ABSTRACT
Nighttime restlessness in dementia is an underestimated problem. Although little is known about the prevalence and not every person with dementia struggles with it, nighttime restlessness puts a heavy burden on the persons themselves and their caregivers.This field study explores nighttime restlessness in nursing homes based on two research questions: (1) What is nighttime restlessness according to professional caregivers? and (2) How is nighttime restlessness managed?Data were collected through diaries, interviews with caregivers and one night of observation in eight nursing homes.Wandering and screaming seem to be the most prevalent nighttime agitated behaviours. Caregivers identify many possible causes, but spatial and sensory factors, such as light or noise, were rarely mentioned spontaneously. The observations highlighted that a lot of light and noise is prominent and this might be causing nighttime restlessness.Caregivers try several strategies: for example talking with the resident, put on a light and apply medication or physical restraints.The management of nighttime restlessness requires a holistic approach. Caregivers' attention for and efforts to ameliorate the spatial and sensory environment in the management of nighttime restlessness are limited.
Subject(s)
Caregivers/psychology , Dementia/complications , Night Care/methods , Psychomotor Agitation/etiology , Wandering Behavior , Dementia/therapy , Homes for the Aged , Humans , Monitoring, Physiologic , Nursing Homes , Psychomotor Agitation/therapy , Safety Management , Surveys and QuestionnairesABSTRACT
Assistive Technology (AT) has been utilized to support people with dementia (PwD) and their carers in the home. Such support can extend the time that PwD can remain safely at home and reduce the burden on the tertiary healthcare sector. Technology can assist people in the hours of darkness as well as during the day. The objective of this literature review is to evaluate reported healthcare technologies appropriate to night time care. This paper summarises and categorises the current evidence base. In all, 131 abstracts were returned from a database search, yielding fifty four relevant papers which were considered in detail. While night-time specific studies identified very few papers (4 papers, 7%), most of the more general AT findings could be adopted to benefit night-time assistance. Studies have used technology for prompting and reminding as loss of time and forgetfulness are major problems; for monitoring daily activities in a sensor enriched environment and utilised location aware technologies to provide information to enhance safety. Technology also supports a range of therapies to alleviate symptoms. Therapies include the delivery of music and familial pictures for reminiscing, the use of light therapy to enhance wellbeing and the provision of mental tasks to stimulate the brain and maintain activity levels.
Subject(s)
Dementia , Night Care/methods , Self-Help Devices , Aged , Cognition Disorders , Dementia/physiopathology , Geriatric Assessment , Humans , PsychologySubject(s)
Child, Hospitalized/psychology , Critical Care/methods , Extracorporeal Membrane Oxygenation/nursing , Music Therapy/methods , Night Care/methods , Touch , Alaska , Attitude of Health Personnel , Child , Critical Care/psychology , Empathy , Extracorporeal Membrane Oxygenation/psychology , Female , Humans , Infant , Intensive Care Units, Pediatric , Inuit/ethnology , Night Care/psychology , Nurse-Patient Relations , Nursing Staff, Hospital/psychology , Psychology, ChildABSTRACT
Nurses working at night have a specific role in supporting sleep and promoting rest and comfort. Sometimes the role of the night duty nurse in promoting sleep and comfort is taken for granted. One author's experience of working as a night duty nurse led to reflection on her responsibilities in improving practice and addressing the sleep-related needs of patients in a palliative care setting. Following a literature review, it was clear that there are very few publications on sleep disturbance in palliative care. Using the four principles of palliative care (Aranda, 1998a), the authors construct a series of strategies to prevent and manage sleep issues.
Subject(s)
Health Promotion/methods , Night Care/methods , Nurse's Role , Palliative Care/methods , Sleep Deprivation/prevention & control , Health Facility Environment/standards , Holistic Health , Hospices/standards , Humans , Models, Nursing , Night Care/standards , Palliative Care/standards , Patient Care Team , Patient-Centered Care/methods , Patient-Centered Care/standards , Philosophy, NursingABSTRACT
BACKGROUND: The advent of night-time exchange devices (NXDs), such as the Quantum, gives the client on home peritoneal dialysis the option of five exchanges well spaced in a day or, for those who need only four exchanges a day, the ability to change their long dwell to the daytime. PURPOSE: To ascertain whether we were able to attain the NKF-DOQI recommended Kt/V of 2.0 for CAPD clients by adding a fifth exchange utilizing the Quantum NXD or by introducing a long daytime dwell for clients who only needed four exchanges per day. We also looked at alternative uses for a NXD. METHOD: As part of our CQI process for all clients on home peritoneal dialysis, dialysis adequacy testing is performed two weeks after the start of full prescription and biannually thereafter. In this study, the first group of clients, the "lifestyle group", changed to using the NXD to allow more daytime freedom. This first group had repeated 24 hour dialysate collections to ensure they maintained adequate Kt/Vs. The second group of clients, the "adequacy group", had Kt/Vs falling below the NKF-DOQI recommendation of 2.0. This second group had their peritoneal dialysis prescription optimized utilizing a computer modeling program. Their prescription was then changed accordingly Two weeks after the change in prescription, 24 hour dialysate collections were repeated for each client to ensure the new Kt/Vs were within the predicted parameters. CONCLUSIONS: We were able to attain the NKF-DOQI recommended Kt/V, utilizing the CANUSA recommended fill volumes, for all clients underdialyzed on CAPD through the addition of a fifth exchange using the NXD. Other clients who may benefit from the use of NXDs are those who need more daytime freedom.