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February 2016: Sleep
Important Not-to-Be Missed Events!



Improving Care Transitions - Utilizing a Geriatric Interprofessional Scholar Program to Hard-wire Geriatric Processes Throughout a Hospital
Date: Feb. 17, 2016 | 
Time: 1:00 PM EST

The Delirium Observation Screening Scale (DOS Scale)
Date: March 9, 2016 | 
Time: 1:00 PM EST
NICHE Member Advances and Resources Update: Sleep

Older adult sleep problems include excessive sleepiness, difficulty falling or staying asleep, sleep apnea, insomnia, and restless leg syndrome. As people age, medical conditions and medications may cause sleep problems. The following is an excerpt from Eileen R. Chasens and Mary Grace Umlauf, Excessive Sleepiness. In: M. Boltz, E. Capezuti, T. Fulmer, & D. Zwicker (eds.) Evidence-Based Geriatric Nursing Protocols for Best Practice (4th ed.). New York: Springer Publishing.
 
Excessive sleepiness is common in the older adult. Fatigue manifests as difficulty in sustaining a high level of physical performance; excessive sleepiness refers to the inability to maintain alertness or vigilance due to hypersomnolence. Many factors can affect nighttime sleep and result in daytime sleepiness in older adults. These include psychological disorders, symptoms of chronic illnesses (e.g., pain), medication side effects, environmental factors, and lifestyle preferences. Increases in sleepiness can result from age-related changes in chronobiology and sleep disorders. 
 
Hospitalization and transitions to other care settings can also interfere with sleep quality or quantity. There are many effective treatments for sleep disorders, but the first step is to identify the cause of excessive daytime sleepiness and then to quantify and aggressively treat this condition in the older adult.
 
Following is an approach developed at a NICHE Hospital related to sleep problems.
Innovation from a NICHE Organization

Delirium Prevention: Making the "Case" for the Importance of Sleep
 
2015 NICHE Conference Poster Presentation. Authors: Carolyn Moretti, RN, BSN, and Stephanie Connor, GRN, BSN, Our Lady of Fatima Hospital, North Providence, Rhode Island.

One of the precipitating risk factors of delirium is a disturbance in the sleep/wake cycle. NICHE GIAP results provided an indication that sleep education should be considered as a step toward delirium prevention in the older adults at this hospital. The site's own educational needs assessment revealed that the stages of sleep, sleep conditions affecting older adults, and beneficial sleep hygiene measures were poorly understood by CNAs and RNs. Also, patients expressed via Press Ganey Scores - and confided in interviews based on the Pittsburg Sleep Index - that the restful environment necessary for quality sleep was often lacking.

Promoting knowledge of non-pharmacological sleep interventions was a goal of the education program developed by Our Lady of Fatima Hospital. The program employed a variety of training elements dealing with:
  • Effects of light exposure on the circadian rhythm
  • Beneficial effects of sleep on immune response, healing, handling of stress
  • Altered gene activity due to insufficient sleep (less than six hours)
  • CVD, DM, obesity, poor brain function, and impaired memory due to sleep deprivation
The program helped improve overall quality improvement scores. There was a significant rise in GIAP Sleep Knowledge Scores (3.8 to 4.24). There was a 30% increase in CNA/RN knowledge post education. And the score for the HCAHPS question "Quietness of hospital environment" improved from 35 in Q3 2013 to 70 in Q2 2014.

NICHE-related Resources
Full access to some of the resources referenced here is only available to NICHE member hospitals.
NICHE GRN Course
Geriatric Resource Nurse
(GRN) Curriculum

NICHE GPCA Course
Geriatric Patient Care Associate (GPCA) (2nd Edition)
 
Critical Care Nursing of Older Adults Course

NICHE Need to Know Sheet
Need to Know by NICHE Series and NICHE for Patient+Family Mobile App
NICHE Online Connect Webinars
NICHE for Patient+Family Encyclopedia 
Evidence-Based Geriatric Nursing Protocols for Best Practice Book (4th ed.)
Other Resources
Spotlight on NICHE
The nurse's role is crucial in making care transitions for the older adult patient NICHE article ...View the article
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Program to improve healthcare in the communities: NICHE  
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Girl Scout Donates Handmade Pillows to Patients in NICHE Program ...View the article

Visit the NICHE Team at:

March 3-5, 2016, Philadelphia, PA
_________________________________________________________________
 
March 17-20, 2016, Washington, D.C.

NICHE � NEW YORK UNIVERSITY COLLEGE OF NURSING
250 Park Ave South, 6th Floor, New York, NY 10003
212.998.5445 � email: [email protected] � nicheprogram.org 
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