Designing and accrediting the evidence-based care guidelines on insomnia and constipation in psychiatric patients

Document Type: Original Quantitative and Qualitative Research Paper


1 Instructor of PSychiatric Nursing, School of Nursing, AJA University of Medical Sciences, Tehran, Iran

2 Assistant professor of Nursing, Department of Psychiatric Nursing, School of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran

3 Assistant professor of Nursing, Department of Management Nursing, School of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran

4 Instructor of Nursing, Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran


Background:Evidence-based care guidelines are one of the new ways to improve the quality of care and increase patient satisfaction. In addition to the mental and emotional problems, mentally ill patient suffers from multiple health problems. The most common patient's bio-psycho problems are insomnia and constipation.
Aim: The aim of this study was to designing and Accredit the evidence-based care guidelines on insomnia, and constipation in psychiatric patients.
Methods: This study is a developmental research and was performed in mental wards of the Baqiyatallah hospital in Tehran in 1392.
Evidence-based care guidelines were designed based on the stetler model in evidence-based approach. To check the validity of the content instruction with Delphi method, comments of ten elected faculty members were considered in three different stages. Application of the guidelines was examined using ten experts in focused group discussions.
 In addition to nursing books, 100 articles from proquest, Pubmed, Google scholar, Elsevier, SID, and Magiran with evidence based nursing care, insomnia, constipation, psychiatric patients, protocol keywords were studied.
Results: In this study, 4 evidence-based care guidelines, including nursing diagnosis, etiology, evaluation criteria, and nursing interventions were designed. These guidelines can be used as a clinical guide for the care of psychiatric patients based on the credible scientific literature and evidence-based approach.
Conclusion: With designing evidence-based nursing care instructions for psychiatric patients, the need of clinical nurses in confronting these patients was removed. It also leads to improve the quality of care and reduce complications in duration of the hospital stay.


Main Subjects

1. Primary Care Management of Sleep Complaints in Adults. Guidelines and Protocols Advisory Committee. 2004;2(1):22-9.

2. Abbasi S, S. M, Bousari P. Relationship between General Health Level and Sleep Quality in Chemical Warfare Victims with Bronchiolitis Obliterans. J Military Medicine.2012;14(1):15-9.

3. Spoormaker VI, Montgomery P. Disturbed Sleep in Post-Traumatic Stress Disorder: Secondary Symptom or Core Feature? Sleep med Res. 2008;12(3):169-84.

4. Pires GN, Tufik S, Andersen ML. Relationship between Sleep Deprivation and Anxiety – Experimental Research Perspective Einstein. 2012;10(4):519-23.

5. Roth T. Insomnia: Definition, Prevalence, Etiology, and Consequences. . clin Sleep Med 2007;3(5):7-10.

6. Franzen P, Siegle GJ, DJ. B. Relationships between Affect, Vigilance, and Sleepiness Following Sleep Deprivation. J Sleep Res. 2008;17(3): 34–41.

7. Krystal Ad, THakur M, Roth T. Sleep Disturbance in Psychiatric Disorders: Effects on Function and Quality of Life in Mood Disorders,Alcoholism, and Schizophrenia. Ann Clin Psychiatry, 2008. 2008; 20(1):39–46.

8. van Dijk M, Benninga MA, Grootenhuis MA, Nieuwenhuizen AMO, Last BF. Chronic Childhood Constipation: a review of the literature and the introduction of a protocolized behavioral intervention program. Patient Education and Counseling. 2007;67(1):63-77.

9. Wald A, C S, Mueller-Lissner, S, al. e. A Multinational Survey of Prevalence and Patterns of Laxative Use Among Adults with Self-defined Constipation. Aliment Pharmacol Ther. 2008;28:917–30.

10. Tack J, Muller S, Stamghellini V, Boeckoxstanen G, et al. Diagnosis and Treatment of Chronic Constipation –a European perspective. Neurogastroenterol Motil 2011;23: 697–710.

11. Amirbaigy MK, Salman Roughani H, Hosseini N, Bootorabi Z. Assessment Of Colon Transit Time In Idiopathic Chronic Constipation. J Shahid Sadoughi Univ Med Sci.  2006;14(3):20-4.

