As a nurse, we are responsible for patient centered care, in that all our actions must be focused individually on the patient. Rest and sleep are necessary for wound healing, protein synthesis, immune function, energy conservation, and restoration of the mind (Ganz, 2012; Gilsenan 2012) (Clark, 2017; Mills 2017). Sleep hygiene is an important factor in health promotion and injury prevention, and should not be ignored or taken lightly. Prolonged lack of sleep can lead to fatigue, irritability, confusion, decreased pain intolerance, and delayed wound healing (Radtke, Obermann, & Teymer, 2014) (Clark, 2017; Mills 2017). According to Luyster, Strollo, Zee, and Walsh (2012) sleep deprivation can exacerbate progression of cardiovascular disease, metabolic disorders, and cancer, and even cause death (Clark, 2014; Mills 2017). Stress, anxiety, and depression also can contribute to insomnia and poor sleep quality (Radtke et al., 2014) (Clark, 2017; Mills 2017). There are several actions that can be done to prevent sleep deprivation and promote healing and restoration in patients.
By following the nursing process – assessment, diagnosis, planning, implementation, and evaluation – as nurses, we can decrease sleep deprivation and increase healing in patients. Quality of sleep is unique to the individual, regarding their own personal preferences. For assessment, I would need to get a general understanding of the patient before asking about their sleeping habits. Asking questions to determine a patient’s level of consciousness, whether they are oriented to person, place, time, and event, if they are pre-op or post-op, if they currently have any open wounds, or if they have stressors or anxieties about their current situation. Checking their history of present illness as well as their past medical history, to see if there are any underlying causes of their sleep deprivation, such as a cardiovascular or metabolic disease, will be beneficial as well. The answers that the patient provides, are baselines for the next step in acting to better individualize bettering the sleep cycle of the patient.
As a nurse, we are responsible for the patient, their health, and their outcomes, while they are in our care. Responsibilities, such as providing attentive care or developing therapeutic communication skills between all patients and staff members, are necessary when caring for patients. Regarding healing as it relates to sleep, there are independent and collaborative actions that can be taken to ensure that your patient is getting the right amount of sleep to promote healing and health restoration. Independent actions that nurses can take are, making sure they have gone to the bathroom prior to bed time, making sure night time medications were given at an appropriate time, such as dinner time – to prevent waking up during the night to urinate –, limiting the amount of time that nurses enter the room at night, respecting quiet hours, and ensuring your patient is comfortable before you leave the room for the evening.
Collaborative measures include implementing a routine or protocol, that is used by all staff members to prevent sleep deprivation. In a study based on Sleep Hygiene in Hospitals for Patient Healing, patients ranked lack of sleep among the top 3 sources of anxiety and stress during hospitalization. (Brand, 2014). According to Sleep Hygiene in Hospitals for Patient Healing, implementing a sleep hygiene protocol improved noise levels, caused less interruptions during the hours of 11pm to 4am, and created a quieter work environment (Brand, 2014). Along with implementing a protocol, as nurses we can also educate the staff on the negative effects of noise, put up reminders for quiet time (Brand, 2014), and observe each other for number of times staff members enter the room during the night shift.
Each patient is unique, meaning each care plan and care processes are individualized to focus on the best possible care and outcome for that patient. The main target here is figuring out why the patient isn’t getting the rest they need for healing and restoration and what we, as nurses, can do to make sure that patients are receiving optimal health promotion. Individually, I would want to know specific sleeping habits or routines that the patient partakes in as their sleep hygiene process, as I mentioned above. Types of sleeping habits I would be interested in would be, the normal hours this patient likes to sleep (i.e. 7pm to 5am or 9pm to 7am), how they prepare for bed, if they brush their teeth or wash their face before bed, and how they get ready for bed at home. Among these small factors, I would also like to know, if they sleep better with or without noise, with or without additional lighting, the temperature they get the best rest in, if they prefer the curtains closed or open while they sleep, specific ways they prop their pillows, and if they have sentimental blankets to determine the underlying cause of the patient’s restlessness.
Lastly, we as nurses not only need to think about optimum health care while in the hospitals, but we also need to think about the future of our patients. If they are having sleep issues within the hospital, there may also be sleeping issues at home. Studies show that there are preventative actions that can be taken to promote optimum health care both in and out of the hospitals (Brand, 2014). To make sure your patient is getting an adequate amount of sleep at home, as a nurse, we can create a sleep hygiene routine. This would incorporate a schedule starting about an hour or two before the patient goes to bed, including but not limited to: limiting amount of fluid intake after dinner, turning on night lights and dimming lamps in the home, turning the television off at an appropriate time, getting dressed, brushing teeth, and washing face before bed, and having a routine bedtime.
If the patient lives with a family member, or has a home health aide, we as nurses can also involve these members in the patient’s sleep hygiene routine. By collaborating with the family or home health aide, we are ensuring optimum care after discharge to promote the continuity of the healing process. To evaluate whether these measures have been beneficial in sleep promotion, we can have the patient track her sleeping habits after the sleep hygiene routine was implemented and compare it to the subjective data that was gathered from the patient prior to this routine. Inevitably, there will be changes made to the care plan to better the health promotion of the patient if the original plan of action did not work.
Rest and sleep are necessary for wound healing, protein synthesis, immune function, energy conservation, and restoration of the mind (Ganz, 2012; Gilsenan 2012). Sleep hygiene is an important factor in health promotion and injury prevention, and should not be ignored or taken lightly. There are several actions that can be done to prevent sleep deprivation and promote healing and restoration in patients.