Background: sleep is a primary need, as it is indispensable for the recovery of the energies used during the day and for the reorganization of some psychic processes such as learning and memory. It has been shown that more than 50% of critical patients, admitted to intensive care units, are also suffering from sleep disorders. Studies with subjective questionnaires reveal a presence of 50-66.7% (within 1 month), 34-64.3% (>1-3 months), 22-57% (>3-6 months), and 10-61% (>6 months) of abnormal sleep post stay in a critical area. The Committee, therefore, stresses the need to identify appropriate non-pharmacological interventions aimed at solving the problem. Objective: guide the best non-pharmacological nursing interventions for the promotion of sleep that can be implemented in an intensive care context, identifying the "best practices" according to scientific evidence. Materials and methods: bibliographic research was conducted between January and April 2023, consulting the main online databases (PudMed, CINAHL Database, Trip Database), websites, and texts useful to highlight key concepts. The articles identified were selected and analysed through the PRISMA method, eventually obtaining a set of practices "Evidence Base". Results: 1416 articles were identified among the databases and other online sources. The selection process of the studies allowed to identify 16 articles as suitable for research. The different strategies that can be implemented by nursing staff to improve the quality and quantity of rest include sleep hygiene, relaxation techniques (which include back massages, meditation using a display and acupressure), earplugs, adjusting the volume of alarms and voice tone, eye masks, music therapy, and white noise. To the above-mentioned interventions can be added both the use of a sleep promotion protocol, which regulates routine care and non-emergency care and guarantees organized and planned nursing care. The arrangement of a setting that promotes the well-being of the patient. Discussion: scientific evidence has shown that a bundle of interventions is much more effective than the use of single treatment. In fact, the combination of proper sleep hygiene, music therapy, eye masks and earplugs represent a first step to prevent sleep disturbances and ensure a restful rest. Conclusions: scientific evidence recommends continuous and constant training of staff on the most up to date "best practices" to ensure a restful sleep. An effective intervention bundle proposed by scientific evidence involves the combination of proper sleep hygiene with music (not exceeding 40 dB), ear plugs and eye mask. It represents a non-invasive, economical, and easy to apply method. In addition, it is advantageous both in terms of the time of assistance to the person and the benefit. Keywords: Nursing Care, Nursing Intervention, Critical Care, Intensive Care Unit, Sleep quality, Sleep deprivation.
Introduzione: il sonno è un bisogno primario, in quanto indispensabile per il recupero delle energie utilizzate durante la giornata e per la riorganizzazione di alcuni processi psichici come l’apprendimento e la memoria. È stato dimostrato come più del 50% dei pazienti critici, ricoverati in unità di terapia intensiva, sono affetti anche da disturbi del sonno. Studi con questionari soggettivi rivelano una presenza di sonno anormale post degenza in area critica del 50-66,7% (entro 1 mese), 34-64,3% (>1-3 mesi), 22- 57% (>3-6 mesi) e 10-61% (>6 mesi). Si sottolinea quindi l’esigenza di identificare interventi non farmacologici appropriati, mirati a risolvere il problema. Obiettivo: fornire indicazioni riguardanti i migliori interventi infermieristici non farmacologici per la promozione del sonno attuabili in un contesto di terapia intensiva, individuando le “best pratices” secondo le evidenze scientifiche. Materiali e metodi: è stata condotta una ricerca bibliografica tra i mesi di gennaio e aprile 2023, consultando le principali banche dati online (PudMed, CINAHL Database, Trip Database), siti internet e testi utili ad evidenziare i concetti chiave. Gli articoli individuati sono stati selezionati e analizzati attraverso il metodo PRISMA, ottenendo in fine un insieme di pratiche “Evidence Base”. Risultati: sono stati individuati 1416 articoli tra le banche dati e altre fonti online. Il processo di selezione degli studi ha permesso di identificare 16 articoli come idonei alla ricerca. Le diverse strategie che possono essere attuate dal personale infermieristico prevedono: igiene del sonno, aromaterapia, tecniche di rilassamento (che includono massaggi alla schiena, meditazione