運用「靜默時刻」以提升加護病房患者睡眠品質

Implementing “Quiet Time＂ to Improve Patient Sleep in the ICU

睡眠是人類生命需求之一，具有恢復能量及維持人體正常功能。據統計超過60％加護病房病患曾有睡眠剝奪情形。導致睡眠剝削的因素，包含：呼吸器、藥物使用及夜間接受頻繁之護理措施等，然而一旦產生睡眠剝削的情形，容易導致病人產生焦慮、混淆或記認知功能，甚至可能造成譫妄等併發症甚至增加死亡率。經統計本單位2017年12月至2018年02月使用維辛式睡眠品質量表測量單位病人主觀睡眠品質總平均分僅為92.65分，透過現況分析發現：夜間音量太大、夜間照明亮度高於標準值與非必要性的夜間護理活動為病人夜間睡眠中斷主要的原因。因此，本專案小組訂定的解決策略包括：制定降低夜間噪音方案、調整夜間光線照度、採取集中式照護以降低非必要性夜間護理活動、訂立「靜默時刻」提供患者完整的安靜睡眠環境及定期稽核。在專案推行後，再次運用維辛式睡眠品質量表評量，得分由專案實施前92.65分提昇至實施後515分，初步達成此專案之目的。希望藉此專案做為臨床護理人員發展照護重症病患睡眠護理方式之參考，進而提昇重症病人的睡眠品質。

Sleep is the requirement of human life to be with restored energy and maintain the body's normal function. Studies have shown that over 60% of ICU patients with sleep deprivation situation. Sleep deprivation caused by patient-ventilator, medications, patient care interactions, environmental noise and light. Sleep deprivation may cause patients' anxiety, confusion, memory cognition and delirium also associated with increased mortality. The project was conducted from Dec 2017 to Feb 2018. Use the Verran and Snyder-Halpern Sleep Scale was used to measure the patients' sleep quality. At the beginning of the project, the mean sleep quality score was 92.65. The main reason is high volume of noise, constant lighting, and non-essential nursing care. We decided to promote the “Quiet Time＂ as our strategy to improve patients' sleep. The countermeasure includes establishing to reduce noise, management light, and centralized nursing care at night. After implementation of improvements in the environmental conditions of the ICU, the patients' sleep quality was reassessed, and the mean score raised from 92.65 to 515. The result of the project could serve as a reference to be used as a foundation for nursing care of critically ill patients and promoting patients' sleep quality in ICU.