Nurses' views of factors affecting sleep for hospitalized children and their families: A focus group study

Impact of an Intervention Aimed at Improving Sleep Quality in Hospitalized Children

BACKGROUND

Hospitalized children need adequate sleep to favor early recovery.

METHODS

To study the sleep pattern of children admitted to a pediatric inpatient unit, a cross-sectional study was carried out at a reference hospital in northern Spain. The main study variables were medical specialty of admission, sleep-inducing treatment, hours of sleep at home and during admission, number of nocturnal awakenings, and reasons for awakening. Differences in the hours of sleep and nighttime awakenings between the initial period and at six months were calculated using the Student's t-test.

RESULTS

We included 100 baseline patients and 100 post-intervention patients. Up to 4% of the baseline sample and 3% of the six-month sample had been prescribed a sleep-promoting drug. Regarding awakenings, 79% of the children in the baseline sample suffered awakenings, with a mean of 1.98 awakenings (range 1-13). At six months, the percentage of children who experienced awakenings decreased by 17%, with a mean of 1.34 (range 1-5). In the baseline sample, 48% were caused by nursing care, decreasing to 34% after the intervention.

CONCLUSIONS

An educational intervention with the implementation of targeted evidence-based practices is a useful measure for improving the sleep pattern by decreasing the number of awakenings.

Parents' Experiences and Perspectives of Their Child's Sleep Quality During Hospitalization

Sleep is essential for maintenance and restoration of health, yet studies exploring this in hospitalized children are scarce. In a qualitative study, we assessed the perceived quality of sleep, factors affecting sleep, and the role of health care professionals in the sleep environment for hospitalized children aged 1 to 12 years. Data were obtained from 11 semi-structured, audio-recorded, and verbatim-transcribed interviews with parents, and analyzed using a systematic thematic analysis. The interviews were coded based on iterative assessment of transcripts. Subsequently, categories and interpretative main themes were identified. Four themes emerged: (1) being informed, keeping informed; (2) coordination of care; (3) parents as main advocates for their child's sleep; and (4) environmental disturbers. Parents reported differences in their child's sleep quality during hospital compared with home. Sleep is substantially affected during hospitalization, prompting the need for interventions to improve the quality of sleep of children. Parents provided valuable suggestions for improvements.

Understanding the effects of overnight vital signs monitoring on sleep duration and disruptions in hospitalized children: A scoping review

PROBLEM

Overnight vital signs are typically taken every four hours on pediatric acute care units, despite limited evidence supporting the efficacy of this practice. Vital signs are often ordered and collected without considering the patient's clinical status or potential impact that they may have on sleep. We sought to understand the impact that overnight vital sign monitoring has on sleep duration and disruptions among hospitalized children in an acute care setting.

ELIGIBILITY CRITERIA

We conducted a scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols extension for scoping reviews (PRISMA-ScR). Studies were included if they addressed the relationship between vital signs monitoring and sleep among children hospitalized in an acute care unit.

SAMPLE

Eleven studies from 2012 to 2022 were included in the final review.

RESULTS

Vital signs monitoring is the most common sleep disruptor among hospitalized children in acute care units and early evidence suggests that minimizing overnight vital signs may be a safe intervention for clinically stable children. Methods for measuring sleep duration and disruptions are heterogenous and validated tools are not often used. Finally, nurses report comfort with forgoing overnight vital signs when their patient's clinical status is stable.

CONCLUSION

Despite a lack of evidence regarding the efficacy of every 4 h vital signs, overnight vital signs monitoring is consistently the greatest disruptor to sleep for hospitalized children.

IMPLICATIONS

Nurses should play a central role in guiding vital signs monitoring that maintains safety and improves sleep in hospitalized children.

Nonpharmacological interventions to promote sleep and rest among hospitalized pediatric patients in general pediatric wards: a best practice implementation project

OBJECTIVES

The aim of this implementation project was to improve compliance with best practice regarding nonpharmacological interventions used to promote sleep and rest in hospitalized pediatric patients in a nonintensive care setting.

