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sleep disruption, nursing care practices



  1. Schnelle, John F.
  2. Cruise, Patrice A.
  3. Alessi, Cathy A.
  4. Al-Samarrai, Nahla
  5. Ouslander, Joseph G.


Background: Urinary incontinence is a common problem among nursing home (NH) residents and can be successfully treated with prompted voiding during daytime hours. A previous study of incontinent NH residents demonstrated that noise from the staff and other residents and light and noise from staff-initiated incontinence care routines were associated with waking episodes. Nighttime incontinence care should be individualized to minimize sleep disruption while considering moisture exposure that could affect skin health. Although descriptive studies have been published, there are no published intervention studies describing attempts to improve nighttime environmental factors in NHs.


Objective: To individualize nighttime incontinence care while minimizing sleep disruption among NH residents.


Method: Subjects were assigned to a 2- or 4-hour incontinence care schedule based on each resident's risk of skin problems using objective data of spontaneous body movements at night and skin health during baseline, and the research staff provided incontinence care if residents were found awake.


Results: Awakenings due to light and sound associated with incontinence care were significantly reduced during the intervention phases (p <.001), and there were no adverse changes in skin health or on most risk factors associated with skin (e.g., exposure to moisture, body turns).


Conclusions: Incorporating this intervention component into more comprehensive efforts to improve sleep and evaluating the long-term effects of the intervention on skin health are recommended.