Introduction: Sleep disorders are common among shift workers and those who work under stressful and unpredictable conditions. Sleep quality and its promotion in paramedics are understudied. Objective: The study aimed to investigate the quality of sleep in emergency medical service workers, to compare certain relationships between variables (gender, age, length of experience), and to assess whether a cut-off score of 10 is appropriate for the discriminatory ability of the selected instrument in the Czech clinical setting. Design: A cross-sectional study. Methods: Data were obtained using the Pittsburgh Sleep Quality Index (PSQI). The sample comprised 191 paramedics. Data were analyzed using selected statistical methods. Results: The mean PSQI total score was 7.45 (SD 3.60). The lowest scoring component was sleep duration (1.45; SD 1.01). There was no relationship between sleep quality and gender. With respect to age, two components, sleep disturbances and daytime dysfunction, were found to be significant (p < 0.05). Regarding the length of experience, daytime dysfunction was identified as a significant component. The PSQI total parameter with a cut-off of 10 (PSQI total ≤10 good sleep; PSQI total >10 poor sleep) was confirmed to be suitable for discriminating the subjectively perceived sleep quality in paramedics. Conclusion: The study demonstrates that sleep quality is compromised in paramedics. Impaired sleep quality has the greatest impact on daytime dysfunction in paramedics. The PSQI, with a cut-off score of 10, is an appropriate instrument for assessing their sleep disturbances.
- MeSH
- kvalita spánku MeSH
- lidé MeSH
- poruchy cirkadiánního rytmu (spánek) * MeSH
- práce na směny MeSH
- průzkumy a dotazníky MeSH
- zdravotničtí záchranáři MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Česká republika MeSH
Úvod: Existuje mnoho škál hodnocení a predikce rizika deliria, ale jsou málo známé a nejsou rutinně používané zdravotníky v praxi. Diagnostika deliria sestrami je nadále omezená řadou limitací. Design: Prospektivní observační studie zahrnovala 50 konsekutivních neintubovaných pacientů, kteří byli hospitalizováni na JIP déle než 24 hodin. Místo: Anesteziologicko-resuscitační oddělení (5 lůžek) Nemocnice AGEL ve Valašském Meziříčí, od září 2020 do března 2021. Metody: Primárním výstupem bylo porovnání přítomnosti deliria u neintubovaných pacientů na JIP se dvěma současně užívanými hodnoticími nástroji: Neelon and Champagne (NEECHAM) Confusion Scale (škála zmatenosti) a Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Sekundárním výstupem bylo ověření spolehlivosti NEECHAM Confusion Scale v prostředí české jednotky intenzivní péče. Výsledky: Studie zjistila, že incidence deliria pomocí CAM-ICU (32 %) a NEECHAM Confusion Scale (28 %) byly srovnatelné. Současně bylo zjištěno, že téměř třetina CAM-ICU negativních pacientů patří do skupiny mírné zmatenosti nebo hodnocena jako riziková u NEECHAM Confusion Scale. Vnitřní konzistence NEECHAM Confusion Scale, hodnocená pomocí Cronbachovy α, byla 0,703. Statisticky významný vztah byl potvrzen mezi deliriem a dvěma ze sledovaných parametrů pacienta (skóre GCS a užívání antipsychotik). Závěr: Delirium je běžné u pacientů na intenzivních péčích, ale často zůstává nediagnostikováno. K identifikaci byly vyvinuty různé nástroje, které pomáhají detekovat pacienty s deliriem a jejich použití vede k lepším výsledkům. Oba studované nástroje (CAM-ICU a NEECHAM Confusion Scale) se zdají být vhodné a uživatelsky pohodlné.
