Primary care treatment of insomnia: study protocol for a pragmatic, multicentre, randomised controlled trial comparing nurse-delivered sleep restriction therapy to sleep hygiene (the HABIT trial)

INTRODUCTION

Insomnia is a prevalent sleep disorder that negatively affects quality of life. Multicomponent cognitive-behavioural therapy (CBT) is the recommended treatment but access remains limited, particularly in primary care. Sleep restriction therapy (SRT) is one of the principal active components of CBT and could be delivered by generalist staff in primary care. The aim of this randomised controlled trial is to establish whether nurse-delivered SRT for insomnia disorder is clinically and cost-effective compared with sleep hygiene advice.

METHODS AND ANALYSIS

In the HABIT (Health-professional Administered Brief Insomnia Therapy) trial, 588 participants meeting criteria for insomnia disorder will be recruited from primary care in England and randomised (1:1) to either nurse-delivered SRT (plus sleep hygiene booklet) or sleep hygiene booklet on its own. SRT will be delivered over 4 weekly sessions; total therapy time is approximately 1 hour. Outcomes will be collected at baseline, 3, 6 and 12 months post-randomisation. The primary outcome is self-reported insomnia severity using the Insomnia Severity Index at 6 months. Secondary outcomes include health-related and sleep-related quality of life, depressive symptoms, use of prescribed sleep medication, diary and actigraphy-recorded sleep parameters, and work productivity. Analyses will be intention-to-treat. Moderation and mediation analyses will be conducted and a cost-utility analysis and process evaluation will be performed.

ETHICS AND DISSEMINATION

Ethical approval was granted by the Yorkshire and the Humber - Bradford Leeds Research Ethics Committee (reference: 18/YH/0153). We will publish our primary findings in high-impact, peer-reviewed journals. There will be further outputs in relation to process evaluation and secondary analyses focussed on moderation and mediation. Trial results could make the case for the introduction of nurse-delivered sleep therapy in primary care, increasing access to evidence-based treatment for people with insomnia disorder.

TRIAL REGISTRATION NUMBER

ISRCTN42499563.

Sleep Disturbances in Patients with Chronic Heart Failure and Their Holistic Consequences—What Different Care Actions can be Implemented?

Background: Sleep disturbances are prevalent among elderly, especially among those with chronic heart failure (CHF) and can affect all dimensions of quality of life (QOL) negatively.

Aim: To describe the most common causes leading to sleep disturbances in patients with CHF, their consequences from a holistic perspective and different care actions that can be implemented.

Methods: MEDLINE and CINAHL databases were searched from 1989 to July 2004.

Findings: Sleep disordered breathing (SDB), and insomnia were the most common causes for sleep disturbances and occurs in 45–82% (SDB) and one-third (insomnia) of all patients with CHF. SDB cause a disturbed sleep structure with frequent awakenings, as well as several adverse effects on the cardiovascular system causing increased morbidity and mortality. Insomnia, caused by anxiety, an unknown life situation in relation to the debut of CHF, or symptoms/deteriorations of CHF can lead to negative effects on all aspects of QOL, as well as daytime sleepiness.

Conclusion: The high prevalence of sleep disturbances and their holistic consequences should be taken into account when nurses asses and plan the care for patients with CHF. Randomized studies with large sample sizes evaluating non-pharmacological nursing interventions that improve sleep are needed.

[Outpatient cannabis withdrawal programme]

Cannabis is the most consumed illicit substance in France, and its use can lead to dependency. Lille university hospital, le Pari association, offers patients wanting to stop using cannabis a support therapy based on positive feedback led by nurses, as well as symptomatic treatment of anxiety and sleep disorders.

Nursing knowledge of physiological and psychological outcomes related to patient sleep deprivation in the acute care setting

In this study, nurses' knowledge regarding sleep quality outcomes in the acutely ill patient population was assessed. Also evaluated was the possible impact of nurses' knowledge of the effects of quality sleep on their choice of activities to promote patient rest.

