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МЕЖДУНАРОДНЫЕ ОРГАНИЗАЦИИООНмеждународная помощьВеликая Отечественная войнаСОЦИАЛЬНОЕ ОБЕСПЕЧЕНИЕВЕТЕРАНЫИНВАЛИДЫистория БеларусиИСТОРИЯ 20 ВЕК

Sleep quality and mood in mothers and fathers accommodated in the family-centred paediatric ward

Aims and objectives To describe sleep quality and mood in parents accommodated with their sick child in a family‐centred paediatric ward. Secondary aims were to compare mothers’ and fathers’ sleep quality and mood in the paediatric ward and to compare the parents’ sleep quality and mood between the paediatric ward and in a daily‐life home setting after discharge. Background Frequent interruptions, ward noise and anxiety affect parents’ sleep quality and mood negatively when accommodated with their sick child in paediatric wards. Poor sleep quality and negative mood decrease the parents’ ability to sustain attention and focus, and to care for their sick child. Methods This was a prospective and descriptive study. Eighty‐two parents (61 mothers and 21 fathers) with children (median age 6.25 years) admitted to six paediatric wards participated in the study. Uppsala Sleep Inventory, a sleep diary and the Mood Adjective Checklist were used to measure sleep quality and mood. Results The parents had a good sleep quality in the paediatric ward even though they had more nocturnal awakenings compared to home. Moreover, they were less alert, less interested and had reduced concentration, and were more tired, dull and passive in the hospital than at home after discharge. Vital sign checks, noises made by the staff and medical treatment were given reasons influencing sleep. Poor sleep quality correlated with negative mood. Conclusion Parents’ sleep quality in family‐centred paediatric care is good. However, the habitual sleep efficacy before admittance to the hospital is lower than expected and needs to be further investigated. Relevance to Clinical Practice The healthcare professionals should acknowledge parents’ sleep and mood when they are accommodated with their sick child. Further should care at night be scheduled and sleep promoted for the parents to maintain health and well‐being in the family.Funding agencies: Medical Research Council of Southeast Sweden [FORSS-159681]; Region of Ostergotland, Sweden</p

The cortisol response in parents staying with a sick child at hospital

Aim To study the cortisol response in parents staying with their child in paediatric wards, to compare the parents’ cortisol levels between the paediatric ward and at home 4 weeks after discharge and to compare the parents’ cortisol levels with data of an adult reference population, reported by Wust et al., as there are few studies investigating parental cortisol. Design This study has a descriptive and prospective comparative design. Method Thirty‐one parents participated. Saliva samples were collected in the paediatric ward and 4 weeks later at home. Results The parents had lower morning awakening cortisol levels in the paediatric ward than at home after discharge. There were no statistically significant differences in postawakening cortisol or cortisol awakening response (CAR). The child's age, diagnosis or previously diagnosed chronic condition did not affect the parents’ cortisol levels. The morning and postawakening cortisol levels were lower than those of the reference population. Conclusion The hospital stay with a sick child affects parents’ cortisol levels. Parental stress needs more attention to find interventions to prevent the risk of stress‐related complications that subsequently can affect the care of the child.What about the parents?: Sleep quality, mood, saliva cortisol response and sense of coherence in parents with a child admitted to pediatric car

Prevalence of sleep disturbances and long-term reduced health-related quality of life after critical care : a prospective multicenter cohort study

