Unit 11

Module Overview

  • Title: Sleep, Rest, Death and Dying

  • Instructor: Nori Manson-Brick, RN, BSCN, MN

Learning Objectives

  • Understanding the necessity of sleep and rest.

  • Exploring the stages of sleep.

  • Recognizing the importance of sleep and factors that inhibit it.

  • Identifying various sleeping disorders.

  • Discussing types and sources of loss and grief.

  • Learning about the dying process and the body’s responses.

  • Defining the nurse’s role in post-mortem care and caring for families of dying patients.

  • Understanding Medical Assistance in Dying (MAID) and nursing responsibilities.

Sleep and Rest

  • Definitions:

    • Sleep: Essential for health, body function, and healing.

    • Rest: State of relaxation involving the cessation of activity and stress reduction.

  • Physiological Benefits: Impacts hormone secretion related to weight, metabolism, and behavior.

  • Cycle:

    • 24-hour cycle typically includes 16 hours of activity and 8 hours of rest.

    • Adults typically require 6-9 hours of sleep.

    • Less than 6.5 hours may adversely affect health.

Understanding Sleep

  • Purpose: Still debated, but linked to metabolic health, mood recovery, and memory enhancement.

  • Stages of Sleep:

    • Non-Rapid Eye Movement (NREM):

    • N1: Transition phase, light sleep where the person can be easily awakened.

    • N2: Eye movements slow, deeper sleep, harder to awaken.

    • N3: Deepest sleep, critical for body repair, difficult to rouse.

    • Rapid Eye Movement (REM): Characterized by increased brain activity, dreaming, and muscle paralysis. Heart rate and blood pressure increase.

  • Each sleep cycle lasts approximately 90-120 minutes, with healthy sleep comprising about 5-6 cycles per night.

Sleep Issues

  • Sleep Deprivation:

    • Linked to mood disturbances, decreased alertness, and cognitive performance.

    • Associated conditions: mental health disorders, diabetes, cardiovascular disease, gastroesophageal reflux (GERD).

    • Increases risks for illnesses, obesity, and diabetes.

Sleep Disorders

  1. Insomnia:

    • Insufficient sleep quantities affecting daily functioning.

    • Treatment may involve lifestyle changes and medications.

  2. Hypersomnia:

    • Excessive sleepiness without a clear cause.

    • Treatment is dependent on underlying causes.

  3. Narcolepsy:

    • Neurological disorder causing sudden sleep episodes.

    • No cure; treatment focuses on improving alertness.

  4. Sleep Apnea:

    • Characterized by episodes of interrupted breathing during sleep.

    • Treatments include CPAP devices and weight management.

  5. Restless Leg Syndrome:

    • Sensations causing discomfort and restlessness in the legs.

    • Treatment varies based on cause.

  6. Parasomnia:

    • Includes unusual behavior during sleep (e.g., sleepwalking).

    • Focus on patient safety is crucial.

Sleep Hygiene

  • Practices for Quality Sleep:

    • Maintain consistent sleep/wake times.

    • Create a conducive sleep environment (dark, cool).

    • Limit caffeine, alcohol, and screen time before bed.

    • Be mindful of stressors and their timing before sleep.

Grief

  • Nature of Grief: An individual response to loss influenced by personal experiences, psychological makeup, and cultural beliefs.

  • Types of Grief:

    • Normal/Uncomplicated: Varied physical, cognitive, emotional reactions.

    • Complicated: Chronic emotional distress that disrupts daily functioning.

    • Bereavement: A recognized period of mourning and adjustment post-loss.

  • Influencing Factors: Nature of death, coping skills, prior losses, support systems.

Dying and Death

  • Symptoms of the Final Stages:

    • Coolness and change in color/temperature.

    • Increased sleep due to decreased energy.

    • Disorientation and confusion.

    • Decreased oral intake and gastrointestinal changes.

  • Nursing Responsibilities in End-of-Life Care:

    • Provide pain relief and comfort measures.

    • Ensure proper oral and bowel care.

    • Support breathing and manage anxiety and restlessness.

    • Offer emotional support to patients and families.

    • Identify end-of-life transitions and provide holistic care.

Medical Assistance in Dying (MAID)

  • Definition: Involves administering or prescribing a substance to end life at the request of the person.

  • Adjustment to Law: Eligibility changed to include various circumstances regarding natural death.

  • Nurse’s Role:

    • Discuss MAID options with patients seeking information.

    • Facilitate connections with medical practitioners and manage care throughout.

    • Respect personal morals while providing necessary care for clients.

References

  • College of Registered Nurses of Saskatchewan. (2021). MAID guidelines.

  • Government of Canada. MAID law summary.

  • Perry, A., Potter, P., Ostendorf, W., & Cobbett, S. L. (2020). Nursing techniques. Toronto: Elsevier.