Overweight/obese young adults had irregular sleep schedules and patterns, indicators of poor sleep quality, that were possibly associated with changes in dietary behaviors and underlying plasma hormones. In addition to traditional clinical cardiometabolic markers, plasma resistin and ghrelin may be good predictors of heightened vulnerability to cardiometabolic diseases in overweight/obese young adults with poor-quality sleep.

Sleep disorders, depression and anxiety are associated with adverse safety outcomes in healthcare workers: A prospective cohort study

The objective of the study was to determine if sleep disorder, depression or anxiety screening status was associated with safety outcomes in a diverse population of hospital workers. A sample of shift workers at four hospitals participated in a prospective cohort study. Participants were screened for five sleep disorders, depression and anxiety at baseline, then completed prospective monthly surveys for the next 6 months to capture motor vehicle crashes, near-miss crashes, occupational exposures and medical errors. We tested the associations between sleep disorders, depression and anxiety and adverse safety outcomes using incidence rate ratios adjusted for potentially confounding factors in a multivariable negative binomial regression model. Of the 416 hospital workers who participated, two in five (40.9%) screened positive for a sleep disorder and 21.6% screened positive for depression or anxiety. After multivariable adjustment, screening positive for a sleep disorder was associated with 83% increased incidence of adverse safety outcomes. Screening positive for depression or anxiety increased the risk by 63%. Sleep disorders and mood disorders were independently associated with adverse outcomes and contributed additively to risk. Our findings suggest that screening for sleep disorders and mental health screening can help identify individuals who are vulnerable to adverse safety outcomes. Future research should evaluate sleep and mental health screening, evaluation and treatment programmes that may improve safety.

Racial/ethnic sleep disparities in US school-aged children and adolescents: a review of the literature

Sleep is essential for optimal health, well-being, and cognitive functioning, and yet nationwide, youth are not obtaining consistent, adequate, or high-quality sleep. In fact, more than two-thirds of US adolescents are sleeping less than 8 hours nightly on school nights. Racial and ethnic minority children and adolescents are at an increased risk of having shorter sleep duration and poorer sleep quality than their white peers. In this review, we critically examined and compared results from 23 studies that have investigated racial/ethnic sleep disparities in American school-aged children and adolescents ages 6-19 years. We found that White youth generally had more sufficient sleep than minority youth, Hispanics had more than Blacks, and there was inconclusive evidence for Asians and other minorities. Recommendations for researchers include the following: (1) explore underlying causes of the disparities of these subpopulations, with a particular interest in identifying modifiable causes; (2) examine factors that may be impacted by racial/ethnic sleep disparities; (3) use a multidimensional approach to measuring sleep disparities; and (4) examine how beliefs about sleep are patterned by race/ethnicity. Understanding sleep disparities can inform interventions, policies, and educational programs to minimize sleep disparities and their impact on health, psychological, and educational outcomes.

Advanced practice registered nurses and physician assistants in sleep centers and clinics: a survey of current roles and educational background

STUDY OBJECTIVES

To survey Advanced Practice Registered Nurse (APRN) and Physician Assistant (PA) utilization, roles and educational background within the field of sleep medicine.

METHODS

Electronic surveys distributed to American Academy of Sleep Medicine (AASM) member centers and APRNs and PAs working within sleep centers and clinics.

RESULTS

Approximately 40% of responding AASM sleep centers reported utilizing APRNs or PAs in predominantly clinical roles. Of the APRNs and PAs surveyed, 95% reported responsibilities in sleep disordered breathing and more than 50% in insomnia and movement disorders. Most APRNs and PAs were prepared at the graduate level (89%), with sleep-specific education primarily through "on the job" training (86%). All APRNs surveyed were Nurse Practitioners (NPs), with approximately double the number of NPs compared to PAs.

