RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1. / NAME OF THE
CANDIDATE
AND ADDRESS / MISS.YESUDAYA.M
MSC NURSING
AECS MAARUTI COLLEGE OF NURSING, KAMMANAHALLI , OFF BANNERGHATTA ROAD,
BANGALORE.
2. / NAME OF THE
INSTITUTION / AECS MAARUTI COLLEGE OF NURSING, NO-99, NEAR MAARUTI DENTAL COLLEGE, KAMMANAHALLI , OFF BANNERGHATTA ROAD, , BANGALORE-76.
3. / COURSE OF THE STUDY
AND THE SUBJECT / MSC. NURSING 1ST YEAR
MEDICAL SURGICAL NURSING .
4. / DATE OF ADMISSSION TO COURSE / 13,JUNE 2009
5. / TITLE OF THE TOPIC / A STUDY TO ASSESS THE QUALITY OF SLEEP AND FACTORS AFFECTING SLEEP AMONG HOSPITALIZED PATIENTS IN SELECTED HOSPITALS AT BANGALORE WITH A VIEW TO DEVELOP INFORMATION BOOKLET ON SLEEP PROMOTIONAL MEASURES.

INTRODUCTION:

Sleep is a basic need for human survival and is essential to healing and recovery from illness and injury. As well, many vital physiological processes are defined in terms of their relationship to a circadian rhythm and are thus intimately involved in the sleep state. However, sleep disturbances are all too common in hospitalized patients, with repeated arousals and disruptions in sleep, though it is frequently overlooked by nurses and other health care providers. Environmental noise, disruption of light/dark cycle, caregiver interruptions, pain, and stress can all contribute to the inability of hospitalized patients to get adequate, restful sleep. Nearly 38percent of adult patients are suffering from sleep disturbances and they are vulnerable to the deleterious effects of sleep disorders. Because it occurs at a time when sleep needs are greatest, sleep disturbance is a significant source of stress for older adults experiencing acute illness, resulting in impaired protein synthesis and decreased cellular immunity1.

The causes of disruptive sleep can be regarded as interrelated and are categorized into physiological, environmental and psychological influences. Whilst physiological influences affecting sleep quality would include physical discomforts such as pain, these could worsen when patients are placed in noisy environments, where noise emanating from staff, patients and equipment has contributed to sleep loss.

Patients who have psychological disorders affecting mostly the quality of sleep , in terms of sleep disturbance arising as a result of disruption to usual personal lifestyle and habits. A number of factors contribute to the development of sleep disturbance among hospitalized adults. Elders are particularly vulnerable to sleep disturbance as a result of normal, age-related changes in sleep patterns. Mothers and nurses often sing their babies to sleep. That is a very good expedient, and may now and then succeed even with a grown person. Sleep is considered to be of particular importance in the healing process because the secretion of growth hormone that occurs during these stages stimulates protein synthesis, cellular growth, and tissue repair.In every case quietness is indispensable, through the evening and night. Little or no light should, during the night, reach the eyes of the patient: if accustomed to darkness, this will be best2.

6.0 A BRIEF RESUME OF THE INTENDED WORK

6.1 NEED FOR THE STUDY:

Sleep disturbance is a common phenomenon among people. Complaints of disruptive sleep are not uncommon occurrences during hospitalization, with unpleasant consequences arising when disrupted sleep is left unmanaged. In studies examining sleep experiences of patients in different care settings (medical, surgical, psychiatric and geriatric), one-half of them experienced insufficient sleep and difficulty sleeping during the night. Thus, complaints about disruptive sleep were likely to occur during hospitalization and were not entirely related to the clinical specialties patients were admitted into. This is rather alarming particularly when disrupted sleep, if prolonged, can lead to a chain of unpleasant consequences.

The degree of sleep disruptions and its influence on a person’s sleeping pattern is very personal and individualized. This suggests that if the priority is to meet the sleep needs of hospitalized patients, there should be an established procedure in place for nurses to readily ascertain the views of individual patients, whose sleep can be potentially influenced by the ward environment, such as in a thorough sleep assessment conducted at admission and thereafter.

