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Nursing perspectives on patients' sleep during hospital care
Sophiahemmet University.ORCID iD: 0000-0002-1372-7757
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Sleep is crucial for all humans in terms of health, daily functioning and well-being. Previous research has shown that sleep is considered a stressor for patients during hospital care. The general aim of this thesis was to explore and describe, from a nursing perspective, patients’ sleep and how sleep is addressed, promoted and assessed during hospital care.

Methods: To cover the general aim of this thesis, various designs were chosen, and diverse methods of data collection were employed. In Study I, data were collected through qualitative interviews of ten consecutively recruited patients at an acute hospital. In Study II, data were collected through qualitative individual interviews and four focus groups, with a total of twenty-two registered nurses at four acute hospitals in an urban region. Study III was designed as a mixed method study and data were collected through twenty-one qualitative individual interviews as well as from program and course syllabuses and intended learning outcomes at three universities. Data from Studies I-II were analysed by qualitative content analysis with an inductive, latent approach. Data in Study III were analysed by qualitative content analysis with an inductive, manifest approach and collected documents were read word-for-word and scanned for the pre-set word, sleep. Study IV was a cross-sectional study and data were collected through a web-based survey. Acute hospitals in Sweden were subjected to stratified randomized sampling. Registered nurses, head nurses, nursing care developers and local training staff were included in the study. Data were analysed using descriptive statistics, and free-text answers were analysed by a thematic text analysis. Study V was performed as a non-experimental prospective study. Data from a group of twenty-five patients at two hospitals were collected by using the Richards-Campbell Sleep Questionnaire and actigraphy by Vivago® and were analysed with correlation and regression analysis.

Findings: Patients’ sleep during hospital care is affected by several different factors and patients’ sleep is described as an important but undermanaged area. Limited knowledge and education within the area and insufficient support from the organization can be seen as barriers. Study III reveals that several student nurses lack evidence-based knowledge about sleep and sleep-promotion and consider themselves only to be prepared to address and promote sleep to a limited extent. Furthermore, the word, sleep, occurred explicitly only three times in two different learning outcomes at one of three included universities. Study IV shows that the area of sleep is not highlighted in a clinical context; for example, there is an absence of training days and education about sleep, only a few departments actively address patients’ sleep, and the use of sleep-assessment is non-existent. Study V shows a relationship between individual Vivago® graphs and patients’ self-assessed sleep, but a significant correlation for all patients between mean values for the two assessments was only obtained for one of the two included nights.

Conclusions: This thesis indicates that sleep deprivation is common among patients during hospital care. Furthermore, education about patients’ sleep in the investigated nursing programs and in clinical practice seems to be deficient. Assessments with the Richards-Campbell Sleep Questionnaire and measurement with Vivago® capture different dimensions of sleep. In its present form, the RCSQ could have the potential to facilitate nursing actions to promote sleep amongst hospitalized patients in line with person-centred care. Furthermore, it is concluded that patients’ sleep during hospital care is an undermanaged and non-highlighted area. This thesis shows that there are several challenges for nurses, nursing managers and organizations at acute hospitals if better outcomes are to be achieved.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet , 2019. , p. 62
National Category
Nursing
Identifiers
URN: urn:nbn:se:shh:diva-3335ISBN: 978-91-7831-411-9 (print)OAI: oai:DiVA.org:shh-3335DiVA, id: diva2:1319829
Public defence
2019-05-24, Erforssalen, Sophiahemmet Högskola, Valhallavägen 91, Hus R, plan 2, Stockholm, 09:30 (Swedish)
Opponent
Supervisors
Available from: 2019-06-03 Created: 2019-06-03 Last updated: 2019-06-27Bibliographically approved
List of papers
1. Patient's experiences of sleep in hospital: a qualitative interview study
Open this publication in new window or tab >>Patient's experiences of sleep in hospital: a qualitative interview study
2014 (English)In: Journal of Research in Nursing, ISSN 1744-9871, E-ISSN 1744-988X, Vol. 19, no 3, p. 176-188Article in journal (Refereed) Published
Abstract [en]

