How Many Times During the Night Do You Wake Your Patients?

[abundantjoy07, RN]

Do you tend to wake them every few hours? Or do you just pop in and turn on the bathroom light just to take a peek at them?

Of course, there are some that wake up all the time, but the sleepers and the ones that really do need their rest make me wonder what's the most appropriate thing to do.

[azor]

I dont wake my patients but if i need to give them there meds,i dont have any option than to do that besides,they ar in the hospital to get well and not to be left to sleep there life away.

[RN1989]

Working nights I carried a small flashlight. I did not wake the patients unless I had to give them meds. But meds, etc. were timed so as to prevent many p.o. meds. IV meds can usually be given without waking the patient. As long as they were breathing, I let them sleep. Had enough trouble trying to do all the "housekeeping" work that nights was responsible for. Couldn't get it done if EVERY pt was awake and on the call light.

[misslo]

We are required to reposition our residents every 2 hrs. I hate waking them up so sometimes I just rearrange a few pillows or change the position of the bed. That way, it cannot be said that I didn't reposition. Also, if they are actively dying I refuse to move them. Sometimes it seems you just get them comfortable and then it is time to reposition. If it were me, I would put a curse on someone that woke me up every 2 hrs!

[queenjean]

I work on a medical floor. I (or my aide if I have one) checks on the pt every hour. People who are incontinent or debilitated are turned and changed every two hours or sooner as needed. VS are at HS and somewhere between 0400-0500. If they are on tele and are somewhat unstable, new, or had a change in med, or something else is going on (like they are on a PCA) I'll wake them at 0100 or so for a mid-night vs check. I try to coordinate things like that with scheduled med administration, or if they call to go to the bathroom at 0000, I'll just get a set of VS then.

We have all sorts of pts--walky-talkies who are basically waiting for a test in the am, to fairly sick people who need to be more closely monitored. The walkytalkies I might not check on every hour if they find my checks intrusive--if they are light sleepers and keep waking up when I peek in, for example. I'll ask them if they want me to check on them less frequently, and then document it. Usually you can check on someone without waking them, though. I always tell them when I assess them that I'm going to be checking every hour, when I get VS, if I have to wake them up for something, etc so they know what to expect. Usually then if someone is a light sleeper they might ask if it has to be so frequent, and then we discuss it. Sometimes it *does* have to be so frequent because of their condition; othertimes it's negotiable. Mostly people appreciate knowing that someone is keeping a close eye on them.

[mpccrn, BSN, RN]

it depends on their condition.......bedridden, reposition every 2 hours by turning them, not just a change in HOB......prime canidates for pneumonia and atelectasis.......not on my watch. but i work ICU so it depends mostly on what's ordered....sometimes every hour, no more than every 2 hours in between waking them and doing a full assessment......that's what they are there for. when i work the floors i wake most people every 4 hours as that's our VS routine. i group care into those slots as best as i can so i distub them as little as possible. unless warrented, i try to administer care in low light and as gently as i can to accomplish the goal and keep them in sleep mode.

[Elvish, BSN, DNP, RN, NP]

I work on a mother/baby/antepartum floor. We have a mix of VS - some are q4, some are qsh, and some are BID (those are the stable vag deliveries about 24hrs out). Since it's mother/baby, they are up with the babies anyway. If I need to check them or get some VS I tell them to call me when baby wakes up so we can do it all in one fell swoop. If someone's BID vitals, I don't wake them but will check on them at least q2hrs. If they're q4, I try to either get their VS when they're awake w/ baby or if there's no baby, I get them at 2400 and 0400. If they're qsh I get them as close as I can to 2230 (working 12 hours) so they can get tucked in for sleep. Usually the qshifters are antepartums or c/s pts 48hrs out.

If a situation warrants though - pain, bleeding, or an antepartum issue, f. ex. - I will keep a closer eye on them and I tell them that.

If everybody's asleep and they don't need anything and I don't need to do anything, I let them sleep. They are exhausted as it is. I've been known to leave a note in the bathroom or tucked in the foot of baby's crib for mom to call me when she wakes up so we can see how she's doing. Most of our antepartums sleep through the night, and all I do is peek my head in there to make sure they're breathing and not in any sort of distress.

[marachne]

We are required to reposition our residents every 2 hrs. I hate waking them up so sometimes I just rearrange a few pillows or change the position of the bed. That way, it cannot be said that I didn't reposition. Also, if they are actively dying I refuse to move them. Sometimes it seems you just get them comfortable and then it is time to reposition. If it were me, I would put a curse on someone that woke me up every 2 hrs!

One thing to think about with those who are on comfort measures: I understand not wanting to reposition too often, but you might want to do it at least q4h -- think about how stiff you are if you sleep so hard you don't move in your sleep. Repositioning CAN be a comfort measure as it relieves pressure and maybe keeps muscles from tightening up and causing discomfort. A change can be pretty minimal. Also, if someone is really chachetic, you want to make sure none of those bony prominences are rubbing (are all those pillows between knees, under arms, etc still in place?)

Plus, it's an opportunity for touch, which is sure important until death. The one place where I tend to be really conservative is if they have mets to the bones.

[blondy2061h, MSN, RN]

Depending on how many meds they get, and how light of a sleeper they are, I can often get through a shift only waking them 1-2x. I'll do MN meds with MN vitals and 4am meds with 4am vitals and AM lab draw. If their central line is positioned well, I can often do their blood draw without waking them. IV meds I can definitely do without waking them. I&Os I can do without waking them.

I leave the light on in their bathroom and just open the bathroom door to get a little light in the room. Some people, however, are wide awake the second they hear foot steps.

[lsyorke, RN]

I dont wake my patients but if i need to give them there meds,i dont have any option than to do that besides,they ar in the hospital to get well and not to be left to sleep there life away.

Sleep is a vital part of good health. Patients deserve uninterupted sleep whenever possible. They are not "sleeping there life away".....they are sick and sleep is a key part of recovery. Minimizing disturbing sleep, whenever possible, is good nursing practice.

[Vito Andolini]

Wake them as little as possible. They need their rest. They also need their treatments and meds.

This will depend on each individual patient's condition. If they're acutely ill, it's different than for the chronic resident of a long-term facility, than for the actively dying. Head injured? Incontinent? Use good judgment and follow orders.

[lpnstudentin2010, LPN]

When I am in the hospital I am a post op patient....They only wake us of vitals first day my mom says it is usually 4 times during the night, after that it is 2. they try to not wake me, but they always end up waking me because my bp plumits when I am asleep and it worries my nurses.