Sleep disturbances are common in hospitalized patients. More than half of the patients experience some difficulties in their sleep. These sleep difficulties become more prevalent and increase in severity with age. The picture is similar in acute care settings. Self-reported sleep disturbance among hospitalized patients, many of whom are elderly, can range from 22percent to 61percent

Sleep loss among hospitalized patients can have serious consequences for elders, often contributing to daytime impairments in attention and in the capacity to plan and make decisions. In addition to cognitive difficulties, sleep deprivation also can result in increased anxiety levels and disturbances in memory and may contribute to disordered immune function. Poor sleep not only reduces quality of life but also may lead to more adverse outcomes. Seriously compromised total sleep time can predispose the elder to depression, and daytime sleepiness has been found to be a risk or precipitating factor in the development of cardiovascular disease and has been associated with higher rates of mortality3.

Yet sleep problems often go unrecognized by health care providers because their recognition depends in large part on self-report, and older adults may accept changes in sleep patterns as a part of normal aging or be reluctant to report them to a provider unless they perceive resulting symptoms as severe.

A study was conducted on sleep promotion, hospital practice and recovery from illness. For hospital practices seem rarely designed to encourage maximum sleeping. Sleep promotion is defined as the arrangement of conditions so that patients can achieve as much sleep as possible. It is hypothesized that sleep promotion is of benefit, at least by improving patient well-being, possibly also be hastening healing processes. It is recommended that hospital procedures should be designed to encourage sleeping.

To intervene effectively, health care providers must understand the extent and nature of sleep problems in hospitalized adults. In sleep, symptoms of sleep disorders, and the evidenced-based interventions that promote sleep is essential. Knowledge of quality of the sleep and the factors affecting the sleep due to hospitalization is essential for health care providers. With this understanding, providers can advise patients on normal age-related changes in sleep, reassure and educate them to have realistic expectations about their sleep patterns, teach them how to improve existing sleep habits, and recognize symptoms when sleep disorders exist. Hence the investigator felt the need to study the Quality of sleep and the factors affecting the sleep with a view to develop information booklet on sleep promotional measures4.

6.2 REVIEW OF THE LITERATURE:

A study was conducted for an assessment of quality of sleep and the use of drugs with sedating properties in hospitalized adult patients. A single-centre prospective study involved for those patients admitted to the general medicine and family practice units of an acute care. 100 patients were taken for the study and the sleep disturbance scores across all study days ranged 16-681, sleep effectiveness scores ranged 54-402, while sleep supplementation scores ranged between 0-358. Patients tended to have worse sleep scores as compared to healthy non-hospitalized US adult patients. The results of this study reveal that quality of sleep is a problem that affects hospitalized adult medical service patients and a relatively high percentage of these patients are being prescribed a hypnotic prior to and during hospitalization5.

A study was conducted on sleep experiences among hospitalized patients to determine the extent of sleep loss for the hospitalized adult. Research from the patient's perspective, nurses' assessment of patient's sleep and somnographic studies are considered. Although these three methods are inconsistent in the exact extent of sleep loss, all suggest that hospitalized patients experience less sleep than their normal pattern. Reasons for patients losing sleep are explored. Environmental factors in critical care areas are the most cited reason for loss of sleep yet other reasons are suggested. Consequences of sleep loss are explored. Some nursing interventions offered in the existing literature are examined for their feasibility6.

A study was conducted on patient perception of environmental and nursing factors contributing to sleep disturbances in a neurosurgical intensive care unit (NSICU). It includes therapeutic and diagnostic procedures, medications, the underlying disease process, and noise generated in NSICU. The sample consisted of 84 voluntary patients hospitalized at a university hospital. Sixty-six patients (78.6 percent) experienced sleep disturbances, patients being kept immobile 63.6percent and being in a noisy environment 57.6percent were the factors, which most frequently disturbed sleep. Likewise, the nursing interventions were found to have profound influences on patients' sleep; namely, being asked to move an arm/leg or to keep them in the same position for neurological diagnostic reasons 43.9percent, and being asked questions to determine the level of consciousness 40.9percent were identified as the common sleep disturbance factors. In conclusion, immobility, environmental noise factors, and the disturbances from implementing the nursing interventions should not be ignored. Nurses, physicians, nursing and medical students should establish and evaluate the combined interventions required for neurological assessment to decrease the negative effects of various factors on patients' sleep7.

