1. Baird, Carol L.

Article Content

In our hectic world of nursing, it is impossible to read as many journals as we want-or should-to note new research studies important for our field. However, one way to know what is going on in research is to read reviews of research. Reviews may be found by doing a computer search. Most hospital libraries have broad nursing literature search capabilities through CINAHL. A librarian can help you "log on" and complete a search.


I found that there are two routes to search. One way is to search "research review." This will find approximately 200 articles with those specific words in the title or key words. However, because some review articles do not have the specific words, "review of research," it may be useful to search for a specific topic, such as "osteoporosis," and scan through the abstracts to note that are actually reviews or compilations of findings. Here are three reviews with interesting information for orthopaedic nurses.


Creamer, P., & Hochberg, M. C. The relationship between psychosocial variables and pain reporting in osteoarthritis of the knee. Arthritis Care and Research, 11, 60-65.


This review is reported to be a summary of the psychosocial factors associated with perceived pain in knee osteoarthritis (OA). However, the only social factor reviewed is level of education. Less formal education (particularly less than 8 years) is related to increased reporting of pain and disability. This is true even when risk factors of age, knee injury, obesity, and radiographic severity were controlled. The authors do not explain why they excluded other social factors, such as income or social support


Research findings about psychologic factors were described more thoroughly. Depression and anxiety were both negative emotions associated with knee pain. According to two large studies, the NHANES-1 and New Haven Survey of Joint Disease, a significant number of people with knee pain reported more low spirits, low energy level, and less freedom from health worry than those without knee pain.


Several other studies found a significant relationship between depression and/or anxiety and severity of knee pain, rather than just the presence of pain. According to other studies, people with arthritis were at greater risk of depression than those with other chronic diseases, such as diabetes. The rate of depression was also higher for hospitalized patients with OA when compared to community-residing adults with OA. Other indications of psychologic distress, such as presence of recent life stress and the personality trait of hypochondriasis, were also related to knee arthritis.


The review also contained information about possible interventions associated with psychosocial factors. The interventions included social support, education, and cognitive-behavioral interventions as tools to reduce pain and improve physical functioning. Social support interventions, such as regular telephone contact, were effective in enhancing self-esteem and decreased psychologic distress. Educational programs were effective in increasing belief in the ability to reduce pain and improve function. Finally cognitive-behavioral interventions, such as cognitive reframing and teaching people ways to cope with their pain, were also effective. A very positive aspect of this review was the discussion of methodologic and design flaws in research that could have affected outcomes.


Redeker, N.S. (2000). Sleep in acute care settings: An integrative review. Journal of Nursing Scholarship, 32, 31-38.


Because many orthopaedic nurses work in acute-care settings or have patients in those settings, many orthopaedic nurses are concerned about restorative rest while the patient is hospitalized. This review provides a review of 30 years of research concerning sleep patterns and disturbed sleep of patients in acute care settings. One of the purposes of the examination is to present sleep patterns, factors influencing sleep, and sleep interventions in adult patients in acute care settings.


According to the reviewer, sleep studies showed sleep deprivation in many acutely ill patients. Sleep was predominantly stage 1, with a marked reduction of all other stages including the important REM period. Acutely ill patients also had reduced total sleep time, frequent sleep-stage transitions, awakenings (both during the night and early a.m.), frequent napping, requirements for medications to sleep, and a feeling of not being rested. Acute care patients also reported that sleep disturbance was a major source of stress during hospitalization.


While this painted a grim picture for restful sleep in acute care patients, not all research found that subjects had sleep disturbance. In fact, 68% reported they had no problem sleeping in the hospital. Moreover, more people said they had greater sleep disturbances at home (48%) than in the hospital (32%). Only 22% said that they had poor sleep during hospitalization, if they reportedly slept well at home. However, even with these mixed findings, it may be that a great number of hospitalized adults had inadequate sleep or perceived they were not resting well.


