Tuesday, February 5, 2013

Nursing Theory for Sleep Deprivation

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).  

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