Sleep can be defined as a lowered ability of reaction to stimuli though can be easily reversed than a coma or hibernation in some animals. Characteristically, almost all muscles that are involuntary become inactive during sleep. Sleep can be easily defined as a recurring state of lacking consciousness with suspension of the sensory abilities.
Sleep disorders on the other hand or somnipathy refers to a disorder of patterns of sleeping in a person or even animals. Various symptoms of sleep disorders do exist. One of the most common is daytime sleepiness. This is mostly characterized by sleepiness which is persistent, and a feeling of low or lacking energy. There are various ways of measuring the level and degree of daytime sleepiness. Although the objective measure, MSLT (Multiple Sleep Latency Test) bears a gold standard consideration, there exists other ways like the Epworth Sleepiness Scale and the Stanford Sleepiness Scale which are inexpensive and require less time to conduct (Takegami, 2009).
Epworth Sleepiness Scale (E.S.S)
ESS is defined as a questionnaire that can be self-administered with only 8 questions. It provides that persons average propensity of sleep during daytime. This method was first introduced by Dr John Murray in Australia while at the Hospital of Epworth in Melbourne. The method or standard has gained popularity and is now used worldwide for making sleepiness assessments.
Workings of the Epworth Sleepiness Scale
This simple method uses questionnaires which have a scale of between 0 and 3. The questionnaires are meant to find out the probability of sleeping in eight different scenarios engaged by most people even if not every day. Since dozing off depends on the number of times a person happens to be in a position that would cause them to doze off, individuals are not asked how often in particular situations do they doze off. The mental judgment required is easily made meaningfully by most people. A sum ranging from 0 to 24 of the score on the eight items makes the total score of the ESS. Even without assistance these answers are known to be easily provided within 3 minutes. A score of 10 or more may indicate excessive sleepiness and a further doctor’s evaluation may be necessary.
Validity and reliability of the Epworth Sleepiness Scale
Despite the fact that the Multiple Sleep Latency Test is considered a gold standard on which other sleepiness measurements ought to be compared, the ESS can be said to be quite valid and reliable. The fact that more than one sleep propensity situation is measured by ESS gives it a more validity edge. This is from the fact that a persons sleep propensity in a situation might differ given another situation.
Patients experiencing sleep disorders of various kinds are known to have had ESS scores that have significantly correlated with the mean latency of sleep measured by MSLT (Murray, 1991). Patients of sleep disorders have also been distinguished significantly from the test subjects using the ESS. Murray (1991) further assured the reliability of the ESS using two scenarios with different subjects. The first being 104 medical students in their third year of study at the Medical School of Monash University in Melbourne. The students had mean sleep duration of 7.7 hours on week nights and 8.4 during weekends. The second group of subject was 54 patients who were experiencing Obstructive Sleep Apnea Symptoms.
The healthy medical students were instructed to take an ESS in early May 1991.Without warning, the same students were again required to answer the ESS questionnaire 5 months past the first test. It should also be noted that at the time of undertaking the second ESS, they had just come back from a 2 months winter vacation. The mean ESS score for the first instance was 7.4 and a standard deviation (SD) of 3.9 while on the second test it was 7.6 with a standard deviation of 73.8. These two scores produced a mean difference of 0.20 and a standard deviation (SD) of 2.3 which is statistically not significant (Murray, 1991).
On contrary terms, the 54 patients with sleeping disorders had an initial ESS mean score 14.3 and SD 3.6. The range of the score was 5 – 21. On treatment with Continuous Positive Airway Pressure (CPAP), the mean ESS score came down to 7.4 and SD of 4.1. The range of ESS score also reduced to 0 – 16. In the final run, the difference between the two tests was 7.0 with SD of 5.2 which obviously is statistically significant (Murray, 1991).
Therefore, although there is always the possibility of a person giving false information so as to attain the desired ESS score especially in legal matters(Nakayama, 1998), the two subjects that were under the study ended up producing the most logical results. This method can thus be said to have shown reliability in test-retest. It is thus a valid and reliable method for finding out patients who might be having sleep disorders.
Stanford sleepiness scale
Stanford Sleepiness Scale (SSS) is yet another method that quickly measures the alert level of a person. An alert level of 1 would be most ideal. This method that measures the level of alertness at different time periods during the day would portray a serious debt in sleep if a person were to go below 3 when they ought to be alert. The SSS has a scale of between 1 and 7 with x representing asleep. Therefore at different time periods, a person would answer the questionnaires by providing the appropriate scale alongside 8 of the questionnaires (Glenville, 1978).
Validity and reliability of the Stanford Sleepiness Scale
In an experiment by Simon S. Smith to access Accidents and find their possible solutions, 32 novice drivers with a mean age of 19.88 years having a mean of 1.65 years of experience driving were used. Using the SSS scale, they rated their alert levels whereby 1 referred to being active, wide awake or alert. 7 referred to a point of onset of sleep. The test were carried twice once during daytime and another test at 3.a.m. in the night.
The results showed that at night, there was a significant feeling of sleepiness. This feeling attained a mean score of 4.32 with SD of 0.99. During the day however, the SSS score only stood at a mean of 2.22 with a SD of 1.16 (Takegami, 2009). These two results can produce a statistical significance when their mean difference is computed.
Conclusion
It can therefore be concluded that the Stanford Sleepiness Scale produces results that reflect the expected outcomes (Maclean 1992). It can thus be said to be reliable. This method can be validly used to measure the alert level in a person at different times of the day.
References
Glenville M, et al. (1978). Broughton R. Reliability of the Stanford Sleepiness Scale compared to short duration performance tests and the Wilkinson Auditory VigilanceTask. Oxford:PubMed.
Maclean, a. et al. (1992). Psychometric evaluation of the Stanford Sleepiness Scale. Journal of Sleep Research. 1(1), 35-39
Murray,J. et al. (1991). A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6), 540-545
Nakayama, T. et al (1998). Validity, Reliability and Acceptability of the Japanese Version of the General Well-Being Schedule (GWBS). Great Britain:Kluwer.
Takegami, M. et al. (2009). Development of a Japanese version of the Epworth Sleepiness Scale (JESS) based on item response theory. Sleep medicine. 10(5), 556-565
As early as the 14th century an Arab writer described symptoms resembling those of African sleeping sickness. But it was only after the success of European colonization that the disease became well known in the Western world. This medical phenomenon is a vector-borne parasitic disease. The causative agent is a parasite belonging to the Trypanosoma Genus and this is transmitted to humans by tsetse fly bites, which acquired their infection from human beings or from animals who are carriers of the said parasites (WHO, 2009). The African sleeping sickness is the main reason why there is negative socio-economic development in East and West Africa. The World Health Organization, concerned citizens as well as a few pharmaceutical companies are working hand-in-hand to prevent another outbreak and to significantly reduce the number of infections.
Causative Agent
The causative agent is a parasite called trypanosomes. The said parasite is not airborne or waterborne; they are vector-borne using the Tsetse flies to infect humans and animals alike (CDC, 2009). Both male and female tsetse flies feed on blood and bite during the day (Goddard, 2008). When it infects humans it is called African sleeping sickness and when it infects animals the correct term is Nagana (Krinsky, 2002). There are two forms of African sleeping sickness and are named according to their geographic distribution (Krinsky, 2002). The first type is called the West African trypanosome and named Trypanosoma gambiense (T. b. gambiense) for Gambia (Krinsky, 2002).