A study was conducted on sleep disturbance and the patient care activities applied at the night shift in the intensive care unit. Nursing activities, fear and apprehension cause low morale and sleep disturbance. The study was carried out on a descriptive basis in the Surgical Intensive Care Unit. Thirty sedated and 30 non-sedated patients to whom the nursing care were applied. The results demonstrate that patient records indicated a mean of 51 interactions per patient per night. Nursing activities were more frequent between 02.00 and 05.00 hours. It was detected that nursing activities such as mouth and eye care, decubitus ulcer care, change of dressing, bed bath, catheter change for three night shifts were more frequently between 24.00 and 05.00 hours. Mechanical ventilation control and endotracheal suctioning were more frequently performed on sedated patients than on non-sedated patients (P < 0.05). These findings of this study indicate that the nursing activities in the intensive care unit were focused on the activities, which will maximize that are seen to be physiological stability8.

A study was conducted for reducing the effects of noise in hospital to promote sleep. This study identifies noise as a factor in disturbing patients' sleep in hospital and discusses the usefulness of earplugs as a method of reducing perceptions of noise and enhancing sleep. A pilot study, comparing the quality and quantity of sleep in patients who used earplugs, with those who did not, showed them to be an acceptable and effective method of facilitating sleep9.

.

A study was conducted on sleep promotion as an important dimension of maternity nursing. Studies indicate that sleep is disturbed throughout the maternity cycle. The sleep disturbance, leading to reduced sleep time, has been associated with a variety of physical, behavioral, and psychological problems. Nursing intervention to identify sleep deficit and promote sleep is required at all stages of the maternity cycle. Knowledge of sleep structure and the role of each stage of sleep is a prerequisite in understanding the value of sleep in health10.

A study was conducted on examining the feasibility of implementing specific nursing interventions to promote sleep in hospitalized elderly patients. Sleep deprivation and subsequent effects on health restoration have been documented in the literature. Experimental pilot study was done to examine the feasibility of implementing specific nursing interventions to promote sleep. While no differences were noted in sleep quality and duration between groups, the experimental group experienced better sleep quality (P = .001), ability to remain asleep (P = .018) and used fewer sleep medications than the control group (P =.044).Results of this study indicates in addition, those taking sleep medications experienced more awakenings and fewer sleep hours. Experimental group patients identified preferences such as personal hygiene, awareness of normal bedtime, receiving a back rub, straightening bed linens, and receiving a bedtime snack. This pilot provides initial support for the feasibility and utility of implementing a sleep protocol in an acute care setting11.

STATEMENT OF THE PROBLEM:

A study to assess the quality of sleep and factors affecting sleep among Hospitalized patients in selected hospitals at Bangalore with a view to develop information booklet on sleep promotional measures.

6.3 OBJECTIVES OF THE STUDY:

1. To determine the quality of sleep among hospitalized patients

2. To identify the factors affecting sleep among hospitalized patients

3. To determine the association between quality of sleep, factors affecting sleep and selected demographic variables.

4. To develop and distribute information booklet regarding promotional measures for sleep

6.4 OPERATIONAL DEFINITIONS:

Assess: In this study it refers to the measures taken to find out the quality of sleep and factors affecting sleep among hospitalized patients.

Quality of sleep: In this study it refers to the nature and duration of sleep among hospitalized patients which will be assessed by using Verran and Snyder-Halpern Sleep scale in the areas of sleep disturbance, effectiveness and supplementation of sleep.

Factors affecting sleep: In this study it refers to physical, physiological, psychological and environmental factors affecting sleep in hospitals.

Hospitalized patients: In this study it refers to patients aged 18years and above who are admitted in general wards at selected hospitals

Information booklet: In this study it includes facts of information regarding sleep promotional measures among hospitalized patients.

ASSUMPTIONS:

1.  Hospitalization can disrupt sleeping patterns.

2.  Sleep is a basic activity of living. It can be affected by physical, physiological, psychological and environmental factors.

VARIABLES IN THE STUDY:

Research variable: In this study, it refers to the Quality of sleep and factors affecting sleep among hospitalized patients.

Demographic variable: In this study it refers to age sex, education, occupation, income, reason for hospitalization, chief complaints like pain, timing of medications, type of patient unit, bed time rituals etc

7. MATERIALS AND METHODS:

7.1 Source of data: Hospitalized patients aged 18years and above