Sleep journal discussion

Running head: PEAK’S SLEEEP JOURNAL 1 Peak’s Sleeep Journal Regina Peaks Aspen University Health Assessment N495 March 18, 2018 PEAK’S SLEEEP JOURNAL 2 Peak’s Sleep Journal Sleep is probably one of my biggest problems. I feel I am either not getting enough sleep or too much sleep. In any case, I wake up feeling tired and groggy. In recent years, there has been much research performed on sleep and its effect on job performance. In this paper I intend to research and understand how sleep leads to insomnia, affects my health as well as job performance. Causes of my Insomnia For this assignment, I documented my sleep patterns during my working days this week because they are the most hectic days of the week for me and create so much stress. On these days, I suffer insomnia which is the inability to fall asleep. https://sleepfoundation.org/insomnia/content/what-is-insomnia I feel that I suffer from insomnia because I work on an isolation unit where many of the patients are diagnosed with AIDS and suffer from chronic infections. These infections include toxoplasmosis, crytococcal meningitis, and oral candidiasis. These patient are also at greater risk of getting Tuberculosis and Hepatitis as many of them are homeless which is mainly why they are placed on the isolation unit. In addition, the flu season has caused the general public to be overwhelmingly affected with cold symptoms so we currently have an overflow on our unit. Our overflow consists of 5-10 patients that share the waiting area as a room and 1-2 nurses take care of these patients in a make shift unit. This is what causes stress and leads to my insomnia because I often have to work the overflow because we have a lot of new graduates on our unit that are not allowed to work the overflow. Although, I like being a nurse, my current workload is leading to stress which causes insomnia and a poorer quality of sleep. My Sleep Journal PEAK’S SLEEEP JOURNAL 3 Although, my sleep journal appears to be somewhat uniform, the lack of sleep affects me greatly as evidenced by sometimes I become disorganized throughout the work day despite making a plan. For example, I prepare my report sheet documenting the patient’s condition, IV access and any special needs they may have during the shift. Then what happens is the doctors make their rounds and start changing orders like how much and when to hang Vancomycin for instance. I have to call the pharmacy and order the medication and wait for it to be tubed to the unit or go get it from the pharmacy. The problem lies in the fact that the doctors order the medication to be started within the next thirty minutes of when the original bag was supposed to be hung. If you have ever worked on a Med-Surg unit in a hospital, then you know this is close to impossible. At this point, my whole day stops and I become focused on obtaining this medication in order to keep the patient on their schedule. Sleep journal discussion

Because I know at some point, a trough is going to have to be drawn and this result determines the next dosage of the medication. In the meantime, medication for the other patients are due and sometimes I fall behind and have to skip breaks and meals. In one study published in an issue of Health Affairs by the University of Pennsylvania, it was found that “medical errors occurred more often in hospitals when staff nurses work routinely long and unpredictable hours.” Below is documentation of my sleep journal including my working hours for the first three days last week that show unscheduled overtime leading and irregular working hours that lead to less sleep during the night. As you can see I spend a great deal of time commuting to and from work which is like work itself. PEAK’S SLEEEP JOURNAL 4 Peak’s Sleep Journal Monday Tuesday Wednesday March 11, March 12, March 13, 2018 2018 2018 0500 0500 0500 Wake-up Wake-up Wake-up 0600 0600 0600 Drive to Drive to work Drive to work 0658 0653 0701 Clock-In Clock-In Clock-In 2033 2130 1930 Clock-Out Clock-out Clock-out 2200 2300 2033 Arrive at Arrive at Arrive at home home home 2230 2330 2110 Sleep Sleep Sleep work PEAK’S SLEEEP JOURNAL 5 6.5 hours of 6.5 hours of 8.5 hours of sleep sleep sleep Lack of Sleep Effects on job Performance Sleep can lead to delayed response and poor decision making. Although, sleep research is prevalent, there has been a “long –standing conundrum for sleep scientists to create a controlled lab situation that sufficiently simulates the circumstances leading to severe lapses in real-world judgment”. Cite NewsRXHealth Another study shows that “sleep loss, and even poor-quality sleep, can lead to an increase in errors at the workplace, decreased productivity, and accidents that cost both lives and resources” http://healthysleep.med.harvard.edu/healthy/matters/consequences/sleep-performance-andpublic-safety Sleep, Performance, and Public Safety Thankfully, I have not made a fatal mistake yet. But I know that I have misused resources. For example, I take more supplies in patient’s rooms that are needed like IV flushes and 1000ml of normal saline when a 500ml bag of saline would have been more than enough knowing that we are experiencing a shortage of these supplies because of the storms in Puerto Rico which is where the majority of our IV solutions come from. Sleep journal discussion