CONCLUSIONS

APRNs and PAs were reported in sleep centers at proportions similar to national estimates of NPs and PAs in physicians' offices. They report predominantly clinical roles, involving common sleep disorders. Given current predictions that the outpatient healthcare structure will change and the number of APRNs and PAs will increase, understanding the role and utilization of these professionals is necessary to plan for the future care of patients with sleep disorders. Surveyed APRNs and PAs reported a significant deficiency in formal and standardized sleep-specific education. Efforts to provide formal and standardized educational opportunities for APRNs and PAs that focus on their clinical roles within sleep centers could help fill a current educational gap.

Sleep, mood, and quality of life in patients receiving treatment for lung cancer

PURPOSE/OBJECTIVES

To distinguish relationships among subjective and objective characteristics of sleep, mood, and quality of life (QOL) in patients receiving treatment for lung cancer.

DESIGN

Descriptive, correlational study.

SETTING

Two ambulatory oncology clinics.

SAMPLE

35 patients with lung cancer.

METHODS

The following instruments were used to measure the variables of interest: Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale, Functional Assessment of Cancer Treatment-Lung (FACT-L), a sleep diary, and a motionlogger actigraph.

MAIN RESEARCH VARIABLES

Sleep, mood, and QOL.

FINDINGS

Significant differences were found between sleep diary and actigraph measures of sleep efficiency (p = 0.002), sleep latency (p = 0.014), sleep duration (p < 0.001), and wake after sleep onset (p < 0.001). Poor sleepers (PSQI score greater than 5) were significantly different from good sleepers (PSQI score of 5 or lower) on sleep diary measures of sleep efficiency and sleep latency and the FACT-L lung cancer symptom subscale, but not on mood or actigraphy sleep measures.

CONCLUSIONS

Although patients with lung cancer may report an overall acceptable sleep quality when assessed by a single question, those same patients may still have markedly increased sleep latencies or reduced total sleep time. The findings indicate the complexity of sleep disturbances in patients with lung cancer. Lung cancer symptoms had a stronger association with sleep than mood. Research using prospective methods will help to elucidate their clinical significance.

IMPLICATIONS FOR NURSING

Patients receiving treatment for lung cancer are at an increased risk for sleep disturbances and would benefit from routine sleep assessment and management. In addition, assessment and management of common symptoms may improve sleep and, ultimately, QOL.

KNOWLEDGE TRANSLATION

A high frequency of sleep disturbances in patients receiving treatment for lung cancer was evident, and poor sleepers had lower QOL. Sleep disturbances may be more related to lung cancer symptoms than anxiety or depression. Improving lung cancer symptoms such as dyspnea may improve sleep.

Impact of work schedules on sleep duration of critical care nurses

BACKGROUND

Sleep deprivation leads to reduced vigilance and potentially impairs work performance. Nurses may work long shifts that may contribute to sleep deprivation.

OBJECTIVE

To assess how nurses' sleep patterns are affected by work schedules and other factors.

METHODS

Between October 2009 and June 2010, a total of 20 critical care nurses completed daily sleep and activity logs and a demographic survey and wore an actigraph to objectively measure sleep time for 14 days.

RESULTS

In a multivariate model with controls for repeated measures, mean sleep time between consecutive work shifts was short: 6.79 hours between 2 day shifts and 5.68 hours between 2 night shifts (P = .01). Sleep time was much greater between days when no shifts were worked (8.53 hours), consistent with catch-up sleep during these times. Every minute of 1-way commuting time was associated with a reduction of sleep time by 0.84 minutes.

CONCLUSION

Critical care nurses obtain reduced amounts of sleep between consecutive work shifts, particularly between consecutive night shifts. Whether this degree of sleep deprivation adversely affects patients' safety needs further study.

Blood transfusion, embolisation and nephrectomy after percutaneous nephrolithotomy (PCNL)

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Percutaneous treatment for renal stone disease is associated with a risk of significant morbidity. Our large UK series provides contemporary data on the risk of vascular complications and admission to the Intensive Care Unit (ICU) after PCNL. When compared with recent international databases, these data support the current evidence that better outcomes can be achieved in centres performing large numbers of procedures. These data add to the debate for the centralisation of specialist stone surgery.