The second type is called the East African trypanosome and named Trypanosoma rhodesiense (T.b. rhodesiense) for Rhodesia, now Zimbabwe (Krinsky, 2002). Tsetse flies are only found in Sub-Saharan Africa. There are six species of Tsetse flies that are of primary importance to healthcare and disease prevention in Africa. This is because these are vectors of human trypanosomiasis. In the case of T. b. gambiense, the chief vectors are a) Glossina palpalis; b) Glossina fuscipes; and c) Glossina tachinoides (CDC, 2008). The primary vectors of T. b. rhodesiense on the other hand are a) Glossina morsitans; b) Glossina swynnertoni; c) Glossina pallidipes (CDC, 2008). Glossina morsitans can be readily found in wooded areas and brush country in eastern Africa while the Glossina palpalis group can be easily found in banks of streams, rivers, and lakes of western and central Africa (Goddard, 2008).
Disease History
Although the disease was known to Arab scholars as early as the 14th century it was a surgeon named John Atkins – who was on board a slave-trading ship traveling from West Africa to the West Indies – who first provided a more scientific description of the disease (Krinsky, 2002). Atkins was correct in most of his observations regarding the symptoms but he was greatly mistaken when he made assumptions as to the causative agent of the said disease. He reasoned that it was due to the inherent weakness of the African mind, which he labeled as “Negro lethargy” and Atkins attributed to causing of the disease to the “…natural weakness of the brain … brought about by lack of use” (Krinsky, 2002).
Later on, an unbiased scientific study of sleeping sickness revealed that it was trypanosomes and tsetse flies that are the main culprit in the outbreak within Sub-Saharan Africa. In 1903 a team was sent by the British Tsetse Fly commission to investigate outbreaks among the British colony (Krinsky, 2002). The team was led by David Bruce, David Nabarro, and Aldo Castellani (Krinsky, 2002). The team was able to provide more scientific information regarding the disease, especially the link between tsetse fly and the causative agent.
The first major outbreak was recorded in the 19th century. The spread of the disease was linked to the rapid success of the European colonizers. The movement of Europeans in their exploration and conquest of Africa led to the significant dispersal of the disease (Krinsky, 2002). As a result more than 750, 000 people died from African sleeping sickness in the period between 1896 and 1906 (Krinsky, 2002). It is estimated that there are 50 million Africans in 38 countries that are at risk of infection (Krinsky, 2002). There are more than 25,000 individuals that will be infected annually (Krinsky, 2002). The only good thing about this dreadful disease is that it is limited to Africa and the rare cases of infections in the United States are linked to tourists who visited Africa (Krinsky, 2002).
Disease Epidemiology
The term African sleeping sickness refers to the abnormally drowsy demeanor of ill patients (Krinsky, 2002). But the feeling of drowsiness is just the prelude because in many cases there is a steady progression of meningoencephalitis, with an increase of apathy and somnolence (Goddard, 2008). The sleepiness, as well as the increasing time, spent sleeping will gradually lead to the patient becoming more difficult to arouse and if left untreated the patient will become comatose (Goddard, 2008). T. b. gambiense is less severe compared to T. b. rhodesiense (WHO, 2009). When infected with T. b. gambiense the initial symptoms of African sleeping sickness can be characterized by fever, malaise, headache, and anorexia (Goddard, 2008). The fever is not regular and can be initiated by rigor (Goddard, 2008). The sickness is also characterized by enlarged cervical lymph nodes, a condition known as Winterbottom’s sign (Goddard, 2008). If left untreated the parasite will invade the central nervous system.
T. b. gambiense is less severe and more of a chronic illness involving mental deterioration and progressive weakening over a long period of time. But with T. b. rhodesiense the effect is acute and rapidly fatal. Accurate diagnosis is done by demonstrating the presence of trypanosomes in the blood, cerebrospinal fluid, or lymph (Goddard, 2008). Another method of diagnosis is the detection of antibodies specific to T. b. gambiense and T.b. rhodesiense (Goddard, 2008). Using the various forms of detection and diagnosis it was discovered that African sleeping sickness is a major problem in Sub-Saharan Africa.
The following data collated by the World Health Organization provides an overview of the challenges faced by Africans living in Western and Eastern Africa:
In recent epidemic periods, in several villages in the Democratic Republic of Congo, Angola, and Southern Sudan prevalence is as high as 50 percent. Health experts even highlighted the fact that sleeping sickness is the first or second greatest cause of mortality that sometimes overtakes HIV/AIDS (WHO, 2009).
This prompted the World Health Organization to establish a public-private partnership with Aventis Pharma (now Sanofi-Aventis) and this partnership resulted in the creation of a surveillance team that provides support to endemic countries (WHO, 2009). The partnership also made it possible to educate people in practicing control activities it also supplied drugs free of charge (WHO, 2009).
There are two stages in the progression of the disease. During the first stage which often is the case with the less virulent type of sleeping sickness the drugs used are less toxic and easier to administer (WHO, 2009). It is also more effective as it requires less training for health workers who will administer the drug as well as the damage of the parasite is not yet life-threatening (WHO, 2009). But when the disease progressed to stage two, which is often the case with the more virulent type, treatment involves more toxic medications that are also more complicated to administer (WHO, 2009).
There are four drugs that are being used to treat sleeping sickness and these are listed as follows:
Pentamidine
Suramin
Melarsoprol
Eflornithine
Pentamidine was first discovered in 1941 and is the drug of choice for stage one (WHO, 2009). There are side effects but they can be easily tolerated by patients. Suramin was discovered in 1921 and also used in stage one of the disease. The side effects are in the urinary tract (WHO, 2009). Melarsoprol was discovered in 1949 and used in both stage one and stage two. According to experts, the general mode of treatment uses Suramin and/or Melarsoprol but there are reports that Melarsoprol is fatal in 3-10% of patients treated with the said medication (Goddard, 2008). Eflornithine is less toxic was made available in 1990 only. But it is only effective against T. b. gambiense (WHO, 2009).
Aside from providing prompt treatments, especially those who live in isolated places – there is also a need to look into preventive measures to reduce the number of infections. This includes bush clearing along streams to control breeding sites; aerial spraying of insecticides, surveillance; and case detection (Goddard, ). There is also a need to look into more novel approaches such as fly trapping techniques as well as the releasing of sterile males into the environment (Goddard, 2008).
Conclusion
With the use of modern medicine as well as the expert use of insecticides the disease was significantly reduced in the middle part of the 1960s (Goddard, 2008). But complacency and the difficulty of providing the necessary tools of prevention in more isolated resulted in the re-emergence of the disease in many parts of Africa (Goddard, 2008). There is a need for a more concerted effort to reduce the number of infections. The World Health Organization must take the lead in this endeavor.
The public-private partnership initiated by WHO is doing wonders for the people in Sub-Saharan Africa, especially those who are already infected with the said disease. It is important for those who suffer from stage one of sleeping sickness to be diagnosed immediately. If left untreated all forms of trypanosomiasis are lethal; therefore there is a need to send more teams and more health workers to reach these people in time.
References
Centers for Disease Control. (2008). East African Trypanosomiasis.
Centers for Disease Control. (2008). West African Trypanosomiasis Infection.
Goddard, J. (2008). Infectious Diseases and Arthropods. New York: Springer.