Introduction: There are many scales of assessment and prediction of risk of delirium, but they are little known and rarely used by professionals. Recognition of delirium by nurses continues to be limited. Design: The prospective observational study included 50 consecutive non-intubated patients staying in the ICU for more than 24 hours. Setting: Department of anesthesiology and intensive care medicine (5 beds) of AGEL Hospital in Valašské Meziříčí, between September 2020 and March 2021. Methods: Primary outcome was to compare the presence of delirium in non-intubated ICU patients with two simultaneously used assessment tools: the Neelon and Champagne (NEECHAM) Confusion Scale, and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). A secondary outcome was to verify the NEECHAM Confusion Scale reliability in the Czech ICU setting. Results: The study found that the incidence rates detected by the CAM-ICU (32%) and NEECHAM Confusion Scale (28%) were comparable. Nearly a third of CAM-ICU-negative patients were found to belong to the mild confusion or at-risk NEECHAM Confusion Scale groups. The internal consistency of the NEECHAM Confusion Scale assessed with Cronbach's α was 0.703. There was a statistically significant relationship between delirium and two of the studied patient parameters (GCS score and use of antipsychotics). Conclusions: Delirium is common in ICU patients, but it often remains undiagnosed. Various tools have been developed to help identify delirium patients. Their use has been shown to result in better outcomes. Both studied tools (the CAM-ICU and NEECHAM Confusion Scale) appear to be suitable and convenient.
Aim: The study compared two instruments for detecting delirium, the Intensive Care Delirium Screening Checklist (ICDSC) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) as a reference method. Design: Prospective observational study. Methods: The study included 126 consecutive patients staying in the intensive care unit (ICU) for more than 24 hours. The diagnostic properties of both questionnaires and agreement between them were studied and compared. Additionally, the two tests were used to assess the relationship between selected patient parameters and the presence of delirium. Results: There was a high level of agreement between the CAM-ICU and ICDSC, as expressed by Cohen's κ of 0.829 (95% CI: 0.821-0.838). Cronbach's α assessing the internal consistency of a Czech version of the CAM-ICU and ICDSC was 0.903 and 0.865, respectively. The CAM-ICU had 85.5% sensitivity (95% CI: 84.6-91.8) and 94.1% specificity (95% CI: 92.4-95.5); the ICDSC (cut-off ≥ 4) had 90.6% sensitivity (95% CI: 87.0-93.5) and 89.0% specificity (95% CI: 86.8-91.0). Conclusion: Both compared diagnostic instruments, the CAM-ICU and ICDSC, appear to be adequate and usable. When compared with the CAM-ICU as a reference method, the ICDSC showed similar results and a good level of agreement.
- Klíčová slova
- Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), delirium, Intensive Care Delirium Screening Checklist (ICDSC), intensive care unit (ICU),
- MeSH
- delirium * diagnóza ošetřování terapie MeSH
- mechanické ventilátory MeSH
- ošetřovatelská péče o pacienty v kritickém stavu MeSH
- pooperační delirium MeSH
- pozorovací studie jako téma MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
Patients staying in the intensive care unit (ICU) require constant monitoring and numerous nursing interventions performed as needed, irrespective of daytime or night-time. The disturbing effect of nocturnal nursing interventions and their contribution to sleep disruptions are unclear. The review analysed nocturnal nursing interventions, and their character, frequency and effects on sleep quality. The databases CINAHL, PubMed and Scopus were searched to identify and subsequently evaluate 19 studies (1,531 patients) meeting the algorithm used. Although nocturnal nursing interventions provided to ICU patients were frequent and varied, they were responsible for only a minority of observed sleep disruptions. The most frequent nocturnal intervention was Vital signs monitoring (Nursing Interventions Classification, 6,680). Implementation of sleep protocols, of which an integral part is clustering and planning of nocturnal interventions, appears to be effective. The review suggests that nursing interventions are not the main cause of sleep disruptions in the ICU. In an effort to improve the quality of sleep in ICU patients, other factors causing disturbance need to be addressed as well. The current trend is more careful planning of nursing care, clustering of interventions and minimizing nocturnal disruptions to allow patients at least one uninterrupted sleep cycle (90 min).
