Domain 4. Activity-rest
Class 1. Sleep-rest
Diagnostic Code: 00095
Nanda label: Insomnia
Diagnostic focus: Insomnia
Insomnia is one of the most common sleep disorders, characterized by difficulty falling asleep, difficulty staying asleep, and feeling tired even after plenty of sleep. It is a widespread problem affecting around 35% of adults aged 18–60 years worldwide. A nursing diagnosis is an organized statement of the nursing patient’s problem associated with physiological, psychosocial and environmental factors. Nursing diagnosis are based on the NANDA-International Taxonomy classification system that provides a framework to develop, coordinate and communicate nursing care plans. The NANDA-I (North American Nursing Diagnosis Association) has developed a taxonomy of the nursing diagnosis and has identified the diagnosis of Insomnia as a common problem across all populations.
NANDA Nursing Diagnosis Definition
As per the NANDA-I Taxonomy, Insomnia is defined as a “disturbed Sleep related to inadequate nocturnal sleep.” It is categorized under the domain “Sleep-Rest” and also included under the “health promotion” and “risk reduction” categories.
The defining characteristics of Insomnia are classified into subjectives and objectives. Subjectives include:
- Reports difficulty falling asleep
- Reports difficulty staying asleep
- Reports non-refreshing sleep
- Appears tired
- Difficult to arouse
- Agitated awakenings
- Unable to keep regular sleeping schedules
On discussing related factors for Insomnia, the main cause leading to this disorder is an underlying health condition such as depression, anxiety etc. In some cases uncomfortable physical situations (such as fever, coughing or pain) can interrupt sleep. Other related factors include use of medications, working in shifts, caffeine or nicotine consumption, or having an irregular sleep-wake cycle.
At Risk Population
At risk population for developing Insomnia includes people with mental health issues like depression and anxiety, people who work in shifts, those in certain age bracket, persons suffering from chronic illnesses like asthma and arthritis, people who consume large amounts of caffeine or alcohol, and people with specific lifestyle habits (like late night studying).
Insomnia is associated with several conditions such as depression, anxiety, obesity, hypertension, diabetes, COPD, heart diseases and many more.
Suggestions of Use
Nurses may use treatments according to the individual’s need and preferences. They may suggest changes in lifestyle such as regular exercise, following good sleep hygiene practices such as maintaining a regular sleep schedule and avoiding late night dinners and snacks, avoiding stress and noisy environment, reducing use of caffeine and alcohol, etc. In addition, the nurse can also introduce behaviour therapy and cognitive behavioural therapy along with the use of medications.
Suggested Alternative NANDA Nursing Diagnosis
Apart from the Insomnia nursing diagnosis, the following diagnoses may be applicable for the same individual:
- Sleep deprivation related to an altered sleeping environment
- Ineffective Sleep Pattern related to depression
- Chronic confusion related to sleep deprivation
- Risk for Constipation related to disruption of normal sleeping and eating patterns
In making an accurate nursing diagnosis, it is important to note certain aspects such as the severity of Insomnia, personal histories, laboratory tests and physical/psychological examinations. While intervening to treat the symptoms of Insomnia, nurses should take into consideration the client’s lifestyle determinants.
The NOC (Nursing Outcomes Classification) defines a set of expected outcomes for an individual suffering from Insomnia. The outcomes are divided into five domains which are Sleep, Mood, Activity, Cognitive Function and Social Interaction. Examples of NOC outcomes for Insomnia include:
- Sleep:bedtime capacity, quality of sleep and sleep pattern
- Mood:mood content, mood regulation, self-concept, mental alertness
- Activity:activity tolerance, fatigue level, energy conservation
- Cognitive Function:perspective of life, focus, concentration, motivation and organization
- Social Interaction:ability to interact, family functioning and social support
Evaluation Objectives and Criteria
When evaluating Insomnia, nurses should observe the following objectives and criteria:
- The patient should demonstrate improved physiological and psychological wellbeing in terms of improved mood and energy.
- Patients should demonstrate reduced symptoms of insomnia such as improved sleep quality, sleep pattern, and fatigue levels.
NIC (Nursing Interventions Classification) is a standardized language that nurses use to document interventions. Examples of NIC interventions for Insomnia include:
- Health instruction:providing information about sleep hygiene practices and relaxation techniques
- Comfort measures:assessing noise level, room temperature, and light level
- Family Support:providing emotional support and teaching family members how to provide basic care
- Pharmacological Therapy:selecting the appropriate medication and monitoring its effectiveness
- Crisis Intervention:providing counseling for acute crisis situation due to insomnia
Nurses should focus on the following activities while helping individuals who suffer from Insomnia:
- Develop supportive relationships.
- Encourage behavioral strategies to reduce stress.
- Provide psychological support to improve mood.
- Develop healthy sleep hygiene practices.
- Assess the need for medications.
- Develop reasonable activity plans.
- Recommend complementary therapies such as acupuncture, massage, and yoga.
From the above discussion, it can be concluded that Insomnia is a common problem and can affect people of any age. It needs to be managed effectively and care should be taken to identify and address causes for sleeplessness in order to achieve good quality of life. Nurses play an important role in providing interventions that can help individuals struggling with Insomnia.
- What is Insomnia?
Insomnia is a sleep disorder characterized by difficulty falling asleep, difficulty staying asleep, and feeling tired despite having enough sleep.
- Who is at risk for developing Insomnia?
Persons with mental health issues like depression and anxiety, people who work in shifts, those in certain age bracket, persons suffering from chronic illnesses like asthma and arthritis, people who consume large amounts of caffeine or alcohol, and people with specific lifestyle habits (like late night studying) are at risk for developing Insomnia.
- What are the NANDA-I nursing diagnosis for Insomnia?
The NANDA-I (North American Nursing Diagnosis Association) has identified the diagnosis of Insomnia as a common problem across all populations.
- What are the intervention strategies for Insomnia?
Intervention strategies for Insomnia include lifestyle changes (regular exercise, following good sleep hygiene practices and avoiding stressful environment, reducing use of caffeine and alcohol), pharmacological therapy, behavior therapy and cognitive behavioral therapy.
- What are the evaluation objectives and criteria for Insomnia?
When evaluating Insomnia, nurses should observe the following objectives and criteria – The patient should demonstrate improved physiological and psychological wellbeing in terms of improved mood and energy and patients should demonstrate reduced symptoms of insomnia such as improved sleep quality, sleep pattern, and fatigue levels.