INTRODUCTION

Hospitalized children endure numerous hindrances to sleep and rest, including, but not limited to, noise, pain, anxiety, and interruptions for nursing care. Evidence suggests that a multifaceted approach to sleep promotion can reduce the length of time to sleep onset and the length of nighttime awakenings. It is widely accepted, however, rarely practiced, that proven, low-cost, and noninvasive strategies exist to promote sleep and restoration of hospitalized pediatric patients, which fosters healing and recovery.

METHODS

This project used the JBI Evidence Implementation framework. A baseline audit of 22 nurses' and 31 patients'/parents'/caregivers' receipt of education on strategies to promote sleep and rest was obtained via survey; baseline data were also obtained from nurses regarding whether or not a multifaceted approach to sleep promotion is utilized and/or if an evidence-based protocol regarding sleep promotion is in place. Targeted strategies, including a protocol and nurse/patient education of multifaceted approaches to sleep, were then implemented, and a follow-up audit of 25 nurses and 32 patients/caregivers was completed.

RESULTS

Overall, postimplementation audits revealed 93% compliance with best practice, a 78% increase from baseline audits of 15%. Baseline data revealed poor knowledge of and/or compliance with each of the four audit criteria: nurse education on strategies to promote sleep and rest, the use of an evidence-based protocol regarding sleep promotion, a multifaceted approach to sleep promotion, and patient and/or caregiver education regarding sleep promotion. Postimplementation data, however, showed improvement in each of these areas.

CONCLUSION

Deficiencies in best practice recommendations for the promotion of sleep and rest in pediatric patients admitted to general wards were identified, interventions were implemented, and results were beneficial. Further investigation could be taken to assess the long-term effectiveness of interventions and/or sleep quality of patients while hospitalized. Moreover, postimplementation audits should be administered to parents near the end of their stay, after they have had time to implement optional interventions, if they choose.

A systematic review and proposed conceptual model of sleep disturbances during pediatric hospitalizations

STUDY OBJECTIVES

The current review aims to examine factors that influence pediatric inpatient sleep and determine the effectiveness of sleep promotion interventions among hospitalized children.

METHODS

A systematic literature search was conducted across PubMed, PsycINFO, CINAHL, Cochrane Central, Web of Science, Embase, and Scopus databases. Studies included children with a mean age between 1 and 18 years old that either described factors affecting the sleep of children who are hospitalized on a non-intensive care unit or reported on sleep-related intervention outcomes. We conducted separate narrative reviews for each of the two aims and then synthesized findings from quantitative and qualitative studies across both aims.

RESULTS

Forty-five articles were included for review. Despite most sleep disturbances being attributed to environmental disruptions (e.g. noise, staff interruptions), most interventions targeted the child level using relaxation techniques. Although the majority of interventions were small pilot studies, preliminary findings appear to positively impact sleep duration. The Pediatric Inpatient Sleep Model was proposed to illustrate connections between sleep disturbances, factors influencing sleep, and existing intervention components.

CONCLUSIONS

Replication studies are needed, including larger-scale sleep promotion interventions among hospitalized children. Given the identification of environmental factors as the main cause of night wakings, environmental modifications are crucial. Additional research examining contributors to intraindividual variability in disrupted sleep patterns during hospitalizations as well as the consequences of these disturbances is warranted.

Sleep disturbance and psychological distress among hospitalized children in India: Parental perceptions on pediatric inpatient experiences

PURPOSE

Investigate parental perceptions of children's sleep disturbance and psychological distress associated with an inpatient stay in a low-resource hospital setting.

DESIGN AND METHODS

Demographic and validated survey instruments were adapted for administration to parents of children in the medical wards of a tertiary hospital in India. Parents proficient in English, Hindi, Tamil, or Telugu with a child age 4-12 years admitted for at least 48 h were eligible to participate. All respondents completed the Factors Affecting Sleep Disturbance Scale, Sleep Duration Questionnaire, Sleep Disturbance Scale, and Kessler Psychological Distress Scale. Data analysis entailed descriptive statistics, correlations, and multivariate regressions to analyze relationships across responses on demographics, sleep disturbance, and psychological distress.

