THE NIGHTTIME ENVIRONMENT, INCONTINENCE CARE, AND SLEEP DISRUPTION INNURSING-HOMES

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.