Krinsky, W. (2002). Tsetse Flies (Glossinidae). In G. Mullen & L. Durden. (Eds.), Medical and Veterinary Entomology (pp. 303-312). CA: Academic
Sleep is an essential and integral part of human life, as this process affects health, immunity, and behavior. In the absence of other influential problems, unhealthy sleep specifically interferes with mental and physical activity. In their article “Poor sleep quality and insufficient sleep of a collegiate student-athlete population,” Mah et al. (2018) investigate the problem of sleep among student-athletes. Despite the importance of the topic under study and the conclusions reached, the work raised additional questions and had some limitations.
Students experience severe stress and the lack of sleep every day. At the same time, athletes at colleges and universities, being full-time students, devote additional time to training and competitions. Six hundred twenty-eight athletes from twenty-nine varsity teams at Stanford University took part in a study by Mah et al. (2018). The authors’ purpose was to investigate their sleep quality, duration and sleepiness during the day since athletes risk not only failing in classes but also get injured during sports. The article may be interesting to such an audience as coaches and administration at universities to draw their attention to the problem. Furthermore, the source may be useful to sleep problem researchers to identify further study directions.
To achieve the stated purpose of the article, the authors chose to conduct a questionnaire among students. They answered questions about the “sleep quality via a modified Pittsburgh Sleep Quality Index (PSQI)” (Mah et al., 2018, p. 251). As a result, athletic students were found to typically lack quality sleep. This problem’s consequences are reflected in their daily routine in the form of frequent or even constant fatigue and sleepiness. Moreover, the authors presented a crucial finding that sleep is better during travel for competitions than while staying at home or campus.
Three authors of the group, Cheri Mah, Eric Kezirian, and William Dement, have a Doctorate of Medicine degree, and Brandon Marcello is a Ph.D. of the Department of Athletics. Their high academic achievements must attest to the reliability and value of the source. However, studying the article leaves many questions open, making it not convincing enough. For example, one of the aspects that attracted attention is the publication date. Particularly, the survey was held in 2011, and the article was published in 2018 (Mah et al., 2018). Such a long period could negatively affect both the relevance of the data and its quality. The choice of questionnaire as the only research method is quite unusual since it is more suitable for determining attitude or opinion. Nevertheless, PSQI is a useful tool for assessing sleep, and therefore, the findings should be correct.
The inconclusiveness of the findings is more likely justified by the absence of a control group of non-athletes. On the one hand, sleep deprivation are not uncommon among students of different departments. On the other hand, exercise should contribute to better quality and sleep duration (National Sleep Foundation, n.d.). For these reasons, a study of other students’ sleep patterns would help determine which aspects significantly impact the quality of rest. In this regard, one can formulate the first question generated from the article: Is the low quality of student-athletes’ sleep due to additional physical activity or student life’s specifics?
There is no exact answer to the formulated question in this work. However, when reviewing the finding that at home, the quality of sleep is lower than at away competitions, one can find some clues. For example, noise, lighting, and uncomfortable temperatures hinder better sleep on campus. These aspects cannot affect only athletes, thus being relevant to all students. Moreover, during travel competitions, the class load decreases, which also has an impact on sleep.
The source is organized carefully, has the necessary for the scientific article components, and tables supporting the text. However, many limitations, which the authors themselves recognize, indicate the need for additional content. For example, this study would be more substantial not as a separate work but as part of studying the problem of students’ lack of sleep. In that case, it would be appropriate to add a section on future research directions. Another aspect that remained under-stated is the relevance and uniqueness of the study. Specifically, it does not provide information on what other scientists have already said about the problem, or how common it is at universities other than Stanford. These limitations generate another question: Does the quality of sleep differ among student-athletes at other educational institutions, or does the problem present only at Stanford?
In conclusion, the reviewed study conducted by Mah et al. (2018) was formally written and organized in accordance with the main requirements for scientific articles. It raises an important issue that needs to be addressed. However, its uniqueness and relevance are not evident enough, and the conclusions are not convincing. Such deficiencies are due to severe research limitations and make this article less valuable. First, the study of only student-athletes without comparison with ordinary students does not reveal all aspects of the problem. Therefore, the article cannot provide solutions other than a general recommendation to revise the schedule. Second, the survey was conducted at only one university, and it is not clear whether the problem is valid for all institutions or only for one. Thus, the topic either requires further development into a large detailed study or it may be irrelevant at all.
References
Mah, C. D., Kezirian, E. J., Marcello, B. M., & Dement, W. C. (2018). Poor sleep quality and insufficient sleep of a collegiate student-athlete population. Sleep Health, 4(3), 251-257. Web.
Healthcare organizations nationwide launch initiatives to improve the quality of their services, increase personnel performance, and positively impact patient outcomes. Aside from solving practical issues directly, executives and responsible teams develop programs to address broader aspects, such as staff productivity and stress management. For instance, lack of sleep may worsen performance, and intervention will be necessary to help employees combat the problem. The appropriate instrument for outlining a workable strategy is Total Quality Management (TQM), principles of which are applicable for making long-term, efficient change (Reid & Sanders, 2020). According to TQM, the key concepts are all personnel’s involvement in managing conditions in an organization, focusing on durable positive outcomes, and creating a system of material and moral incentives for employees. This quality improvement report aims to apply TQM principles to address the problem of the lack of sleep among healthcare facilities’ staff.
Staff Education
Lack of sleep is a common issue among healthcare providers; thus, they tend to perceive it as an inevitable condition they cannot influence. It is crucial to educate the staff about the severe consequences of sleep problems and encourage them to take action is solving them. Furthermore, TQM principles suggest that every team member’s involvement is necessary for long-term benefits (Reid & Sanders, 2020). For instance, healthcare providers may use collaborative brainstorming, which entails teams coming together to generate new ideas and thoughts on how they can solve the problem (LaNoue et al., 2019). It is a workable strategy to educate and train staff in addressing the quality of sleep issue because it is based on process improvement theory, where analysis and actions are combined.
Another aspect of increasing employees’ awareness about the severe outcomes of lack of sleep and encouraging them to address it is presenting visual information that can be easily accessed and reviewed. Indeed, developing concise and useful graphics would increase staff interest and engagement crucial for the TQM-based strategy implementation (Ansari, 2022). For example, simple diagrams, timelines, Pareto, or control plots about lack of sleep and methods to successfully implement a lifestyle change may be crafted and given to the team. Collaborative brainstorming and providing healthcare personnel with visual information are essential to educate and train them to find workable solutions for eliminating the adverse outcomes of sleep deprivation.
Schedule Optimization
Healthcare providers build their lifestyle habits around their work planning which frequently includes long night shifts or extra hours. According to the TQM principle of fact-based solutions selection, schedule optimization is a direct approach to addressing the lack of sleep among personnel (Reid & Sanders, 2020). Various techniques are available for adjusting the timetable, such as scheduling based on a circadian rhythm based on scientific evidence on how the physiological and behavioral daily activities occur within the twenty-four-hour cycle (Farhud & Aryan, 2018). Staff should be assigned to explore their rhythms and collaboratively change the current schedule to minimize the lack of sleep.
Furthermore, healthcare providers have individual work-life balance necessities, and awareness of their sleep patterns is crucial for optimizing the schedule. Staff members who perform better and night might prioritize the late shifts, while their colleagues who work more efficiently in the morning may select the early hours (Farhud & Aryan, 2018). Schedule optimization for large teams might not address everyone’s needs; however, exploring behavioral and physiological characteristics and preferences is a strategy to influence the lack of sleep problem deliberately.
