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The Centers for Disease Control and Prevention estimates that 34.8% of adults in the United States experience non-restorative sleep. The restorative theory of sleep is based on sleep as a means for the restoration of cellular function that is needed for activities when awake. Non-restorative sleep leads to awakening feeling unrefreshed and not ready for the activities of the day three or more times weekly. Aims: The aim of this quality improvement project was to increase restorative sleep by increasing the average amount of sleep over units of 24 h, decreasing perceived insufficient sleep, and decreasing episodes of unintended daytime sleep among patients with depressive symptoms ages 18 to 80 years in an outpatient mental health clinic. Methods: Ten patients with depressive symptoms and reporting non-restorative sleep volunteered to participate in the project. Participants kept a sleep diary and followed principles of healthy sleep such as limiting time in bed and going to bed at the same time nightly. The change in and the average amount of sleep over 24 h and daytime sleepiness were evaluated using the Behavioral Risk Factor Surveillance System. Results: All participants achieved at least one more day of restorative sleep, with nine increasing restorative sleep by at least 30 min per day, and nine having no episodes of unintentionally falling asleep.

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Graduate students in a psychiatric mental health nurse practitioner program in the United States and undergraduate students in a first-year English course, Writing and Rhetoric, at a university in Ecuador participated in a Collaborative Online International Learning (COIL) experience in Fall Semester 2021. The purpose of the COIL experience was to develop global perspectives and cultural competencies regarding diversity and inclusion in mental health. The objectives of the COIL experience were to identify and discuss changes in thinking in four areas: eugenics and cultural bias, cultural bias in research, culture and mental illness, and institutional and care policies. Groups of students created educational posters about diversity and inclusion in mental health that were presented at a virtual mini conference to which other students and faculty at the participating universities were invited.

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Background: The Centers for Disease Control and Prevention (CDC) reported that between 28.5% and 44.1% of adults in the US sleep less than seven hours nightly. Aims: The aim of this quality improvement project was to improve sleep quality and duration among patients aged 40 and older with insomnia disorder in an outpatient mental health clinic. Methods: Patients diagnosed with insomnia disorder who were sleeping less than seven hours at least three nights weekly participated in the project (n = 20). Sleep hygiene education was provided and participants kept a sleep diary. The duration and quality of sleep was evaluated by comparing the information recorded in the diaries with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition description of insomnia disorder. Results: All participants achieved improvement to 6-8 hours of restful sleep nightly.

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Sleep problems are prevalent among youth with mental health disorders. Consistent with national statistics, sleep problems were present in approximately 80% of the patients attending a children's hospital psychiatric partial hospitalization program in the Midwestern United States. The aim of this quality improvement (QI) project was to decrease sleep problems in youth with mental health disorders. The Pittsburgh Sleep Quality Index (PSQI) was administered to patients ages 12-18 with mental health disorders to screen for sleep problems. Patients identified by the PSQI as having a sleep problem, and their parents, were given verbal and written education on sleep hygiene practices and stimulus control. Each patient participated in a cognitive behavioral therapy group that included relaxation therapy. Evidence-based interventions used to improve sleep were reinforced daily by providers. Self-reported sleep quality, as measured by the PSQI, was improved in 95% of the patients participating in this QI project. Adequately screening for and treating sleep problems in youth with mental health disorders can lead to improved outcomes.

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This article is a report of a project to improve the quality and duration of sleep among patients ages 3-17 years in an outpatient mental health clinic. The Pediatric Insomnia Severity Index (PISI) (now the Behavioral Sleep Medicine Clinic Sleep Questionnaire) was administered at baseline. Patients and parents were provided with education about the American Academy of Pediatrics sleep tips. Compliance with the sleep tips was tracked using an electronic health record (EHR) checklist. The PISI was administered again after the interventions and showed overall improvement in sleep quality and duration. Some patients experienced no change or a decline in sleep quality or duration and some had an increase in daytime somnolence.

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Introduction: Judaism, Christianity, and Islam are three world religions that occupy much of the world stage in health care, journalism, and media. Nurses frequently provide care for representatives of these groups. Culturally competent nurses recognize that there are differences and similarities within and between these religions. Methodology: This article incorporates findings from a scholarly review of the literature and transcultural nursing/health care principles and is guided by Leininger's Culture Care Diversity and Universality Theory. It discusses the roots from which these religions emerged, and the similarities and differences in religious beliefs and practices as pertained to health care. Conclusion: Nurses and other health care professionals may use knowledge presented in this article to conduct individualized cultural assessments and provide culturally congruent health care to Jewish, Christian, and Muslim populations. Leininger's three culture care modes of decisions and actions offer a creative approach to providing meaningful and helpful culturally sensitive care.

