The Impact of Disruption to Sleep Patterns in the Intensive Care Unit - Essay Example

? IMPACT OF DISRUPTION TO SLEEP PATTERNS IN THE INTENSIVE CARE UNIT By Introduction Sleep disruptions in the Intensive Care Units (ICU) remain one of the central concerns in the field of nursing. Consequences of sleep disruptions range from the impairment of the cognition of patients to reduced capacity of the patients’ immune system. Some experts have cited psychological disorders and cases of irritability as some of the other challenges that are associated with poor sleep patterns in the ICU (Friese, 2007, p. 1211; Stuck, Clarc & Connely, 2011, p. 316). The search for a lasting solution to the problem of sleep disruptions has involved various strategies such as the use of sleep inducers to the conditioning of the environment in ways that make it possible to relax and get sufficient sleep. One indisputable fact is that lack of sleep affects the health and progress of the healing for patients in the ICU. A study on the impacts of sleep disruptions in the ICU indicated that the nature of sleep patterns in a nursing environment has some significant associations with the mortality rates (Friese, 2007, p. 1210). Nursing institutions that promote good sleep habits for patients in the ICU have also shown significant reductions in the levels of mortality. On the other hand, nursing institutions that do not have any structures for promoting good sleep habits were also associated with high mortality rates. The findings of this study were consistent with other findings that showed a positive association between the states of health of patients in the ICU with the number of hours of sleep that the patients managed to get (Friese, 2007, p. 1212). For instance, these findings showed that most of the patients who managed to get uninterrupted sleep were able to respond faster and better to treatment than those who were occasionally interrupted by the nurses or other factors. Discussion Various studies have developed an association between the rate of patients’ readmission to the nursing homes and the disruptions to the sleep patterns (Patel, Chipman, Carlin & Shade, 2008, p. 309; Patel, Chipman, Carlin & Shade, 2008, p. 310). Some of the inferences drawn from this study are that the sleep patterns of the patients in the ICU promoted the natural defences of the body, thus, allowing the patients to develop long-terms health stability. These associations are also consistent with other studies that have established the existence of positive influences between long term health balances of individuals to the quality of sleep that they receive (Eliassen & Hopstock, 2011, p. 140). Opinions of some nursing experts suggest that the promotion of environmental conditions that support quality sleeping patterns is more sustainable than interventions that involve the use of sleep inducers. Patients who are occasionally subjected to sleep inducers often lapse into delirium after a short while and may require stronger inducers in order for them to acquire the same amount of sleep (Patel, Chipman, Carlin & Shade, 2008, p. 310). Some of the studies have established a connection between the impairment of the body’s ability to combat infections (Eliassen & Hopstock, 2011; Friese, 2007). Quality sleep strengthens the immune system and provides the enabling environment for the functioning of the defensive mechanism of the body. Poor sleeping patterns are usually associated with prolonged healing and negative responses to the treatment processes. Patients who fail to get sufficient sleep are also likely to suffer from hallucinations and unstable psychological states. This is because the state of a patient’s mental balance is affected by the kind of pressure and strain that occur during the period of wakefulness. In order for a patient in the ICU to develop the necessary defences, it is necessary to develop a stable sleeping schedule with sufficient time that would allow for the release of the strain and pressure that operate at the mental level. The role of nurses in mitigating the adverse impacts of sleep disruptions often entails various approaches. Comprehensive remedies are often preferred in addressing the problem of delirium in the ICU. These strategies involve the development of methods that promote general good health. Such practices involve good diet practices for the patients, which make it possible for the patients to get quality sleep. It is usually recommended that certain beverages should not be served to the patients around sleeping hours. For instance, stimulants, such as coffee, have been known to disrupt the sleeping patterns of the patients (Eliassen & Hopstock, 2011, p. 138; Friese, 2007, p. 1211). In usual cases, the disruption of sleep occurs after the patients receive their evening meals. Some scholars have suggested that the time for feeding and that of sleeping should be separated by some hours in order to eliminate sleeping challenges caused by digestion challenges. One of the challenges involved in addressing the problem of delirium in the ICU relates to the process of medication. Some of the medicines administered to the patients are known to cause significant sleeping challenges. These medicines affect the body systems in such a way that affects the release of sleep hormones. In many cases, these medicines are administered in regular doses, which mean that they encourage the development of certain patterns in the body processes that ultimately lead to delirium. It is important to consider the fact that the regular promotion of these conditions eventually yields conditioned of acquired sleeplessness, which eventually affects the body’s defences. An assessment of the impact of sleeplessness on the patients in the ICU should also involve an acknowledgement of the environment and activities that naturally take place in the ICU. Many patients require sufficient comfort and familiarity in order to acquire