[External barriers to good sleep from the nursing home residents' perspective]

BACKGROUND

Nursing home residents often suffer from sleep disorders. For nurses, nursing home residents' sleep disorders are a complex problem. The nursing home residents' perspective on sleep and sleep disorders has been unknown yet. The Aim of this article is to describe external barriers to good sleep from the nursing home residents' perspective and to deduce implications for nursing practice.

METHODS

A qualitative interview study. 30 nursing home residents (at least 64 years old and oriented on place and person) from five different nursing homes in Berlin have been interviewed through episodic interviews. The data has been analyzed by use of thematic coding.

RESULTS

The sample consists of 20 women and 10 men, born between 1909 and 1944. From the nursing home residents' perspective, noise and light at night disturb their sleep. Noise and light can be caused by other residents or staff. The interviewed residents perceived disorientated room mates and room mates who needed frequently care at night as disturbing their night sleep. Additionally, the interviewed residents perceived the nurses' nightly rounds as disturbing.

CONCLUSIONS

Nurses and residents should look together for possibilities of reducing nightly disturbances of sleep. Nursing home residents who need frequent nightly care should be living in rooms together with residents demanding a similar amount of nightly care. Nightly rounds should be minimized.

Nursing interventions to alleviate insomnia

Insomnia or disturbed sleep is experienced by many older people and has adverse effects on physical and psychological health. Nurses should be aware of insomnia and how they can help patients to get a good night's sleep. This article first examines normal sleep patterns and then insomnia. It discusses what nurses can do to assess sleep disturbances and suggests practical strategies to promote quality sleep in inpatients and care home residents.

[Insomnia: clinical evaluation and nursing management]

The insomnia is one of the most frequent sleep disorders seen by physicians. It is currently recognized as a disease that greatly affects the daily routine and quality of life of sufferers. This article primarily discusses insomnia factors of influence, currently used evaluation tools, and the proper role of nursing care in treating insomnia. With adequate cognition and by employing adaptive management techniques, nurses can administer proper treatment to resolve patient insomnia problems.

Randomized clinical effectiveness trial of nurse-administered small-group cognitive behavior therapy for persistent insomnia in general practice

STUDY OBJECTIVES

Persistent insomnia, although very common in general practice, often proves problematic to manage. This study investigates the clinical effectiveness and the feasibility of applying cognitive behavior therapy (CBT) methods for insomnia in primary care.

DESIGN

Pragmatic randomized controlled trial of CBT versus treatment as usual.

SETTING

General medical practice.

PARTICIPANTS

Two hundred one adults (mean age, 54 years) randomly assigned to receive CBT (n = 107; 72 women) or treatment as usual (n = 94; 65 women).

INTERVENTION

CBT comprised 5 sessions delivered in small groups by primary care nurses. Treatment as usual comprised usual care from general practitioners.

MEASUREMENTS AND RESULTS

Assessments were completed at baseline, after treatment, and at 6-month follow-up visits. Sleep outcomes were appraised by sleep diary, actigraphy, and clinical endpoint. CBT was associated with improvements in self-reported sleep latency, wakefulness after sleep onset, and sleep efficiency. Improvements were partly sustained at follow-up. Effect sizes were moderate for the index variable of sleep efficiency. Participants receiving treatment as usual did not improve. Actigraphically estimated sleep improved modestly after CBT, relative to no change in treatment as usual. CBT was also associated with significant positive changes in mental health and energy/vitality. Comorbid physical and mental health difficulties did not impair sleep improvement following CBT.

CONCLUSION

This study suggests that trained and supervised nurses can effectively deliver CBT for insomnia in routine general medical practice. Treatment response to small-group service delivery was encouraging, although effect sizes were smaller than those obtained in efficacy studies. Further research is required to consider the possibility that CBT could become the treatment of first choice for persistent insomnia in primary healthcare.