attraverso l’utilizzo di un display e digitopressione), tappi per le orecchie, regolazione del rumore nelle sue varie forme, mascherine per gli occhi, musicoterapia e rumore bianco. Agli interventi indicati si può aggiungere l’utilizzo di un protocollo di promozione del sonno, che regola le cure di routine e di assistenza non urgenti, e garantisce un’assistenza infermieristica organizzata e pianificata. Discussione: dalle evidenze scientifiche è emerso che un bundle di interventi risulta molto più efficace che l’utilizzo del singolo trattamento. Infatti, la combinazione di una corretta igiene del sonno, la musicoterapia, le maschere per gli occhi e i tappi per le orecchie rappresentano un primo passo per prevenire i disturbi del sonno e garantire un riposo ristoratore. Conclusione: le evidenze scientifiche raccomandano una continua e costante formazione del personale sulle più aggiornate “best practices” per garantire un sonno adeguato. Un bundle di interventi efficace proposto dalle evidenze scientifiche prevede la combinazione di una corretta igiene del sonno con la musica (che non superi i 40 dB), i tappi per le orecchie e la maschera per gli occhi. Rappresenta un metodo non invasivo, economico e facile da applicare. Inoltre, risulta vantaggioso sia in materia di tempo di assistenza alla persona che di beneficio. Parole chiave: assistenza infermieristica, interventi infermieristici, cure infermieristiche , terapia intensiva, area critica, qualità del sonno
Dormire in unità di terapia intensiva: interventi non farmacologici per la promozione del sonno, una revisione di letteratura
BALDIN, SARA
2022/2023
Abstract
Background: sleep is a primary need, as it is indispensable for the recovery of the energies used during the day and for the reorganization of some psychic processes such as learning and memory. It has been shown that more than 50% of critical patients, admitted to intensive care units, are also suffering from sleep disorders. Studies with subjective questionnaires reveal a presence of 50-66.7% (within 1 month), 34-64.3% (>1-3 months), 22-57% (>3-6 months), and 10-61% (>6 months) of abnormal sleep post stay in a critical area. The Committee, therefore, stresses the need to identify appropriate non-pharmacological interventions aimed at solving the problem. Objective: guide the best non-pharmacological nursing interventions for the promotion of sleep that can be implemented in an intensive care context, identifying the "best practices" according to scientific evidence. Materials and methods: bibliographic research was conducted between January and April 2023, consulting the main online databases (PudMed, CINAHL Database, Trip Database), websites, and texts useful to highlight key concepts. The articles identified were selected and analysed through the PRISMA method, eventually obtaining a set of practices "Evidence Base". Results: 1416 articles were identified among the databases and other online sources. The selection process of the studies allowed to identify 16 articles as suitable for research. The different strategies that can be implemented by nursing staff to improve the quality and quantity of rest include sleep hygiene, relaxation techniques (which include back massages, meditation using a display and acupressure), earplugs, adjusting the volume of alarms and voice tone, eye masks, music therapy, and white noise. To the above-mentioned interventions can be added both the use of a sleep promotion protocol, which regulates routine care and non-emergency care and guarantees organized and planned nursing care. The arrangement of a setting that promotes the well-being of the patient. Discussion: scientific evidence has shown that a bundle of interventions is much more effective than the use of single treatment. In fact, the combination of proper sleep hygiene, music therapy, eye masks and earplugs represent a first step to prevent sleep disturbances and ensure a restful rest. Conclusions: scientific evidence recommends continuous and constant training of staff on the most up to date "best practices" to ensure a restful sleep. An effective intervention bundle proposed by scientific evidence involves the combination of proper sleep hygiene with music (not exceeding 40 dB), ear plugs and eye mask. It represents a non-invasive, economical, and easy to apply method. In addition, it is advantageous both in terms of the time of assistance to the person and the benefit. Keywords: Nursing Care, Nursing Intervention, Critical Care, Intensive Care Unit, Sleep quality, Sleep deprivation.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/58200