Richardson Annette, Crow Wendy, Coghill Elaine, Turnock Christopher
Critical Care, Newcastle upon Tyne Hospitals NHS Trust, Newcastle-upon-Tyne, UK.
J Clin Nurs. 2007 Sep;16(9):1660-8. doi: 10.1111/j.1365-2702.2005.01546.x. Epub 2007 Apr 24.
The aim of this critical care sleep assessment pilot study was to evaluate the usefulness of three sleep assessment tools to identify which, if any, provided the closest comparison between the nurses' judgement and the patients' experience of their sleep. The study objectives were to: (i) compare patients' and nurses' assessment of sleep using three different rating tools. (ii) Ascertain patients' preferences with non-interventional, user friendly, practical tools in critical care. (iii) Recommend changes and improvements to the way that sleep is assessed and documented.
Sleep is important for promoting critical care recovery and sleep disturbance is known to cause irritability, aggression and increased stress levels. The availability and use of valid critical care sleep assessment tools is limited.
A descriptive comparative study using three sleep assessment-rating scales were constructed to provide easy to understand tools for completion by both patients and nurses in critical care.
Structured interviews were undertaken with 82 patients and 82 nurses using a convenience sample from four multispecialty critical care units in one large teaching trust. Patients were included in the study if they met a list of pre-defined criteria to obtain responses from lucid orientated patients.
No tool produced a close association between the nurses' assessment of the patients sleep and the patients' assessment of their sleep. Patients found two of the three tools easy to use when rating their sleep. Discussion. Objective invasive measurements of sleep as well as complex subjective tools appear inappropriate to be used as a part of daily critical care practice. The application of simple rating scores has a high degree of error when nurses assess patients' sleep, even though high levels of patient observation and assessment are practiced in critical care.
More research is needed to examine the assessment of sleep in critical care, particularly linking rating scales to alternative methods of physiological assessment of sleep. Findings indicate nurses are unable to accurately assess critical care patients' sleep using rating assessment tools. However patients were found to prefer two sleep assessment tools, one banded in hours to assess sleep quantity and one as a comparison against normal sleep to assess sleep quality.
This study reviews the importance of sleep assessment and the diverse methods available for assessing sleep focussing on the critically ill patient. More noteworthy it highlights how nurses sole judgements of patients sleep is not a reliable method in clinical practice, however it provides some indication on the application of 'easy to use' tools to assist in the patients assessments of their sleep.
这项重症监护睡眠评估试点研究的目的是评估三种睡眠评估工具的实用性，以确定哪一种（如果有的话）能在护士的判断与患者的睡眠体验之间提供最接近的比较。研究目标如下：（i）使用三种不同的评分工具比较患者和护士对睡眠的评估。（ii）通过非干预性、用户友好且实用的工具确定重症监护患者的偏好。（iii）就睡眠评估和记录方式提出改进建议。
睡眠对于促进重症监护恢复很重要，且已知睡眠障碍会导致易怒、攻击性和压力水平升高。有效的重症监护睡眠评估工具的可用性和使用情况有限。
一项描述性比较研究，构建了三种睡眠评估评分量表，为重症监护中的患者和护士提供易于理解的工具来完成评估。
从一家大型教学信托机构的四个多专科重症监护病房中选取便利样本，对82名患者和82名护士进行了结构化访谈。如果患者符合一系列预定义标准，以获取神志清醒患者的回答，则将其纳入研究。
没有一种工具能在护士对患者睡眠的评估与患者对自身睡眠的评估之间产生紧密关联。患者发现三种工具中的两种在对睡眠进行评分时易于使用。讨论。睡眠的客观侵入性测量以及复杂的主观工具似乎不适用于日常重症监护实践。当护士评估患者睡眠时，即使在重症监护中进行了高水平的患者观察和评估，简单评分的应用仍存在高度误差。
需要更多研究来审视重症监护中的睡眠评估，特别是将评分量表与睡眠生理评估的替代方法联系起来。研究结果表明，护士无法使用评分评估工具准确评估重症监护患者的睡眠。然而，发现患者更喜欢两种睡眠评估工具，一种按小时划分以评估睡眠量，另一种作为与正常睡眠的比较以评估睡眠质量。
本研究回顾了睡眠评估的重要性以及可用于评估睡眠的多种方法，重点关注重症患者。更值得注意的是，它强调了护士对患者睡眠的单一判断在临床实践中并非可靠方法，不过它为应用“易于使用”的工具协助患者进行睡眠评估提供了一些指示。
