A Study to Assess the Level of quality of sleep among post-Operative Patients Admitted in Jubilee Mission Medical College and Research Institute Thrissur

 

Aleena Saju, Ancy E.S, Anitta Joy, Aneeta Agustin, Aswathy V, Anna Aneena Alby,

Chanchal Chacko, Fousitha H.S

Jubilee Mission College of Nursing, Thrissur.

 

ABSTRACT:

The study was conducted to assess the level of quality of sleep among postoperative patients admitted  in JMMC and RI, Thrissur. Objectives: Objectives were to assess the level of quality of sleep among post-operative patients admitted in JMMC and RI, Thrissur and to associate socio-demographic and clinical data variables with level of quality of sleep among post-operative patients admitted in JMMC and RI, Thrissur. Methodology: A non experimental approach with descriptive design was used. The study was conducted by purposive sampling technique with 91 samples having age above 18 years from the general surgery ward of JMMC and RI. The data collection tool used in the study are demographic and clinical data variables and self developed questionnaire. Questionnaire score <45 is considered as adequate sleep and >45 is considered as inadequate sleep. Both descriptive (frequency, percentage) and inferential statistics were used to analyze the data. Results: Socio-demographic data shows that majority of people 22 (24.2%) belong to the age group greater than 58 years and 39-48 years and 47 (51.6%) are males, 51 (56%) are Hindus. Clinical data variables shows that majority of people 74 (81.3%) were given general anesthesia, 38 (41.8%) of people is on 2 nd post operative day, 39 (42.8%) slept for 2-4 hours, 79 (86.8%) use general ward, 57 (62.6%) does not have any comorbid conditions, 75 (82.4%) have sleep disturbances, 39 (42.8%) have moderate pain and 83 (91.2%) have no history of past use of sleep medications. Inference from the Self developed Questionnaire shows that majority scored >45, 63 (69.23%) post-operative patients had inadequate sleep and only 28 (30.6%) patients scored <45 and had adequate sleep.¹ There is significant association (p=0.001) between quality of sleep and sleeping hours. There is significant association (p=0.001) between quality of sleep and post-operative pain. Also there is significant association (p=0.001) between sleep quality and sleep. It is also evident that there is no association between quality of sleep and other  socio-demographic and clinical data variables among post-operative patients thus adequacy of sleep identified here.² Conclusion: The present study was to assess the level of quality of sleep among postoperative patients admitted in JMMC and RI,Thrissur. At the end of the study the investigators team found that majority 63 (69.23%) of post-operative patients have sleep disturbances only 28 (30.6%) had adequate sleep. This reflects that specific nursing care protocols for quality sleep in post-operative patients need to be developed and implemented.³

 

 

 

INTRODUCTION:

Sleep is a reversible behavioral state of perceptual disengagement and unresponsiveness to the environment.⁵ It is one of the most important physiological process required to maintain the physical and mental well-being of an individual.⁶ There is evidence that sleep helps healing and improving tissue growth and recovery from injury.⁷ Post-operative period has been associated with issues related to falling asleep and reduced duration of sleep.⁸ Sleep deprivation is defined as a prolonged period without the usual amount of sleep or a sufficient lack of restorative sleep over a cumulative period so as to cause physical symptoms and affect routine tasks.⁹ Sleep deprivation has a deleterious effect on recovery in post-Operative patients as it can lead to potentially dangerous side effects.¹⁰ Approximately 30% of a variety of adult samples drawn from different countries report one or more of the symptoms of insomnia; difficulty in initiating sleep, difficulty in maintaining sleep, waking up too early and in some cases non-restorative or poor quality of sleep.¹¹It is estimated that 10% to 30% of adults live with chronic insomnia.¹² Prevalence of chronic insomnia in adult patients and it's correlation with medical comorbidities.¹³ Some estimates place the life time risk of insomnia as 40% higher in women.¹⁴

 

OBJECTIVE:

To assess the level of quality of sleep among postoperative patients admitted in JMMC &RI Thrissur.

To associate sociodemographic and clinical data variable with level of quality of sleep among postoperative patients admitted in JMMC &RI Thrissur.

 

HYPOTHESIS:

There is significant association between quality of sleep among post-op patient with selected socio-demographic and clinical data variable.

 

MATERIALS AND METHOD:

Research Approach: Quantitative non experimental research approach

 

Research Design: Descriptive design.

 

Target population: Post-operative patients.

 

Accessible Population: Post-operative patients admitted to the general surgery ward of JMMC and RI.

 

Sampling Technique:  Purposive sampling

 

Sample Size: 91

 

Data collection procedures: Questionnaire

 

Data Analysis: Descriptive and inferential statistics

 

Criteria Measure: Postoperative quality of sleep

 

Setting: General surgery ward of JMMC and RI

 

RESULTS:

1. To assess the level of quality of sleep among post-operative patients admitted in JMMC and RI, Thrissur.

 

Table 1: Distribution of post-operative patients based on the socio-demographic variables suchasage, gender, religion, education, occupation, maritalstatus, typeofanesthesia, post-operativeday, sleep disturbance, sleep medicine and post-operativepain.       n=91

 

Table 1 shows that majority of people 22(24.2%) belong to two age groups that is age group greater than 58 yrs, and age group of 39-48yrs.47 (51.6%) are males.51(56%) are Hindus, 33 (36.3%) have primary education.37 (40.7) are unemployed.73(80.2%) are married. 43 (47.3%) have a monthly income below 5000.74 (81.3%) were given general anesthesia, 38 (41.8% ) of people is on 2 nd post operative day, 75 (82.4%) have sleep disturbances,83 (91.2% ) have no history of past use of sleep medications and 39( 42.8%) have moderate pain.

