Treating Depression and Sleep Impairment to Improve Pain Levels and Quality of Life for Patients with Sickle Cell Disease: A Quality Improvement Project
Sheran Maxwell Simo, DNP, MS, APRN, ACHPN, FNP-BC
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Background: Vaso-occlusive crisis (VOC) pain is both an acute and chronic factor for patients with sickle cell disease (SCD). Acute, recurrent, and unrelenting pain is often joined by other affective disorders that impact pain chronicity, and some patients with sickle cell disease have depression and/or sleep disturbances that may impact pain levels and quality of life.
Aim: The purpose of this quality improvement project is to improve the process of assessment and treatment of depression and sleep disturbance in patients admitted to Bridgeport Hospital, Bridgeport, CT with VOC. The goal of this project is to improve overall pain levels and quality of life for patients with SCD through efficient and effective evaluation and treatment for depression and sleep disturbance.
Method: An interdisciplinary team, led by the palliative care (PC) advance practice registered nurse (APRN), used the Stetler Model to guide the process of translating existing research regarding the impact of depression and sleep impairment on pain and quality of life in patients presenting with VOC, into evidence-based practice. The team created the Guideline for the Evaluation and Treatment of Depression and Sleep Impairment in Sickle Cell Disease. Patients were assessed, offered treatments and reassessed during the project period.
Results: Both depression and QOL scores showed significant improvement by the end of the project. Significant correlations were found between pain, depression and sleep; depression, pain, sleep and QOL; sleep, pain, and depression; and QOL and depression. Patient admissions as well as average length of stay decreased over the course of the project.
Limitations: The small convenience sample size limits the generalizability of the results to other practice sites. Patients who were not readmitted during the project timeframe were lost to follow-up, and were not reassessed to determine the effects of treatment recommended by the guideline.
Conclusions: Interdisciplinary teams are effective in creating a guideline to assess and treat depression and sleep impairment and their effects on pain and QOL in patients with SCD.
Implications for Practice: PC APRNs provide support and symptom management to patients with life-limiting and serious illnesses, including patients with SCD, as a means of improving QOL. This project has significance for APRNs in both palliative care and specialty SCD/Hematology care as a means to translate existing research into evidence-based practice; as well as provide an efficient and effective means to evaluate and treat depression and sleep impairment and their impact on pain and quality of life.
|Review Type||Faculty Approved: Degree-based Submission|
|Keywords||Sickle Cell Disease;
|CINAHL Subject(s)||Anemia, Sickle Cell;
Anemia, Sickle Cell--Complications;
Quality of Life
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