الفهرس 
Abstract
Aims of the studyOnly 14 pages are availabe for public view
 |  | from | 145 |  |  |
| | | from | 145 | | |
Abstract
A comfortable environment is needed for optimal sleep. The ICU environment is not only strange and unfamiliar to patients, but also full of environmental stimuli that can adversely affect sleep. Noise, light, and ambient temperature has been shown to relate to poor sleep in the ICU.
In light of the growing awareness of sleep disruption and their potential adverse effects for the ICU patient after open-heart surgery; it is important that nurses implement strategies to promote sleep and rest among their patients. Because disturbed sleep is caused by multiple interacting factors, no single intervention is likely to produce the desired outcome. Implementing strategy to promote sleep must be started before surgery throw proper preoperative psychological preparation for patients after that apply the ICU environment management to minimize disruption of sleep.
Aims of the study
The first aim of the study was evaluate causes of sleep disruption in post-operative ICU among patients after open-heart surgery. The second aim was evaluate the effect of applying nursing interventions to improve sleep quality and reduce complications of sleep disruption among those patients.
The study was conducted in post- operative intensive care unit at Assiut university hospitals.
The sample of the study was a convenient sample of 40 adult patients (male and female) divided equally into two groups (control group and study group).
The sample included all adults (18-60 yrs) patients were admitted immediately at the post-operative intensive care unit after open-heart surgery and connected with mechanical ventilation. The patients stayed at the (ICU) for at least 3 days.
The current study was excluding those patients whom have a history of sleep disturbances and whom have psychological disorders.
First Tool:
Patient’s assessment sheet , it include three parts, 1st part it consists of socio-demographic data of the patient as name , age , sex, level of education , and type of occupation, 2nd part it consists of medical data as: date and time of admission , medical diagnosis ,type of surgery, time of connection and disconnection with mechanical ventilation, length of ICU stay and mechanical ventilation setting, 3rd par it consists of the vital signs (temperature , pulse, respiration and blood pressure ) , laboratory investigation (ABG, liver function test, prothrombin time and prothrombin concentration).
Second Tool: this tool was consisted of two main categories as the following:
1. A questionnaire that assessed the sleep quality of ICU patients and the factors that contributed to sleep disruption among these patients. (Freedomman, Kotzer, and Schwab 2001).
2. Sleep disruption scale after open-heart surgery as a non-physiological assessment. (Psychiatric Prof.Dr.Samy Abd-Elkawy Ali 2010).
The main results:
The results of this study revealed that, Patients after open-heart surgery in postoperative intensive care unit experience poor sleep quality and consistently report poor perceived sleep quality in the ICU (1.5 ± 0.6) compared to home (9.9 ± 0.3). Regarding the causes of sleep disruption of control group it was found that ICU environment noises represented 100%, light 90%, taking vital signs 80%, nursing intervention 70%, administration of medication 65%, and blood samples was 60% . The study revealed that there was a highly statistical significant difference (P<0.001) regarding the overall quality of sleep in ICU stay for both groups (4.7 ± 3.0) of study group and control group (1.5 ± 0.6). There was a highly significant difference between studied groups as regards to overall degree of daytime sleepiness during ICU stay (5.7 ± 2.2) of study group and control group (4.7 ± 2.8). Regarding the overall quality of sleep at home for both groups there was no statistical significant difference as well as regards to quality of sleep on the first night in the ICU (P= 0.840). The result revealed that there was a statistical significant difference between both groups regarding symptoms of disorder concentration and memory, affective symptoms, sensory symptoms, and symptoms of the autonomic nervous system. There was significant difference as regards symptoms of cognitive disorder and significant as regards symptoms of thinking and awareness.
Based on the current study finding it was recommended that:
1. Hospital should provide continuous learning programs for ICU nurses to explain the impact of sleep disruption on these patients to raise awareness of the problem.
2. Preparation and provision of information should start from time of the surgeon’s decision that surgery is required. The patients must visit the cardiac surgery unit 2 weeks prior to surgery for the preoperative work up, to prepare them and provide information in the form of booklets, videos, and one to one counseling sessions.
3. Follow-up care for patients with open-heart surgery phone calls, home health visits and clinic visits would help to pinpoint problems and solve it.