some sleep. These patients have argued that the environment in the hospital makes it impossible for them to receive sufficient sleep. They contend that the unfamiliarity of the environment poses challenges of sleep thus leading to long hours of wakefulness. There is often some situation of mental fatigue, which affects the natural processes of sleep. By its very nature, the ICU requires consistent observation of by the nurses and doctors. For instance, nurses and doctors usually perform night rounds to watch the progress of the patients or administer some form of treatment as the cases may demand. This means that there is always some measure of physical disruptions that affect the ability of the patients to get some quality sleep. Other disruptions involve physical objects such as machinery and lighting. The noise produced by some machinery or even their very presence in the room may make it difficult for the patients to receive sufficient sleep. In general terms, it is difficult for the patients to develop a sense of comfort necessary for quality sleep due to the presence of these machineries. Another challenge relates to light. The presence of light affects patients in different ways. Studies conducted on the sleeping conditions in the ICU established that many patients are not used to sleeping with the lights switched on. The problematic aspect of this discovery is that lights are necessary for the monitoring of situations in the ICU. Although some patients tend to get used to the lights after some period of time, many others admitted that they did not receive any sufficient sleep for the entire period of time that they stayed in the ICU. Those who held onto this position also argued that it was generally difficult to get sufficient sleep with the kind of physical arrangement of the ICU (Foreman, Fulmer & Milisen, 2009). These category of patients also agreed that they suffered some form of stress and depression to lack of sufficient sleep. It has often been argued that the amount of sleep that patients receive determines the amount of time that the patients will stay in the hospital before being discharged. Medical studies show that most healing processes take place in the periods when the patients are asleep (Friese, 2007). Sleep disruptions are also related to the kind of suffering. In most cases, physical injuries demand that the patients sleep in certain positions in order not to disrupt the healing process of sustain more injuries. In order to improve the processes of sleep in the patients, some studies have proposed the installation of soothing music in the intensive care units. According to these studies music has the effect of redirecting the attention of the patients away from the physical and mental disruptions, which affect their processes of healing (Friese, 2007). Usually, some of the factors that relate to the process of healing have to do with the mental composure of the patients. Mental composure is supporting to the central nervous system and the general immune system. Mentally composed patients are more likely to respond better to treatment than patients who show signs of restlessness. One role of music, according to medical experts is to develop the suitable environment for healing. The effect of music promotes anaesthetic feelings on the minds of patients thereby making it possible for the healing process to proceed without much disruption. However, some patients do not prefer any type of music during sleeping times. Such patients argue that music itself has a disrupting effect and that they prefer total silence. Another challenge related to music therapy for patients with delirium relates to the matter of choice. Deciding on the right kind of music remains one of the most problematic aspects of addressing the challenges of sleeplessness in intensive care units. Patients who are admitted to the intensive care units are of varied demographic identities. The implication of these variations is that the patients will comprise of various preferences. These preferences may be determined by cultural and religious factors or other factors that usually distinguish between one person and another. Some studies have argued in favour of patient-centred approaches in addressing the problem of sleep disruptions in the ICU (Kaplow & Hardin, 2007; Stuck, Clarc & Connely, 2011). According to one particular study, the mechanical arrangement of schedules in the nursing facilities usually makes it difficult for the patients to get enough sleep. In this regard, there have been suggestions that the schedules in hospitals should be organized in ways that promote the particular and unique preferences of the patients. According to this line of thought the patients should have the power to decide when they want to engage in processes such as eating, bathing or meeting with relatives (Stuck, Clarc & Connely, 2011). When hospitals and nursing institutions adopt such flexible schedules, it becomes possible for the patients to continue their normal lives within the nursing homes. The thinking behind this suggestion is anchored on the fact that patients are human beings without a uniform kind of life. Every patient has unique interests and preferences and will often be affected by any forms of disruptions (Stuck, Clarc & Connely, 2011). The hospital schedules should be designs that allow the patients to fit their personal lives within the superstructure of the hospitals. The result of such an arrangement is that the lives of the patients become a uniform continuum within which the patient manages to get sufficient sleep. The value of this information could be matched with separate studies that have established that elderly patients are more likely to suffer from sleeplessness than younger patients. Naturally, the age of an individual determines the degree to which they develop attachments to certain patterns of life. It therefore follows that elderly people will be more rigid in