Download PICO Presentation: For hospitalized patients - Danielle Elore

PICO PRESENTATION:
FOR HOSPITALIZED PATIENTS, DOES THE USE OF
HYPNOTIC AGENTS AS COMPARED WITH NONPHARMACEUTICAL SLEEP AIDS IMPROVE SLEEP?
Danielle
Elore
COHP 450
Ferris State
University
LITERATURE SEARCH RESULTS
 Using FLITE, I searched CINAHL, which is a nursing database.
 Search words included: “Hypnotics sleep,” “hospitalized patients
sleep,” and “noise reduction hospitals”
 “Hypnotics sleep”: search produced a good research article about
hypnotic sedatives prescribed for sleep
 “Hospitalized patients sleep” and “noise reduction hospitals” did not
produce adequate results
 Using Google, I was able to find an article on the National
Institutes of Health Website.
 Search words included: “noise reduction hospital setting” and “noise
reduction hospital patients sleep”
 “Noise reduction hospital setting” did not provide adequate results
 “Noise reduction hospital patients sleep” produced a good research
article about noise reduction strategies and the impact of noise on
hospitalized patients’ sleep
LITERATURE SEARCH RESULTS
 Moloney, M.E., Konrad, T.R. & Zimmer, C.R. (2011). The
medicalization of sleeplessness: A public health concern.
American Journal of Public Health, 8, 1429-1433. doi:
10.2105/AJPH.2010.300014
 Xie, H., Kang, J. & Mills, G.H. (2009). Clinical review: The
impact of noise on patients’ sleep and the ef fectiveness of
noise reduction strategies in intensive care units. Critical
Care, 13(2), 208-215. doi: 10.1186/cc7154
LITERATURE SEARCH RESULTS
 The Medicalization of Sleeplessness: A Public Health Concern
 This article is research on benzodiazepines and hypnotic sedatives
prescribed for sleep. I chose this one because the article researches
the increase in people being prescribed these agents and often do
not have a medical diagnosis of insomnia.
 Clinical Review: The Impact of Noise on Patients’ Sleep and
the Ef fectiveness of Noise Reduction Strategies in Intensive
Care Units
 This article is research on the impact noise has on hospitalized
patients’ sleep and the non-pharmaceutical measures taken to
provide sleep by reducing noise.
RESEARCH STUDY EVALUATION
Medicalization of
Sleeplessness
Clinical Review: Noise
Reduction
 Quantitative
 Study Design: Crosssectional survey,
retrospective
 Sample: Adults 18+ 1993
to 2007
 Variables: Sleeplessness,
insomnia diagnosis,
Benzodiazepine/NBSH
prescription
 Statistical Analysis: SVY
commands, bivariate linear
model, descriptive statistics
 Quantitative
 Study design: Literature
Review, retrospective
 Sample: Hospitalized ICU
patients
 Variables: Hospital noise,
noise reduction
interventions
 Statistical Analysis:
Descriptive Statistics,
Cochrane Collaboration
RESEARCH STUDY EVALUATION
 Medicalization of Sleeplessness Results
 NBSH prescriptions grew 21 times more rapidly than sleeplessness
complaints and 5 times more rapidly than insomnia diagnoses
 Ages 18-65 outpaced 65+ on all sleeplessness related measures
 Very large rise in number of sleeplessness complaints in 2006 -2007
 NBSH increase sleep time by less than 12 minutes on average
 Side effects include sleep driving, sleep eating, sleep walking and
short term amnesia. Also, NBSH are risky for patients who take
multiple medications, have a history of drug abuse or mental illness
and those that are at risk for falls.
 Proven nondrug treatments exist: sleep hygiene and environmental
modifications.
RESEARCH STUDY EVALUATION
 Clinical Review: Noise Reduction Results
 Noise is just one of a number of factors that may disrupt sleep of an
ICU patient
 Staff conversation and alarms are regarded as the most disturbing
noises for patients’ sleep in the ICU.
 Four interventions exist for sleep improvement including: earplugs,
behavioral modification, sound masking and acoustic absorption.
 Sound absorbing treatment is an effective noise strategy
 Sound masking is the most effective technique for improving sleep.
ETHICAL CONSIDERATIONS
Medicalization of
Sleeplessness
Clinical Review: Noise
Reduction
 Used National
Ambulatory Medical
Care Survey (NAMCS)
conducted by the
National Center for
Health Statistics
(NCHS).
http://www.cdc.gov/nc
hs/about.htm
 Did a literature review
of other research
studies using specific
search engines. Found
167 studies, used 23
that included key
criteria. Gave credit to
each study used within
this literature review.
Medicalization of
Sleeplessness
Peer Reviewed
Adequate background for
research
Threat to external validity
Level of Measure: Ratio data
RESEARCH
STUDY
EVALUATION
Strength
Quality
Credibility
Clinical Review: Noise
Reduction
Peer Reviewed
Adequate background for
research
No threats to validity
Level of measure: Nominal
data
RESEARCH
STUDY
EVALUATION
Strength
Quality
Credibility
EVIDENCE BASED PRACTICE
CONTRIBUTIONS
Medicalization of
Sleeplessness
 This article can
contribute to EBP
 Complaints of
sleeplessness and/or
diagnoses of insomnia
should increase with
prescriptions of
sedative hypnotics
Clinical Review: Noise
Reduction
 This article can
contribute to EBP
 More emphasis should
be placed on nondrug
interventions to
promote sleep as they
are proven to help
without the side
effects.
RELEVANCE TO PRACTICE
Medicalization of
Sleeplessness
 This research can be used
in practice at the
professional level.
 Information and statistics
on sedative hypnotics is
important to know when
educating patients on
these drugs
 Educate patients on
sleeplessness and
insomnia as well.
Clinical Review: Noise
Reduction
 This research can be
used in practice at the
professional level.
 Results found when
using nondrug
interventions to
promote sleep are in
favor of using nondrug
interventions vs.
sedative hypnotics.
POTENTIAL BARRIERS
 Pharmaceutical Companies
 They will continue to produce sedative hypnotics. They are expensive
and they make the company money. They will continue to advertise
about these medications.
 Physicians
 Physicians have pharmaceutical companies promoting these drugs.
 Physicians have patients asking for these drugs.
 Physicians know the risks and low effectiveness, yet they prescribe
them anyways.
ADDITIONAL PICO QUESTIONS
 For patients with a history of drug abuse, does the use of
sedative hypnotics as compared with no sedative hypnotics
produce addictive tendencies?
 For elderly patients with an unsteady gait, does the use of
sedative hypnotics as compared with no sedative hypnotics
increase the risk of falls?
 For hospitalized patients, does the use of
earplugs/headphones as compared with music/white noise
increase sleep?
 For hospitalized patients, does the hospital noise/staff
communication as compared with reason for hospital stay
decrease sleep?
CONCLUSION
 For hospitalized patients, does the use of hypnotic agents as
compared with non-pharmaceutical sleep aids improve sleep ?
 Both articles are credible resources that can be used to
contribute to EBP and can be used in current practice.
 Based on the research provided in this presentation:
 Sedative hypnotics are ineffective.
 Sedative hypnotics have potentially harmful side effects.
 Sedative hypnotics are over-prescribed by physicians, especially when
there is not a diagnosis for insomnia.
 At least half of hospitalized patients state noise is the reason for
inadequate sleep.
 Noise reduction interventions work.
 Other nondrug interventions available.