Sleep deprivation is a multifactorial phenomenon, occurring frequently in the intensive care unit (ICU) and linked to adverse patient healthcare outcomes. The key practice question of this project focused on determining if retiming of routine laboratory and imaging testing outside of the designated “quiet time” can improve sleep quality among adult patients in the ICU. The purpose was to evaluate the effectiveness of implementing an evidence-based intervention to improve sleep quality in the ICU setting. The theoretical framework was the plan-do-study-act model, which offered a process for implementing a practice change and reevaluation of the intervention’s sustainability within the organization. A thorough literature search of over 100 scholarly journal articles, book references, and expert scholarly reports was completed to gain an understanding of this phenomenon in the ICU setting. The Richards-Campbell Sleep Questionnaire (RCSQ) was the data collection tool used to measure improvement in sleep quality. There were 72 participants that are included in the project. The Wilcoxon rank sum and chi square tests were used for the statistical analysis. The findings did not show statistical significance in the improvement in the RCSQ scores after implementation of the intervention. The recommendations include sleep deprivation training for nursing staff and providers, routine use of the RCSQ for data collection, and repeating the study with an increased number of participants and redefined inclusion and exclusion criteria to be more representative of the ICU patient population. The implication for social change is that this project empowers nursing to embrace a leadership role in using evidence-based practice to change clinical guidelines and improve patient outcomes.

Bakgrund Sömnen har många viktiga funktioner. Det är bland annat under sömnen kroppen återhämtar sig. Vid inläggning på sjukhus upplever patienter att sömnen störs. Sömnstörning påverkar läkningsprocessen negativt. Syfte med denna litteraturstudie var att undersöka hur inneliggande vuxna patienter upplever sömnen i sjukhusmiljön samt vilken omvårdnad som främjar patienters sömn. Metod Allmän litteraturöversikt med en deskriptiv design. Studien innefattade tolv artiklar med både kvalitativa och kvantitativa ansatser. Artiklarna granskades med granskningsmallar och artiklarnas resultat analyserades och kategoriserades in under olika områden. Resultatet visade att patienternas upplevelse av orsaken till sömnstörning övergripande berodde på; tankar och oro som uppkom i sjukhusmiljön, störande faktorer i sjukhusmiljön, sjukdom och symtom samt rutiner på avdelningarna. Omvårdnadsåtgärder som främjade sömn var lindring av oro, anpassning av miljö, delaktighet och tillfredsställande smärtlindring. Slutsats Sjukhusmiljön har stor inverkan på sömnen. Öronproppar och sovmask kan erbjudas till patienter för att eliminera ljud och ljus. En dialog mellan sjuksköterska och patient kan vara till hjälp för att upptäcka och hitta lösningar till patientens sömnstörning. Det finns ett behov av mer utbildning och forskning kring sömnfrämjande omvårdnad. / Background Sleep is vital for various functions. Among other things sleep aid the human body to recover. Due to hospitalization many patients experience sleep disturbances. Sleep disruptions effects the healing process negatively. Purpose The purpose of this study was to investigate how adult inpatients experience sleep in the hospital environment and to identify promoting nursing care. Method Literature review with a descriptive design. The study included twelve articles both with qualitative and quantitative design. The quality of the articles was assessed and the content regarding sleep analyzed and categorized into subcategories. Result Showed that the reason for inpatients sleep disturbances were mainly caused by; thoughts and worries caused by the hospital environment, disturbing factors in the environment, illness and symptoms and also routines in the hospital wards. The result even showed nursing care that promoted sleep were relief of worry, adaptation of the environment, participation and sufficient pain relief. Conclusion Hospital environment have a major impact on sleep. Earplugs and eyemasks can be offered to patients to eliminate sound and light. A dialogue between the nurse and the patient can be helpful to discover and find solutions to the patient's sleep deprivation. There is a need for more education and research in sleep-promoting nursing.

