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Sleep-wake disturbances are common in patients with cancer. Despite the high prevalence of altered sleep patterns in oncology settings, there remains a gap in consistent assessment of sleep, leading to an underrecognized and undertreated condition. Provider failure in addressing sleep-wake disturbances can result in chronic issues with insomnia and has a negative impact on quality of life and cancer survivorship. Often sleep-wake disturbances present in symptom "clusters" including, anxiety, depression, and fatigue, which adds to the complexity of managing sleep disorders in oncology. Aggressive management strategies for managing underlying symptom burden from disease or medications effects is a priority., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Traumatic injuries affect millions of Americans annually, resulting in $671 billion in healthcare costs and lost productivity. Postinjury symptoms, like pain, sleep disturbance, anxiety, depression, and stressor-related disorders are highly prevalent following traumatic orthopedic injuries (TOI) and may contribute to negative long-term outcomes. Symptoms rarely present in isolation, but in clusters of two or more symptoms that co-occur to affect health in aggregate. Identifying symptom cluster profiles following TOI may identify those at highest risk for negative outcomes. Dysregulation of brain-derived neurotrophic factor (BDNF) is a potential biological mechanism responsible for symptom cluster profile membership after TOI and may be targeted in future precision-health applications. The purpose of this paper is to present the protocol of a cross-sectional study designed to identify symptom cluster profiles and measure the extent to which the BDNF val66met mutation and serum concentration of BDNF are associated with membership in symptom cluster profiles. We plan to recruit 150 TOI survivors within the first 72 h of injury. The study aims are to (1) describe TOI survivors' membership in symptom cluster profiles, indicated by pain, sleep disturbance, and symptoms of anxiety, depression, and stressor-related disorders, immediately following a TOI; (2) examine associations between demographic and clinical factors and symptom cluster profile membership among TOI survivors; (3) test the hypothesis that low serum concentrations of BDNF are associated with membership among symptom cluster profiles following TOI; and (4) test the hypothesis that the presence of the val66met mutation on one or both alleles of the BDNF gene is associated with membership among symptom cluster profiles following TOI., (© 2020 Wiley Periodicals LLC.)

Topic: Sleep in the intensive care unit can be poorly consolidated and highly fragmented. This review examines the neurobiology of normal and abnormal sleep, with a focus on the changes that occur in the intensive care unit environment., Clinical Relevance: Patients in the intensive care unit demonstrate a lack of rapid-eye-movement sleep and an inability to effectively transition from light to deep stages of sleep. These abnormalities can adversely affect hemodynamic parameters and physiological and psychological outcomes., Purpose: To describe the brain mechanisms and electroencephalographic characteristics of wakefulness and the different stages of sleep. This review also describes how sleep can be altered by hospitalization in the intensive care unit and how nurses can design interventions that improve sleep and outcomes., Content Covered: The review examines sleep mechanisms, including brain electrical activity, regulatory centers in the brain, and circadian and diurnal patterns of sleep and hemodynamic function. Nursing interventions for specific patient risk factors in the intensive care unit are proposed., (©2020 American Association of Critical-Care Nurses.)

Aim: To explore and describe how patients' sleep is addressed at acute-care hospitals in Sweden with regard to nursing care, management and the development of knowledge in this area., Background: Sleep is a basic human need and thus important for health and health maintenance. Patients describe sleeping in hospital as a stressor, and research shows that nurses tend to underestimate patients' perceived problems with sleep during hospitalisation. How do nursing staff at acute hospitals address patients' sleep and the development of knowledge in this area?, Design/method: A cross-sectional descriptive study was conducted based on data collected through a web survey. Head nurses, registered nurses, nursing care developers and local training supervisors at 36 randomised acute-care hospitals in Sweden were invited to participate. This study was executed and reported in accordance with SQUIRE 2.0., Results: The results of the survey (53 responses from 19 wards at 15 acute-care hospitals) showed that no policy documents exist and no current training addresses sleep during hospital stay. All participants agreed that sleep should be considered a nursing topic and that it is important for hospitalised patients., Conclusion: Patients' sleep during hospitalisation is undermanaged at acute-care hospitals. Nurses, health care managers and organisations face challenges if they are to achieve better outcomes., Relevance to Clinical Practice: This study shows that nurses do consider patients' sleep important and addressing sleep as part of nursing care. Future studies in the area should focus on what kinds of support and education are needed in the clinical context., (© 2019 John Wiley & Sons Ltd.)

Background: Depressive symptoms are prevalent in patients with cancer and are heterogeneous; however, existing methods of grouping patients with heterogeneous symptoms have limitations., Objectives: The purpose of this study was to identify depressive symptom clusters in patients with cancer using a data-driven method and to explore their relationships with symptoms of anxiety and posttraumatic stress disorder., Methods: Data from 247 patients were analyzed in this cross-sectional study. Latent class analysis was used to identify depressive symptom clusters, using 9 depressive symptoms from the Patient Health Questionnaire. Symptoms of anxiety and posttraumatic stress disorder were measured, and the relationships between them and the clusters were explored through linear regression analyses., Results: Four clusters of depressive symptoms were identified: (1) minimal with sleep and appetite disturbances (23.9%), (2) somatic (22.3%), (3) moderate with sleep disturbance and fatigue (32.4%), and (4) severe (21.5%). The order of severity of anxiety and posttraumatic stress disorder symptoms was comparable across the 4 clusters of depressive symptoms. The anxiety and posttraumatic stress disorder symptoms of patients in clusters 3 and 4 were more severe than those in cluster 1 (B = 4.70-19.19, P < .001)., Conclusion: Using latent class analysis, 4 clusters of depressive symptoms were identified in patients with cancer, which were significantly correlated with symptoms of anxiety and posttraumatic stress disorder., Implications for Practice: Latent class analysis can be used to identify clusters of depressive symptoms in patients with cancer. Such groupings may hasten the development of individualized intervention approaches tailored to patients' specific depressive clusters.

