Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.

Close

Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more

Does two-hourly pressure area care affect sleep?

  • Comments (22)

This week’s Behind the Rituals is from Liz Charalambous, staff nurse at Nottingham University Hospital

We have had a discussion on our ward about how two-hourly pressure area care affects sleep. The tissue viability team has introduced a skin bundle, which prescribes care for patients depending on whether they are classed as red, amber or green.

The latest meta-analysis from the Cochrane Collaboration finds no difference in pressure ulcer prevention when a risk assessment tool is used compared with clinical judgement. However, the current scheme does not allow for clinical judgement to supersede the tool.

What do you think?

I am doing a research study into prevention of delirium, and part of the criteria for preventing delirium is sleep hygiene. This involves ensuring patients get enough sleep.

  • Should clinical judgement override policies in this situation?
  • Is there any evidence to support a decision to do this?
  • Comments (22)

Readers' comments (22)

  • Anonymous

    I certainly think it does and it's not just the patient being turned that loses sleep the whole ward or bay does as lights have to be turned on, equipment moved etc.

    The NHS spends £M's on renting these alternating pressure relieving mattresses yet we still perform the ritual of two-hourly turns needlessly.

    Most managers seem to think that nothing really happens at night and I think turns are a way to demonstrate that staff are actually working.

    Unsuitable or offensive? Report this comment

  • Anonymous

    One of my students this week told me that 2 hourly turns originates from the war and the time has just stayed the same, its not evidence based

    Unsuitable or offensive? Report this comment

  • Anonymous

    There is good and bad points to this issues. Where patients are more prone to pressure marking ,turning them 2hrly has reduced their risk factors of developing pressure ulcers. On the other hand sleep is also important to recovery. Each patient is different, mobility, skin integraty,nutrition intake, health condition are important factor. Hospitals are now being fined for hospital acquired pressure ulcers,it could be argued that the focus on pressure care can is impacting on patients sleep and dignity.Having worked on an acute elderly care unit l can see for and against pressure care,most patients requiring pressure care are often immobile or incontinent which puts them at high risk and are check two hourly but others at less risk are also turned just because they may appear they are not turning themselves at night. How can we expect them to comply with rehabilitation if they are tired and would we like to be woken during the night. Bariatric bed are designed to turn patients and do not disturb sleep, would it not be more economical into looking into replacing beds on ward with high risk patients.

    Unsuitable or offensive? Report this comment

  • Anonymous

    The two hourly turns originated in Crimea, because that was the time needed to complete the turns for everyone in the ward.
    On a more serious point, a person who is in REM sleep is unable to move, therefore they wouldn't be able to alter their position. This level of sleep is possibly the most important type of sleep, by disturbing anyone every two hours means they are unable to obtain this.

    Unsuitable or offensive? Report this comment

  • Anonymous

    Respiratory care is also part of this equation as moving people aids air entry into different parts of the lungs helping to prevent chest infections.

    Unsuitable or offensive? Report this comment

  • Anonymous

    it's alright if patients can say no but what about acting in their best interests under mental capacity act 2005? What IS the best thing if they are getting no REM sleep because of turns? Sleep aids skin healing anyway....

    Unsuitable or offensive? Report this comment

  • It all boils down to benefit and risk. Patients should be turned at least once in the night, if unable to do so themselves. Also, take into account the type of incontinence aid used. Clinical judgement time.

    Unsuitable or offensive? Report this comment

  • Tinkerbell

    waking someone every 2 hours - although not intended is a bit like mental cruelty. I wouldn't like to be woken every 2 hours. Could I opt for 4 hourly at least?

    Unsuitable or offensive? Report this comment

  • Anonymous

    we always carried pa care according to need. if patients needed cleaning and turning every two hours so be it. if they were unable to move themselves or were unconscious it was considered very necessary, others were four hourly and others obviously not at all. we also tried to use the best aids available to avoid such frequent care but even with this there were still a few patients who needed this extra attention and care which we tried to carry out with as little disruption to them as possible. obviously if we could skip one episode of care we would but till needed to check they were clean and dry and in a comfortable position.

    Unsuitable or offensive? Report this comment

  • Anonymous

    quick search shows very little evidence to support 2 hrly turns, everything I read seems to avoid the issue of time, no mention of how often we should turn patients.
    http://www.ncbi.nlm.nih.gov/books/NBK48938/
    lots of evidence here and in depth info but still no time scales. Why do we bother with air mattresses then f we are still turning patients every 2 hours? I think we should let the nurses use their clinical judgement, if patient is incontinent then they may be wet and will need checking anyway

    Unsuitable or offensive? Report this comment

Show 102050results per page

Have your say

You must sign in to make a comment.

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions. Links may be included in your comments but HTML is not permitted.