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Shih CY, Wang AY, Chang KM, Yang CC, Tsai YC, Fan CC, Chuang HJ, Thi Phuc N, Chiu HY. Dynamic prevalence of sleep disturbance among critically ill patients in intensive care units and after hospitalisation: A systematic review and meta-analysis. Intensive Crit Care Nurs 2023; 75:103349. [PMID: 36464604 DOI: 10.1016/j.iccn.2022.103349] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Sleep disturbance is a common complaint among critically ill patients in intensive care units and after hospitalisation. However, the prevalence of sleep disturbance among critically ill patients varies widely. OBJECTIVE To estimate the prevalence of sleep disturbance among critically ill patients in the intensive care unit and after hospitalisation. METHODS Electronic databases were searched from their inception until 15 August 2022. Only observational studies with cross-sectional, prospective, and retrospective designs investigating sleep disturbance prevalence among critically ill adults (aged ≥ 18 years) during intensive care unit stay and after hospitalisation were included. RESULTS We found 13 studies investigating sleep disturbance prevalence in intensive care units and 14 investigating sleep disturbance prevalence after hospitalisation, with 1,228 and 3,065 participants, respectively. The prevalence of sleep disturbance during an ICU stay was 66 %, and at two, three, six and ≥ 12 months after hospitalisation was 64 %, 49 %, 40 %, and 28 %, respectively. Studies using the Richards-Campbell Sleep Questionnaire detected a higher prevalence of sleep disturbance among patients in intensive care units than non-intensive care unit specific questionnaires; studies reported comparable sleep disturbance prevalence during intensive care stays for patients with and without mechanical ventilation. CONCLUSION Sleep disturbance is prevalent in critically ill patients admitted to an intensive care unit and persists for up to one year after hospitalisation, with prevalence ranging from 28 % to 66 %. The study results highlight the importance of implementing effective interventions as early as possible to improve intensive care unit sleep quality.
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Affiliation(s)
- Chun-Ying Shih
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - An-Yi Wang
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Critical Care Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Kai-Mei Chang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chi-Chen Yang
- Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ying-Chieh Tsai
- Department of Nursing, Cathay General Hospital, Taipei, Taiwan
| | - Chu-Chi Fan
- Department of Nursing, Cathay General Hospital, Taipei, Taiwan
| | - Han-Ju Chuang
- Department of Nursing, Cathay General Hospital, Taipei, Taiwan
| | - Nguyen Thi Phuc
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Nursing Department, Vinmec Times City Hospital, Vinmec HealthCare System, Hanoi, Viet Nam
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan; Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Sleep of Intensive Care Patients: A Qualitative Study Based on Experiences of Nurses. Dimens Crit Care Nurs 2022; 41:305-312. [PMID: 36179308 DOI: 10.1097/dcc.0000000000000550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Intensive care patients experience a high rate of poor sleep quality. As the sleep quality is improved with nursing practices, patients' recovery and the length of stay in the intensive care unit (ICU) may be positively influenced, and patients may benefit from treatment and care at the highest level. Therefore, it is important to explore the experiences and evaluation of nurses working in ICUs. OBJECTIVES This study was carried out to explore the experiences and evaluations of ICU nurses about patients' sleep. METHODS The study is a qualitative study conducted in a descriptive phenomenological design. The data were collected using the individual in-depth interview method with the semistructured interview form. Thematic analysis was performed to analyze the data. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used. RESULTS The analysis revealed 4 main themes, which are (1) importance of sleep, (2) evaluation of sleep, (3) reasons for poor sleep, and (4) sleep promotion interventions. CONCLUSIONS This study revealed that nurses are aware of the importance of sleep; however, they do not evaluate sleep and try to improve sleep quality only based on their own knowledge and experience rather than on evidence-based approaches. However, their interventions are not sufficient and they are restricted because of physical conditions and intensive care procedures.
