Nursing, Locating and Retrieving Evidence - Research Paper Example

Topic: Nursing Research Name: Course Code: Institution: Date of Submission: Part 1. Asking a clinical question 1. Introduction The clinical issue addressed by this paper is irregular sleeping patterns among the elderly in the community or in the care centers. The aim of the assignment was to address intervention methods that are most suitable to enable the elderly people develop regular sleeping patters which is the general problem experienced by the elderly people in the community. The key areas of focus included determination of symptoms of irregular sleeping patterns and the demographic groups who are affected by the condition and the therapeutic as well as medications recommended for the elderly people in care centers and in the community. 2. Question What are the intervention strategies for the elderly people with irregular sleeping patterns and what are the expected outcomes as a result of implementation of the intervention measures? The above questions satisfy the PICO requirement in the following way: P: Are elderly people with irregular sleep patterns I: Are intervention strategies C: Involves the use of the word ‘strategies’ which means that there are a number of alternatives being considered O: It asks the possible outcomes as a result of the use of various intervention methods. The rationale of the development of the PICO question above is that it provided a guide in management of irregular sleeping patterns by identifying the contributing factors to the condition faced by the elderly people in the community and methods through which they could be assisted to overcome the conditions. This is because Roland, N., (2011) stated that when the contributing factors to irregular sleeping patterns are identified, it is possible to develop the right intervention measures. The question that needed to be answered is the intervention measures for irregular sleeping patterns among the elderly. 3. Locating and retrieving Evidence In order to retrieve evidence regarding the research question, a number of published materials that explain intervention methods for irregular sleep patterns were used. Competence in management of irregular sleeping patterns among the elderly was examined through referring to articles that discuss the problem among the elderly people in the community. This is because Martin (2000) states that management of irregular sleep patterns involves identifying the symptoms, prevalence, and assessment methods for a particular sleep pattern irregularity so that the right intervention strategy can be determined. In order to use the journal effectively, keywords such as ‘eating habits’ and ‘exercises ‘ were searched in order to enable understanding how these words were related to irregular sleep patterns among the elderly. This is based on the fact that the populations in the case study have been observed to be involved in less physical exercise and not eating well. In addition, the keyword ‘age’ was searched in the journal to determine the impact of age on the possibility of a person to develop irregular sleeping pattern this will enable the researcher understand the Prevalence/Population part of the PICO. Another keyword that was significant in the effort to understand nursing practices for people with irregular sleeping pattern was ‘elderly’ because it ensured the identified strategies were mainly relevant for the elderly people in the community. Furthermore, the keyword ‘alternative’ was used by the researcher to determine other methods that could be applied in enabling an affected person overcome irregular sleep patterns. The inclusion criteria involved accepting all information that discussed prevalence intervention and alternatives for irregular sleeping patterns among the elderly while the exclusion criteria involved ignoring information such as intervention for school children that suffer from irregular sleeping patterns. This is because; this research was mainly focused on addressing irregular sleeping patterns among the elderly in the community and care centers. 4. Summarizing the Evidence ­­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 1. (Austin, 2007). Assessing sleep needed by elderly people followed by intervention methods for sleep deprived people What are non-pharmacological interventions for sleep deprivation? To establish the contributing factors to sleep deprivation People living in the community with present condition of irregular sleep patterns Secondary research 2. (Boonstra, et al. 2010) Identification of factors contributing to sleep deprivation among HSCT patients What are the contributing factors to deprived sleep patterns? To investigate sleep disturbances in hematopoietic stem cells transplant (HSCTs)patients ­patients undergoing (HSCTs) Descriptive study design of establishing the extent of sleep disturbance in the patients 3. Flick, U., Garms-Holomova, V. & Rhonsch, G. (2010). Symptoms of people with deprived sleep patterns and intervention methods Which intervention strategies can be used to assist patients with irregular sleep patterns To symptoms of patients with irregular sleep patterns and the corresponding intervention strategies Geriatric nurses, residential nurses, nursing assistants and caregivers without formal qualifications Interviews with staffs from nursing facilities and analysis of secondary materials 4. Martin, J., (2000). Identification of symptoms of irregular sleep patterns, identification of contributing factors and suggestion of intervention methods What are the factors that contribute to irregular sleep patterns among the elderly To determine factors contributing to irregular sleep characteristics among older people and the treatment strategies for the elderly in the community The elderly people Secondary research on interventions for irregular sleep characteristics among the elderly 5. McCurry, S., Logsdon, R.G., Terry, L., & Vitiello, L., (2014). Data collection, data analysis, making recommendation for each contributing factor to irregular sleep pattern Characteristics of patients with irregular sleep patterns and intervention methods for such patients. To investigate the factors that contribute to irregular sleep patterns based on data in the databases such as PbMed. Adult groups whose age ranges from 18 years to 60 years whose irregular sleep patterns could be obtained from the databases. Secondary research by use of PubMed, PsyciNFO and the Cochrane Controlled Trials Register (CENTRAL) 6. Montgomery P, Dennis JA.