Addressing Sleep Deprivation in Adult Critical Care: A Framework for Evidence-Based Practice

Selected Area of Advanced Practice Nursing: Adult Critical Care Nurse Practitioner (ACNP)

Theory/Model: Roy Adaptation Model (RAM)

Issue/Concern: Sleep deprivation is a prevalent issue in critically ill patients within the Intensive Care Unit (ICU). This can lead to a cascade of negative consequences impacting patient outcomes.

Impact on Healthcare Outcomes:

• Impaired cognitive function and decision-making
• Increased risk of delirium and ventilator dependence
• Weakened immune system and increased susceptibility to infections
• Longer hospital stays and higher mortality rates

Roy Adaptation Model (RAM) as a Framework:

The RAM posits that humans are continuously adapting to stimuli in their environment. In the ICU setting, critical illness disrupts a patient’s physiological, psychological, and social modes of adaptation.

RAM’s Relevance to Sleep Deprivation:

• Physiologic Mode: Sleep deprivation directly impacts physiological adaptation. It disrupts circadian rhythms, hormonal balance, and the inflammatory response.
• Psychological Mode: Sleep deprivation can lead to anxiety, depression, and cognitive dysfunction. This can hinder a patient’s coping ability and participation in recovery.
• Social Mode: Sleep deprivation can negatively affect communication and interaction between patients, families, and healthcare providers.

Using RAM for Evidence-Based Practice:

By applying RAM, ACNPs can assess the impact of sleep deprivation on all three adaptive modes. This framework can guide evidence-based interventions to promote sleep hygiene in the ICU:

• Physiological: Implementing structured sleep schedules, minimizing noise and light disruptions, and using melatonin supplementation (when appropriate).
• Psychological: Providing psychotherapeutic interventions like relaxation techniques or cognitive behavioral therapy for anxiety.
• Social: Encouraging family presence during designated quiet times and facilitating open communication about sleep concerns.

Unique Insights from RAM:

RAM goes beyond addressing physical symptoms. It highlights the interconnectedness of physiological, psychological, and social factors in sleep deprivation and recovery. This holistic perspective guides ACNPs to create a comprehensive sleep promotion plan for each patient’s unique needs.