Objective: Sleep deprivation has been proposed as a potential correlate of obesity, particularly influencing energy intake. Therefore, the purpose of this study was to compare neural indices of attention related to food motivation and energy intake in normal-weight and obese women under two separate sleep conditions: 1) sleep-restricted (<5 hours) and 2) recommended sleep (~8 hours). This study used a combined cross-over and ex post facto design with condition order counter-balanced. Methods: Twenty-two normal-weight (age=30.9±9.5y, BMI=22.0±1.6 kg/m2) and 18 obese (age=29.7±10.7 y, BMI=36.4±5.3 kg/m2) women completed both sleep conditions. To confirm sleep levels, participants recorded sleep quality and quantity via sleep logs and wore a wrist actigraph. Following each condition, participants reported to the laboratory under the same fed state (energy shake ~10% of total daily needs) to verify they followed the sleep protocol. Subsequently, motivation for food was tested using electroencephalogram (EEG); participants completed a computerized passive-viewing task of food and flowers, while event-related brain potentials (ERPs) were recorded. After EEG testing, participants continued their normal routine but recorded all energy intake using weighed food scales. There were no instructions or limitations on dietary intake. Analyses included P300 and LPP amplitudes in response to picture type, total next day energy intake, and energy intake by several periods of the day. Results: Participants averaged 4.7±0.4 hours of sleep during the sleep-restricted condition and 7.7±0.3 hours during the recommended sleep condition (F=1057.02; P<0.0001). There was no group*condition interaction for next day food motivation (P300: F<2.896, P>0.09; LPP: F<2.967, P>0.093). Next day total energy intake also did not differ by group*condition (F=1.81; P=0.187). When participants were pooled, there was no difference in energy intake by sleep condition (F=0.00; P=0.953). However, when participants’ energy intake was analyzed during the lunch period (following testing to 1:30pm) there was a significant group*condition interaction (F=6.12; P=0.018). The obese women ate significantly more (~300 kcal) during the sleep-deprived condition compared to the recommended condition, whereas the normal-weight women did not. Conclusion: Compared to suggested levels of sleep, sleep restriction and obesity do not influence next day food motivation or total next day energy intake. However, sleep restriction and obesity may influence feeding during certain portions of the day.

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Sleep is an essential component of optimal physiological and psychological functioning in humans. However, numerous studies have identified sleep deficits in patients within the critical care setting. Sleep deprivation has been shown to cause adverse effects including cardiovascular, respiratory, and endocrine variations, and altered psychological functioning such as cognitive dysfunction, decreased concentration, mood variability, and delirium. The critical care environment often contains stimuli that may be a causative factor in sleep alterations such as sleep deprivation, fragmentation or alterations in sleeping patterns. These environmental stimuli include noise, light, pain, discomfort, nursing care activities, medications, psychological stressors and underlying disease and have the capability to severely impact the quantity and quality of sleep in critically ill patients. The integrated research review identifies correlations between environmental stressors and sleep alterations in critically ill patients. Outcomes of interventions including earplugs and eye masks, behavior modification, complementary and alternative medicine and pharmacological considerations are examined. Additionally, implications for nursing education, research and practice are addressed. A current integrated research review incorporating nursing implications and alternative interventions could be significant to the provision of nursing care for the critically ill patient.

