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. 2015 Feb 27:9:1-9.
doi: 10.2174/1874434601509010001. eCollection 2015.

Theory of Inpatient Circadian Care (TICC): A Proposal for a Middle-Range Theory

Andrés Camargo-Sanchez  1 , Carmen L Niño  1 , Leonardo Sánchez  1 , Sonia Echeverri  2 , Diana P Gutiérrez  3 , Andrés F Duque  4 , Oscar Pianeta  5 , Jenny A Jaramillo-Gómez  6 , Martin A Pilonieta  7 , Nhora Cataño  8 , Humberto Arboleda  9 , Patricia V Agostino  10 , Claudia P Alvarez-Baron  11 , Rafael Vargas  12
Affiliations

Theory of Inpatient Circadian Care (TICC): A Proposal for a Middle-Range Theory

Andrés Camargo-Sanchez et al. Open Nurs J. .

Abstract

The circadian system controls the daily rhythms of a variety of physiological processes. Most organisms show physiological, metabolic and behavioral rhythms that are coupled to environmental signals. In humans, the main synchronizer is the light/dark cycle, although non-photic cues such as food availability, noise, and work schedules are also involved. In a continuously operating hospital, the lack of rhythmicity in these elements can alter the patient's biological rhythms and resilience. This paper presents a Theory of Inpatient Circadian Care (TICC) grounded in circadian principles. We conducted a literature search on biological rhythms, chronobiology, nursing care, and middle-range theories in the databases PubMed, SciELO Public Health, and Google Scholar. The search was performed considering a period of 6 decades from 1950 to 2013. Information was analyzed to look for links between chronobiology concepts and characteristics of inpatient care. TICC aims to integrate multidisciplinary knowledge of biomedical sciences and apply it to clinical practice in a formal way. The conceptual points of this theory are supported by abundant literature related to disease and altered biological rhythms. Our theory will be able to enrich current and future professional practice.

Keywords: Biological rhythms; chronobiology; circadian rhythms; hospital; middle-range theory; nursing.

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Figures

Fig. (1)
Fig. (1)
Inpatient Circadian Care (TICC). Biological rhythms are regulated by the environment due to the presence of timers or Zeitgebers (1). Disease is characterized by structural and functional changes that can be caused by alterations in biologic rhythms and/or interfere with the internal rhythms of the individual (2). Hospitalization represents a new environment for the patient, with new ambient timers that can complicate the recovery of the patient (3). The role of nursing is to intervene with the factors, both external and individual, that contributes to the desynchronization of the internal rhythms to favor patient´s recovery.
Fig. (2)
Fig. (2)
The circadian nursing care of the hospitalized patient and costs in health system. A scientific nursing practice that makes the accurate intervention to correct the disruption of the patient´s biological rhythms can reduce costs by avoiding prolonged hospitalary stays and severe complications in the patient (1). An inappropriate attention of the patient without considering biological rhythm´s synchronizing and desynchronizing factors implies the probability of raising costs in the attention of health services and inappropriate quality of attention (2).
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