Grace E. Dean

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.

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.

Sleep-wake disturbances in cancer patients: narrative review of literature focusing on improving quality of life outcomes.

Purpose Evidence suggests a high prevalence of sleep–wake disturbances in patients with cancer, occurring at diagnosis, during treatment, and continuing to survivorship. Yet associations between sleep–wake disturbances and the impact on quality of life outcomes is less clear. The purpose of this narrative review of the literature is to evaluate sleep–wake disturbances in patients with cancer, to describe the influence of poor sleep on quality of life as an outcome, and to evaluate the evidence to recommend future interventions. Framework and methods This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. Four databases (CINAHL, MEDLINE, PsycINFO, and Embase) were searched using terms “cancer OR neoplasm”, “sleep, sleep disturbance, sleep disorders or insomnia”, and “quality of life”; the search included all years, English language, and peer-reviewed articles on research studies. Studies included measurements of sleep and quality of life in cancer patients at a minimum of two time points and demonstrated relationships between sleep and quality of life. Data were collected on date, patient demographics, cancer type and treatment, timeframe, design, measurement, variables, and results. Results This narrative review demonstrates that sleep–wake disturbance is a major problem/symptom in patients with cancer. Of the 18 studies included, measurement of sleep-related variables included objective and subjective measures; however, direct measurement of the associations between sleep and quality of life was not common. Cognitive behavioral therapy for insomnia and mind–body interventions demonstrated feasibility when implemented into cancer care settings. In addition, the majority of interventions exhibited moderate effectiveness in improving sleep–wake disturbance and quality of life outcomes. Conclusion The studies predominantly reported that poor sleep negatively impacts quality of life. The intervention studies included nonpharmacologic interventions such as cognitive behavioral treatment and mind–body and exercise interventions with moderate-to-high levels of evidence for improvement in sleep measures and quality of life.

Sleeping with the enemy: sleep and quality of life in patients with lung cancer.

Background: Patients with lung cancer have the poorest sleep quality compared with other patients with cancer and noncancer control subjects. However, few studies have examined sleep longitudinally. Objective: The objective of this study was to characterize and correlate sleep quality, daytime sleepiness, sleep-wake actigraphy, and quality of life (QOL) before, during, and after chemotherapy for non–small cell lung cancer (NSCLC). Methods: Using a prospective repeated-measures 1-group design, patients scheduled to receive chemotherapy for NSCLC were recruited. Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Functional Assessment of Cancer Treatment–Lung (FACT-L), and Motionlogger Actigraph were used for data collection. Results: Poor nocturnal sleep and QOL were evident among 29 patients with NSCLC before treatment. The FACT-L subscale scores worsened and then improved significantly from baseline through 2 rounds of chemotherapy. Objective sleep duration and sleep efficiency were positively associated with FACT-L scores, whereas objective sleep latency and wake after sleep onset were negatively associated with FACT-L scores. Sleepy patients had significantly worse FACT-L scores than did nonsleepy patients. The FACT-L subscale items that demonstrated significant worsening and then improvement over time were shortness of breath, weight loss, coughing, and chest tightness. Lung cancer patients experience early and middle insomnia before and during treatment. Conclusion: Poor sleep quality is common in patients receiving treatment for NSCLC and is related to poorer QOL and respiratory symptoms. Implication for Practice: Patients with NSCLC require routine screening for sleep disturbances. A positive screen for sleep disturbance warrants a thorough sleep assessment using practice guidelines and, if necessary, referral to a sleep specialist for diagnosis and treatment.

Research to Practice: A Practical Program to Enhance the Use of Evidence-Based Practice at the Unit Level

PURPOSE/OBJECTIVES To assist clinical nurses in translating research into clinical practice. DATA SOURCES City of Hope Quality-of-Life (QOL) Model to guide presentations and discussion, research utilization theories, and evidence-based practice literature. DATA SYNTHESIS Based on percentage of individual participant involvement, the four domains of QOL, and a knowledge survey. OUTCOMES Attendance, discussion, QOL domain ranking, satisfaction, and pre- and postknowledge scores. Attendance averaged 13 individuals; average discussion participation was 54%. The psychological QOL domain was most important (58%), and discussion averaged a score of 3 (1 = slow to 5 = lively). A one-point increase (scale 1-5) measured a change in knowledge. CONCLUSIONS The challenge for nursing assessment is to fully address patient issues in the psychological domain. IMPLICATIONS FOR NURSING A practical program can be formulated to bring evidence-based practice to the clinical setting.

