病人在醫院出現失眠。護理師應優先執行哪項措施？

病人在醫院中出現失眠是常見的現象，可能由多種因素引起，例如環境陌生、噪音、疼痛、焦慮、藥物副作用或作息改變。護理師在處理病人失眠問題時，應遵循護理過程的第一步：評估（assessment），以全面了解導致失眠的潛在原因和病人的個人習慣。只有透過仔細的評估，才能制定出最適合病人的、個別化的介入措施。 了解病人平常的睡前習慣（usual bedtime routine）是評估失眠的首要步驟。這包括病人習慣的就寢時間、睡前活動（如閱讀、聽音樂）、飲食習慣（如睡前是否飲用咖啡因）、對睡眠環境的要求等。這些資訊能幫助護理師識別醫院環境與病人原有習慣的衝突點，並據此調整照護計畫，盡可能地為病人創造一個類似其居家睡眠的環境，從而促進自然入睡，而非立即依賴藥物。這體現了以病人為中心的整體性護理理念。

Insomnia in hospitalized clients is common and may be caused by various factors, such as unfamiliar environment, noise, pain, anxiety, medication side effects, or routine changes. When addressing a client's insomnia, the nurse should follow the first step of the nursing process: assessment, in order to comprehensively understand the underlying causes of insomnia and the client's personal habits. Only through careful assessment can the most suitable, individualized interventions be developed for the client. Understanding the client's usual bedtime routine is the first step in assessing insomnia. This includes the client's habitual bedtime, pre-sleep activities (such as reading or listening to music), dietary habits (such as caffeine intake before bed), and environmental sleep preferences. This information helps the nurse identify conflicts between the hospital environment and the client's usual habits, and adjust the care plan accordingly to create an environment as similar as possible to the client's home sleep environment, thereby promoting natural sleep without immediately resorting to medication. This reflects the patient-centered, holistic nursing philosophy.

在美國，護理師在評估病人失眠時，會更強調使用標準化的睡眠評估工具（如匹茲堡睡眠品質量表PSQI或Epworth嗜睡量表ESS），並記錄睡眠日誌。對於非藥物介入，會鼓勵病人嘗試睡眠衛生（sleep hygiene）原則，如建立規律作息、避免睡前使用電子產品等。台灣的臨床實踐也重視睡眠評估和非藥物介入，但對於工具的常規使用程度和衛教的深度可能因機構而異。在兩地，藥物介入通常被視為次要選項，優先考慮非藥物療法。