睡眠护理干预对改善脑卒中患者睡眠颠倒及促进康复的效果

目的:分析脑卒中睡眠颠倒患者经睡眠护理干预的康复效果.方法:选取2019年1月至2020年1月福建省泉州市第一医院城东院区N20区神经内科收治的脑卒中合并睡眠颠倒患者72例作为研究对象,随机分为观察组和对照组,每组36例,对照组实施常规护理,观察组实施睡眠护理干预,并对2组睡眠总有效率、运动功能与日常生活活动评分进行比...     

Cosleeping and Behavioral Sleep Problems in School-aged Children with Neurodevelopmental and Mental Health Disorders

The aim of this study was to explore the presence of sleep-related complaints and their relationship to cosleeping in a sample of 57 children with mental health disorders. Information about the practice of cosleeping was collected through an interview and behavioral sleep problems were evaluated with a subset of items from the Spanish version of the Pediatric Sleep Questionnaire (PSQ). Controlling for age, cosleepers scored higher on insomnia, daytime sleepiness and poor sleep scheduling, compared to solitary sleepers. Therefore, mental health professionals should explore the child's sleep environment and, when necessary, use appropriate interventions to address such problems.     

Addiction treatment: level of care determination

Substance use disorders occur in 10% to 20% of patients presenting to the primary care physician. It is estimated that every fifth patient in a primary care practice has a substance use disorder. One of the challenges for the primary care physician after the initial assessment is a referral to the appropriate level of care. Substance abuse treatment is now a multibillion dollar industry, and there are a wide variety of options for those with resources. Most patients depend on community resources and state- and county-funded programs.     

观察心理护理干预对焦虑症患者睡眠质量的影响

目的:观察心理护理干预对焦虑症患者睡眠质量的影响.方法:选取2018年5月至2019年12月哈尔滨职业技术学院收治的焦虑症患者60例作为研究对象,按照随机数字表法分为观察组和对照组,每组30例,对照组给与基础护理干预,观察组在对照组基础上给予心理护理干预.实施分组治疗,采用自制睡眠质量量表比较2组患者干预前后的睡眠质量...     

The effectiveness of nurse practitioner care for patients with mental health conditions in primary care settings: A systematic review

BackgroundThe nurse practitioner (NP) workforce is key to meeting the demand for mental health services in primary care settings.PurposeThe purpose of this study is to synthesize the evidence focused on the effectiveness of NP care for patients with mental health conditions in primary care settings, particularly focused on primary care NPs and psychiatric mental health NPs and patients with anxiety, depression, and substance use disorders.MethodsStudies published since 2014 in the United States studying NP care of patients with anxiety, depression, or substance use disorders in primary care settings were included.FindingsSeventeen studies were included. Four high-quality studies showed that NP evidence-based care and prescribing were comparable to that of physicians. Seven low-quality studies suggest that NP-led collaborative care is associated with reduced symptoms.DiscussionMore high-quality evidence is needed to determine the effectiveness of NP care for patients with mental health conditions in primary care settings.     

Sleep disorders in advanced cancer patients: prevalence and factors associated

Goals of work Sleep disorders have been invariably reported in cancer population. However, the prevalence of this problem in advanced cancer patients has never been assessed. The aim of this study was to evaluate the frequency of sleep disturbances in terms of quantity and quality, and possible associated factors.Patients and methods A consecutive sample of patients admitted to a pain relief and palliative care unit were surveyed. Patients with severe cognitive problems or who were too ill were excluded. Epidemiological and clinical data, including the performance status, habits, relevant symptoms, and drug use were recorded. Patients were asked to answer a small questionnaire regarding their sleep, and duration and characteristics (nocturnal and diurnal hours slept, falling asleep, awaking, getting back to sleep, early awaking, restoring sleep, nightmares, feeling depressed or anxious). The level of information about the illness was also assessed.Main results Among the causes of admission, pain control was the main indication (about 58%). Of 123 patients surveyed, 30% slept less than 5 h. Women significantly slept more hours than men (p=0.042). Anxiety (p=0.045), falling asleep (p=0.003), awaking (p=0.035), early awaking (p=0.001), getting beck to sleep (p=0.021), and nightmares (p=0.034), were significantly associated with less hours slept. This relationship was highly significant for less restoring sleep, fatigue, and drowsiness (p<0.0005). No differences were found for age (p=0.294), primary tumor (p=0.225), level of information (p=0.529), Karnofsky status (p=0.539), depression (p= 0.095), confusion (p=0.074), possible causes of awaking (p= 0.881), use of opioids (p= 0.798), use of hypnotics (p= 0.197), other morbidities (p=0.460), or use of alcohol or coffee (p= 0.141). Patients admitted for pain control and/or those receiving opioids more frequently had drowsiness (p=0.01) Patients with lower Karnofsky scores had more drowsiness and diurnal hours slept (p=0.01). Anxiety created more difficulties in falling asleep, produced a less restoring sleep, and nightmares. Depression was associated with early awaking, nonrestorative sleep, fatigue, and nightmares. Confusion was associated with fatigue and nightmares.Conclusion Sleep problems appear to be a significant issue for advanced cancer patients. Attention to sleep disturbance needs to be incorporated into the routine practice in palliative care evaluation.     

