IntroductionMany intensive care patients experience sleep disruption potentially related to noise, light and treatment interventions. The purpose of this study was to characterise, in terms of quantity and quality, the sleep of intensive care patients, taking into account the impact of environmental factors.MethodsThis observational study was conducted in the adult ICU of a tertiary referral hospital in Australia, enrolling 57 patients. Polysomnography (PSG) was performed over a 24-hour period to assess the quantity (total sleep time: hh:mm) and quality (percentage per stage, duration of sleep episode) of patients' sleep while in ICU. Rechtschaffen and Kales criteria were used to categorise sleep. Interrater checks were performed. Sound pressure and illuminance levels and care events were simultaneously recorded. Patients reported on their sleep quality in ICU using the Richards Campbell Sleep Questionnaire and the Sleep in Intensive Care Questionnaire. Data were summarised using frequencies and proportions or measures of central tendency and dispersion as appropriate and Cohen's Kappa statistic was used for interrater reliability of the sleep data analysis.ResultsPatients' median total sleep time was 05:00 (IQR: 02:52 to 07:14). The majority of sleep was stage 1 and 2 (medians: 19 and 73%) with scant slow wave and REM sleep. The median duration of sleep without waking was 00:03. Sound levels were high (mean Leq 53.95 dB(A) during the day and 50.20 dB(A) at night) and illuminance levels were appropriate at night (median <2 lux) but low during the day (median: 74.20 lux). There was a median 1.7 care events/h. Patients' mean self-reported sleep quality was poor. Interrater reliability of sleep staging was highest for slow wave sleep and lowest for stage 1 sleep.ConclusionsThe quantity and quality of sleep in intensive care patients are poor and may be related to noise, critical illness itself and treatment events that disturb sleep. The study highlights the challenge of quantifying sleep in the critical care setting and the need for alternative methods of measuring sleep. The results suggest that a sound reduction program is required and other interventions to improve clinical practices to promote sleep in intensive care patients.Trial registrationAustralian New Zealand clinical trial registry (http://www.anzctr.org.au/): ACTRN12610000688088.

BackgroundInfancy is an important period for the promotion of healthy eating, diet and weight. However little is known about how best to engage caregivers of infants in healthy eating programs. This is particularly true for caregivers, infants and children from socioeconomically disadvantaged backgrounds who experience greater rates of overweight and obesity yet are more challenging to reach in health programs. Behaviour change interventions targeting parent-infant feeding interactions are more likely to be effective if assumptions about what needs to change for the target behaviours to occur are identified. As such we explored the precursors of key obesity promoting infant feeding practices in mothers with low educational attainment.MethodsOne–on–one semi-structured telephone interviews were developed around the Capability Opportunity Motivation Behaviour (COM-B) framework and applied to parental feeding practices associated with infant excess or healthy weight gain. The target behaviours and their competing alternatives were (a) initiating breastfeeding/formula feeding, (b) prolonging breastfeeding/replacing breast milk with formula, (c) best practice formula preparation/sub-optimal formula preparation, (d) delaying the introduction of solid foods until around six months of age/introducing solids earlier than four months of age, and (e) introducing healthy first foods/introducing unhealthy first foods, and (f) feeding to appetite/use of non-nutritive (i.e., feeding for reasons other than hunger) feeding. The participants’ education level was used as the indicator of socioeconomic disadvantage. Two researchers independently undertook thematic analysis.ResultsParticipants were 29 mothers of infants aged 2–11 months. The COM-B elements of Social and Environmental Opportunity, Psychological Capability, and Reflective Motivation were the key elements identified as determinants of a mother’s likelihood to adopt the healthy target behaviours although the relative importance of each of the COM-B factors varied with each of the target feeding behaviours.ConclusionsInterventions targeting healthy infant feeding practices should be tailored to the unique factors that may influence mothers’ various feeding practices, taking into account motivational and social influences.