(2002). Selection of relevant databases, searching for ideas explained about the role of light therapy on irregular sleep pattern control, analyzing the findings and making recommendations Intervention measures for people with irregular sleep patterns To investigate the impact of bright light therapy in enhancing sleep quality among adults aged 60 years and above Adults aged 60 years and above with irregular sleep patterns Secondary research on databases such as PubMed, The Cochrane Library, Bibliographies of existing reviews in the area and MEDLINE 7. Roland, N., (2011). Involves investigation of factors that contribute to irregular sleep patterns followed by suggestions of non-pharmacological intervention strategies for irregular sleep patterns Intervention strategies that need to be implemented to assist elderly people with sleep disturbances so that they can develop regular sleep patterns. To create awareness about actions that need to be taken to promote health by enabling elderly people overcome their irregular sleep patterns characteristics Elderly people suffering from irregular sleep patterns Secondary research that investigates the ideas from articles, journals and publications 8. Safi AJ, Hodgson NA (2014) Investigating the existence of irregular sleep patterns followed by identification of intervention measures and the expected outcomes Intervention measures that need to be implemented to assist patients with irregular sleep patterns To investigate the impact of timing activities on reduction of irregular sleep patterns among patients Hospitalized patients with irregular sleep patterns Primary research on patients with irregular sleep patterns 9. Schutte-Rodin S; Broch L; Buysse D; Dorsey C; Sateia M. (2008). Intervention strategies for people with irregular sleep patterns and alternatives to various intervention measures To investigate the various psychological, pharmacological and evidence-based practices for people with irregular sleep patterns Adults suffering from insomnia condition Primary research on people with irregular sleep patterns 10. Tinney, J., Moore, K., Dowson, L. & Ledgerwood, K., (2008). Identification of the problem or population, establishment of the symptoms of irregular sleep patterns and recommendations of intervention measures Intervention measures for irregular sleep patterns To investigate various forms of therapies such as music, light therapy, aromatherapy, acupuncture and night time care on restoration of normal sleep patterns Adults experiencing irregular sleep patterns Secondary study on various therapies that restores sleep patterns to normal conditions 5. Synthesis of the Evidence There are a number of findings from the evidences in the articles. I learnt that in order to address the problem of irregular sleep patterns among patients, it is important to begin by investigating the symptoms, followed by prevalence then assessment and diagnosis (Martin, 2000). I also learned that the use of positive airwave pressure can be efficient in treatment of older adults that experience irregular sleep patterns (Martin, 2000). Furthermore, I learned that there are other non-pharmacological treatments that facilitate management of irregular sleep patterns and ensure a person sleeps well as night. These include body massage, acupuncture, aromatherapy, music therapy, light therapy and cognitive behavioral therapy (CBT) (Tinney, Moore, Dowson & Ledgerwood, 2008). Furthermore, I learned that older people are more likely to develop irregular sleep patterns compared with the younger people because they undergo a number of psychological and developmental changes (Roland, 2011). These developmental changes result into increased arousals that ensure they remain awake more than usual. From the evidences provided, I would recommend that irregular sleep pattern should be controlled by first educating the public on methods they should use to identify a person with irregular sleep patterns. They should also be educated on various intervention strategies they need to apply so that those close to them who have irregular sleep patterns can be assisted to overcome the conditions as suggested by (Montgomery & Dennis 2002). However, I would strongly recommend that non-pharmacological methods should be emphasized among the people during education about irregular sleep pattern prevention. This is because; it is less expensive and will be applicable to those who do not have funds to access medications for irregular sleep patterns. The main gap that I found in the literature includes lack of focus on eating habits that need to be developed so that a person overcomes irregular sleep patterns. This is because, the population involved in this study was involved in an inadequate eating habit. Thus it does not address this area in the process of suggesting intervention measures for the problem of irregular sleep patterns. Another gap that I found in the analysis of the articles is that they do not explain the limitations in the previous studies that promoted them to be published. Thus, there is a possibility that they were written in a similar manner that previously published articles were written hence incorporating mistakes in the previously published articles. This could be a limitation on their ability to provide a particular solution to the irregular sleep patterns experienced at present based on the existing living environment. The strengths of the findings are that they provide a number of alternatives for management of irregular sleep patterns that involves both pharmacological interventions and non-pharmacological interventions as illustrated by (Tinney, Moore, Dowson & Ledgerwood, 2008). This implies that a person can implement non-pharmacological interventions when there are no funds to afford pharmacological interventions thus ensuring the goal of management of irregular sleep patterns are achieved (Boonstra, et al. 2010). Furthermore, the ideas suggested by the articles are easy to implement, hence, they address the research topic effectively. Part 2. Critically analyzing evidence 1. Critique of one Research article The article: Montgomery P, Dennis JA. (2002). Bright light therapy for sleep problems in adults aged 60+. