Daytime Sleepiness in Aged Care Residents - Research Paper Example

Evidence in Relation to Daytime Sleepiness in Aged Care Residents Introduction: 98 words The clinical issue under consideration involves daytime sleepiness in aged-care residents depicted by irregular sleeping patterns among the clients and being awake most of the night. Further, the clients present very poor eating habits which may result to frailty and increase fall incidences. This study outlines a clinical question by utilising the PICO aspect in order to retrieve relevant literature for effective study findings. The retrieved literature provides evidence that will be summarised and synthesised to expound critically in the study aspect. Finally, a critique of an article on aged care will be done followed by a conclusion. Clinical Question: 99 words Table 1: Clinical question Specific Question: How effective will enhancing effective sleeping patterns during the night and alleviating daytime sleepiness reduce rate of falls among the aged in care centres? Patient/Problem Intervention Comparison Outcome Aged palliative care patients experiencing falls Introduce regular sleeping patterns at night, physical activities and effective eating habits. Irregular sleeping patterns and daytime sleepiness. Reduce the rate of falls. Key Words: Falls among aged, Frailty Regular sleeping patterns. Irregular eating habits Rate of fall among aged. The PICO components are: Intervention to ensure effective and regular sleeping and eating patterns to reduce rate of falls. Process of Locating and Retrieving Evidence: 265 words Credible information in respect to literature review will be retrieved effectively from credible nursing databases with the use of key words to the clinical question targeting the study objectives. Consequently, the use of key words in literature search and retrieval have been accompanied by Boolean articles for multiple searches to acquire concise information for the research study and specifically related to the clinical question. Key words like aged care, palliative care, sleeping patterns and daytime sleepiness have been utilised in the retrieval of credible information and derived from the clinical question, giving effective guide to the search. Data will be accessed from the USQ website by use of the keywords and adjacent Boolean operators like ‘AND”, “Or” to retrieve relevant information targeting the clinical questions. Key words connected with operators involved palliative care, sleep patterns, aged care and falls. From the search of USQ website, 38 links were accessed from the initial search with respect to reducing falls among palliative and/or reducing daytime sleepiness to enhance comfortable sleep at night. The search narrowed to the last 15 sources upon reading their abstracts, and the rest were discarded. The inclusion criteria involved English language that tackled sleeping problems among palliative care patients and the aged. The exclusion criteria involved ignoring articles discussing palliative care without a bias towards sleep and fatigue problems. Finally, the most credible and explicit ten sources were selected for purposes of coming up with critical literature review to support the study objectives and answer the clinical question. The screenshot below gives the proof of search and retrieval of evidence for this study. Summary of the Evidence: 500words Authors and year of publication Hierarchy of Evidence – Type of Evidence & Ranking The Research Question / or Problem being addressed Aim of the Study Description of participants/subjects involved in the study Type of Research Method Renom-Guiteras, et al. (2014) Appropriateness level 3 (JBI) How often does Insomnia occur among clients within palliative care units? To establish the frequency of insomnia among patients during admission to palliative care. 61 patients admitted and palliative care unit with severe cognitive problems or too low performance status. Prospective observational study method. Jim, Jacobsen, et al. (2013) Effectiveness level 2 (JBI) Sleep disturbance, fatigue and depression among patients treated with chemotherapy. To examine lagged changes among symptoms occurring daily during platinum-base chemotherapy. 