Sleep as an Occupation in Geriatric Nursing Facilities

PURPOSE: The purpose of this research was to identify the need for developing a sleep routine protocol for nursing home residents.

RESEARCH QUESTIONS:

Would a Needs Assessment Survey of health care professionals (HCPs) and nursing home residents yield results in favor of occupational therapy (OT) sleep routine protocol?

Can an OT sleep routine protocol be developed considering premorbid functioning and multiple factors affecting sleep function of nursing home residents?

RATIONALE: Nursing home residents commonly present with sleep disturbances due to medical as well as psychosocial reasons. Sleep disturbances result in decreased functional capacity and labor-intensive burden of care. Factors necessitating admittance to a nursing home include the loss of independence related to activities of daily living (ADLs), household chores, and community integration.

Lack of sleep also impedes residents’ ability to participate in therapy, recreational activities, and socialization. It may result in slower progress toward goals and thus delay discharge and increase the length of stay and the costs of health care. The Occupational Therapy Practice Framework: Domain and Process (3rd ed.; American Occupational Therapy Association, 2014) has included sleep as an occupation for the OT domain of practice.

DESIGN: Exploratory needs assessment survey

PARTICIPANTS: There were two sets of participants—the HCPs and the nursing facility residents. The participants for this study were limited to a 120-bed geriatric nursing facility using a purposive, convenience sampling. The resident inclusion criterion was a score of 19 and above on the Mini-Mental State Examination.

METHOD: This study were completed in two phases. First, the HCPs and the nursing home residents completed a survey. Then, an OT sleep routine protocol was developed using outcome data from the data analysis of the surveys.

The researcher developed two Likert rating scale closed-ended questionnaires using SurveyMonkey. A content expert reviewed the survey tools in order to increase the validity of the tools. These questions collected HCPs’ opinions for OT evaluation and intervention aspects of the sleep routine.

The HCPs survey was completed with SurveyMonkey. The nursing home resident survey questions were designed to explore factors affecting sleep routines such as medical condition, medications, comfort with the focus, and the sleep routine. The questions inquired for information on the premorbid sleep routine and the sleep routine during facility stay. These participants completed a manual survey. Responses from the survey were manually entered into SurveyMonkey.

ANALYSIS: All the collected data were analyzed using the “analyze results” feature of SurveyMonkey. Data analysis is presented in term of percentages to reveal HCPs’ and residents’ agreement for sleep routine protocol.

RESULTS: HCPs survey results: Thirty-one (91%) out of 34 valid respondents agree that OT should include a sleep routine protocol in the geriatric setting to achieve balance in life.

Resident survey results: Among 27 participants, 19 (70.37%) were willing to work with OT in developing a sleep routine protocol, and 26 (96.29%) were willing to adapt sleep routine protocol.

DISCUSSION: The medical model of OT in the nursing facility primarily focuses on ADL retraining, mobility, range of motion, strengthening, and balance. In some instances, OT may focus on bed positioning for comfort or performing ADL tasks. Seldom is any attention given to the sleep routine, even though this concern is frequently expressed by the nursing home residents.

Protocol includes OT assessment of sleep routine and factors affecting sleep. In addition to OT assessment of self-care skills, mobility, and underlying impairments assessment of factors affecting sleep routine wounds, medications, cognition, pain/sensory factors, positioning, and the environment is needed.

IMPACT STATEMENT: Based on the resident survey, occupational therapists working in the nursing home setting should consider systematic evaluation of factors affecting sleep routines and providing intervention of the factors to facilitate an individualized sleep routine in order to create a life balance in the nursing home residents.

References

American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006