老年睡眠障礙患者接受溫水足浴改善睡眠之實證照護

Evidence-Based Application of the Warm Foot Bath to Improve Older Patient’s Sleep Quality

失眠的盛行率隨著年齡增加而遞增，已是老年人 常見的健康問題。本案例是一位老年睡眠障礙患 者，重複且未規則服藥，導致嚴重藥物副作用 而入院。筆者以精神科專科護理師角度，評估個 案對藥物已產生高度預期性焦慮，抗拒服藥， 遂思索各種非藥物療法。運用實證方法探討足浴 是否可以改善睡眠。利用Pubmed、EMBASE、 Cochrane library、CEPS及Google學術搜尋等資 料庫，使用關鍵字“warm footbath＂、“ elderly＂及 “insomnia＂之MeSH term及同義字，搜尋2018 年7月7日以前的中英文文獻。篩選後共有4篇 老人睡眠障礙與足浴相關性研究納入分析，並 以CASP、Critical review form查核文獻以比較研 究之完整性與品質。結果發現睡前以41－42℃ 的水溫，深10公分溫水足浴20分鐘可改善老年 人的睡眠品質，有效緩解睡眠遲滯，維持白天 功能。本實證結果的應用確實可改善此個案的睡 眠總時數與效率，且足浴實行方便，不具侵入 性，作為另類輔助療法個案接受度高且滿意。期 望藉此照護經驗，激發醫護人員依據病患的真實 需求，善用實證技巧找出最佳照護模式。

 

The prevalence of insomnia increases with age, and insomnia is a common health problem in old adults. This case is on an elder patient with sleep disorder who was hospitalized for double-dose medication intake, which led to severe medication side effects. From a psychiatric nurse practitioner’s professional perspective, this patient had developed an anticipatory anxiety regarding the medication and thus exhibited poor compliance. To solve this clinical problem, the author considered various non-medication treatments and used evidence-based approach to determine whether footbaths improved sleep quality. The keywords “warm footbath,” “elderly,” and “insomnia” as well as the MeSH terms and synonyms of these keywords were searched for in Chinese and English language studies published before July 7, 2018, in databases including PubMed, Embase, the Cochrane library, CEPS, and Google Scholar. After filtering the search results, we identified four studies discussing the relationship between sleep quality in the elderly and footbaths for subsequent analysis; the completeness and quality of these studies were then investigated using the CASP and Critical Review Form. The results revealed that a 20-minute footbath with water temperature of 41–42 ℃ and depth of 10 cm improved the sleep quality of the patient. It decreased the patient’s sleep latency and maintained their daytime activities. These empirical results demonstrated that a footbath improved the patient’s sleep time and sleep efficiency; moreover, the easy and noninvasive implementation of the footbath served as an assistive treatment that was highly acceptable and satisfactory to the patient. According to this care experience, medical professionals are encouraged to employ empirical skills to identify the health care model that conforms to the actual needs of individual patients.