Because I am on an isolation unit, whatever I take in the room has to be used in there. It is our unit’s policy not to stockpile medication in the patient’s room so it has to be discarded. So the lack of sleep affects my judgment and I wind of wasting products that cost the hospital in the long term. What did you learn about your sleep schedule? The thing that I learned most about my sleep schedule is that I am not getting quality sleep. I am sleeping between 6-8 hours a night but I am either thinking about the day’s events or PEAK’S SLEEEP JOURNAL 6 preoccupied about getting up in the morning to be on time for work. This affects my sleep greatly because I am not truly sleeping because of subconscious thoughts. Sleep is supposed to be a period of time where the body replenishes and rebuilds energy. The body needs sleep in order to regulate temperature, blood pressure, and levels of oxygen, carbon dioxide, and glucose in the blood. Higher demands are required to regulate these mechanisms when the body is awake. As a result of a lack of sleep, disorders in the body systems can occur. http://healthysleep.med.harvard.edu/healthy/matters/consequences/sleep-performanceand-public-safety Sleep, Performance, and Public Safety Research has shown that a lack of sleep can lead to several disease processes and disorders. There are three main types of study that help us understand the links between sleep habits and the risk of developing certain diseases. The first type (called sleep deprivation studies) involves depriving healthy research volunteers of sleep and examining any short-term physiological changes that could trigger disease. The second type of research (called cross-sectional epidemiological studies) involves examining questionnaires that provide information about habitual sleep duration and the existence of a particular disease or group of diseases in large populations at one point in time. The third and most convincing type of evidence that long-term sleep habits are associated with the development of numerous diseases comes from tracking the sleep habits and disease patterns over long periods of time in individuals who are initially healthy (i.e., longitudinal epidemiological studies). Some disorders that come from a lack of sleep include Obesity Diabetes Heart Disease and Hypertension Mood Disorders Immune Function Life Expectancy. For example, studies have shown that people who habitually sleep less than six hours per night are much more likely to have a higher than average body mass index (BMI) and that people who sleep eight hours have the lowest BMI. One short- PEAK’S SLEEEP JOURNAL 7 term sleep restriction study found that a group of healthy subjects who had their sleep cut back from 8 to 4 hours per night processed glucose more slowly than they did when they were permitted to sleep 12 hours. Studies have found that a single night of inadequate sleep in people who have existing hypertension can cause elevated blood pressure throughout the following day. This effect may begin to explain the correlation between poor sleep and cardiovascular disease and stroke. For example, one study found that sleeping too little (less than six hours) or too much (more than nine hours) increased the risk of coronary heart disease in women. Sleep journal discussion
Chronic sleep issues have been correlated with depression, anxiety, and mental distress. In one study, subjects who slept four and a half hours per night reported feeling more stressed, sad, angry, and mentally exhausted. In another study, subjects who slept four hours per night showed declining levels of optimism and sociability as a function of days of inadequate sleep. All of these self-reported symptoms improved dramatically when subjects returned to a normal sleep schedule. Data from three large cross-sectional epidemiological studies reveal that sleeping five hours or less per night increased mortality risk from all causes by roughly 15 percent. Of course, just as sleep problems can affect disease risk, several diseases and disorders can also affect the amount of sleep we get. While an estimated 50 to 70 million Americans suffer from some type of sleep disorder, most people do not mention their sleeping problems to their doctors, and most doctors do not necessarily ask about them. This widespread lack of awareness of the impact of sleep problems can have serious and costly public health consequences. Sleep and Disease Risk http://healthysleep.med.harvard.edu/healthy/matters/consequences/sleep-and-disease-risk PEAK’S SLEEEP JOURNAL 8 If you woke up during the night why did you wake