Quality of Teamwork Optimization
The initiative to address the lack of sleep among employees and consequently improve their performance and the quality of services requires teamwork optimization. Positive outcomes of employees’ education, training, and schedule updates will be maximized if intercommunication and collaboration are involved at every stage. Furthermore, social interactions at the workplace, such as casual conversations between practitioners and physicians and group activities, help the team sustain wakefulness. Also, the lack of sleep significantly influences an individual’s productivity and quality of socialization (Pilcher & Morris, 2020). When operating as a team, staff members develop a supportive environment and address the TQM principles of systematic improvement and communication.
The quality of teamwork needs optimization to help encourage staff to offer initiatives and establish awarding practices for positive change advocation. Healthcare providers might lack the motivation to work as they have to stay awake for an extended period; yet, if incentivized, they will have a certain goal in mind and work toward it (Manzoor et al., 2021). Groups where different projects are created and supported operate more efficiently and are more willing to address sleep issues.
Conclusion
The problem of sleep deprivation severely influences the productivity of healthcare workers, the quality of services they provide, and overall patient outcomes. Based on the TQM principles, strategies to resolve the issue must include employees’ education and training to increase their awareness of the negative consequences of continuous lack of sleep. Schedule optimization may be applied considering scientific sleep management and individual preferences related to productivity and sleeping patterns. Team building events and intercommunication are crucial to maintaining staff’s involvement to develop long-lasting results and timely address the challenges.
Some sleep disorders during infancy and early childhood may be caused by specific behaviors, whereas others are because of neurological or medical issues. Contributing factors may include parental inability to set limits and maladaptive sleep onset associations. Children who resist or refuse to go to bed due to limit-setting issues may experience behavioral sleep problems. The above occurrence is most common in toddlers and older kids. It is caused by a lack of consistency in nighttime routines and the enforcement of defined restrictions. Bedtime resistance is common in young children and is often transient. Behavioral causes of sleep disorders are primarily associated with young children aged five years and below; however, the condition can last throughout middle childhood.
Sleep onset associations, such as being rocked or fed as an infant or toddler, might result in slow sleep onset and protracted night arousal, necessitating parental assistance. Any disorder that alters the craniofacial or pharyngeal anatomy predisposes the child to obstructive narcolepsy is considered a medical problem associated with sleep disturbances in children (Leschziner, 2019). Cerebral palsy, autism spectrum disorder, and other neurological disorders are linked to neurobehavioral and circadian sleep disruption.
Different Presentations of Sleep Disorders
There are many presentations of sleep disorders: firstly is about parasomnias, which are unpleasant physical events or feelings that happen at the start of the doze, throughout the nap, or when waking from a snooze. They include nightmares, sleep paralysis, and sleep enuresis (Shibeika & Al-Jewair, 2019). Confusional arousals are similar to nocturnal episodes, and they are characterized by confusion, disorientation, grogginess, and agitation upon awakening from sleep (Leschziner, 2019). Sleep terrors are episodes of arousal from sleep that are accompanied by autonomic system responses such as tachycardia, sweating, dilated pupils, and intense fear and screaming.
Secondly, enuresis is defined as uncontrollable urination during sleep twice a week for at least three months in children over five. Enuresis can be primary if the child has never been dry for six months or secondary if it has been dry but not bedwetting at least twice a week. Thirdly, breathing-related sleep disorders, such as Obstructive Sleep Apnea (OSA), cause a child’s breathing to be disrupted as they sleep (Leschziner, 2019). OSA is characterized by periods of persistent airway blockage while sleeping, resulting in partial or complete cessation of airflow at the nose or mouth. It is common in children with enlarged tonsils and adenoids, obesity, and craniofacial anomalies. It also affects children with neuromuscular disorders such as muscular dystrophy, which cause muscle weakness. Central Sleep Apnea is the repeated cessation or decrease in airflow and ventilatory effort while sleeping (Shibeika & Al-Jewair, 2019). The etiology can be either primary or secondary. Cheyne-stokes breathing is an example of secondary central sleep apnea.
Fourthly is rhythmic movements associated with sleep where children frequently use rhythmic movements such as bruxism, body rocking, headbanging, and head rolling to self-soothe. This can happen at the start of sleep or after arousals during the night. Fifthly is the syndrome of restless legs, which is the desire to move one’s legs accompanied by unpleasant sensations in the lower extremities. Increased leg movement alleviates the discomfort and urges to move.
Pathophysiology
The first step in treating child sleep disorders is developing expectations about typical pediatric sleep. Behavioral modification methods may be able to help with some of the problems. The Clinics have teams of behavioral psychologists certified in treating sleep issues who work with children and their families. In addition, there are platform pediatric and adult sleep experts with experience in pediatric sleep disorders (Leschziner, 2019). In some disorders, regular awakenings, positive thinking, and other measures may be helpful. A doctor may prescribe medications or supplements to address a particular sleep problem or other illness.
Differential Diagnosis
Delayed sleep-wake cycle disorder is a condition that disrupts the body’s internal mechanism. It occurs when a sleeping pattern lags behind a regular sleep routine by two hours or more, causing one to sleep later and wake up later (Shibeika & Al-Jewair, 2019). Idiopathic hypersomnia is described as a condition characterized by excessive daytime sleepiness. Self-stimulatory or self-injurious behavior, such as head banging, is typical in children with developmental delay (Leschziner, 2019). Frequent nightmares may be linked to psychiatric disorders such as bipolar disorder, anxiety, or posttraumatic stress disorder. In child abuse, children who have been subjected to emotional, sexual, or physical abuse may experience nighttime terrors.
Pertinent Subjective and Objective Data
The subjective data include difficulties in falling asleep and getting up earlier than usual and problems in sleeping without the assistance of a caregiver. Moreover, excessive daytime sleepiness and its consequences concentration are impaired. Others include irritability, being prone to mistakes or accidents, challenges with behavior, aggression, impulsivity, and hyperactivity (Leschziner, 2019). In addition, complaints about sleep dissatisfaction and reluctance to adhere to a reasonable schedule are also issues.
The first objective is a complete and detailed sleep history, bedtime schedule, presence of a set bedtime, consistency of respite, and caregiver enforcement. The second objective is routines for rest, which includes evening activities such as watching television, playing video games, and participating in sports. The time at which the bedtime routine begins, and the practice’s length and location are all factors to consider (Leschziner, 2019). Thirdly, it is about the environment and sleeping arrangements, including bedroom space and location, co-sleeping, bedroom sharing, and bedding type. Lastly, there is always a specific time for waking up in the morning: however, one experiences difficulties.
Management Plans
Behavioral or non-pharmacological therapy, the overall therapy to eradicate faulty sleep onset connections and minimize undesired evening behaviors, is the first strategy to manage the above issues. Developing a regular nighttime regimen that excludes engaging activities will help achieve this (Leschziner, 2019). Others include making new sleep associations, improving their self-soothing abilities, reducing parental attention to problem behavior, and reinforcing appropriate behaviors with positive support. Teaching techniques for self-relaxation and cognitive behavior strategies are also necessary.
Secondly is the application of pharmacologic therapy since melatonin is the most well-studied pharmacologic intervention. Thus, it may be prescribed for mentally delayed children who have sleep issues. A standard dose varies from 1–10 mg and is administered 30-1 hour before intended bedtime. Antihistamines are the most often utilized sedative in children and can cause tolerance (Leschziner, 2019). Moreover, surgery or adenotonsillectomy is recommended for children with obstructive sleep apnea to remove enlarged tonsils and adenoids. However, if the child has unusual facial anatomy, surgery is not recommended.