Many patients experience sleep disturbances and a reduced quality of sleep while hospitalised. Studies have shown that a person with a disease and/or a bodily injury has an increased need for sleep. Patients' experiences of sleep should govern how sleep disturbances should be managed. It is thus necessary to focus upon and describe patients’ needs and experiences. The aim of this study was to explore and describe patients’ experiences of sleeping in hospital. This study is based on qualitative semi-structured interviews with 10 consecutively included patients. The interviews were conducted between October 2010 and March 2011 and were audio recorded and transcribed verbatim. Collected data were analysed by qualitative content analysis. The participants reported physical and psychological experiences that had affected their sleep. Their experiences were categorised using four themes: bedside manner, physical factors, being involved and integrity. Patients considered that experiencing some degree of control, feeling involved and preserving one’s integrity affect sleep during hospitalisation. Several factors have an impact on patients’ sleep. It is not only physical factors but also psychological factors such as bedside manner and having the opportunity to influence and be involved. The patients’ accounts provide a new perspective and open the door to changes in nursing care regarding patients’ sleep.

Keywords
Bedside manner, Experiences, Nursing care, Patient, Person-centred, Sleep
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-1379 (URN)10.1177/1744987113490415 (DOI)
Available from: 2013-06-26 Created: 2013-06-26 Last updated: 2019-06-03Bibliographically approved
2. Nurses' experiences of hospitalised patients' sleep in Sweden: a qualitative study
Open this publication in new window or tab >>Nurses' experiences of hospitalised patients' sleep in Sweden: a qualitative study
2015 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 23/24, p. 3664-3673Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES:

The aim was to describe nurses' experiences of patients' sleep at an emergency hospital and their perceptions of sleep-promoting interventions.

BACKGROUND:

Promotion of patients' sleep during hospital care is an important intervention for the nursing profession. To promote sleep and to initiate sleep-promoting interventions, nurses need basic knowledge about sleep and its physiology. Therefore, it is of importance to explore and expand knowledge about how nurses experience patients' sleep and how they perceive working with it while providing care.

DESIGN:

A qualitative descriptive design was used.

METHODS:

Data were collected from four focus groups and seven individual interviews. A total of twenty-two registered nurses participated. Data were analysed using a qualitative content analysis.

RESULTS:

Nurses expressed a desire and an ambition to work in ways that promote patients' sleep during hospitalisation. Nurses reported that health care services and emergency hospitals were not organised according to patients' perspective and needs. Furthermore, they did not have opportunities to work effectively to promote sleep according to the patients' wishes. Several nurses stated that they did not have sufficient knowledge about sleep and that they did the best they could under prevailing circumstances. Nurses emphasised the importance of sleep for patients and that it was an area that should be given far greater priority.

CONCLUSIONS:

The results indicate that nurses currently have insufficient knowledge about sleep and sleep-promoting interventions. These aspects of nursing is based on personal experience and common sense rather than being evidence based. Furthermore, sleep as a nursing topic needs to be developed and given more focus in order for nurses to be able to deliver high quality care at emergency hospitals.

RELEVANCE TO CLINICAL PRACTICE:

Nurses require more knowledge and education to gain deeper understanding of sleep and to deliver evidence-based, high quality care.

Keywords
Emergency hospital, Focus groups, Individual interviews, Knowledge, Nurses' experiences, Patient's sleep
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-1965 (URN)10.1111/jocn.12985 (DOI)26373981 (PubMedID)
Available from: 2015-09-17 Created: 2015-09-17 Last updated: 2019-06-03Bibliographically approved
3. Sleep as a topic in nursing education programs? A mixed method study of syllabuses and nursing students' perceptions
Open this publication in new window or tab >>Sleep as a topic in nursing education programs? A mixed method study of syllabuses and nursing students' perceptions
2019 (English)In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 79, p. 168-174, article id S0260-6917(18)30846-3Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Sleep is a basic human need and is considered important for maintaining health. It is even more important during illness due to its impact for example on our immune system. Nurses have an important role in identifying sleep deprivation. They are also in a unique position to promote and address sleep among patients. However, it is essential that they are provided with the appropriate knowledge during training.