[Literature review of back massage and similar techniques to promote sleep in elderly people]

Insomnia is a frequent problem among elderly people. As a consequence, sedative hypnotic drugs are prescribed very often that can lead to problematic effects. As an alternative to sedative hypnotic drugs nurses use relaxing interventions to promote sleep. One of these techniques, the back massage, is very popular because of the expected relaxing effect of touch. Against this background, this review includes 16 surveys of the international nursing literature and the German literature until the year 2004, that analyse the most common intervention in Germany, the "Atemstimulierende Einreibung" (similar to Effleurage). These studies are presented and evaluated. The results indicate that these interventions promote relaxation and sleep and that they are perceived as very pleasant by the elderly. However; they do not explain in detail the reasons for effects these and the role of touch. This review shows that further research (RCTs) is necessary to determine the effects of back massage and "Atemstimulierende Einreibung" on relaxation and sleep.

[The effects of foot reflexology on fatigue and insomnia in patients suffering from coal workers' pneumoconiosis]

PURPOSE

The purpose of this study was to determine the effects of foot reflexology on fatigue and insomnia in patients suffering from coal workers' pneumoconiosis.

METHOD

This study was a quasi-experimental study of pre-test and post-test design in a non-equivalent control group. The subjects of this study consisted of both the experimental group of twenty-nine and the control group of thirty coal workers' pneumoconiosis patients. Data was collected from December 10, 2002 to February 15, 2003. Foot reflexology was performed for 60 minutes twice a week through five weeks in the experimental group, but none in the control group. To evaluate the effects of foot reflexology, the scores of fatigue and insomnia were measured before and after the experiment in both groups. Fatigue was evaluated by Fatigue Symptoms Inventory. Insomnia was measured with the visual analogue scale (VAS). Data of this experiment was analyzed by Chi-square test, t-test, unpaired t-test and Repeated Measures ANOVA with the SAS Program.

RESULTS

The scores of fatigue and insomnia decreased in the experimental group but not in the control group. There was a significant difference of fatigue and insomnia between the two groups.

CONCLUSION

It is suggested that foot reflexology might have beneficial effects on reducing fatigue and insomnia in patients suffering from coal workers' pneumoconiosis, and can be recommended as a nursing intervention program for patients with coal workers' pneumoconiosis.

A brief behavioral sleep intervention for family caregivers of persons with cancer

Behavioral interventions that support caregivers' restful sleep may delay the onset or decrease the severity of debilitating depressive symptoms. This, in turn, may increase caregivers' physical and psychological health and wellbeing. A repeated-measures experimental design was used to test the feasibility and effectiveness of a brief behavioral sleep intervention for family caregivers of persons with advanced stage cancer. The CAregiver Sleep Intervention (CASI) includes stimulus control, relaxation, cognitive therapy, and sleep hygiene elements. CASI is individualized and delivered to accommodate caregiver burden. Thirty adult caregivers participated. The Pittsburgh Sleep Quality Index (PSQI), Center for Epidemiological Studies-Depression scale (CES-D), and Caregiver Quality of Life-Cancer scale (CQOLC) were used to measure self-reported sleep quality, depressive symptoms, and quality of life. Actigraphs measured latency, duration, efficiency, and wake after sleep onset (WASO) scores. Data were collected at baseline, 3 and 5 weeks, 2, 3, and 4 months post baseline. Improvement was seen across groups; however, intervention caregivers showed more improvement in PSQI and CES-D scores than control caregivers. The CASI appears to be effective in improving sleep quality and depressive symptoms in caregivers of persons with cancer. Improvements in quality of life scores were similar across groups. Sample size and homogeneity limit generalizability.

The Sh-h-h-h Project

Promoting rest and sleep is integral to the profession of nursing. The Sh-h-h-h Project, a nonpharmacological program designed to enhance rest and sleep, was implemented on a hospital medical unit. Nursing assistants provided patients with various modalities to improve sleep, including back rubs, warm drinks, blankets warmed in a blanket warmer, aromatherapy, relaxation music, and earplugs. Additional interventions were taken to reduce noise. The outcomes of the Sh-h-h-h Project are reported here, with patients indicating improved sleep quality and quantity.

