Sleep hygiene program implementation in patients with traumatic brain injury.
OBJECTIVE
Traumatic brain injury (TBI) is a serious public health problem. The impact of TBI on the individual is multifaceted and includes neurocognitive, behavioral, and psychiatric disturbances as well as greater predisposition for dementia. A common but significant problem reported by patients after TBI is sleep disturbance. The purpose of this manuscript is twofold: (1) to describe our experience with implementation of the newly developed sleep hygiene guidelines; and (2) to report our preliminary results of implementation of the sleep hygiene guidelines on TBI patient outcomes.


METHODS
A mixed methods approach was used to assess implementation of sleep hygiene guidelines and to gather preliminary data on outcomes.


RESULTS
Although not statistically significant, the average self-reported sleep duration of these TBI patients was slightly higher in 2010 than 2009, with a FIM score that was similar for both time points. In 2009, the mean change in functional independence measure (FIM) score (n = 34) was 1.44. In 2010, the mean change in FIM score (n = 33) was 1.42. In 2009, most patients (n = 13) admitted to the hospital continued to take medications and were discharged with a sleep aid. In 2010, most patients reported a change in their sleep medication prescriptions (on medications at admission and none at discharge) or had continued to take their prescribed sleep medications from admission to discharge (n = 12).


CONCLUSIONS
Sleep disorders have a major impact on health outcomes in patients with TBI. To optimize rehabilitation and ultimately improve functional outcomes of patients with TBI, implementation of evidence-based clinical guidelines for sleep is imperative. We report our initial experience with implementation of sleep guidelines.
Department of Nursing, VA Palo Alto Health Care System, Palo Alto, California, USA.
Linda
L
De La Rue-Evans
Karen
K
Nesbitt
Roberta K
RK
Oka
D000328:Adult; D001930:Brain Injuries / Q000451:nursing / Q000534:rehabilitation*; D002140:California; D005260:Female; D006284:Health Plan Implementation; D006801:Humans; D007318:Inservice Training; D008297:Male; D017410:Practice Guidelines as Topic; D012893:Sleep Wake Disorders / Q000517:prevention & control*