Association of Insomnia and Obstructive Sleep Apnea with Worse Oral Mucositis and Quality of Life in Head and Neck Cancer Patients Undergoing Radiation Therapy.

Background: Patients with head and neck cancer (HNC) undergoing radiation therapy (RT) often experience sleep disturbances that may contribute to oral mucositis (OM) and quality of life (QOL).

Methods: Patients with HNC treated with RT at a single institution were examined. Sleep questionnaires were given on the first day of RT to assess for insomnia and obstructive sleep apnea (OSA).

Electronic health record competency in graduate nurses: A grounded theory study.

Background: The use of electronic health records is ubiquitous in healthcare settings, yet newly graduated nurses struggle with developing electronic health record competency prior to entry into nursing practice. Insufficient electronic health record knowledge, skills, and attitudes among newly graduated nurses are contributing to patient harm, clinical burn-out, and unsafe practices. In this study, we interviewed electronic health record educators to identify how newly graduated nurses develop electronic health record competency characteristics and to learn about their educational approaches for teaching electronic health record proficiency.

Deep learning classification of capnography waveforms: secondary analysis of the PRODIGY study.

Capnography monitors trigger high priority 'no breath' alarms when CO measurements do not exceed a given threshold over a specified time-period. False alarms occur when the underlying breathing pattern is stable, but the alarm is triggered when the CO value reduces even slightly below the threshold. True 'no breath' events can be falsely classified as breathing if waveform artifact causes an aberrant spike in CO values above the threshold.

Electronic Health Record Knowledge, Skills, and Attitudes Among Newly Graduated Nurses: A Scoping Review.

Background This scoping review aimed to identify key characteristics related to electronic health record (EHR) end-user system optimization levels among graduating/newly graduated nurses. Method Using a systematic approach to conducting a scoping review, 11 articles were identified from three databases. Articles were reviewed for nursing level status, type of EHR used for research, type of assessment, and which EHR knowledge, skills, or attitudes were studied.

An Educational Intervention to Improve Comfort with Applying and Interpreting Transcutaneous CO and End-tidal CO Monitoring in the PACU.

Purpose: The purpose of this study was to assess the effectiveness of an educational program about measuring ventilation using devices that assess carbon dioxide levels in patients recovering from a surgical procedure.

Design: A pre-post survey of knowledge attainment from an educational intervention about measuring ventilation using end-tidal carbon dioxide (EtCO) and transcutaneous carbon dioxide (tcPCO) devices in the postanesthesia care unit (PACU) was distributed to current members of the American Society of PeriAnesthesia Nurses.

Methods: Participants received a 12-question pre-intervention (five were related to demographics) and a five-question post-intervention survey.

Nurses' Experience and Perception of Technology Use in Practice: A Qualitative Study Using an Extended Technology Acceptance Model.

The purposes of this study are to provide insight into the factors identified as benefits and drawbacks of technology use by nurses and obtain suggestions on improving technology, based on challenges identified to improve patient outcomes. Holden's extended technology acceptance model was used to describe nurses' perception of technology use in practice. A descriptive design and thematic analysis were used to evaluate participants' logged reflections of their experiences and suggestions for improvements of health information technology.

Patient Deterioration on General Care Units: A Concept Analysis.

Patient deterioration is a phenomenon that occurs from the inability to recognize it or respond to a change in condition. Despite the published reports on recognizing a deteriorating patient on general care floors, a gap remains in the ability of nurses to describe the concept, affecting patient outcomes. Walker and Avant's approach was applied to analyze patient deterioration.

Predicting Prolonged Apnea During Nurse-Administered Procedural Sedation: Machine Learning Study.

Background: Capnography is commonly used for nurse-administered procedural sedation. Distinguishing between capnography waveform abnormalities that signal the need for clinical intervention for an event and those that do not indicate the need for intervention is essential for the successful implementation of this technology into practice. It is possible that capnography alarm management may be improved by using machine learning to create a "smart alarm" that can alert clinicians to apneic events that are predicted to be prolonged.

