Clinical Practice Guidelines for the Management of Patients with Insomnia in Primary Care.

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  1. Introduction
  2. Scope and objectives
  3. Methodology
  4. Epidemiology of insomnia
  5. Concepts, definitions, clinical features and classifications
  6. Diagnosis of insomnia
  7. Treatment of insomnia
  8. Patient information and adherence to treatment
  9. Nursing role
  10. Diagnostic and therapeutic strategies
  11. Dissemination and implementation
  12. Recommendations for future research
  13. Appendices
  14. Bibliography
  15. Full list of tables and figures

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9. Nursing role

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:
  • How he describes his health.
  • Knowledge regarding the sleep problem.
  • What he has done to improve it.
  • Use of drugs (prescribed or self-medication).
• Nutritional:
  • Daily food and drink intake patterns.
  • Intake of substances that may affect sleep (coffee, tea, alcohol, etc).
  • Fatigue (+++)
• Toilet visits:
  • Presence of nocturia.
• Activity / exercise:
  • Description of daily routine activities.
• Rest / sleep:
  • Normal sleep pattern.
  • Difficulties with sleeping.
• Self-perception:
  • What concerns the patient most.
  • His aims in relation to his current situation.
  • If his perception has changed as a result of having this problem.
• Role / relationships:
  • Thoughts on family and social life.
• Sexuality:
  • If there has been any change.
• Change / stress:
  • Losses or changes in his life during the past year.
  • If there is anything he would change in his life.
  • How he handles or has handled other stressful situations.

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.

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Table 16. Classifications NIC and NOC

NOC
0004. Sleep
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)
Evaluation scale:
1. Severely compromised
2. Substantially compromised
3. Moderately compromised
4. Slightly compromised
5. Not compromised
NIC
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, if appropriate.
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:

  1. - To standardise interventions by practitioners.
  2. - To perform a follow-up to quantify the evolution of the problem through specific indicators.
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Section 09 bibliography


  1. 63. North American Nursing Diagnosis Association. NANDA-I. DIAGNOSTICOS ENFERMEROS: DEFINICIONES Y CLASIFICACION, 2007-2008. 2008.

Latest update: May 2010

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