AIM: To explore and describe nursing students' perceptions of preparedness to adress and support patients' sleep during hospitalization and to apply sleep-promoting interventions in a clinical context. Furthermore, the aim was to investigate if, and how, the topic of sleep is explicitly incorporated in nursing education programs.

DESIGN: A descriptive study based on a mixed method approach.

METHODS: Quantitative and qualitative data were collected from program and course syllabuses and intended learning outcomes from three universities. Twenty-one nursing students from the same universities were interviewed during their final year of education.

RESULTS: The results of both quantitative and qualitative data consistently show that education regarding sleep and patients' sleep is limited and, in some respects, absent in the Bachelor of Science Nursing programs investigated.

CONCLUSION: This study indicates that education about sleep and patients' sleep in the nursing programs studied is insufficient and limited. This gap in knowledge may lead to prospective registered nurses using their own experiences instead of evidence-based knowledge when assessing, supporting and applying sleep-promoting interventions.

Keywords
Interviews, Mixed method, Nursing education, Preparedness, Sleep, Students' knowledge
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-3332 (URN)10.1016/j.nedt.2019.05.030 (DOI)31132729 (PubMedID)
Available from: 2019-06-03 Created: 2019-06-03 Last updated: 2019-08-16Bibliographically approved
4. Nursing care and management of patients' sleep during hospitalization: A cross-sectional study
Open this publication in new window or tab >>Nursing care and management of patients' sleep during hospitalization: A cross-sectional study
2019 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, no 19-20, p. 3400-3407Article in journal (Refereed) Published
Abstract [en]

AIM: To explore and describe how patients' sleep is addressed at acute-care hospitals in Sweden with regard to nursing care, management, and the development of knowledge in this area.

BACKGROUND: Sleep is a basic human need and thus important for health and health maintenance. Patients describe sleeping in hospital as a stressor, and research shows that nurses tend to underestimate patients' perceived problems with sleep during hospitalization. How do nursing staff at acute hospitals address patients' sleep and the development of knowledge in this area?.

DESIGN/METHOD: A cross-sectional descriptive study was conducted based on data collected through a web survey. Head nurses, registered nurses, nursing care developers, and local training supervisors at 36 randomized acute-care hospitals in Sweden were invited to participate. This study was executed and reported in accordance with SQUIRE 2.0.

RESULTS: The results of the survey (53 responses from 19 wards at 15 acute-care hospitals) showed that no policy documents exist and no current training addresses sleep during hospital stay. All participants agreed that sleep should be considered a nursing topic and that it is important for hospitalized patients.

CONCLUSION: Patients' sleep during hospitalization is undermanaged at acute-care hospitals. Nurses, health care managers, and organizations face challenges if they are to achieve better outcomes.

RELEVANCE TO CLINICAL PRACTICE: This study shows that nurses do consider patients' sleep important and addressing sleep as part of nursing care. Future studies in the area should focus on what kinds of support and education are needed in the clinical context. This article is protected by copyright. All rights reserved.

Keywords
Cross-sectional study, hospitalization, management, nursing care, patients, sleep
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-3317 (URN)10.1111/jocn.14915 (DOI)31091343 (PubMedID)
Available from: 2019-05-22 Created: 2019-05-22 Last updated: 2019-09-18Bibliographically approved
5. Patients' sleep in hospital: Outcomes of self-assessed vs objectively measured sleep as a nursing tool
Open this publication in new window or tab >>Patients' sleep in hospital: Outcomes of self-assessed vs objectively measured sleep as a nursing tool
(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-3334 (URN)
Available from: 2019-06-03 Created: 2019-06-03 Last updated: 2019-06-03Bibliographically approved

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