Question

Identify factors that might be barriers to normal sleep and nursing interventions that could help alleviate those barriers (i.e. how would you assess for those barriers; what might you need to teach the patient to help them sleep better; what interventions might you do as the nurse to help your patient get a better night’s sleep in the hospital).

Answer 1

Sleep is a vital activity of daily living as it restores and refreshes. However, there are environmental, physiological and psychological factors that can affect normal sleep patterns. The importance of a good night’s sleep for hospital patients can’t be stressed enough. It’s one of the most significant factors affecting their recovery. But due to practices such as late-night rounding, it’s difficult for patients to rest. There are many ways in which nurses can help patients achieve a good night's sleep.

Many aspects of a hospital stay can contribute to a patient having difficulty sleeping. Besides late-night rounds and vital-sign checks, sleep can also be disturbed by noisy machines in the hospital room, bright fluorescent lights and the general discomfort sick patients experience. Not only does a lack of sleep negatively affect recovery (and can even make certain patients more susceptible to developing delirium), it can hurt hospitals’ patient satisfaction scores.

Sleep is one thing that is universal to people. It is a human need and in fact, humans spend a third of their lives sleeping. It is vital for optimal psychological and physiological functioning. Sleep is essential to conserve energy, prevent fatigue, and to restore the mind and the body.

In promoting sleep, nurses are mainly involved in sleep hygiene, which refers to the set of interventions used to improve and promote sleep. Nurses use nonpharmacologic measures to increase the quantity and quality of clients’ sleep. Sleep hygiene encompasses health education on sleep rituals and habits, restful environment, comfort and relaxation, and occasionally, use of hypnotic medicines.

Individuals should need to realize the importance of sleep and its relation to fulfillment, productivity, and activity. Here are seven sleep-promoting tips nurses must share to their clients:

1. Relief for the Sleep-Challenged
For individuals who have difficulty initiating and maintaining sleep, establishing regular bedtime and wake-up time must be observed strictly. Through this, biologic rhythm is enhanced, and the body slowly falls into the established routine. For individuals who are unable to sleep, they must get out of bed and spend some time in another room. There, they can start some relaxing activities like reading and listening to soft music. They should continue the activity till they fill drowsy. Bedtime stories can relax children, holding onto a favorite toy or blanket, and a goodnight kiss. Of course, some individuals are fond of naps. However, there are few considerations about naps. For example, a short daytime nap of 15-30 minutes can be restorative for elders and will not interfere with the nighttime sleep. On the other hand, insomniacs are cautioned to avoid naps.

2. Beating the Hours Before Bedtime
Questions about appropriate activities near bedtime hours are common. In fact, activities are one of the major factors that can affect sleep. As a rule, dealing with office work and family problems should be avoided before bedtime. It is also helpful to establish a regular and relaxing bedtime routine composed of quiet activities like taking a warm bath and reading. It is important that one associates bedroom for sleep. Therefore, the bedroom should only be used for sleep and sexual activities. Work materials, television, and computers should be taken out of the bedroom. Having television and computers inside the room will only strengthen the association between wakefulness and sleep. Lastly, for individuals who only have the night available for exercising, avoid excessive physical exertion three (3) hours before bedtime. Rituals can be supported in institutionalized patients by assisting them with a hand and face wash, massage, pillow plumping, and even talking about today’s accomplishments and enjoyable events. These can promote relaxation and peace of mind.

3. Setting Up a Sleep-Inviting Environment
A sleep-conducive environment should have minimal noise, comfortable room temperature, mattress, and pillows, and appropriate ventilation and lighting. According to studies, music is discouraged because it is interesting and will promote wakefulness. Extraneous noise from a fan, air conditioner, and white noise machine must be blocked out. Most people may prefer a darkened environment, but children and individuals in a strange environment would benefit from a low light source. For patients in the hospital, factors that can prevent sound sleep include staff noise during shift , telephones and call lights, doors, paging systems, and even carts wheeled through corridors. Safety and comfort can be promoted by raising side rails, placing the bed in a low position, and using night-lights.

4. Diet for Good Sleep
For a good quality of sleep, heavy meals should be avoided 2-3 hours before bedtime. Foods that contain alcohol and caffeine (e.g. chocolates, coffee, etc.to easily fall) should be avoided 4 hours before bedtime. Both substances can interfere with sleep because of their diuretic properties. They will cause individuals to feel the need to void during sleep time. If bedtime snack is necessary, a glass of milk or a share of light carbohydrates is recommended. Heavy and spicy foods should be avoided because they can disturb sleep by inducing gastrointestinal distress.

5. Promoting Comfort and Relaxation
These measures are essential to help the client all and stay asleep, especially if an illness is present and interferes with sleep. Nurses and family members should be concerned and caring during these times. Interventions that can promote comfort and relaxation include assisting with hygienic routines, providing loose-fitting nightwear, encouraging voiding before sleeping, and making sure bed linen is smooth, clean, and dry. Elders are susceptible to feeling cold so encouraging them to wear their own clothing together with socks or leg warmers instead of hospital gowns can help. A prewarmed bath blanket or cotton flannel sheets can also be used.

6. Addressing Emotional Stress
It is nearly impossible for individuals who are emotional to fall easily into a deep slumber. Emotional stress interferes with the individual’s ability to rest, relax, and sleep. Slow and deep breathing techniques for few minutes can alleviate tension and induce calm. Other techniques that can be taught include imagery, yoga, and meditation.

7. Medication for Enhanced Sleep
Sometimes, medications are prescribed on per needed basis. Sedative-hypnotics can induce sleep. Antianxiety or tranquilizers can reduce anxiety and tension. For patients feeling pain, analgesics must be taken before bedtime to relieve aches and pains. Other medications may cause insomnia so a consultation with the provider is encouraged. Medications are only used as a last resort. Caution is advised on over-the-counter (OTC) drugs because they might have antihistamine components which can cause daytime drowsiness.

These self-promoting measures are actually simple but today’s indulgence for modern technology and other factors can challenge its strict implementation. There is not a more painful thing than not finding solace in an activity that is supposed to re-energize you. This is why nurses must be active in their involvement for sleep promotion.