OBJECTIVE

To audit the outcome of percutaneous nephrolithotomy (PCNL) at a UK stone centre over a 10-year period, and provide patients with understandable contemporary data on blood loss and vascular risk.

PATIENTS AND METHODS

A single centre retrospective analysis of all PCNLs undertaken between April 2000 and December 2010. The association between transfusion and patient age, operative duration and positive preoperative mid-stream urine (MSU) sample was subject to statistical analysis.

RESULTS

Data on 568 patients was analysed. 21 were paediatric cases with a mean (range) age of 8 (2-16) years; 547 were adult cases with a mean (range) age of 55 (17-84) years. 3.8% of adult patients (21/547) received a blood transfusion; mean age 60 years (55 years in those not transfused) with a mean operative duration of 119 min (103 min in those not transfused). 23.8% of patients transfused had a confirmed preoperative urinary tract infection compared with 16.1% of those not transfused. Seven patients underwent angiography, with five having selective arterial embolisation (0.9%). There were no deaths in this series although one patient (0.2%) required an urgent nephrectomy due to cardiovascular instability from bleeding.

CONCLUSIONS

Large UK series that provides contemporary data for consent on vascular risk at PCNL. The risk of transfusion is associated with increased patient age, operative duration and the presence of a positive preoperative MSU sample. Data compares favourably with other large published series, and supports the argument for centralisation of percutaneous stone management.

Sleep, stress and compensatory behaviors in Australian nurses and midwives

OBJECTIVE: To describe sleep, stress and compensatory behaviors in nurses and midwives. METHODS: The study included 41 midwives and 21 nurses working in Australian hospitals between 2005 and 2009. Participation was voluntary. All participants recorded on a daily basis their work and sleep hours, levels of stress and exhaustion, caffeine intake and use of sleep aids for a month (1,736 days, 1,002 work shifts). RESULTS: Participants reported moderate to high levels of stress and exhaustion on 20-40% of work days; experienced sleep disruption on more than 50% of work days; struggled to remain awake on 27% of work days; and suffered extreme drowsiness or experienced a near accident while travelling home on 9% of workdays. Age, perceived sleep duration and work hours were significant predictors of caffeine intake. About 60% of participants reported using sleep aids (about 20% reported taking prescription medications and 44% of nurses and 9% of midwives reported alcohol use as a sleep aid at least once during the study). Stress and workdays were significant predictors of sedative use. Overall, 22% reported being indifferent or mildly dissatisfied with their job. CONCLUSIONS: Sleep problems, high levels of stress and exhaustion and low job satisfaction are prevalent among nurses and midwives. The use of alcohol and sleeping pills as sleep aids, and the use of caffeine to help maintain alertness is also common. Nurses and midwives may use caffeine to compensate for reduced sleep, especially on workdays, and sleeping pills to cope with their daily work-related stress.

Part 1. International Classification of Functioning, Disability and Health (ICF) Core Sets for persons with sleep disorders: results of the consensus process integrating evidence from preparatory studies

BACKGROUND/OBJECTIVES

The International Classification of Functioning, Disability and Health (ICF) provides a comprehensive and universally accepted framework to classify changes in functioning related to health conditions. Comprehensive and Brief Core Sets have been defined for various disorders but not for sleep disorders. Such a Core Set would greatly enhance the techniques available to describe the impact of sleep disorders on patients. The overarching purpose of this paper is to report on phase 1 of the international and World Health Organization (WHO) endorsed consensus process in identifying ICF Core Sets for sleep disorders.

METHODS

A formal decision-making and consensus process which integrated evidence gathered from preparatory studies was carried out. Relevant ICF categories were selected by a sample of international experts from different backgrounds using the nominal group technique.

