The Harry Crossley Children's Nursing Development Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town.
Curationis. 2021 Oct 6;44(1):e1-e10. doi: 10.4102/curationis.v44i1.2219.
Adequate sleep in hospitalised children is important for a variety of physiological and psychological processes associated with growth, development, and recovery from illness and injury. Hospitalisation often prioritises clinical care activities at the expense of age-appropriate sleep. Nurses and the wider healthcare team contribute to this paradox. However, through conscious practice and partnering with mothers, nurses are able to enact change and promote sleep.
To adopt, adapt or contextualise existing guidelines to develop an evidence-based practice guideline to promote sleep-friendly ward environments and routines facilitated by nurses, and in partnership with mothers.
A six-step methodology for guideline adaptation was followed, as recommended by the South African Guidelines Excellence project: (1) existing guidelines and protocols were identified and (2) appraised using the AGREE II instrument; (3) an evidence base was developed; (4) recommendations were modified, (5) assigned levels of evidence and grades of recommendation; and (6) end user guidance was developed. Expert consultation was sought throughout.
Existing relevant guidance comprised 61 adult-centric recommendations. Modification of the evidence base led to six composited recommendations that facilitate sleep in hospitalised children: (1) prioritising patient safety; (2) collaborating with the mother or caregiver to promote sleep; (3) coordinating ward routine and (4) environment to improve sleep; (5) work with clinical and non-clinical staff; and (6) performing basic sleep assessments. Practice recommendations were aligned to the South African regulatory framework for nursing.
Hospitalisation is a time of physiological and psychological dysregulation for children, which is amplified by poor sleep in a hospital. Nurses have the opportunity to promote sleep during hospitalisation by implementing this African-centric guideline in partnership with mothers.
对于住院儿童来说，充足的睡眠对于与生长、发育和疾病与损伤康复相关的各种生理和心理过程都很重要。住院往往以临床护理活动为优先，而牺牲了适合年龄的睡眠。护士和更广泛的医疗团队对此负有责任。然而，通过有意识的实践和与母亲合作，护士能够采取行动并促进睡眠。
采用、改编或调整现有的指南，制定以证据为基础的实践指南，以促进护士和母亲合作创造有利于睡眠的病房环境和常规。
按照南非指南卓越项目建议的六个步骤的指南改编方法：（1）确定现有的指南和协议；（2）使用 AGREE II 工具进行评估；（3）开发证据基础；（4）修改建议；（5）分配证据水平和推荐等级；（6）制定最终用户指南。整个过程都征求了专家意见。
现有的相关指南包括 61 项以成人为主的建议。对证据基础的修改导致了六项综合建议，以促进住院儿童的睡眠：（1）优先考虑患者安全；（2）与母亲或照顾者合作促进睡眠；（3）协调病房常规和环境以改善睡眠；（4）与临床和非临床工作人员合作；（5）进行基本睡眠评估。实践建议与南非护理监管框架保持一致。
住院对儿童来说是一个生理和心理失调的时期，而在医院中睡眠质量差则会加剧这种失调。护士有机会通过与母亲合作实施这个以非洲为中心的指南，在住院期间促进睡眠。