Purpose: The purpose of this first of two review articles providing an update on sleep disorders was to examine the pathophysiology, epidemiology, and treatment of obstructive sleep apnea (OSA). OSA is a common sleep disorder whose prevalence is similar to asthma. As with other sleep disorders, OSA has a broad impact on individuals, affecting their daily behaviors, cognitive abilities, and performance, and putting them at increased risk for accidents, mood disorders, cancer, cardiovascular disease, and hypertension. Thus, early recognition and management, much of which can be implemented by nurses, can reduce health and accident risks and improve daily functioning., Methods: This narrative review utilized medical databases such as PubMed to identify relevant English language original and systematic review articles predominantly from peer-reviewed journals from 2012 to 2018. However, as background, findings from classic articles prior to 2012 were also included., Clinical Relevance: OSA is a common condition with considerable impact on daily functioning and potential for accidents and serious comorbidities such as hypertension, cardiovascular disease, diabetes, and depressed mood. The impairments and comorbidities associated with OSA can be reduced through early detection, encouraging treatment, providing education about sleep and OSA, and, importantly, promoting adherence to the predominant therapy, positive airway pressure., (© 2019 Sigma Theta Tau International.)

Background: Difficulty sleeping is a common symptom for patients living with cancer that significantly affects their lives. However, although sleep disorders are common, it is an overlooked problem in cancer care., Purpose: This study assessed the prevalence of sleep disturbances among patients living with cancer, and assessed the adequacy of sleep assessment and intervention for patients from both nurses' and patients' perspectives., Method: Descriptive, cross-sectional and correlational design was used in this study. A convenience sample of 129 patients with cancer and 113 registered nurses working with cancer patients was recruited. A structured face-to-face interview was used to complete the patients' questionnaires and a self-administered questionnaire was given to nurses., Findings: The majority of patients with cancer reported having poor sleep quality (69.8%). About 86.7% (n=98) of nurses reported that they have never screened patients with cancer for any sleep problems, and 76.7% (n=99) of the patients reported that they have never been assessed for sleep problems by the nursing staff during hospitalisation. Only 8% of patients with cancer who reported having problems sleeping to a nurse received interventions to promote better sleep., Conclusion: Assessment of sleep disturbances in patients with cancer should be unified using a comprehensive reliable valid instrument, as well as providing evidence-based interventions according to patient's need. A written policy should be introduced to encourage sleep documentation and to make sleep care for patients part of routine nursing care.

Background: Sleep disturbance is common and can have harmful psychological and physical effects. While sleep problems in children with Down syndrome (DS) have received a reasonable amount of attention, very little has been written about this topic in adults with DS., Method: The present study consisted of an online survey completed by 100 family carers of adults with DS., Results: High rates of sleep problems of different types were reported in the adults with DS comparable to those found in children with DS in previous research. Significant associations were found between sleep problems and body mass index, excessive daytime sleepiness and a range of health and psychological problems. Low rates of treatments for sleep problems were reported. The majority of family caregivers felt their own sleep was affected., Conclusions: Sleep problems in adults with DS are common and varied. Assessment and treatment of such problems are likely to improve quality of life., (© 2019 John Wiley & Sons Ltd.)

Background: Although people who sleep poorly may attempt to relieve anxiety for better sleep quality, whether daily alcohol consumption is a factor that moderates anxiety and sleep disturbance is not known., Purpose: The aim of the study was to explore (a) the association between anxiety and sleep quality and (b) whether daily alcohol consumption acted as a moderator between anxiety and sleep quality in those who reported sleeping poorly., Methods: Eighty-four participants aged 20-80 years who reported poor sleep (Pittsburgh Sleep Quality Index > 5) in northern Taiwan were enrolled in this cross-sectional study. A structured questionnaire covering demographics (including daily alcohol consumption), level of anxiety, level of depression, and perceived sleep quality was used to collect data., Results: The participants were mostly women (72.6%). The mean age was 41.81 (SD = 12.62) years; 51.2%, 19.0%, 13.1%, and 14.3%, respectively, had minimal, mild, moderate, and severe anxiety. After adjusting for factors related to sleep quality using multiple regression analysis, receiving sleep therapy, consuming alcohol on a daily basis, and having anxiety were found to be predictors of poor sleep quality. Moreover, daily alcohol consumption was found to moderate the relationship between anxiety and sleep quality., Conclusions/implications for Practice: People who sleep poorly should avoid misusing alcohol to self-treat poor sleep quality or anxiety and should instead utilize sleep hygiene education and mental healthcare. Daily alcohol consumption may be a moderator between anxiety status and sleep quality.

Background: Sleep problems are much more prevalent in nursing home residents than in their community-dwelling counterparts. Cognitive behavioural therapy is likely to improve sleep quality in older adults. However, these interventions have a narrow scope to generalise to nursing home practice, and there are minimal data on the effectiveness of the integration of cognitive behavioural therapy and motivational interviewing in nursing home settings., Aim: The purpose of this study was to investigate the impact of a nurse-led sleep programme on the sleep quality and depressive symptomatology in cognitively intact nursing home residents., Methods: A non-randomised controlled study design was applied to 52 older adults living in three different nursing homes in the same locality. Then, we categorised our study cohort into the following two groups: intervention group in which the older adults received the nurse-led sleep programme and control group in which the older adults received regular nursing home services. One nursing home was assigned to the intervention, and two were assigned to control. The intervention group participated in four weekly 1-hr sessions performed by the first author., Results: Follow-up assessments conducted at 8 and 12 weeks after the intervention ended revealed that participants in the intervention group experienced a significant improvement in some objective sleep parameters, including awakenings, total wake time, wake after sleep onset and sleep efficiency, as well as a significant decrease in depressive symptomatology., Conclusion: To summarise, the results of this study showed that the nurse-led sleep programme improved the sleep quality and reduced depressive symptomatology in cognitively intact nursing home residents. In this context, we can assert that interventions for sleep problems should be individualised by addressing sleep experience and sleep management strategies of older adults living in nursing homes and should be integrated with motivational interviewing techniques., (© 2018 John Wiley & Sons Ltd.)

