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My specialty is family nurse practitioner. The problem that I have identified is the lack of diagnosis of obstructive sleep apnea (OSA) in the primary care setting.

Discussion #1 My specialty is family nurse practitioner. The problem that I have identified is the lack of diagnosis of obstructive sleep apnea (OSA) in the primary care setting. This is of interest to me because it is a highly prevalent sleep and airway disorder that can lead to increased morbidity and mortality (Shoib, 2018, p. 74). OSA causes nocturnal hypoxia and fragmented sleep (Shoib, 2018, p. 74). Left untreated, OSA can lead to metabolic, cardiovascular and neurocognitive morbidities (Chiang, 2018, p.1086). It has been shown that 93% of females and 82% of males remain undiagnosed (Shoib, 2018, p. 74).    To search for articles on the subject, I used the key words sleep apnea AND primary care as well as sleep apnea AND screening. I limited these searches by using the years 2014-2019 and further narrowed it down by selecting only academic journals. This resulted in multiple studies and literature reviews that related how obstructive sleep apnea is rarely screened for and is therefore underdiagnosed. Miller & Berger (2016), noted in their literature review of multiple studies, that family medicine clinics did not screen for sleep disturbance issues as often as lifestyle issues and that primary care physicians (PCPs) do not routinely screen for obstructive sleep apnea. Shoib did a cross-sectional study at Srinagar Hospital from July 2013 to August 2014 and screened the number of patients referred to by PCPs compared to specialty services (Shoib, 2018, p. 74). According to Shoib (2018), PCPs under recognize OSA and that since there is a lack of  methodology, infrastructure and resources to deal with OSA, 90% of patients remain undiagnosed. Miles, Doles, & DiLeo did a study at a family clinic to see if use of the ESS screening tool increased referral to sleep specialists and increased diagnosis of OSA (Miles, Dols, & DiLeo, 2017, p. 278). Prior to the start of the study, they noted that in the clinic, 91% of patients had conditions that put them at high risk of obstructive sleep apnea, but that none of them had been screened (Miles, Dols, & DiLeo, 2017,pp. 278-279). An innovation I might consider as a solution would be the use of a screening tool, such as the Berlin questionnaire or STOP bang measurements, as part of the routine physical exam of a patient. Routinely screening for OSA, could help improve diagnosis of OSA and referral for a sleep study. PCPs see a large number of patients and are therefore important for the recognition of patients signs and risks for sleep apnea (Shoib, 2018, p. 76). Discussion #2 Family nurse practitioners see patients from birth to death. Personally, I have worked primarily with women. Women are a very unique group in the population that has their own unique set of challenges. Some of the challenges that women can experience can range from breast health, reproductive health, postpartum depression, menopause and many others. Specifically, I would like to further research the effects of skin to skin contact of newborn with mother after delivery.              The medical world has been filled with many tests, procedures, technological innovations and assistive devices. Unfortunately, it has taken away from some of the innate and natural processes. Pregnancy is viewed as an illness versus a state of wellness and therefore postpartum is treated in that same manner. Mothers are separated from their babies in order to perform “necessary testing” despite an understanding of the importance of skin to skin contact.              The literature shows that skin to skin is very important. According to Safari, Saeed, Hasan and Moghaddam-Banaem (2018), maternal and infant skin to skin contact has many healing effects such as temperature regulation, vital sign stabilization, quicker milk supply, better latch to breast, and hormonal release for uterine contracture. A recent study also showed that skin to skin also reduces the risk for postpartum hemorrhage (Saxton, Fahy, Rolfe, Skinner, & Hastie, 2015). The literature will show that magic hour can be an effective solution (Abdollahpour, Khosravi & Bolbolhaghighi, 2016) .    

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