Jf. Schnelle et al., THE NIGHTTIME ENVIRONMENT, INCONTINENCE CARE, AND SLEEP DISRUPTION INNURSING-HOMES, Journal of the American Geriatrics Society, 41(9), 1993, pp. 910-914
Objective: To evaluate the association between noise, light, nursing c
are practices, and nighttime awakenings in incontinent nursing home re
sidents. Design: Cross-sectional survey. Setting; Four long-term care
nursing facilities. Participants: One hundred eighteen incontinent nur
sing home residents. Measurements: Over two nights, bedside monitoring
equipment recorded wrist activity, resident bed movements, and enviro
nmental noise and light changes in consecutive 2-minute intervals. Cha
nges in sleep and bed movement were compared with changes in noise and
light that occurred within the same or proximal 2-minute intervals. N
oise and light changes in combination with large resident movement at
the hip and shoulder were interpreted as related to incontinence care
based on observational measures. Specific outcome measures were: (1) t
he number of noise and light changes as well as staff care practices t
hat did not wake the resident during periods of consecutive sleep, ie,
sleep lasting a minimum of 10 minutes; (2) the number of noise and li
ght changes as well as staff care practices that occurred immediately
before or during the 2-minute intervals during which a resident woke f
rom a period of consecutive sleep; and (3) the number of such staff ca
re practices that were related to incontinence care. Results: Noise an
d light changes associated with both general environmental events and
more specific nurse care practices were associated with 50% of all wak
ing episodes of 4 minutes or longer and 35% of all waking episodes of
2 minutes or shorter. The major sources of all noise were traced to nu
rsing staff. Eighty-seven percent of all incontinence care practices w
ere associated with episodes of waking. Conclusion: The data reported
in this paper document that general environmental noise and incidents
of nursing care practices, particularly those related to incontinence
care, are responsible for a substantial amount of the sleep fragmentat
ion that is common among nursing home residents.