Welcome! Our topic is rest and sleep, and
my name is Diana Shenefield. So in this topic,
we’re going to talk about the importance
of rest and sleep, and how important it is
as nurses that we try to help our patients
get a good night’s rest. And that we help
them to be able to relax so that their
body can heal.
So, one of the learning outcomes that we can
attach to this is to assess the needs.
Sometimes our patients come into the hospital and they’ll
complain that this isn’t a place of rest.
And we know that. But what can we do as nurses
to help our patients rest? We know the effects
of sleep deprivation. We know the effects of
not getting enough sleep or too much sleep.
And so, being able to assess our patients who is
at risk, maybe what medications are causing
problems, or who has a disease process that
makes it really hard for them to rest.
So, our practice NCLEX question. Which most
common cause sleep deprivation in the hospital
should the nurse consider when planning care?
Again, if you’re thinking about your mind,
if you’ve ever worked night shift, sometimes
as nurses, we think that when we’re up,
everybody is up. And we kind of forget that
our patients are trying to sleep at night.
So, what can we do? What causes sleep deprivation?
Is it fragmented sleep? Is it early awakening,
that’s the problem? Is it restless legs? Or
is it sleep apnea? Now, all of those things
can cause a patient to have problems with
sleep, but what is the most common cause of
sleep deprivation? Hopefully, you picked A,
So think about your patient. Think about when
you go in and they’re trying to nap and
it’s time for vital signs. Lab comes
in, they’re taking a nap. Their dietary
comes in and you don’t want them to have
cold food. Are we letting our patients have
long extended periods of sleep? So, why is
it important to understand sleep? We know
that when patients are sleep deprived, their
pain is worse, their nausea vomiting is worse,
they can’t relax, their blood pressure goes
up, their heart rate goes up. And when you
can’t sleep, you sit and think about all
the things that are wrong with you.
And so it’s hard to get our patients to relax.
And how can I evaluate their pain if their
pain is exacerbated by the fact that they’re
not sleeping? So, as nurses, what do we need
to do? One of the things is that we need to
work really hard to keep the environment quiet.
Now, we know a nurse, if you stay in the hospital
just in the hallway and you listen to all
the sounds, most of the sounds that you hear
are sounds that we need to have. We have
bed alarms. We have telemetry alarms. We have
call lights, telephones. All of those things
are needed to run a safe hospital. But when
you’re the patient lying in the bed, all
of those noises now become a distraction and
become a cause of not being able to sleep.
So, what can you do as a nurse? What can we
eliminate to make sure that our patients are
getting the sleep? What can we do? Promote
bedtime routines. Some patients have a definite
routine that they do before they go to bed.
When they come into the hospital all of the
sudden, we change that whole routine. And
bedtime routine is one of them. And a lot of times,
people have trouble sleeping unless they follow
a certain routine. So as nurses, if I don’t
assess my patient, if I don’t ask them why
they’re having trouble sleeping or is there
anything that you do at night to help you
get to sleep, then I’m putting my patient
at a disadvantage. There’s no reason why.
They can’t maybe
watch their favorite show or maybe have a
warm glass of milk unless it’s contraindicated.
But what can we do to keep that routine that
they have at home? And then promoting comfort.
Back in the day long time ago, we used to
give our patients back rubs at night.
That was part of the care at night. And I think
we’ve gotten away from that a lot. But there’s
a lot to be said with being able to help somebody
relax before they go to sleep. We know the hospital
beds aren’t the beds at home. And sleeping
in a different place makes it hard to sleep.
The beds aren’t the same beds.
That’s not their pillows.
So, what can we do? Again, a back rub, keeping
their routine the same, are all things that
we can do to try to help them be able to sleep.
We want to avoid heavy meals. We usually don’t
have a problem with that at the hospital,
but again, if their tray has been delayed.
Heavy meals make it hard to sleep, especially if
your patient has GERD or any kind of intestinal
problems. What about promoting appropriate
activity, encouraging people to not be real
active right before bed? And don’t forget
about your patients who work the night shift.
