Sleep-Wake Disturbances in Oncology.

Sleep-wake disturbances are common in patients with cancer. Despite the high prevalence of altered sleep patterns in oncology settings, there remains a gap in consistent assessment of sleep, leading to an underrecognized and undertreated condition. Provider failure in addressing sleep-wake disturbances can result in chronic issues with insomnia and has a negative impact on quality of life and cancer survivorship. Often sleep-wake disturbances present in symptom "clusters" including, anxiety, depression, and fatigue, which adds to the complexity of managing sleep disorders in oncology. Aggressive management strategies for managing underlying symptom burden from disease or medications effects is a priority.

Symptom cluster profiles following traumatic orthopedic injuries: A protocol.

Traumatic injuries affect millions of Americans annually, resulting in $671 billion in healthcare costs and lost productivity. Postinjury symptoms, like pain, sleep disturbance, anxiety, depression, and stressor-related disorders are highly prevalent following traumatic orthopedic injuries (TOI) and may contribute to negative long-term outcomes. Symptoms rarely present in isolation, but in clusters of two or more symptoms that co-occur to affect health in aggregate. Identifying symptom cluster profiles following TOI may identify those at highest risk for negative outcomes. Dysregulation of brain-derived neurotrophic factor (BDNF) is a potential biological mechanism responsible for symptom cluster profile membership after TOI and may be targeted in future precision-health applications. The purpose of this paper is to present the protocol of a cross-sectional study designed to identify symptom cluster profiles and measure the extent to which the BDNF val66met mutation and serum concentration of BDNF are associated with membership in symptom cluster profiles. We plan to recruit 150 TOI survivors within the first 72 h of injury. The study aims are to (1) describe TOI survivors' membership in symptom cluster profiles, indicated by pain, sleep disturbance, and symptoms of anxiety, depression, and stressor-related disorders, immediately following a TOI; (2) examine associations between demographic and clinical factors and symptom cluster profile membership among TOI survivors; (3) test the hypothesis that low serum concentrations of BDNF are associated with membership among symptom cluster profiles following TOI; and (4) test the hypothesis that the presence of the val66met mutation on one or both alleles of the BDNF gene is associated with membership among symptom cluster profiles following TOI.

Intervenciones no farmacológicas para la promoción del sueño en la UCI / Non-pharmacological interventions for sleep promotion in the ICU

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Sleep Neurobiology and the Critical Care Environment.

TOPIC: Sleep in the intensive care unit can be poorly consolidated and highly fragmented. This review examines the neurobiology of normal and abnormal sleep, with a focus on the changes that occur in the intensive care unit environment. CLINICAL RELEVANCE: Patients in the intensive care unit demonstrate a lack of rapid-eye-movement sleep and an inability to effectively transition from light to deep stages of sleep. These abnormalities can adversely affect hemodynamic parameters and physiological and psychological outcomes. PURPOSE: To describe the brain mechanisms and electroencephalographic characteristics of wakefulness and the different stages of sleep. This review also describes how sleep can be altered by hospitalization in the intensive care unit and how nurses can design interventions that improve sleep and outcomes. CONTENT COVERED: The review examines sleep mechanisms, including brain electrical activity, regulatory centers in the brain, and circadian and diurnal patterns of sleep and hemodynamic function. Nursing interventions for specific patient risk factors in the intensive care unit are proposed.

Influence of baby massage on sleep quantity in baby of 3-6 months age in Tirawuta health center, East Kolaka District, Indonesia

