1. Aaron Fischer, MSN
Larry Maturin, MSN, APN, ACNS-BC, CEN, CCRN
Use of Acupressure Improves Sleep in ESRD Patients with Sleep Disorders
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Picture 2: Seibert NeuroPsych, LLC. (2017). EEG results. Photos. Retrieved July 30, 2017 from
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Picture 4: Koberda, J. L. (2015) LORETA Z-score neurofeedback-effectiveness in rehabilitation of patients suffering from traumatic brain injury. J. Neurobiol 1(4): doi
Picture 5: Sherlin, L. H., Arns, M, Lubar, J. Heinrich, H., Kerson, C., Strehl, Ul, & Sternman. M. B. (2011). Neurofeedback and basic learning theory: Implications for research and practice. Journal of Neurotherapy, 15, /
BACKGROUND
Conceptual Framework
Johns Hopkins Evidence Based Practice PET Model
RESULTS
Insomnia is a significant source of stress and has been associated with increased mortality of ESRD patients1. Current research suggests that the mechanism behind sleep disorders in these patients is poorly understood, and is more complicated than simple accumulation of wastes due to declining kidney function2. Drug therapy has been used as treatment, but it is associated with decreasing quality of life in these patients3. This presents an opportunity for alternative therapies that can be applied by a nurse.
Findings were that the global PSQI scores improved for acupressure groups over the placebo group and the routine care groups. Only one study found that both the acupressure and placebo groups showed no improvement. One study of the six contradicted the others, founding the intervention to be no better than placebo. This was the only study of them conducted in a western country. Of the three main sets of acupoints applied, the most efficacious was the He7, Li4, and SP6 applied by Wu, Zou, Liu, Wu & Lin (2014)6. 6
This model was applied to examine the quality of the evidence to determine if it can be brought into evidence-based practice. The evidence steps were applied in this research.
Acupoints for Sleep
CONCLUSION
Overall, acupressure seems to be a safe, effective treatment for sleep disorders in these patients if routine care is also provided. 4 5
Acupressure alters brain chemistry by affecting the release of neurotransmitters and neurohormones3. Modulation of the ANS is another plausible mechanism5. The auriculovagal afferent pathway depresses sympathetic activity and activates parasympathetic nerves5.
Acupressure alters brain chemistry by affecting the release of neurotransmitters and neurohormones3. Modulation of the ANS is another plausible mechanism5. The auriculovagal afferent pathway depresses sympathetic activity and activates parasympathetic nerves5.
NURSING IMPLICATIONS
Further research needs to be conducted on this patient population, but current research suggests that it is evidence based. Furthermore, the intervention was found to be safe, well-tolerated and highly acceptable alongside routine care, suggesting that this intervention may enter the body of evidence-based nursing practice.
PURPOSE
METHODOLOGY
Examine the effects of acupressure for ESDR and hemodialysis patients with sleep disorders to determine if it has a place in EBP.
Internal/external search for evidence
Literature reviewed from CINAHL, MEDline, and ProQuest Nursing and Allied Health. Sources were gathered by searching subject headings (a) acupressure, (b) sleep, and (c) ESRD.
References:
1. Hanly, P.J., Pierratos, A., Musci, I., & Novak, M. (2017). Sleep disorders in end-stage renal disease. UpToDate. Retrieved from
2. Abassi, M. R., Safavi, A., Haghverdi, M., & Saedi, B. (2016). Sleep Disorders in ESRD Patients Undergoing Hemodialysis. Acta Medica Iranica, 54(3),
3. Tsay, S., & Chen, M. (2003). Acupressure and quality of sleep in patients with end-stage renal disease--a randomized controlled trial. International Journal Of Nursing Studies, 40(1), 1-7.
4. Shariati, A., Jahani, S., Hooshmand, M., & Khalili, N. (2012). The effect of acupressure on sleep quality in hemodialysis patients. Complementary Therapies In Medicine, 20(6), doi: /j.ctim
5. Wu, Y., Zou, C., Liu, X., Wu, X., & Lin, Q. (2014). Auricular Acupressure Helps Improve Sleep Quality for Severe Insomnia in Maintenance Hemodialysis Patients: A Pilot Study. Journal Of Alternative & Complementary Medicine, 20(5),
6. Adapted from Johns Hopkins Center for Evidence-Based Practice, n.d., Retrieved March 3, 2017, from ©The Johns Hopkins Hospital/The Johns Hopkins University. Reprinted with permission.