Diagnóstico NANDA-I Insomnio en salud laboral: conceptualización de los elementos diagnósticos y análisis de las intervenciones derivadas
|Alternative title||NANDA-I Diagnosis for Insomnia in Occupational Health: conceptualization of the diagnostic elements and analysis of related interventions|
|Author||Vega Escaño, Juan|
|Director||Porcel Gálvez, Ana María
Barrientos Trigo, Sergio
Romero Sánchez, José Manuel
|Department||Universidad de Sevilla. Departamento de Enfermería|
|Abstract||Introduction. Insomnia is a public health problem on a worldwide scale and has become one of
the commonest sleep disorders. It is also one of the most significant occupational risk
factors, which leads to a deterioration ...
Introduction. Insomnia is a public health problem on a worldwide scale and has become one of the commonest sleep disorders. It is also one of the most significant occupational risk factors, which leads to a deterioration in workers’ quality of life and affects productivity and occupational accidents. Currently, its prevalence is heterogeneous and ranges from 5.8% to 20%, if the diagnosis is followed up, although due to the subjectivity of its symptoms, it can vary as widely as 4% - 50%. The factors associated with the onset of insomnia include being female, being elderly, suffering from some type of psychiatric disorder or mental illness, a low socioeconomic status, being divorced or widowed and engaging in toxic habits such as alcohol or narcotics consumption. As regards work, shift work is clearly the main associated risk, given that in Europe as many as 21% of all workers are required to do to some type of shift work, and this can disturb the circadian rhythm and the sleepingwaking cycle. The nursing taxonomy and, in particular, the nursing diagnosis of "insomnia" (00095) as defined by NANDA International, is an effective basic tool for identifying and managing disorders or health problems such as insomnia. However, to date there are few studies which provide a set of operational definitions that contextualize these nursing diagnoses to make them more understandable in the context of the area where they are used, which would allow for better orientation and accuracy in the diagnosis. Objectives 1. To contextualize the items of the NANDA-I Insomnia (00095) nursing diagnosis in Occupational Health 2. To analyse the interventions derived from the NANDA-I Insomnia (00095) diagnosis in Occupational Health Methods Two studies were carried out to accomplish the first objective. The first was a systematic review following the PRISMA statement, using MeSH descriptors and free terms such as: “Insomnia” AND “Occupational health” AND “Shift work” in the Pubmed, Scopus, Web of Science and CINAHL databases. We evaluated the methodological quality of the studies according to the CONSORT and STROBE guidelines. The second study consisted of a 2-stage methodological study. In stage 1, we proposed preliminary definitions to establish operational definitions and designed a questionnaire with the aim of contextualizing the nursing diagnosis of "insomnia" (00095) in nurses’ day-to-day clinical practice. In stage 2, the operational definitions were validated in two rounds by a group of experts recruited through an online delphi panel. As regards the second objective, a systematic review and meta-analysis were performed following the PRISMA statement and according to the meta-analysis reporting standards (MARS). We consulted the SCOPUS, PubMed, Web of Science, CINHAL and PsycINFO databases using the key words: “Insomnia” AND “Occupational Health”. The Cochrane Review Manager software (RevMan 5.3) was used to perform a metaanalysis following the random effects model, and we used the Insomnia Severity Index (ISI) as the outcome measure. We evaluated the risk of bias using the Cochrane collaboration tool, the CONSORT guidelines were used to assess the methodological quality and the GRADE tool was used to assess the quality of the evidence. Results To pursue the first objective, we included a total of 13 studies which met the inclusion criteria in the first systematic review study. These showed a prevalence for shift-related insomnia of 25% to 53%. As regards the appearance of insomnia symptoms, they also reflected the benefits of performing 12-hour shifts with rapid forward rotations. Factors that were influenced by shift work were also pinpointed, such as stress, anxiety, perceived health, healthy lifestyles and toxic habits, occupational accidents, fatigue or weight of workload. In the study, 8 out of the 15 preliminary operational definitions proposed by the group of experts were accepted in the first round, 4 in the second round, and the remaining 3 in the third round. To validate the content of these operational definitions, the questionnaire was answered by 186 experts after the first round and by 71 experts in the second round. Initially, 6 operational definitions were validated with a Diagnostic Content Validation Index (DCVI) of between 0.89 and 0.80 and then, in the second round, another 5 operational definitions were validated after reformulation, with an DCVI of 0.94 - 0.80. The 4 operative definitions that were left unvalidated produced an DCVI between 0.64 and 0.77 and were finally validated by a consensus of experts since the DCVI was close to the level agreed on as acceptable. As regards the second objective, 22 studies were included in the systematic review and 12 studies in the meta-analysis. The sample consisted of 827 workers with a mean age of 44 years (SD 5.4), of whom 57.5% were women and 71.9% had a high educational level. 68.1% were interventions based on cognitive behavioural therapy, 13.6% on health programs and 9.1% on other therapies such as mindfulness, creative writing or drug therapy. According to the meta-analysis, a moderate effect was obtained for the reduction of insomnia symptoms after the intervention (MD -2.08, 95% CI: [-2.68, -1.47]) according to the scores obtained in the Insomnia Severity Index (ISI) used to measure the outcome. The degree of heterogeneity obtained was acceptable (P = 0.64; I2 = 0%), after 4 of the studies were excluded. The quality of the evidence and the risk of bias were moderate. Conclusions Insomnia caused by shift work is a worldwide public health problem that affects the worker’s quality of life on both a personal and professional level. The effect is also influenced by the characteristics and context in which the shift work takes place, sometimes combined with other factors. To counter this, interventions on insomnia in the workplace are moderately effective, with cognitive behavioural therapy the commonest type of intervention used. As regards sleep, the interventions improved sleep quality and reduced insomnia symptoms, producing a greater perception of satisfaction with sleep. On a professional level, positive effects were noted in productivity, presenteeism and fatigue. Finally, as regards the approach to this pathology from the nursing taxonomies, the operational definitions for the defining characteristic contained in the nursing diagnosis of "insomnia" (00095) in the NANDA-I, mostly produced an acceptable value for DCVI, showing a consensus from the group of experts, although these point out that some defining characteristics lack a certain degree of representation in the field of occupational health.
|Citation||Vega Escaño, J. (2021). Diagnóstico NANDA-I Insomnio en salud laboral: conceptualización de los elementos diagnósticos y análisis de las intervenciones derivadas. (Tesis Doctoral Inédita). Universidad de Sevilla, Sevilla.|