Based on the results of the initial survey it was known that the number of babies who visited Puskesmas Tirawuta in 2017 were 42 in number. Whereas in 2018 March-May there were 25 babies at Puskesmas Tirawuta, East Kolaka District. In addition, the initial interview on March 26, 2018 showed that the author did this at Puskesmas Tirawuta, and it obtained a mother who had a baby and visited for immunizations. About 7 people said the baby had trouble in sleeping and sometimes they were fussy. Besides, some report frequent waking up when sleeping at night, crying when waking up and so on. Among the mothers who brought their babies to Puskesmas, 7 mothers said they knew or had heard about baby massage but is not knowledgeable how to massage properly. About 3 people said that at the same time they did not know how to massage a baby. The purpose of this study was to determine the effect of baby massage toward the quantity of sleeping among the babies aged 3-6 month at the Puskesmas Tirawuta in East Kolaka District. The design of this study is quasi-experimental where the design used was "One Group Pretest-Posttest Design". The population in this study was the number of babies aged 3-6 months with decreased sleeping quantity. Nearly 25 babies with a sample of 13 respondents were there. Data was processed using Paired T-Test. The results of the analysis obtained the value of t count=3.742>1.356 where t table for df 12 with the results of statistical tests was significant at a value 0.003<0.20. This showed that there was a significant effect of giving baby massage on the quantity of sleep among babies aged 3-6 months at Puskesmas Tirawuta, East Kolaka District. From the results of the research, suggestions were proposed that health workers need to conduct counseling, demonstration and distribution of leaflets. Hence, mothers were motivated to massage their babies. This could be done through Integrated Healthcare Center activities

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Promoción del sueño en unidades de cuidados intensivos neonatales: scoping review / Promoção do sono em unidades de cuidados intensivos neonatais: scoping review / Sleep promotion in neonatal intensive care units: scoping review

El sueño desempeña un papel fundamental en el crecimiento y desarrollo de los recién nacidos, su privación presenta numerosos efectos negativos. El ambiente de las unidades de cuidados intensivos neonatales (UCIN) se presenta como perturbador y nocivo del sueño neonatal. OBJETIVO: Mapear la evidencia científica existente en cuanto a las estrategias promotoras del sueño de los recién nacidos en contexto de UCIN. Metodología: Scoping review basada en la metodología propuesta por el Joanna Briggs Institute, utilizando los siguientes motores de búsqueda y bases de datos: MEDLINE via PubMed, CINHAL Plus with Full Text e Nursing & Allied Health Collection: Comprehensive via EBSCO-HOST, Academic Search Complete, ScienceDirect e Directory of Open Access Journals via B-ON, LILACS, RCAAP e SciELO. Definido como limitadores artículos publicados en los últimos 5 años (hasta febrero de 2019), disponibles en portugués o inglés y en texto completo. RESULTADOS: Se localizaron 186 registros, y la muestra final incluyó 9 estudios que respondieron al objetivo de la revisión sobre la base de los criterios de inclusión definidos. Las estrategias promotoras del sueño identificadas remiten a la gestión del ambiente en la UCIN, concentración de los cuidados de enfermería respetando el ciclo de sueño / vigilia de los recién nacidos, posicionamiento adecuado, contención, succión no nutritiva, técnica de Yakson, toque humano suave, canguro materno, masaje, estímulos auditivos tranquilos y colchón modelador. Conclusión: Dada la importancia del sueño en el desarrollo de los recién nacidos, es fundamental el papel del Enfermero a través de la adopción de estrategias protectoras y promotoras de éste, especialmente en contexto de UCIN

O sono tem um papel fundamental no crescimento e desenvolvimento dos recém-nascidos, com a sua privação a apresentar inúmeros efeitos negativos. O ambiente das unidades de cuidados intensivos neonatais (UCIN) apresenta-se como perturbador e nocivo do sono neonatal. OBJETIVO: Mapear a evidência científica existente quanto às estratégias promotoras do sono do recém-nascido em contexto de UCIN. Método: Scoping review baseada na metodologia proposta pelo Joanna Briggs Institute, com recurso aos seguintes motores de busca e bases de dados: MEDLINE via PubMed, CINHAL Plus with Full Text e Nursing & Allied Health Collection: Comprehensive via EBSCO-HOST, Academic Search Complete, ScienceDirect e Directory of Open Access Journals via B-ON, LILACS, RCAAP e SciELO. Definidos como limitadores artigos publicados nos últimos 5 anos (até fevereiro de 2019), disponíveis em português ou inglês e em texto integral. RESULTADOS: Foram localizados 186 registos, tendo a amostra final incluído 9 estudos que responderam ao objetivo da revisão com base nos critérios de inclusão definidos. As estratégias promotoras do sono identificadas remetem para a gestão do ambiente na UCIN, concentração dos cuidados de Enfermagem respeitando o ciclo de sono-vigília dos recém-nascidos, posicionamento adequado, contenção, sucção não-nutritiva, técnica de Yakson, toque humano suave, canguru materno, massagem, estímulos auditivos calmos e colchão modelador. Conclusão: Dada a importância do sono no desenvolvimento dos recém-nascidos, é fulcral o papel do Enfermeiro através da adoção de estratégias protetoras e promotoras deste, especialmente em contexto de UCIN

