提升護理之家住民睡眠品質之改善專案

A Quality Improvement Project to Enhance Sleep Quality Among Nursing Home Residents

背景：護理之家住民普遍存在睡眠品質不佳問題，相關研究顯示高比例住民有睡眠困擾，此易加速身體機能退化、增加跌倒風險，並影響安全與生活品質。本院現況調查發現，住民睡眠困擾比率高達77.5%，整體睡眠滿意度僅3.8分，主要導因：缺乏標準化睡眠評估流程、夜間照護活動干擾，以及環境噪音與燈光不當等因素。
目的：本專案旨在降低住民睡眠困擾並提升夜間睡眠滿意度。
解決方案：專案小組「制訂睡眠品質評估流程」，導入多面向「金好眠組合式照護」，由照護作息、噪音管理與燈光調整著手，並推動「日光輕履活動」，結合光照療法與日間輕度活動，調整燈具位置及夜間照度規範。
結果：介入後，住民睡眠困擾比率由77.5%降至52.5%，整體睡眠滿意度由3.8分提升至4.5分，達成專案設定目標。
結論：本專案透過標準化評估與多元非藥物介入措施，有效改善住民睡眠品質，提升其照護體驗與生活品質，具實務應用與推廣價值。

Background & Problems: Poor sleep quality, highly prevalent among nursing home residents, is associated with accelerated functional decline, increased risk of falls, and compromised safety and quality of life. A baseline audit at our facility revealed that 77.5% of the residents experienced sleep disturbances, with a mean overall sleep satisfaction score of 3.8 (out of 5). Factors found to influence sleep disturbance among the residents included the absence of a standardized sleep-assessment protocol, interruptions in nighttime care routines, and environmental conditions such as noise and inappropriate lighting.
Purpose: A project was developed and implemented to reduce the prevalence of sleep disturbance among the residents and improve their nighttime sleep satisfaction.
Resolutions: A standardized sleep-quality assessment pathway was developed and a multicomponent Good-Sleep Care Bundle was implemented targeting care routines, noise control, and lighting optimization. We concurrently launched a Daylight & Light-Activity program that combined scheduled bright-light therapy with low-intensity daytime activity, lighting fixture repositioning, and the mandating of nighttime illumination thresholds.
Results: After implementation, the proportion of residents with poor sleep decreased from 77.5% to 52.5%, and the average nighttime sleep-satisfaction score improved from 3.8 to 4.5, meeting the predefined targets of this project.
Conclusions: The developed program, a standardized assessment pathway coupled with a multicomponent, non-pharmacological care bundle, effectively improved sleep quality and nighttime satisfaction in the residents, enhancing their care experience and quality of life. The program is feasible, low risk, and scalable for routine implementation in nursing homes.