Sleep Hygiene And Insomnia On Stroke Patient During Pandemic.
Pra-Experiment Juwi Athia Rahmini1.
Achir Yani2.
Masfuri3,Hening Pujasari4 Doctoral Student of Nursing Faculty.
Universitas Indonesia
2,3,4
Nursing Faculty.
Universitas Indonesia *corresponding author: athia_r@yahoo.
ABSTRACT
Insomnia is a sleep disorder that often occurs and its prevalence is increasing in stroke patients.
Insomnia is associated with impaired sleep regulation due to damage to the parts of the central nervous system that regulate sleep.
Sleep hygiene is an intervention that can improve sleep quality by avoiding things that disturb sleep such as adjusting sleep schedules, avoiding things that are not recommended before going to bed, relaxation and bedtime rituals.
The purpose of this study was to determine the effect of sleep hygiene on insomnia in stroke patients.
The method used was pra-experimental, with the accidental sampling method for 1 week and obtained 15 respondents by providing sleep hygiene interventions through educational videos and providing sleep records at the stroke outpatient polyclinic.
Insomnia was measured using the Pittsburgh Sleep Quality Index (PSQI).
The results of this study indicate that there is an effect of sleep hygiene interventions on insomnia in stroke patients, which means an increase in the quality of sleep of stroke patients.
There was a significant improvement in quality sleep of stroke The post score of quality of sleep were decrease.
The average age of the respondents was 65 years, female, had comorbid hypertension and has been suffering from stroke for 5 years.
Further research related to sleep hygiene needs to be carried out with other experimental methods and in combination with other interventions related to patient complaints such as pain and headaches.
Keywords: Sleep Hygiene.
Insomnia.
Stroke 2nd International Health Conference STIKes Panca Bhakti (IHCPB) INTRODUCTION Stroke affects 795,000 people in the United States.
Stroke is the second leading cause of death and the leading cause of disability.
More than 6 million died and another 5 million were permanently disabled (WHO, 2.
Meanwhile, stroke has increased from 2007 to 2013 in Indonesia.
The Health Research and Development Agency through Basic Health Research (Kemenkes, 2.
, estimated that there were 2,120,362 stroke sufferers in 2018.
Furthermore, stroke was around 10.
9% based on doctor's diagnosis, of which the highest number was 50, 2% suffered by patients aged > 75 years and 45.
3% aged 65-74 years (Kemenkes RI, 2.
Ischemic and hemorrhagic stroke patients had sleep problems which accounted for 42% severe sleep disturbances, 20% moderate and 16% mild levels totaling 200 people in the neurology clinic of the medical faculty of the University of Tuzla Bosnia & Herzegovina (Pasic.
Smajlovic .
Dostovic.
Kojic, & Selmanovic, 2.
In line with a study on post-stroke patients after being hospitalized for the previous 3 months in a row, 36.
6% of patients reported symptoms of insomnia while 12.
6% reported symptoms of insomnia with daytime sleepiness .
ften feeling tire.
(Chen, 2.
Stroke survivors with ongoing physical disabilities report worse sleep disturbances and experience greater daytime sleepiness.
This is caused by changes in the abnormal shape of sleep waves in stroke patients, namely a decrease in slow waves, rapid eye movement (REM) and sleep-wake disorder.
Meanwhile Research Salah et al .
states excessive sleepiness throughout the day with sleep symptoms apnea or fatigue caused by insomnia has a major influence on the patient's ability to follow the rehabilitation program that will be affect the functional ability of the patient and the prognosis of the attack second stroke.
In various studies it is stated that sleep disturbances become risk factors for stroke.
The information obtained by the author through observations and interviews with patients and practitioners in hospitals when carrying out nursing care that stroke patients have sleep problems, plus the Covid-19 pandemic situation which adds to the fear of stroke patients.
overcome this problem the patient will be consulted to a doctor and given medication if he has severe sleep disturbances.
Therefore, nurses play a role in providing nursing interventions for this sleep disorder problem.
Sleep hygiene is one of the main behavioral interventions recommended to ensure poor sleep habits that do not interfere with the benefits of the effects of other interventions such as medication.
Sleep hygiene has been shown to improve sleep 2nd International Health Conference STIKes Panca Bhakti (IHCPB) quality in post-stroke patients in the Australian New Zealand Clinical Trial Registry (Nguyen.
Sleep Hygiene is beneficial in the ability to regulate sleep, change previous bad habits about what is recommended before going to bed, reduce previously experienced sleep disturbances and can improve sleep quality (Carney & Edinger.
D, 2.
Based on the background of this phenomenon, this paper aims to describe the effect of sleep hygiene on insomnia in stroke patients.
