2. Danielle Elore COHP 450 Ferris State University PICO PRESENTATION: FOR HOSPITALIZED PATIENTS, DOES THE USE OF HYPNOTIC AGENTS AS COMPARED WITH NON- PHARMACEUTICAL SLEEP AIDS IMPROVE SLEEP?

3.  Using FLITE, I searched CINAHL, which is a nursing database.  Search words included: “Hypnotics sleep,” “hospitalized patients sleep,” and “noise reduction hospitals”  “Hypnotics sleep”: search produced a good research article about hypnotic sedatives prescribed for sleep  “Hospitalized patients sleep” and “noise reduction hospitals” did not produce adequate results  Using Google, I was able to find an article on the National Institutes of Health Website.  Search words included: “noise reduction hospital setting” and “noise reduction hospital patients sleep”  “Noise reduction hospital setting” did not provide adequate results  “Noise reduction hospital patients sleep” produced a good research article about noise reduction strategies and the impact of noise on hospitalized patients’ sleep LITERATURE SEARCH RESULTS

4.  Moloney, M.E., Konrad, T.R. & Zimmer, C.R. (2011). The medicalization of sleeplessness: A public health concern. American Journal of Public Health, 8, 1429-1433. doi: 10.2105/AJPH.2010.300014  Xie, H., Kang, J. & Mills, G.H. (2009). Clinical review: The impact of noise on patients’ sleep and the effectiveness of noise reduction strategies in intensive care units. Critical Care, 13(2), 208-215. doi: 10.1186/cc7154 LITERATURE SEARCH RESULTS

5.  The Medicalization of Sleeplessness: A Public Health Concern  This article is research on benzodiazepines and hypnotic sedatives prescribed for sleep. I chose this one because the article researches the increase in people being prescribed these agents and often do not have a medical diagnosis of insomnia.  Clinical Review: The Impact of Noise on Patients’ Sleep and the Effectiveness of Noise Reduction Strategies in Intensive Care Units  This article is research on the impact noise has on hospitalized patients’ sleep and the non-pharmaceutical measures taken to provide sleep by reducing noise. LITERATURE SEARCH RESULTS

6. Medicalization of Sleeplessness  Quantitative  Study Design: Cross- sectional survey, retrospective  Sample: Adults 18+ 1993 to 2007  Variables: Sleeplessness, insomnia diagnosis, Benzodiazepine/NBSH prescription  Statistical Analysis: SVY commands, bivariate linear model, descriptive statistics Clinical Review: Noise Reduction  Quantitative  Study design: Literature Review, retrospective  Sample: Hospitalized ICU patients  Variables: Hospital noise, noise reduction interventions  Statistical Analysis: Descriptive Statistics, Cochrane Collaboration RESEARCH STUDY EVALUATION

7.  Medicalization of Sleeplessness Results  NBSH prescriptions grew 21 times more rapidly than sleeplessness complaints and 5 times more rapidly than insomnia diagnoses  Ages 18-65 outpaced 65+ on all sleeplessness related measures  Very large rise in number of sleeplessness complaints in 2006-2007  NBSH increase sleep time by less than 12 minutes on average  Side effects include sleep driving, sleep eating, sleep walking and short term amnesia. Also, NBSH are risky for patients who take multiple medications, have a history of drug abuse or mental illness and those that are at risk for falls.  Proven nondrug treatments exist: sleep hygiene and environmental modifications. RESEARCH STUDY EVALUATION

8.  Clinical Review: Noise Reduction Results  Noise is just one of a number of factors that may disrupt sleep of an ICU patient  Staff conversation and alarms are regarded as the most disturbing noises for patients’ sleep in the ICU.  Four interventions exist for sleep improvement including: earplugs, behavioral modification, sound masking and acoustic absorption.  Sound absorbing treatment is an effective noise strategy  Sound masking is the most effective technique for improving sleep. RESEARCH STUDY EVALUATION

9. Medicalization of Sleeplessness  Used National Ambulatory Medical Care Survey (NAMCS) conducted by the National Center for Health Statistics (NCHS). http://www.cdc.gov/nc hs/about.htm http://www.cdc.gov/nc hs/about.htm Clinical Review: Noise Reduction  Did a literature review of other research studies using specific search engines. Found 167 studies, used 23 that included key criteria. Gave credit to each study used within this literature review. ETHICAL CONSIDERATIONS

10.  Medicalization of Sleeplessness  Peer Reviewed  Adequate background for research  Threat to external validity  Level of Measure: Ratio data Strength Quality Credibility RESEARCH STUDY EVALUATION

11.  Clinical Review: Noise Reduction  Peer Reviewed  Adequate background for research  No threats to validity  Level of measure: Nominal data Strength Quality Credibility RESEARCH STUDY EVALUATION

12. Medicalization of Sleeplessness  This article can contribute to EBP  Complaints of sleeplessness and/or diagnoses of insomnia should increase with prescriptions of sedative hypnotics Clinical Review: Noise Reduction  This article can contribute to EBP  More emphasis should be placed on nondrug interventions to promote sleep as they are proven to help without the side effects. EVIDENCE BASED PRACTICE CONTRIBUTIONS

13. Medicalization of Sleeplessness  This research can be used in practice at the professional level.  Information and statistics on sedative hypnotics is important to know when educating patients on these drugs  Educate patients on sleeplessness and insomnia as well. Clinical Review: Noise Reduction  This research can be used in practice at the professional level.  Results found when using nondrug interventions to promote sleep are in favor of using nondrug interventions vs. sedative hypnotics. RELEVANCE TO PRACTICE

14.  Pharmaceutical Companies  They will continue to produce sedative hypnotics. They are expensive and they make the company money. They will continue to advertise about these medications.  Physicians  Physicians have pharmaceutical companies promoting these drugs.  Physicians have patients asking for these drugs.  Physicians know the risks and low effectiveness, yet they prescribe them anyways. POTENTIAL BARRIERS

15.  For patients with a history of drug abuse, does the use of sedative hypnotics as compared with no sedative hypnotics produce addictive tendencies?  For elderly patients with an unsteady gait, does the use of sedative hypnotics as compared with no sedative hypnotics increase the risk of falls?  For hospitalized patients, does the use of earplugs/headphones as compared with music/white noise increase sleep?  For hospitalized patients, does the hospital noise/staff communication as compared with reason for hospital stay decrease sleep? ADDITIONAL PICO QUESTIONS

16.  For hospitalized patients, does the use of hypnotic agents as compared with non-pharmaceutical sleep aids improve sleep?  Both articles are credible resources that can be used to contribute to EBP and can be used in current practice.  Based on the research provided in this presentation:  Sedative hypnotics are ineffective.  Sedative hypnotics have potentially harmful side effects.  Sedative hypnotics are over-prescribed by physicians, especially when there is not a diagnosis for insomnia.  At least half of hospitalized patients state noise is the reason for inadequate sleep.  Noise reduction interventions work.  Other nondrug interventions available. CONCLUSION