RESULTS

Twenty-six experts from 22 countries and different professional backgrounds attended the consensus conference. Altogether 120 second- or third-level ICF categories were included in the Comprehensive ICF Core Set with the following ICF component split: 49 categories from body functions, 8 from body structures, 31 from activities and participation and 32 from environmental factors. The Brief ICF Core Set included a total of 15 second-level categories: 5 body functions (sleep, energy and drive, attention, consciousness, respiration functions); 3 body structures (brain, respiratory system, pharynx); 4 activities and participation (focusing attention, driving, handling stress and other psychological demands, carrying out daily routine); and 3 environmental factors (immediate family; health services, systems, and policies; and health professionals).

CONCLUSION

A formal consensus process integrating evidence and expert opinion led to the first version of the ICF Core Sets for persons with sleep disorders. Further validation of the Core Set is needed.

A safety assessment of branched chain saturated alcohols when used as fragrance ingredients

The Branched Chain Saturated Alcohol (BCSA) group of fragrance ingredients was evaluated for safety. In humans, no evidence of skin irritation was found at concentrations of 2-10%. Undiluted, 11 materials evaluated caused moderate to severe eye irritation. As current end product use levels are between 0.001% and 1.7%, eye irritation is not a concern. The materials have no or low sensitizing potential. For individuals who are already sensitized, an elicitation reaction is possible. Due to lack of UVA/UVB light-absorbing structures, and review of phototoxic/photoallergy data, the BCSA are not expected to elicit phototoxicity or photoallergy. The 15 materials tested have a low order of acute toxicity. Following repeated application, seven BCSA tested were of low systemic toxicity. Studies performed on eight BCSA and three metabolites show no in vivo or in vitro genotoxicity. A valid carcinogenicity study showed that 2-ethyl-1-hexanol is a weak inducer of liver tumors in female mice, however, the relevance of this effect and mode of action to humans is still a matter of debate. The Panel is of the opinion that there are no safety concerns regarding BCSA under the present levels of use and exposure.

A Pilot Study of the Safety Implications of Australian Nurses' Sleep and Work Hours

The frequency and severity of adverse events in Australian healthcare is under increasing scrutiny. A recent state government report identified 31 events involving "death or serious [patient] harm" and 452 "very high risk" incidents. Australia-wide, a previous study identified 2,324 adverse medical events (AME) in a single year, with more than half considered preventable. Despite the recognized link between fatigue and error in other industries, to date, few studies of medical errors have assessed the fatigue of the healthcare professionals involved. Nurses work extended and unpredictable hours with a lack of regular breaks and are therefore likely to experience elevated fatigue. Currently, there is very little available information on Australian nurses' sleep or fatigue levels, nor is there any information about whether this affects their performance. This study therefore aims to examine work hours, sleep, fatigue and error occurrence in Australian nurses. Using logbooks, 23 full-time nurses in a metropolitan hospital completed daily recordings for one month (644 days, 377 shifts) of their scheduled and actual work hours, sleep length and quality, sleepiness, and fatigue levels. Frequency and type of nursing errors, near errors, and observed errors (made by others) were recorded. Nurses reported struggling to remain awake during 36% of shifts. Moderate to high levels of stress, physical exhaustion, and mental exhaustion were reported on 23%, 40%, and 36% of shifts, respectively. Extreme drowsiness while driving or cycling home was reported on 45 occasions (11.5%), with three reports of near accidents. Overall, 20 errors, 13 near errors, and 22 observed errors were reported. The perceived potential consequences for the majority of errors were minor; however, 11 errors were associated with moderate and four with potentially severe consequences. Nurses reported that they had trouble falling asleep on 26.8% of days, had frequent arousals on 34.0% of days, and that work-related concerns were either partially or fully responsible for their sleep disruption on 12.5% of occasions. Fourteen out of the 23 nurses reported using a sleep aid. The most commonly reported sleep aids were prescription medications (62.7%), followed by alcohol (26.9%). Total sleep duration was significantly shorter on workdays than days off (p < 0.01). In comparison to other workdays, sleep was significantly shorter on days when an error (p < 0.05) or a near error (p < 0.01) was recorded. In contrast, sleep was higher on workdays when someone else's error was recorded (p = 0.08). Logistic regression analysis indicated that sleep duration was a significant predictor of error occurrence (chi2 = 6.739, p = 0.009, e beta = 0.727). The findings of this pilot study suggest that Australian nurses experience sleepiness and related physical symptoms at work and during their trip home. Further, a measurable number of errors occur of various types and severity. Less sleep may lead to the increased likelihood of making an error, and importantly, the decreased likelihood of catching someone else's error. These pilot results suggest that further investigation into the effects of sleep loss in nursing may be necessary for patient safety from an individual nurse perspective and from a healthcare team perspective.

