Sleeping on a problem: the impact of sleep disturbance on intensive care patients - a clinical review

Sleep disturbance is commonly encountered amongst intensive care patients and has significant psychophysiological effects, which protract recovery and increases mortality. Bio-physiological monitoring of intensive care patients reveal alterations in sleep architecture, with reduced sleep quality and continuity. The etiological causes of sleep disturbance are considered to be multifactorial, although environmental stressors namely, noise, light and clinical care interactions have been frequently cited in both subjective and objective studies. As a result, interventions are targeted towards modifiable factors to ameliorate their impact. This paper reviews normal sleep physiology and the impact that sleep disturbance has on patient psychophysiological recovery, and the contribution that the clinical environment has on intensive care patients' sleep

Investigating the application of motion accelerometers as a sleep monitoring technique and the clinical burden of the intensive care environment on sleep quality: study protocol for a prospective observational study in Australia

Introduction: Sleep is a state of quiescence that facilitates the significant restorative processes that enhance individuals’ physiological and psychological well-being. Patients admitted to the intensive care unit (ICU) experience substantial sleep disturbance. Despite the biological importance of sleep, sleep monitoring does not form part of standard clinical care for critically ill patients. There exists an unmet need to assess the feasibility and accuracy of a range of sleep assessment techniques that have the potential to allow widespread implementation of sleep monitoring in the ICU. Key measures: The coprimary outcome measures of this study are to: determine the accuracy and feasibility of motion accelerometer monitoring (ie, actigraphy) and subjective assessments of sleep (nursing-based observations and patient self-reports) to the gold standard of sleep monitoring (ie, polysomnography) in evaluating sleep continuity and disturbance. The secondary outcome measures of the study will include: (1) the association between sleep disturbance and environmental factors (eg, noise, light and clinical interactions) and (2) to describe the sleep architecture of intensive care patients. Methods and analysis: A prospective, single centre observational design with a within subjects’ assessment of sleep monitoring techniques. The sample will comprise 80 adults (aged 18 years or more) inclusive of ventilated and non-ventilated patients, admitted to a tertiary ICU with a Richmond Agitation-Sedation Scale score between +2 (agitated) and −3 (moderate sedation) and an anticipated length of stay >24 hours. Patients’ sleep quality, total sleep time and sleep fragmentations will be continuously monitored for 24 hours using polysomnography and actigraphy. Behavioural assessments (nursing observations) and patients’ self-reports of sleep quality will be assessed during the 24-hour period using the Richards-Campbell Sleep Questionnaire, subjective sleepiness evaluated via the Karolinska Sleepiness Scale, along with a prehospital discharge survey regarding patients’ perception of sleep quality and disturbing factors using the Little Sleep Questionnaire will be undertaken. Associations between sleep disturbance, noise and light levels, and the frequency of clinical interactions will also be investigated. Sound and luminance levels will be recorded at 1 s epochs via Extech SDL600 and SDL400 monitoring devices. Clinical interactions will be logged via the electronic patient record system Metavision which documents patient monitoring and clinical care. Ethics and dissemination: The relevant institutions have approved the study protocol and consent procedures. The findings of the study will contribute to the understanding of sleep disturbance, and the ability to implement sleep monitoring methods within ICUs. Understanding the contribution of a clinical environment on sleep disturbance may provide insight into the need to address clinical environmental issues that may positively influence patient outcomes, and could dispel notions that the environment is a primary factor in sleep disturbance. The research findings will be disseminated via presentations at national and international conferences, proceedings and published articles in peer-reviewed journals.This work is supported by the Canberra Hospital Foundation (ACT, Australia), VMedical Australia Pty Ltd and the Intensive Care Foundation Research Grant

A Study on Copyright Protection of Mobile Applications in Small and Micro Computer Enterprises

As more and more small and micro software developers begin to participate in the development process and gradually become the intermediate force of Internet innovation, people are enjoying their life in scientific and technological progress. As a special kind of software, mobile application has the characteristics of lightweight and simple development, which enhances the difficulty of protecting rights and interests of its copyright owners, especially the small and micro software copyright owners. This paper will explore the particularity of its right protection and its solution, and dig out ways to further motivate social innovation