Modeling the Cost Savings of Continuous Pulse Oximetry and Capnography Monitoring of United States General Care Floor Patients Receiving Opioids Based on the PRODIGY Trial.

Introduction: Despite the high incidence of respiratory depression on the general care floor and evidence that continuous monitoring improves patient outcomes, the cost-benefit of continuous pulse oximetry and capnography monitoring of general care floor patients remains unknown. This study modeled the cost and length of stay savings, investment break-even point, and likelihood of cost savings for continuous pulse oximetry and capnography monitoring of general care floor patients at risk for respiratory depression.

Methods: A decision tree model was created to compare intermittent pulse oximetry versus continuous pulse oximetry and capnography monitoring.

Opioid-induced respiratory depression increases hospital costs and length of stay in patients recovering on the general care floor.

Background: Opioid-induced respiratory depression is common on the general care floor. However, the clinical and economic burden of respiratory depression is not well-described. The PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) trial created a prediction tool to identify patients at risk of respiratory depression.

Healthcare Shift Workers' Temporal Habits for Eating, Sleeping, and Light Exposure: A Multi-Instrument Pilot Study.

Background: Circadian misalignment can impair healthcare shift workers' physical and mental health, resulting in sleep deprivation, obesity, and chronic disease. This multidisciplinary research team assessed eating patterns and sleep/physical activity of healthcare workers on three different shifts (day, night, and rotating-shift). To date, no study of real-world shift workers' daily eating and sleep has utilized a largely-objective measurement.

Prediction of Opioid-Induced Respiratory Depression on Inpatient Wards Using Continuous Capnography and Oximetry: An International Prospective, Observational Trial.

Background: Opioid-related adverse events are a serious problem in hospitalized patients. Little is known about patients who are likely to experience opioid-induced respiratory depression events on the general care floor and may benefit from improved monitoring and early intervention. The trial objective was to derive and validate a risk prediction tool for respiratory depression in patients receiving opioids, as detected by continuous pulse oximetry and capnography monitoring.

Prediction model development of women's daily asthma control using fitness tracker sleep disruption.

Background: Night-time wakening with asthma symptoms is an important indicator of disease control and severity, with no gold-standard objective measurement.

Objective: The study objective was to use fitness tracker sleep data to develop predictive models of daily disease control-related asthma-specific wakening and FEV in working-aged women with poorly controlled asthma.

Methods: A repeated measures panel design included data from 43 women with poorly controlled asthma.

Efficacy of Precise Foot Massage Therapy on Pain and Anxiety Following Cardiac Surgery: Pilot Study.

Background: Pain is the most pervasive distressing symptom following cardiac surgery. Forty percent of postoperative cardiac patients report inadequate pain management. Undertreated acute pain results in increased anxiety, delayed wound healing, and increased chance of persistent chronic pain.

Nurse-Delivered Brief Behavioral Treatment for Insomnia in Lung Cancer Survivors: A Pilot RCT.

: Insomnia occurs in 50 to 80% of lung cancer survivors. Cognitive behavioral therapy is the standard treatment for insomnia (CBTI); however, treatment length and lack of psychologists trained in CBTI limits access. Brief Behavioral Treatment for Insomnia (BBTI), a nurse-delivered modified CBTI, is proposed.

American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression: Revisions.

Objectives: This report presents up-to-date evidence and expert consensus-based revisions to the ASPMN 2011 guidelines that inform interprofessional clinical decision-making for hospitalized adults receiving opioid analgesics.

Design: Systematic review of the literature.

Methods: A 14-member expert panel was charged with reviewing and grading the strength of scientific evidence published in peer reviewed journals and revising the ASPMN 2011 existing guidelines.

Opioid-Induced Sedation and Respiratory Depression: Are Sedation Scales Enough to Prevent Adverse Drug Events Postoperatively?