RESULTS

Among 105 parents with hospitalized children, most had children 4-6 years old (54%), including 65% boys and 35% girls. Parents reported that their children slept overnight in the hospital for a mean of 8.3 ± 1.6 h. Children 4-6 year old (relative risk ratio [RRR] = 0.63, p = .004), dyspnea (RRR = 8.73, p = .04), previous hospitalization (RRR = 9.17, p = .03), nighttime procedures (RRR = 2.97, p = .03, and missing home (RRR = 6.78, p < .001) were the factors affecting sleep. Factors affecting psychological distress was nighttime medication administration (RRR = 4.92, p = .01). Sleep disturbances correlated with psychological distress (r = 0.56; p < .01).

CONCLUSION

Sleep disturbance and associated psychological distress in hospitalized children were widely reported by parents queried in this low-resource hospital setting.

PRACTICAL IMPLICATIONS

Nurses can lead efforts in ameliorating sleep in hospitalized children, including partnering with stakeholders on measures to reduce sleep disruption. Child-centered interventions may improve sleep hygiene and decrease psychological distress among children.

Sleep in hospitalized children and adolescents: A scoping review

Hospitalized children and adolescents are at risk of short sleep and subsequent adverse health effects, but little is known about actual sleep duration, the factors that cause sleep disturbances in an inpatient pediatric setting, and what has been done to promote sleep in this population. The aim of this review was to systematically identify, categorize, and synthesize the literature on sleep in children and adolescents in an inpatient setting. We searched five electronic databases (PubMed, CENTRAL, CINAHL, PsycINFO, and Scopus) and of the 3770 references identified, 28 were eligible for inclusion. From studies reporting age-specific sleep durations, we found that four out of nineteen fell within the National Sleep Foundations recommendations for age-specific sleep durations. Reported causes of sleep disturbances were primarily related to modifiable, external factors, e.g., nursing care activities and noise from equipment and other patients. Sleep-promoting interventions seemed acceptable to patients, parents, and healthcare professionals. However, the literature in this area is heterogeneous regarding methodology, reporting, and population characteristics. Our findings underline the importance of prioritizing and optimizing sleep in hospitalized pediatric patients and highlight the need for standardization in the planning and reporting of studies within this field.

Sleep in the Hospitalized Child: A Contemporary Review

Acute illness and hospitalization introduce several risk factors for sleep disruption in children that can negatively affect recovery and healing and potentially compromise long-term cognition and executive function. The hospital setting is not optimized for pediatric sleep promotion, and many of the pharmacologic interventions intended to promote sleep in the hospital actually may have deleterious effects on sleep quality and quantity. To date, evidence to support pharmacologic sleep promotion in the pediatric inpatient setting is sparse. Therefore, nonpharmacologic interventions to optimize sleep-wake patterns are of highest yield in a vulnerable population of patients undergoing active neurocognitive development. In this review, we briefly examine what is known about healthy sleep in children and describe risk factors for sleep disturbances, available sleep measurement tools, and potential interventions for sleep promotion in the pediatric inpatient setting.

Objective Sleep Characteristics and Factors Associated With Sleep Duration and Waking During Pediatric Hospitalization

IMPORTANCE

Children's sleep may be affected by hospitalization, yet few objective determinations of sleep patterns are reported for children in intensive care or general medicine units. There is limited research on relationships between sleep in hospital and child (eg, age, pain), treatment (eg, medications, nurse presence), or environmental (eg, noise, light, type of unit) factors.

OBJECTIVE

To determine sleep quantity and patterns in hospitalized children and determine factors associated with sleep quantity and nighttime waking for children in hospital.

DESIGN, SETTING, AND PARTICIPANTS

This was a prospective cross-sectional study of children admitted to a general pediatric unit or a pediatric intensive care unit at a pediatric quaternary teaching hospital in Toronto, Ontario, Canada, from October 2007 to July 2008. Participants included children aged 1 to 18 years who were expected to stay in hospital for at least 2 nights. Demographic data, information about the hospital stay and illness, and usual sleep habits were collected. Children wore an actigraph for 1 to 3 consecutive days and nights and completed a sleep diary. Sound and light meters were placed at the bedside. Data analyses took place in April 2009.

