The involvement of nursing professionals for the treatment of insomnia is essential, both in individual and group approaches in primary care.
The assessment of Behaviour Patterns can be used to structure the clinical interview (see Table 15) to detect sleep-related problems. This assessment can be completed with the questionnaires mentioned previously in the guide.
Table 15. Assessment of Behavioural Patterns
|• Perception / Control of health:
This assessment may help in detecting changes that may lead to a diagnosis of insomnia or troubled sleep patterns that require action by nursing staff. If it is insomnia, it must be addressed in the best way possible to stop it from becoming a chronic problem.
As specified in Chapter 5, the NANDA classification (International Nursing Diagnoses and Classifications) includes the diagnosis of insomnia in its classification, with its defining characteristics and related factors (see Table 6)63.
The Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC) in relation to insomnia are presented below.
Table 16. Classifications NIC and NOC
000403. Sleep pattern
000404. Sleep quality
000405. Sleep efficiency
000407. Sleep habit
000417. dependence on assistance for sleeping (Scale: 1
Severe, 2 Substantial, 3 Moderate, 4 Slight, 5 none)
1. Severely compromised
2. Substantially compromised
3. Moderately compromised
4. Slightly compromised
5. Not compromised
|1850. Improving sleep
Include the regular sleep/wake cycle of the patient in care planning. determine the effects of medication in the patient’s sleep pattern. Observe/record the pattern and number of hours of sleep the patient has.
|Check the patient’s sleep pattern and observe the physical circumstances (sleep apnea,
airway obstruction, pain/discomfort and urinary frequency) and/or psychological ones (fear/
anxiety) that disrupt sleep.
Show the patient how to control the sleep patterns.
Control participation in activities that cause fatigue during waking hours to avoid excessive fatigue.
Adjust the environment (light, noise, temperature, mattress and bedding) to promote sleep.
Encourage the patient to establish a routine when going to bed to ease the transition from wakefulness to sleep.
Help to eliminate stressful situations before going to bed.
Help the patient to refuse food or drinks that interfere with sleep just before going bed.
|Help the patient to limit sleep during the day by providing an activity to promote wakefulness,
Show the patient how to perform autogenic muscle relaxation or another non-pharmacologic sleep induction exercise.
Group activities to minimise the number of awakenings. allow sleep cycles of at least 90 minutes. Adjust the medication programme to help the patient’s sleep/wake cycle.
Explain those factors that contribute to disturbing the sleep pattern to the patient and loved ones (physiological, psychological, lifestyle, frequent changes of shift, rapid time zone changes, excessively long working hours and other environmental factors).
Discuss techniques to promote sleep with the patient and family. Provide written information, pamphlets etc, on sleep promotion techniques.
The use of nursing diagnoses, along with the classification of results (NOC) and nursing
interventions (NIC) allow the following:
Latest update: May 2010