The factors shown to influence sleep disturbances included patient characteristics and environmental factors. One patient characteristic was severity of illness. While the studies reviewed had conflicting results, most of the studies indicated a significant relationship between severity of illness and sleep disturbances.


Another patient characteristic investigated was type of symptoms. Pain and discomfort were the symptoms most likely to be related to perception of poor sleep. Many studies indicated significant relationships between pain ratings and perceived sleep disturbances, effectiveness of sleep, and actual length of time spent in sleep. Age and gender were also patient characteristics that reportedly had an influence on restful sleep. Aging was related to more awakenings, increased time awake after going to sleep, decreased sleep efficiency, and decreased REM sleep. Older adults also had earlier awakenings and more daytime napping. The reviewer pointed out that these indications may be part of normal aging and not related exclusively to hospitalization. Findings about gender were mixed. One study reported that women had similar sleep quality in the hospital as they had before hospitalization; men did not. Women may also have more environmental and personal factors disrupting sleep than men.


Environmental factors included noise, light, and being awakened for nursing and medical care. Sources of noise included other patients, alarms, and the loud talking of staff. Light and disruptions from interventions and diagnostic testing were even more disruptive than noise. Light was a problem particularly in critical care areas. Activities such as giving medications, taking vital signs, weighing, measuring output, and gathering blood samples occurred sometimes hourly and certainly caused sleep disturbances.


Interventions to promote a more normal biologic rhythm and sleep patterns were suggested. For example, light could be used therapeutically to mimic normal circadian cycles. "White noise" was found to mask disruptive noise and led to better depth and quality of sleep with less awakenings. Ear plugs were occasionally helpful. Timing of care to lessening awakenings was also suggested by the studies. Changing times for medication administration, clustering patient care activities, and educating personnel about sleep disturbances and possible interventions were found to lead to better sleep.


It must be pointed out that much of the literature reviewed was critical care and cardiology patient research. Research with patients undergoing treatment for orthopaedic problems may produce different results.


Gillis, A. J. (1993). Determinants of a health-promoting lifestyle: An integrative review. Journal of Advanced Nursing, 18, 345-353.


A health-promoting lifestyle is of interest to all nurses. This author provides a thorough review of 23 studies published between 1983 and 1991. Pender's Health Promotion Model provides a framework for the review. Besides the cognitive-perceptual factors described below, the author reviewed theoretical frameworks and questionnaires and other instruments used in the research.


The most common factor studied was health locus of control. Having an internal health locus of control-believing you can affect your health-was highly related to having a healthy lifestyle. Believing that others controlled health and that health was simply by chance were related to not having a healthy lifestyle. Some of the lifestyles questions addressed global issues, such as participating in preventive health behaviors, and specific issues such as being able to halt cigarette smoking.


Health status and importance of health to the individual tied for second of the most researched factors; self-efficacy was a close third. Most research found a significant relationship between self-reported health status and a health-promoting lifestyle. Research also noted a significant relationship between how important health was to the individual and health-promoting behaviors.


Health behavior self-efficacy (the beliefs that you can successfully perform healthy behaviors and the behaviors will improve health) was an important factor researched in seven studies. In fact, one of the researchers stated that self-efficacy and better health status were the most important predictors of a health-promoting lifestyle.


The final three factors, health definition, barriers to use, and benefits of use, were studied in very few research investigations. A personal definition of health as "high-level wellness" was related to health-promoting lifestyle more than a definition of health as "absence of disease." Barriers to use healthy behaviors, such as poor transportation to clinics, were predictors of not having a health-promoting lifestyle. Conversely, recognizing the benefits of a health-promoting lifestyle led to more healthy behaviors.


The review of research on health- promoting lifestyle did not include any critique of the individual research. In fact, the review was a presentation of the frequency in which factors were investigated, not the weight of importance of factors. The author did suggest specific ways to improve studies in the future.