Factors influencing sleep for parents of critically ill hospitalised children: a qualitative analysis

Parental sleep when their child is sick: A phased principle-based concept analysis

Sleep is a common challenge for parents with sick children and can impact parents' health, wellbeing, and caregiving responsibilities. Despite the vast research around parental sleep when their child is sick, the concept is not clearly defined. A phased principle-based concept analysis that includes triangulation of methods and quality criteria assessment was used to explore how the concept is described, used, and measured in the current literature. The aim was to analyse and clarify the conceptual, operational, and theoretical basis of parental sleep when their child is sick to produce an evidence-based definition and to identify knowledge gaps. A systematic literature search including databases CINAHL, Embase, MEDLINE, PsychARTICLES, PsychINFO, Pubmed, Scopus and Web of Science, identified 546 articles. The final dataset comprised 74 articles published between 2005 and 2021 and was assessed using a criteria tool for principle-based concept analysis. Data were managed using NVivo, and thematic analysis was undertaken. A precise definition is not present in the literature. Various tools have been used to measure parents' sleep, as well as exploration via interviews, open-ended questions, and sleep diaries. The terminology used varied. Parental sleep when their child is sick is interrelated with other concepts (e.g., stress). A recommended definition is offered. A conceptual understanding of parental sleep when their child is sick will help to guide translational research and to conduct studies critical to clinical practice and research. Future research includes developing a measurement tool for parental sleep when their child is sick to be used in study design and future interventions.

Sleep characteristics of the parents of children admitted to a pediatric intensive care unit: risk factors and repercussion on their daily life activities

OBJECTIVE

to analyze the sleep characteristics of the parents of children admitted to a pediatric intensive care unit (PICU), the possible risk factors and impact of sleep quality on their daily life activities.

METHODS

Parents of children admitted to PICU for at least 48 h filled in a survey. Demographic data, sleep characteristics before and during admission and its impact on daily life activities measured by the FOSQ-10 questionnaire, were collected.

RESULTS

100 surveys from parents of 53 children admitted to the PICU were collected. Most children (74%) were cardiac patients. 55% of them had had previous PICU admissions. 45% of parents lived in a different city. They spent a median of 14 h a day (IQR 12-16) at the hospital and 89.2% did not attend work. Parents had significantly worse subjective sleep quality (p = 0.001), less sleeping hours/day (p = 0.001), more difficulty falling asleep (p = 0.001) and more night arousals (p = 0.001) during PICU admission than before. 77% of parents also had a bad FOSQ-10 score. Perceived sleep quality and FOSQ-10 score had a good correlation (p = 0.00, Kappa 0.43). Significant risk factors were living in a different city (p = 0.03), programmed admissions (p = 0.001), previous PICU admissions (p = 0.001), prolonged PICU length of stay (p = 0.03) and longer distance from home (p = 0.03).

CONCLUSIONS

Three quarters of the parents of children admitted to PICU suffer from sleep disorders, which negatively affects their personal lives. Perceived sleep quality had a good correlation with FOSQ-10 score. Institutional support is needed to optimize parents' resting conditions during their child's hospitalization.

A comparative study of mothers of infants hospitalized in an open ward neonatal intensive care unit and a combined pod and single-family room design

Background

The well-being of mothers of infants requiring Neonatal Intensive Care Unit (NICU) hospitalization may be affected by the architectural design of the unit. A few recent studies suggest there may be some drawbacks of single-family rooms (SFRs) for infants and their mothers, such as isolation of mothers and reduced exposure to auditory stimulation for infants.

Purpose

To compare NICU-stress, symptoms of depression, perceptions of nurse-parent support and family-centered care, sleep disturbances, breastfeeding self-efficacy and readiness for discharge in mothers of infants cared for in an open ward (OW) to those cared for in a unit that includes both pods and SFRs.