up (bad dream, hot/cold, bathroom, heard a noise)? Did not wake during the night What is your sleep environment (dark, TV on, radio on)? What activity do you do before you go to bed (played game on tablet or phone, watched TV, read book, answered emails)? I sleep in a dark room with tv on watching a tv show that has monotone narration. can not go to sleep in quiet environment PEAK’S SLEEEP JOURNAL 9 What have you learned about your sleep pattern? What changes can you make to improve your health? ANA position on working hours for nurses PEAK’S SLEEEP JOURNAL 10 Association Position Nurses are responsible for independent judgement related to patient care and treatment; therefore, it is imperative that they monitor their own fatigue levels. They should be aware of factors that may influence prevalence and intensity of work-related fatigue and take actions to modify those factors. Nurses should • not work more than 12 hours per day or 48 hours per week • take a minimum of one 20-minute meal or rest break when working for 6 hours or more • take a minimum of one 10-15 minute break every 4 hours • limit the number of consecutive 12-hour shifts to 3 per week and consider having a minimum of 2 rest days in between. Persistent concerns regarding shift length promoted several professional organizations and regulators to issue recommendations regarding shift length fatigue and overtime in relation to patient safety (American Nurses Association 2014; The Joint Commission, 2011; Ellis, 2008; Institute of Medicine [IOM], 2004). The American Nurses Association (ANA) published recommendations in their position statement, “Assuring Patient Safety: The Employers’ Role in Promoting Healthy Work Hours for Registered Nurses in All Roles and Settings,” based on account research linking human fatigue with healthcare errors (ANA, 2006a). The statement also clarifies that nurses have an ethical responsibility and duty to their patients to recognize their level of fatigue before accepting patient assignments that extend beyond their scheduled work time (ANA, 2006b). PEAK’S SLEEEP JOURNAL 11 The ANA’s 2014 position statement, “Addressing Nurse Fatigue to Promote Safety and Health: Joint Responsibilities of Registered Nurses and Employers to Reduce Risk” addresses nurse fatigue in the interest of promoting safety and nurse well-being. Consistent with findings by Bannai and Tamakoshi (2014), the ANA (2014) acknowledges the relationship between working long hours and increased risk for sleep disturbances, injuries, musculoskeletal disorders, gastrointestinal problems, gastric ulcers, mood disorders, anxiety, obesity, diabetes mellitus, metabolic syndrome, cardiovascular disease, cancer, and adverse reproductive outcomes.Sleep journal discussion http://nann.org/uploads/About/PositionPDFS/1.4.1_Effect%20of%20Staff%20Nurses%20 Shift%20Length%20and%20Fatigue%20on%20Patient%20Safety%20and%20Nurses%2 0Health.pdf Does your currently employer follow this policy? No. Due to the nursing shortage and flu epidemic, it is not possible. Do you feel this is an issue and how should nurses address this issue? They should but it would take an independent group to implement strategies to reduce longer working hours leading to less sleep. Insomnia is a widespread problem that can and should be managed by the nursing profession. It is a problem that is associated with other medical conditions. If not addressed it has the potential to exacerbate other health issues. The nurse’s role in the management of insomnia includes: evaluating the condition, identifying possible causes of the insomnia, helping the patient implement lifestyle changes to manage insomnia and lastly assist the patient to work with their doctor to use any PEAK’S SLEEEP JOURNAL 12 medications used in the management of insomnia. https://ceufast.com/course/insomniainability-to-sleep Conclusion The phenomena of sleep inertia, or Sleep, Performance, and Public Safety At a Glance Benefits of Sleep Consequences of Insufficient Sleep • Sleep and Disease Risk • Sleep, Performance, and Public Safety Historical and Cultural Perspectives of Sleep how long it takes to be fully awake and able to function… more Features on this page • The demands and expectations of our modern society have placed increasing demands on our time, and more than ever people are making up for those demands by cutting back on sleep. Sleep and Judgment • At the same time, it is becoming increasingly clear that the cost of insufficient sleep is much higher than most people recognize. Factors That Affect Performance Drowsy Driving