Made available in DSpace on 2015-07-22T20:50:42Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-01-26 / A recordação livre de listas de palavras é uma tarefa que tem sido utilizada para avaliar os efeitos da privação de sono prévia na memória declarativa, porém os resultados são controversos. Uma possível explicação é a “impureza” da tarefa, pois o número total de palavras recordadas reflete o uso de diferentes tipos de memória e estratégias de organização de informações, algumas das quais podem não ser prejudicadas durante a privação de sono. Nosso objetivo foi estudar os efeitos de duas noites de privação de sono e uma noite de recuperação de sono na recordação imediata de listas de palavras considerando a recordação pela curva de posição serial, que pode refletir o uso de diferentes estratégias e tipos de memória. Investigamos também a susceptibilidade à interferência. Para este fim, 24 voluntários jovens saudáveis foram alocados em um de dois grupos experimentais: duas noites de privação total de sono seguidas de uma noite de recuperação de sono (n=11) ou três noites de sono normal (grupo controle; n=13). Os voluntários leram e recordaram, em voz alta, cinco listas de quinze palavras não relacionadas, uma de cada vez, no período da tarde, num momento basal e após as três noites subsequentes. Na análise de variância (ANOVA com medidas repetidas) não foi observada diminuição na recordação livre durante a privação de sono quando da comparação direta entre grupos em cada uma das posições e sessões de testes, tampouco aumento da suscetibilidade à interferência. Porém, houve melhora no desempenho em ambos os grupos em relação ao desempenho basal ao longo do experimento relativo às palavras nas primeiras e posições seriais intermediárias, indicando o desenvolvimento de estratégias de recordação de memórias declarativas. Porém, este aprendizado ocorreu antes no grupo controle e foi evidenciado no grupo privado somente após a recuperação de sono. Não houve alteração da recordação das palavras nas últimas posições seriais, indicando que a memória fonológica de curto prazo foi preservada. Conclui-se que a privação prévia de sono não prejudica a memória ou aumenta a interferência, e permite o desenvolvimento de estratégias, mas pode diminuir a vantagem no uso dessas estratégias de aprendizagem. Contudo, o uso dessas estratégias é equivalente à do grupo controle após uma noite de recuperação de sono. / Free recall of word lists is a task that has been used to evaluate the effects of prior sleep deprivation on declarative memory, but the results are controversial. A possible explanation for this is task impurity, because the total number of words recalled reflects use of different types of memory and strategies for organizing information, some of which may be spared by sleep deprivation. We studied the effects of two nights of total sleep deprivation and one night of recovery sleep on immediate recall of word lists considering recall by serial position, which can reflect the use of different strategies and types of memory. We also assessed susceptibility to interference. To this end, 24 healthy young volunteers were allocated to one of two groups: two nights of total sleep deprivation followed by one night of recovery sleep (n = 11) or three nights of normal sleep (group control, n = 13). Participants read and remembered aloud lists of five lists of fifteen unrelated words, one at a time, in the afternoon, a baseline and after three subsequent nights. In the analysis of variance (ANOVA with repeated measures) was not reduction in free recall during sleep deprivation when a direct comparison between groups in each of the test sessions was carried out, nor increase of susceptibility to interference. However, there was an improvement in performance in both groups throughout the experiment considering baseline performance relative to the first and intermediate serial positions, suggesting the development of recall strategies of declarative memories. This type of learning, however, occurred in the control group earlier in the study and was evident in the deprived group only after recovery sleep. There was no change in recall of words in the last serial positions, indicating that phonological short-term memory was preserved. We conclude that prior sleep deprivation does not affect memory or increase interference, and allows the development of strategies, but may decrease the advantage in using these learning strategies, which returns to control levels after one night of recovery sleep. / TEDE / BV UNIFESP: Teses e dissertações

Zielbereiche der vorliegenden Arbeit stellten sowohl die Analysen zur Auswirkung eines Schlafentzuges (SE) unter Tryptophan-Depletion (TD) auf die hormonellen Parameter Prolaktin (PRL), Cortisol, Thyreotropin (TSH), Trijodthyronin (T3) und Thyroxin (T4) als auch die daraus resultierenden Rückschlüsse im Hinblick auf eine Verzahnung dieser Parameter nicht nur mit der depressiven Symptomatik sondern auch mit den SE-Wirkmechanismen dar. Zur Untersuchung dieser bislang im Rahmen der biologischen Depressionsforschung unberücksichtigten Kombination gelangten 22 SE-Responder, die sich einem doppelblind aktiv placebokontrollierten (SHAM) Parallelgruppendesign unterzogen. Die eigenen Beobachtungen einer blanden Response nach SE unter TD im Vergleich zur SHAM-Version des PRL und TSH einerseits sowie des Cortisols andererseits im Sinne eines abgeschwächten Plasmakonzentrationsanstiegs bzw. -abfalls sprechen zugunsten der Hypothese, daß der SE über serotonerge Wirkmechanismen zumindest teilreguliert werden dürfte. Die Konzentrationsunterschiede zwischen den Untersuchungsgruppen, die am SE-Nachmittag für PRL, Cortisol und TSH signifikant ausfallen, trotz gleichzeitig deutlicher Besserung der depressiven Symptomatik aller Patienten, legen zudem die Folgerung nahe, daß die divergierende hormonelle Antwort auf eine TD als Trigger einer klinischen Differenzierbarkeit der Depressionstiefe insuffizient zu sein scheint. / The present double-blind and placebo-controlled study was designed to analyse the impact of sleep-deprivation under tryptophane-depletion in depressed patients on hormones, e.g. prolactine, cortisol, TSH, T3, and T4. Current data support the hypothesis that sleep-deprivation might act as an antidepressant by serotonergic pathways. Thus, alterations of these relevant humoral parameters could expected by decreased serotonergic activity after tryptophane-depletion. We investigated 22 depressed patients who responded to one night of sleep-deprivation. Tryptophane-depletion led to a blunted increase of prolactine and TSH, whereas cortisol plasma-level revealed a blunted decrease. No difference between tryptophane-depletion and placebo could be spot concerning neither T3 nor T4. Our results support the idea that serotonergic pathways might be involved in the interactions following sleep-deprivation, but cannot explain the complex alterations of the aforementioned hormones alone.