78 women suffering from gynaecologic cancer Wrist actigraphy method of data collection. Flynn et al. (2010) Effectiveness level 2 (JBI) What is the relation of sleep patterns among cancer patients with treatment and distress? To explore the scope of difficulties with sleep among diverse group of cancer patients. Data obtained from 10 focus groups recruited from Duke University tumour registry and haematology clinics. Descriptive focus analysis Howell et al. (2013). Meaningfulness level 3 (JBI) Reason why sleep disturbance is prevalent among cancer patients and its effects? To identify the evidence base for the assessment and management of cancer related insomnia. Secondary systematic review of clinical practice guidelines Exclusion and inclusion are the secondary method of data collection. Stenberg, Ruland and Miaskowski (2009). Feasibility level 3(JBI) How to effectively help family caregivers of cancer patients? To understand the complexity of the problem and responsibilities associated with cancer patients’ illness and family caregivers’ experience. Data acquired from secondary sources. Descriptive research method used to meet study objectives. Pokpalagon, et al. (2012) Effectiveness level 4 (JBI) Do care strategies vary in various care settings? To describe and compare palliative care strategies used in quality life in advanced cancer patients in various settings. Involved 1294 Thai clients diagnosed by Physicians as having stage IV cancer and under treatment Cross-sectional quantitative descriptive method Dowson et al. (2012 Effectiveness level 3 (JBI) How to identify evidence-based strategies to improve sleep in residential aged care? To identify probable evidence-based practices to enhance sleep among the aged in residential care. Review of 34 research papers. Secondary document analysis Peters, Goedendorp, et al. (2014) Appropriateness level 2 (JBI) What is the relation between severe fatigue and other symptoms in cancer patients? To investigate the prevalence of severe fatigue among cancer patients in palliative care centres. Patients with incurable cancer McGill Pain questionnaire survey Keeney and Barbara (2011) Meaningful level 2 (JBI) Can fatigue be managed in palliative care among cancer patients? To effectively address the phenomenon of fatigue and its management in palliative care for cancer patients. 58 year old lady having limited-stage small-cell lung cancer. Multi-factorial research approach Bowen (2014) Appropriateness level 2 (JBI) Do multi-disciplinary care teams enhance holistic care in palliative care centres? To identify the role and effectiveness of the multi-disciplinary team in palliative care. 36 year old patient with metastatic triple negative breast cancer stage t4b N3 M1. Descriptive research method Synthesis of the Evidence: 690 words The aspect of palliative care revolves around minimisation of suffering among critically ill patients or the aged. Nursing practices undertaken in the centres are aimed at promoting quality of end of life among clients (Keeney and Barbara, 2011). The aspect of irregular sleeping patterns is critical with regard to being brought about by various aspects among the aged. Jim et al. (2013) goes further to associate sleep disturbance to fatigue among cancer patients undergoing chemotherapy treatment. The study tries to outline the lagged relationship and changes experienced in respect to daily symptoms during palliative treatments of cancer patients. This is a clear indication that fatigue and irregular sleeping patterns have a direct correlation. In context, to effectively address sleep-disturbances, there is need for evidenced based practices within the palliative care centre to establish the root cause of the daytime sleepiness and come up with mitigation measures (Renom-Guiteras et al., 2014). Keeney and Barbara (2011) indicate that fatigue related to cancer is a common symptom that is multi-factorial in nature. Conversely, Flynn et al. (2011) opine that cancer and its treatment among the patients results to disruption of the sleep-wake functioning. These studies clearly outline the aspects of fatigue and sleep-patterns, but fail critically to give the root cause or the scientific aspect of the disturbances of sleep. Stahl (2008) categorises disruption of sleeping pattern in two broad categories of excessive night-time arousal and deficient daytime arousal. According to Stahl, two critical neurotransmitters; histamine and GABA are used in the regulation of sleep-wake patterns. A high level of histamine during the day results to wake pattern and increased level of GABA during the night controls sleep patterns. Consequently, the hypothalamus contributes greatly towards sleep-wake patterns acting as the internal body clock triggered by melatonin, light and activity to promote either sleep or wake (Stahl, 2008: 822). In context, disruption of sleep patterns is observed with deficient production of neurotransmitters. During the night, increased histamine is produced and not enough GABA resulting in insomnia and vice versa during the day. Palliative care clients require critical and quality care from various groups of specialists. According to Bowen (2014), multidisciplinary interventions in the palliative care practices enhance quality care and ensure clients get relevant care and treatment. Stenberg, Ruland and Miaskowski (2009) in their literature review outline the effects of caring for cancer patients. Clear understanding of the problems associated with patients in need of end of life care is imperative for family members as potential care givers. To critically understand problems among