Role of registered nurses in error prevention, discovery and correction

BACKGROUND

Registered nurses have a vital role in discovering and correcting medical error.

OBJECTIVE

To describe the type and frequency of errors detected by American critical care nurses, and to ascertain who made the errors discovered by study participants.

METHODS

Daily logbooks were used to collect information about errors discovered by a random sample of 502 critical care nurses during a 28-day period.

RESULTS

Although the majority of errors discovered and corrected by critical care nurses involved medications (163/367), procedural errors were common (n = 115). Charting and transcription errors were less frequently discovered. The errors discovered by participants were attributed to a wide variety of staff members including nurses, doctors, pharmacists, technicians and unit secretaries.

CONCLUSIONS

Given the importance of nurses in maintaining patient safety, future studies should identify factors that enhance their effectiveness to prevent, intercept and correct healthcare errors.

A toxicologic and dermatologic assessment of cyclic acetates when used as fragrance ingredients

An evaluation and review of a structurally related group of fragrance materials.

The relationship between nurse work schedules, sleep duration, and drowsy driving

STUDY OBJECTIVES

Recent studies have shown that extended shifts worked by hospital staff nurses are associated with significantly higher risk of errors, yet little information is available about the ability to remain alert during the nurses' commutes following the completion of an extended work shift. The purpose of this study is to describe the prevalence of drowsy driving episodes and the relationship between drowsy driving and nurse work hours, alertness on duty, working at night, and sleep duration.

PARTICIPANTS

Data were collected from 2 national random samples of registered nurses (n=895).

MEASUREMENTS AND RESULTS

Full-time hospital staff nurses (n=895) completed logbooks on a daily basis for 4 weeks providing information concerning work hours, sleep duration, drowsy and sleep episodes at work, and drowsy driving occurrences. Almost 600 of the nurses (596/895) reported at least 1 episode of drowsy driving, and 30 nurses reported experiencing drowsy driving following every shift worked. Shorter sleep durations, working at night, and difficulties remaining awake at work significantly increased the likelihood of drowsy driving episodes.

CONCLUSIONS

Given the large numbers of nurses who reported struggling to stay awake when driving home from work and the frequency with which nurses reported drowsy driving, greater attention should be paid to increasing nurse awareness of the risks and to implementing strategies to prevent drowsy driving episodes to ensure public safety. Without mitigation, fatigued nurses will continue to put the public and themselves at risk.

Sleep and quality of life in long-term lung cancer survivors

BACKGROUND

Sleep problems are common in lung cancer survivors, yet little is known about the prevalence, determinants, and effects on quality of life (QoL) of these sleep problems in long-term lung cancer survivors.

METHODS

A case-control study design comparing 76 elderly lung cancer survivors (LCS, >5 years post diagnosis with mean survival time of 8 years+/-2.1 years) and 78 elderly non-cancer controls (NCC). Measurements included a standardized questionnaire for sleep (Pittsburgh Sleep Quality Index-PSQI), and analogue scales for dyspnea, pain, and other comorbid symptoms, as well as demographic factors and cancer history.

RESULTS

Overall, 56.6% of LCS had poor sleep (PSQI global score >5) as compared to only 29.5% of NCC (p<0.001), and 49.2% of LCS who did not have sleep difficulties prior to their lung cancer diagnosis ultimately developed them. There was also evidence of significant impairments in sleep efficiency in LCS (78.3%) relative to NCC (89.6%, p<0.001), predominantly due to increased nocturnal awakenings. A single-item analogue scale for sleep quality was not as effective in identifying sleep problems as more specific questions about sleep duration and sleep efficiency. Poor sleep quality was significantly correlated with impairments in quality of life, even when controlling for other factors, such as dyspnea.