INTRODUCTION: The aim of the present prospective multicenter cohort study was to examine the prevalence of sleep disturbance and its relation to the patient's reported health-related quality of life after intensive care. We also assessed the possible underlying causes of sleep disturbance, including factors related to the critical illness. METHODS: Between August 2000 and November 2003 we included 1,625 consecutive patients older than 17 years of age admitted for more than 24 hours to combined medical and surgical intensive care units (ICUs) at three hospitals in Sweden. Conventional intensive care variables were prospectively recorded in the unit database. Six months and 12 months after discharge from hospital, sleep disturbances and the health-related quality of life were evaluated using the Basic Nordic Sleep Questionnaire and the Medical Outcomes Study 36-item Short-form Health Survey, respectively. As a nonvalidated single-item assessment, the quality of sleep prior to the ICU period was measured. As a reference group, a random sample (n = 10,000) of the main intake area of the hospitals was used. RESULTS: The prevalence of self-reported quality of sleep did not change from the pre-ICU period to the post-ICU period. Intensive care patients reported significantly more sleep disturbances than the reference group (P &lt; 0.01). At both 6 and 12 months, the main factor that affected sleep in the former hospitalised patients with an ICU stay was concurrent disease. No effects were related to the ICU period, such as the Acute Physiology and Chronic Health Evaluation score, the length of stay or the treatment diagnosis. There were minor correlations between the rate and extent of sleep disturbance and the health-related quality of life. CONCLUSION: There is little change in the long-term quality of sleep patterns among hospitalised patients with an ICU stay. This applies both to the comparison before and after critical care as well as between 6 and 12 months after the ICU stay. Furthermore, sleep disturbances for this group are common. Concurrent disease was found to be most important as an underlying cause, which emphasises that it is essential to include assessment of concurrent disease in sleep-related research in this group of patients.Original Publication: Lotti Orvelius, Anders Nordlund, Peter Nordlund, Ulla Edéll-Gustafsson and Folke Sjöberg, Prevalence of sleep disturbances and long-term reduced health-related quality of life after critical care: a prospective multicenter cohort study, 2008, Critical care (London, England), (12), 4, R97. http://dx.doi.org/10.1186/cc6973 Licencee: BioMed Central http://www.biomedcentral.com/</p

Nurses conceptions of facilitative strategies of weaning patients from mechanical ventilation-A phenomenographic study

Background: Mechanical ventilator withdrawal can amount up to 40% of total ventilator time. Being on a mechanical ventilator is associated with risk of anxiety, post-traumatic stress syndrome, nosocomial pneumonia and premature mortality. Purpose: The purpose of the present study was to describe different conceptions of nurses facilitating decision-making strategies regarding weaning patients from mechanical ventilations cared for in intensive care unit (ICU). Method: Semi-structured interviews were analysed within the phenomenographic framework. Twenty ICU nurses were interviewed. Findings: The findings revealed three main categories of nurses facilitating decision-making strategies: "The intuitive and interpretative strategy" featured nurses pre-understandings. "The instrumental strategy" involved analysis and assessment of technological and physiological parameters. "The cooperative strategy" was characterised by interpersonal relationships in the work situation. Absence of a common strategy and lack of understanding of others strategies were a source of frustration. The main goals were to end mechanical ventilator support, create a sense of security, and avoid further complications. Conclusion: Although these findings need to be confirmed by further studies we suggest that nurses variable use of individual strategies more likely complicate an efficient and safe weaning process of the patients from mechanical ventilation.Original Publication:Jeanette Eckerblad, Helene Eriksson, Anita Kärner and Ulla Edéll-Gustafsson, Nurses conceptions of facilitative strategies of weaning patients from mechanical ventilation-A phenomenographic study, 2009, Intensive and Critical Care Nursing, (25), 5, 225-232.http://dx.doi.org/10.1016/j.iccn.2009.06.008Copyright: Elsevier Science B.V., Amsterdamhttp://www.elsevier.com

Evaluation of an individualised programme to promote self-care in sleep-activity in patients with coronary artery disease - a randomised intervention study