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An Automated Algorithm for Determining Sleep Using Single-Channel Electroencephalography to Detect Delirium: A Prospective Observational Study in Intensive Care Units. Healthcare (Basel) 2022; 10:healthcare10091776. [PMID: 36141389 PMCID: PMC9498606 DOI: 10.3390/healthcare10091776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/11/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
The relationship between polysomnography-based objective sleep and delirium in the intensive care unit (ICU) is inconsistent across studies, suggesting limitations in manually determining the sleep stage of critically ill patients. We objectively measured 24-h sleep using a single-channel electroencephalogram (SleepScope [SS]) and an under-mattress sleep monitor (Nemuri SCAN [NSCAN]), both of which have independent algorithms that automatically determine sleep and wakefulness. Eighteen patients (median age, 68 years) admitted to the ICU after valvular surgery or coronary artery bypass grafting were included, and their sleep time was measured one day after extubation. The median total sleep times (TSTs) measured by SS (TST-SS) and NSCAN were 548 (48−1050) and 1024 (462−1257) min, respectively. Two patients with delirium during the 24-h sleep measurement had very short TST-SS of 48 and 125 min, and the percentage of daytime sleep accounted for >80% in both SS and NSCAN. This preliminary case series showed marked sleep deprivation and increased rates of daytime sleeping in ICU patients with delirium. Although data accuracy from under-mattress sleep monitors is contentious, automated algorithmic sleep/wakefulness determination using a single-channel electroencephalogram may be useful in detecting delirium in ICU patients and could even be superior to polysomnography.
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Elliott R, Axelin A, Richards KC, Vahlberg T, Ritmala‐Castren M. Sensitivity and specificity of proposed Richards‐Campbell Sleep Questionnaire cut‐off scores for good quality sleep during an ICU stay. J Clin Nurs 2022; 32:2700-2708. [PMID: 35570380 DOI: 10.1111/jocn.16348] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/12/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The 5-visual analogue scale Richards-Campbell Sleep Questionnaire subjective sleep measure is widely used in intensive care. A cut-off score indicative of good quality sleep has not been established and is required to guide the categorisation of individual patient and unit wide sleep quality. DESIGN AND METHODS The aim was to determine the global Richards-Campbell Sleep Questionnaire cut-off score for good to very good sleep during an intensive care unit stay in non-ventilated patients. The study was a secondary (cohort) retrospective analysis of patient self-report data (n = 32) from an interventional study testing a sleep promotion bundle. The Standards for Reporting Diagnostic Accuracy studies statement were used to report the study. The study was conducted in two mixed adult 12 and 20-bed ICUs of a tertiary referral hospital in a metropolitan area. In the morning, eligible patients were administered the Richards-Campbell Sleep Questionnaire together with a 5-category item Likert scale in which patients rated their nocturnal sleep quality as 'very poor', 'poor', 'fair', 'good' and 'very good'. Receiver Operator Curve analysis was performed. RESULTS Thirty-seven per cent (n = 32) of the total sample of 84 adult intensive care patients were females. The median age was 61.5 (51, 72) years. Self-reported median global Richards-Campbell Sleep Questionnaire score was 54.4 (30.1, 77.1) mm. A global score of ≥63.4 mm was the optimal cut-off for self-reported 'good sleep' (sensitivity: 87%, specificity: 81% and area under the curve: 0.896). CONCLUSIONS Although the study requires replication in ventilated patients and other ICU settings, the cut-off score (63 mm) could be used to guide the categorisation of individual patient and unit wide sleep quality.
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Affiliation(s)
- Rosalind Elliott
- Nursing and Midwifery Centre Nursing and Midwifery Directorate Northern Sydney Local Health District St Leonards NSW Australia
- School of Nursing and Midwifery Faculty of Health University of Technology Sydney NSW Australia
| | - Anna Axelin
- Department of Nursing Science University of Turku Turku Finland
| | | | - Tero Vahlberg
- Department of Biostatistics University of Turku Turku Finland
| | - Marita Ritmala‐Castren
- Department of Nursing Science University of Turku Turku Finland
- Nursing Administration Helsinki University Hospital Helsinki Finland
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Delaney LJ, Litton E, Huang HCC, Lopez V, van Haren FMP. The accuracy of simple, feasible alternatives to polysomnography for assessing sleep in intensive care: An observational study. Aust Crit Care 2022; 36:361-369. [PMID: 35361553 DOI: 10.1016/j.aucc.2022.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/06/2022] [Accepted: 02/06/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Sleep disturbance is common in intensive care patients. Understanding the accuracy of simple, feasible sleep measurement techniques is essential to informing their possible role in usual clinical care. OBJECTIVE The aim of the study was to investigate whether sleep monitoring techniques such as actigraphy (ACTG), behavioural assessments, and patient surveys are comparable with polysomnography (PSG) in accurately reporting sleep quantity and quality among conscious, intensive care patients. METHODS An observational study was conducted in 20 patients admitted to the intensive care unit (ICU) for a minimum duration of 24 h, who underwent concurrent sleep monitoring via PSG, ACTG, nursing-based observations, and self-reported assessment using the Richards-Campbell Sleep Questionnaire. RESULTS The reported total sleep time (TST) for the 20 participants measured by PSG was 328.2 min (±106 min) compared with ACTG (362.4 min [±62.1 min]; mean difference = 34.22 min [±129 min]). Bland-Altman analysis indicated that PSG and ACTG demonstrated clinical agreement and did not perform differently across a number of sleep variables including TST, awakening, sleep-onset latency, and sleep efficiency. Nursing observations overestimated sleep duration compared to PSG TST (mean difference = 9.95 ± 136.3 min, p > 0.05), and patient-reported TST was underestimated compared to PSG TST (mean difference = -51.81 ± 144.1 7, p > 0.05). CONCLUSIONS Amongst conscious patients treated in the ICU, sleep characteristics measured by ACTG were similar to those measured by PSG. ACTG may provide a clinically feasible and acceptable proxy approach to sleep monitoring in conscious ICU patients.