Methods

A pre-post quasi-experimental study was conducted in a Canadian level 3 unit before and after transitioning to a new unit of 6-bed pods and SFRs. OW data were collected in 2014 and pod/SFR data 1 year after the transition in 2017 to 2018. Mothers of infants hospitalized for at least 2 weeks completed questionnaires about stress, depressive symptoms, support, family-centered care, and sleep disturbances. In the week prior to discharge, they responded to breastfeeding self-efficacy and readiness for discharge questionnaires. They described their presence in the NICU at enrollment and again prior to discharge.

Results

Pod/SFR mothers reported significantly less NICU-stress compared to OW mothers. OW mothers had greater sights and sounds stress and felt more restricted in their parental role. Pod/SFR mothers reported greater respect from staff. Controlling for maternal education, pod/SFR mothers perceived their infant’s readiness for discharge to be greater than OW mothers. There were no significant differences between groups in depressive symptoms, nurse-parent support, sleep disturbances, and breastfeeding self-efficacy.

At enrollment and again in the weeks preceding discharge, pod/SFR mothers were present significantly more hours per week than OW mothers, controlling for maternal education.

Conclusions

Further study of small pods is indicated as these units may be less stressful for parents, and enhance family-centered care, as well as maternal presence, compared to OWs.

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.

"Like Walking in a Fog"-Parents' perceptions of sleep and consequences of sleep loss when staying overnight with their child in hospital

Disruption of parental sleep in hospital, with frequent awakenings and poor sleep quality, limits the parents' resources to meet the child's needs and maintain parental wellbeing. The aim of the study was to explore and describe how parents perceive their sleep when staying overnight with their sick child in hospital. A further aim was to explore and describe parents' perception of what circumstances influence their sleep in the hospital. Twenty-two parents who were accommodated with their sick child (0-17 years) in paediatric wards in Norway and Sweden participated. Interviews were conducted during the hospital stay to elicit their perspectives. Phenomenography was used to analyse data. Two descriptive categories were found: (a) "Perceptions of sleep", with two sub-categories: "Sleep in the paediatric ward" and "Consequences of sleep loss"; and (b) "Circumstances influencing sleep in the paediatric ward" with three sub-categories: "The importance of the family", "Information and routines at the paediatric ward", and "Accommodation facilities". Parents' sleep and needs must be acknowledged in paediatric wards. An individual plan of care for the upcoming night could be a valuable tool for both the parents and nurses. The child's medical needs must be met with respect to the parents' willingness to take part in the child's care during the night, and the need for rest and sleep for both parent and child.

The cortisol response in parents staying with a sick child at hospital

AIM

To study the cortisol response in parents staying with their child in paediatric wards, to compare the parents' cortisol levels between the paediatric ward and at home 4 weeks after discharge and to compare the parents' cortisol levels with data of an adult reference population, reported by Wust et al., as there are few studies investigating parental cortisol.

DESIGN

This study has a descriptive and prospective comparative design.

METHOD

Thirty-one parents participated. Saliva samples were collected in the paediatric ward and 4 weeks later at home.

RESULTS

The parents had lower morning awakening cortisol levels in the paediatric ward than at home after discharge. There were no statistically significant differences in postawakening cortisol or cortisol awakening response (CAR). The child's age, diagnosis or previously diagnosed chronic condition did not affect the parents' cortisol levels. The morning and postawakening cortisol levels were lower than those of the reference population.

CONCLUSION

The hospital stay with a sick child affects parents' cortisol levels. Parental stress needs more attention to find interventions to prevent the risk of stress-related complications that subsequently can affect the care of the child.

Family members' experiences of waiting in intensive care: a concept analysis

AIM

The aim of this study was to explore the meaning of family members' experience of waiting in an intensive care context using Rodgers' evolutionary method of concept analysis.

METHOD

Systematic searches in CINAHL and PubMed retrieved 38 articles which illustrated the waiting experienced by family members in an intensive care context. Rodgers' evolutionary method of concept analysis was applied to the data.

