Psychosocial Correlates of Insomnia Severity in Primary Care

Purpose: Insomnia is a substantive primary care issue that leads to adverse outcomes. These can be improved by addressing factors that accentuate insomnia severity. Accordingly, this study identifies correlates of insomnia severity and determines whether these relationships vary with sociodemographic attributes. Methods: This correlational cross-sectional study was conducted in a hospital-sponsored primary care clinic and 2 urban, academic family practice centers. Participants consisted of 236 patients 18 years old or older with clinically significant insomnia (Insomnia Severity Index scores of 7 or more). Surveys instruments included the Insomnia Severity Index, SF-8 (Medical Outcomes Study SF-8 global health status measure), CES-D (Center for Epidemiologic Studies-Depression Scale), DBAS (Dysfunctional Beliefs about Sleep scale), SE-S (Self-Efficacy for Sleep Scale), and a researcher-designed demographic survey. Analytic techniques included descriptive statistics to characterize the study sample, Pearson or Spearman Correlation Coefficients to examine individual associations with insomnia severity, and step-wise linear regression to identify net predictors. Results: Insomnia severity was significantly correlated with health status, depression, self-efficacy, and dysfunctional beliefs (P \u3c .001) but not with sociodemographic attributes. Linear regression demonstrated insomnia severity was best predicted by low self-efficacy and high depression scores. Discussion: These findings indicate that clinicians treating insomnia should not only manage comorbid depression but also facilitate self-efficacy for sleep-inducing behavioral change

Acceptability of Behavioral Treatments for Insomnia

Background: Behavioral treatments for insomnia are safe and efficacious but may not be embraced by patients in primary care. Understanding factors associated with acceptability can enhance successful use of these modalities. The objective of this study was to identify demographic and clinical/psychosocial correlates of behavioral insomnia treatment acceptability. Methods: This nonexperimental, inventory-based, cross-sectional study enrolled patients from a hospital-sponsored primary care clinic and 2 urban academic family practices. Participants (n = 236) were 18 years of age or older who had clinically significant insomnia (Insomnia Severity Index score \u3e= 8) and were recruited consecutively at these sites. A study coordinator obtained informed consent then distributed survey materials. Participants received a $10 honorarium. The main outcome measure was the Acceptability Insomnia Treatment Acceptability Scale-Behavioral subscale (ITAS-B). Results: Only acceptability of medications (r = 0.259) and dysfunctional beliefs (r = 0.234) scores had significant bivariate correlations with ITAS-B scores (P \u3c .001). Medication acceptability, dysfunctional beliefs, and self-efficacy accounted for 12.45% of ITAS-B variance in linear regression. Conclusions: Screening for dysfunctional beliefs about sleep may identify patients with interest in behavioral approaches. Improving self-efficacy for sleep may improve acceptance of behavioral insomnia therapies. Interest in behavioral and medication treatments are not mutually exclusive. However, the modest variance reported here suggests other factors impact acceptance of behavioral treatments

The Noncompete Clause and the Nurse Anethetist: An Assessment of Knowledge, Perception, and Experience

Economic pressures and the challenge to maintain competitive advantage have resulted in many health-care entities requiring their practitioners to contractually enter into noncompete clauses (NCCs). Many student registered nurse anesthetists (SRNAs) and Certified Registered Nurse Anesthetists (CRNAs) are unaware of NCCs in employee contracts. An anonymous, web-based questionnaire regard-ing NCCs was distributed to SRNAs and CRNAs nation-wide. Of 242 practicing CRNAs who responded, 147 (60.7%) were employed without a noncompete clause and 22 (9.1%) were unaware whether they had such a provision in their employment contracts. The knowledge level of the nurse anesthetist respondents was low (average score of 55.3%). There was a significant difference in knowledge level between independently practicing CRNAs and group-practice CRNAs (P = .007) as well as practicing CRNAs vs SRNAs (n = 8, P = .006). Independent CRNAs had more experience with declining positions, changing positions, and loss of employment due to NCCs. More CRNAs believed the NCC is not applicable to practice, and no evidence existed to show a relationship between geographic location and having an NCC. Business-minded CRNAs with a practical knowledge of keyterms, concepts, and legal implications of NCCs are in a better position to bargain and negotiate against objectionable provisions

Animal Assisted Therapy in a Special Needs Dental Practice: An Interprofessional Model for Anxiety Reduction

Purpose: Individuals with intellectual and developmental disabilities (IDD) suffer from poor oral hygiene and periodontal disease that may predispose them to systemic diseases. In order to receive dental care, the assistance of a certified registered nurse anesthetist (CRNA) is often needed. The role of the CRNA is to provide sedation to reduce the high level of anxiety demonstrated by many individuals with intellectual disabilities in the dental suite. However, this can become a challenge with patients that are anxious when they arrive. The purpose of this paper is to describe an interprofessional dental team that added a certified therapy dog and handler to reduce anxiety of individuals with IDD when they arrive in the dental suite. Methods: A convenience sample of 30 individuals with intellectual disability seen for dental care in an outpatient setting met with a therapy dog prior to receiving preventative dental care. Comparisons were made between observed anxiety levels and behaviors measured by the ADAMS (anxiety scale) and a researcher-developed behavior tool prior to and after the interaction with the therapy dog. Results:This program suggested that the addition of the therapy dog to the interprofessional team prior to sedation decreased anxiety levels and improved the behavioral outcomes of the individual with intellectual disabilities. Conclusions:The incorporation of a certified therapy dog and handler as part of an interprofessional healthcare team in the dental suite may pay great dividends in improving the compliance and comfort of the individual with intellectual and developmental disabilities during dental care visits

Animal Assisted Therapy in a Special Needs Dental Practice: An Interprofessional Model for Anxiety Reduction