Factors related to persistent fatigue following completion of breast cancer treatment

PURPOSE/OBJECTIVES

To verify the predictive capacity of the stress-process theory to emeanplain persistent fatigue following completion of breast cancer treatments; to verify the relationship between interleukin-1b and fatigue.

DESIGN

Correlational.

SETTING

Tertiary medical center in Quebec City, Canada.

SAMPLE

A systematic sample of 103 women in remission from breast cancer was recruited. The mean age was 54 years. Participants with a depressive mood, insomnia, or stage IV cancer were emeancluded.

METHODS

Participants were met during their follow-up appointment after the end of radiation therapy. Questionnaires on fatigue, stress variables, and other confounding variables were completed by telephone interview. Blood samples also were collected to measure the serum level of interleukin-1b.

MAIN RESEARCH VARIABLES

Fatigue, several variables from the stress-process theory, pain, menopausal symptoms, and demographic and medical variables.

FINDINGS

Fatigue was related theoretically and coherently to many stress-process variables. By controlling for pain, the final regression model included cancer stressors and passive and active coping as predictors, which accounted for 41% of the variance in fatigue. No relationship was found between fatigue and interleukin-1b.

CONCLUSIONS

The results supported the relevance of the stress-process theory for emeanplaining cancer-related fatigue.

IMPLICATIONS FOR NURSING

Nursing interventions based on this theoretical framework could be developed. In addition, further clinical research that tests the efficacy of these psycho-educative interventions in preventing persistent fatigue and improving the quality of life of women with breast cancer is recommended.

Cognitive behavioural therapy for primary insomnia: a systematic review

AIM

This paper reports a systematic review of seven studies evaluating the efficacy of cognitive behavioural therapy (CBT) for persistent primary insomnia.

BACKGROUND

Insomnia is one of the most common health complaints reported in the primary care setting. Although non-pharmacological treatments such as the CBT have been suggested to be useful in combating the persistent insomnia, the efficacy and clinical utility of CBT for primary insomnia have yet to be determined.

METHOD

A systematic search of Ovid, MEDLINE, psychINFO, PsycARTICLES, CINAHL, and EMBASE databases of papers published between 1993 and 2004 was conducted, using the following medical subject headings or key words: insomnia, primary insomnia, psychophysiological insomnia, sleep maintenance disorders, sleep initiation disorders, non-pharmacological treatment, and cognitive behavioural therapy. A total of seven papers was included in the review.

FINDINGS

Stimulus control, sleep restriction, sleep hygiene education and cognitive restructuring were the main treatment components. Interventions were provided by psychiatrists except for one study, in which the CBT was delivered by nurses. Among beneficial outcomes, improvement of sleep efficacy, sleep onset latency and wake after sleep onset were the most frequently reported. In addition, participants significantly reduced sleep medication use. Some studies gave follow-up data which indicated that the CBT produced durable clinical changes in total sleep time and night-time wakefulness.

CONCLUSIONS

These randomized controlled trial studies demonstrated that CBT was superior to any single-component treatment such as stimulus control, relaxation training, educational programmes, or other control conditions. However, heterogeneity in patient assessment, CBT protocols, and outcome indicators made determination of the relative efficacy and clinical utility of the therapy difficult. Therefore, the standard components of CBT need to be clearly defined. In addition, a comprehensive assessment of patients is essential for future studies.