Advice to Parents
Parents are advised to put their infant or child into practice. Starting around 10-12 weeks, children should be laid to bed while drowsy but awake. This prevents the development of sleep associations such as rocking or being held. Thus, allow the child to sleep in the parent’s room. Ideally, the baby should sleep in one’s room alone in a crib, bassinet, or other infant-specific structure for at least six months and possibly up to a year. This could help to lower the risk of sudden infant death syndrome. However, toddlers should not be allowed to sleep in adult beds. A baby can become entrapped and suffocate between the slats of the headboard, the mattress, and the bed frame, or the mattress and the wall. If a sleeping parent rolls over and accidentally covers the baby’s nose and mouth, the baby can suffocate.
Reference
Leschziner, G. (2019). The nocturnal brain: Nightmares, neuroscience, and the secret world of sleep. St. Martin’s Publishing Group.
Shibeika, D., & Al-Jewair, T. (2019). The association between temporomandibular joint disorders and sleep disorders in adults: A systematic review. Sleep Medicine, 64, S8.
Since the change in three domains revolves around the physical, cognitive, and psychological, development is multidimensional. Although the stage theories of Freud, Erikson, Piaget, and Kohlberg (also known as theorists of development) consider development as discontinuous progress, lifespan theorists are aware that development may be perceived and assessed in several ways (Berk, 2019). Other theories, like behaviorists, Vygotsky, and others who focus on information processing, believe that growth occurs across time and is known as continuous development. The central nervous system’s ability to process and respond adaptively to environmental cues brought in by sensory systems is known as sensory processing (Chen et al., 2019). However, it may be a sign of sensory processing issues, such as sensory sensitivity and reactivity, when sensory processing fails to produce an effective or appropriate response to registered stimuli (Berk, 2019). The research will analyze rest quality for toddlers and the optimal frequency.
Research Question
What durations and frequencies of rest are optimal for toddlers?
Sleep Dynamics
Although the understanding of the structure and regulation of sleep is still limited, it is widely accepted that healthy sleep which includes getting enough sleep—is essential for a better health and wellbeing. The anaysis is based on studies with small samples that are synchronized to establish the dynamism of sleep patterns. In research that contained 56 children aged eight conducted in 2009, Berk found that particular sensory reactivity, such as tactile sensitivity, movement sensitivity, auditory filtering, and total sensory processing scores, were inversely connected with sleep. More recently, several studies have suggested that poor sleep habits in children between the ages of 6 months and 2.5 years (n = 160), as well as in primary school children between the ages of 7 and 8 and 12 (n = 45; n = 231), may also negatively affect sensory processing outcomes (Berk, 2019). These studies included children between 0 and 36 months (n = 177) and children between the ages of 6 months and 2.5 years (n = 160) (Berk, 2019Therefore, this study aimed to investigate the relationship between sleep (duration and quality) and sensory reactivity in a sample of Spanish school-aged children with normal development.
Methodology
The research is a cross-sectional population-based study conducted in Alicante, Spain, on normally developing kids between the ages of 3 and 7. Approximately 1,700 eligible kids were chosen at random from 21 Alicante-area schools (Berk, 2019). They received an envelope with an invitation letter to their parents inviting them to participate in the study. Children were removed from the trial if they displayed any handicap after around two or three weeks and after all the paperwork was reviewed. As a result, the research analysis did not include children with allergic disorders (n = 6), atopic dermatitis (n = 1), asthma (n = 1), bronchopulmonary dysplasia (n = 1), tumors (n = 1), ASD (n = 1), or ADHD (n = 1). Finally, 620 kids were included in the sample, giving a response rate of roughly 37%. Participants in the research were recruited from February to May 2016. All the kids who eventually participated in the study completed informed consent forms with their parents (Berk, 2019). The Miguel Hernandez University of Elche’s Ethical Committee approved the conduct of this study (DPC.ASP.02.16). Five hundred seventy-nine children (93.4%) were used in the analysis because they had complete data for the key research variables.
Discussion
Overall SSP, tactile sensitivity, flavor sensitivity, under-responsive/seek feeling, auditory filtering, low energy/weak, and visual/auditory sensitivity SSP subscales were all substantially correlated with a higher incidence of sensory reactivity in children aged 3–7 (Bjørnestad & Os, 2018). However, no statistically significant relationships between sleep duration and the frequency of sensory reactivity in kids in this age range were found. This connection has never been mentioned or investigated in a population-based study of school-age children. Sensory processing problems and sleep disturbances are frequent symptoms in kids with developmental impairments like ASD, according to a prior study (Sipple et al., 2020). However, there is only very limited information about the connection between children’s sensory processing difficulties and sleep outcomes, and it is based primarily on preliminary findings from descriptive analyses.
The daily average of hours of sleep was strikingly identical among children categorized as having or not having sensory reactivity (9.8 and 9.9 h/day, respectively) but consistent with past findings, which may be related to sleep length was relatively homogeneous overall (Berk, 2019).
Although the PSQ is not the best tool for evaluating sleep quality in children, it is a suitable tool for epidemiological research. It can help categorize kids at risk of sleep disturbance because this questionnaire was specifically designed for detecting sleep-related breathing disorders. To evaluate relationships with sensory reactivity, the PSQ enabled us to categorize children as a group at risk (i.e., children with sleep disorders) (Berk, 2019). Therefore, in terms of study, the PSQ score is a good proxy for evaluating children’s sleep quality. In addition, we used numerous statistical models to examine the data after adjusting for potential confounding factors. However, there may be bias or residual confounding due to missing data. Finally, we performed several sensitivity analyses to investigate the impact of distinct circumstances that could be connected to the kids’ sensory processing to test the robustness of our findings.
Conclusion
In this population-based investigation, which included children ages 3 to 7, we found a statistically significant correlation between poor sleep quality and a greater incidence of sensory reactivity as assessed by the overall SSP and nearly all SSP subscales. This is the first time, to our knowledge, that this link has been investigated and published. Even though there was no correlation between sleep length and sensory reactivity, further research into the connection between sleep deprivation and sensory processing outcomes is necessary, given the potential negative implications on children’s health and wellbeing. Our results offer compelling evidence based on an epidemiological approach. They are consistent with early findings of a possible relationship between sleep and sensory processing functioning, pending future investigation from prospective studies. The interaction of these elements should be considered in therapies expressly designed to improve sleep disruptions or sensory processing difficulties in children as a possible negative determinant that may adversely affect children’s health and normal development.
References
Berk, L. E. (2019). Development through the lifespan (7th Ed.). Pearson.
In this case study, the investigator focused on ischemic stroke, one of the most common types of stroke in the world. Ischemic stroke, as Bhatnagar et al. (2015) observe, is a medical condition where a blood clot blocks a vital vessel that transports nutrients into a given part of the brain. If it is not addressed urgently, the cell in that part of the brain, which is denied blood, starts dying. The author selected a patient with this condition because of the agony she was going through at the time she visited the hospital.
The patient had an intense headache at the time when she was admitted to the unit. She appeared confused and did not understand simple questions or instructions given to her by the medical team. This life-shortening illness is currently a major pandemic in the United Kingdom (Ciccone et al. 2013).
