Richard-Campbell Sleep Questionnaire Instrument Critique - Research Paper Example

? Richard-Campbell Sleep Questionnaire Instrument Critique RICHARD-CAMPBELL SLEEP QUESTIONNAIRE INSTRUMENT CRITIQUE The Richards-Campbell Sleep Questionnaire is a validated instrument used in surveys for taking measurements of sleep quality in patients who are in intensive care. While it can be completed by both nurses and patients, the Richard-Campbell Sleep Questionnaire’s agreement and inter-reliability between the two have not yet been validated (Richards et al, 2000). Development of the Richard-Campbell Sleep Questionnaire provided a cost-effective and easy to use perceptive sleep measure, which can be used in the measurement of interventions that healthcare staff uses to improve sleep for patients who are critically ill. In the development of the instrument, studies describing critically ill patients’ patterns of sleep were used as a theoretical basis for various items incorporated into the instrument. The instrument was validated against the polysomnograph and found to be an improvement in measuring sleep quality for patients in intensive care (Richards et al, 2000). As currently used, the Richard-Campbell Sleep Questionnaire reflects five items that are used for measuring sleep quality in ICU patients. These are the depth of sleep, ability to fall asleep, number of times the patients wake up, percentage of the time the patients are awake, and the overall sleep quality of the patients (Richards et al, 2000). The Richard-Campbell Sleep Questionnaire, on top of these five items, also includes a rating for noise during the nighttime, which are scored using a visual analogue scale. The five scores for the Richard-Campbell Sleep Questionnaire is averaged, and the mean score used in determining sleep quality. Night shift nurses are required to complete the Richard-Campbell Sleep Questionnaire with regards to the sleep quality of their patients overnight, while the patients also fill in the Richard-Campbell Sleep Questionnaire after they wake up. The instrument was modified to measure how many awakenings the patient had during their sleep in order to differentiate between patients who woke up frequently and those who did not wake up during their sleep. Further advances in the instrument involved the requirement that the items and directions on the questionnaire be read out to the patients in intensive care (Richards et al, 2000). This was because, while patients have been found to have little trouble in completing it if nurses read the items and directions out to them, majority of the critically ill patients had problems when completing the questionnaire without provision of assistance. However, for obvious reasons, this survey is only useful if the patients are awake and non-delirious. The visual analog nature of the Richard-Campbell Sleep Questionnaire scales means that, as a measure of the latency of sleep, it is not very sensitive in comparison to other modalities of scaling (Richards et al, 2000). For this reason, there is a need to revise the instrument. This could be done in order to improve the Richard-Campbell Sleep Questionnaire’s ability to predict the efficiency of sleep in intensive care patients. For example, the instrument could be revised by adding more items in an attempt to predict sleep efficiency with an improved percentage of variance. However, this will be done at the risk of decreasing the practicality of outcome measurements for patients who are critically ill (Richards et al, 2000), especially as increasing the number of items may be too much for nurses who are overworked and patients who are critically ill and may be too weak to answer them. The Richard-Campbell Sleep Questionnaire’s predictive ability could also be potentially improved by adding another section with more items for nurses. This additional section would consist of additional observations that the nurses make for the critically ill patients’ quality of sleep (Richards et al, 2000). The Richard-Campbell Sleep Questionnaire could also be revised to account for sleep characteristic differences among patients in intensive care. For example, the instrument could integrate such critical factors as sleep disorders, circadian rhythm, wakefulness, or duration of prior sleep, level of acuity, and age. These factors will give the instrument added capabilities in a large sample with diversity since it would allow for prediction enhancement. Testing for the Richard-Campbell Sleep Questionnaire could be improved in a number of ways, which would, in turn, aid in its revision. For instance, most testing has been done in an already existing project for sleep quality, which has involved checklists by nurses in a nightly basis for interventions to improve the sleep quality for patients. In view of this, it is probable that the nurses could have taken the measurements with bias for sleep ratings, particularly during promotion of sleep at night (Richards et al, 2000). Actively promoting sleep quality in patients, for instance by switching lights and TV off, could result in bias entries for both patients and nurses. For this reason, the instrument should be tested in situations where the nurses are not actively trying to improve the patients’ sleep quality, which will give a better measurement of sleep quality. In addition, the entry of information into the Richard-Campbell Sleep Questionnaire during testing of the instrument could be done during a time when nurses are not fatigued. This is because daily filling of the questionnaire, especially at a time when the nurses were fatigued after an entire night shift, could lead to a decrease in vigilance on the nurse’s side in filling the questionnaire (Richards et al, 2000). This could be one factor in results, which have found smaller SD in scores entered by nurses compared to those by patients in insensitive care. The exclusion of patients with physical or cognitive inability to complete the Richard-Campbell Sleep Questionnaire in many testing studies has also led to enrollment of critically ill patients in heterogeneous samples with high illness burdens (Richards et al, 2000). This could have led to the patients having worse experiences of sleep quality compared to other patients in the ICU. For this reason, testing outcomes of the instrument could improve if the studies consisted of patients with lower levels of acuity, such as those without strict exclusion criteria, those who have not been in the ICU for long, patients who are yet to be operated on, and those without mechanical ventilation support. Most testing studies of the Richard-Campbell Sleep Questionnaire have adhered strictly to recent guidelines regarding agreement and reliability of studies (Richards et al, 2000). This can be relaxed somewhat during future testing studies since it leads to estimates that are more conservative during the evaluation and interpretation of agreement/reliability estimates. In addition, future testing should also evaluate the difference of patient characteristics and ICU settings in measuring sleep quality, which will aid in evaluating any potential bias related to the proxy. Finally, since most of the testing has been done on samples that were almost wholly constituted of male patients with an average age of over fifty years (Richards et al, 2000), there is a need for the Richard-Campbell Sleep Questionnaire to be tested using a sample with more diversity. For example, this is using critically ill patients with a wider age variety, as well as female patients. The Richard-Campbell Sleep Questionnaire can be used in various ways, in future healthcare research. One reason why this instrument portends solutions for future research is that nurses working with critically ill patients have limited ability in the systematic evaluation of initiated interventions for sleep improvement and their ultimate outcomes, as well as the need for therapies that promote sleep. These factors place the instrument at the forefront of sleep quality research for. The limited length of the Richard-Campbell Sleep Questionnaire with only five questions ensures that it will be a practical tool for the busy nurse and the critically ill patient (Richards et al, 2000). For one, it can be used for researching sleep disturbance and its course, as well as how sleep disturbance interacts with the trajectory of disease progression in patients who are critically ill. For those patients who are identified as being at risk of disturbances in sleep pattern, recording subjective impressions of sleep perception using the instrument would be eased considerably. This could be done by using the instrument in a similar way to that in which the Glasgow Coma Scores are documented in individuals suffering from neurological impairment (Richards et al, 2000). The instrument could also be used in future health care research since it has proved to be a simple, valid, and reliable screening measure. This validity, reliability, and ease of use make it a candidate instrument for research into the identification of critically ill patients with the highest need and probability to benefit from strategies aimed at promotion of sleep, as well as outcome evaluation research for interventions meant to improve sleep quality and their suitability and success rates. References Richards, Kathy. C. O'Sullivan, Patricia. S. & Phillips, Robin. L. (2000). Measurement of Sleep in Critically Ill Patients. Journal of Nursing Measurement, 8 (2), 131-144. Read More