n.Symptoms of a disturbance: Do you grind your
teeth at night?
o.Interventions attempted and results: What
measures have you taken to promote a comfort-
able sleep environment?APPLYING YOUR KNOWLEDGE
REFLECTIVE PRACTICE USING CRITICAL
THINKING SKILLS
Sample Answers
1.What nursing interventions might the nurse
employ to help alleviate Mr. Bittner’s sleep
disturbances?
Nursing strategies for promoting rest and sleep in
older adults include encouraging physical activity,
discouraging napping, arranging an assessment for
depression and treatment, reviewing medications,
assessing for any side effects of sleep pattern distur-
bance, and decreasing fluids in the evening.
2.What would be a successful outcome for this patient?
At next visit, Mr. Bittner lists 3 strategies to follow
to help alleviate his sleep disturbance.
In 3 weeks, Mr. Bittner reports obtaining 6
undisturbed hours of sleep at night.
3.What intellectual, technical, interpersonal, and/or
ethical/legal competencies are most likely to bring
about the desired outcome?
Intellectual: knowledge of the factors that affect rest
and sleep, including developmental variables
Interpersonal: ability to assist older adults to
develop methods to promote adequate sleep and
cope with disturbed sleep patterns
Ethical/Legal: ability to practice in an ethically and
legally defensible manner when providing care to
patients experiencing disturbed sleep pattern
4.What resources might be helpful for Mr. Bittner?
Printed materials on sleep enhancement strategies,
relaxation therapy, consultation with a sleep therapist
PATIENT CARE STUDY
1.Objective data are underlined; subjective data are in
boldface.
Gina Cioffi, a 23-year-old graduate nurse, has been
in her new position as a critical care staff nurse in a
large tertiary-care medical center for 3 months.“I
was so excited about working three 12-hour
shifts a week when I started this job, thinking I’d
have lots of time for other things I want to do,
but I’m not sure anymore,” she says. “I’ve been
doing extra shifts when we’re short-staffed
because the money is so good, and right now it
seems I’m always tired and all I think about all
day long is how soon I can get back to bed.
Worst of all, when I do finally get into bed, I
often can’t fall asleep, especially if things have
been busy at work and someone ‘went bad.’Does
everyone else feel like me?” Looking at Gina, you
notice dark circles under her eyesand are suddenly
struck by the change in her appearance from whenshe first started working. At that time, she
“bounced into work” looking fresh each morning,
and her features were always animated. Now, her
skin is pale, her hair and clothes look rumpled, and
the “brightness” that was so characteristic of her
earlier is strikingly absent. With some gentle ques-
tioning, you discover that she frequently goes out
with new friends she has made at the hospital
when her shift is over, and sometimes goes for 48
hours without sleep. “I know I’ve gotten myself
into a rut. How do I get out of it? I used to think
my sleep habits were bad at school, but this is a
hundred times worse because there never seems
to be time to crash. I just have to keep on going.”
2.Nursing Process Worksheet
Health Problem:Sleep pattern disturbance: altered
sleep–wake patterns
Etiology: Twelve-hour shift work and stress of new job
Signs and Symptoms: Works three 12-hour shifts plus
two or three extra shifts per week; “right now it
seems like I am always tired and all I think about all
day long is how soon I can get back to bed; when I
do finally get into bed I often can’t fall asleep.”
Dark circles under eyes; pale skin; sometimes goes
48 hours without sleep; reports being less animated.
Expected Outcome: By this time next month
(7/22/11), patient will report she is sleeping
soundly for a minimum of 6 hours per night at least
6 days a week, as evidenced by her feeling less
fatigued and more in control of sleep situation.
Nursing Interventions:
a.Instruct patient to keep a sleep diary for 7 days
and analyze its contents at the end of the week.
b.Counsel patient about the need to reevaluate pri-
orities (e.g., working extra shifts).
c. Develop stress management strategies, including
relaxation exercises.
d.Identify and reduce (where possible) factors
interfering with sleep.
Evaluative Statement:10/6/11 Expected outcome met:
Sleeping 7 to 8 hours per night and generally feels
refreshed upon awakening.—N. McLoughlin, RN
3.Patient strengths: Strongly motivated to address
this problem
Personal strengths: Comprehensive knowledge of
the physiology of sleep and sleep requirements and
patterns; familiarity with the stresses of clinical
nursing, especially for the graduate nurse; strong
interpersonal skills; creative problem solver
4.10/6/11: Patient “bounced into the office” with the
vigor and enthusiasm she displayed when she first
started working. Her skin had regained its usual col-
oring and glow, and her face was animated. She
expressed gratitude for “helping me recover my old
self” and reported that she is sleeping 7 to 8 hours
per night and usually wakes up refreshed and ready
to tackle the new day. On questioning, she expressed
an appreciation for the need to balance rest and
activity and appears to have developed a workable
plan for ensuring adequate rest.—N. McLoughlin, RNCopyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing:ANSWER KEY 391
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