2. Use of White Noise Machine in Long-Term Care Patients Jamie Wilson COHP 450

3. PICO Question: In long-term care patients with sleep disorders (P), does the introduction of a white noise machine (I) compared with no white noise machine (C) decrease the risk of sleep disturbances (O)? Purpose: ~Assess if the use of a white noise machine decreases the risk of sleep disturbances ~ Increase nonpharmacological sleep interventions ~ Decrease use of sleep assistance medications Introduction

4. Search words: White noise machine in long-term care, sleep disturbances in long-term care, noise machine in long-term care, white noise machine, and elderly sleep Search engines: PubMed, CINAHL, and Google Scholar Results: The search revealed few articles on the PICO question subject. Numerous searches were conducted to locate relevant articles. Literature Search Results

5. Alessi, C., Martin, J., Webber, A., Kim, C., Harker, J., & Josephson, K. (2005). Randomized, controlled trial of a nonpharmacological intervention to improve abnormal sleep/wake patterns in nursing home residents. The American Geriatrics Society. 53, 803-810 Missildine, K., Bergstrom, N., Meininger, J., Richards, K., & Foreman, M. (2010). Sleep in hospitalized elders: A pilot study. Geriatric Nursing. 31(4), 263- 271 Reference

6. Randomized, controlled trial of a nonpharmacological intervention to improve abnormal sleep/wake patterns in nursing home residents- Nonpharmacological sleep interventions, sleep disruptions in the long-term care facility, study to improve elder sleep Sleep in hospitalized elders: A pilot study- Sleep disruptions (noise/light), elder sleep/wake cycles, recommendations to decrease sleep disturbances Rationale for Article Selection

7. Randomized, Controlled Trial of a Nonpharmacological Intervention to Improve Abnormal Sleep/Wake Patterns in Nursing Home Residents Theory: “The specific research question were to study whether the intervention would lead to decreased daytime sleep, increased nighttime sleep, and improvement in observable characteristics of quality of life, including increased participation in activities of social interaction” (Alessi et al., 2005). Type of study: Analytic Study Evaluation of Results Findings

8. Design: Randomized, controlled trial Methods: Setting- Participants- Procedures- Randomization- Equipment- Behavioral Observations- Intervention- Data Analysis- Findings: Reduced sleep disturbances lead to decrease daytime sleeping, increased social participation, which leads to an improved quality of life (Alessi et al., 2005). Sleep in Hospitalized Elders: A pilot study Theory: “The purpose of this study was to describe objectively and subjectively the sleep of elders hospitalized on general medical units and to determine the link between sleep and night-time noise and light levels” (Missildine et al., 2010). Evaluation of Results Findings Cont.

9. Type of Study: Analytical Study Design: Descriptive Explanatory Study Methods: Recruitment and Sample, Procedures, Measures, and Data Analysis Findings: The study showed sleep time was brief, with a mean of 3.75 hours and there was an average of 13 awakenings per night. “Recommendations include light and sound reduction measures and dedicated “do not disturb” times to allow for a full 90 minute sleep cycle” (Missildine et al., 2010). Evaluation of Results Findings Cont.

10. Randomized, Controlled Trial of a Nonpharmacological Intervention to Improve Abnormal Sleep/Wake Patterns in Nursing Home Residents -All resident at participating sites were screened for sleep patterns (the article did not discuss if the participants were aware and/or able to withdraw from the study). -A wrist monitoring device was worn to monitor movement during sleep hours Sleep in Hospitalized Elders: A pilot study -Participants were approached upon admission to general medical unit. -Wrist monitoring devices were worn to monitor movement during sleep hours. Ethical Considerations

11. Strength: High strength level. Quality: High-level of quality. Credibility: Peer reviewed, Published through American Geriatrics Society. Authors maintain credentials relevant to the study completed. Criteria used: Residents were screened for excessive daytime sleeping and nighttime sleep disruption. 120 of 339 screened were selected. Randomized, Controlled Trial of a Nonpharmacological Intervention to Improve Abnormal Sleep/Wake Patterns in Nursing Home Residents

12. EBP: Yes, this study showed that light and sound disturbances lead to sleep disruptions, using this information health care workers can promote sleep in the long-term care residents. Sleep in Hospitalized Elders: A pilot study Strength: High strength level. Quality: High-level of quality. Credibility: Peer reviewed. Published through Geriatric Nursing. Each of the authors maintain a PhD, degrees are relevant to study conducted. Continued

13. Criteria used: Elderly patients were approached upon admission to a general medical unit at a hospital. Patients were able to participate or refuse participation. Those who decided to participate were assessed to ensure they comprehended what their participation entailed. EBP: Yes, this study details how increased levels of nighttime light and sound in the health care setting can cause sleep disturbances. This information can be implemented in the long-term care setting to create a sleep promoting environment during the nighttime hours. Sleep in Hospitalized Elders: A pilot study

14. Relevance of findings: -Shows a need to implementation of a nonpharmacological program prior to initiation of psychoactive medication for sleep assistance. Findings communication: -Presentation developed with findings and how they specifically relate and will benefit the residents and facility - Presented to Director of Nursing Relevance of Findings to Practice

15. Implications for use in clinical setting: -Current practice can easily change with implementation of nonpharmacological interventions -Decreasing sleep disturbances will lead in an increased quality of life - Lead to reduction of psychoactive medications Potential Barriers to implementation: -Initial cost of purchase of white-noise machines for facility -Implementation of nonpharmacological policy prior to initiation of sleep assisting medications Relevance of Findings to Practice Cont.

16. PICO Question: For long-term care residents with sleep disturbances(P) does the use of a designated “do not disturb” nighttime environment (I) reduce the future risk of sleep disturbances (O) compared with no designated “do not disturb” environment (C)? PICO Question: For long-term care residents with sleep disturbances (P) does the use of daytime sleep reduction (I) reduce the future risk of nighttime sleep disturbances(O) compared with no reduction in daytime sleep (C)? Additional PICO Questions

17. Although the articles were not specifically discussing implementing a white-noise machine in the long-term care setting, they were beneficial in providing differences in sleep patterns for the elderly when not in a home setting. Including noise and light level. The articles discussed nonpharmacological interventions to assist in decreasing sleep disturbances. Rationale was provided to support implementation of nonpharmacological interventions for sleep disturbances in the elderly Summary