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD003403. DOI: 10.1002/14651858.CD003403. The method for critiquing the above article can include establishing whether the right research strategy was used, the right data collection method was used and whether the research question was addressed. The data collection method used in this article involved the use of mixed research method. This is where both primary research and secondary research are conducted to address a research question. The primary research method involved investigation of respondents who were aged 6-+ years regarding the research problem. In this article, it is found that secondary research design involved the search for data in electronic databases such as The Cochrane Library, MEDLINE, CINHL, National Research Register (NRR) and a number of existing bibliographies. These databases contain a range of information regarding therapies for irregular sleep management. Furthermore, the information provided is based on expert opinion. This implies that when the recommendations of these databases are implemented, it is possible to achieve high level of recovery for people with irregular sleep patterns. The use of a combination of both primary and secondary research ensured that the researcher could obtain supporting information that complemented both primary research and secondary research. The process used to analyze data in the above article is relevant in arriving at the solution of the problem in the case study. For instance, it identifies sleep duration, awake time and personal opinion of people about problems they encountered in relation to irregular sleep disturbances. This ensures interventions can be focused on addressing the problems in the results of data analysis. Nurses who need to use the outcome of the research can understand various areas addressed by the research based on the range of parameters of irregular sleep patterns explained in the research. The sample selection criterion was effective because the study focused on a sample of adults aged 60+ years. This is an age group that experience high levels of irregular sleep patterns. Thus, the paper provided a better understanding of the problem as well as establishing a better solution to those who have irregular sleep patterns in general. In addition, the sample selection focused on people who had been diagnosed with sleep problems through measures such as Multiple Sleep Latency Test, Objective measures in sleep laboratory and sleep diaries provided by the participants. However, the article does not provide an estimate of the sample size used. Thus, it is difficult to understand whether the sample size was large enough to enable the researcher address the research question. On the other hand, it can be assumed that the sample size was adequate since the researcher did not report any difficulty in achieving the results of the research. The research also provided a discussion of the findings of the research. These discussions enable easy understanding of the outcomes of the research so that recommendations of the research can be implemented by the user of the article with little difficulties. These qualities of the article make it suitable towards understanding of irregular sleep patterns in the community so that the residents can be empowered to manage the condition among their family members. 2. Conclusion This paper provides various strategies that were flowed in researching so that the problem of irregular sleeping patterns among the population involved in the case study could be solved. It has been possible to dress the problems in the case study because the articles researched provided a better understanding of methods of identification of the population of people with irregular sleep patterns. Furthermore, it suggested intervention measures and a number of alternatives that ensure a particular irregular sleep pattern is managed. Thus, it can be concluded that if the suggestions n the articles are implemented, those who are affected by irregular sleep patterns are able to overcome the conditions. References Austin, B. (2007). Sleep Deprivation in the College Student A Problem Worth Addressing. Journal of a Clinican project. Washington State University-Vancouver Intercollegiate College of Nursing, 5 (3), 37-135. Boonstra, et al. (2010). Sleep Disturbance in Hospitalized Recipients of Stem Cell Transplantation. Clinical Journal of Oncology Nursing Volume 15, Number 3. Flick, U., Garms-Holomova, V. & Rhonsch, G. (2010). ‘When They Sleep, They Sleep’: Daytime Activities and Sleep Disorders in Nursing Homes. Journal of Health Psychology. Vol 15(5) 755–764 DOI: 10.1177/1359105310368182. Martin, J., (2000). Assessment and treatment of Sleep disturbances in Older adults. Clinical Psychology Review, Vol. 20, No. 6, pp. 783–805. McCurry, S., Logsdon, R.G., Terry, L., & Vitiello, L., (2014). Evidence-Based Psychological Treatments for Insomnia in Older Adults, American Journal of psychological Association, Vol. 22, No. 1, 18 –27. Montgomery P, Dennis JA.(2002). Bright light therapy for sleep problems in adults aged 60+. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD003403. DOI: 10.1002/14651858.CD003403. Roland, N., (2011). Sleep disturbance among elderly people in Nursing home: A nonpharmacological approach. Human Aging and Elderly Services Journal.1(2), 28-37. Safi AJ, Hodgson NA (2014) Timing of Activities and their Effects on Circadian Rhythm in the Elderly with Dementia: A Literature Review. J Sleep Disord Ther 3: 176. doi:10.4172/2167-0277.1000176. Schutte-Rodin S; Broch L; Buysse D; Dorsey C; Sateia M. (2008). Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 2008;4(5):487-504. Tinney, J., Moore, K., Dowson, L. & Ledgerwood, K., (2008). Sleep in Residential Care. National Ageing Research Institute. Read More