Sleep plays a fundamental role in the growth and development of newborns, with their deprivation having many negative effects. The environment of the neonatal intensive care units (NICU) presents itself as disturbing and harmful for the neonatal sleep. OBJECTIVE: Map the existing scientific evidence regarding the strategies promoting newborn's sleep in the NICU setting. Methodology: Scoping review based on the methodology proposed by the Joanna Briggs Institute, using the following search engines and databases: MEDLINE via PubMed, CINHAL Plus with Full Text and Nursing & Allied Health Collection: Comprehensive via EBSCO-HOST, Academic Search Complete, ScienceDirect and Directory of Open Access Journals via B-ON, LILACS, RCAAP and SciELO. As search limiters, there were defined articles published in the last 5 years (until February 2019), available in Portuguese or in English and in full text. RESULTS: A total of 186 results were listed, and the final sample included 9 studies that responded to the review objective based on the selected inclusion criteria. The sleep-promoting strategies identified refer to the management of the environment in the NICU, the concentration of Nursing care respecting the newborn's sleep-wake cycle, and non-pharmacological interventions such as proper positioning, physical restraint, non-nutritive sucking, Yakson technique, gentle human touch, kangaroo mother care, massage, calm auditory stimuli and remolding mattress. Conclusion: Given the importance of sleep in the newborn's development, the nurse's role is crucial through the implementation of protective and promoting sleep strategies, especially in the NICU

Update on Research and Practices in Major Sleep Disorders: Part I. Obstructive Sleep Apnea Syndrome.

PURPOSE: The purpose of this first of two review articles providing an update on sleep disorders was to examine the pathophysiology, epidemiology, and treatment of obstructive sleep apnea (OSA). OSA is a common sleep disorder whose prevalence is similar to asthma. As with other sleep disorders, OSA has a broad impact on individuals, affecting their daily behaviors, cognitive abilities, and performance, and putting them at increased risk for accidents, mood disorders, cancer, cardiovascular disease, and hypertension. Thus, early recognition and management, much of which can be implemented by nurses, can reduce health and accident risks and improve daily functioning. METHODS: This narrative review utilized medical databases such as PubMed to identify relevant English language original and systematic review articles predominantly from peer-reviewed journals from 2012 to 2018. However, as background, findings from classic articles prior to 2012 were also included. CLINICAL RELEVANCE: OSA is a common condition with considerable impact on daily functioning and potential for accidents and serious comorbidities such as hypertension, cardiovascular disease, diabetes, and depressed mood. The impairments and comorbidities associated with OSA can be reduced through early detection, encouraging treatment, providing education about sleep and OSA, and, importantly, promoting adherence to the predominant therapy, positive airway pressure.

Sleep assessment and interventions for patients living with cancer from the patients' and nurses' perspective.

