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A study to determine the type and frequency of interruptions sustained by postcardiotomy patients in an intensive care unit Nicholson, Billie Patricia

Abstract

The environment of the intensive care unit is cited as one etiological factor of postoperative psychosis in patients following open-heart surgery. This descriptive study was undertaken to document the type and frequency of interruptions sustained by post-cardiotomy patients in one intensive care unit. The study was designed to answer three questions: 1. How frequent are the interruptions sustained by these patients? 2. How long are the blocks of uninterrupted time? 3. What are the types of interruptions? To collect the data a checklist of interrupting activities was utilized. The sample included 108 hours of observation that covered the first fifty-six postoperative hours. These hours were divided into early, mid, and late postoperative periods with thirty-six hours of observation in each period. To facilitate continuous observation, the observation periods were divided into four-hour blocks. A random sampling of the four-hour time blocks in each postoperative period over the days of the week was carried out. A descriptive analysis of the data collected centered around the three questions. Also, to facilitate analysis of data the types of interruptions were organized into four main categories: (1) nursing activities, (2) patient initiated activities, (3) activities of others, and (4) environment. Basic to the discussion of the data were the fallowing findings reported in the literature: (1) adults require eighty-five to ninety minutes to complete one sleep cycle, (2) there is a close resemblance between the psychosis of sleep deprivation and postcardiotomy psychosis, and (3) the environment of the postcardiotomy intensive care unit is not conducive to giving patients time for rest and sleep. Within the limits of the small sample size the findings of the study indicated that patients were frequently interrupted. Second, the interrupted time blocks are not long enough for patients to obtain rest and sleep. Finally, nursing activities were responsible for 50 percent of the interruptions. These findings supported the findings of other studies undertaken in the postcardiotomy intensive care unit. In addition, implications and recommendations far nurses regarding management of these patients were discussed. Finally, recommendations for further investigation were suggested.

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