4. Establishment of specialized cardiothoracic clinics in all health centers to help guiding and caring for patient with open-heart surgery.
Summary
A comfortable environment is needed for optimal sleep. The ICU environment is not only strange and unfamiliar to patients, but also full of environmental stimuli that can adversely affect sleep. Noise, light, and ambient temperature has been shown to relate to poor sleep in the ICU.
In light of the growing awareness of sleep disruption and their potential adverse effects for the ICU patient after open-heart surgery; it is important that nurses implement strategies to promote sleep and rest among their patients. Because disturbed sleep is caused by multiple interacting factors, no single intervention is likely to produce the desired outcome. Implementing strategy to promote sleep must be started before surgery throw proper preoperative psychological preparation for patients after that apply the ICU environment management to minimize disruption of sleep.
Aims of the study
The first aim of the study was evaluate causes of sleep disruption in post-operative ICU among patients after open-heart surgery. The second aim was evaluate the effect of applying nursing interventions to improve sleep quality and reduce complications of sleep disruption among those patients.
The study was conducted in post- operative intensive care unit at Assiut university hospitals.
The sample of the study was a convenient sample of 40 adult patients (male and female) divided equally into two groups (control group and study group).
The sample included all adults (18-60 yrs) patients were admitted immediately at the post-operative intensive care unit after open-heart surgery and connected with mechanical ventilation. The patients stayed at the (ICU) for at least 3 days.
The current study was excluding those patients whom have a history of sleep disturbances and whom have psychological disorders.
First Tool:
Patient’s assessment sheet , it include three parts, 1st part it consists of socio-demographic data of the patient as name , age , sex, level of education , and type of occupation, 2nd part it consists of medical data as: date and time of admission , medical diagnosis ,type of surgery, time of connection and disconnection with mechanical ventilation, length of ICU stay and mechanical ventilation setting, 3rd par it consists of the vital signs (temperature , pulse, respiration and blood pressure ) , laboratory investigation (ABG, liver function test, prothrombin time and prothrombin concentration).
Second Tool: this tool was consisted of two main categories as the following:
1. A questionnaire that assessed the sleep quality of ICU patients and the factors that contributed to sleep disruption among these patients. (Freedomman, Kotzer, and Schwab 2001).
2. Sleep disruption scale after open-heart surgery as a non-physiological assessment. (Psychiatric Prof.Dr.Samy Abd-Elkawy Ali 2010).
The main results:
The results of this study revealed that, Patients after open-heart surgery in postoperative intensive care unit experience poor sleep quality and consistently report poor perceived sleep quality in the ICU (1.5 ± 0.6) compared to home (9.9 ± 0.3). Regarding the causes of sleep disruption of control group it was found that ICU environment noises represented 100%, light 90%, taking vital signs 80%, nursing intervention 70%, administration of medication 65%, and blood samples was 60% . The study revealed that there was a highly statistical significant difference (P<0.001) regarding the overall quality of sleep in ICU stay for both groups (4.7 ± 3.0) of study group and control group (1.5 ± 0.6). There was a highly significant difference between studied groups as regards to overall degree of daytime sleepiness during ICU stay (5.7 ± 2.2) of study group and control group (4.7 ± 2.8). Regarding the overall quality of sleep at home for both groups there was no statistical significant difference as well as regards to quality of sleep on the first night in the ICU (P= 0.840). The result revealed that there was a statistical significant difference between both groups regarding symptoms of disorder concentration and memory, affective symptoms, sensory symptoms, and symptoms of the autonomic nervous system. There was significant difference as regards symptoms of cognitive disorder and significant as regards symptoms of thinking and awareness.
Based on the current study finding it was recommended that:
1. Hospital should provide continuous learning programs for ICU nurses to explain the impact of sleep disruption on these patients to raise awareness of the problem.
2. Preparation and provision of information should start from time of the surgeon’s decision that surgery is required. The patients must visit the cardiac surgery unit 2 weeks prior to surgery for the preoperative work up, to prepare them and provide information in the form of booklets, videos, and one to one counseling sessions.
3. Follow-up care for patients with open-heart surgery phone calls, home health visits and clinic visits would help to pinpoint problems and solve it.
4. Establishment of specialized cardiothoracic clinics in all health centers to help guiding and caring for patient with open-heart surgery.<br.