睡眠护理管理对脑梗死患者病情康复与睡眠质量的影响

目的:研究分析睡眠护理管理对脑梗死患者病情康复与睡眠质量的影响.方法:选取2018年9月至2019年9月宁津县中医院收治的脑梗死患者94例作为研究对象,按照随机数字表法分为对照组和观察组,每组47例,对照组实施传统护理,观察组实施传统护理+睡眠护理管理,护理后对照组间患者病情康复情况与睡眠质量.结果:观察组患者经护理后...     

Sleep and delirium in ICU patients: a review of mechanisms and manifestations

Sleep deprivation and delirium are conditions commonly encountered in intensive care unit patients. Sleep in these patients is characterized by sleep fragmentation, an increase in light sleep, and a decrease of both slow wave sleep and rapid eye movement sleep. The most common types of delirium in this population are hypoactive and mixed-type. Knowledge about the mechanisms of sleep and delirium has evolved over time, but these phenomena are not yet well understood. What is known, however, is that different areas in the brainstem transmit information to the thalamus and cortex necessary for sleep–wake regulation. Delirium is related to an imbalance in the synthesis, release, and inactivation of some neurotransmitters, particularly acetylcholine and dopamine. The relationship between sleep deprivation and delirium has been studied for many years and has been viewed as reciprocal. The link between them may be ascribed to shared mechanisms. An imbalance in neurotransmitters as well as alteration of melatonin production may contribute to the pathogenesis of both phenomena. A better understanding of the mechanisms and factors that contribute to sleep deprivation and delirium can guide the development of new methods and models for prevention and treatment of these problems and consequently improve patient outcomes.     

Cardiometabolic health nursing to improve health and primary care access in community mental health consumers: Protocol for a randomised controlled trial

Background

People with a serious mental illness are at significantly greater risk of poor cardiometabolic health with recent studies showing a greater than two-fold increase in the risk of obesity, infectious diseases, diabetes and cardiovascular disease. Contributing factors to this disparity include poorer health behaviours such as suboptimal physical activity, poor diet, smoking, alcohol and illicit drug misuse. In particular, the limited access to primary health care experienced by people with a serious mental illness has been highlighted. Persons with a serious mental illness are around 30% less likely than those without serious mental illness to receive health assessments, hospital admissions or procedures for cardiovascular disease and diabetes, and are less likely to undergo cancer screening or receive vaccinations. Studies show that mental health consumers may be more likely to use mental health services rather than primary care for contact with the health care system. However mental health nurses report several barriers to their capacity to provide cardiometabolic health care crucial for the treatment of people with a serious mental illness.

Objectives

To assess the impact of a specialist Cardiometabolic Health Nurse on the physical health care of community based mental health consumers.

Setting

Community mental health facility in a large regional centre in Central Queensland, Australia.

Design/methods

Community based mental health consumers will be randomised to receive either usual care, or consultations with a Cardiometabolic Health Nurse. The Cardiometabolic Health Nurse will be responsible for assessing the client and coordinating cardiometabolic health care as required. Post intervention review of health records will be performed with the primary outcome measure being self-reported physical health. Secondary outcomes include the utilisation of primary care services and changes in health behaviours. We hypothesise that the Cardiometabolic Health Nurse will increase the utilisation of health care services for mental health consumers.

Results

Data collection commenced in March 2013 and will conclude September 2013. Preliminary finding are expected in December 2013.     

Improving forensic mental health care for Aboriginal Australians: Challenges and opportunities

Mental illnesses constitute a major burden of disease in Aboriginal Australians and Torres Strait Islanders (hereafter Aboriginal Australians), who are also overrepresented in the prison system. A legacy of colonization compounds such prevalence, and is further exacerbated by the persistence of racial discrimination and insensitivity across many sectors, including health. This research completed in a Western Australian forensic mental health setting identifies non‐Aboriginal health professionals' support needs to deliver high‐quality, culturally‐safe care to Aboriginal patients. Data were collected from health professionals using an online survey and 10 semistructured interviews. Survey and interview results found that ongoing education was needed for staff to provide culturally‐safe care, where Aboriginal knowledge, beliefs, and values were respected. The findings also support previous research linking Aboriginal health providers to improved health outcomes for Aboriginal patients. In a colonized country, such as Australia, education programmes that critically reflect on power relations privileging white Anglo‐Australian cultural dominance and subjugating Aboriginal knowledge, beliefs, and values are important to identify factors promoting or compromising the care of Aboriginal patients and developing a deeper understanding of ‘cultural safety’ and its clinical application. Organizational commitment is needed to translate the findings to support non‐Aboriginal health professionals deliver high‐quality care to Aboriginal patients that is respectful of cultural differences.     

Addressing diversity in mental health care: a review of guidance documents

Discriminated against and marginalised groups of people within our communities continue to be over represented within mental health services and frequently their particular needs are not met. Challenging discrimination and working towards more equitable services are a vital part of anyone's role working within mental health services. This paper provides a review of guidance documents on diversity issues with a particular focus on ethnicity, gender, sexuality, learning disability, spirituality, homelessness and age. The review concludes with a summary of the range of approaches that are currently being advocated for translating guidelines and recommendations into improved and equitable mental health services that meet the needs of service users from a wide range of diverse groups.