Promoting quality sleep in older people: the nursing care role

Sleep is a basic activity of living. Its restorative properties in healthcare settings--both hospital and community--should be considered by healthcare workers. Its significance in gerontological nursing should not be underestimated. As older people are prone to multiple pathology, disease processes may mask their need for effective sleep and rest. "Sleep architecture" is a term that applies to the mechanics of sleep or its stages and clinicians may fail to identify when this is disrupted. "Sleep hygiene" refers to measures or interventions used to promote sleep and a person-centred approach is necessary, with support from specialist agencies to achieve effective sleep hygiene. The need for long periods of sleep may diminish owing to ageing. However, the quality of the sleep experiences, i.e. feeling rested and refreshed, should be the same. Several factors have been identified in the causation of insomnia. In healthcare settings, environmental factors such as noise and light pollution are the commonest features. Other issues that may be present in both healthcare and community settings are related to varied perspectives, such as physiological, psychological and spiritual-religious. Providing a climate conducive to health sleep in all settings becomes a requisite in the planning of care.

Insomnia, depression and anxiety disorders and their association with benzodiazepine drug use among the community-dwelling elderly: implications for mental health nursing

Benzodiazepine (BZD) drug use among seniors is an important public health issue because the benefit from their use is moderate and of short duration and numerous adverse events have been linked to their use. Furthermore, there is a significant discrepancy between the prevalence of mental health disorders and BZD drug use in the elderly population, which can be attributed to a measurement issue. The goal of this cross-sectional descriptive study was to determine the prevalence of mental health disorders among seniors using BZD and living in the community, basing this information on both a thorough face-to-face interview and a pair of self-reported validated instruments. Among the 216 seniors recruited in our study, nearly 20 % were users of BZD and over three quarters of them had been using this drug for more than a year. Thirteen subjects were recognized as depressed according to a self-report measure compared to 18 according to the interview. Likewise, 13 seniors were categorized as anxious, based on a self-report questionnaire compared to 39 based on the interview. Among self-reported measures of mental health variables, logistic regression indicated that insomnia increases by 7 the likelihood of using BZD (odds ratio: 7.2) and is the only statistically significant variable associated with BZD consumption. Based on thorough interviews, logistic regression showed that insomnia (odds ratio: 6.9) is still the dominant symptom associated with BZD drugs. In conclusion, our results clearly support the assertion that mental health status is influenced according to how it is measured. Finally, nurses should be aware that not all individuals are capable of expressing their mental health problems using either psychological or emotional terminologies. They may opt for expressing their psychological suffering as a physical symptom such as sleeping problems.

A study on the experience of insomnia in a psychiatric inpatient population

Complaints of insomnia among psychiatric inpatients are high. Many technical studies about insomnia are available in the literature, but few make reference to individual experience. This study examines the subjective experience of insomnia for psychiatric patients in one mental health unit. A random purposive sample of seven subjects was selected from the population of patients complaining of insomnia. Subjective experience was examined using a tape-recorded semistructured interview. The data were analysed using Burnard's content analysis framework. Ten categories were identified: control, wants and desires, holistic, assessment, individualisms, beliefs, conflict, communication, resignation and sleep signatures. Biographical data, and data from clinical notes about sleep were also collected. Results show that the impact of insomnia should not be underestimated and that attention to this aspect of a patient's experience could have a general effect on their mental health and well-being.

Sleep promotion in hospitalized elders

Older adult patients often have poor, fragmented sleep when they are in the hospital. The factors contributing to sleep disturbance in hospitalized elders will be explored, and interventions for promoting sleep among these patients will be discussed.

Developmental stages of sleep from birth to adolescence, common childhood sleep disorders: overview and nursing implications

Sleep is an important physiological process with profound impact on the body. Sleep undergoes normal developmental changes and common sleep problems are seen in general pediatric practice. This article discusses normal developmental changes related to sleep, common sleep disorders experienced by children and how nurses can assist parents in coping with these changes and disorders.

Management of chronic insomnia in the elderly

Insomnia is a common complaint in the elderly. It is not a disease in and of itself, but a symptom of an underlying problem with the potential for medical, psychological, and functional complications. Approximately one half the persons aged 65 years and older experience insomnia. However, few mention their sleep problems to their primary care providers. Because of the prevalence of insomnia in the elderly and the potential for complications, it is important for primary health care providers to understand the cause, assessment, and management of chronic insomnia. Both pharmacologic and behavioral therapies are effective in the treatment of insomnia. Early recognition and treatment may increase the quality of life for the elderly insomniac.