Background: Sleep disturbance is a significant issue, particularly for patients with advanced terminal illness. Currently, there are no practice-based recommended approaches for managing sleep and circadian disruptions in this population. To address this gap, a cross-sectional focus group study was performed engaging 32 staff members at four hospices/end-of-life programs in three demographically diverse counties in New York State., Methods: Participants responded to structured open-ended questions. Responses were transcribed and subjected to qualitative content analysis. The themes and recommendations for improved practice that emerged were tabulated using Atlas TI qualitative software., Results: This report details the experiences of hospice and end-of-life care staff in managing sleep and circadian disruptions affecting patients and analyzes their recommendations for improving care. Caregivers involved in the study described potential interventions that would improve sleep and reduce circadian disruptions. They particularly highlighted a need for improved evaluation and monitoring systems, as well as sleep education programs for both formal and informal caregivers., Conclusions: The voiced experiences of frontline hospice and end-of-life caregivers confirmed that disruption in sleep and circadian rhythms is a common issue for their patients and is not effectively addressed in current research and practice. The caregivers' recommendations focused on management strategies and underscored the need for well-tested interventions to promote sleep in patients receiving end-of-life care. Additional research is needed to examine the effectiveness of systematic programs that can be easily integrated into the end-of-life care process to attenuate sleep disturbances.

Background and Purpose: An estimated 40%-80% of children with autism spectrum disorders (ASD) have sleep problems. The Simons Simplex Collection Sleep Interview (SSCSI) is a parent-report questionnaire assessing bedtime and nighttime sleep problems and daytime function. The present study evaluated the factorial model of the SSCSI that best characterizes children aged 4-18 years with ASD., Methods: Exploratory factor analysis was performed using principal component analysis and promax rotation, beginning with 16 items and ending with 10 items., Results: Exploratory factor analysis concluded with ten dichotomous items, plus ageand regular sleep duration, in three factors: nighttime problems, daytime problems, andsleep duration problems. The analysis was performed on the full sample, and onprepubertal (4-8-years), pubertal (9-13-years), and postpubertal (14-18-years) subgroups., Conclusion: Further refinement, including confirmatory factor analysis, test-retest reliability, and convergent validity testing, is needed., (© 2018 Springer Publishing Company, LLC.)

Objectives: To provide an overview of the symptoms commonly experienced by patients with malignant glioma, and discuss the pathophysiology and interventions associated with those., Data Sources: A review of published scientific literature and clinical literature, and online information from National Comprehensive Cancer Network, Oncology Nursing Society, Epilepsy Foundation of America, and the American Brain Tumor Association., Conclusion: The unique symptom burden associated with a malignant glioma diagnosis often disrupts the lives of patients and their caregivers. Clinical support and interventions addressing malignant glioma-related focal deficits, seizures, headaches, venous thromboembolism, mood disturbances, fatigue, and sleep-wake disturbance can positively impact patient and caregiver experiences while living with malignant glioma., Implications for Nursing Practice: Understanding the pathophysiology of these symptoms and reviewing nursing-led and supported interventions will empower the nurse in providing comprehensive care to patients with malignant glioma and their caregivers., (Copyright © 2018. Published by Elsevier Inc.)

Objective: to present the knowledge produced about sleep and Acute Coronary Syndrome in order to assist in the elaboration of the operational and conceptual definitions of the defining characteristics of the nursing diagnosis Disturbed Sleep Pattern (00198)., Method: integrative review in the following databases: COCHRANE; SCOPUS; MEDLINE (Medical Literature Analysis and Retrieval System Online) via Pubmed; LILACS (Latin American and Caribbean Health Science Literature Database); CINAHL (Cumulative Index to Nursing and Allied Health Literature) and EMBASE (The Excerpta Medical Database). At the end of the search, 2827 studies were found, 43 were selected for reading, and 10 were included in the review. The gray literature was also included., Results: important findings related to clinical evidence and contributing factors of sleep were found in the review. However, in order to build definitions of the defining characteristics, it was necessary to use gray literature, such as a Portuguese dictionary and two textbooks about sleep., Conclusion: the definitions will help nurses in their practice in the collection of information, in the determination of the nursing diagnosis studied here, and in directing care measures with respect to quantity and quality of sleep of Acute Coronary Syndrome inpatients. They will also assist in the next steps of the validation of this diagnosis to the referred population.

Background: Patients of adult intensive care units (ICUs) often suffer from a lack of sleep. Reducing anxiety by promoting adaptation to the ICU prior to admission may be an appropriate way to increase sleep quality., Objective: The aim of this study was to evaluate the impact on sleep quality of a brief nurse intervention., Methods: This was a pilot randomized controlled trial in Spain. Forty patients admitted in hospital for valve cardiac surgery were randomly allocated to (1) control group (n = 20), receiving usual care, and to (2) experimental group (EG, n = 20), receiving a nurse intervention the day before surgery and admission in the ICU. The intervention was based on Roy Adaptation Model. A trained nurse anticipated the stressful stimulus to patients in order to develop functional adaptive behaviors. A set of photographs and videos was used to illustrate the environment and assistance in the ICU. Sleep quality in the ICU was measured with the Richards-Campbell Sleep Questionnaire and usual sleep quality with the Pittsburgh Sleep Quality Index., Results: After the intervention, sleep quality was lower in the EG compared with the control group (-4 points in Richards-Campbell Sleep Questionnaire, P = .69). Adjustment for main confounders led this reduction to -1.9 points (P = .87) among patients in EG. Stratified analyses shown a positive impact for people who usually slept well (+5.2 points, P = .77), but negative for those who had previous poor sleep quality (-20.0 points, P = .24)., Conclusion: A nurse intervention prior to ICU admission did not increase patients' sleep quality. In addition, the intervention could have incremented anxiety over the patients who used to sleep poorly at their homes.