FINDINGS

In total, five elements of the concept were identified in the analysis. These were as follows: living in limbo; feeling helpless and powerless; hoping; enduring; and fearing the worst. Family members' vigilance regarding their relative proved to be a related concept, but vigilance does not share the same set of attributes. The consequences of waiting were often negative for the relatives and caused them suffering. The references show that the concept was manifested in different situations and in intensive care units (ICUs) with various types of specialties.

CONCLUSIONS

The application of concept analysis has brought a deeper understanding and meaning to the experience of waiting among family members in an intensive care context. This may provide professionals with an awareness of how to take care of family members in this situation. The waiting is inevitable, but improved communication between the ICU staff and family members is necessary to reduce stress and alleviate the suffering of family members. It is important to acknowledge that waiting cannot be eliminated but family-centred care, including a friendly and welcoming hospital environment, can ease the burden of family members with a loved one in an ICU.

Sleep in parents of preterm infants: A systematic review

BACKGROUND

Sleep disruption during the first postpartum year is associated with several negative health outcomes including postpartum depression. Such disruption may be a greater issue for parents of preterm neonates, yet literature on this subject has not been critically reviewed.

OBJECTIVE

To synthesize literature on sleep quantity, sleep quality, and factors influencing sleep among parents of preterm infants during infant hospitalization and following discharge.

DESIGN

A systematic review.

DATA SOURCES

Medline, EMBASE, CINAHL, PsycINFO, Scopus, and Cochrane Database of Systematic Reviews were searched from their inception to February 2017.

METHODS

Potentially eligible citations were reviewed by two independent reviewers. Both quantitative and qualitative studies were eligible for inclusion. Data on eligible studies and review outcomes were extracted using a customized form.

FINDINGS

Eighteen reports from 16 studies met inclusion criteria. Four studies included a control group of parents of full-term infants. Three studies reported sleep quantity means, of which only one provided values for an exclusive sample of mothers of preterm infants and found on average, mothers obtained 6.3 h of sleep/day in the first 5-10 days. Twelve studies reported on sleep quality; most (n = 10) relied on self-reported measures and identified poor subjective sleep quality whereas two studies objectively measured sleep of poor quality. Parental stress was the most consistent factor associated with sleep quality.

CONCLUSION AND IMPLICATIONS

Quality and quantity of sleep among parents of preterm infants is inadequate and may negatively influence family health outcomes. Further research on correlates and changes in sleep is required to identify at-risk parents and inform targeted clinical recommendations and interventions aimed at maximizing sleep for parents of preterm infants.

Sleep and its relationship to health in parents of preterm infants: a scoping review

BACKGROUND

Sleep is essential for human health and functioning. Parents of preterm infants are susceptible to sleep disturbances because of stress related to the preterm birth. Poor sleep has the potential to affect parental health and well-being. The aim of this study was to identify and map evidence on sleep and its relationship to health in parents of preterm infants. No review has summarized the evidence on this topic.

METHODS

A scoping review was conducted. Seven health and medical electronic research databases were searched for relevant quantitative and qualitative primary studies, including grey literature. The search was performed March 2-7, 2017.

RESULTS

Ten American studies and one Australian study were included in the review. Most research was quantitative and focused on maternal sleep and mental health within the first two weeks after the childbirth. Both objective and subjective sleep measures were used to study sleep at the hospital; actigraphs were not used after discharge. Maternal sleep was poor early postpartum, and this was associated with negative health outcomes. Two cohort studies compared sleep in mothers of preterm and term infants, but the results were conflicting. In one qualitative study, fathers described their inability to catch up on sleep after homecoming with a preterm baby.

CONCLUSIONS

Quantitative studies reporting on maternal sleep early postpartum was most frequently occurring in the results. Qualitative research on the topic was identified as a knowledge gap. More cultural and geographical breadth, including research on fathers' sleep, is recommended in future research.