Introduction: It has been repeatedly shown that sleep of intensive care unit (ICU) patients is fragmented and its architecture is impaired. As sleep disorders have numerous negative effects on the organism, there have been efforts to implement sleep-promoting strategies into practice. When comparing the effectiveness of such measures, sleep quality assessment itself is a considerable problem. Objective: The study aimed to assess the quality and quantity of night sleep in ICU patients simultaneously with actigraphy (ACT) and the Richards-Campbell Sleep Questionnaire (RCSQ). The secondary goals were to test the performance and effectiveness of the above methods and to verify correlations between selected RCSQ items and actigraph parameters. Methods: A single-center prospective observational study (20 patients staying in a Interdisciplinary Intensive Care Unit). The quality of sleep was assessed using a Czech version of the RCSQ and ACT. The obtained data were analyzed and their dependence or correlations were verified by selected statistical tests. Results: The mean RCSQ score was 47.6 (SD 24.4). The worst results were found for sleep latency (44.4; SD 31.2); the best results were for sleep quality (50.2; SD 29.4). The mean sleep effciency measured with ACT reached 86.6% (SD 9.2); the mean number of awakenings per night was 17.1 (SD 8.5). The RCSQ total parameter with a cutoff of 50 (RCSQ total = 50 good sleep / RCSQ total < 50 poor sleep) was shown to be suitable for discrimination of subjectively perceived sleep quality in ICU patients. However, the study failed to show statistically significant relations between subjectively perceived sleep quality (RCSQ) and ACT measurements. Conclusion: The RCSQ appears to be a suitable instrument for assessing night sleep quality in ICU patients. On the other hand, the study showed a very low level of agreement between subjective sleep quality assessment and objective ACT measurements. The main drawback of ACT is low reliability of obtained data. Further research is needed to determine its role in sleep quality assessment in the ICU setting.
- Publikační typ
- časopisecké články MeSH
Cíl: Cílem výzkumu bylo určit míru vnitřní konzistence Richards-Campbell Sleep Questionnaire (RCSQ) a porovnat vytipované vztahy mezi proměnnými (pohlaví, věk, druh přijetí) v českém klinickém prostředí jednotky intenzivní péče. Design: průřezová studie. Metodika: RCSQ byl přeložen podle manuálu pro překlad a kulturní adaptaci. Hodnocení kvality spánku bylo zjišťováno pomocí české verze RCSQ. Soubor tvořilo 105 pacientů hospitalizovaných na mezioborové jednotce intenzivní péče. Hodnocení kvality spánku bylo měřeno pomocí vizuální analogové škály (0-100). Výsledky: Průměrné skóre RCSQ v souboru bylo 53.2 (SD 20.1). Nejníže hodnocenou položkou bylo opětovné usínání po probuzení - 51 (SD 24.2), naopak nejlépe hodnocenou položkou byla kvalita spánku - 55.6 (SD 26.4). Vnitřní konzistence (Cronbachova α) české verze RCSQ je 0.89. Nebyl potvrzen statisticky signifikantní vztah (p < 0.05) mezi kvalitou spánku a vytipovanými proměnnými: věk (F = 0.1, p = 0.736), pohlaví (F = 0, p = 0.929), druh přijetí (F = 1.8, p = 0.183). Závěr: Studie demonstruje, že RCSQ v české verzi je hodnocen jako spolehlivý nástroj a může být používán k subjektivnímu hodnocení kvality spánku u kriticky nemocných. Asociace mezi kvalitou spánku a vytipovanými proměnnými nebyla statisticky prokázaná a jeho vnímání je velmi individuální.
Objective: The objective of the research was to determine the internal consistency of the Richards-Campbell Sleep Questionnaire (RCSQ) and to compare the selected relationships between the variables (gender, age, type of admission) in the Czech clinical environment of the intensive care unit. Design: Cross-sectional study. Methods: The RCSQ has been translated according to the translation and cultural adaptation manual. The quality of sleep was assessed using the Czech version of the RCSQ. The sample consisted of 105 patients hospitalised in an interdisciplinary intensive care unit. The quality of sleep was measured using a visual analogue scale (0-100). Results: The internal consistency (Cronbach's α) of the Czech version of the RCSQ is 0.89. The average RCSQ score in the sample was 53.2 (SD 20.1). Return to sleep was the lowest rated item at 51 (SD 24.2), while sleep quality was the highest rated item at 55.6 (SD 26.4). There was no statistically significant relationship (p < 0.05) between sleep quality and selected variables: age (F = 0.1; p = 0.736), gender (F = 0; p = 0.929), type of admission (F = 1.8; p = 0.183). Conclusions: The study demonstrates that the Czech version of the RCSQ is rated as a reliable tool and can be used to subjectively assess sleep quality in critically ill patients. The association between sleep quality and selected variables has not been statistically proven and its perception is very individual.
