The National Library of Medicine notes an emerging area of research interest is the relationship between substance abuse and sleep (Mahfoud et al., 2009). According to the same 2007 National Survey on Drug Use and Health, “7.6 percent of Americans older than 12 years met the criteria for alcohol abuse or dependence” and goes on to highlight the mundanity of sleep disorder. Additionally, the 2008 National Sleep Foundation’s “Sleep in American” poll demonstrated “addicts in recovery are 5 to 10 times more likely to experience sleep disorders.” (Moufoud et al., 2009). Clinical Site 1 is an agency in Downtown Seattle focusing on maintaining recovery, reducing relapse, building relationships, and regaining a sense of independence. The agency notes the importance for healing and hope, and has already helped many people transform their lives. It has become a safe, home-like, and family-oriented place filled with meals, coffee, love, and respect. Four nursing students from Seattle Pacific University were assigned to design and implement an intervention in this population. To determine a nursing diagnosis, a windshield survey and verbal assessments were conducted. The results indicated a comprehensive knowledge deficit among the clients related to social determinants of health (SDOH) as evidenced by reported sleep hygiene habits.
The assessments at Clinical Site 1 populated a wide variety of health needs, dependent on each person's unique recovery journey. It was collectively decided that a significant health concept that affects the majority of the population at the site is sleep quality. Multiple clients reported not getting quality sleep, as well as a sleep hygiene knowledge deficit. Sleep is a basic 3 human necessity that affects both a person's physical and mental status. Researchers at Harvard Medical School noted the functions and mechanisms of sleep is, “essential for many vital functions including development, energy conservation, brain waste clearance, modulation of immune responses, cognition, performance, vigilance, disease, and psychological state” (Zielinkski, et al., 2016). Additionally, targeting interventions around sleep hygiene can improve the client's recovery progress (Substance Use and Mental Health services Administration, 2014). Many adjustments to this populations sleep routine did not require access to medical supervision or expensive supplies. Individuals can improve their sleep habits themselves after receiving education regarding sleep hygiene. These recommendations based in education can turn into new habits and furthermore increase their sleep quantity and quality, and the overall functions of their mind and body. The Model of Change states that interventions at the preparation and action stage lead to the maintenance stage where clients can self-sustain habits (Raihan, 2023). Improper sleep hygiene is prevented at the secondary level of prevention in the Three Levels of Prevention model because it targets an already existing problem by encouraging behavior modification (Kisling, 2022).
Activities with rationale
To maintain a schedule and focused goal as a team, a GANTT chart and Logic Model were produced prior to beginning implementing the intervention (Table 4, Table 1). To more fully determine the sleep quality of the population, a 10 question survey was produced (Table 3, Figure 3). Over the weeks of intervention, the survey was also readministered on previously educated clients to assess intervention efficacy (Table 5). To target the secondary level of prevention at the preparation and action stages of change, client educational pamphlets and 4 client sleep kits were made using the budget of $30. The client education pamphlets addressed 5 drug-free topics — exercise habits, sleep environment, diet and substance habits, power napping, and consistency, inspired by the Tips For Better Sleep (Centers for Disease Control and Prevention, 2022), which coincides with published findings at Fargo that demonstrate “Sleep hygiene education has the potential to be a key strategy for improving sleep in the general population” (Irish, 2015). Because researchers at Baylor conclude “participants who wrote a to-do list at bedtime fell asleep faster” (Scullin, 2018), sleep kits included pens and journals, as well as earplugs, toothbrushes, toothpaste, hand sanitizer, and hand lotion. In the study, regardless of what they wrote down, their sleep improved, and those who used the strategy of making a to-do list before bed further eased their transition into sleep. With both of the sleep kit and education interventions, the main focus was to find realistic interventions that would not only be effective but also achievable and sustainable for the client population. Distribution of pamphlets and sleep kits was a both passive and active process. Both resources were set-out on the coffee counters as well as solicited directly to accommodate different levels of client sociability. In the Knowledge-Skills-Abilities (KSA) framework, this intervention targets the knowledge stage with education, and the skills stage with supplies to practice journaling (Centers for Disease Control and Prevention, n.d.). This project engages the assurance stage of the Public Health Function model by directly engaging the community (Centers for Disease Control and Prevention, 2023). This intervention also targets the behavioral outcomes in the Pender model of individual characteristics and experiences, behavior-specific cognitions and affect, and behavioral outcomes (Pender, 2011). Lastly, survey data and open ended responses were compiled into graphics and tables to determine their impact.
Overall, clients at Clinical Site 1 demonstrate a moderate knowledge deficit related to SDOH as evidenced by reported sleep hygiene habits. From the approximately 64 clients at Clinical Site 1 interacted with, 57% voluntarily engaged in the intervention process (Figure 1). From the 10 Question Survey, most clients reported sleeping at night (91%), most sleep in their own living space (77%), and nearly none use ear plugs to sleep (8%) (Figure 3). Across the span of 3 weeks, 20 sleep kits and approximately 50 pamphlets were distributed directly to clients (Table 2, Figure 2). Statements from clients regarding habit changes post-education are recorded in Table 5. Notably, the most common response regarded improving the quietness of their sleep environment, followed by working towards a consistent time to sleep. Overall, clients demonstrated an increased understanding in sleep hygiene.
In conclusion, clients have expressed a desire to increase their quality of sleep based on interventions performed. For the clients that actively engaged, the data shows a growth in their progress towards improving their sleep. For the unengaged clients at Clinical Site 1, further work is needed to promote healthy sleep habits. Moving forward, more resources can be considered including sleep masks and meditation training. These resources can potentially be obtained through fundraising and/or neighborhood outreach. Throughout this intervention, limited resources and time have negatively influenced the depth of behavior modifications. Findings conclude clients with knowledge deficit related to SDOH improved in regard to sleep hygiene behaviors.
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