The Promotion of Sleep Quality in the Elderly Person Admitted to the Emergency Department
Background: Sleep represents an important role in maintaining the health and well-being of the elderly. The aging process, by itself, causes a change in the circadian rhythm, which makes the elderly person's sleep more superficial and less efficient (Missildine et al, 2010). Stress of hospitalization, nocturnal wake-ups for caring, pain, and changes in the environment are factors that may compromise the elderly person's sleep during hospitalization (Fulmer, 2007). Nurses have an essential role to play in meeting this fundamental human need (Henderson, 1966), which in the emergency department (ED) is more complex. Objectives: To identify the disturbing factors of sleep quality in the elderly person hospitalized in the ED, from the perspective of nurses and hospitalized elderly people; to identify the nursing care activities during the night shift to minimize disturbances in the sleep pattern of the hospitalized elderly person and present interventions that could be implemented in order to promote the quality of sleep. Methodology: Descriptive study of a qualitative nature, based on a Case Study. Instruments for data collection: questionnaires applied to 28 nurses and semi-structured interviews with 12 elderly people who met the inclusion criteria. The data were the subject of statistical analysis and content analysis of Bardin (2013). The categories were defined a priori based on the information extracted in the literature review (factors associated with the environment, care and inherent to the person), taking into account the objectives of the study and the subcategories and sub-subcategories a posteriori by induction of the meanings mentioned by the subjects explicitly and implicitly and by frequency analysis. The accomplishment of this study had positive opinion of the Ethics Board and Board of Administration of the respective hospital. Results: The disturbing factors of sleep quality in the elderly are based on a multifactorial etiology: environmental factors, patient care activities and patient-specific factors (physiological and psychological). In the opinion of nurses and the elderly, environmental factors are the most disturbing of sleep quality in ED, namely noise. To promote sleep quality nurses value decreased light intensity and noise level and referred as an important measure to implementing care organization in order to allow an uninterrupted period of sleep. Conclusions: Although many of the sleep-disturbing factors are unavoidable there are, nonetheless, some controllable by changing health team behaviors. In order to improve the quality of sleep in the hospitalized elderly person and consequently to qualify for their recovery, it is suggested to implement a "Quiet Time" protocol, based on a care concept that seeks to have a partnership relationship with the elderly (Gomes, 2016).