Conducive environments reduce sleep disturbances and improve sleep quality: a quality improvement project

Orthopaedic patients' experiences of their sleep during hospitalisation and suggestions for improvements

PURPOSE

To describe orthopaedic patients' perspectives on their sleep quality and their suggestions for improvement initiatives to achieve better sleep quality during hospitalisation.

METHODS

In a qualitative design, 265 (50%) of 533 patients from a questionnaire survey responded to two free-text questions. Data were analysed based on a phenomenological-hermeneutic approach inspired by Paul Ricoeur's theory of narrative and interpretation.

RESULTS

Three themes emerged: 1) Sleeping environment and preferences tailored to the individual patient, 2) The link between orthopaedic surgery care and sleeping, and 3) Noise challenged a good night's sleep. Good sleep was related to nurses' professional behaviour and the physical environment, such as quality beds and sleeping aids. Single and shared rooms, room lighting, and fresh air all influenced sleep quality. Unfamiliar and uncomfortable sleeping positions posed a challenge for orthopaedic patients but aids such as pillows, and duvets could provide more comfort at night. Offset circadian rhythms could affect sleep quality, as could nausea and vomiting. Pain and lack of pain relief were associated with poor sleep quality. Noise from both nurses and other patients affected sleep quality. Therefore, unnecessary care activities should be kept to a minimum, and a "night noise level" was suggested.

CONCLUSION

Patients' sleep disturbance following orthopaedic surgery needs to be addressed by both nurses and hospital management. Patients' involvement is essential to create a sleep environment tailored to individual needs and to provide strategies patients use at home for addressing sleeping problems.

Effect of Ward Noise Management Combined with Meditation Training on Stroke Rehabilitation Patients

OBJECTIVE

To study the value of ward noise management combined with meditation training in stroke rehabilitation patients.

METHODS

According to the retrospective analysis method, 150 stroke patients hospitalized in the rehabilitation center of a Tangshan Workers' Hospital from July 2020 to December 2023 were selected as study objects. They were divided into three groups, namely the control group (routine rehabilitation care, n = 50), observation group A (meditation training, n = 50), and observation group B (meditation training and ward noise management, n = 50) according to whether they received ward noise management and meditation training. The general demographic data, Fatigue Severity Scale (FSS), Pittsburgh Sleep Quality Index (PSQI), and the Short Form 36 (SF-36) were collected. Chi-square test and analysis of variance were used to analyse the data.

RESULTS

The baseline data of the patients in each group were not statistically significant (P > 0.05). Before treatment, no difference in the FSS, PSQI, SF-36 scores and environmental noise level between the groups (P > 0.05) was observed. After management, the scores of SF-36 in observation group B were higher than those in the control group and observation group A (P < 0.05) except for somatic pain. Other indicators in observation group B were lower than those in the control and observation group A (P < 0.001).

CONCLUSIONS

Ward noise management and meditation training can effectively reduce patients' fatigue, significantly reducing ambient noise levels, promoting the improvement of life quality, and improving sleep quality.

Hospital Environmental Disruptors and Caregiver Sleep During Hospitalization

PURPOSE

Caregivers must cope with a poor sleep environment when caring for someone admitted to the hospital. The aim was to study the environmental factors associated with a sleep disruption pattern in caregivers during hospitalization and to test their association with caregivers' insomnia symptoms.

DESIGN

This was a cross-sectional study.

METHODS

One hundred twenty-three caregivers completed the study. The effect of environmental stimuli on sleep disruption was measured on a scale from 1 to 10 (1 = no disruption, 10 = significant disruption). Type of room (single vs shared), insomnia symptoms, anxiety and depression, and patients' dependence (Barthel Index) were assessed as well. Caregiver and patient characteristics as well as identified hospital disruptors were compared with Student t test, χ2 test, and Fisher exact test according to the caregivers' type of room. A linear regression model using main caregiver and patient sociodemographic variables, questionnaires, and the sum of all hospital disruptors determined the factors associated with caregivers' insomnia symptoms.

RESULTS

Of the caregivers and their care recipients, 51.2% shared a room with 1 to 2 other patients. Higher self-reported levels of sleep disruption due to environmental stimuli were found in shared rooms when compared with single rooms (eg, nursing care, noise, and light) (P < .05). Hospital sleep disruptors (adjusted regression coefficient, 0.15; 95% confidence interval, 0.06-0.24) and caregiver anxiety (adjusted regression coefficient, 0.57; 95% confidence interval, 0.33-0.81) were predictors for insomnia (P < .01). However, caregivers' type of room was not associated with insomnia severity symptoms (P > .05).

CONCLUSIONS

Interventions are urgent to implement, such as relieving caregivers from patient needs during the night, providing them with single rooms, and conducting multiple nursing tasks in 1 visit to minimize night hospital noise.

Insomnia Symptoms and Associated Factors in Caregivers of Adult Hospitalized Patients

Caregivers experience high levels of emotional stress and must cope with several clinical and hospital-related environmental factors that seriously impact their night’s rest. The purpose of this study was to establish the prevalence of insomnia symptoms in a sample of caregivers of adult hospitalized patients and to examine the relationships between insomnia symptoms and patient and caregiver-associated factors. A total of 152 caregivers were enrolled from the two main hospitals in Granada, Spain. Sociodemographic, economic, and care-related data were collected. Insomnia symptoms, burden, anxiety and depression, social support, and resilience were assessed. Information on patients’ hospital admission, dependence, and neuropsychiatric symptoms was also obtained. Most caregivers were middle-aged women caring for their spouses. Self-reported insomnia prevalence was set at 45.4%. Comparison analyses between caregivers suffering from insomnia symptoms and non-insomniacs showed significantly higher burden, anxiety and depression and patients’ neuropsychiatric symptoms (p < 0.05) and lower resilience and social support in the former (p < 0.01). A regression analysis showed that anxiety (ORa = 1.15; p < 0.05) and higher caregiver education level (ORa = 5.50; p < 0.05) were factors significantly associated with insomnia symptoms. Patients’ neuropsychiatric symptoms showed a trend toward statistical significance as well (ORa = 1.09; p = 0.06). There is an acute need to address, prevent and treat insomnia problems in caregivers.

A Survey of the General Hospital Environment: Focusing on Pajama Design in a Japanese University Hospital

This study investigated nurses' and patients' perceptions of hospital room environment and patient pajama design. Nurses working in a Japanese university hospital and patients aged 20 and older were surveyed. Over 75% of patients rated the hospital environment and hospital rooms as "very good" or "good," but less than one in three nurses rated them similarly. Patients were more likely than nurses to rate rental pajamas as "very good" or "good." Contrary to the nurses, only about one in four patients valued wearing well-designed pajamas. Nurses' and patients' perceptions differed regarding hospital pajamas, but not about improving hospital rooms.