MAIN OUTCOMES AND MEASURES

The primary outcome was the mean number of minutes of child nighttime sleep from 7:30 pm to 7:29 am. Sleep variables were averaged over days and nights recorded (mean [SD] days and nights of wear, 2.54 [0.71]) and examined for associations with sleep quantity and patterns, as well as hazard of waking in the night.

RESULTS

Of 124 eligible children approached for inclusion, 69 children consented (35 [51%] female; 20 [29%] aged 1-3 years, 10 [14%] aged 4-7 years, 17 [24%] aged 8-12 years, and 22 [32%] aged 13-18 years; 58 [84%] in the general pediatric unit). Children aged 1 to 3, 4 to 7, 8 to 12, and 13 to 18 years obtained a mean (SD) of 444 (132), 475 (86), 436 (114), and 384 (83) minutes of nighttime sleep, respectively; mean (SD) number of night awakenings was 14 (3), 18 (3), 14 (8), and 12 (6), respectively. Children on general pediatric units slept 258 minutes more per night than children sleeping in the pediatric intensive care unit (95% CI, 165.16-350.56 minutes; P < .001), children admitted for planned surgery slept 123 minutes more than children admitted for exacerbations of chronic illness (95% CI, 49.23-196.01 minutes; P < .01), and children sleeping in rooms with other patients slept 141 minutes fewer than children in private rooms (95% CI, -253.51 to -28.35 minutes; P = .01). Sound events greater than 80 dB were significantly associated with increased risk of instantaneous waking (hazard ratio [HR], 1.35; 95% CI, 1.02-1.80; P = .04), as were light events greater than 150 lux (HR, 1.17; 95% CI, 1.01-1.36; P = .03), receiving a medication that promoted sleep (HR, 1.04; 95% CI, 1.00-1.08; P = .03), and having a nurse in the room for most or all of the night (HR, 1.08; 95% CI, 1.03-1.13; P = .003). Sleeping on the general pediatrics unit was significantly associated with decreased risk of instantaneous waking (HR, 0.81; 95% CI, 0.77-0.85; P < .001), as was being admitted for planned surgery (HR, 0.95; 95% CI, 0.91-0.99; P = .04), receiving a medication that promoted wakefulness (HR, 0.96; 95% CI, 0.93-0.995; P = .02), and sharing a room with another patient (HR, 0.78; 95% CI, 0.72-0.84; P < .001).

CONCLUSIONS AND RELEVANCE

In this cross-sectional study of hospitalized children, children experienced considerable nighttime waking and sleep restriction to levels below national clinical recommendations at a time when they most needed the benefits of sleep. Given light and noise were the greatest contributors to nighttime waking in hospital, clinicians, administrators and hospital design experts should work together for solutions.

Optimizing Oral Medication Schedules for Inpatient Sleep: A Quality Improvement Intervention

OBJECTIVES

Hospitalized children experience frequent nighttime awakenings. Oral medications are commonly administered around the clock despite the comparable efficacy of daytime administration schedules, which promote sleep. With this study, we evaluated the effectiveness of a quality improvement initiative to increase the proportion of sleep-friendly antibiotic administration schedules.

METHODS

Interprofessional stakeholders modified computerized provider order entry defaults for 4 oral antibiotic medications, from around the clock to administration occurring exclusively during waking hours. Additionally, care-team members received targeted education. Outcome measures included the proportion of sleep-friendly administration schedules and patient caregiver-reported disruptions to sleep. Pre- and posteducation surveys were used to evaluate education effectiveness. Balancing measures were missed antibiotic doses and related escalations of care.

RESULTS

Interrupted time series analysis revealed a 72% increase (intercept_pre: 18%; intercept_post: 90%; 95% confidence interval: 65%-79%; P < .001) in intercept for percentage of orders with sleep-friendly administration schedules (orders: n _pre = 1014 and n _post = 649). Compared with preeducation surveys, care-team members posteducation were more likely to agree that oral medications scheduled around the clock cause sleep disruption (resident: 71% pre, 90% post [P = .01]; nurse: 63% pre, 79% post [P = .03]). Although sleep-friendly orders increased, patient caregivers reported an increase in sleep disruption due to medications (pre 28%, post 46%; P < .001).