The relevant statistics provided by numerous healthcare units indicate that approximately 152,000 cases of stroke occur in the country every year (Ahn et al. 2013). It means that for every five minutes, the health problem emerges. More than 1.1 million people in the country are stroke survivors, some of whom are under close medical observation because of their delicate conditions. Lee (2017) argues that other than being a major cause of death, stroke is also a leading cause of disability among adults who are lucky enough to survive it. They have to rely on their family members to lead a normal life because some of them are paralysed in various ways (Fleisher 2013).
About 50% of cases of stroke reported in the country are caused by high blood pressure. A report by Doeppner and Hermann (2016) estimates that for every 100,000 people in the United Kingdom, 380 men and 299 women suffer from stroke. Through the efforts put in place by the government and private stakeholders, cases of stroke declined by over 24% in women and 18% in men from 1995 to 2004 (Lapchak & Zhang 2017).
Goyal et al. (2015) argue that the African-Caribbean people are the worst affected group. The condition is not unique in the United Kingdom (Williams, Perry & Watkins 2013). The World Health Organization estimates that about 15 million people across the globe suffer from a stroke (Bhalla & Birns 2015). In the given paper I will revolve around the state of a particular patients health and her current condition. I will introduce the confidentiality statement to ensure that her agreement is obtained.
The paper will also contain such sections as the patients presentation that describes her current state; pathophysiology that demonstrates peculiarity of the suggested health problem; physical, social and psychological changes in the patient under the impact of the stroke; medical/nursing care part that discusses the provided treatment and medications; integrated care; health promotion and patients empowerment and conclusion sections. These are the basic parts of the paper needed to investigate the case.
Confidentiality Statement
When conducting this case study, it was important to observe the code of conduct set by the Nursing and Midwifery Council (NMC) (2015) to ensure that the patient will not suffer from unethical actions or abuse of basic human rights. Additionally, basic human rights guarantee non-interference in a persons private life and protection of information he/she does not want to share (NMC 2015).
For this reason, all participants should demonstrate their desire to participate or provide data. Assuring patients of the commitment to protect their identity is one of the aspects that make their participation in the project more probable (NMC 2015). The author ensured that the name, exact location, and age of the patient remained anonymous; hence she is only referred to as Jane. In such a way, her informed consent was acquired. She did not participate in the study; however, she agreed to provide all information about her case to the researcher and said that it could be used for the investigation.
Patient Presentation
The patient was an adult female who was admitted to the hospital with a complaint of an intense headache, poor coordination of body parts, faecal incontinence, and general confusion. She was brought in by ambulance paramedics after she felt extremely bad and her close people noticed the first signs of the disease when she was at home.
At the time of admission, she demonstrated reduced communication and cognitive skills – sometimes she could answer simple questions correctly; however, in the majority of cases, she was not able to find an appropriate answer as it was difficult for her. However, the medical team was able to get past medical history of the patient. Jane reported that she has never been admitted to a hospital in her adult life. She stated that over the past three years, she had been experiencing discomfort in the chest and at the back of her head, but considered it a minor issue that did not warrant hospitalisation.
The patient is a single mother of three (a boy and two girls). Within that period, she has been the sole breadwinner for the family. She reported that she had two jobs. This middle-aged woman stated that her eldest child is aged 12 while her last-born is only 4 years. She has been able to meet all their basic needs, and all of them attend school. Her current partner plays a very limited role as a parent and a spouse in the family. He is always out of the house, and she noted that one could not predict when he would be back. She is worried that her current condition might have a pernicious impact on her children as there were no relatives to care for them, bring them back from school. Her partner is not responsible and could not be trusted. It evidently impacts her state.
Pathophysiology
Ischemic stroke is characterised by a sudden loss of circulation of blood to a given part of the brain. Lee (2017) states that depending on its cause, it may take different paths. Acute ischemic stroke, as Lohse, Lang, and Boyd (2014) observe, is caused by embolic or thrombotic occlusion. If the blockage affects a large area of the brain and it is not addressed within the shortest time possible, then one can lose his or her life. Sometimes it may end in paralysis even if one is lucky enough to get the right medication in time.
The Patient’s Case
The patient complained that she was having a sporadic severe headache that caused her lack of comfort. Therefore, the symptoms exhibited by the patient and the outcome of the medical examinations strongly suggested she was suffering from ischemic stroke. The emergence of the health problem was preconditioned by the thrombotic occlusion observed in her brain. The most probable causes for the appearance of the thrombotic occlusion are hypertension (the patients blood pressure is higher than the norm), and the high level of stress. Altogether, hypertension is of the central factors for stroke.
Thus, the circulation failure in the patients brain preconditioned the appearance of oxygen deficit and a decrease in specific functions. With time, it resulted in the deterioration of the patients speech, cognitive function, movements, and other symptoms peculiar to stroke. The inability of the patient to raise both hands in a coordinated manner must have been as a result of primary motor cortex being affected. At the same time, paralysis of some limbs, problematic movement, speech, language problems and a specific behavioural style demonstrate that the left brain is affected by the stroke and the thrombotic occlusion could be found there (Lee 2017).
The cells in this part of the brain that was denied blood started dying because of the lack of nutrients and oxygen. For this reason, the inability of the left brain to function in an appropriate way resulted in difficulties in walking. The patient may also have other physical or mental issues and problems with eyesight if the investigation discovers the corruption of optic nerves.
Physical, Social, and Psychological Changes
It was established that the condition of the patient had a significant impact on her life from various dimensions. Based on her accounts about the experiences she has had since the symptoms started getting serious and the physical observations and tests, the team established that a number of things have changed in her life and the people around her. She is going through challenging times, and it is unfortunate that it took her so long to know about her condition.
Psychological Impact of the Condition
Barrett and Meschia (2013) say that stroke may have a significant psychological impact on a patient. It was our responsibility to inform the patient about her condition and to explain how she could deal with it in the best way possible. When looking at the psychological impact, it is important to look at it before and after Jane received the information about her new condition. When working with the patient, I engaged the patient to understand the kind of experiences she has gone through and how the problems that she has been having impacted on her psychologically. Thus, at the moment she feels so lonely and rejected, especially considering the fact that her partner avoids communication with her.
When the patient was told that she had been diagnosed with ischemic stroke and she was lucky enough to receive the needed care, Jane demonstrated an apparent emotional response. It was evident that the patient was in a shock. The patient remained motionless for several seconds, lying face down in bed. The team wanted to help her through this challenging experience, so they gave her time to absorb the news.
However, when she turned to face us, she was dejected and somehow harsh. She was in denial, a common stage among patients diagnosed with life-shortening illnesses, especially if their condition is not stable, as was the case with her (Berkhemer et al. 2015). She was given time but maintained tight surveillance on her to ensure that she does not harm herself or others around her. When I finally offered to talk to her, she started sobbing.
She was constantly referring to her children and the extent to which they would be left to suffer if she succumbs to the disease. After giving her some time, she was able to accept the new condition, but it was evident that she had a sense of rejection even after several sessions with a psychotherapist. Her biggest worry, which was valid from a medical point of view, was that even after surviving this first attack, she might be permanently paralysed for the rest of her life and will not be able to look after her children.
Socioeconomic Impact of the Condition
According to the patient, the condition will have a serious impact on her social and economic life. As the sole breadwinner in her family, the patient has to work on a daily basis. To increase her income and improve her family’s standards of living, she has been working two shifts. However, that may not be possible because of the disease. The pain and fatigue have made it impossible for her to go to work on a regular basis.
