1. Insomnia is a disorder of falling asleep and maintenance of sleep from sleep onset. Insomnia includes difficulty in falling asleep, early awakening in the morning, short sleep duration, interrupted sleep, and excessive daytime sleep. Insomnia brings disturbance to the physical and mental health of patients, disrupts the physiological rhythm and reduces the activity capacity, which seriously affects the repair of the organism. Kang Xinmin, Department of Orthopedics, Lanzhou Hospital of Traditional Chinese Medicine and Orthopedic Surgery
2. Analysis of insomnia-related factors
2.1. Difficulty in falling asleep is the most common type of insomnia in orthopedic patients, which is mainly determined by the characteristics of orthopedic patients. Emergency trauma patients have no psychological preparation for sudden and unexpected injuries, while orthopedic patients face changes in the environment of disease torment all day long, the psychology of uneasiness about surgery, the stimulation of pain, the worry about disease prognosis, etc.. In this regard, we firstly try to provide a quiet sleeping environment and create good sleeping conditions for patients, try to meet the personal lifestyle without affecting the therapeutic care, respect the patients’ living habits, and secondly instruct patients to pay attention to sleep hygiene and develop good sleeping habits. 2.2. Pain is the primary problem of insomnia in orthopedic patients, pain is a common symptom of orthopedic diseases, at night due to the regulation of the vegetative nervous system and the night environment exacerbates the pain of patients.
2.3. Financial problems affect sleep. Although most patients now have medical insurance, the proportion of patients who have to pay for it themselves is also a concern.
2.4. Tension makes patients unable to sleep peacefully. Orthopedic emergencies account for the majority of orthopedic visits. Regardless of the cause of the fracture, the sudden stimulus will cause patients to have stress reactions, such as anxiety and tension, fear, etc. Patients are worried about whether they can be disabled, whether they are operated, whether there is a risk of life, etc. and they exude emotions such as irritability and feeling allergic.
2.5 Prolonged bed rest causes patients to sleep too much during the day, resulting in poor night sleep. It takes a long time for the fracture to heal, and prolonged bed rest causes the patient’s sleep pattern to be disturbed.
3 Nursing measures
3.1 Arrangement of the environment
Attention should be paid to the arrangement of the ward environment, so that the beds are soft and comfortable, the room temperature and light are adjusted, and the noise is reduced; all kinds of nursing and treatment work should not be carried out at night as far as possible, and the “four light” (walking, closing doors and windows, operating and talking) should be achieved, and all kinds of factors that may cause insecurity should be removed.
3.2 Establish a good nurse-patient relationship, give timely health education and make good psychological care.
To eliminate the patient’s nervousness, we combined with the overall nursing work, completed the patient’s admission propaganda, disease knowledge propaganda and dietary guidance within 24 hours of admission, patiently introduced the relevant situation, and reduced the patient’s psychological burden. At the same time, psychological support was given to patients according to their performance in different periods.
3.3 Care of pain
Give the patient the correct and comfortable position according to different fracture sites so that the patient’s limbs can get maximum relaxation; use painkillers reasonably to relieve pain; ensure the position and weight of various traction.
3.4 Reasonable arrangement of hospital expenses from the patient’s point of view, so that the patient has one point less to worry about and more to feel relieved. Implement a daily list system so that the patient can know at a glance the expenses used on that day and be relieved of worries. The nurse should inform in advance and patiently explain the significance of each examination for the higher cost items, and be accompanied by a nurse during the examination to increase the patient’s sense of security.
3.5 Instruct patients about sleep hygiene: sleep hygiene is helpful for many insomnia patients. First of all, insomniacs should be encouraged to establish a regular rest regime, and they should insist on not napping during the day, and naps should be cancelled, saving all the sleep they should get for the night. Dinner for insomniacs should be light, not too full, and avoid drinking night tea and coffee. Reduce the evening visitation, so as not to cause emotional excitement; do not engage in stressful and exciting activities before bedtime; in addition, hot baths, massage have a relaxing effect on the spirit, thus promoting sleep; should be timed to bed, turn off the lights to sleep, forming a conditioned reflex.
3.6 Correctly take hypnotic drugs: insomnia patients, for hypnotic drugs may produce two diametrically opposed attitudes, some patients are overly dependent on drugs, must be taken every night, the more doses; other patients and excessive fear of hypnotic drugs, rather than painful tossing and turning, not even dare to take a piece of medicine. It is important to tell patients that both attitudes are wrong. Based on the treatment of the cause of insomnia and sleep hygiene, patients should be instructed to use hypnotics intermittently and reasonably in order to give full play to their effects and reduce their side effects. It must be clear to both the nurse and the patient that the purpose of medication is not to make sleep dependent on the drug, but to use the drug as a means to re-establish the normal pattern of sleep. Since drug dependence can occur with existing hypnotic drugs, hypnotic drugs should be applied intermittently and discontinued decisively after the drug has had its effect. Patients should be told that a few nights of poor sleep have little effect on their health and that a natural sleep often follows. The nurse should master the effects and side effects of various hypnotic drugs, try to choose the ideal drug, strive to achieve the purpose with the smallest dose, and pay attention to the use of all possible favorable factors with hypnotic drugs. Long-term bedridden patients are not forced to sleep the same as healthy people, daytime and nighttime sleep time is often disproportionate, the total sleep time is not significantly reduced. Except for those who do not sleep all day or have severe insomnia, no treatment is usually necessary.
4 Conclusion
Insomnia, as a common sleep disorder, has a negative impact on the physical strength, energy and recovery of the patient’s body. The analysis of the above-mentioned patients’ sleep conditions has given us a further understanding of the insomnia problem in specialist patients, and we should actively take corresponding measures for the care of orthopedic insomnia patients, so as to provide purposeful and targeted care for insomnia patients.