Cíl: Cílem výzkumu bylo určit míru vnitřní konzistence Richards-Campbell Sleep Questionnaire (RCSQ) a porovnat vytipované vztahy mezi proměnnými (pohlaví, věk, druh přijetí) v českém klinickém prostředí jednotky intenzivní péče. Design: průřezová studie. Metodika: RCSQ byl přeložen podle manuálu pro překlad a kulturní adaptaci. Hodnocení kvality spánku bylo zjišťováno pomocí české verze RCSQ. Soubor tvořilo 105 pacientů hospitalizovaných na mezioborové jednotce intenzivní péče. Hodnocení kvality spánku bylo měřeno pomocí vizuální analogové škály (0-100). Výsledky: Průměrné skóre RCSQ v souboru bylo 53.2 (SD 20.1). Nejníže hodnocenou položkou bylo opětovné usínání po probuzení - 51 (SD 24.2), naopak nejlépe hodnocenou položkou byla kvalita spánku - 55.6 (SD 26.4). Vnitřní konzistence (Cronbachova α) české verze RCSQ je 0.89. Nebyl potvrzen statisticky signifikantní vztah (p < 0.05) mezi kvalitou spánku a vytipovanými proměnnými: věk (F = 0.1, p = 0.736), pohlaví (F = 0, p = 0.929), druh přijetí (F = 1.8, p = 0.183). Závěr: Studie demonstruje, že RCSQ v české verzi je hodnocen jako spolehlivý nástroj a může být používán k subjektivnímu hodnocení kvality spánku u kriticky nemocných. Asociace mezi kvalitou spánku a vytipovanými proměnnými nebyla statisticky prokázaná a jeho vnímání je velmi individuální.
Objective: The objective of the research was to determine the internal consistency of the Richards-Campbell Sleep Questionnaire (RCSQ) and to compare the selected relationships between the variables (gender, age, type of admission) in the Czech clinical environment of the intensive care unit. Design: Cross-sectional study. Methods: The RCSQ has been translated according to the translation and cultural adaptation manual. The quality of sleep was assessed using the Czech version of the RCSQ. The sample consisted of 105 patients hospitalised in an interdisciplinary intensive care unit. The quality of sleep was measured using a visual analogue scale (0-100). Results: The internal consistency (Cronbach's α) of the Czech version of the RCSQ is 0.89. The average RCSQ score in the sample was 53.2 (SD 20.1). Return to sleep was the lowest rated item at 51 (SD 24.2), while sleep quality was the highest rated item at 55.6 (SD 26.4). There was no statistically significant relationship (p < 0.05) between sleep quality and selected variables: age (F = 0.1; p = 0.736), gender (F = 0; p = 0.929), type of admission (F = 1.8; p = 0.183). Conclusions: The study demonstrates that the Czech version of the RCSQ is rated as a reliable tool and can be used to subjectively assess sleep quality in critically ill patients. The association between sleep quality and selected variables has not been statistically proven and its perception is very individual.