• Scientific research is revealing, for example, how sleep loss, and even poor-quality sleep, can lead to an increase in errors at the workplace, decreased productivity, and accidents that cost both lives and resources. Awareness can help you improve your sleep habits and in turn your safety. Costly, Preventable Accidents Insufficient sleep may not have led the news in reporting on serious accidents in recent decades. However, that doesn’t mean fatigue and inattention due to sleep loss didn’t play a role in these disasters. For example, investigators have ruled that sleep deprivation was a significant factor in the 1979 nuclear accident at Three Mile Island, as well as the 1986 nuclear meltdown at Chernobyl. Investigations of the grounding of the Exxon Valdez oil tanker, as well as the explosion of the space shuttle Challenger, have concluded that sleep deprivation also played a critical role in these accidents. In both cases, those in charge of the operations and required to make critical decisions were operating under extreme sleep deprivation. While the Challenger disaster put the multi-billion dollar shuttle program in peril, the Exxon Valdez oil spill resulted in incalculable ecological, environmental, and economic damage. Sleep and Judgment (1:06) Dr. Robert Stickgold discusses a study that suggests a link between sleep loss and increased impairment in judgment. watch video In addition to the ties between such high-profile disasters and sleep deprivation, there is a growing recognition of the link between lack of sleep and medical errors in our hospitals. According to the Institutes of Medicine, over one million injuries and between 50,000 and 100,000 deaths each year result from preventable medical errors, and many of these may be the result of insufficient sleep, Doctors, especially newly graduated interns, are often expected to work continuous shifts of 24 to 36 hours with little or no opportunity for sleep. Although it is difficult to estimate the extent that sleep deprivation plays in medical errors, studies have shown a significant impact. For example, a 2004 study led by Dr. Charles Czeisler of the Division of Sleep Medicine at Harvard Medical School found that hospitals could reduce the number of medical errors by as much as 36 percent by limiting an individual doctor’s work shifts to 16 hours and reducing the total work schedule to no more than 80 hours per week. Long shifts and other factors that result in sleep loss have safety consequences for our highways as well. A National Sleep Foundation survey has revealed that 60 percent of adult drivers—about 168 million people—say they have driven a vehicle while feeling drowsy in the past year, and that more than one-third (103 million people) have actually fallen asleep at the wheel. Unfortunately, many of these situations end in tragedy. The National Highway Traffic Safety Administration estimates that 100,000 police-reported crashes are the direct result of driver fatigue each year, and they consider this a conservative estimate. More recent data suggests that the true Sleep deprivation can critically impair jo b performance, sometimes with disastrous long-term consequences. number is likely much higher. Sleep journal discussion

The Institute of Medicine estimates—based on recent high quality naturalistic and epidemiologic studies—that drowsy driving is responsible for fully 20 percent of all motor vehicle crashes. That would mean that drowsy driving causes approximately 1 million crashes, 500,000 injuries, and 8,000 deaths each year in the U.S. Drowsy Driving (0:42) Dr. Charles Czeisler discusses the link between motor vehicle accidents and tired drivers. watch video How Sleep Deprivation Affects Mental Performance The earliest scientific evidence of a link between sleep and performance dates back to the early 1930’s, when Nathaniel Kleitman, one of most significant figures in the field of sleep medicine, discovered a daily pattern in the speed and accuracy of cognitive performance. He showed that even in well-rested individuals there was a decrease in the level of individual performance that occurred in the early morning and again late at night. Thus, even when we are getting the amount of sleep we need, we can still expect normal fluctuations in our ability to function. In addition to these normal fluctuations, not getting enough sleep—whether for just one night or over the course of weeks to months—has a significant effect on our ability to function. Sleep deprivation negatively impacts our mood, our ability to focus, and our ability to access higher-level cognitive functions. The combination of these factors is what we generally refer to as mental performance. In the laboratory, researchers use scientific studies to determine just how significantly varying levels of sleep disturbance impact various types of mental performance. Nathaniel Kleitman in the 1930’s produced some of the earliest scientific evidence of the link between sleep and performance. Factors That Affect Performance (1:43) Dr. Charles Czeisler describes four factors that affect alertness and performance. watch video The most immediate effect of sleep deprivation is sleepiness. In our daily lives, we may experience this as a general fatigue, lack of motivation, or even the experience of nodding off. In the research or clinical setting, …Sleep journal discussion