CONCLUSIONS

A simple, low-cost intervention of computerized provider order entry default modifications and education can increase the proportion of sleep-friendly oral antibiotic administration schedules for hospitalized children. Patient perception of sleep is impacted by multiple factors and often does not align with objective data. An increased focus on improving sleep during hospitalization may result in heightened awareness of disruptions.

Improving Hospitalized Children's Sleep by Reducing Excessive Overnight Blood Pressure Monitoring

BACKGROUND

Although required for healing, sleep is often disrupted during hospitalization. Blood pressure (BP) monitoring can be especially disruptive for pediatric inpatients and has few clinical indications. Our aim in this pilot study was to reduce unnecessary overnight BP monitoring and improve sleep for pediatric inpatients.

METHODS

The intervention in June 2018 involved clinician education sessions and updated electronic health record (EHR) orders that enabled the forgoing of overnight BP checks. The postintervention period from July 2018 to May 2019 examined patient-caregiver surveys as outcome measures. These surveys measured inpatient sleep and overnight disruptions and were adopted from validated surveys: the Patient Sleep Questionnaire, expanded Brief Infant Sleep Questionnaire, and Potential Hospital Sleep Disruptions and Noises Questionnaire. Uptake of new sleep-friendly EHR orders was a process measure. Reported patient care escalations served as a balancing measure.

RESULTS

Interrupted time series analysis of EHR orders (n_pre = 493; n_post = 1472) showed an increase in intercept for the proportion of patients forgoing overnight BP postintervention (+50.7%; 95% confidence interval 41.2% to 60.3%; P < .001) and a subsequent decrease in slope each week (-0.16%; 95% confidence interval -0.32% to -0.01%; P = .037). Statistical process control of surveys (n_pre = 263; n_post = 131) showed a significant increase in sleep duration for patients older than 2, and nighttime disruptions by clinicians decreased by 19% (P < .001). Annual estimated cost savings were $15 842.01. No major adverse events in patients forgoing BP were reported.

CONCLUSIONS

A pilot study combining EHR changes and clinician education safely decreased overnight BP checks, increased pediatric inpatient sleep duration, and reduced nighttime disruptions by clinicians.

Adolescents' Experiences of Staying Overnight at Family-Centered Pediatric Wards

Background

Sleep is essential for health and recovery. Hospital stays may affect adolescents' sleep quality negatively as routines in the ward are not adapted for adolescents' developmental status or sleep habits. The aims with this study were to (a) explore and describe how adolescents experience sleep in the family-centered pediatric ward, (b) explore and describe how adolescents experience the presence or absence of a parent during the hospital stay, and (c) identify circumstances that the adolescents describe as influential of their sleep in the pediatric wards.

Methods

This is a qualitative interview study employing thematic analysis with an inductive and exploratory approach. Sixteen adolescents aged between 13 and 17 years participated in the study.

Results

Three themes were found: the importance of good sleep, safety as a prerequisite for sleep in hospital, and circumstances influencing adolescents' sleep in hospital.

Conclusion

The adolescents described their sleep at the pediatric ward positively, but mentioned disturbing factors associated with pain, nightly check-ups, noises, and inactivity. Parental presence was perceived as very positive both during the night and the day.

A systematic integrative review of parents' experience and perception of sleep when they stay overnight in the hospital together with their sick children

AIMS AND OBJECTIVES

To elucidate knowledge available on parents' experience and perception of sleep when they stay overnight in hospital together with their sick children.

BACKGROUND

In Nordic countries, children are entitled to have at least one parent with them during hospitalisation. Parents' sleep, when accommodated at the hospital during the child's admission, may be a challenge.