BACKGROUND: Difficulty sleeping is a common symptom for patients living with cancer that significantly affects their lives. However, although sleep disorders are common, it is an overlooked problem in cancer care. PURPOSE: This study assessed the prevalence of sleep disturbances among patients living with cancer, and assessed the adequacy of sleep assessment and intervention for patients from both nurses' and patients' perspectives. METHOD: Descriptive, cross-sectional and correlational design was used in this study. A convenience sample of 129 patients with cancer and 113 registered nurses working with cancer patients was recruited. A structured face-to-face interview was used to complete the patients' questionnaires and a self-administered questionnaire was given to nurses. FINDINGS: The majority of patients with cancer reported having poor sleep quality (69.8%). About 86.7% (n=98) of nurses reported that they have never screened patients with cancer for any sleep problems, and 76.7% (n=99) of the patients reported that they have never been assessed for sleep problems by the nursing staff during hospitalisation. Only 8% of patients with cancer who reported having problems sleeping to a nurse received interventions to promote better sleep. CONCLUSION: Assessment of sleep disturbances in patients with cancer should be unified using a comprehensive reliable valid instrument, as well as providing evidence-based interventions according to patient's need. A written policy should be introduced to encourage sleep documentation and to make sleep care for patients part of routine nursing care.

Alcohol Consumption as a Moderator of Anxiety and Sleep Quality.

BACKGROUND: Although people who sleep poorly may attempt to relieve anxiety for better sleep quality, whether daily alcohol consumption is a factor that moderates anxiety and sleep disturbance is not known. PURPOSE: The aim of the study was to explore (a) the association between anxiety and sleep quality and (b) whether daily alcohol consumption acted as a moderator between anxiety and sleep quality in those who reported sleeping poorly. METHODS: Eighty-four participants aged 20-80 years who reported poor sleep (Pittsburgh Sleep Quality Index > 5) in northern Taiwan were enrolled in this cross-sectional study. A structured questionnaire covering demographics (including daily alcohol consumption), level of anxiety, level of depression, and perceived sleep quality was used to collect data. RESULTS: The participants were mostly women (72.6%). The mean age was 41.81 (SD = 12.62) years; 51.2%, 19.0%, 13.1%, and 14.3%, respectively, had minimal, mild, moderate, and severe anxiety. After adjusting for factors related to sleep quality using multiple regression analysis, receiving sleep therapy, consuming alcohol on a daily basis, and having anxiety were found to be predictors of poor sleep quality. Moreover, daily alcohol consumption was found to moderate the relationship between anxiety and sleep quality. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: People who sleep poorly should avoid misusing alcohol to self-treat poor sleep quality or anxiety and should instead utilize sleep hygiene education and mental healthcare. Daily alcohol consumption may be a moderator between anxiety status and sleep quality.

Nursing care and management of patients' sleep during hospitalisation: A cross-sectional study.

AIM: To explore and describe how patients' sleep is addressed at acute-care hospitals in Sweden with regard to nursing care, management and the development of knowledge in this area. BACKGROUND: Sleep is a basic human need and thus important for health and health maintenance. Patients describe sleeping in hospital as a stressor, and research shows that nurses tend to underestimate patients' perceived problems with sleep during hospitalisation. How do nursing staff at acute hospitals address patients' sleep and the development of knowledge in this area? DESIGN/METHOD: A cross-sectional descriptive study was conducted based on data collected through a web survey. Head nurses, registered nurses, nursing care developers and local training supervisors at 36 randomised acute-care hospitals in Sweden were invited to participate. This study was executed and reported in accordance with SQUIRE 2.0. RESULTS: The results of the survey (53 responses from 19 wards at 15 acute-care hospitals) showed that no policy documents exist and no current training addresses sleep during hospital stay. All participants agreed that sleep should be considered a nursing topic and that it is important for hospitalised patients. CONCLUSION: Patients' sleep during hospitalisation is undermanaged at acute-care hospitals. Nurses, health care managers and organisations face challenges if they are to achieve better outcomes. RELEVANCE TO CLINICAL PRACTICE: This study shows that nurses do consider patients' sleep important and addressing sleep as part of nursing care. Future studies in the area should focus on what kinds of support and education are needed in the clinical context.

Sleep problems in adults with Down syndrome and their family carers.