Intensive care unit (ICU) environment has a very strong and unavoidable negative impact on patients' sleep. Sleep deprivation in ICU patients has been already studied and negative effects on their outcome (prolonged ICU stay, decreased recovery) and complication rates (incidence of delirium, neuropsychological sequels of critical illness) discussed. Several interventions potentially improving the sleep disturbance in ICU (sleep-promotion strategies) have been assumed and tested for clinical practice. We present a review of recent literature focused on chosen types of non-pharmacological interventions (earplugs and eye mask) analysing their effect on sleep quality/quantity. From the total amount of 82 papers found in biomedical databases (CINAHL, PubMed and SCOPUS) we included the 19 most eligible studies meeting defined inclusion/exclusion criteria involving 1 379 participants. Both experimental and clinical trials, either ICU and non-ICU patient populations were analysed in the review. Most of the reviewed studies showed a significant improvement of subjective sleep quality when using described non-pharmacological interventions (objective parameters were not significantly validated). Measuring the sleep quality is a major concern limiting the objective comparison of the studies' results since non-standardised (and mainly individual) tools for sleep quality assessment were used. Despite the heterogeneity of analysed studies and some common methodological issues (sample size, design, outcome parameters choice and comparison) earplugs and eye mask showed potential positive effects on sleep quality and the incidence of delirium in ICU patients.
- MeSH
- chrániče sluchu * trendy MeSH
- delirium epidemiologie patofyziologie terapie MeSH
- jednotky intenzivní péče * trendy MeSH
- lidé MeSH
- ochranné prostředky očí * trendy MeSH
- péče o pacienty v kritickém stavu metody trendy MeSH
- poruchy spánku a bdění epidemiologie patofyziologie prevence a kontrola MeSH
- randomizované kontrolované studie jako téma metody MeSH
- spánek fyziologie MeSH
- spánková deprivace epidemiologie patofyziologie prevence a kontrola MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- systematický přehled MeSH
Aim: To examine the effects of mechanical ventilation on the quality of sleep in patients in the intensive care unit (ICU) using recent and relevant literature. Methods: To verify the examined objective, the results of the analysis of available original scientific works have been used including defined inclusion/exclusion criteria and search strategy. Appropriate works found were analysed further. The applied methodology was in line with the general principles of Evidence-Based Medicine. The following literary databases were used: CINAHL, Medline and gray literature: Google Scholar. Results: A total of 91 trials were found. Eleven of these relevant to the follow-up analysis were selected: all trials were carried out under real ICU conditions and the total of 192 patients were included in the review. There is an agreement within all trials that sleep in patients requiring mechanical ventilation is disturbed. Most reviewed trials have shown that mechanical ventilation is probably not the main factor causing sleep disturbances, but an appropriate ventilation strategy can significantly help to improve its quality by reducing the frequency of the patient-ventilator asynchrony. Conclusion: Based on the analysis, it appears that an appropriate ventilation mode setting can have a beneficial effect on the quality of sleep in ICU patients.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Aim:The aim of this study was to compare the perception of selected stressors acting on the Czech intensive care unit (ICU) ofCzech patients, their families and attending nurses. Design:A descriptive comparative study. Methods:Stressor perception was measured by a Czech version of the standardised questionnaire, The Environmental Stressor Questionnaire (ESQ). The sample group consisted of 90 people. Data were obtained via pairing (patient –relative –nurse). The family and the attending nurses evaluated stressors by empathising with the patient. Results:When evaluating the data obtained, it was ascertained that the relatives and attending nurses perceive stressors acting on the ICU as worse than patients themselves do. The overall level of stressor perception in the relatives was statistically significantly higher than in the patients (z = -3.72;p < 0.001). Astatistically significant difference was also confirmed with regard to perception of stressors between attending nurses and patients (z = -2.23; p < 0.001). Conclusion:Both the relatives and attending nurses perceive stressors in the intensive care unit as worse than the patients themselves do. The negative impacts of stressors can be reduced by implementing new approaches in nursing care.
- MeSH
- empatie MeSH
- jednotky intenzivní péče * MeSH
- lidé MeSH
- pacienti hospitalizovaní psychologie MeSH
- percepce MeSH
- prostředí zdravotnických zařízení MeSH
- průzkumy a dotazníky MeSH
- psychický stres * psychologie MeSH
- rodina psychologie MeSH
- statistika jako téma MeSH
- zdravotní sestry psychologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- srovnávací studie MeSH
- Geografické názvy
- Česká republika MeSH