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Ritmala-Castren M, Salanterä S, Holm A, Heino M, Lundgrén-Laine H, Koivunen M. Sleep improvement intervention and its effect on patients' sleep on the ward. J Clin Nurs 2021; 31:275-282. [PMID: 34114280 DOI: 10.1111/jocn.15906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/22/2021] [Accepted: 05/17/2021] [Indexed: 12/01/2022]
Abstract
AIM AND OBJECTIVE The aim of the study was to investigate how the sleep improvement interventions developed for the wards were associated with patients' sleep. The objective was to promote patients' sleep. BACKGROUND The quality of sleep is vital for patients' health and recovery from illness. However, patients generally sleep poorly during hospitalisation. Sleep-disturbing factors are connected to the hospital environment, patients' physical illness, emotional state and the activities of the staff. Many sleep-disturbing factors can be influenced by appropriate nursing interventions. DESIGN A two-group intervention study including the development of nursing interventions aimed at supporting patients' sleep. One group received a sleep promotion intervention and the other received standard care. Both groups evaluated their sleep in the morning. METHODS A survey of participants' sleep evaluations was collected with the five-item Richards-Campbell Sleep Questionnaire. The data were analysed statistically. The STROBE checklist was used to report the study. RESULTS From the participants' perspective, sleep was better in the intervention group, even though statistically significantly only among men. The pain intensity correlated with sleep quality. The number of patients in the room or whether participants had had an operation had no effect on their sleep evaluations. CONCLUSIONS Interventions targeted at supporting and promoting the sleep quality of hospital inpatients may be effective. They should be developed in collaboration with patients and nurses. Several nursing interventions can be proposed to promote better sleep among patients; however, more research is needed to confirm the results. Sleep promotion should include both standardised protocols and individualised sleep support. RELEVANCE TO CLINICAL PRACTICE Investing in nursing interventions to promote patients' sleep is important. Patients' individual sleep-related needs should be part of their care plan. Training programmes that support nurses' knowledge and skills of patients' sleep promotion should be part of nursing education in healthcare organisations.
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Affiliation(s)
- Marita Ritmala-Castren
- Department of Nursing Science, University of Turku, Turku, Finland.,Helsinki University Hospital, Nursing Administration, Helsinki, Finland
| | - Sanna Salanterä
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Anu Holm
- Unit of Clinical Neurophysiology, Satakunta Hospital District, Pori, Finland.,Faculty of Health and Welfare, Satakunta University of Applied Sciences, Pori, Finland
| | | | - Heljä Lundgrén-Laine
- Department of Nursing Science, University of Turku, Turku, Finland.,Central Finland Hospital Nova, Central Finland Health Care District, Jyvaskyla, Finland
| | - Marita Koivunen
- Department of Nursing Science, University of Turku, Turku, Finland.,Satakunta Hospital District, Pori, Finland
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Ritmala-Castren M, Axelin A, Richards KC, Mitchell ML, Vahlberg T, Leino-Kilpi H. Investigating the construct and concurrent validity of the Richards-Campbell Sleep Questionnaire with intensive care unit patients and home sleepers. Aust Crit Care 2021; 35:130-135. [PMID: 34049774 DOI: 10.1016/j.aucc.2021.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 03/16/2021] [Accepted: 04/17/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Sleep is vital to our wellbeing. Critically ill patients are vulnerable with effects of sleep deprivation including weakened immune function, decreased glucose tolerance, and increased sympathetic activity. Intensive care unit (ICU) patients' sleep evaluation is difficult and often not reliable. The most commonly used instrument for assessing ICU patients' perspective of their sleep, Richards-Campbell Sleep Questionnaire (RCSQ), has not been reported to have undergone known-group construct validity testing or concurrent validity testing with the criterion measure of feeling refreshed. OBJECTIVES The aim of the study was to explore the construct validity of the RCSQ with known-groups technique and concurrent validity with the criterion measure of feeling refreshed on awakening. METHODS A cross-sectional descriptive survey study using the RCSQ was conducted on people sleeping at home (n = 114) over seven nights. The results were compared with the RCSQ sleep scores of nonintubated alert oriented adult ICU patients (n = 114). Home sleepers were also asked to rate how refreshed they felt on awakening. The study was executed and reported in accordance with the STROBE checklist for observational studies. FINDINGS RCSQ construct validity was supported because home sleepers' and ICU sleepers' sleep evaluations differed significantly. Home sleepers rated their sleep significantly better than ICU patients in all five sleep domains of the RCSQ. Concurrent validity was supported because the item "feeling refreshed on awakening" correlated strongly with all sleep domains. CONCLUSIONS Sleep quality may be accurately measured using the RCSQ in alert people both in the ICU and at home. This study has added to the validity discussion around the RCSQ. The RCSQ can be used for sleep evaluation in ICUs to promote wellbeing and recovery.