Additionally, her current state will likely result in the appearance of new problems with finances. The situation may be worse in case she is paralysed by this condition. She laments that no other responsible adult is around who can ensure that the family has the basic needs, let alone caring for her as would be expected. She feels that the life of her and her family may be completely changed for the worst.
Over the past year, the patient has spent a lot of money on the over-the-counter medicine to deal with the pain. The cost of medication is an additional expense that she has to meet. The patient narrates that within the last two months, she and her children have been forced to change their lifestyle because of a reduced source of money and increased expenses. It means that today, due to the ischaemic stroke, the situation could become worse. The patient is depressed by this fact and is scared that she will not be able to take care of her children and social services will take them. In such a way, at the moment money and her children are the major concerns.
Physical Impact of the Condition
Currently, the main physical impact of her condition is her inability to coordinate her arms and legs. The team observed that she has a fallen face, which has slightly changed her physical appearance. However, the patient fears that she may have serious physical problems in case her condition leaves her physically paralysed. She looks weak and very pale. Although she demonstrates tendencies towards the improvement of the state, she is barely able to bathe herself.
She is yet to gain proper physical strength in her arms. She feels that her fallen face has negatively affected her beauty. The condition has resulted in excruciating pain, especially the constant headache. The patient noted that lack of physical strength had forced her to delegate some of the family chores to her eldest daughter, something that she had never considered doing before. However, the family had to adjust to the new lifestyle due to the patient’s condition.
Medical/Nursing Care
When the patient was admitted to the hospital, it was critical to attend to her as soon as possible because her condition was considered an emergency. A team of medical experts (physicians, cardiologists, neurologists, nurses) was quickly assembled to handle the patient and start treatment using specific guidelines (Figure 1). The medical team initiated diagnosing by physically examining the condition of the patient.
Figure 1. Management of patients with suspected stroke (Jauch et al. 2010).
The doctor then asked about the historical record of the problem, when it started and the nature of the discomfort that the patient has had. The patient stated that she had a frequent headache, straining of the left eye or sometimes both eyes, and discomfort at the back of her head. The blood pressure test revealed that she had a higher than normal blood pressure level, at 148/95 (Campbell et al. 2015).
The doctor recommended a computerised tomography (CT) scan to determine the cause of her lack of proper coordination. The scan revealed a minor blockage in one of the vessels that supply blood to the left side of the brain. The brain cells in that part of the brain were not adversely damaged, but the continued blockade of the vessel that transport blood into that part of the brain was putting the patient in danger. It was at this point that the medical team confirmed that the patient was suffering from ischemic stroke.
When the diagnosis had been determined, the medical team ensured that policies set by the National Institute for Health and Care Excellence regarding the specialist care, pharmacology, nutrition, and care delivery were followed strictly. These also include administration of appropriate medications, procedures, and interventions to avoid the further deterioration of the state of an individual.
For this reason, the first urgent care that was given to the patient was the administration of medicine to improve blood flow (National Collaborating Centre for Chronic Conditions 2008). Recombinant tissue plasminogen activator (rtPA) was administered immediately by the physician, as recommended by Food and Drug Administration (FDA) (Wardlaw et al. 2012). As Campbell et al. (2015) observe, rtPA helps in dissolving the clot. It also improves the flow of blood to parts of the brain affected by stroke. In accordance with the existing guidelines, the recommended dose is 0,9 mg/kg with the 10% of the total dose that should be administered as an initial intravenous bolus over 1 minute and then infused during 60 minutes (Peschillo 2016).
For this reason, the patient was provided with 50 mg Activase (generic name Alteplase) (Acton 2012). The monitoring for bleeding was also introduced. Continuous hemodynamic monitoring to scan blood pressure an avoid its increase was implemented. These measures helped to stop the further deterioration of the patients state and serious brain damage. After the administration, the patient should continue taking warfarin to prevent the development of thrombosis (Ovbiagele & Turan 2016).
As for the nursing care, it should be focused on the rehabilitation and minimisation of the negative impact ischemic stroke might have had on the patient (Chang 2014). Nurses assessed the patients memory, cognitive function, orientation, speech, movement, etc. (Roedde 2012). Regarding the nature of the disease, the nursing care also included the focus on impairment of function in diverse daily activities.
There was a particular nurse who worked with a patient constantly to monitor alterations in her state and report them to therapists with the primary aim to introduce new interventions if they are needed or alter the existing ones to guarantee enhanced results. The patient was educated about the rehabilitation practices needed to restore her damaged skills and improve the quality of her life. In the majority of cases, all important portions of information were followed by the detailed explanation provided by the nurse.
Additionally, all rehabilitation procedures starting from those aimed at the restoration of the patients cognitive function and ending with her motor function were introduced by a team consisting of a nurse, therapist, and other specialists responsible for the provision of this sort of intervention. Moreover, Jane had consultations with a psychologist to decrease her panic regarding the diagnosis and cope with the problem. In general, the appropriate delivery of nursing care becomes crucial in cases of Ischemic stroke as it is a central element of the recovery process.
Integrated Care
Integrated care, also known as comprehensive care, or holistic care is a new trend in care system where an emphasis is placed on a coordinated form of care provision (Palmer, Brown & Hobson 2013). The approach is gaining popularity because it integrated primary care, management of mental illnesses among adults, and management of common physical conditions. Davies (2012) says that is important to note that the state of the patient needed attention in all the three areas mentioned above (primary care, management of mental illnesses, and management of common physical conditions).
When handling this patient, the inter-professional team involving doctors, nurses, and even social workers was focused on the restoration of the patients health statues and guaranteeing her complete recovery (Saver et al. 2016).
Incorporating this holistic approach will not only help in managing the patient’s medical condition but also mental problems that she is currently battling. Therefore, it is encouraging that this hospital has developed its integrated care pathways that enable doctors and nurses to work closely and in a coordinated manner when managing patients (Siotto et al. 2017). The same we could observe in Janes case as the efficient cooperation of specialists helped to improve her health.
The difference in approaches is mainly caused by laxity of the management to implement the policies strictly. As explained in the pharmacology section above, management of the patient’s condition required multidrug therapy (MDT) to ensure that entire process was holistic. The United Kingdom’s government has come up with various strategies to help promote integrated care, such as the NHS Five Year Forward View, House of Care Model, and Wanless Report (Kernan et al. 2016).
Thus, the central idea of this report is the provision of the combination of services to ensure that a patient will rehabilitate and improvements in all aspects of his/her life would be admitted. In such a way, in accordance with this report, Jane was provided with comprehensive and integrated care. First, as it has already been stated, her children are the main concern as the patient is the only close person who cares for them. In such a way, health workers of the hospital informed social workers about the complexity of the case and a problem that appears due to Janes health issues. Social workers suggested communication with the father to guarantee that children will be protected.
However, this idea failed as the man did not have any desire to help his former partner and look after adolescents. It is apparent that this fact had a pernicious impact on the patient and her recovery as she was worried about her childrens destiny. That is why social workers suggested a specific pattern that presupposed their assistance and provision of the needed care for Janes family. In other words, a person was appointed to live with children, feed and protect them. The patient accepted this very approach as it was the only possible solution to the problem. At the same time, being a social program designed for people who suffer from particular diseases and experience financial or other needs, the provision of this assistance was voluntary.