CONCLUSIONS

Even 8 years after diagnosis, LCS continue to have significant sleep difficulties. By asking specific questions about sleep medication use, nocturnal awakenings and sleep efficiency, health care providers can identify sleep problems that could be treated and potentially improve the quality of life of their patients.

The Experience of Hot Flushes After Breast Cancer

As survival from breast cancer increases, there is a corresponding rise in the number of women living with the long-term consequences of its treatment. Distressing menopausal hot flushes occur in many of these women. This article reports on interviews conducted with 8 women, exploring the experience of hot flushes after breast cancer. Women's accounts of hot flushes varied from being a mild sensation to an intensely unpleasant sensation affecting the whole body and accompanied by drenching perspiration. Flushes affected all aspects of the women's lives, including sleeping, clothing, social situations, intimate relationships, and ability to work. Emotionally, women talked about being out of control. Having cancer and menopause simultaneously made it more difficult for the women to cope, and cancer treatment could cause flushing. The women used many strategies to help relieve their difficulties. Some resorted to hormone replacement therapy, whereas others turned to herbal medications and other alternative interventions such as acupuncture. Most women adopted behavioral strategies to try to regain control. Ultimately, they found that control was gained by attitude of mind. Cognitive behavioral techniques may enhance the sense of control and contribute to coping during hot flushes.

Evidenced based research of complementary and alternative medicine (CAM) for sleep in the community dwelling older adult

Older adults who complain of sleep disturbances frequently find their concerns are ignored or are considered a normal part of aging. Sleep disturbances are common in older adults and should receive prompt assessment and treatment due to outcomes of decreased quality of life, increased health care costs, and, more importantly, increased morbidity and mortality in combination with a variety of chronic illnesses. Treatment options for older adults may include use of complementary and alternative medicine (CAM). This paper provides an overview of complementary and alternative medicine in older adults and will provide evidenced based research on CAM for sleep that may be used in the older adult. Implications for health care providers who care for older adults in the community will be included.

Frequency and type of errors and near errors reported by critical care nurses

Research suggests that critically ill patients may be at high risk for medical errors. The purpose of this descriptive study was to determine the type and frequency of errors and near errors reported by a randomly selected sample of 502 critical care nurses. Data on errors and near errors were recorded in logbooks daily for 28 days. Over one quarter of the participants reported making an error and more than one third reported catching themselves making an error. There were 224 errors and 350 near errors reported during the study period. The most frequent type of error (56.7%) involved medication administration. Procedural errors and near errors, as well as transcription and charting errors, were also reported. These findings have significant implications for patient safety among a seriously ill population that has little natural resilience or ability to protect itself from health-care mishaps.

Infants at risk: when nurse fatigue jeopardizes quality care

Although most research on medical error has been conducted on adult inpatient units, the few studies conducted in pediatric settings suggest that errors occur more frequently in neonatal intensive care units (NICUs) than in other inpatient units. The effects of fatigue, due to long work hours, working at night, and insufficient sleep, are often underestimated. This article reviews basic information about fatigue and sleep and includes examples drawn from data provided by 6 NICU nurses who participated in a recent study to highlight the relationship between fatigue and error. These case studies reinforce the concept that NICU nurses need to be alert enough to provide safe care for their patients, as well as alert enough to detect and correct the errors made by others. Employing good sleep habits, minimizing shift rotations and excessive work hours, and using strategic naps can reduce the adverse effects of fatigue that could potentially put patients, especially the most vulnerable ones, at risk.

The Impact of Multiple Care Giving Roles on Fatigue, Stress, and Work Performance Among Hospital Staff Nurses

OBJECTIVE

This study describes fatigue and stress among a random sample of full-time hospital staff nurses (n=393) who provide care for aging family members, compares the results to nurses with and without children younger than 18 years living at home, examines differences in sleep duration, and explores the effects on work performance by care giving status during a 4-week period.