Parents' Experience of Their Sleep and Rest When Admitted to Hospital with Their Ill Child: A Qualitative Study

The aim of this study was to explore parents' experiences of sleep and rest while admitted to hospital together with their ill child. When a child is hospitalized, it can be a traumatic experience for the entire family. Adaptation to the new situation and new parental responsibilities is necessary. Hospitalized children demand more supervision and care, making sleep disturbance a common challenge among these parents. A qualitative exploratory interview study was conducted using semi-structured individual or couple interviews with 17 parents (12 mothers and five fathers) admitted together with their ill child for shorter or longer periods at pediatric wards at a university hospital in Sweden. Interviews were analyzed with content analysis. Sufficient amount of sleep and rest was described as vital for parental functioning. The main theme Factors influencing sleep and rest emerged with three subthemes. Environmental factors describe experiences such as disturbing sounds and uncomfortable beds. Interpersonal factors describe how supportive relations with spouses, relatives, nurses, and doctors were experienced as strengthening the parental confidence and helping parents to relax. Parents wanted to participate in the care but appreciated help from the nurses when they needed rest or support. The last subtheme, Organizational factors, describe how continuous information about the child's care and prognosis was experienced as the most important factor to feel secure and calm. Parents expressed that a possibility to buy lunch and dinner at the ward would greatly relieve parents' stress and help them rest. Parents in this study were grateful that they were allowed to stay by their child's side, but pointed out improvement opportunities. Single rooms with comfortable beds for the parents were in high demand to promote relaxation and sleep. Continuous, adjusted, information was seen as important. All hospitalized children have the right to partake in their own treatment and care, and they need a parent at their side. By optimizing parents' sleep and rest in the hospital, a more positive experience of the hospitalization can be achieved for the entire family.

Implementation of Step 7 of the Baby-Friendly Hospital Initiative (BFHI) in Finland: Rooming-in according to mothers and maternity-ward staff

INTRODUCTION

Rooming-in is an evidence-based practice during which postpartum mothers and infants stay together. Rooming-in benefits both the mother and infant, and is especially important for breastfeeding. This study aims to describe rooming-in (Step 7 of the BFHI), according to mothers and maternity-ward staff in Finnish maternity hospitals, as well as the factors associated with its implementation.

METHODS

The presented research adopted a cross-sectional study approach. Questionnaires were used to collect data from mothers (n=111) who had given birth and the attending maternity-ward staff (f=1554 reported events) at 8 Finnish maternity hospitals. The data were analysed using descriptive statistics, as well as chi-squared, t-test, and Fisher, Mann-Whitney, Kruskal-Wallis tests. Answers to the open-ended questions were analysed using content specifications.

RESULTS

Rooming-in was utilised to a satisfactory extent, especially after vaginal birth. Most of the mothers regarded it as a very positive experience. Rooming-in was delayed mainly because of a mother's tiredness and the infant's condition. Factors such as a staff member's age, work experience, and completion of breastfeeding counselling training (WHO 20-h), a mother's parity, need for supplementation, and mode of childbirth, were found to be associated with the decision to implement rooming-in.

CONCLUSIONS

Rooming-in should be used more with infants born by caesarean section and primiparous mothers. The need for supplementation clearly increased when roomingin was not employed. The presented information could be crucial for effectively allocating maternity ward resources and demonstrating the importance of rooming-in to a diverse audience of health care professionals.

Discussing Death as a Possible Outcome of PICU Care

OBJECTIVES

To describe practical considerations related to discussions about death or possible death of a critically ill child.

DATA SOURCES

Personal experience and reflection. Published English language literature.

STUDY SELECTION

Selected illustrative studies.

DATA EXTRACTION

Not available.

DATA SYNTHESIS

Narrative and experiential review were used to describe the following areas benefits and potential adverse consequences of conversations about risk of death and the timing of, preparation for, and conduct of conversations about risk of death.