Parents/caregivers of hospitalized patients are at risk of sleep disruption. We performed a cross-sectional quantitative and qualitative evaluation of sleep in parents/caregivers of children undergoing hematopoietic stem cell transplant (HSCT; n = 17). Additionally, we explored the frequency of room entries for hospitalized patients undergoing HSCT (n = 189 nights). Twelve caregivers (71%) demonstrated significant sleep disturbance, 12 (71%) described sleep quality as poor, 15 (88%) averaged < 6 hours of sleep per night, 14 (82%) awakened at least four times per night. Patient rooms were entered a median of 12 times per night (interquartile range 10-15). Intervention studies to improve caregiver sleep during hospitalization are needed., (© 2018 Wiley Periodicals, Inc.)

Aims and Objectives: To explore the context and the influence of night-time care routine interactions (NCRIs) on night-time sleep effectiveness (NSE) and daytime sleepiness (DSS) of patients in the cardiac surgery critical-care and progressive-care units of a hospital., Background: There exists a paucity of empirical data regarding the influence of NCRIs on sleep and associated outcomes in hospitalised adult cardiac surgery patients., Methods: An exploratory repeated-measures research design was employed on the data provided by 38 elective cardiac surgery patients (mean age 60.0 ± 15.9 years). NCRI forms were completed by the bedside nurses and patients completed a 9-item Visual Analogue Sleep Scale (100-mm horizontal lines measuring NSE and DSS variables). All data were collected during postoperative nights/days (PON/POD) 1 through 5 and analysed with IBM SPSS software., Results: Patient assessment, medication administration and laboratory/diagnostic procedures were the top three NCRIs reported between midnight and 6:00 a.m. During PON/POD 1 through 5, the respective mean NSE and DSS scores ranged from 52.9 ± 17.2 to 57.8 ± 13.5 and from 27.0 ± 22.6 to 45.6 ± 16.5. Repeated-measures ANOVA showed significant changes in DSS scores (p < .05). NSE and DSS were negatively correlated (r = -.44, p < .05), but changes in NSE scores were not significant (p > .05). Finally, of 8 NCRIs, only 1 (postoperative exercises) was significantly related to sleep variables (r > .40, p < .05)., Conclusion and Relevance to Clinical Practice: Frequent NCRIs are a common occurrence in cardiac surgery units of a hospital. Further research is needed to make a definitive conclusion about the impact of NCRIs on sleep/sleep disruptions and daytime sleepiness in adult cardiac surgery. Worldwide, acute and critical-care nurses are well positioned to lead initiatives aimed at improving sleep and clinical outcomes in cardiac surgery., (© 2018 John Wiley & Sons Ltd.)

Objective: To explore the current practices and challenges in night-time care for people with dementia living in care homes in the UK., Methods: Focus group discussions (FGD) were held with care staff and family carers from five care homes in South London. To supplement the FGD data, an online survey was circulated to family carers (n = 16), and informal interviews were conducted with night-time care staff and nurses (n = 19). The questions for the online survey were designed to specifically explore the themes that emerged from the FGD., Results: Thematic analysis revealed eight key themes in the management of sleep disturbance in people with dementia living in care homes: current night-time care practices, dissonance in perceived causes of sleep disturbances, inconsistencies in treatment options, insufficient staffing levels, working relationships between shifts, nurse burden and responsibility, communication as a critical challenge, connecting with residents and one overarching theme of balance., Conclusions: The findings of this study highlight the need for an evidence-based sleep disturbance management programme designed for use in care homes and informed by stakeholders. The key themes identified represent the major barriers to good quality care and areas which future programmes will need to address to improve the quality of night-time care in care homes. There are clearly opportunities for future examination of non-pharmacological night-time care management programmes for use in the population. Copyright © 2017 John Wiley & Sons, Ltd., (Copyright © 2017 John Wiley & Sons, Ltd.)

Non-pharmacological treatment of hospital patients with sleeping problems - the nurse perspective Abstract., Background: Elderly patients suffer from sleep disturbances during hospitalization. These patients often receive hypnotics and sedatives; despite of the known risks and although non-pharmacological treatments are available., Aim: The study investigates the experiences of nurses when using non-pharmacological treatments for elderly patients with sleeping problems., Methods: Semi-structured interviews with 13 nurses from a general hospital were analyzed according to Mayring's qualitative content analysis., Results: Nurses used a variety of non-pharmacological treatments for elderly inpatients with sleeping problems: (1) structural measures (regulation of temperature and light), (2) organizational measures (more time for conversation during the nightshift), (3) nursing measures (asking about night-time routines) and (4) household remedies. From the nurses' perspective, the more intensive contact required when applying non-pharmacological treatments can lead to higher patient satisfaction and a lower bell frequency during the night shift. Barriers result from limited time and personnel, a lack of standards and individual patient needs., Conclusion: Nurses know several kinds of non-pharmacological treatments to help elderly inpatients sleep better. A lack of resources as well as a lack of professional consensus about the treatment of temporary sleeping disturbances can be an obstacle to their use. A professional climate should restrict the use of drugs for sleeping problems as far as possible.