Purpose: Individuals with intellectual and developmental disabilities (IDD) suffer from poor oral hygiene and periodontal disease that may predispose them to systemic diseases. In order to receive dental care, the assistance of a certified registered nurse anesthetist (CRNA) is often needed. The role of the CRNA is to provide sedation to reduce the high level of anxiety demonstrated by many individuals with intellectual disabilities in the dental suite. However, this can become a challenge with patients that are anxious when they arrive. The purpose of this paper is to describe an interprofessional dental team that added a certified therapy dog and handler to reduce anxiety of individuals with IDD when they arrive in the dental suite.Methods: A convenience sample of 30 individuals with intellectual disability seen for dental care in an outpatient setting met with a therapy dog prior to receiving preventative dental care. Comparisons were made between observed anxiety levels and behaviors measured by the ADAMS (anxiety scale) and a researcher-developed behavior tool prior to and after the interaction with the therapy dog.Results: This program suggested that the addition of the therapy dog to the interprofessional team prior to sedation decreased anxiety levels and improved the behavioral outcomes of the individual with intellectual disabilities.Conclusions: The incorporation of a certified therapy dog and handler as part of an interprofessional healthcare team in the dental suite may pay great dividends in improving the compliance and comfort of the individual with intellectual and developmental disabilities during dental care visits

Using Standardized Patients to Teach and Evaluate Nurse Practitioner Students on Cultural Competency

With the increasing diversity in the American population, it is imperative that nurse practitioners learn to manage patients with varying healthcare beliefs and needs. In order to develop culturally competent nurse practitioners, a number of methods have been developed. Many of the current methods focus on improving the awareness and knowledge of nurse practitioners regarding diverse populations. However, very few of the current programs focus on improving the skills and increasing the encounters the students have with diverse populations. This paper focuses on providing nurse practitioner students with diverse encounters using culturally enhanced standardized patient scenarios. The standardized patient programs provide nurse practitioner students with the opportunity to develop knowledge and skills related to cultural competency in a safe environment where the students can practice communication and physical assessment skills as they receive feedback from the patients they are seeing

Sensitizing Students to Functional Limitations in the Elderly: An Aging Simulation

Background and Objectives: Using activities of daily living (ADLs) and instrumental activities of daily living (IADLs) as a focus, faculty at Eastern Virginia Medical School provide an aging simulation exercise for a mandatory fouth-year clerkship in geriatrics. The specific aims of the simulation are to 1) experience the physical frailties of aging, 2) develop creative problem-solving techniques, 3) identify feelings regarding the experience of functional loss, and 4) develop proactive clinical approaches to the care of the elderly. Methods: Students are assigned one of four diagnoses (Parkinson\u27s disease, rheumatoid arthritis, advanced diabetes, or stroke) and are then impaired to simulate the frailties of the condition, using a variety of clothes, bindings, and other devices. In their impaired states, they perform ADLs and IADLs, such as paying bills, organizing their pills, shopping, toileting, dressing, and eating. Results: Evaluation results show the aging simulation to be the highest rated program in the clerkship. A pre- and post-course survey on attitudes toward the elderly showed a statistically significant improvement in students attitudes toward the elderly following the course. Conclusions: Simulation exercises in aging are useful activities for helping students better understand the feelings and needs of the elderly

Telehealth: Preparing Advanced Practice Nurses to Address Healthcare Needs in Rural and Underserved Populations

Healthcare is being confronted with questions on how to deliver quality, affordable, and timely care to patients, especially those in rural areas, in systems already burdened by the lack of providers. Advanced Practice Registered Nurses (APRNs) have been challenged to lead this movement in providing care to these populations through the use of technologies, specifically telehealth. Unfortunately, APRNs have limited exposure to telehealth during their educational experience, thereby limiting their understanding and comfort with telehealth. To address this problem, a telehealth program was developed at a large university that prepares Doctor of Nursing Practice (DNP) APRN students. The telehealth program, embedded into the DNP curriculum, consisted of a simulation workshop, practice immersion, and written project. This program was well received by students, making them aware of the benefits and barriers to the implementation of telehealth as a care delivery modality. Telehealth was embraced as students implemented the program in their own practice

Telehealth and eHealth in Nurse Practitioner Training: Current Perspectives

Telehealth is becoming a vital process for providing access to cost-effective quality care to patients at a distance. As such, it is important for nurse practitioners, often the primary providers for rural and disadvantaged populations, to develop the knowledge, skills, and attitudes needed to utilize telehealth technologies in practice. In reviewing the literature, very little information was found on programs that addressed nurse practitioner training in telehealth. This article provides an overview of both the topics and the techniques that have been utilized for training nurse practitioners and nurse practitioner students in the delivery of care utilizing telehealth. Specifically, this article focuses on topics including 1) defining telehealth, 2) telehealth etiquette, 3) interprofessional collaboration, 4) regulations, 5) reimbursement, 6) security/Health Insurance Portability and Accountability Act (HIPAA), 7) ethical practice in telehealth, and 8) satisfaction of patients and providers. A multimodal approach based on a review of the literature is presented for providing the training: 1) didactics, 2) simulations including standardized patient encounters, 3) practice immersions, and 4) telehealth projects. Studies found that training using the multimodal approach allowed the students to develop comfort, knowledge, and skills needed to embrace the utilization of telehealth in health care

The Importance of Religion for Parents Coping with a Chronically Ill Child

This study examines differences in the stability and consequences of religious coping among parents (N = 102) of chronically ill children. Analyses revealed that changes in religious patterns due to a child\u27s illness were reflected in changes in other, non-religious coping resources. Specifically, parents whose pre-illness religious patterns were satisfactory did not alter their use of other coping resources, whereas parents who reported changes in their religious patterns also made changes in their use of familial financial and social support systems