CONCLUSIONS

Timely conversations about death as a possible outcome of PICU care are an important part of high-quality ICU care. Not all patients "require" these conversations; however, identifying patients for whom conversations are indicated should be an active process. Informed conversations require preparation to provide the best available objective information. Information should include distillation of local experience, incorporate the patients' clinical trajectory, the potential impact(s) of alternate treatments, describe possible modes of death, and acknowledge the extent of uncertainty. We suggest the more factual understanding of risk of death should be initially separated from the more inherent value-laden treatment recommendations and decisions. Gathering and sharing of collective knowledge, conduct of additional investigations, and time can increase the factual content of risk of death discussions. Timely and sensitive delivery of this best available knowledge then provides foundation for high-quality treatment recommendations and decision-making.

Implementing the SCCM Family-Centered Care Guidelines in Critical Care Nursing Practice

Family-centered care is an important component of holistic nursing practice, particularly in critical care, where the impact on families of admitted patients can be physiologically and psychologically burdensome. Family-centered care guidelines, developed by an international group of nursing, medical, and academic experts for the American College of Critical Care Medicine/Society of Critical Care Medicine, explore the evidence base in 5 key areas of family-centered care. Evidence in each of the guideline areas is outlined and recommendations are made about how critical care nurses can use this information in family-centered care practice.

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.

Using Qualitative Research to Inform Development of Professional Guidelines: A Case Study of the Society of Critical Care Medicine Family-Centered Care Guidelines

OBJECTIVES

To explore the importance, challenges, and opportunities using qualitative research to enhance development of clinical practice guidelines, using recent guidelines for family-centered care in the ICU as an example.

METHODS

In developing the Society of Critical Care Medicine guidelines for family-centered care in the neonatal ICU, PICU, and adult ICU, we developed an innovative adaptation of the Grading of Recommendations, Assessments, Development and Evaluations approach to explicitly incorporate qualitative research. Using Grading of Recommendations, Assessments, Development and Evaluations and the Council of Medical Specialty Societies principles, we conducted a systematic review of qualitative research to establish family-centered domains and outcomes. Thematic analyses were undertaken on study findings and used to support Population, Intervention, Comparison, Outcome question development.

RESULTS

We identified and employed three approaches using qualitative research in these guidelines. First, previously published qualitative research was used to identify important domains for the Population, Intervention, Comparison, Outcome questions. Second, this qualitative research was used to identify and prioritize key outcomes to be evaluated. Finally, we used qualitative methods, member checking with patients and families, to validate the process and outcome of the guideline development.

CONCLUSIONS

In this, a novel report, we provide direction for standardizing the use of qualitative evidence in future guidelines. Recommendations are made to incorporate qualitative literature review and appraisal, include qualitative methodologists in guideline taskforce teams, and develop training for evaluation of qualitative research into guideline development procedures. Effective methods of involving patients and families as members of guideline development represent opportunities for future work.

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.

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

Light, noise, and interruptions from hospital staff lead to frequent awakenings and detrimental changes to sleep quantity and quality for children who are hospitalized and their parents who stay with them overnight. An understanding of nurses' views on how care affects sleep for the hospitalized child and parent is crucial to the development of strategies to decrease sleep disturbance in hospital. The purpose of this descriptive qualitative study was to gain an understanding of nurses' views on their role in and influence on sleep for families; perceived barriers and facilitators of patient and parent sleep at night; strategies nurses use to preserve sleep; the distribution, between parent and nurse, of care for the child at night; views of the parent as a recipient of nursing care at night; and the nature of interactions between nurses and families at night. Thirty registered nurses from general pediatric and critical care units participated in one of four semi-structured focus groups. Four main influences on sleep were identified: child factors; environmental factors; nurse-parent interaction factors; and nursing care factors. Some of these restricted nurses' ability to optimize sleep, but many factors were amenable to intervention. Balancing strategies to preserve sleep with the provision of nursing assessment and intervention was challenging and complicated by the difficult nature of work outside of usual waking hours. Nurses highlighted the need for formal policy and mentoring related to provision of nursing care at night in pediatric settings.