Aims and Objectives: To explore and synthesise current research to assess the state of science about the relationship between sleep disturbance and glycaemic control in adults with type 2 diabetes., Background: Sleep disturbance is suggested a risk factor for type 2 diabetes. Diabetes alone is a leading cause of death, but when coupled with sleep disturbance poses additional health risks. However, little is known about the relationship between sleep disturbance and glycaemic control in people with overt diabetes., Design: An integrative review., Methods: Whittemore and Knafl's methodology guided this integrative review. Original studies published before October 2016 were identified through systematic searches of seven databases using terms: diabet*; sleep or insomnia; glycem* or glucose or A1C or HbA1c or sugar; and their combinations. The matrix and narrative synthesis were employed to organise and synthesise the findings, respectively. The Crowe Critical Appraisal Tool was used to evaluate the study quality., Results: A total of 26 studies were identified; 17 of which reported significant relationships between sleep measures and glycaemic control. In 13 studies, sleep duration was associated with glycaemic control in both linear (n = 2) and nonlinear (n = 3) relationships; however, eight studies reported no significant relationships. Sleep quality was significantly related to glycaemic control in 14 of 22 studies. Nine studies found no relationship between any measure of sleep and glycaemic control., Conclusions: There is strong evidence supporting the relationship between sleep quality and glycaemic control but further examination of the relationship between sleep duration and glycaemic control is warranted. Sleep disturbance, particularly impaired sleep quality, could potentially influence glycaemic control in adults with type 2 diabetes., Relevance to Clinical Practice: Nurses who treat patients with diabetes should include assessment of sleep, education for healthy sleep, and referral for treatment of sleep disturbance in order to maximise the potential for achieving good glycaemic control., (© 2017 John Wiley & Sons Ltd.)

A survey carried out in 2004 studied the link between quality of sleep and the nocturnal management of incontinence. This same survey was repeated 10 years later. The results reveal the impact on quality of sleep, the deteriorating management of incontinence with the lenghtening of waiting time and the causes of waking. This discussion process on the quality of sleep must continue., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Aim The burden of referrals to investigate sleep disorders has escalated considerably. In order to address this, the feasibility of a nurse-led sleep disorder clinic was investigated. Methods Sleep referrals were stratified on the basis of information contained within the primary care referral, and appropriate home-based sleep studies arranged if obstructive sleep apnoea was considered the most likely working diagnosis. Selected patients were started on continuous positive airway pressure treatment if deemed appropriate. Education was almost exclusively provided by specialist nursing staff or by means of validated information by the British Lung Foundation. Results Eighty patients were included in the respiratory nurse-led sleep service. Feedback from the patient questionnaire was positive and 59 patients were managed without requirement to attend consultant-led outpatient services. Non-sleep breathing disorders as the reason for daytime somnolence, and patients requiring referral to tertiary services, were identified. Conclusion Developing a respiratory nurse-led sleep service is adequate to identify non-sleep breathing disorders, is fit for purpose, functions broadly in accordance with American Sleep Society guidelines, and is well received by patients.

Aims and Objectives: To explore sleep quality in patients with chronic illness in primary care., Background: Many people suffer from chronic illness with the numbers increasing. One common issue arises from problems that people have with their quality of sleep: a largely under-researched topic. This study exploring poor quality sleep allowed patients to describe their daily struggles with poor sleep in their own lives. This allowed the development of a deeper understanding of what it means to sleep poorly and find out how participants cope with not sleeping well., Design: A qualitative approach enabling a deep exploration of patient's experiences of sleep quality was used. Interviews were conducted with a purposive sample of nine participants from a primary care clinic. Analysis utilised an interpretative approach., Results: Data analysed produced four recurrent themes that were grouped into two categories. First, themes that identified the recognition by participants that 'something was wrong' were abrupt beginning and impact on their life. Second, themes that identified that the participants considered there was 'nothing wrong' were I am fine and I just carry on., Conclusion: Data revealed that poor quality sleep can have a profound effect on quality of life. Participants lived without good quality sleep for years. They had come to accept two seemingly irreconcilable ideas that not being able to sleep is an enduring problem with a distinct starting point, and paradoxically, this is not a problem that deserves much professional attention., Relevance to Clinical Practice: Important original data were generated on the impact of poor quality sleep indicating that chronically disturbed sleep can increase the disease burden on patients with chronic illness. The results of this study suggest healthcare professionals need to understand how sleep quality issues impact on patient's experience of chronic illness. Data from this study will help nurses and other health professionals to deepen their understanding of the profound impact of poor quality sleep on patients with chronic illness. A programme of education highlighting the important role of sleep quality in chronic illness is suggested by the issues raised in this study. Nurses are ideally placed to assess sleep quality in patients and tailor intervention to positively affect the quality of life for this group., (© 2016 John Wiley & Sons Ltd.)

Aims and Objectives: To determine how intensive care unit evaluations of patients' sleep by nurses correspond to polysomnography and if changes in patients' physiologic parameters could be helpful in sleep evaluation., Background: The evaluations of patients' sleep by nurses have not corresponded very well with objective sleep recordings, so there is a need for further knowledge in this field., Design: Correlational study of patients' sleep, nurses' sleep evaluations and the sleep-related heart rate and blood pressure changes., Methods: The standard overnight polysomnography was recorded on 21 patients. Simultaneously, nurses marked into an electronic patient care documentation system all the changes noted in the patients' sleep status. Patients' arterial blood pressure and heart-rate data were automatically saved into the electronic patient care documentation., Results: The evaluations of patients' sleep/wake state by nurses corresponded to polysomnography 68% of the time. A correlation was found between nurses' evaluations and polysomnography recordings only on total sleep time. There was no correlation in the other sleep aspects (sleep latency, amount of awakenings or movements during sleep). Most patients' blood pressures and heart rate varied according to sleep/wake state. There was less variation if the patient had received noradrenalin for blood pressure control., Conclusion: The evaluations of patients' sleep/wake state by nurses only correspond to the polysomnography two-thirds of the time. Thus, more sophisticated evaluation methods should be developed to aid nurses in sleep evaluations. Sleep-related changes in blood pressure and heart rate can be seen in intensive care unit patients, so using these parameters as part of the patients' sleep evaluation should be further explored., Relevance to Clinical Practice: The nurses' evaluation practices of intensive care unit patients' sleep need further development. Monitoring the changes in patients' heart rate and blood pressure may aid in evaluating his/her sleep., (© 2016 John Wiley & Sons Ltd.)