BACKGROUND

Little attention has been given to the effects of care giver well-being when individuals assume dual roles as family and professional care givers.

METHODS

Hospital staff nurses recorded daily information concerning their work hours, errors, sleep/wake patterns, perceptions of fatigue, alertness, and stress and periods of drowsiness and sleep episodes while on duty for 28 days.

RESULTS

Fatigue and stress levels were significantly higher among nurses caring for both children and elders. However, nurses providing elder care at home were more fatigued, sleep-deprived, and likely to make errors at work.

CONCLUSIONS

These findings underscore the importance of restorative sleep interventions and fatigue countermeasures for hospital staff nurses involved in dual care giving roles. Limiting overtime and applying circadian principles to hospital scheduling processes would ensure a more alert workforce, minimize health risks for nurses, and maximize the safety of those in their care.

Effects of critical care nurses' work hours on vigilance and patients' safety

BACKGROUND

To minimize the occurrence of adverse events among patients, critical care nurses must be alert to subtle changes in patients' conditions, perform accurate clinical assessments, and respond expediently. However, little is known about the effects of the nurses' work hours on vigilance and patients' safety.

OBJECTIVES

To describe the work patterns of critical care nurses, determine if an association exists between the occurrence of errors and the hours worked by the nurses, and explore whether these work hours have adverse effects on the nurses' vigilance.

METHODS

Data were obtained from a random sample of critical care nurses in the United States. Nurses eligible for the study were mailed two 14-day logbooks to fill out. Information collected included the hours worked, the time of day worked, overtime hours, days off, and sleep-wake patterns. On days worked, the respondents completed all work-related questions and questions about difficulties in remaining awake while on duty. Space was provided for descriptions of any errors or near errors that might have occurred. On days off, the nurses completed only those questions about sleep-wake patterns, mood, and caffeine intake.

RESULTS

The 502 respondents consistently worked longer than scheduled and for extended periods. Longer work duration increased the risk of errors and near errors and decreased nurses' vigilance.

CONCLUSIONS

The findings support the Institute of Medicine recommendations to minimize the use of 12-hour shifts and to limit nurses' work hours to no more than 12 consecutive hours during a 24-hour period.

Effects of Critical Care Nurses’ Work Hours on Vigilance and Patients’ Safety

• Background To minimize the occurrence of adverse events among patients, critical care nurses must be alert to subtle changes in patients’ conditions, perform accurate clinical assessments, and respond expediently. However, little is known about the effects of the nurses’ work hours on vigilance and patients’ safety.

• Objectives To describe the work patterns of critical care nurses, determine if an association exists between the occurrence of errors and the hours worked by the nurses, and explore whether these work hours have adverse effects on the nurses’ vigilance.

• Methods Data were obtained from a random sample of critical care nurses in the United States. Nurses eligible for the study were mailed two 14-day logbooks to fill out. Information collected included the hours worked, the time of day worked, overtime hours, days off, and sleep-wake patterns. On days worked, the respondents completed all work-related questions and questions about difficulties in remaining awake while on duty. Space was provided for descriptions of any errors or near errors that might have occurred. On days off, the nurses completed only those questions about sleep-wake patterns, mood, and caffeine intake.

• Results The 502 respondents consistently worked longer than scheduled and for extended periods. Longer work duration increased the risk of errors and near errors and decreased nurses’ vigilance.

• Conclusions The findings support the Institute of Medicine recommendations to minimize the use of 12-hour shifts and to limit nurses’ work hours to no more than 12 consecutive hours during a 24-hour period.

A randomised controlled trial to assess the effectiveness and cost of a patient orientated self management approach to chronic inflammatory bowel disease

OBJECTIVES

We developed a patient centred approach to chronic disease self management by providing information designed to promote patient choice. We then conducted a randomised controlled trial of the approach in inflammatory bowel disease (IBD) to assess whether it could alter clinical outcome and affect health service use.

