Towards a nursing theory of addressing
ICU sleep deprivation
Sleep deprivation
is a condition that is common in ICU. This is a phenomenon that may have
serious effect on critically ill patients. Some of the detrimental effects of
this problem include increased catabolism as well as impaired humural and
cellular immunity (Dines-Kallnowski,
2002). This is a group of patients that require sufficient sleep and lack of it
pose a challenge to their recovery. The disruption in their sleep has been
known to be caused by the regular treatments and monitoring. Other factors that
have been suggested as causing the problem include the underlying condition and
the environment of the intensive care unit. Nevertheless, pain and
round-the-clock monitoring are not the only causes of the problem in the ICU (Figueroa-Ramos,
Arroyo-Novoa, Lee, Padilla and Puntillo, 2009). Though this condition seems to
be common in the nursing practice, it is not yet well understood. There is need
for development of a nursing theory to explain to ICU sleep deprivation
phenomenon, its causes and what can be done to alleviate the problem.
Current nursing theory development
There is no much
research in the area of sleep deprivation in the ICU. However, there are
various theories that have been developed in explaining possible reasons behind
the problem particularly in the ICU. Even if sleep mechanisms are not well
understood, it is a fact that it is very important for the normal functioning
of the body. This means that lack of sufficient sleep has detrimental effects. The
current literature has suggested that critically ill patients in the ICU spend
most of their time in lighter phases than they spend during the restorative
phases in the sleep cycle. Some of the hypothetical factors that have been
suggested as those behind the lack of sleep for this group of patients include:
doctor’s activities in the ICU, pain and stress, and the setting of the ICU
itself (Tembo and Parker, 2009). Some researchers have suggested that anxiety
can interfere with the biological functions that are related to the normal
sleep cycle. Hormones such as Corticotropin-releasing hormone,
adrenocorticotropic hormone, and cortisol are released in the morning in order
to prepare for the day’s stressors. Where the wake-sleep cycle is disrupted,
the hormones will fail to be secreted at the appropriate times leading to the
feeling of tiredness and disorientation (Figueroa-Ramos, Arroyo-Novoa, Lee, Padilla
and Puntillo, 2009).
Gabor et al
investigated the effect of noise in the intensive care unit. They realized that
noise and disruptions by doctors accounted for about 20 percent of sleep
deprivation in critically ill patients. Mechanical ventilation is another
factor that was assessed as being one of those behind sleep deprivation. Gabor
et al found out that mechanically ventilated patients experienced significant
sleep disruption. Factors related to ventilation that can cause this problem
include masks, tubes, and sanctioning. Severity
of the illness can also have a significant effect on the patient’s sleep
(Olofsson, Alling, Lundberg and Malmros, 2004). Patients in pain were reported
to have slept less than those who were in less pain. Physical restraints in
some nations may lead to stress and anxiety that may cause disruptions in
sleeping patterns. Though these are some of the factors that some researchers
believe to be behind sleep deprivations, some other studies reveal
contradicting results. A research that was performed with the use of
polysomnography in particular groups of patients in the ICU could not be
applied to patents in general ICUS. Patients are different and have different
illnesses. It is therefore not possible to develop conclusions in general as to
why patients in the ICU suffer sleep deprivation. Researches that seem helpful
in addressing this issue are the one that focus on specific groups of ICU
patients and not general ICU patients (Cooper, Thornley, Young and Slutsky, et
al 2000).
The need for theoretical development
As sleep
deprivation and what causes it is not well understood in the nursing practice,
there is a problem since it is an issue that continues to have detrimental
effects on patients in the ICU. The detrimental effects of ICU sleep
deprivation are a major issue among professionals in the nursing practice. This
is made worse by the fact that there is no single solution that has been
identified in research or practice to deal with this problem. Patients continue
to suffer as professionals feel the need to relieve their suffering. This
indicates the need for a theoretical framework addressing the problem, its
causes and possible remedy. Emphasizing only on the causes without finding possible
solutions is not effective in helping the patients. Additionally,
identification of the effects without finding solutions is not helpful for the
patients. The theory should be such that it addresses the major aspects of ICU
sleep deprivation, that is, causes, effects and solutions. This is because it
is the only way for professionals to be equipped with an effective means of
solving the problem of sleep deprivation in the ICU (Dines-Kallnowski, 2002).
References:
Cooper, A. B., Thornley, K. S.,
Young, G. B. & Slutsky, A. S. et al (2000). Sleep in critically ill
patients requiring
mechanical ventilation, Chest; 117,
3; ProQuest Central pg. 809
Dines-Kallnowski, C. M. (2002). Patients who need the most sleep are often those who get the
least. A few simple changes can help staff
promote sleep in the ICU. Nurs
Manage 33(4): 48-49
Dines-Kallnowski, C. M. (2002). Nature’s nurse: promoting sleep in
the ICU. Dimens Grit Care
Nurs 21(1). 32-34.
Figueroa-Ramos, M. I., Arroyo-Novoa,
G. M., Lee, K. A., Padilla, G. & Puntillo, K. A. (2009).
Sleep and delirium
in ICU patients: a review of mechanisms and manifestations, Intensive Care Med 35:781–795
Olofsson, K., Alling, C., Lundberg,
D. & Malmros, C. (2004). Abolished circadian rhythm of
melatonin secretion
in sedated and artificially ventilated intensive care patients, Acta naesthesiol Scand 48: 679—684
Tembo A. C. & Parker, V.
(2009). Factors That Impact on Sleep in Intensive Care Patients,
Intensive Crit Care Nurs. 25:314-322
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