Maybe they sleep during the day. So, what
do we do as nurses? We wake everybody
up in the morning. Maybe their routine is to
sleep during the day. So, there are certain
things that we can adjust. Is there things
that maybe don’t have to be done in the
morning hours, when they would normally be
sleeping? And if needed, we do have medications
available to help people sleep. Again, if
we can control the routine, if we can help
them get relaxed, maybe they don’t need the
medications. But we also need to understand
that there are medications available that
sometimes are needed while the patient is
in the hospital. So again, one of the
things we need to think
about when we’re doing assessment. Is your
patient going through any kind of withdraw?
Where there’s alcohol withdraw, nicotine
withdraw, drug withdraw. When they’re in
the hospital, obviously, those things aren’t
available to them, and that can cause anxiety.
Can also cause a lack of sleep and comfort.
Sometimes patients won’t voluntarily tell
you. Most patients aren’t going to tell you
that they’re addicted to drugs or they’re
addicted to alcohol, but you can start seeing
those signs and symptoms. And is that the
reason they can’t sleep? Do they suffer
from insomnia? Did you ask your patient?
Maybe they’ve had insomnia
for years and they haven’t slept in a long
time. One is that something that you can address
or that you can help with. But two, expecting
them to go to sleep when they haven’t slept
for a long time isn’t going to work either.
So we need to make sure we’re asking our
patients how many hours do they sleep at night.
Do they have trouble going to sleep? Do they
wake up a lot during the night? Or are they
very early risers? All those are things that
we can assess on our patient and maybe adjust
our care accordingly. Does your
patient have to get up multiple
times at night to go to the bathroom? If you’ve
ever had to get up, you know you get woke
up. It’s hard to get back to sleep. So is
it something wrong with the patient’s urinary
system? Is there a reason why they get up
in the middle of the night? And is there a
problem that’s not being addressed? What
about if your patient have trouble staying
up at night and they sleep during the day,
do they have their nights and days mixed up?
Is it because of shift work or is it because
of maybe a head injury or a stroke? Patients
that have been in the hospital, if they’ve
been confined to a room and we don’t see
day and night, if their blinds are pulled,
it’s easy to get mixed up on day and night.
And so, what can we do to keep them oriented to
the time of day? Restless leg is another one.
A lot of people have restless legs. Maybe
it’s not something that they’re medicated
for, but they know at night, they have to
get up and walk around. Is it something that
we can address? Is it something that we can
help with? But we need to ask about it because
a lot of people don’t know that restless
leg is actually a diagnosis. They may just
think that they have wiggly legs or something.
So make sure that you’re doing a good assessment.
And does your patient on medications, one
that keeps them from sleeping? Or are they
on medications to help them sleep? How long
have they been on it? Are they taking anything
over the counter for it, that maybe is contraindicated
with the medications that we’re giving them?
Again, you need to know about Ambien. Ambien
is one of the most common medications that
shouldn’t be taken long-term. So if you
have a patient that says they’ve been on
Ambien for a couple of years, that’s probably
a problem too that needs to be addressed.
But remember, one of the side effects with
Ambien is daytime sleepiness. And so again, then we come
into a safety problem. So, being able to educate
our patients, making sure that our physicians
know that patients are already on these sleeping
medicines, and what kind of effects it’s
having on their safety and their
So again, think about when you’re at work,
wherever you work or think about a time when
you were a patient and all the noises in the
hospital. And is there ways that we can still
provide very good care but allow the patient
longer periods of sleep? And when you’re
answering NCLEX questions, look for things
like clustering your care, promoting sleep,
and all of the things that a sleep deprivation
does to our patients, whether it makes their
pain worse or their nausea vomiting worse,
what is it about the sleep deprivation that’s
going to make their disease process work?
And what can I do as a nurse to help comfort
them so that they get the rest that they need?
Good luck on NCLEX.