In recent years, translational research (TR) has become a new approach for bridging basic research and clinical practice. This article examines studies in which the authors used TR to learn more about the underlying causes of selected symptoms, and to discuss these results in the context of cancer nursing and symptom management. A literature review was undertaken, plus critical analysis of the authors. TR conducted by cancer nursing scholars has been relatively limited in the past, but is becoming more common as nurses complete additional academic work in the basic sciences and develop research teams with colleagues of those areas of knowledge. The goal in these studies is to show how a set of variables explains differential interventional effects. The availability of TR provides new evidence for the management of symptoms experienced by individuals with cancer, which could lead to improvements in the care of cancer patients across the world.

There is much research concerning the psychological and physical effects of sleep deprivation on patients in healthcare systems, yet interrupted sleep on hospital wards at night remains a problem. Staff at Plymouth Hospitals NHS Trust, Devon, wanted to identify the factors that prevent patients from sleeping well at night. Two audits were carried out, between April and August 2015, to assess noise and light levels on wards at night, and to engage nurses in ways of reducing these. A number of recommendations were made based on the audit findings, many of which have been put into practice.

Background and Purpose: Sleep hygiene is one factor that contributes to poor sleep in breast cancer survivors but is poorly measured. The purposes of this study were to (a) evaluate the psychometric properties of the Sleep Hygiene Awareness and Practice Scale (SHAPS) and (b) compare SHAPS scores between midlife women with and without breast cancer., Methods: Cross-sectional, descriptive data from a single-blinded, controlled hot flash intervention trial., Results: 194 women (88 breast cancer survivors; 106 menopausal women). Reliability of the three sections of the SHAPS was inadequate with Cronbach's alphas ranging from 0.23 to 0.67. Sleep hygiene practices were modestly correlated with global sleep quality in both groups., Conclusions: Findings suggest the SHAPS would need to be revised to be a psychometrically sound measure of sleep hygiene awareness and practice.

Health-related quality of life (HRQOL) of children and adolescents with chronic health conditions is a multifactorial concept that combines a child's perception and adaptation to physical, social, emotional, and school environments regardless of particular medical diagnosis. Children with chronic kidney disease (CKD) experience non-kidney specific co-morbidities, including depression, body image alterations, and sleep disturbance, that impair their daily lives. This article reviews the pediatric nephrology literature to highlight the evidence identifying these riskr to HRQOL and suggesting ways in which nurses in both nephrology and primary care are poised to identify and modify these risk factors.

Aims and Objectives: The aim was to describe nurses' experiences of patients' sleep at an emergency hospital and their perceptions of sleep-promoting interventions., Background: Promotion of patients' sleep during hospital care is an important intervention for the nursing profession. To promote sleep and to initiate sleep-promoting interventions, nurses need basic knowledge about sleep and its physiology. Therefore, it is of importance to explore and expand knowledge about how nurses experience patients' sleep and how they perceive working with it while providing care., Design: A qualitative descriptive design was used., Methods: Data were collected from four focus groups and seven individual interviews. A total of twenty-two registered nurses participated. Data were analysed using a qualitative content analysis., Results: Nurses expressed a desire and an ambition to work in ways that promote patients' sleep during hospitalisation. Nurses reported that health care services and emergency hospitals were not organised according to patients' perspective and needs. Furthermore, they did not have opportunities to work effectively to promote sleep according to the patients' wishes. Several nurses stated that they did not have sufficient knowledge about sleep and that they did the best they could under prevailing circumstances. Nurses emphasised the importance of sleep for patients and that it was an area that should be given far greater priority., Conclusions: The results indicate that nurses currently have insufficient knowledge about sleep and sleep-promoting interventions. These aspects of nursing is based on personal experience and common sense rather than being evidence based. Furthermore, sleep as a nursing topic needs to be developed and given more focus in order for nurses to be able to deliver high quality care at emergency hospitals., Relevance to Clinical Practice: Nurses require more knowledge and education to gain deeper understanding of sleep and to deliver evidence-based, high quality care., (© 2015 John Wiley & Sons Ltd.)

Aims and Objectives: The aim of this study was to investigate the effects of a cognitive behavioural intervention combined with a breathing relaxation exercise on sleep quality and heart rate variability in patients with major depression., Background: Depression is a long-lasting illness with significant effects not only in individuals themselves, but on their family, work and social relationships as well. Cognitive behavioural therapy is considered to be an effective treatment for major depression. Breathing relaxation may improve heart rate variability, but few studies have comprehensively examined the effect of a cognitive behavioural intervention combined with relaxing breathing on patients with major depression., Design: An experimental research design with a repeated measure was used., Methods: Eighty-nine participants completed this study and entered data analysed. The experimental group (n = 43) received the cognitive behavioural intervention combined with a breathing relaxation exercise for four weeks, whereas the control group (n = 46) did not. Sleep quality and heart rate variability were measured at baseline, posttest1, posttest2 and follow-up. Data were examined by chi-square tests, t-tests and generalised estimating equations., Results: After adjusting for age, socioeconomic status, severity of disease and psychiatric history, the quality of sleep of the experimental group improved, with the results at posttest achieving significance. Heart rate variability parameters were also significantly improved., Conclusions: This study supported the hypothesis that the cognitive behavioural intervention combined with a breathing relaxation exercise could improve sleep quality and heart rate variability in patients with major depression, and the effectiveness was lasting., Relevance to Clinical Practice: The cognitive behavioural intervention combined with a breathing relaxation exercise that included muscle relaxation, deep breathing and sleep hygiene could be provided with major depression during hospitalisation. Through group practice and experience sharing, participants could modulate their heart rate variability and share feeling about good sleep as well relaxation., (© 2015 John Wiley & Sons Ltd.)