Implementing a Dedicated Education Unit: A Practice Partnership With Oncology Nurses

An urgent need exists to identify innovative and evidence-based educational methods to help oncology nurses provide safe and high-quality patient care. One promising solution is the dedicated education unit (DEU) educational model, which partners nursing faculty and skilled nursing clinicians to facilitate the clinical experience of undergraduate baccalaureate nursing students. This article describes the collaborative DEU initiative developed between a university school of nursing and a tertiary cancer center to provide senior nursing students with an innovative method to develop their competencies in oncology nursing practice and care.

Sleep in Lung Cancer: The Role of Anxiety, Alcohol and Tobacco

&NA; Lung cancer patients constitute a subgroup of cancer patients most at risk for experiencing sleep disturbances. Anxiety is not a significant problem in this population, but may be blunted by alcohol use or smoking. The purpose of this study is to describe anxiety, alcohol use, smoking, and sleep disturbances in a sample of patients with lung cancer. Guided by the classic model of insomnia by Spielman, this study describes anxiety as a predisposing factor, alcohol use and smoking as precipitating factors, and perpetuating factors that maintain or exacerbate sleep disturbances. Nurses across all specialty areas should address these modifiable factors during encounters with patients with lung cancer.

Experiences of Patients With Advanced Lung Cancer: Being Resigned to Sleep-Wake Disturbances While Maintaining Hope for Optimal Treatment Outcomes.

Background: Sleep-wake disturbances are prevalent in patients with lung cancer yet are infrequently studied over time. This article reports on the qualitative results of a mixed-methods study of newly diagnosed patients’ narratives over 6 months. Objective: The objective of this study was to gain an understanding of the treatment and illness trajectory related to sleep-wake disturbances as well as the beliefs and practices of patients while seeking optimal treatment outcomes. Methods: Longitudinal interview narratives of 26 patients’ experiences with advanced lung cancer diagnosis (at baseline, pre–second and third treatment, and 6 months) were obtained from participants recruited from Veterans Administration Hospital Center and a Comprehensive Cancer Center in Northeast United States. Analysis of illness narratives used interpretive phenomenology based on Heideggarian hermeneutic traditions. Results: At diagnosis, participants described poor sleep such as trouble falling asleep and frequent awakenings. Over time, as the treatment worsened their sleep symptoms, these participants still maintained hope for more time with treatment. This focus enabled them to tolerate the sleep-wake disturbances and treatment adverse effects. As the treatment effectiveness declined, their focus changed to spiritual meanings for the future and to keep living life with a purpose. Conclusions: By explicating lung cancer patients’ experiences with sleep-wake disturbances, nurses will gain insight into potential interventions to improve sleep and support effective outcomes as well as open a dialogue about hope. Implications for Practice: Findings offer insight for oncology nurses to provide opportunities for dialogue about treatment options and techniques to improve sleep, which will facilitate patients living their lives.

Sleep-wake disturbance: A systematic review of evidence-based interventions for management in patients with cancer

&NA; Figure. No Caption available. BACKGROUND: New or worsening sleep‐wake disturbance (SWD) can occur throughout the cancer trajectory. OBJECTIVES: The purpose of this article is to critically review available empirical evidence supporting the efficacy of interventions for SWD, highlighting new evidence since the 2006 and 2009 Putting Evidence Into Practice (PEP) SWD publications. METHODS: A systematic review of studies published from 2009‐2017 was conducted to identify effective interventions for cancer‐related SWD. The PEP weight of evidence classification schema was used to categorize the strength of evidence. FINDINGS: Cognitive behavioral intervention/approach is the only intervention that is recommended for practice. Mindfulness‐based stress reduction and exercise interventions are likely to be effective but require more evidence. Pharmacologic interventions, relaxation, imagery, meditation, acupuncture, yoga, massage, and psychoeducation have insufficient evidence.

Impaired Sleep: A Multifaceted Geriatric Syndrome.

Impaired sleep increases in prevalence in older adults, with multiple possible causes that can interact with each other and can lead to poor health outcomes. This article describes normal changes in sleep with aging, sleep disorders that increase in prevalence in older adults, medications and sleep, and medical conditions and psychosocial conditions associated with impaired sleep. In addition, a brief assessment that nurses could use to assess for impaired sleep and nonpharmacologic interventions to improve sleep are discussed.