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Title: Surgical patients' experiences of sleep, night-time pain and analgesic provision
Author: Closs, Susan José
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1992
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This thesis examines the interactions between sleep and pain through three studies of surgical patients. The first survey examined 200 patients' experiences of sleep in hospital; the second study examined analgesic provision retrospectively for a sub-sample of 36 patients from the initial survey; and the third study concentrated on 100 patients' experiences of, and the relationships between, sleep, pain and analgesic provision. The first study indicated that the majority of patients felt that their sleep was worse in hospital than at home. Pain or discomfort were cited by 90% of patients as disturbing sleep at night. The frequency with which pain was reported as a cause of disrupted sleep prompted the next stage of work. Second, a retrospective examination of analgesic provision for a sub-sample of patients from the first study showed that analgesics were given approximately half as frequently during the night than during the day. It was also found that a mean of only 27% of the maximum doses of analgesics prescribed were actually given within the immediate post-operative period. In the third study, closer attention was paid to relationships between post-operative pain, sleep and analgesic provision. Pain was the most commonly reported cause of night-time sleep disturbance. Almost three-quarters of the sample reported that pain had interfered with sleep in some way. Virtually half of the patients felt that pain was worse at night. Many patients held strong beliefs about the relationships between pain and sleep. Over one-third of the patients felt that tiredness affected post-operative pain, for the most part making it worse. One-third felt that sleep reduced the intensity of the pain. Over three-quarters felt that sleep helped them to cope effectively with their pain and almost all believed that sleep had a positive effect on recovery. Patients received fewest doses of opioid analgesics during the night (as in the second study), while the majority of doses were given in the morning and evening. This circadian pattern of administration was not evident for non-opioid analgesics. Between one-fifth and one-quarter of the maximum possible amount of analgesics prescribed was actually given during the first two post-operative days. Overall, these studies underline that sleep and pain are inextricably linked and achieving adequate sleep and pain control presents particular problems for post-operative patients. It is recommended that the interactions between sleep and pain should be recognised by nurse practitioners, educators and researchers. Ways of improving night-time post-operative care are discussed with particular reference to the development of effective and efficient methods of assessing and controlling pain at night. Such advances in care might promote sleep and recovery from surgery.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available