Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
11/29/07
5:26 PM
Page 56
SLEEP/ REST
Sleep-Rest Pattern
Sleep is restorative. Theories from sleep research suggest that during sleep: The body repairs and renews cells. New information from short-term memory is organized and integrated into long-term memory by the brain (Hodgson, 1991). Usually, adults require 7 to 8 hours of sleep per day. Specific amounts vary with lifestyle and health condition. The focus of the sleep-rest pattern assessment is on whether the person feels rested and ready for the days activities.
Individual Assessment
The sleep-rest pattern describes: Quality of sleep time. Quantity of sleep. Rest and relaxation or quiet periods during the day. Sleep disturbances. Use of aids to sleep, such as medications or nighttime routines.
Individuals at Risk
Some individuals are at increased risk for problems in this area. Be sensitive to cues when assessing individuals with any of the following characteristics:
56
07Gordan(F)-07
11/29/07
5:26 PM
Page 57
57
Shift-work job. Daytime boredom and inactivity. Unrelieved pain. Restless leg syndrome. Nocturia. Anxiety. Depression. New parents. Teenagers. Cardiac or respiratory patients with dyspnea. Poststroke patients. Working parents. Home caregivers.
Assessment Items
History
Generally feel rested and ready for daily activities after sleep? Sleep onset problems? Sleep aids used? (If you suspect a sleep problem, see Sleep Pattern Disturbance Tool below.) Dreams or night awakening? Snoring? Headache when awakening? Ever doze off for a second while driving? When stopped at a light or stopped in traffic? Dozing during the day? (If yes, see Epworth Daytime Sleepiness Scale at the end of this tab; if a problem, refer to physician for sleep apnea evaluation.) Usual bedtime? Bedtime routines? Rest-relaxation periods during the day or evening?
Examination
Diagnostic Categories
The following nursing diagnoses from the NANDA International Taxonomy II (2007) describe diagnostic judgments. Blue type indicates diagnoses developed by the author, not yet reviewed by NANDA, but found useful in clinical practice (Gordon, 2006). Sleep Deprivation: Prolonged periods of time (2 to 3 days or more) without sleep (sustained natural, periodic suspension of relative unconsciousness). Insomnia: Disruption in the amount and quality of sleep that impairs functioning.
SLEEP/ REST
07Gordan(F)-07
11/29/07
5:26 PM
Page 58
SLEEP/ REST
Delayed Sleep Onset: Inability to sleep after 30 minutes when the expectation is that sleep will occur. Sleep Pattern Reversal: Change in sleep-wake cycle from nighttime sleep to predominantly daytime sleep. Readiness for Enhanced Sleep: Pattern of natural, periodic suspension of consciousness that provides adequate rest, sustains a desired lifestyle, and can be strengthened.
Family Assessment
Healthy patterns of sleep and rest are learned in the family, but not all sleep problems arise from familial factors. Environmental factors such as sleeping arrangements, sleep interruptions, and outside noises can interfere with the sleep patterns of family members. The family pattern of sleep, rest, and relaxation includes: Quality and quantity of members sleep. Energy level. Use of sleep aids. Nighttime routines.
Families at Risk
Some families are at increased risk for problems in the sleep-rest pattern. Be sensitive to cues when assessing families with any of the following characteristics: Disorganized lifestyle. Living in overcrowded housing. Member who does shift work. Nocturnal neighborhood activity.
Assessment Items
History
Most days, do family members seem to be well rested and ready for school and work? Regularity of family sleep pattern? Sufficient space? Quiet, dark sleeping space available? Young baby in family? Toddler asking to sleep in parents bed? Family members find time to relax before sleep?
Examination
If opportunity available: Observe sleeping space and arrangements. Family members appear alert and well rested?
58
07Gordan(F)-07
11/29/07
5:26 PM
Page 59
59
Diagnostic Categories
No family diagnoses have been identified in this pattern.
Community Assessment
Communities have patterns of sleeping, resting, and relaxation. Some towns are said to never shut down, whereas others seem deserted in the evening. Assessment focuses on environmental factors that can interfere with sleep and rest. When assessing the community, keep these points in mind: Factors disturbing a community sleep-rest pattern can be obtained from residents. Observation of the community will reveal whether the environment is conducive to sleep and relaxation. Policies and regulations can be reviewed regarding noise pollution in industrial communities.
Communities at Risk
Some communities are at increased risk for problems in this area. Be sensitive to cues when assessing communities with any of the following characteristics: Housing built along a major highway or busy city street. Housing built near an airport or late-closing commercial area.
Assessment Items
Generally quiet at night in most neighborhoods? Usual business hours? Round-the-clock industry?
Examination
Activity-noise levels in business and residential districts? Noise regulations or laws? Areas where elderly people can rest when shopping, such as chairs or benches?
Diagnostic Categories
No community diagnoses have been identified in this pattern.
SLEEP/ REST
07Gordan(F)-07
11/29/07
5:26 PM
Page 60
SLEEP/ REST
60
07Gordan(F)-07
11/29/07
5:26 PM
Page 61
61
____I toss and turn for over an hour or more. ____I doze a bit after meals in the daytime. ____My joints ache when I go to bed. ____My legs seem to jump when I am trying to sleep. ____I have trouble breathing in bed. ____My heart pounds sometimes, and it is scary. From Chesson AL, Anderson WM, Littner M, et al (1999). Practice parameters for the nonpharmacologic treatment of chronic insomnia. Sleep 22(8), 15, with permission.
Situation
____Sitting and reading ____Watching TV ____Sitting inactive in a public place (e.g., theater or a meeting) ____As a passenger in a car for an hour without a break ____Lying down to rest in the afternoon when circumstances permit ____Sitting and talking to someone ____Sitting quietly after a lunch without alcohol ____In a car while stopped for a few minutes in traffic ____Driving alone on a monotonous highway for an hour *Scoring 10 points 1012 points 1317 points 1824 points Probably normal Mild sleepiness Moderate sleepiness Severe sleepiness
SLEEP/ REST