Correlates of sleep quality in persons with HIV disease

This study used the Symptom Experience dimension of the revised UCSF Symptom Management Conceptual model to examine correlates of sleep quality in HIV-infected persons. According to this model, person, health/illness, and environment categories influence perception of a symptom. The average person in the sample (N = 58) reported being HIV-infected for 8.5 years and was 46 years old, not working, and a person of color. Depending on the level of data, either chi square or Pearson correlations were computed between the person, health/illness, and environment categories and the dependent variable, sleep quality, as measured by the Pittsburgh Sleep Quality Index. Person variables significantly related to sleep quality were employment status, trait anxiety, and general well-being. Health/illness variables significantly related to sleep quality were length of time living with HIV disease and five health status measures (depressive symptoms, state anxiety, symptom severity, daytime sleepiness, and functional status). The environmental variables associated with sleep quality were sleeping alone, having a separate bedroom, and sleeping in a noisy room. Correlates of better sleep quality are positive general well-being, less anxious personality trait and emotional state, less daytime sleepiness, less depressive symptoms, and less symptom severity. Correlates of worse sleep quality are impaired functional status and longer duration of living with HIV disease.

Sleep promotion in adults

Insomnia is among the most frequent health complaints brought to the attention of primary care providers. The prevalence estimates are highest in women, older adults, and patients with medical or psychiatric disorders. Clinical researchers have studied many barriers to sleep as well as some sleep promotion interventions for the ill and aging adult. Environmental, personal, and person-environment rhythm factors have been identified as correlates of poor sleep. All interventions studied by nurse researchers are non-pharmacological and have been classified as interventions that (a) create an environment more conductive to sleep, (b) relax the sleeper, or (c) entrain the circadian sleep-wake rhythm. This chapter summarizes results of published research on correlates of poor sleep and interventions to promote sleep. The chapter includes the relevant studies conducted by researchers in related disciplines as well as nurses' research. The arcs software package was used to facilitate summarization of intervention studies. It was concluded that correlates of poor sleep are well described, but theories of sleep promotion are not well explicated. Also, the research base for sleep promotion interventions for use with clinical populations other than those with chronic insomnia is sparse. Gaps in knowledge are identified and conceptual and methodological issues are discussed as the basis for future directions in sleep promotion research.

Health visitor-run adult sleep clinics

Two sleep clinics run by health visitors were set up in Dundee to provide a brief, time-limited programme of advice and treatment for adults with insomnia and referred by their GPs. This article describes the clinics and reports the clinical features and outcome of the first 100 patients referred.

A nonpharmacologic sleep protocol for hospitalized older patients

OBJECTIVES

To evaluate the feasibility of and adherence to a nonpharmacologic sleep protocol targeted to nurses for acutely ill older patients and to test the effectiveness of the protocol on enhancing sleep and reducing sedative-hypnotic drug (SHD) use.

DESIGN

Prospective cohort study.

SETTING

A 34-bed general medical unit in a university-affiliated teaching hospital.

PARTICIPANTS

A total of 175 consecutive admissions aged 70 years or older.

INTERVENTION

A nonpharmacologic sleep protocol consisting of a back rub, warm drink, and relaxation tapes was administered by nursing personnel to patients who complained of difficulty initiating sleep or who requested a SHD. After 1 hour, if the patient still requested it, the nurse administered the SHD.

MEASUREMENTS

The main outcomes of sleep quality and SHD use were measured by patient interview and chart abstraction. Feasibility and adherence to the protocol were tracked daily by patient and nurse interviews and chart abstraction.