BackgroundChildhood obesity is an ongoing problem in developed countries that needs targeted prevention in the youngest age groups. Children in socioeconomically disadvantaged families are most at risk. Mobile health (mHealth) interventions offer a potential route to target these families because of its relatively low cost and high reach. The Growing healthy program was developed to provide evidence-based information on infant feeding from birth to 9 months via app or website. Understanding user engagement with these media is vital to developing successful interventions. Engagement is a complex, multifactorial concept that needs to move beyond simple metrics.ObjectiveThe aim of our study was to describe the development of an engagement index (EI) to monitor participant interaction with the Growing healthy app. The index included a number of subindices and cut-points to categorize engagement.MethodsThe Growing program was a feasibility study in which 300 mother-infant dyads were provided with an app which included 3 push notifications that was sent each week. Growing healthy participants completed surveys at 3 time points: baseline (T1) (infant age ≤3 months), infant aged 6 months (T2), and infant aged 9 months (T3). In addition, app usage data were captured from the app. The EI was adapted from the Web Analytics Demystified visitor EI. Our EI included 5 subindices: (1) click depth, (2) loyalty, (3) interaction, (4) recency, and (5) feedback. The overall EI summarized the subindices from date of registration through to 39 weeks (9 months) from the infant’s date of birth.Basic descriptive data analysis was performed on the metrics and components of the EI as well as the final EI score. Group comparisons used t tests, analysis of variance (ANOVA), Mann-Whitney, Kruskal-Wallis, and Spearman correlation tests as appropriate. Consideration of independent variables associated with the EI score were modeled using linear regression models.ResultsThe overall EI mean score was 30.0% (SD 11.5%) with a range of 1.8% - 57.6%. The cut-points used for high engagement were scores greater than 37.1% and for poor engagement were scores less than 21.1%. Significant explanatory variables of the EI score included: parity (P=.005), system type including “app only” users or “both” app and email users (P<.001), recruitment method (P=.02), and baby age at recruitment (P=.005).ConclusionsThe EI provided a comprehensive understanding of participant behavior with the app over the 9-month period of the Growing healthy program. The use of the EI in this study demonstrates that rich and useful data can be collected and used to inform assessments of the strengths and weaknesses of the app and in turn inform future interventions.

COVID-19 has created an unprecedented public health emergency. Nurses are classified as frontline workers and face significant risk for high viral loads, infection, and death (Sim, 2020). Currently, nurses and nursing are highly visible in the media, conducting fever clinics, responding to workforce surges, and caring for critically ill patients, and world leaders acknowledge their contribution in daily reports. This has culminated in a new zeitgeist when the anonymous street artist and political activist, Banksy, portrayed nurses as superheroes (Morris, 2020). Although this acknowledgement and support for nurses is welcome, there is increasing concern about the current constructs of angel and hero used to describe nurses (Stokes-Parish, 2020). This concern was echoed by the British Association of Critical Care Nurses' president, Nicki Credland: We're not angels, we're not heroes, we are human beings that have chosen a career, that are highly educated, that work in a patient safety-critical profession, who simply want to go and do the job that we trained to do and be protected to do it. (British Association of Critical Care Nurses, 2020) In this contemporary discussion article, we propose that the hero and angel constructs undermine the professionalism of the nursing workforce, and reinforces the perception that nursing is an innately feminine, nurturing role. We argue that this discourse continues to undermine the continuing endeavors to consolidate nursing's standing as a profession. Heroes in the COVID-19 Era-The Evolution Nurses' contribution to healthcare outcomes is well documented (Aiken et al., 2011; Guetterman et al., 2019). There are almost 28 million nurses globally, accounting for nearly 60% of the healthcare workforce and delivering approximately 90% of primary healthcare services internationally (World Health Organization, 2020). Nurses are increasingly working in clinical situations where access to essential equipment is limited or denied; they have been exposed to heavy COVID-19 viral loads and have worked long hours, in some instances, and with suboptimal nurse-patient ratios to manage the surge in healthcare demand. Additionally, many have had to simultaneously upskill and develop new ways of working. According to the International Council of Nurses (2020), at least 600 nurses have died as a result of the pandemic. Nurses and nursing have responded to these challenges with maturity, responsiveness, and agility, and perhaps for this reason the constructs angel and hero have been adopted by the media (Frost, 2020; Johnson, 2020; Mosley, 2020; Pownall, 2020). This depiction of nurses as heroes and angels is not new. In their study of the image of the nurse in mass media, Kalish and Kalish (1983) identified that nurses have been portrayed as angels of mercy since the mid-nineteenth century. Although the acknowledgement and support for nursing is welcome, there is increasing concern from political, clinical, and research perspectives about this portrayal. Before examining the consequences of the ange...