So the importance of this writing can solve the problem of insomnia in stroke patients who will contribute to the field of nursing and become a reference for nurses who will be useful for hospitals in particular and society in general.
This intervention adds knowledge and information so that nurses begin to innovate through technology in providing nursing care to stroke insomnia patients.
Therefore, the urgency of the research is deemed necessary because the quality of nursing services is the ultimate goal of managing the insomnia problem of stroke patients which will impact the nursing care provided later.
In fact, this intervention is expected to prevent further complications, improve the quality of life of patients and reduce the cost of care in this post-pandemic era.
METHOD
This research was conducted by the STIKes Binalita Sudama team who have obtained ethical approval with Number A/001/08/LPPM/STIKes/BSM/VII/202.
All methods were performed in conformity with the relevant guidelines and standard recommendations.
This study is a quantitative study using a pra-experimental research design from 22 September to 30 September 2021, which is a design that involves a group by testing an intervention to determine the effect of sleep hygiene.
on insomnia before and after the intervention.
This research was conducted at the Regional Hospital of Medan City.
The population in this study were all stroke patients in the outpatient polyclinic of Medan City Hospital, the Non-Probability Sampling method used was accidental sampling, so that 15 samples were obtained within 7 This research has obtained ethical approval from the ethics committee and obtained permission from the research and development unit at the hospital, the head of the outpatient polyclinic and the head of the polyneurology room.
2nd International Health Conference STIKes Panca Bhakti (IHCPB) The data collection procedure was taken in the outpatient poly room in the morning while the patient was waiting to be taken for anamnesis by the doctor.
The researcher asked the patient's willingness to participate in this study by signing an informed consent.
In this study, researchers selected stroke patients who met the inclusion criteria of outpatients at the Outpatient Polyclinic of Medan Hospital, did not use depressant drugs and sleeping pills, had a partner or family who cared for them, were cooperative, could use a smart phone, the patient has a private bed environment as a comfortable resting place.
comfortable, quiet and clean.
We further excluded participants who did not attend this study or complete the educational intervention, pre-test, and post-test.
Patients filled out a questionnaire distributed via the Google form which contained demographic data, an insomnia questionnaire .
re-tes.
with the Pittsburgh Sleep Quality index (PSQI).
Respondents with a value of > 5 were declared to have sleep disorders.
Then a video of Healthy Sleep Information (Sleep Hygien.
was given, followed by a discussion and questions and answers about 15 minutes.
Respondents were directed to fill in a sleep diary in the morning and before starting the sleep program at night.
Respondents will be monitored via whatsapp, telephone or video call and recorded in a sleep diary.
Furthermore, on the eighth day an assessment of insomnia .
ost tes.
was carried out on the respondents.
Submitted responses were extracted from Google Forms to the Microsoft Excel ver.
(Microsoft Corporation.
Redmond.
WA.
USA) for further data processing and coding.
Dichotomous data were presented as frequencies and proportions, whereas continuous data were presented based on data normality in mean A standard deviation (SD) or median .
nterquartile range/IQR).
The comparison between pre-test and post-test scores for insomnia was analyzed using the Wilcoxon signed-rank test due to the data's normality.
All normalities were tested following the principle of the Shapiro-Wilk test.
Furthermore, the data before and after the sleep hygiene intervention were analyzed using the one-sample T-test.
A two-tailed pvalue of less than 0.
05 was considered statistically significant.
All statistical analyzes were performed using SPSS software (SPSS Inc.
Chicago.
IL.
USA) 2nd International Health Conference STIKes Panca Bhakti (IHCPB) Figure 1.
Research Flowchart
RESULTS
Characteristics of Respondents A total of 15 participants who successfully met the eligibility criteria were included in this The average age of the respondents was 65 years (IQR.
, 9 people .
%) were female, 6 people .
%) had comorbid hypertension and had an average stroke of 5 years (IQR 1- .
The detailed characteristics of the study participants are given in Table 1 2nd International Health Conference STIKes Panca Bhakti (IHCPB) Table-1 Characteristics of the study participants Variabel Age .
Gender Man Woman Comorbidities Hypertension Length of time suffering from stroke .
Participants .
-11 ) .
The Wilcoxon signed-rank test was used for PSQI kuesioner.
The comparison analysis between pre-test and post-test scores of the insomnia showed a significant difference .
=0.
The scores and comparison results between pre-test and post-test are summarized in Table 2.
Table-2 Analysis of the Effect of Sleep Hygiene on Insomnia in stroke patients Variabel Insomnia
Intervesi
Pre
Post
Hygiene Mean ASD
11,30A3,169
10A2,478
Nilai p
0,0001*
DISCUSSION