BACKGROUND: Sleep disturbance is common and can have harmful psychological and physical effects. While sleep problems in children with Down syndrome (DS) have received a reasonable amount of attention, very little has been written about this topic in adults with DS. METHOD: The present study consisted of an online survey completed by 100 family carers of adults with DS. RESULTS: High rates of sleep problems of different types were reported in the adults with DS comparable to those found in children with DS in previous research. Significant associations were found between sleep problems and body mass index, excessive daytime sleepiness and a range of health and psychological problems. Low rates of treatments for sleep problems were reported. The majority of family caregivers felt their own sleep was affected. CONCLUSIONS: Sleep problems in adults with DS are common and varied. Assessment and treatment of such problems are likely to improve quality of life.

Impact of a nurse-led sleep programme on the sleep quality and depressive symptomatology among older adults in nursing homes: A non-randomised controlled study.

BACKGROUND: Sleep problems are much more prevalent in nursing home residents than in their community-dwelling counterparts. Cognitive behavioural therapy is likely to improve sleep quality in older adults. However, these interventions have a narrow scope to generalise to nursing home practice, and there are minimal data on the effectiveness of the integration of cognitive behavioural therapy and motivational interviewing in nursing home settings. AIM: The purpose of this study was to investigate the impact of a nurse-led sleep programme on the sleep quality and depressive symptomatology in cognitively intact nursing home residents. METHODS: A non-randomised controlled study design was applied to 52 older adults living in three different nursing homes in the same locality. Then, we categorised our study cohort into the following two groups: intervention group in which the older adults received the nurse-led sleep programme and control group in which the older adults received regular nursing home services. One nursing home was assigned to the intervention, and two were assigned to control. The intervention group participated in four weekly 1-hr sessions performed by the first author. RESULTS: Follow-up assessments conducted at 8 and 12 weeks after the intervention ended revealed that participants in the intervention group experienced a significant improvement in some objective sleep parameters, including awakenings, total wake time, wake after sleep onset and sleep efficiency, as well as a significant decrease in depressive symptomatology. CONCLUSION: To summarise, the results of this study showed that the nurse-led sleep programme improved the sleep quality and reduced depressive symptomatology in cognitively intact nursing home residents. In this context, we can assert that interventions for sleep problems should be individualised by addressing sleep experience and sleep management strategies of older adults living in nursing homes and should be integrated with motivational interviewing techniques.

Depressive Symptom Clusters and Their Relationships With Anxiety and Posttraumatic Stress Disorder Symptoms in Patients With Cancer: The Use of Latent Class Analysis.

BACKGROUND: Depressive symptoms are prevalent in patients with cancer and are heterogeneous; however, existing methods of grouping patients with heterogeneous symptoms have limitations. OBJECTIVES: The purpose of this study was to identify depressive symptom clusters in patients with cancer using a data-driven method and to explore their relationships with symptoms of anxiety and posttraumatic stress disorder. METHODS: Data from 247 patients were analyzed in this cross-sectional study. Latent class analysis was used to identify depressive symptom clusters, using 9 depressive symptoms from the Patient Health Questionnaire. Symptoms of anxiety and posttraumatic stress disorder were measured, and the relationships between them and the clusters were explored through linear regression analyses. RESULTS: Four clusters of depressive symptoms were identified: (1) minimal with sleep and appetite disturbances (23.9%), (2) somatic (22.3%), (3) moderate with sleep disturbance and fatigue (32.4%), and (4) severe (21.5%). The order of severity of anxiety and posttraumatic stress disorder symptoms was comparable across the 4 clusters of depressive symptoms. The anxiety and posttraumatic stress disorder symptoms of patients in clusters 3 and 4 were more severe than those in cluster 1 (B = 4.70-19.19, P < .001). CONCLUSION: Using latent class analysis, 4 clusters of depressive symptoms were identified in patients with cancer, which were significantly correlated with symptoms of anxiety and posttraumatic stress disorder. IMPLICATIONS FOR PRACTICE: Latent class analysis can be used to identify clusters of depressive symptoms in patients with cancer. Such groupings may hasten the development of individualized intervention approaches tailored to patients' specific depressive clusters.