RESULTS

A cohort of 111 patients, mean age 79.3 (+/- 6.4), 68% women, received the sleep protocol. Patients required the protocol for a mean of 4.9 days per patient, totalling 539 patients-days. The overall adherence rate was 400/539 (74%) patient-days. The rate of complete nonadherence was 139/539 (26%), with reasons for nonadherence including nurse nonadherence in 30 (6%), patient refusal in 104 (19%), and medical contraindications in five (1%). The quality of sleep correlated strongly with the number of parts of the protocol received, suggesting a dose-response relationship, with the highest correlation for receiving two to three parts (p = .64, P < 0.001). The sleep protocol was successful in reducing SHD use from the baseline preintervention rate of 51/94 (54%) to 34/111 (31%) (P < .002). The sleep protocol had a stronger association with quality of sleep (p = .75, P = .001) than did SHDs (p = .07, P = .45). However, chronic SHD users were more likely to refuse the protocol than nonusers (64% vs 41%, P < .03) and received SHDs 4.5 times more often than nonusers (67% vs 15%, P = .001).

CONCLUSION

The nonpharmacologic sleep protocol provides a feasible, effective, and nontoxic alternative to SHDs to promote sleep in older hospitalized patients. Use of the protocol can substantially decrease use of SHDs.

Insomnia, alcohol, and over-the-counter drug use in old-old urban women

Insomnia is a common complaint of older adults. Historically, alcohol and over-the-counter (OTC) medications have been used as sedatives. Yet, there is a lack of information regarding the use of these substances by old-old urban women. A volunteer sample of 155 urban women over the age of 85 participated in a two-part structured interview to obtain data related to their health, sleep patterns, use of alcohol and OTC medication to improve sleep, awareness of hazards associated with use of these substances, and reason for seeking health care for insomnia. Findings indicate that all of the women had health problems and difficulty in sleeping. The majority used alcohol, OTC medication, or both on a regular basis in an effort to improve their sleep. Nurses who work with very old women need to assess clients' use of these substances and the side effects associated with them.

Insomnia and mental health

The night care team's role in promoting mental health is not simply administering hypnotics. This paper describes the knowledge base needed and identifies several behavioural and cognitive strategies to aid patient empowerment.

An investigation into primary nursing and its effect upon the nursing attitudes about and administration of prn night sedation

This study aims to explore the administration of prn night sedation by qualified night nurses on primary nursing and team nursing wards using a quasi-experimental design. The purpose of the study was to examine the attitudes of qualified nurses (n = 20) about sleep problems in hospital and sleep medication and compare these attitudes with behaviour (the administration of prn night sedation) reporting any differences between wards using team and primary nursing philosophies of care. Ten nurses from team nursing wards and 10 nurses from primary nursing wards were interviewed about the amount of night sedation they had administered during one night shift. This was followed by a questionnaire aimed at examining their attitudes about sleep and night sedation using several visual analogue scales. Findings proved to be significant in that results confirmed that team nurses gave out almost three times as much prn night sedation as nurses on primary nursing wards and held attitudes that closely correlated with more of a 'medical model' approach such as an emphasis on the advantages of night sedation and the need for its continued use in the clinical area.

Effect of the use of sleep medication in Dutch hospitals on the use of sleep medication at home

Insomnia is an important nursing problem in hospitals. Although the use of sleep medication is often criticized, it is one of the commonest interventions with regard to sleep problems. In this study, the effect of the administration of sleep medication in Dutch hospitals on the use of sleep medication at home is investigated. Only patients were included who had never used sleep medication before admittance in hospital. Results show that patients who used sleep medication for at least 5 days in hospital (n = 233) used sleep medication more often at home after discharge than patients who did not use sleep medication in hospital (n = 55). Furthermore, the study showed that those patients who used at least 5 days' sleep medication, especially those patients who used sleep medication more often in hospital, also used sleep medication more often at home. This is in line with the addictive effects of sleep medication. From these results it can be concluded that the administration of sleep medication is not without danger. Therefore, it is recommended to search for alternative interventions, especially for patients who are in hospital for a longer period.