Stacy J. Parry and Dr. Joan H. Baldwin, Nursing
Introduction
Sleep plays an important role in maintaining health. Sleep affects two types of physiologic functions; the nervous system itself and other structures of the body. Sleep deprivation is often associated with continuous malfunction of the mind and at other times can cause abnormal behavioral activities of the nervous system. Sleep restores the natural balance among the neuronal centers (1). “Everyone has a sleep-wake cycle that corresponds to her or his optimum degree of physical, mental, and spiritual well-being. Studies show that adequate sleep enhances attentiveness, concentration, mood, and motivation.” (2)
The productivity of nursing students is dependent on many factors. Sleep is one of the essential components which influences productivity and competence. Beginning Brigham Young University (BYU) nursing core students (first 2.5 semesters of nursing program) have a potential risk for sleep deprivation and decreased productivity. Due to the rigorous nature of other classes plus the nursing core curriculum/clinical activities, sleep may be decreased in an effort to maintain performance levels and continue high standards of academic achievement.
Method
This was a qualitative descriptive study involving focus groups in a guided interview to encourage participants to discuss their perceptions on sleep deprivation and performance. The four nursing core classes were visited where the study and its purpose were presented and a sign-up sheet was passed around for volunteers. Three focus groups were conducted with a total of twenty participants from the varying nursing core classes. Each participant signed an informed consent before the group interview. During the audio taped focus group sessions, I led guided interview questions to stimulate discussion.
Data Analysis
I transcribed the comments from the audio taped focus group discussions by hand and organized the emerging themes.
Results
Many themes emerged during the discussions. Sleep deprivation was described as a lack of sleep and also not receiving adequate amount of sleep that was needed to accomplish varying tasks. Participants commented that sleep deprivation can be determined by how the body feels rather than the number of hours slept. Many causes were identified by the participants. A cause that affected all of the students is a lack of balance in their lives. Many of the nursing students are busy and are involved in several activities other than nursing. One student commented that nursing is not the problem, but balancing nursing with other things in life is the problem. A majority strive to have balance in their lives and therefore something has to give, which is usually sleep. Some work at night, have children to care for, are pregnant, have active social lives, are involved in service organizations, or have time-consuming responsibilities with church. Some of the participants characterized themselves as perfectionists and therefore desired to fulfill with their responsibilities perfectly. Another cause of sleep deprivation in nursing students discussed is that many students stay up late for various reasons (work, social, roommates, doing assignments) and have to wake up very early (sometimes 4:00 a.m.) for clinical rotations at the hospital. Others stated that the night before clinicals they can not sleep due to stress/anticipation of the following day. Many stated that they wake up every hour to see if it is time to wake-up.
Various effects of sleep deprivation were discussed by the participants. Many expressed that their motivation to learn or to volunteer to perform a specific procedure was decreased. Many felt that they could do what was required of them, but could not go the extra mile. For example, one student stated that she could do her assessment of the patient and do the daily care, but if she was tired she was reluctant to do “little extra nice things” like fill up their water bottle with fresh water. Also, many commented that whenever they sat and were not busy they would instantly fall asleep or when they studied or sat in class it was a struggle to keep their eyes open. Some stated the physical effects of sleep deprivation, such as watery, bloodshot eyes or that their body feels achy. Others discussed effects such as inability to think, decreased effort in assignments, inability to function, or feeling without energy. One student commented that at clinical (at the hospital) her teacher explained a concept about four or five times before she finally grasped the concept. Later when she went home and was rested she reviewed the concept and realized that it was a very simple concept and felt stupid that she could not get it when she was tired. Many discussed that they were more emotional, they found they cried easily, were short with people, felt an inability to cope and had less patience. Two students commented that they would lose all emotions and had an uncaring attitude. Most of the participants recognized that the lack of sleep did affect their spirituality. They would read their scriptures or pray out of duty, but would not be able to completely implement the comforting words or meanings.
The participants also discussed different ways they utilized or desired to use to improve sleeping patterns. A common theme that existed in this area was the importance of receiving quality sleep. A few commented that when they took time to relax and unwind before they retired to bed it helped them fall asleep easier and sleep better. One participant would take a shower. She commented that this helped her to leave her day behind and clear her mind before she went to bed. Some felt that catch-up sleep helped, either through power naps or sleeping longer in the mornings when time was available. A few discussed that when they changed priorities they received more sleep. For example, one student commented that if the dishes were not done and it was late instead of staying up and washing them like she did before, she would not worry about them and go to bed. Others felt a regular schedule or retiring earlier could help.
Recommendations for future studies:
Throughout the group interview discussions many ideas arose for future studies. Some of them include: What is the relationship between sleep deprivation and “night people” or “day people”? Do people become night owls because of their environment? How can people stop waking up throughout the night? What is the effect of power naps?
References
- Guyton, A. (1991). Medical physiology. Philadelphia: W.B. Saunders Company.
- Edlin, G. & Golanty, E. (1992). Health and wellness. Boston: Jones and Bartlett Publishers.