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This literature review shows that sleep is important for healing and survival of critical illness (Richardson et al., 2007; Straham and Brown, 2004). Sleep deprivation impinges on recovery, ability to resist infection, brings about neurological problems such as delirium, respiratory problems because it weakens upper air way muscles thus prolonging the duration of ventilation, ICU stay and complicating periods just after extubation (Friese, 2008; Parthasarathy and Tobin, 2004). Noise, pain and discomfort (Jacobi et al., 2002; Honkus, 2003) modes of ventilation and drugs have been cited as causes of sleep deprivation in critically ill patients (Friese, 2008; Parthasarathy and Tobin, 2004). The inability of nurses to accurately assess patients' sleep has also been cited as a concern while polysonography has been cited as the most effective way of assessing patients' sleep despite the difficulties associated with it. While some of these causes of sleep disruption can not be easily alleviated, every effort must be made to promote REM and SWS sleep. More research is needed to find solutions to sleep disruption in ICU. More research is needed to ascertain the impact of mechanical ventilation on sleep disruption and more focused ways of sleep assessment are needed. Nurses need to minimise disruptions by clustering their care at night in order to allow patients to have the much needed REM sleep. Furthermore, more specific way of sleep assessment in the critically ill.
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PMID:Factors that impact on sleep in intensive care patients. 1988 Mar 19

Low mobility during hospitalization is an under-recognized epidemic leading to adverse outcomes (Brown et al. 2009). The goal of the Mobility Volunteer Program (MVP) is to keep older people as active as possible while in hospital to prevent delirium and loss of strength. Maintaining or improving function from admission to discharge increases the likelihood of patients being able to return home sooner and to their prior level of functioning. The MVP is a valuable component of a multi-pronged corporate strategy to improve rates of mobilization at Sunnybrook Health Sciences Centre. We will describe the MVP and share stakeholder feedback and lessons learned.
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PMID:The Mobility Volunteer Program: Stepping into the Future of Senior-Friendly Care. 3005 13

Background: Although there is growing evidence that close reading of literature and reflective writing can improve providers' appreciation of the patient experience, foster physician development, and combat burnout, there has been less work on the experience of reading literature with patients, and even less literature about its effect on those facing serious or life-threatening illness. In addition, longer form reading may be unsuitable for some patient populations, given high burden of fatigue and possible contribution of delirium. Time pressure may also preclude discussion by a practitioner working in a busy clinical context. Hypothesis: We feel the condensed medium of poetry presents a natural opportunity to engage patients with the medical humanities, helping them to articulate difficult or joyful experiences, and/or serving as necessary diversion when facing serious illness. Project Description: Poetry for patients-a project developed through collaboration between Northwestern Memorial Hospital, The Jesse Brown VA, and the Poetry Foundation in Chicago, an independent literary organization committed to a vigorous presence for poetry in our culture-has developed three short collections of poems, and an accompanying discussion guides for use specifically with patients and families. Hereunder, we present three case examples of a short (10-30 minutes) reading session with patients demonstrating that it is feasible to incorporate reading poetry with patients facing serious illness. Potential therapeutic value includes helping patients to articulate pain and joy, giving patients a vehicle to recapture their creative voice, and altering the power dynamics inherit to the provider-patient relationship. We have also noted enhanced life review, often on themes otherwise difficult to access. In turn, these readings have deepened our ability to see out patients as creative, intellectual, and larger than their medical illness.
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PMID:Poetry for Veterans: Using Poetry to Help Care for Patients in Palliative Care-A Case Series. 3283 Sep 90