Digging Into Age-Old Medical Advice to ‘Get Some Rest’

All nurses have probably encouraged patients to “get some rest.” But what, exactly, does that mean? Are they recommending that patients sleep soundly through the night, take a nap, relax in a chair or take a walk to clear their minds? Esther Bernhofer, PhD, RN-BC, CPE, Senior Nurse Researcher at Cleveland Clinic, analyzed the concept of rest in the article “Investigating the concept of rest for research and practice” in the May 2016 issue of the Journal of Advanced Nursing.

Pursuing a long-held curiosity about “rest”

Dr. Bernhofer’s quest to better define the meaning of rest began years ago, when she was a mother of four young daughters and pregnant with her son. The midwife suggested that she get some rest. “I looked at her and asked, ‘When? How? Do you mean sleep?’ It was so ambiguous, and yet the need was there,” says Dr. Bernhofer. “I recognized that she was right. I needed to rest, but I didn’t know how.”

As a nurse, Dr. Bernhofer has offered the same advice to patients countless times. The concept seems simple in theory, but is less so when put into practice. “Mankind has always known that rest is clearly important, and we offer that advice to everyone we love,” says Bernhofer. “But we don’t really know what it means.”

Dr. Bernhofer sought to find a consistent use and meaning of rest in current scientific literature and to present a theoretical definition of rest, which could then provide a strong basis for research and practice. “Without a clear definition of rest and understanding of its parameters, its restorative benefits may not be realized and the advice to rest, based on little evidence, has limited usefulness and unknown risks,” posits Dr. Bernhofer in her article in the Journal of Advanced Nursing.

Carrying out a concept analysis

Dr. Bernhofer began by querying scientific peer-reviewed literature of five healthcare disciplines that recommended rest for patients: nursing, medicine, physical therapy, psychology and occupational therapy. She took into consideration 27 articles published between 1970 and 2015. Dr. Bernhofer used the Morse criterion-based method of concept investigation. “The goal was to come up with a definition of rest that healthcare practitioners could work with to move to the next step of defining rest for patients, removing some of the ambiguity and measuring the benefits of rest,” she says.

Dr. Bernhofer concluded that the epistemological, pragmatic, linguistic and logical descriptions of rest found in the literature “remain immature, poorly defined, rarely operationalized and inconsistently used.” However, she says a basic understanding of rest emerged, including these three primary types of rest:

1. Physical Rest –“Physical rest is the easiest to recommend or impose on patients,” says Dr. Bernhofer. “We tell them to go to bed or put their feet up, or we stop a joint from moving by applying a splint or cast to a limb. We know when physical rest is happening, but we still don’t always know how much is actually beneficial.”
2. Mental/Emotional Rest – When the work of constant problem-solving and worry becomes exhausting, we need mental and emotional rest. However, mental and emotional rest may be difficult to assess and attain, although mindfulness and relaxation techniques may help. We still don’t know how much mental/emotional rest is most effective for each individual.
3. Spiritual Rest – The work of searching for purpose and meaning in life often results in a need for spiritual rest. This is the hardest aspect of rest to pinpoint because it revolves around a person’s belief system, says Dr. Bernhofer. “As healthcare practitioners, we need to be aware of patients’ spiritual rest needs and consider referring patients to a spiritual leader – a priest, pastor, rabbi, imam or counselor – who could guide them toward spiritual rest.”

Through the literature review, Dr. Bernhofer formulated a theoretical definition of rest: Rest is a beneficial state that is intentional, temporary and restorative. Rest involves cessation, minimization or change in physical, mental or spiritual work, fatigue, trauma, illness or stress.

Setting sights on the next step

Dr. Bernhofer adds that further research is necessary, beginning with qualitative investigations, to advance the concept of rest and move toward an operational definition and perhaps a new nursing middle-range theory. It would be beneficial to begin by querying physicians, nurses and other practitioners on what they mean when they prescribe rest and what they think it means to their patients.

“A definition and understanding of rest is important so that healthcare providers can help patients get the rest they need and eventually find out how much and what type of rest is most effective,” says Dr. Bernhofer. “Right now we only recommend rest based on a personal and subjective experience. We are working with only the lowest level of evidence.”