All social workers were volunteers who wanted to help Jane to recover and ensure that her children would be fine. This program perfectly demonstrates the efficiency of the integrated care and the high need for policies of this sort that will be focused on the provision of specific and complex care to patients who need it because of diverse limits or barriers. Although these policies have helped in promoting integrated care, there are issues that were ignored because not all stakeholders were involved (Jabbour 2012). For instance, there is still a lack of the coordination between diverse healthcare providers based on actual forces in a healthcare setting (Blythe & Buchan 2016).
When caring for the patient, it was important to incorporate 6C’s of care to deliver excellent service (Jovin et al. 2015). Care, commitment and compassion were critical in ensuring that the patient’s needs were met by the medical staff and effective communication helped in understanding the condition of the patient and progress made during the process of medication. Thus, regarding Janes case, 6Cs of care were incorporated to improve her critical state.
Health Promotion and Patient Empowerment
Nevertheless, numerous research works demonstrate that the efficiency of health promotions and patient empowerment strategies applied to patients who have experienced an ischemic stroke precondition the overall success of the treatment (Bhalla & Birns 2015). For this reason, Jane was offered a specific plan of actions designed to ensure elimination of the negative impact of stroke on her body.
First of all, she was educated about the importance of lifestyle modification and its role in reducing vascular risk (Bhalla & Birns 2015). Regarding the patients hypertension, antihypertensive drug therapy to decrease the average level of her blood pressure was prescribed (Aslani et al. 2016). Additionally, Jane was provided with the diet rich in vegetables and fruits to minimise the risk of thrombosis and improve her dietary habits (Sit et al. 2016). Moreover, she was engaged in regular aerobic physical activity focused on the improvement of her cardiovascular system and overall rehabilitation. This set of measures contributed to the enhancement of treatment outcomes and Janes ability to continue working and communicating with her close friends and family.
Conclusion
Ischemic stroke is currently one of the leading causes of death and disability in the United Kingdom. It is estimated that 152,000 cases strokes are reported in the country every year. The problem is more common among African-Caribbean people than it is among the whites. However, it does not mean that the rest of the population is safe. The condition can affect anybody, especially those with poor lifestyle and those in abusive relationships or highly stressing careers.
Studies suggest that ischemic stroke is currently one of the leading causes of disabilities among senior adults in the country. It is also one of the top causes of deaths in the country, especially among the elderly in the United Kingdom and around the world. In the case study, it was evident that the patient did not know that she had an ischemic stroke. It means that the level of awareness of the disease among the people of the country, especially the elderly, is low. For those who are already with the condition, they should be helped to overcome their state. The following are the recommendations made based on this case study:
Nursing and Midwifery Council should work with various government agencies and non-governmental organisation to sensitive the public about ischemic stroke. They need to be informed or reminded about the causes of the condition, the need to lead a responsible lifestyle, and importance of early diagnosis in case one suspects that he or she has first symptoms of the health problem.
It is important to equip nurses when it comes to handling ischemic stroke patients, especially those who are emotionally unstable. Although the team was able to help the patient, it was not easy managing her emotional instability. For this reason, it might be helpful to invite psychotherapists to consult patients with the disease.
When handling patients who are having this condition, nurses should always be considerate and able to understand that some of their abnormal behaviours are because of the intense pain and mental impairment caused by the issue.
Reference List
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Sleep is considered one of the most important parts of any individual’s life. Some researchers emphasize the usefulness of sleep for productivity, while others focus on its impact on people’s health. The present paper will offer several different opinions on the role that sleep plays in the satisfaction of humans’ well-being. A brief overview of four videos will be followed by a discussion of the lessons that should be taken from the speeches.
Brief Summaries of Videos
Each of the speakers in the videos focuses on a different characteristic of sleep, but all of them agree that without enough sleep, one does not perform to the fullest potential. Arianna Huffington (2010) analyzes sleep as a crucial constituent of happiness. In her speech, Huffington (2010) mentions that sleep deprivation can lead to detrimental outcomes and describes her own negative example of not receiving enough rest. The speaker remarks that women are more likely to arrange the revolution of sleep because, for men, sleep deprivation has become “a virility symbol” (Huffington, 2010). Thus, this speech stresses the importance of sleep and considers women as the most probable change agents in the sleep revolution.
Another speech given by a woman is not focused on feminism. Jessa Gamble (2010) considers sleep as a vital element of humans’ body clocks. In her presentation, Gamble (2010) offers several examples of how people’s sleep habits are correspondent with animals’ chemical clocks. Sleep is thus associated with culture, and the role of sleep in the establishment of a healthy lifestyle is underlined in the speech.
The other two videos present researchers’ talks on sleep and its functions. Russel Foster (2013), a neuroscientist, explains why people need sleep and what can happen when they disregard this vital behavioral experience. In his speech, Foster (2013) provides numerous examples of how people treated sleep at different times and notes that individuals’ ignorance about sleep is too big. Therefore, from the neuroscientist’s point of view, not only the duration of sleep but also its quality is highly important.
The last speech is focused on unique functions of the brain that can only be performed while one is asleep. Jeff Iliff (2014) remarks that during sleep, brain vessels “clear away waste,” which is impossible to do while being awake. Thus, it is crucial for people to have enough sleep for their brain to receive time for restoration. Appropriate brain rest helps to avoid serious disease and enables individuals to discover the full potential of their brain.
The Valuable Information Obtained from Videos
Although all speakers analyze sleep from different points of view, they all agree that it is highly significant for people to have a sufficient amount of rest. The videos give information on the value of sleep for health, safety, happiness, academic achievement, and other aspects without which it would be impossible for individuals to live successfully. The most crucial data is given by Iliff (2014) and Foster (2013). These two speakers provide a detailed account of neurological processes taking place in the brain and explain a variety of functions that sleep deprivation can obstruct or eliminate. In particular, scholars remark that the brain does not sleep when the organism is resting. A variety of genes work only during sleep (Foster, 2013; Iliff, 2014). Therefore, sleep is needed not only for restoration but also for the productive work of the organism on the next day. Both Iliff (2014) and Foster (2013) compare the need to clear the brain at night to the need to clean one’s house. Neither of the two kinds of “chores” can be put off for a long time since postponing them would cause inconvenience and discomfort. Thus, from the scientific point of view, sleep is highly important for the brain.
Irrespective of their profession and connection with science, all four speakers emphasize the positive effect of sleep on the well-being of any person. Huffington (2010) mentions that having enough sleep makes individuals more inspired and productive. Gamble (2010) remarks that a body clock is crucial for organizing one’s life successfully. Iliff (2014) notes that the clarity of the mind helps to sustain one’s body in harmony. Foster (2013) explains that at every age, people’s sleep needs are different, but these requirements are frequently higher than people allow themselves to spend sleeping. Particular attention is paid to the negative impact of shift work on one’s sleep pattern (Foster, 2013; Gambler, 2010). Therefore, all speakers urge the audience to review their attitude to sleep and start having enough rest to become healthier and happier.
Conclusion
Sleep is a rather significant component of any individual’s existence. The videos give insight into the most intricate aspects of neural processes and explain why it is not acceptable to sleep too little. All speakers focus on the importance of sleep for people’s health, productivity, and happiness. Watching these videos helps to realize how thoughtless people sometimes are and how necessary it is for them to alter some of their habits in order to be strong both physically and morally.