Objectives: Nurses who care for hospitalized patients are responsible for ensuring adequate pain management is provided in a safe manner. The clinical challenge is balancing the effective control of the patient's pain with the side effects of administering opioids. The aim of this literature review is to explore the evidence on how nurses assess for opioid-induced sedation and advancing respiratory depression and how they integrate those data in their critical thinking skills when deciding to administer opioids for pain.

Identifying Patients Experiencing Opioid-Induced Respiratory Depression During Recovery From Anesthesia: The Application of Electronic Monitoring Devices.

Background: Postsurgical patients experiencing opioid-related adverse drug events have 55% longer hospital stays, 47% higher costs associated with their care, 36% increased risk of 30-day readmission, and 3.4 times higher risk of inpatient mortality compared to those with no opioid-related adverse drug events. Most of the adverse events are preventable.

Preventing Opioid-Induced Respiratory Depression in the Hospitalized Patient With Obstructive Sleep Apnea.

Purpose: To enhance the role of nursing interventions in the management of perioperative opioid-induced respiratory depression (OIRD) in patients with obstructive sleep apnea (OSA).

Design: Narrative review of the literature.

Methods: Literature reviewed with emphasis on recommendations by professional and accrediting organizations.

The common meanings and shared practices of sedation assessment in the context of managing patients with an opioid: A phenomenological study.

Aims And Objectives: To examine the common meanings of opioid-induced sedation and shared practices in the context of post-operative pain management in expert Post-Anesthesia Care Unit nurses during patient's pain management with opioids.

Background: Within the clinical setting, linear pain and sedation scales are not enough to support clinical judgement with acute pain management. Because sedation measurement rests along a fluctuating continuum, it is possible for a patient to be sedated and then shift to increasing alertness, and then to drift back to a sedated state.

Validation of fitness tracker for sleep measures in women with asthma.

Objective: Nighttime wakening with asthma symptoms is a key to assessment and therapy decisions, with no gold standard objective measure. The study aims were to (1) determine the feasibility, (2) explore equivalence, and (3) test concordance of a consumer-based accelerometer with standard actigraphy for measurement of sleep patterns in women with asthma as an adjunct to self-report.

Methods: Panel study design of women with poorly controlled asthma from a university-affiliated primary care clinic system was used.

Sedation scales: Do they capture the concept of opioid-induced sedation?

Aim: The purpose of this study was to explore the concept of opioid-induced sedation and how nurses define and measure sedation in the hospital setting.

Background: Opioid medications are the primary treatment for acute pain in the postoperative setting. One of the most serious side effects of opioid therapy is excessive sedation and respiratory depression.

Current Ketamine Practice: Results of the 2016 American Society of Pain Management Nursing Survey on Ketamine.

Background: Ketamine is increasingly utilized for a variety of pain management challenges. Audience comments from a ketamine presentation at the 2015 American Society of Pain Management Nursing (ASPMN) Conference reflected wide variation in ketamine practices as well as barriers to use.

Aim: The goal was to gain a greater understanding of ASPMN member practice patterns and barriers related to ketamine as adjunctive therapy for pain management.

Perioperative Implementation of Noninvasive Positive Airway Pressure Therapies.

Noninvasively applied positive airway pressure therapy (PAP) is available in 3 basic modes: continuous positive airway pressure (CPAP), bi-level positive airway pressure (BPAP), and adaptive servo-ventilation. These are in widespread use in home and hospital settings to treat a variety of disorders of ventilation or gas exchange, including obstructive sleep apnea, sleep-related hypoventilation, periodic breathing, acute and chronic hypercapnic respiratory failure, and acute respiratory failure. They are increasingly being used perioperatively to prevent or treat upper airway obstruction, hypoventilation, and periodic breathing, and they have been found to improve postoperative outcomes in the case of obstructive sleep apnea.