Validation of a novel sleep-quality questionnaire to assess sleep in the coronary care unit: a polysomnography study

INTRODUCTION

The sleep of patients admitted to coronary care unit (CCU) may be compromised. A feasible and cost-effective tool to evaluate sleep in this scenario could provide important data. The aim of this study was to evaluate sleep with a questionnaire developed specifically for the CCU and to validate it with polysomnography (PSG).

METHODS

Ninety-nine patients (68% male; 56 ± 10 years old) with acute coronary syndrome were included. PSG was performed within 36 h of admission. A specific 18-question questionnaire (CCU questionnaire) was developed and applied after the PSG. Cronbach's alpha test was used to validate the questionnaire. The Spearman test was used to analyze the correlation between the PSG variables and the questionnaire, and the Kruskal-Wallis test was used to compare the PSG variables among patients with good, regular, or poor sleep.

RESULTS

The total sleep time was 265 ± 81 min, sleep efficiency 62 ± 18%, REM sleep 10 ± 7%, apnea/hypopnea index 15 ± 23, and the arousal index 24 ± 15. Cronbach's alpha test was 0.69. The CCU questionnaire showed correlation with the sleep efficiency evaluated by PSG (r: 0.52; p < 0.001). Sleep quality was divided into three categories according to the CCU questionnaire: patients with good sleep had a sleep efficiency of 72 ± 9%, better than those with a regular or poor sleep (60 ± 16% and 53 ± 20%, respectively; p < 0.01).

CONCLUSION

The CCU questionnaire is a feasible and reliable tool to evaluate sleep in the CCU, showing correlation with the PSG sleep efficiency.

Hindering and buffering factors for parental sleep in neonatal care. A phenomenographic study

AIMS AND OBJECTIVES

To explore and describe how parents of preterm and/or sick infants in neonatal care perceive their sleep.

BACKGROUND

Parents experience many stressful situations when their newborn infant is preterm and/or sick. This affects bonding. By developing more family-centred care units with single-family rooms, parents are given the opportunity to stay and care for their newborn infant(s) 24 hours a day. Lack of sleep may affect new parents' ability to cope with the many challenges they face on a daily basis.

DESIGN

A phenomenographic study with an inductive and exploratory design.

METHODS

Semi-structured interviews were conducted with twelve parents of infants in neonatal care between January-March 2012. To describe variations in perception of the phenomenon, data were analysed using phenomenography.

FINDINGS

Four descriptive categories were identified within the phenomenon sleep in parents of preterm and/or sick infants in neonatal care: impact of stress on sleep; how the environment affects sleep; keeping the family together improves sleep; and, how parents manage and prevent tiredness.

CONCLUSION

Anxiety, uncertainty and powerlessness have a negative influence on sleep. This can be decreased by continuous information, guidance and practical support. Skin-to-skin care was perceived as a stress-reducing factor that improved relaxation and sleep and should be encouraged by the nurse. The parents also mentioned the importance of being together. Having a private place where they could relax and take care of themselves and their newborn infant improved sleep. It was also desirable to involve older siblings in order to decrease feelings of loneliness, sadness and isolation.

RELEVANCE FOR CLINICAL PRACTICE

Improved parental sleep in neonatal care may help the families cope with the situation and facilitate problem-solving, emotional regulation and the transition to parenthood.

Where do parents sleep best when children are hospitalized? A pilot comparison study

This pilot study compared the sleep quality and quantity of parents who slept at their hospitalized child's bedside with parents who slept at the hospital's onsite Ronald McDonald House® (RMH). Wrist actigraphy and questionnaires were used to estimate parent sleep quality and quantity. Parents who slept at their hospitalized child's bedside (n = 27) experienced more sleep disruption (wake after sleep onset) and reported poorer sleep quality and feeling less rested than parents who slept at RMH (n = 11). Bedside accommodation was associated with poorer parent sleep even when controlling for the covariates of child age and parent gender. Nearby family accommodations, such as RMH, may facilitate parent-child proximity during a child's hospitalization while also providing parents with opportunities for essential sleep.

