Date of Award


Degree Type


Degree Name

Master of Nursing


Faculty of Health and Human Sciences

First Advisor

Gerry Farrell


Living in an institutional setting places on residents certain constraints in relation to freedom of choice as to when, where, and how they conduct activities of daily living, such as, sleeping eating, attending to hygiene needs. Studies indicate this loss of control over the environment contributes to loss of self-esteem, leads to stress, and at times precipitates agitation among nursing home residents. Cognitive impairment may render dementia sufferers more vulnerable to loss of control over their control over their environment and result in agitation, which may in turn influence sleep. The study therefore, investigated if ‘environmental manipulation’ as in introducing flexibility in place of strict time schedules affected agitation and 24-hour sleep in 33 institutionalised dementia sufferers. The Cohen-Mansfield Agitation Inventory (CMAI) and the sleep scale included in the Dementia Mood Assessment Scale were used to quantify agitation and 24-hour sleep respectively. A ‘within-subject’ longitudinal time design comprising 4 phases was used with each phases was used with each phase covering 4 weeks. ‘Environmental manipulation’ was introduced following phase 2. Agitation was examined under 4 categories: aggressive, non-aggressive, verbally agitated, and ‘other agitated’ behaviours. A significant reduction in verbal agitation and a significant increase in ‘other agitated’ behaviours were observed on the early nursing shift. Descriptive statistics indicated a reduction in total agitated behaviours following the intervention on the early shift. Although 24-hour sleep as well as day sleep increased significantly immediately following the intervention, they returned to pre-intervention levels in phase 4. Night sleep was not affected. Findings of the study are of considerable clinical significance as there are few empirically validated nursing interventions to manage agitation and fragmented sleep in dementia sufferers.