12. Martin BC, Barghout V, Cerulli A. Direct Medical Costs of Constipation in the United States. Managed Care Interface,. 2006;19(12):43–9.

13. Johanson J, Kralstein J. Chronic constipation: a survey of the patient perspective. Aliment Pharmacol Ther. 2007;25:599–608.

14. Fuller JM, Wong KK, Krass I, Grunstein R, Saini B. Sleep Disorders Screening, Sleep Health Awareness, and Patient Follow-up by Community Pharmacists in Australia. Patient Education and Counseling.83(3):325-35.

15. Woolery M, Annette Bisanz, Hannah F. Lyons, Lindsay Gaido, Mary Yenulevich, Stephanie Fulton, et al. Putting Evidence Into Practice:Evidence-Based Interventions for the Prevention and Management of Constipation in Patients With Cancer Clin J Oncol Nurs. 2011;12(12):370-1.

16. Hewitt-Taylor J. Clinical Guidelines and Care Protocols. Intensive Crit Care Nurs. 2004 Feb;20(1):45-52.

17. Spiby H, Munro J. The Development and Peer Review of Evidence-based Guidelines to Support Midwifery Led Care in Labour. Midwifery. 2009 Apr;25(2):163-71.

18. Mohammadpor A. Comparative Standards of Hospital Hygiene Standards of the International Joint Commission on Hospital Accreditation, in Management and Information. Iran medical science university tehran . 2009;3(2): 2-3 (persian).

19. Salsali M BL, Taleghanizade F,. Research in Nursing Process, Critical Thinking, Application,  Boshra. 2003:123-73.(persian).

20. L G. Applying Research to Making Life-affecting Judgments and Decisions. Research on Social. WorkbPractice. 2007;17:143-50.

21. Dehghannayyeri N, Sayalani KH, Movahedi A, Farsi Z, Babamohammadi H. The Practice of Nursing Research Conduct, critique and utilization. Tehran: : Andishe rafie;2010.(persian).

22. mohamadpor A. Comparative Standards of Hospital Hygiene Standards of the International Joint Commission on Hospital Accreditation. tehran: Iran medical science universit ,2006:23-38 (persian).

23. Richey R, Klein JD, Nelson WA. Developmental Research: Studies of Instructional Design and Development. 2012:29-38.

24. Hamilton. National Collaborating Centre for Methods and Tools.Stetler Model of  Evidence-Based Practice. 2011:235-80.

25. Krassioukov A, Eng JJ, Claxton G, Sakakibara BM, Shum S. Neurogenic Bowel Management After Spinal Cord Injury: a systematic review of the evidence. Spinal cord.48(10):718-33.

26. Cortesi F, Giannotti F, Ivanenko A, Johnson K. Sleep in Children with Autistic Spectrum Disorder. Sleep med Res.11(7):659-64.

27. Moradi A, Khademolhoseini M, Madani J, Mokhtari Nouri J. Designing Evidence Based Nursing Care Instructions for Mechanically Ventilated Patients in Intensive Care Unit. Iran J Crit Care Nurs 2013;6(2):109-18.(persian).

28. Nezamzadeh M, Khademolhosseini M, Mokhtari Nouri J, Ebadi A. Design of Guidelines  Evidence-Based Nursing Care in Patients with Angina Pectoris. Iran J Crit Care Nurs


29. Habibi S, Wong KK, Krass I, Grunstein R, Saini B. Enhancing Information Literacy as a Base of Developing Evidence-based Nursing. Health Information Management. 2010;7(3).(persian).

30. Lofthouse N, . MAF, Splaingard. M, . KK, . JH, Resko. S. Web-survey of Pharmacological and Non-Pharmacological Sleep Interventions for Children with Early-onset Bipolar Spectrum Disorders. J Affect Disord. 2010;120: 267–71.

31. Belsey J, Greenfield s, Candy D. Systematic Review: Impact of Constipation on Quality of Life in Adults and Children. Aliment Pharmacol Ther , 2010;31:938–49.