DESIGN

A multicentre cluster randomised controlled trial.

SETTING

The trial was conducted in the outpatient departments of 19 hospitals with randomisation by treatment centre, 10 control sites, and nine intervention sites. For patients at intervention sites, an individual self management plan was negotiated and written information provided.

PARTICIPANTS

A total of 700 patients with established inflammatory bowel disease were recruited.

MAIN OUTCOME MEASURES

Main outcome measures recorded at one year were: quality of life, health service resource use, and patient satisfaction. Secondary outcomes included measures of enablement-confidence to cope with the condition.

RESULTS

One year following the intervention, self managing patients had made fewer hospital visits (difference -1.04 (95% confidence interval (CI) -1.43 to -0.65); p<0.001) without increase in the number of primary care visits, and quality of life was maintained without evidence of anxiety about the programme. The two groups were similar with respect to satisfaction with consultations. Immediately after the initial consultation, those who had undergone self management training reported greater confidence in being able to cope with their condition (difference 0.90 (95% CI 0.12-1.68); p<0.03).

CONCLUSIONS

Adoption of this approach for the management of chronic disease such as IBD in the NHS and other managed health care organisations would considerably reduce health provision costs and benefit disease control.

The prevalence and nature of errors and near errors reported by hospital staff nurses

The purpose of this article is to describe the nature and prevalence of errors and near errors reported by 393 full-time hospital staff nurses. One hundred nineteen nurses (30%) reported making at least one error, and 127 nurses (33%) reported at least one near error, for a total of 199 errors and 213 near errors in the 28-day data collection period. Although the majority of errors and near errors identified in this study involved medication administration, the number of procedural, transcription, and charting errors that occurred suggests the need for further examination of the way we currently deliver health care.

The Effects of Work Breaks on Staff Nurse Performance

OBJECTIVE

To determine if skipping breaks and meal periods increases the risk of errors.

BACKGROUND

Anecdotal data suggest that staff nurses frequently skip their breaks and/or meal periods to provide patient care. Neither the prevalence nor the impact of this practice on patient safety is known.

METHODS

Three hundred ninety-three nurses completed logbooks for 28 days providing information about their work hours, errors, and episodes of drowsiness and actual sleep on duty. Participants were asked if they were able to take a break or sit down for a meal during their shift, to indicate the total duration of breaks taken during the shift, and if they were relieved of patient care responsibilities during their meals and/or break periods.

RESULTS

Nurses reported having a break or meal period free of patient care responsibilities less than half of the shifts they worked (2,429/5,211 shifts). There were no differences in the risk of errors reported by nurses who had a break free of patient care responsibilities compared with those who were unable to take a break.

CONCLUSIONS

Although skipping breaks and/or meal periods was not associated with a higher risk of making errors, there are other compelling reasons for nurses to take breaks.

The working hours of hospital staff nurses and patient safety

The use of extended work shifts and overtime has escalated as hospitals cope with a shortage of registered nurses (RNs). Little is known, however, about the prevalence of these extended work periods and their effects on patient safety. Logbooks completed by 393 hospital staff nurses revealed that participants usually worked longer than scheduled and that approximately 40 percent of the 5,317 work shifts they logged exceeded twelve hours. The risks of making an error were significantly increased when work shifts were longer than twelve hours, when nurses worked overtime, or when they worked more than forty hours per week.

Narcolepsy

Narcolepsy is a chronic disorder of EDS. All patients experience EDS. Other symptoms include cataplexy, sleep paralysis, hypnagogic hallucinations, and disrupted nocturnal sleep. Treatment, usually with stimulants and low-doses of antidepressant medications, can dramatically improve the patient's quality of life. Although only advanced practice nurses may be actively involved in the diagnosis and treatment of this disorder, all nurses can encourage their patients who complain of EDS to consult a specialist in sleep disorders medicine, provide emotional support after diagnosis, and educate patients and their families about narcolepsy and its treatment.