Learning for professional practice 6

The contents of this book are compiled from the following books: -- Pharmacology for health professionals, fourth edition, by Bronwen Bryant and Kathleen Knights -- Lewis's Medical-surgical nursing, fourth edition, by Di Brown et al. -- Lehne's Pharmacology for nursing care, ninth edition, by Jacqueline Rosenjack Burchum et al. -- ACCCM's Critical care nursing, third edition, by Leanne Aitken et al. -- Priorities in ciritical care nursing, seventh edition, by Linda D. Urden et al. -- Drugs for the heart, fourth edition, by Lionel H. Opie and Bernard J. Gersh. Custom edition for the University of Canberr

Unfolding case studies in pre-registration nursing education: lessons learned

Nursing education is undergoing radical change worldwide. There is criticism surrounding the content of education and the delivery. As a result, traditional methods of teaching and learning have been replaced by strategies that place greater emphasis on active learner interaction, critical thinking, and decision-making. Assisting pre-registration nurses to become competent and confident in clinical practice requires immersion in practice with sufficient support and coaching based on real life scenarios. Simulation via an unfolding case study approach is one way to provide interactive learning experiences where students acquire new skills that advance their clinical judgment with the aim of becoming safe, competent practitioners. Lessons learned from implementing an unfolding case study are discussed in this paper

Patients' quality of sleep at Canberra Hospital

Background: Hospitals are intrinsically noisy environments where noise emanates from a multitude of sources. As a result hospital patients often report poor quality sleep, which can have significant psycho-physiological consequences, protracts recovery and increases mortality. ..

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jackatar ntimber consists mostly of white birch. It would prove a magnificent site for a small settlement were it only more accessible or nearer the seashore, but unfortunately it is too far in and I fear too hard to get at to be utilized for a long time to come. However, I believe it is quite possible to make a good road into it. We found a birch rind side camp here quite [reverse] recently occupied by three men whose footing we saw in the sand. They had killed a deer and a lot of geese. The were evidently some of the jackatars from Bank Head or Flat Bay who knew I was coming in here and determ ined to get before me. The either killed or drove off all the game. Yet we saw two deer, but did not fire at them. Fixed up the old camp for the night and found plenty of the big mosquitoes here awaiting us but the night proved a cold one so high up in the mountains and without our blankets we soon got rid of the mosquitoes.MAR 1 1990 W.J.KIRWINUsed I and SupUsed I and Sup1Not usedjackie tar, jackitar, jack-o-tar, jackotaw, jacky tar, jack-tar, jackyChecked by Sarah Budgell on Thu 09 Apr 2015; Checked by Cathy Wiseman on Mon 13 Jul 2015; reverse side of J_1347

Factors influencing nursing students’ ability to recognise and respond to simulated patient deterioration : A scoping review

Aim: The aim of this scoping review was to identify empirical literature on simulation used to develop undergraduate nursing student's clinical assessment skills to recognise and respond to patient deterioration. Background: Early recognition and response to clinical deterioration is necessary to ensure the best outcome for the patient. Undergraduate nursing students have limited exposure to deteriorating patient situations, therefore simulation is widely implemented in nursing courses to address this educational need. It is imperative to identify the simulation modalities and features that best optimise student learning. Design: Scoping review using the Joanna Briggs Institute scoping reviews methodology and the Arksey and O'Malley framework. Review methods: Seven health databases were searched electronically for relevant literature and complemented with hand searching for additional relevant sources. A total of 344 potential articles were identified from the seven databases: Cumulative Index to Nursing and Allied Health Literature (n = 234); PubMed (n = 16); Medline (n = 51); Scopus (n = 21); Embase (n = 3); American Psychological Association PsychInfo (n = 13); and JBI (n = 6). After applying inclusion and exclusion criteria, 15 research articles were included in the review. Results: Most research on clinical deterioration simulation was quantitative (n = 12), two were qualitative and one used a mixed method approach. Findings included a lack of situational awareness, distractors causing incomplete patient assessment and failure to recognise deterioration. Repeated simulation showed positive results. Conclusions: Findings of this review suggest students lack situational awareness, perform incomplete assessment and fixate on single cues rather than an entire clinical picture. The use of a variety of simulation modalities was effective in improving student performance. Repeated practice within a single simulated learning experience, was shown to improve performance and situational awareness. This approach to simulation is under-researched in nursing and needs further exploration.</p

What hath night to do with sleep; noise levels in ICU - Preliminary findings (Conference Abstract)

Noise is frequently attributed to sleep disturbance, particularly in the Intensive Care Unit (ICU) where noise emanates from a plethora of sources. As a result, ICU patients’ experience fragmented sleep, which deleteriously effects their physiological recovery, neurocognitive function, and increases morbidity and mortality..