Psychometric Properties of the Simons Simplex Collection Sleep Interview.

BACKGROUND AND PURPOSE: An estimated 40%-80% of children with autism spectrum disorders (ASD) have sleep problems. The Simons Simplex Collection Sleep Interview (SSCSI) is a parent-report questionnaire assessing bedtime and nighttime sleep problems and daytime function. The present study evaluated the factorial model of the SSCSI that best characterizes children aged 4-18 years with ASD. METHODS: Exploratory factor analysis was performed using principal component analysis and promax rotation, beginning with 16 items and ending with 10 items. RESULTS: Exploratory factor analysis concluded with ten dichotomous items, plus ageand regular sleep duration, in three factors: nighttime problems, daytime problems, andsleep duration problems. The analysis was performed on the full sample, and onprepubertal (4-8-years), pubertal (9-13-years), and postpubertal (14-18-years) subgroups. CONCLUSION: Further refinement, including confirmatory factor analysis, test-retest reliability, and convergent validity testing, is needed.

Non-pharmacological solutions to sleep and circadian rhythm disruption: voiced bedside experiences of hospice and end-of-life staff caregivers.

BACKGROUND: Sleep disturbance is a significant issue, particularly for patients with advanced terminal illness. Currently, there are no practice-based recommended approaches for managing sleep and circadian disruptions in this population. To address this gap, a cross-sectional focus group study was performed engaging 32 staff members at four hospices/end-of-life programs in three demographically diverse counties in New York State. METHODS: Participants responded to structured open-ended questions. Responses were transcribed and subjected to qualitative content analysis. The themes and recommendations for improved practice that emerged were tabulated using Atlas TI qualitative software. RESULTS: This report details the experiences of hospice and end-of-life care staff in managing sleep and circadian disruptions affecting patients and analyzes their recommendations for improving care. Caregivers involved in the study described potential interventions that would improve sleep and reduce circadian disruptions. They particularly highlighted a need for improved evaluation and monitoring systems, as well as sleep education programs for both formal and informal caregivers. CONCLUSIONS: The voiced experiences of frontline hospice and end-of-life caregivers confirmed that disruption in sleep and circadian rhythms is a common issue for their patients and is not effectively addressed in current research and practice. The caregivers' recommendations focused on management strategies and underscored the need for well-tested interventions to promote sleep in patients receiving end-of-life care. Additional research is needed to examine the effectiveness of systematic programs that can be easily integrated into the end-of-life care process to attenuate sleep disturbances.

Conceptual and operational definitions of the defining characteristics of the nursing diagnosis Disturbed Sleep Pattern.

OBJECTIVE: to present the knowledge produced about sleep and Acute Coronary Syndrome in order to assist in the elaboration of the operational and conceptual definitions of the defining characteristics of the nursing diagnosis Disturbed Sleep Pattern (00198). METHOD: integrative review in the following databases: COCHRANE; SCOPUS; MEDLINE (Medical Literature Analysis and Retrieval System Online) via Pubmed; LILACS (Latin American and Caribbean Health Science Literature Database); CINAHL (Cumulative Index to Nursing and Allied Health Literature) and EMBASE (The Excerpta Medical Database). At the end of the search, 2827 studies were found, 43 were selected for reading, and 10 were included in the review. The gray literature was also included. RESULTS: important findings related to clinical evidence and contributing factors of sleep were found in the review. However, in order to build definitions of the defining characteristics, it was necessary to use gray literature, such as a Portuguese dictionary and two textbooks about sleep. CONCLUSION: the definitions will help nurses in their practice in the collection of information, in the determination of the nursing diagnosis studied here, and in directing care measures with respect to quantity and quality of sleep of Acute Coronary Syndrome inpatients. They will also assist in the next steps of the validation of this diagnosis to the referred population.

Nursing Guide to Management of Major Symptoms in Patients with Malignant Glioma.

