Sleep Deprivation and the Clinical Nurse



Sleep Deprivation and the Clinical Nurse

Nicholas Kurek

Ferris State University

Abstract

Sleep is an essential part of our lives. A basic understanding of sleep including the different stages of sleep is provided. The importance of getting adequate sleep is explained. Sleep deprivation is defined. Some of the potential results of sleep deprivation as well as the impact of shift work and a few strategies to help cope with it are explored. The conclusion demonstrates the efficacy of the health promotion class.

Sleep Deprivation and the Clinical Nurse

What is sleep? Why do we need sleep? These are commonly asked questions. In order to explore sleep deprivation and the clinical nurse, we must first establish a basic working understanding of what sleep is and why we need it.

As defined by the American Heritage Dictionary, sleep is “a natural, periodically recurring physiological state of rest, characterized by relative physical and nervous inactivity, unconsciousness, and lessened responsiveness to external stimuli” (Houghton Mifflin, 1982, p. 1150). Over the years, researchers have observed people sleep while attached to an electroencephalogram (EEG), electrooculogram (EOG), and an electromyogram (EMG). This has helped them identify both the stages and types of sleep. There are two types of sleep: non- rapid eye movement (NREM) and rapid eye movement (REM). The complete sleep cycle consists of a progression through the 4 stages of NREM into REM. (Palladino & Bloom, 2007,n.p.).

Each of us marches to our own little drummer (circadian rhythm) which helps ensure proper balance (homeostasis) between awake and sleep. While there are several theories that address the question of why we need sleep, none have satisfactorily and comprehensively answered the question. It is commonly thought that during sleep are bodies restore themselves.

When we do not get enough sleep (sleep deprivation) our body simply does not get the opportunity to restore itself. It is commonly accepted that sleep deprivation can result in irritability, a weakened immune system, as well as cognitive impairment including memory lapses, memory loss, and poor moral judgment and decision making. We need sleep and do not function well with prolonged inadequate sleep (Ohlmann & O’Sullivan, 2009, n.p.). It is important that clinical nurses strive to ensure adequate sleep for both their patients’ and themselves. It seems the proverbial bottom-line is summed up nicely by Weinger & Ancoli-Israel (2002) who state that “sleep deprivation can affect clinical performance and may be an important factor in patient safety” (n.p.).

Clinical nurses work a variety of shifts. Spaggiari (2008) noted that “shift-work has been associated with breast cancer, due to a circadian disruption and to a nocturnal suppression in melatonin production” (n.p.). Su et al. (2008) concluded that “12 – hour night shift work may elevate blood pressure and heart rate and decrease heart rate variability. It is also associated with delayed BP recovery” (n.p.). In a study looking specifically at shift work in nursing, Admi, Tzischinsky, Epstein, Herer, & Lavie (2008) concluded:

The first finding is that female shift workers complain significantly more about sleep disorders than male shift workers. Second, although high rates of nurses whose sleep was not adapted to work were found, this did not have a more advance impact on their health, absenteeism rates, or performance (reported and incidents), compared to their “daytime” colleagues (n.p.).

In a controlled study monitoring surgeons performance on simulators after a night of call, Lehmann et al. (2010) concluded that “although there is no doubt that sleep deprivation ultimately impairs human functioning, typical surgical skills do not necessarily deteriorate with a limited amount of sleep loss under clinical conditions” (n.p.).

The reality of life is that we often do not maintain adequate levels of sleep for one reason or another. What can the clinical nurse do? Coffee is the old standard. Goldstein et al. (2010) found “caffeine can enhance vigilance during bouts of extended exhaustive exercise, as well as periods of sustained sleep deprivation” (n.p.). Tunnicliffe, Erdman, Reimer, Lun, & Shearer (2008) point out that there are some undesired effects of caffeine consumption including sleep disturbance (n.p.). Westcott (2005) found that “although many pharmacologic agents have been studied in an attempt to find a safe medication to enhance alertness and cognitive function, no safe non-addictive options have been identified” (n.p.). Berger & Hobbs (2006) suggested that “nurses can adopt counter measures such as power napping, eliminating overtime on 12-hour shifts, and completing challenging tasks before 4 am to reduce patient care errors” (n.p.).