clients within aged palliative care facilities, multi-disciplinary team practices will critically ensure the achievement of this objective. Keeney and Barbara (2011), indicate cancer related fatigue as a great contributor of discomfort among cancer patients. Nevertheless, it is evident that regular sleeping patterns are necessary among clients within palliative care centres and especially the aged for comfort and resting purposes. Albeit, the presence of other symptoms due to critical illness, old age or medication process may bring about discontinuity in the natural sleeping patterns or disruptions of triggers to normal sleep patterns (Lowery, 2014). Thus, there is greater need for evidence based practices among nurses’ practitioners and other clinical staff to come up with effective and strategic measure to address issues regarding the irregular sleeping patterns among the aged. In conclusion, sleep disturbances is recognised by Howell et al. (2010) as a prevalent problem that need critical research in the future to give more insights on strategic ways to overcome the challenge in palliative care. Flynn, et al. (2010) consequently underscores the multi-faceted nature of sleep-wake difficulties among cancer patients who also constitute substantive number of clients within palliative care centres. The study further outlines critical directions necessary for the development of strategic measures tailored to realise the full scope of the complex aspect of difficulties experienced by palliative care patients. In context, with incorporation of multi-disciplinary efforts as discussed by Bowen (2014) within palliative care, their collaborative practice and deliberations is expected to optimise patients care and quality of life at the centres. Dowson et al. (2012) outline various literature reviews and highlight the necessity for improving sleep patterns among the aged in residential centres and further asserts the need for more research create guidelines to curb sleep disorders. Critique of Research Article: 621 words This section critically evaluates the article, “Insomnia among patients with advanced disease during admission in a palliative care unit: A prospective observational study on its frequency and association with psychological, physical and environmental factors” by Renom-Guiteras et al. (2014). DOI: 10.1186/1472-684X-13-40. Based on the aims to assess the frequency of insomnia among patients during admission to palliative care centres, as well as the association of emotional distress and insomnia; the study incorporates environmental and other factors to outline the aspect of sleep disturbance among clients in palliative centres. Insomnia is characterised by lack of regular sleep at night orchestrated by irregular triggers caused by hormonal imbalance. Lowery (2014) opines that insomnia is the most common and distressing problems among patients and survivors of cancer. Generally, sleep has a critical role in the achievement of quality health and effective functioning of the immune system. The occurrence of elaborated lack of sleep among individuals can be attributed to poor physical and psychological health attributes, increased use of healthcare and heightened risk of morbidity and mortality (Lowery, 2014). Cancer patients are recorded to have higher levels of insomnia in comparison to the general population. Among cancer patients admitted in palliative care in their advanced stages, insomnia is estimated to between 45% and 95% (Renom-Guiteras et al. 2014:2). On critically evaluating the research approach, it effectively addresses the aspect of insomnia among cancer patients and subsequently outlines various factors enhancing its occurrence. Nevertheless, there lacks concrete analysis of the biological aspects towards insomnia occurrence. The study utilises a prospective observational study to look inclusively into patients admitted to palliative care units (PCU). The main point of assessment is insomnia as the major single query with emotional distress evaluated via the Hospital Anxiety and Depression Scale (HADS) (Renom-Guiteras et al. 2014). The study critically evaluates physical, environmental and other potential psychological factors that interfere with sleep patterns. Data analysis was done via univariate and multivariate regression analyses to give the relation between insomnia and the factors. Insomnia has been recorded as highly frequent in the research study and various physical, psychological and environmental factors identified as key factors enhancing insomnia. Jim et al. (2013) indicates that research shows that sleep disturbance, fatigue and depressed mood consist of a composition of symptoms experienced by cancer patients under chemotherapy. This is an indication that the symptoms are triggered by therapeutic practices aimed at treating the disorder. The disturbance in the biological nature of the body results to chemical imbalance of the