their preferences and more regular in their routine practices than younger people who have a higher capacity of adjusting to new environments. Consequently, the elderly patients are more likely to incur the negative consequences of delirium than the younger patients. A study conducted by Friese et al (2007) revealed that patients in the ICU can improve their sleep if necessary conditions and strategic arrangements are put in place. According to this study, the amount of hours spent by the patients could improve significantly if the patients were allowed sufficient time and space by the nurses. This would imply that the obstacles involved in sleep disruptions are largely determined external factors rather than factors that relate to individual factors. Revising the external conditions ultimately impacts positively on the quality of sleep in terms of intensity and duration. Wakefulness and irregular patterns of sleep are largely caused by some factors that relate to the effect of the external obstacles and processes that intrude into the patterns of life of the patients in the ICU. Further academic inquiries into the impact of sleep disruptions on patients in the ICU have sought to relate the architectural effects of the nursing facility to the psychological imbalances that cause poor sleeping patterns among the patients (Redeker & McEnany, 2011; Kaplow & Hardin, 2007). This argument draws from studies, which suggest that the kind of architectural design of a facility will eventually determine the reactions and habits of the people who come into contact with it. Both the interior and exterior architectural features have significant impacts on the mental posture of the patients. The reactions may range from fear to horror. The reactions may take place at the subliminal levels but the impact tends to last and reveal themselves through observable characteristics. In some cases, some patients report being disturbed by occasional nightmares and hallucinations (Redeker & McEnany, 2011). These are often caused by the unease at the psychological level, which are caused by the resistance of the mind to the physical edifice of the facility. Suggestions for redesigning the architectural features of these facilities are some of the recommendations that have been brought forward by some psychoanalytic experts. The fear of closed spaces is one of the outcomes that affect the sleeping patterns of the patients in the ICU. In most nursing facilities, the ICU is structures in such a way that the patient remain alone separated from other patients. Claustrophobic patients tend to develop resistance of the medical rooms because they associate them with negative happenings. To some, the design and arrangement of the ICU facilities remind them, at the subconscious levels, about their states of vulnerability and the possibility of death. Revising the physical aspects of the facility could have significant positive impacts on the sleep patterns of such patients. Relating the challenge of sleep disruptions to psychological states of mind on the part of the patients reinforces the view that environmental factors, feelings of alienation, and the fear of the unfamiliar affects the process of adjustment and acclimatization to the nursing environment. Generally, sleep occurs during moments of comfort. Anxiety and restlessness often works against the process of sleep. Conclusion The disruption of sleep for patients in the ICU is associated with multiple factors. Some of these factors have to do with the type of medication while others are related to the physical disturbances by some of the usual processes that take place within the nursing environment. Indisputably, these disruptions have enormous negative impacts on the state of health of the patients with particular regard to the healing process. The literature explored on this subject cited low immunity, depression, high rates of readmission, and unstable psychological states expressed in hallucinations, nightmares and trances as some of the possible impacts of sleep disruptions. Poor memory, loss of concentration, and visual impairment are other consequences that have been shown in the various studies. Various remedies have been suggested by some experts on the problem of sleep disruptions within the ICU facilities. Some of these remedies included the reorganization of the schedules of the hospital in ways that adopt patient-centred routines. Other suggestions include the revising of the architectural designs of the nursing facilities in order to minimize the psychological disturbance on the patients. Other studies have argued in favour of the introduction of soothing music in the ICU facilities in order to lull the patients into quality sleep. All these strategies can work in complementary ways, which could lessen the negative impacts of sleep disruptions for patients in the ICU. References List Eliassen, KM & Hopstock, LA 2011, Sleep Promotion in the Intensive Care Unit – A Survey of Nurses Interventions, Intensive and Critical Care Nursing, 27, 138-142. Foreman, MD, Fulmer, TT & Milisen, K 2009, Critical Care Nursing of Older Adults: Best Practices, Springer Publishing Company, New York. Friese, RS 2007, Quantity and Quality of Sleep in the Surgical Intensive Care Unit: Are Our Patients Sleeping? The Journal of Trauma, Injury Infection and Critical Care, 63, (6). 1210-1214. Kaplow, R & Hardin, SR 2007, Critical Care Nursing: Synergy for Optimal Outcomes, Jones & Bartlett Learning, New York. Patel, M, Chipman, J, Carlin, BW & Shade, D 2008, Sleep in the Intensive Care Unit Setting. Critical Care Nursing Quaterly, 31 (4). 309 – 318. Redeker, N & McEnany, GP 2011, Sleep Disorders and Sleep Promotion in Nursing Practice, Springer Publishing Company, New York. Stuck, A, Clarc, MJ & Connely, CD 2011, Preventing Intensive Care Unit Delirium: A Patient-Centred Approach to Reducing Sleep Disruptions. Dimensions of Critical Nursing, 30 (6). 315- 320. Read More