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每日跟讀#552: Why Hospitals Should Let You Sleep

為什麼醫院應該讓你好眠?

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每日跟讀#552: Why Hospitals Should Let You Sleep

If part of a hospital stay is to recover from a procedure or illness, why is it so hard to get any rest?

如果住院的部分原因是要從手術或疾病康復,為什麼想要歇息片刻會這麼難?

There is more noise and light than is conducive for sleep. And nurses and others visit frequently to give medications, take vitals, draw blood or perform tests and checkups — in many cases waking patients to do so.

噪音和光線多(或強)到足以讓人難以入眠。護理師等人頻繁前來給藥、量取生命徵象、抽血或進行檢測,許多時候是叫醒病人來做。

Some monitoring is necessary, of course. Medication must be given; some vital signs do need to be checked. And frequent monitoring is warranted for some patients — such as those in intensive care units. But others are best left mostly alone. Yet many hospitals don’t distinguish between the two, disrupting everyone on a predefined schedule.

當然,有的監測有其必要。藥一定要給;有些生命徵象必須檢查。頻繁的監測對某些病人而言也是必要的,例如加護病房的病人,其他病人則最好少去打擾,然而許多醫院並未將二者加以區分,照著預定時程打擾每個病人。

Peter Ubel understands the problem as both a physician and patient. When he spent a night in the hospital recovering from surgery in 2013, he was interrupted multiple times by blood draws, vital sign checks, other lab tests, as well as by the beeping of machines. “Not an hour went by without some kind of disruption,” said Ubel, a physician with Duke University. “It’s a terrible way to start recovery.”

既是醫師又當過病人的伍柏了解這個問題。2013年他為了從手術恢復而住院一晚,當晚他被抽血、生命徵象檢查、其他檢驗和機器嗶嗶聲打擾多次。現為美國杜克大學內科醫師的伍柏說:「沒有一小時沒受到某種打擾,這是展開復原過程的可怕方式。」

It’s more than annoying — such disruptions can harm patients. Short sleep durations are associated with reduced immune function, delirium, hypertension and mood disorders. Hospital conditions, including sleep disruptions, may contribute to “posthospital syndrome” — the period of vulnerability to a host of health problems after hospitalization that are not related to the reason for that hospitalization.

這樣的干擾不只惱人,還可能傷害病人。睡眠期間短暫與免疫功能下降、譫妄、血壓高和情感疾患有關。醫院的環境,包括睡眠干擾,可能導致「出院症候群」,就是病人出院後有一段期間容易出現許多健康問題,而這些問題跟住院原因無關。

“In addressing a patient’s acute illness, we may inadvertently be causing harm by ignoring the important restorative powers of a healing environment,” said Harlan Krumholz, a Yale University physician who has been calling attention to posthospital syndrome for several years. “The key to a successful recovery after illness may be a less stressful, more supportive, more humane experience during the hospitalization.”

耶魯大學醫師克朗霍茲呼籲重視出院症候群已有多年,他說:「在治療病人的急性疾病時,我們可能忽視了有治療功用的環境重要的幫助復原力量,因而在無意中造成傷害。病後順利復原的關鍵,或許正是少點壓力、多點支持、而且更人道的住院經驗。」

It’s an environment that, all too often, seems set up for everyone else’s convenience but the patient’s. To help patients deal with the stresses of hospitalization, sedatives are often prescribed. These medications, including opioids, carry their own risks, such as addiction.

醫院的環境往往似乎是為所有其他人的方便而設,獨獨忽視了病人的方便。為了幫助病人應付住院的壓力,醫師通常會開鎮靜劑。這些藥劑,包括鴉片類藥物,帶有風險,譬如使人上癮。

“Instead, we could make the environment more conducive to rest and reduce the use of sedatives,” Ubel said.

伍柏說:「我們大可讓醫院環境更有助於休息,並減少鎮靜劑的使用。」

Solutions aren’t hard to fathom. Ubel listed some in 2013. Hospital workers could coordinate so that one disruption serves multiple needs: a blood draw and a vitals check at the same time instead of two hours apart.

解決方法並不難懂。伍柏2013年列舉過一些。醫院人員可以協調,使一次打擾滿足多種需求:同時抽血和測量生命徵象,而不是隔兩小時分開做。

Or they could allow patients’ needs to guide schedules. If a patient is at low risk and can go six or eight hours without a vitals check, for example, perhaps don’t do that check once every four hours.

或者他們可以根據病人的需求安排時程。比方說,如果病人屬於低危險群,可以連續6或8小時無須測量生命徵象,也許就不用每4小時測一次。

Source article: https://paper.udn.com/udnpaper/POH0067/337387/web/

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