OBJECTIVES: To provide an overview of the symptoms commonly experienced by patients with malignant glioma, and discuss the pathophysiology and interventions associated with those. DATA SOURCES: A review of published scientific literature and clinical literature, and online information from National Comprehensive Cancer Network, Oncology Nursing Society, Epilepsy Foundation of America, and the American Brain Tumor Association. CONCLUSION: The unique symptom burden associated with a malignant glioma diagnosis often disrupts the lives of patients and their caregivers. Clinical support and interventions addressing malignant glioma-related focal deficits, seizures, headaches, venous thromboembolism, mood disturbances, fatigue, and sleep-wake disturbance can positively impact patient and caregiver experiences while living with malignant glioma. IMPLICATIONS FOR NURSING PRACTICE: Understanding the pathophysiology of these symptoms and reviewing nursing-led and supported interventions will empower the nurse in providing comprehensive care to patients with malignant glioma and their caregivers.

[Non-pharmacological treatment of hospital patients with sleeping problems - the nurse perspective]. / Nicht-medikamentöse Maßnahmen bei Ein- und Durchschlafproblemen von älteren Patienten im Krankenhaus ­ Qualitative Interviews mit Pflegenden.

Non-pharmacological treatment of hospital patients with sleeping problems - the nurse perspective Abstract. BACKGROUND: Elderly patients suffer from sleep disturbances during hospitalization. These patients often receive hypnotics and sedatives; despite of the known risks and although non-pharmacological treatments are available. AIM: The study investigates the experiences of nurses when using non-pharmacological treatments for elderly patients with sleeping problems. METHODS: Semi-structured interviews with 13 nurses from a general hospital were analyzed according to Mayring's qualitative content analysis. RESULTS: Nurses used a variety of non-pharmacological treatments for elderly inpatients with sleeping problems: (1) structural measures (regulation of temperature and light), (2) organizational measures (more time for conversation during the nightshift), (3) nursing measures (asking about night-time routines) and (4) household remedies. From the nurses' perspective, the more intensive contact required when applying non-pharmacological treatments can lead to higher patient satisfaction and a lower bell frequency during the night shift. Barriers result from limited time and personnel, a lack of standards and individual patient needs. CONCLUSION: Nurses know several kinds of non-pharmacological treatments to help elderly inpatients sleep better. A lack of resources as well as a lack of professional consensus about the treatment of temporary sleeping disturbances can be an obstacle to their use. A professional climate should restrict the use of drugs for sleeping problems as far as possible.

Impact of a Nurse Intervention to Improve Sleep Quality in Intensive Care Units: Results From a Randomized Controlled Trial.

BACKGROUND: Patients of adult intensive care units (ICUs) often suffer from a lack of sleep. Reducing anxiety by promoting adaptation to the ICU prior to admission may be an appropriate way to increase sleep quality. OBJECTIVE: The aim of this study was to evaluate the impact on sleep quality of a brief nurse intervention. METHODS: This was a pilot randomized controlled trial in Spain. Forty patients admitted in hospital for valve cardiac surgery were randomly allocated to (1) control group (n = 20), receiving usual care, and to (2) experimental group (EG, n = 20), receiving a nurse intervention the day before surgery and admission in the ICU. The intervention was based on Roy Adaptation Model. A trained nurse anticipated the stressful stimulus to patients in order to develop functional adaptive behaviors. A set of photographs and videos was used to illustrate the environment and assistance in the ICU. Sleep quality in the ICU was measured with the Richards-Campbell Sleep Questionnaire and usual sleep quality with the Pittsburgh Sleep Quality Index. RESULTS: After the intervention, sleep quality was lower in the EG compared with the control group (-4 points in Richards-Campbell Sleep Questionnaire, P = .69). Adjustment for main confounders led this reduction to -1.9 points (P = .87) among patients in EG. Stratified analyses shown a positive impact for people who usually slept well (+5.2 points, P = .77), but negative for those who had previous poor sleep quality (-20.0 points, P = .24). CONCLUSION: A nurse intervention prior to ICU admission did not increase patients' sleep quality. In addition, the intervention could have incremented anxiety over the patients who used to sleep poorly at their homes.