Sleep, sleepiness, and fatigue outcomes for parents of critically ill children

OBJECTIVES

To describe sleep quantity, sleep patterns, fatigue, and sleepiness for parents of critically ill hospitalized children.

DESIGN

Prospective observational study.

SETTING

Quaternary academic PICU.

PARTICIPANTS

One hundred eighteen parents of 91 children recruited during their child's PICU stay.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

For 5 days and nights, parents wore an actigraph to determine objective sleep-wake times and reported sleep location, level of fatigue (Fatigue Visual Analogue Scale), and sleepiness (Stanford Sleepiness Scale). Mean amounts of nocturnal sleep were less than recommended for optimal health (398 min, fathers vs 422 min, mothers; p = 0.04). Parents woke frequently (7.8 wakes, fathers; 7.2 wakes, mothers) and spent over an hour awake at night (65 min, fathers; 60 min, mothers). On 130 nights (26%), parents slept less than 6 hours and 209 nights (44%) were evaluated as "worse" sleep than usual. Fifty-four parents (53%) experienced more than 30% difference in minutes of sleep between consecutive nights. Mean morning fatigue levels (41 mm, fathers vs 46 mm, mothers; p = 0.03) indicated clinically significant fatigue. Sleeping in a hotel, parent room, or residence was associated with 3.2 more wakes per night (95% CI, 0.61-5.78; p = 0.015) than sleeping in a hospital lounge or waiting room.

CONCLUSIONS

We performed a prospective observational study of 118 parents of critically ill children using objective measures of sleep and validated scales to assess fatigue and sleepiness. We found that more than a quarter of nights met criteria for acute sleep deprivation, there was considerable variability in the amount of nocturnal sleep that individual participants slept on different nights, and sleep was fragmented with a large portion of the night spent awake. Future research should focus on interventions that improve parents' ability to return to sleep upon awakening and maintain regular sleep-wake schedules.

Bright Light Therapy to Promote Sleep in Mothers of Low-Birth-Weight Infants

Having a low-birth-weight (LBW) infant in a neonatal intensive care unit (NICU) can intensify a mother’s sleep disturbances due to both stress and the dim lighting in the ICU setting, which desynchronizes circadian rhythms. The purpose of this pilot study was to examine the effectiveness of a 3-week bright light therapy intervention on sleep and health outcomes of mothers with LBW infants in the NICU. Controlled stratified randomization was used to assign 30 mothers to a treatment or control group. Data were collected at pretreatment (second week postpartum) and after the 3-week intervention. Sleep data were assessed by wrist actigraph (total sleep time [TST], circadian activity rhythms [CARs]) and the General Sleep Disturbance scale. Other outcome variables were measured by the Lee’s Fatigue scale, Edinburgh Postpartum Depression scale, and the Medical Outcomes Short Form 36, version 2. Mothers averaged 26.6 ( SD = 6.3) years of age, and the majority were Black (73%). The mean gestational age for the infants was 27.7 ( SD = 2.0) weeks. Small to large effect sizes were found when comparing the pre- to posttreatment differences between groups. Although none of the differences were statistically significant in this small sample, for mothers in the treatment group nocturnal TST ( d = .33), CAR ( d = 1.06), morning fatigue ( d = .22), depressive symptoms ( d = .40), physical health–related quality of life ( d = .33), and mental health–related quality of life ( d = .60) all improved compared to the control group. Bright light therapy is feasible for mothers with infants in an NICU. Clinically significant improvements have been evidenced; a larger-scale trial of effectiveness is needed.