Background: Resource constraints may inhibit the provision of appropriate interventions for children with neurodisabilities presenting with behavioural sleep problems. Telephone calls (TC), as opposed to home visits (HV), may be a more resource efficient means of supporting these families., Objective: To conduct a preliminary investigation exploring the feasibility and acceptability of replacing HV with TC to support parents implementing sleep management strategies and to gather evidence to inform the design and methods of a full trial., Methods: Parents referred to a sleep management intervention routinely delivered by a community paediatric team were alternately allocated to receive implementation support via HV (n = 7) or TC (n = 8). Activity logs recorded the frequency, duration and mode of support. Parents and practitioners were interviewed about their experiences of receiving/delivering the intervention., Results: Intervention drop-out was low, the frequency, number of contacts and intervention duration appeared comparable. Parents allocated TC received less contact time. Parents valued implementation support irrespective of delivery mode and practitioners reported that despite initial reservations, implementation support via TC appeared to work well., Conclusions: TC appears an acceptable and convenient mode of delivering sleep support, valued by both parents and practitioners. We recommend a full-scale trial to investigate effectiveness., (© 2015 John Wiley & Sons Ltd.)

Background: The need to educate the future nursing workforce to increase understanding of healthy sleep practices, adverse health consequences of impaired sleep, and common sleep disorders is pressing. Unfortunately, education about sleep and sleep disorders has not been part of established undergraduate nursing curricula., Method: This study developed a sleep education program for college nursing students and tested its effect on knowledge about sleep and sleep disorders., Results: With a total time commitment of 10 hours, this program included three sequential components: traditional in-classroom teaching, guided online virtual self-learning, and interactive simulation-based discussion. This innovative education program was implemented in a core course offered to senior nursing students in spring 2013, and demonstrated its effectiveness in improving knowledge about sleep and sleep disorders., Conclusion: Translating into undergraduate nursing curriculum, it will lay a foundation for improving health care of patients and decreasing the health risks of nurses as care providers., (Copyright 2015, SLACK Incorporated.)

Light, noise, and interruptions from hospital staff lead to frequent awakenings and detrimental changes to sleep quantity and quality for children who are hospitalized and their parents who stay with them overnight. An understanding of nurses' views on how care affects sleep for the hospitalized child and parent is crucial to the development of strategies to decrease sleep disturbance in hospital. The purpose of this descriptive qualitative study was to gain an understanding of nurses' views on their role in and influence on sleep for families; perceived barriers and facilitators of patient and parent sleep at night; strategies nurses use to preserve sleep; the distribution, between parent and nurse, of care for the child at night; views of the parent as a recipient of nursing care at night; and the nature of interactions between nurses and families at night. Thirty registered nurses from general pediatric and critical care units participated in one of four semi-structured focus groups. Four main influences on sleep were identified: child factors; environmental factors; nurse-parent interaction factors; and nursing care factors. Some of these restricted nurses' ability to optimize sleep, but many factors were amenable to intervention. Balancing strategies to preserve sleep with the provision of nursing assessment and intervention was challenging and complicated by the difficult nature of work outside of usual waking hours. Nurses highlighted the need for formal policy and mentoring related to provision of nursing care at night in pediatric settings., (© 2015 Wiley Periodicals, Inc.)

Purpose: To examine clinical and psychological indicators associated with sleeplessness and insomnia in adult patients with sickle cell., Data Sources: PubMed, Scopus, Cochrane Library. Data were collected from adult sickle cell participants (N = 72) in outpatient clinics at a Midwest National Cancer Institute designated comprehensive cancer center. A retrospective chart review observed for clinical and psychological indicators associated with sleeplessness and insomnia., Conclusions: Findings included that adults with sickle cell experienced insomnia (47%) and sleep impairment (15%). Significant associations existed between pain and sleep impairment (p = .00), insomnia and pain (p = .00), morning hours of sleep (p = .00), and evening hours (p = .00). Pain may contribute to insomnia or interrupt sleep; daytime sleeping was not conducive to nighttime sleep. Anxiolytics, antidepressants, and long-acting opioids were not associated with insomnia (p = .00, p = .43, and p = .10), respectively; reduction in anxiety may reduce insomnia. Long-acting opioids may provide for improved pain control sleep., Implications for Practice: Healthcare providers play a pivotal role in the assessment of sleep impairment or disorders. Effective management is necessary for improved quality of life. Further investigation is warranted to understand the meaning of sleep impairment in adult patients with sickle cell with prospective controlled studies to examine the efficacy of interventions., (©2015 American Association of Nurse Practitioners.)