normal body conditions presents a critical consideration in the management of critically cancer patients in the palliative care centres (Stahl, 2008). Lack of enough sleep may result to exacerbated fatigue which may in turn trigger falls among the aged and weakling patients in the palliative care centres. The study by Renom-Guiteras et al. (2014) clearly outlines the aspect of insomnia and related physical, psychological and environmental factors related to the occurrence of insomnia in palliative care centres. Palliative care centres are prompted to provide end of life quality by promoting comfort among its clients. Lack of sufficient and regular sleep patterns among clients within palliative care centres calls for the inclusion of multi-disciplinary teams to come up with evidence based practices to counter the level of discomfort caused (Bowen, 2014). Alternatively, providing medication of problems triggering or related to the insomnia results to substantial reduction in the rates of irregular sleep patterns (Stenberg and Miaskowski, 2009). The study does not give the relation of clinical emotional, distress to insomnia but gives the nocturnal rumination associated to insomnia measured by both tools in the study. Prospective studies ought to critically look into the aspect of management of insomnia and management of after results triggered by irregular sleep patterns. Conclusion: 95 words In conclusion, management of sleepiness among aged persons in palliative care involves various strategies. Understanding the actual cause of insomnia among the clients is inevitable to initiate measures and guidelines to overcome the problem. Further, effective evidence-based practice touching on sleepiness management among the aged is inevitable. As per the reviewed studies in this paper, lack of sleep among the aged clients in palliative centres point towards a problem emanating from ill health. Thus, to ensure effective health and wellbeing among aged clients in palliative care centres, effective monitoring and establishing cause sleepiness is paramount. References Bowen, L. (2014). The multidisciplinary team in palliative care: A case reflection. Indian Journal of Palliative Care. 20(2): 142-145. Dowson, L., Moore, K., Tinney, J., Ledgerwood, K. and Dow, B. (2012). Sleep in residential aged care: A review of the literature. Research Paper. Australian Journal of of Addvanced Nursing. 29(4): 11-18. Flynn, K.E., Shelby, R.A., Mitchell, S.A., Fawzy, M.R., Hardy, N.C., Husain, A.M., Keefe, F.J., et al., (2010). Sleep-wake functioning along the cancer continuum: Focus group results from patient-reported outcomes measurement information system (PROMIS TM). Psychooncology. 19(10): 1086-1093. Doi: 10.1002/pon.1664. Howell, D., Oliver, T.K., Keller-Olaman, S., Davidson, J.R., Garland, S., Samuels, C., Savard, S., Harris, C., Aubin, M., Olson, K., Sussman, J., MacFarlane, J. and Taylor, C. (2013). Sleep disturbance in adults with cancer: A systematic review of evidence for best practices in assessment and management for clinical practice. Annals of Oncology. 00: 1-10. Doi: 10.1093/annonc/mdt506. Jim, H.S.L., Jacobsen, P.B., Phillips, K.M., Wenham, R.M., Roberts, W. and Small, B.J. (2013). Lagged relationships among sleep disturbance, fatigue, and depressed mood during chemotherapy. Health Psychology. 32(7): 768-774. Keeney, C. and Barbara, A. (2011). Palliative nursing care of the patient with cancer-related fatigue. Journal of Hospice and Palliative Nursing. 13(5): 270-278. Lowery, A.E. (2014). Insomnia screening and treatment in cancer care: Current practices, barriers and future directions. JSM Clinical Oncology Research. 2(4): 1026. Peters, M.E., Goedendorp, M.M., Verhagen, C.A., van der Graaf, W.T. and Bleijenberg, G. (2014). Severe fatigue during the palliative treatment phase of cancer. Cabcer Nurs. 37(20: 139-145. Pokpalagon, P., Hanucharamkul, S., McCorkle, R., Tongrateep, T., Patoomwan, A. and Viwatongkasem, C. (2012). Comparison of care strategies and quality of life of advanced cancer patients from four different palliative settings. Pacific Rim International Journal of Nursing Research. 16(4): 326-342. Renom-Guiteras, A., Planas, J., Farriols, C., Mojal, S., Miralles, R., Silvent, M.A. and Ruiz-Ripoll, A.I. (2014). Insomnia among patients with advanced disease during admission in a palliative care unit: A prospective observational study on its frequency and association with psychological, physical and environmental factors. BMC Palliative Care. 13:40. doi: 10.1186/1472-684X-13-40. Stahl, S.M. (2008). Stahl’s essential psychopharmacology: Neuroscientific basic and practical applications. 3rd ed. New York, NY: Cambridge University Press. Stenberg, U. and Miaskowski, C. (2009). Review of literature on the effects of caring for patients with cancer. Journal of the Psychological, Social and Behavioural Dimensions of Cancer. 19(10): 1013-1025. Doi: 10.1002/po.1670. Read More