 

Table 2: Distribution of Sleep Quality among postoperative patients.                                               n=91

 

Table 2 Shows the distribution quality of sleep among post-operative patients. (30.6%) have adequate sleep quality and 69.23% have inadequate sleep quality

 

Figure 1: Distribution of quality of sleep in post-operative patients                                                     n=91

 

Figure 1 Shows the quality of sleep among post-operative patients. 30.67% have adequate sleep and 69.23% have inadequate sleep.

 

 

2. To Associate Socio-Demographic and Clinical data variable with level of quality of sleep among post-operative patients admitted to JMMC & RI, Thrissur.

Table 3: CHI square value df p value of association of socio-demographic and clinical data variables like age, type of anesthesia used, post-operative day, sleepinghours, sleepdisturbances, post-operative pain with quality of sleep among post-operative patients.

 

 

 

Table 3 shows that there is significant association (p=0.001) between quality of sleep and sleeping hours.  There is significant association (p=0.001) between quality of sleep and post- operative pain. Also there is significant association (p=0.001) between sleep quality and sleep disturbances. It is also evident that there is no significant association (p> 0.001) between quality of sleep and other socio-demographic and clinical data variables among post-operative patients.

 

DISCUSSION:

The findings of the study were discussed in terms of objects of study. The data collected from the findings of the present study was compared and contrasted with those other similar studies conducted in other settings.

 

*To Assess the Level of Quality of Sleep among postoperative patients admitted in JMMC &RI Thrissur.

The study shows that majority of patients 63 (69.23%) have adequate sleep and 28 (30.76%) have inadequate sleep.

 

These findings are supported by a non experimental descriptive study was conducted on 2018 to assess the quality of sleep on cardiac patients admitted in cardiac ward of JMMC and RI, Thrissur. There are 30 samples selected having age above 40yrs and below 18years by purposive sampling technique from selected cardiac ward of JMMC and RI, Thrissur. Demographic snd clinical data variables & Pittsburgh sleep quality index scale are used. The findings of the study shows that 73% of patients have adequate quality of sleep and 27% of them have inadequate quality of sleep in cardiac patients.

 

To Associate Sociodemographic and Clinical data variable with level of quality of sleep among postoperative patients admitted in JMMC and RI Thrissur:

There is significant association (p = 0.001) between quality of sleep and sleeping hours. There is significant association between quality of sleep and post- operative pain. Also there is significant association (p=0.001) between sleep quality and sleep disturbances. It is also evident that there is no association between quality of sleep and other socio-demographic and clinical data variables among post-operative patients

 

These Findings are supported by a multicenter cross-sectional study design conducted on 424 postsurgical patients who were selected by a systematic random sampling method. Data was collected using the Pittsburgh Sleep Quality Index by a face-to-face interview.¹⁵ Data analysis was done using SPSS version 25. For categorical data, a chi-square test was done. Bivariable and Multivariable analyses were performed to determine whether each of the independent Variables is associated with the outcome variable. Based on this study result, the prevalence of Poor sleep quality was 64.9%. Among the factors included in this study, variables which had an association with poor postoperative sleep quality were age range 25–54 years (AOR = 15.13), male gender (AOR = 4.81), educational level of secondary school (AOR = 6.29), patient income less than 2500 (AOR=3.77), anxiety (AOR=2.53), Depression(AOR = 22.8), light exposure(AOR = 19.60), poor social support (AOR = 1.98), Being emergency surgery (AOR = 2.46) and having a history of moderate to severe pain( AOR=38.18).¹⁶

 

CONCLUSION:

The main conclusion from the present study was to assess the Quality of sleep among postoperative patients admitted in JMMC&RI, Thrissur. The study shows that majority of patients 63 (69.23%) have adequate sleep and 28 (30.76%) have inadequate sleep.

 

At the end of the study the investigation team found that majority of patients have sleep disturbances during the fifth postoperative day. The sleep disturbance is associated with sociodemographic and clinical data variables. Some of the suggestions for improving post operative sleep are doing deep breathing exercises, practicing progressive muscle relaxation techniques, taking pain medicines 30 minutes before bedtime, maintaining a quiet and dim environment, and decreasing interruptions from care activities at night. Take a shower or bath, or listen to music, Share concerns etc. All of the above induces sleep.

 

NURSING IMPLICATIONS:

The present study has implications which are of vital concerns to the field of nursing education, nursing practice, nursing administration and nursing service.

 

Nursing staff can continue to provide health education regarding sleep hygiene practice in postoperative patients.  They can focus on problem with sleep quality and practice Nurse can provide appropriate intervention for improving sleep quality Nurse can periodically asses the sleep quality of postoperative patients.¹⁷

 

Nursing Administration:

Nursing administration department can take initiative in conducting health education campaigns regarding sleep quality in postoperative patients.  Administrative team can take initiative in allotting nurse educators Special endeavors by nursing administrator and educator to develop knowledge and practice of improving sleep quality. 

 

Nursing Research:

In future investigator can conduct the study in large scale Researches can be contacted by including the effectiveness of sleep hygiene practice. 

 

LIMITATIONS:

·        The study was limited to 91 samples. 

·        The study included only postoperative patients above 18 years of age Duration of study was limited to two weeks. 

·        Generalization of the study findings is limited due to small sample size of 91. 

·        The study is confined to a specific setting. 

·        No interventions were provided. 

 

RECOMMENDATIONS:

A similar study can be conducted in other setting on large sample with large periods of time. A similar study can be done by including more clinical and sociodemographic variables.  Experimental study can be conducted to assess the effect of sleep hygiene practice to improve the sleep.

 

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Received on 23.05.2022        Modified on 10.09.2022

Accepted on 17.11.2022       ©A&V Publications All right reserved