This is an occasional series featuring members of the American Sleep Apnea Association’s Sleep Health Medical Advisory Council (SHMAC). Council members come from a variety of backgrounds and interests but share in common one passion: patient-centered advocacy in the field of sleep medicine.
Could nurses help patients “connect the dots” between sleep and wellness?
Robyn Woidtke thinks nurses could be a strong force for good in the effort to better identify, diagnose, and treat sleep disorders… if they were given a comprehensive, multidisciplinary education focused on sleep health.
However, like many physicians in medical school, nurses in training tend to receive minimal education in sleep health. They may receive only one or two hours of study in this subject during their entire academic career.
Woidtke is a nurse and nursing educator, as well as a sleep technologist and sleep health educator. She recognizes the broad potential for better patient outcomes through a more intentional intersection between nursing and sleep medicine.
Her reasoning? Nurses spend more face time with patients than their physician counterparts. They are responsible for gathering key vital signs that could be linked to sleep disorders. They also hear many complaints that patients may not share with their doctors.
“Connecting the dots” between patient complaints, symptoms, and unidentified or untreated sleep disorders could make an impact on the diagnosis and treatment of many of our most chronic health problems, such as cardiovascular disease, diabetes, and obesity. (In this unique “sleep navigator” program we reported on last spring, this is absolutely true.)
Would a nurse asking just two or three questions of every patient at every encounter make a difference? Maybe in a perfect world. Woidtke would be the first to say we’re not there yet, not until every single nurse knows confidently “what to ask for, what to look for.”
10 questions for Robyn Woidtke
We recently connected with Robyn to chat about the value that nurses can bring to sleep disordered patients and the sleep medicine community at large.
American Sleep Apnea Association (ASAA): Why did you decide to join the SHMAC? What unique perspective do you bring to a patient-driven nonprofit focused on sleep healthcare?
Robyn Woidtke (Robyn): I was invited to join due to my long history in sleep health. My nursing background brings a different perspective. I believe in patient advocacy, and sleep health has long been my passion, so I believed that my background could be beneficial to the SHMAC.
ASAA: In the field of nursing, what are some trends you see taking hold in sleep medicine that you think are of particular importance to patients?
Robyn: I am not sure if the field of nursing has actually embraced the need for sleep inquiry on a routine basis.
The literature points to a lack of curriculum in this area. My hypothesis is, if it is not part of the nursing curricula, how can it be important in how I practice as a nurse? If nurses are not trained in sleep assessment and promotion, then it is difficult to implement.
I recently lectured to a group of ICU (intensive care unit) nurses. None had heard of the STOP-BANG questionnaire [a common screening tool for sleep apnea], which is interesting because the PACU [post-anesthesia care unit) nurses are pretty aware. What this tells me is that the communication for at-risk patients for OSA [obstructive sleep apnea] might not be happening during hand off**.
One of the comments from the ICU nurse audience was that “we assess for everything else, but I never assess for sleep issues. This lecture has made me more aware and I will begin to query my patients now.”
ASAA: Do you have a personal philosophy about patient-centered healthcare that relates in some way to these trends in nursing and sleep medicine?
Robyn: The trend is in value-based care: care that focuses on not only the healthcare outcomes that we define, but also the patient’s perspective of what is needed. There is a new way to look at this: not only asking, “What is the matter with you?” but also “What matters to you?” in regards to patient-centered care.
My healthcare hero is Donald Berwick. He ran the Institute for Healthcare Improvement and has been an inspiration.
Related to patient centeredness, I have use this quote of his in my presentations:
“That’s what scares me: to be made helpless before my time, to be made ignorant when I want to know, to be made to sit when I wish to stand, to be alone when I need to hold my wife’s hand, to eat what I do not wish to eat, to be named what I do not wish to be named, to be told when I wish to be asked, to be awoken when I wish to sleep.”—Don Berwick
ASAA: If you could isolate one major problem inside healthcare in relation to nursing and sleep medicine, what would it be and why are you concerned about it? What are its key obstacles?
Robyn: One of the major concerns that I have is that nurses number greater than three million in the US; they are the single largest provider of healthcare across specialties, acute and preventive medicine. They touch a lot of patients and, according to the 2016 Gallup Poll, are the most trusted health professional. I think if nurses can stress the importance of good sleep, it would go a long way.
ASAA: What are some thoughts about possible solutions to this problem that you’d like to share?
Robyn: In 2004, sleep nursing leaders published an article to address the issue of sleep in nursing curriculum. After reading some of the most recent literature, it does not seem that integration of sleep health and promotion has been adequately addressed. Once nurses are educated, they really understand and begin to integrate [sleep health] into their practice.
ASAA: In a perfect world, how might sleep medicine, nursing, and patient health best intersect?
Robyn: Nurses need to understand the consequences of poor sleep and the bi-directionality of other chronic illness. In other words, “connect the dots.”
- If they are working in OB-GYN, for example, are they asking all patients about gestational apnea?
- Are post-menopausal women queried about sleep symptoms (such as sleep-disordered breathing or increased insomnia symptoms)?
- All all diabetics and hypertensive patients asked about sleep?
Understanding the nursing implications is important. I know that sleep is addressed by the North American Nursing Diagnosis Association (NANDA) and may include discussions such as sleep disturbance, insomnia, and sleep deprivation. I am not sure how often it is actually addressed in practice.
ASAA: What advice would you give to sleep health patients working with nurses in hospitals, clinics, or labs?
Robyn: If you have symptoms of sleep problems, discuss them. Don’t assume that because you are tired, it is related to other conditions or life (stress, job, etc.). Sleep is an important component of overall health. It deserves to be addressed. Don’t be dismissive! Ask the questions that are important to you.
ASAA: What’s coming up for Robyn Woidtke in the world of sleep advocacy and education?
Robyn: I have my two-day program in “Fundamentals in Sleep for Nurses” [September 30 to October 1] in the Philadelphia area***. The course provides continuing education credits and provides the attendees with a robust overview of sleep fundamentals, covering normal sleep and sleep disorders as well as population and public health issues. I am also recently involved with a dental sleep group, the National Sleep Alliance, which is a group that aims to align sleep physicians with dental providers with the concept that the physician drives the sleep diagnosis, but that collectively, the patient is seen by both the dentist and physician with care coordination at the center.
ASAA: Do you have a favorite sleep-related quote?
Robyn: I guess it would have to be “Laugh and the world laughs with you, snore and you sleep alone.” (Not sure who it is from.) I also like some of the Shakespeare references to sleep. I have in my daughter’s bedroom [this quote]: “Let her sleep, for when she awakens, she will move mountains.”
Probably true for many of us as well, for without sleep, we cannot attain our highest potential.
ASAA: Who is your sleep medicine hero?
Robyn: There are so many!!!
Robyn Woidtke MSN RN RPSGT CCSH can be reached at 510.728.0828.
*MSN: Master of Science in Nursing; RN: Registered Nurse; RPSGT: Registered Polysomnograpic Sleep Technologist; CCSH: Certificate in Clinical Sleep Health
**Handoff is a nursing term describing the transfer of a patient from one nurse at shift’s end to the incoming nurse on duty.
***The ASAA will also be in attendance at the Sleep For Nurses event. If you are a nurse, respiratory therapist, or sleep technologist also planning to attend, please find our booth in the exhibits hall.