DESIGN

A systematic literature search was conducted in EMBASE, MEDLINE and PsycINFO; period is restricted from 1 January 2007 to 1 April 2019. Studies included were those in which parents were accommodated in hospital with their child, 0-18 years of age, for at least one night. Original peer-reviewed scientific research papers conducting qualitative, quantitative or mixed designs were included. Systematic reviews were not included. This systematic integrative review was registered in PROSPERO and performed according to the PRISMA guidelines. All authors participated in study selection, data extraction and quality assessment of the literature.

RESULTS

Fifteen studies were included, and they varied in terms of origin, aims, design, methods used and sample size. Three overall main themes appeared: sleep quality, factors affecting sleep and consequences of sleep loss. Combined psychological factors were found to affect parents' sleep, as well as isolated psychological factors, for example, stress, anxiety, worries and difficult thoughts. Environmental and social factors were also identified, for example, privacy and caring for family.

CONCLUSION

Study of this subject is still in its exploratory phase. There is a need for the development of theory of substance in the clarification of the meaning of sleep among parents during difficult times such as children's hospitalisation.

RELEVANCE TO CLINICAL PRACTICE

Understanding risk factors associated with sleep and sleep deprivation in parents staying overnight in the hospital with their sick child is important, since lack of sleep may lead to serious stress-related outcomes for the parents.

Sleep in Infancy: A Concept Analysis

PROBLEM

Sleep has historically been defined by adult standards that fail to recognize the dynamic physiologic process in the first year of life.

ELIGIBILITY CRITERIA

A literature review and concept analysis were conducted to examine what is known about sleep in infancy. Studies were included if sleep was objectively measured and healthy infants 0 to 12 months old were the focus of the study.

SAMPLE

Of 647 records identified, 348 were assessed for eligibility and 20 studies were included in the review of the literature.

RESULTS

Sleep in infancy is a time of evolving sleep architecture, sleep consolidation, and extensive neural activity resulting in neurodevelopment.

CONCLUSIONS

It is imperative to recognize the critical role of sleep for optimal infant neurodevelopment on the part of healthcare providers and society at large.

IMPLICATIONS

Efforts should be made to protect sleep periods in both healthy and hospitalized infants. The proposed definition has the potential to improve the care of healthy and hospitalized infants by preserving and promoting neurodevelopment.

Timing and Duration of Sleep in Hospitalized Children: An Observational Study

BACKGROUND AND OBJECTIVES

Sleep during hospitalization is important, but data on children's sleep quality during hospitalization are lacking. We sought to document sleep duration and awakenings in hospitalized children and explore associations between sleep and chronic care complexity, home sleep quality, and late-night food consumption.

METHODS

Children aged 2 to 17 years admitted to a hospitalist service for at least 24 hours were approached for participation. Children were video recorded from 20:00 to 08:00. Paired investigators reviewed recordings and extracted data. Investigators blinded to sleep data separately extracted clinical and demographic information. Analyses included Spearman correlations and linear and generalized linear regression models with t and Wald χ² tests.

RESULTS

The mean time subjects (n = 57) initiated sleep was 22:35 (range: 20:00-02:47), with a mean sleep duration of 475 minutes (89-719 minutes). Subjects awakened 2.2 times (0-7 times, SD: 1.9) per night, on average, with the average total time awake during those awakenings of 55.7 minutes (2-352 minutes, SD: 75 minutes). In multivariate analysis, children with private insurance had longer sleep duration. Additionally, subjects who ate a snack after 21:00 went to sleep much later (odds ratio: 9.5; confidence interval: 2.6 to 34.9) and had 64 minutes less total sleep time and spent less time in bed than patients who did not eat late (P = .007).

CONCLUSIONS

Hospitalized children sleep less than recommended and experience frequent awakenings. Some demographic variables are related to sleep. Many hospitalized children also consume food at night, which is associated with later bedtime and less sleep. Future efforts to improve sleep in hospitalized children are needed.