We can surmise that sleep hygiene is important and the shift worked does not matter as much as maintaining adequate levels of sleep. Most nurses are care-givers by nature and have a tendency to care for others and not themselves. Nurses need to realize that taking care of themselves enables them to better care for others. It is a seemingly simple concept which naturally evolves during a health promotion class.

References

Admi, H., Tzischinsky, O., Epstein, R., Herer, P., & Lavie, P. (2008, July-August). Shift work in nursing: Is it really a risk factor for nurses’ health and patients’ safety? Nursing Economics, 26(4), 250-7. Retrieved from

Berger, A. M., & Hobbs, B. B. (2006, August). Impact of shift work on the health and safety of nurses and patient.. Clinical Journal of Oncology Nursing, 10(4), 465-71. Retrieved from

Goldstein, E. R., Ziegenfuss, T., Kalman, D., Krieder, R., Campbell, B., Wilborn, C., Taylor, L., & Antonio, J. (2010, January). International society of sports nutrition position stand: Caffeine and performance. Journal of the International Society of Sports Nutrition, 7(1)(), 5. Retrieved from

Lehmann, K. S., Mantus, P., Maass, H., Holmer, C., Zurbuchen, U., Bretthauer, G., Buhr, H. J., & Ritz, J. P. (2010, February). Impact of sleep deprivation on medium-term psychomotor and cognitive performance of surgeons: Prospective crossover study with a virtual simulator and psychometric tests. Surgery, 147(2), 246-54. Retrieved from

Ohlmann, K. K., & O’Sullivan, M. I. (2009, September). The costs of short sleep. American Association of Occupational Health Nurses Journal, 57(9), 381-5. Retrieved from

Palladino, J. J., & Bloom, C. M. (2007). States of consciousness. 21st Century psychology: A reference handbook.. Retrieved from .

Spaggiari, M. C. (2008, July-September). Sleep medicine in occupational health. G Ital Med Lav Ergon, 30(3), 276-9. Retrieved from

Su, T. C., Lin, L. Y., Baker, D., Schnall, P. L., Chen, M. F., Hwang, W. C., Chen, C. F., & Wang, J. D. (2008, July 25). Elevated blood pressure, decreased heart rate variability and incomplete blood pressure recovery after a 12-hour night shift work. Journal of Occupational Health, 50(5), 380-6. Retrieved from

The American Heritage Dictionary. (2nd college ed.). (1982). Boston, MA: Houghton Mifflin.

Tunnicliffe, J. M., Erdman, K. A., Reimer, R. A., Lun, V., & Shearer, J. (2008, December). Consumption of dietary caffeine and coffee in physically active populations: physiological interactions. Applied Physiology, Nutrition, and Metabolism, 33(6), 1301-10. Retrieved from

Weinger, M. B., & Ancoli-Israel, S. (2002, February 27). Sleep deprivation and clinical performance. The Journal of the American Medical Association, 287, 955-7. Retrieved from

Westcott, K. J. (2005, April). Modafinil, sleep deprivation, and cognitive function in military and medical settings. Military Medicine, 170(4), 333-5. Retrieved from

Appendix

|Content |Points |Points |

|Criteria |Available |Awarded |

|Question at issue: Is the topic clearly identified? Can the reader readily identify the focus of the paper?|10 |  |

|Information: Is the key information for the topic included and adequately sourced? |10 |  |

|Point of view: Are the key viewpoints articulated and examined? |10 |  |

|Assumptions: What underlying assumptions are foundational to this issue? What does the reader need to |10 |  |

|understand about the issue? | | |

|Concepts: Are the key concepts of the topic identified? Is their relevance clear? |10 |  |

|Purpose: What is the purpose in examining this topic? Why is it important to nurses and nursing? To |10 |  |

|clinical populations? | | |

|Inference: What is the logical interpretation of the data about this issue? |10 |  |

|Implications/consequences: What are the likely outcomes of the various positions on this issue? |10 |  |

|Format Criteria |  |  |

|APA considerations, Intellectual Standards, Format (abstract, introduction, references, etc) |20 |  |

|Total  |100 |  |

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