Aims and objectives. To evaluate the effectiveness of an individualised programme to promote self-care in sleep-activity in patients with coronary artery disease. Background. Recent scientific findings have shown that low physical exercise and stress interfere with coronary artery disease patients sleep quality and sleep efficiency independent of gender, age and co-morbidity. Design. A randomised pretest-post-test control design. Methods. Forty-seven patients who had undergone a coronary revascularisation procedure and/or pharmacological treatment three to seven weeks earlier at a general hospital were randomised to either an intervention group or a control group. Data collection was carried out by questionnaires, a study-specific sleep diary and actigraphy registration for 10 consecutive 24-hour periods, with a follow-up after three to four months. The intervention group underwent a nurse-led individualised education programme to promote self-care of sleep-activity. Sleep habits and sleep-related lifestyle together formed the basis for setting up individual goals together with the nurse. Individual advice on physical training, relaxation exercise and a CD-based relaxation programme was provided by a physiotherapist. Both groups received a brochure about sleep and stress. Results. At a three-to four-month follow-up, the main improvements were seen in the intervention group regarding sleep quality, sleep duration and sleep efficiency in the sleep diary and sleep efficiency in actigraphy. Statistical improvements in health-related quality of life were revealed. This was not so obvious in the control group. Conclusions. An individualised intervention programme to promote self-care of sleep-activity including relaxation in patients with coronary artery disease led by a nurse may improve sleep quality. However, a longitudinal study to promote self-care in sleep-activity should be performed using a larger sample and multiple sites with continuous follow-ups to determine whether any positive effects remain stable over time. Relevance to clinical practice. Implementation of a multiprofessional individualised programme to promote self-care of sleep-activity including relaxation based on patients needs, supported by a healthcare team and led by nurses, is important in clinical practice.Funding Agencies|Skaraborg Hospital, Sweden [VGSKAS-9122]; Skaraborg Institute, Sweden [07/1036]</p

Evaluation of an individual sleep intervention programme in people undergoing peritoneal dialysis treatment

Objective: This study aimed at evaluate effects of a individually designed nonpharmacological intervention on sleep, activity and fatigue in peritoneal dialysis (PD) by use of both actigraphy registration and self-assessed questionnaires. Design: A prospective multiple baseline single-case experimental design. Methods: Two women and seven men with sleep problems, 48-77 years, treated with PD participated in a 17-week study. Two interventions were separately implemented. First, a pressure relieving mattress and second, a four week individual sleep hygiene and sleep scheduling intervention. The two interventions were evaluated both objectively by actigraphy and subjectively by questionnaires. Results: Totally 315 sleep-wake cycles from nine individuals were evaluated. Of the nine measured outcome variables i.e. sleep onset latency, nocturnal sleep duration, numbers and duration of napping, movement and fragmentation index (MFI), number of steps, metabolic equivalent unit (METs), sleep efficiency and fatigue, three patients improved clinically significantly in five or more of the outcomes. The other six patients also showed improvements but to a lesser degree. Physical activity advice was the intervention that yielded most sleep improvements. Conclusions: This study shows that patients on peritoneal dialysis treatment have a wide variety of sleep problems and that an individual sleep hygiene and sleep scheduling program can be applied with clinically significant improvements even in this heterogeneous and frail patient group. The intervention should be easy to use in daily clinical routines

Hindering and buffering factors for parental sleep in neonatal care. A phenomenographic study

AIMS AND OBJECTIVES: To explore and describe how parents of preterm and/or sick infants in neonatal care perceive their sleep. BACKGROUND: Parents experience many stressful situations when their newborn infant is preterm and/or sick. This affects bonding. By developing more family-centred care units with single-family rooms, parents are given the opportunity to stay and care for their newborn infant(s) 24 hours a day. Lack of sleep may affect new parents' ability to cope with the many challenges they face on a daily basis. DESIGN: A phenomenographic study with an inductive and exploratory design. METHODS: Semi-structured interviews were conducted with twelve parents of infants in neonatal care between January-March 2012. To describe variations in perception of the phenomenon, data were analysed using phenomenography. FINDINGS: Four descriptive categories were identified within the phenomenon sleep in parents of preterm and/or sick infants in neonatal care: impact of stress on sleep; how the environment affects sleep; keeping the family together improves sleep; and, how parents manage and prevent tiredness. CONCLUSION: Anxiety, uncertainty and powerlessness have a negative influence on sleep. This can be decreased by continuous information, guidance and practical support. Skin-to-skin care was perceived as a stress-reducing factor that improved relaxation and sleep and should be encouraged by the nurse. The parents also mentioned the importance of being together. Having a private place where they could relax and take care of themselves and their newborn infant improved sleep. It was also desirable to involve older siblings in order to decrease feelings of loneliness, sadness and isolation. RELEVANCE FOR CLINICAL PRACTICE: Improved parental sleep in neonatal care may help the families cope with the situation and facilitate problem-solving, emotional regulation and the transition to parenthood