Qualidade do sono das crianças internadas com síndrome do respirador bucal

Objetivo: analisar a qualidade do sono das crianças internadas em hospital com síndrome de respiração bucal.Método: pesquisa descritiva, com componente analítico e abordagem quantitativa, desenvolvido com 80 crianças na faixa etária de 5 a 12 anos, internadas em hospital da região Nordeste do Brasil. Realizada a partir de entrevista com pais e/ou responsáveis pelas crianças participantes e questionário Índice de qualidade do sono de Pittsburgh.Resultados: 30,0 % das crianças respiradoras bucais apresentaram qualidade do sono muito boa e 43,8 % boa. Os componentes que mais interferiram para qualidade do sono boaforam: qualidade do sono (p < 0,001), latência (p < 0,000) e disfunção diurna (p < 0,000), assim como duração do sono, eficiência habitual do sono e uso de medicação para dormir, com valor de p sem significância.Conclusão: as crianças respiradoras bucais apresentaram boa qualidade do sono, segundo percepções de pais e/ou cuidadores.

Characterizing pediatric inpatient sleep duration and disruptions

OBJECTIVE

To contextualize inpatient sleep duration and disruptions in a general pediatric hospital ward by comparing in-hospital and at-home sleep durations to recommended guidelines and to objectively measure nighttime room entries.

METHODS

Caregivers of patients four weeks - 18 years of age reported patient sleep duration and disruptions in anonymous surveys. Average at-home and in-hospital sleep durations were compared to National Sleep Foundation recommendations. Objective nighttime traffic was evaluated as the average number of room entries between 11:00pm and 7:00am using GOJO brand hand-hygiene room entry data.

RESULTS

Among 246 patients, patients slept less in the hospital than at home with newborn and infant cohorts experiencing 7- and 4-h sleep deficits respectively (Newborn: 787 ± 318 min at home vs. 354 ± 211 min in hospital, p < 0.001; Infants: 703 ± 203 min at home vs. 412 ± 152 min in hospital, p < 0.01). Newborn children also experienced >2 h sleep deficits at home when compared to NSF recommendations (Newborns: 787 ± 318 min at home vs. 930 min recommended, p < 0.05). Objective nighttime traffic measures revealed that hospitalized children experienced 7.3 room entries/night (7.3 ± 0.25 entries). Nighttime traffic was significantly correlated with caregiver-reported nighttime awakenings (Spearman Rank Correlation Coefficient: 0.83, p < 0.001).

CONCLUSION

Hospitalization is a missed opportunity to improve sleep both in the hospital and at home.

Caregiver and Staff Perceptions of Disruptions to Pediatric Inpatient Sleep

STUDY OBJECTIVES

Sleep is critical to a child's health and well-being, but children are likely to sleep less and be awakened more often during the night in the hospital than at home. To date no studies have compared caregiver, nurse, and physician perspectives of nighttime sleep disruptions in the pediatric general medicine setting. Our aim was to assess caregiver, nurse, and physician perspectives on the most frequent in-hospital disruptors of sleep for pediatric patients. Additionally, we evaluated the degree of agreement of those opinions between the caregivers and medical team.

METHODS

Caregivers, nurses, and physicians were surveyed using the Potential Hospital Sleep Disruption and Noises Questionnaire (PHSDNQ) regarding their opinions on factors that disrupt sleep. Caregiver responses were collected via a convenience sample of patients hospitalized from February to August 2017 and hospital staff was surveyed once regarding overall perception. The perceived percentage of patients disrupted by each factor was calculated and compared among groups using chi-square tests. Using caregiver rank order based on mean response as the reference gold standard, the absolute differences of nurse and physician rank orders were summed and analyzed using a two-sample test of proportion. In addition, staff was asked knowledge and empowerment questions about how to maximize patient sleep in the hospital and responses were compared using chi-square tests.

RESULTS

A total of 162 caregivers, 77 nurses (84% response rate), and 81 physicians (90% response rate) completed surveys. Checking vital signs (50%), nurse/physician interruption (49%), and continuous pulse oximetry (38%) were the three most prevalent disruptors of pediatric inpatient sleep as reported by caregivers. Significant differences were observed between caregiver, nurse, and physician responses for pain, anxiety, alarms, noise, and tests (P ≤ .001 for all). Both nurse and physician rank orders were discordant when compared to caregivers; there was no significant difference between the two staff groups. When compared to physicians, nurses reported doing more to help children sleep in the hospital (33% versus 94%, P < .001).