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Depression management in primary care settings is the norm, in the United States and globally. As incidence and prevalence of depression continue to mount, there are innovative models of treatment, newer understandings, more open philosophies, and evidence-informed treatments that may address this troubling public health issue. This article attempts to succinctly examine the evidence in identifying and treating this in the United States in an expedient, evidence-informed manner to assist those in need of have care that is patient centered, of high quality, affordable, and readily accessible across the lifespan.

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Management of attention-deficit/hyperactivity disorders require provider skill, rapport, and referral acumen to treat patients across the life span. Incidence and prevalence have increased in the United States and globally. There are innovative models of evidence-informed screening techniques, treatment strategies to help providers work with patients and their families. Diplomatic management of highly charged treatment controversies, drug diversion, and risk factor reduction helps to ethically address this growing public health phenomenon. This article examines risk factors and treatment considerations in the United States for evidence-informed care, with a focus on affordable and readily accessible treatment in primary care settings.

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Nurses provide care for people of many cultures. Understanding the patient's culture and incorporating cultural beliefs and practices into care are important to the patient's holistic well-being. Cultural and professional awareness creates culturally congruent care. Biblical teachings remind us to love one another; laws require culturally appropriate care, and nursing theory lays the path for understanding. The purpose of this article is to present a Christian view of caring, the theoretical and ethical underpinnings of cultural care, and the organizational and legal aspects of doing what is right.

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The Future of Nursing: Leading Change, Advancing Health was published by the of Medicine (IOM) of the National Academies in 2011. The Missouri Nurses Foundation and Missouri nurses modeled a sustainable project, the Early Career Nurse Innovator Project, exemplifying the intent of that report. The Missouri Nurses Foundation Executive Board comprises experienced nurses, nurse educators, nurses in other leadership roles, retired nurses, public members of the board, and administrative support staff. This article describes a project that was developed, implemented, and evaluated to recognize and encourage early-career nurses who have designed and led innovations to improve and promote the health of Missourians. Five of these early-career nurses were the recipients of monetary awards to encourage future innovations; the second recognition cycle is in the planning phase. Through the work of the Missouri Nurses Foundation, the scholarship of bedside nurses was recognized.

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Distress remains a pervasive experience of patients with cancer. As a result, a quality improvement project was conducted in the breast cancer clinic of a university cancer center in the midwestern United States. Nurses identified a need to increase identification of distress over a six-month period when they made only eight referrals for distress support during 1,291 patient encounters. The eight referrals were the result of patient exhibitions of severe distress in the clinic. To increase identification of distress, as well as referrals for support before patients exhibited severe distress, the National Comprehensive Cancer Network's Distress Thermometer screening tool was implemented in the clinic from June 1 through July 6, 2010. The instrument was completed by each participant during a patient encounter, followed by a review of the responses with a nurse. Referrals for support were offered by nurses when responses indicated a significant level of distress. Nurses increased identification of distress by using the instrument. In addition, referrals for support increased before patients exhibited severe distress. Nurses are positioned to improve care by identifying distress and making referrals for support.

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BACKGROUND: This 10-year retrospective chart review evaluates the potential impact the most recent U.S. Preventative Services Task Force (USPSTF) report recommending against annual mammographic screening of women aged 40-49 years. METHODS: The medical record database was systematically searched to discover all women aged 40-49 years treated for breast cancer over a 10-year period. These women were separated into 2 cohorts-mammographically detected cancer (MDC) and nonmammographically detected cancer (NMDC). Statistical analysis of the cohorts was performed for family history (FH), sentinel lymph node (SLN) status, tumor size at presentation, and disease-free and overall survival. RESULTS: A total of 1581 women were treated for breast cancer; of these, 311 were between the ages of 40 and 49 years with complete diagnostic information, 145 were MDC, and 166 were NMDC. The average tumor diameter of the MDC group was 20.68 mm, which was significantly smaller than that of the NMDC group at 30.38 mm (P < .0001). Women with MDC had a significantly lower incidence of SLN positive cancer than the NMDC group, 28 of 113 (24.78%) vs. 85 of 152 (55.92%; P < .0001), respectively. The 5-year disease-free survival for both groups was MDC 94% (95% confidence interval [95% CI], 87-97%) and NMDC 71% (95% CI 62-78%). The overall 5-year survival estimates were MDC 97% (95% CI 92-99%) and NMDC 78% (95% CI 69-85%), respectively. CONCLUSION: This review demonstrates the significance of mammographic screening for early detection and treatment of breast cancer. Mammographic screening in women aged 40-49 detected smaller tumors with less nodal metastasis, resulting in improved survival, which supports annual mammographic screening in this age group.

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