重症病人睡眠品質改善專案

Improving Patient Sleep Quality in the Intensive-Care Unit

加護病房為24小時開燈的單位，除非病人或家屬要求，才於夜班時段選擇性將燈光調整，因此，除光線的刺激外，人員的講話聲加上機器警報聲響，都是造成環境吵雜的原因，導致入住的病人無法好好休息，獲得充足的睡眠。單位人員希望透過專案的執行，找出影響病人睡眠品質相關因素進行改善，使護理人員提供更適當的護理措施，促進病人疾病恢復。本單位於2007年7月15日至2007年7月30日，針對入住加護病房大於48小時、意識清醒可表達的病人，以「維辛式睡眠量表」調查入住加護病房病人睡眠品質情形，經問卷調查結果得知，入住加護病房病人睡眠品質總平均為46.65分。經由單位人員針對病人睡眠中斷原因進行查檢，分析發現在加護病房中，睡眠評估不受重視、病人不知晝夜、身上有管路壓到、被約束不舒服、手術後傷口疼痛、工作人員交談音量未注意、警告聲響音量無一致性且聲音過大沒有立即解除、工作車噪音等皆為造成病人睡眠不足的主要因，因此針對以上要因擬定改善方案。專案實施後，再次以「維辛式睡眠量表」評估，單位病人睡眠品質由46.65分提昇至76.87分，在專案的實施過程，讓我們深刻體會在重症單位裡，因病人疾病嚴重度高，醫護人員護理焦點大多著重在醫療與疾病的病程進展，基本的生活作息與睡眠習慣，反而越容易讓人忽略。經過積極發現問題並致力改善後，使人員在護理照護過程中，不但重視且滿足病人的基本生理需求。

Various environmental features of the hospital intensive-care unit (ICU) can negatively affect patients’ sleep quality. The unit is typically lit 24 hours a day, with the lighting dimmed only during the late-night shift. Moreover, ambient noise, mainly from staff conversation and mechanically regulated alarms, is relatively constant. This study was undertaken to assess the sleep quality of patients in our hospital’s ICU and determine ways to improve it. The study was conducted from July 15 to July 30, 2007, and involved selected patients who were confined to the ICU for more than 48 hours and were conscious and able to communicate with us. In addition to patient questionnaires, the Verran and Snyder-Halpern Sleep Scale was used to measure the patients’ sleep quality. At the beginning of the study, the mean sleep quality score was 46.65. Analysis of the data revealed that sleep was not assigned much importance in the ICU. Patients did not experience the passage of time because of the constant lighting. They felt significant discomfort from the pressure of invasive tubes and other devices, restraint of their extremities, and postoperative wound pain. The nursing staff generated a high volume of noise, and warning bells and alarms were excessively loud and not turned off quickly. All of these factors disturbed patients’ sleep. After implementation of improvements in the environmental conditions of the ICU, the patients’ sleep quality was reassessed, and the mean score was 76.87. In the ICU unit, where patients are severely ill, staff attention tends to focus on medical treatment and disease status. This can easily lead to disregard of patient comfort and sleep quality. Significant improvement can be achieved through education of medical personnel and emphasis on the importance of meeting patients’ basic physiological needs. The results may include improved nursing care and faster patient recovery.