CONCLUSIONS

Although caregivers report medical interventions such as checking vital signs, nurse/physician interruption, and continuous pulse oximetry as the most frequent disruptors of inpatient pediatric sleep, pediatric staff has poor insight into these disruptions.

Sleep in the Intensive Care Unit in a Model of Family-Centered Care

The desire for families to be physically present to support their loved ones in the intensive care unit, and guidelines in favor of this open visitation approach, require that clinicians consider both patient and family sleep. This article reviews the causes of poor sleep for patients and their family members in the intensive care unit as well as the expected changes in cognition and emotion that can result from sleep deprivation. Measures are proposed to improve the intensive care unit environment to promote family sleep. A framework to educate family members and engage them in preservation of their and their loved one's circadian rhythm is also presented. Although further research is needed, the proposed framework has the potential to improve outcomes for patients and their families in the intensive care unit.

Sleep quality and mood in mothers and fathers accommodated in the family-centred paediatric ward

AIMS AND OBJECTIVES

To describe sleep quality and mood in parents accommodated with their sick child in a family-centred paediatric ward. Secondary aims were to compare mothers' and fathers' sleep quality and mood in the paediatric ward and to compare the parents' sleep quality and mood between the paediatric ward and in a daily-life home setting after discharge.

BACKGROUND

Frequent interruptions, ward noise and anxiety affect parents' sleep quality and mood negatively when accommodated with their sick child in paediatric wards. Poor sleep quality and negative mood decrease the parents' ability to sustain attention and focus, and to care for their sick child.

METHODS

This was a prospective and descriptive study. Eighty-two parents (61 mothers and 21 fathers) with children (median age 6.25 years) admitted to six paediatric wards participated in the study. Uppsala Sleep Inventory, a sleep diary and the Mood Adjective Checklist were used to measure sleep quality and mood.

RESULTS

The parents had a good sleep quality in the paediatric ward even though they had more nocturnal awakenings compared to home. Moreover, they were less alert, less interested and had reduced concentration, and were more tired, dull and passive in the hospital than at home after discharge. Vital sign checks, noises made by the staff and medical treatment were given reasons influencing sleep. Poor sleep quality correlated with negative mood.

CONCLUSION

Parents' sleep quality in family-centred paediatric care is good. However, the habitual sleep efficacy before admittance to the hospital is lower than expected and needs to be further investigated.

RELEVANCE TO CLINICAL PRACTICE

The healthcare professionals should acknowledge parents' sleep and mood when they are accommodated with their sick child. Further should care at night be scheduled and sleep promoted for the parents to maintain health and well-being in the family.

Psychological Outcomes in Parents of Critically Ill Hospitalized Children

Parents of children in pediatric intensive care units (PICUs) are subjected to significant psychological stress. The purpose of this study was to determine the prevalence of, and factors associated with anxiety, depressive symptoms and decisional conflict in parents of children hospitalized in the PICU. The study employed a descriptive, cross-sectional design to investigate the psychological status of 118 parents of 91 children (74 mothers and 44 fathers) admitted to the PICU, using measures of anxiety (STAI), depression (CES-D), and decisional conflict (DCS). Using hospital data and self-administered questionnaires, information on child and parent characteristics and psychological outcomes were collected. Objective measures of parental sleep also were examined using actigraphy and sleep diaries. The research findings indicated that 24% of parents achieved scores characteristic of severe anxiety. Proportions of parents with symptoms indicative of major depression and significant decisional conflict were 51% and 26% respectively. For all psychological outcomes, higher levels of social support were protective. Inconsistency in sleep schedule and sleep location affected psychological outcomes and are possible targets for future interventions. Given evidence that parents of children admitted to the PICU are at risk for developing post-traumatic stress symptoms, future studies should examine the effects of hospitalization on long-term parental psychological outcomes. Screening for those at risk and implementing interventions to promote coping strategies and reduce decisional conflict may be beneficial. Pediatric nurses have a critical role in assessing parents' psychological distress and promoting family health during a child's hospitalization.