Background: Sleep disturbance in an intensive care unit is a common problem. One of the main factors causing sleep disturbances in an intensive care unit is nocturnal patient care interventions., Aims and Objectives: This study aims to determine the impact of patient care interventions performed at night in a neurosurgical intensive care unit on patients' sleep and their nursing care satisfaction., Methods: The descriptive study was conducted on 82 patients in a neurosurgical intensive care unit between January 2009 and March 2010. The data were collected by data collection instruments and Newcastle Satisfaction with Nursing Scales. The data were statistically analyzed by frequency, mean, standard deviation, chi-square, and Mann-Whitney U test., Results: The study showed that 53.7% of the patients experienced sleep disturbances in the neurosurgical intensive care unit. Because of nursing interventions at night, 39.1% of these patients had their sleep affected, but this problem did not cause any negative impact on the patients' satisfaction (Newcastle Satisfaction with Nursing Scales score = 88.21 ± 9.83). The patients received, on average, 42.21 ± 7.45 times patient care interventions at night; however, the frequency of patient care interventions at night showed no effect on sleep disturbances in this study (p > .05). The most frequently given patient care interventions were, respectively, vital signs monitoring, neurological assessment, and repositioning in bed. These interventions were performed commonly at 6 a.m., 12 a.m., and 7 p.m., Conclusion: In this study, despite the patients reporting sleep disturbances in the neurosurgical intensive care unit because of nocturnal patient care interventions that prevented them from sleeping, the patients' satisfaction on the given nursing care was not negatively impacted. To reduce sleep disturbances because of nursing care initiatives and promote uninterrupted sleep in the intensive care unit, it can be useful to develop new protocols regulating night care activities.

Background: In this study, we aimed at assessing Inflammatory Bowel Disease patients' needs and current nursing practice to investigate to what extent consensus statements (European Crohn's and Colitis Organization) on the nursing roles in caring for patients with IBD concur with local practice., Methods: We used a mixed-method convergent design to combine quantitative data prospectively collected in the Swiss IBD cohort study and qualitative data from structured interviews with IBD healthcare experts. Symptoms, quality of life, and anxiety and depression scores were retrieved from physician charts and patient self-reported questionnaires. Descriptive analyses were performed based on quantitative and qualitative data., Results: 230 patients of a single center were included, 60% of patients were males, and median age was 40 (range 18-85). The prevalence of abdominal pain was 42%. Self-reported data were obtained from 75 out of 230 patients. General health was perceived significantly lower compared with the general population (p < 0.001). Prevalence of tiredness was 73%; sleep problems, 78%; issues related to work, 20%; sexual constraints, 35%; diarrhea, 67%; being afraid of not finding a bathroom, 42%; depression, 11%; and anxiety symptoms, 23%. According to experts' interviews, the consensus statements are found mostly relevant with many recommendations that are not yet realized in clinical practice., Conclusion: Identified prevalence may help clinicians in detecting patients at risk and improve patient management.

Aims and Objectives: To evaluate the effectiveness of an individualised programme to promote self-care in sleep-activity in patients with coronary artery disease., Background: Recent scientific findings have shown that low physical exercise and stress interfere with coronary artery disease patients' sleep quality and sleep efficiency independent of gender, age and co-morbidity., Design: A randomised pretest-post-test control design., Methods: Forty-seven patients who had undergone a coronary revascularisation procedure and/or pharmacological treatment three to seven weeks earlier at a general hospital were randomised to either an intervention group or a control group. Data collection was carried out by questionnaires, a study-specific sleep diary and actigraphy registration for 10 consecutive 24-hour periods, with a follow-up after three to four months. The intervention group underwent a nurse-led individualised education programme to promote self-care of sleep-activity. Sleep habits and sleep-related lifestyle together formed the basis for setting up individual goals together with the nurse. Individual advice on physical training, relaxation exercise and a CD-based relaxation programme was provided by a physiotherapist. Both groups received a brochure about sleep and stress., Results: At a three- to four-month follow-up, the main improvements were seen in the intervention group regarding sleep quality, sleep duration and sleep efficiency in the sleep diary and sleep efficiency in actigraphy. Statistical improvements in health-related quality of life were revealed. This was not so obvious in the control group., Conclusions: An individualised intervention programme to promote self-care of sleep-activity including relaxation in patients with coronary artery disease led by a nurse may improve sleep quality. However, a longitudinal study to promote self-care in sleep-activity should be performed using a larger sample and multiple sites with continuous follow-ups to determine whether any positive effects remain stable over time., Relevance to Clinical Practice: Implementation of a multiprofessional individualised programme to promote self-care of sleep-activity including relaxation based on patients' needs, supported by a healthcare team and led by nurses, is important in clinical practice., (© 2014 John Wiley & Sons Ltd.)

Aims and Objectives: To examine the pretreatment symptoms and symptom clusters that women awaiting breast cancer surgery are experiencing and the impact of these symptoms on their quality of life., Background: Most women diagnosed with breast cancer will have surgery as a first-line treatment. The presence of presurgery symptoms may be significant in contributing to distress and impaired quality of life. While it seems that women with breast cancer may experience the symptoms of fatigue, pain, depression and sleep disturbance as a cluster, this has not yet been confirmed by empirical research in the presurgery time period., Design: A multiple-point prospective longitudinal cohort panel design is used., Methods: Presurgery symptoms and quality of life were assessed using the Hospital Anxiety and Depression Scale, Insomnia Severity Index, Functional Assessment of Cancer Therapy-Fatigue, Brief Pain Inventory and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30(3)., Results: Participants (n = 94, age range 30-92) experienced symptoms prior to surgery, with pain being a more prevalent symptom (35%) than fatigue (32%), sleep disturbances (25·5%) or depression (11%). global quality of life was significantly impacted on by fatigue and showed a moderate correlation with emotional functioning and a weak correlation with physical and social functioning. Hierarchical cluster analysis identified the presence of five clusters with symptoms present in differing intensities in each cluster., Conclusion: In this cohort of women, healthy other than having a diagnosis of breast cancer, symptoms were impacting on quality of life. It is evident that clusters of symptoms are present presurgery that must be assessed and managed., Relevance to Practice: Healthcare delivery systems must ensure that early symptoms are addressed effectively in the presurgery period to improve quality of life and reduce adverse outcomes postsurgery., (© 2013 John Wiley & Sons Ltd.)