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Affiliation(s)
- Marita Ritmala-Castren
- Helsinki University Hospital, Po BOX 100, FI-00029 HUS, Finland; Department of Nursing Science, University of Turku, FI-20014 TURUN YLIOPISTO, Finland.
| | - Anna Axelin
- Department of Nursing Science, University of Turku, FI-20014 TURUN YLIOPISTO, Finland.
| | - Kathy C Richards
- University of Texas at Austin, School of Nursing, 1710 Red River St., Austin, TX 78712, USA.
| | - Marion L Mitchell
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, N48 2.14, Nathan Campus, 170 Kessels Road, Nathan, Queensland 4111, Australia; Princess Alexandra Hospital Intensive Care Unit, 199 Ipswich Rd, Woolloongabba, Queensland 4102, Australia.
| | - Tero Vahlberg
- Department of Biostatistics, University of Turku, FI-20014 TURUN YLIOPISTO, Finland.
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, FI-20014 TURUN YLIOPISTO, Finland; Turku University Hospital, PO Box 52, FI-20521 TURKU, Finland.
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Aydın Sayılan A, Kulakaç N, Sayılan S. The effects of noise levels on pain, anxiety, and sleep in patients. Nurs Crit Care 2020; 26:79-85. [PMID: 32621391 DOI: 10.1111/nicc.12525] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 05/24/2020] [Accepted: 06/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intensive care is a noisy environment for patients and one that affects pain, anxiety levels, and sleep quality. AIMS AND OBJECTIVES To determine the relationship between noise levels and pain, anxiety, and sleep levels in patients in intensive care units. DESIGN A descriptive and observational study design was used. METHODS This study was conducted between June and December 2018 in a public hospital and included 111 patients admitted to surgical critical care for at least 24 hours. Three Benetech Gm1351 manual sound level metres were used to measure noise. A Patient Information Form, a pain Visual Analog Scale (VAS), the Spielberger State-Trait Anxiety Inventory, and the Richards Campbell Sleep Questionnaire (RCSQ) were used for data collection. RESULTS The mean age of the patients was 57.29 years. The mean noise level detected in the intensive care unit was 66.52 dB (dB). Patients' mean pain VAS score was 3.79 ± 1.72, the mean State Anxiety Inventory score was 39.74 ± 2.98, and the mean total RCSQ score was 25.10 ± 13.17. Our findings show that patients in the intensive care unit are exposed to high noise levels and that, while this has no effect on pain, it significantly impacts anxiety and quality of sleep. CONCLUSIONS Noise levels in intensive care units significantly exceed recommended thresholds, and this adversely affects patients' anxiety levels and sleep quality. It is important for suitably restful conditions to be provided for patients, to be aware of the potential for anxiety, and for these factors to be borne in mind when planning nursing interventions. RELEVANCE TO CLINICAL PRACTICE Further studies on the effects of noise levels on pain, anxiety, and sleep levels in patients admitted to intensive care units are needed.
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Affiliation(s)
- Aylin Aydın Sayılan
- Department of Nursing, School of Health Sciences, Kırklareli University, Kırklareli, Turkey
| | - Nurşen Kulakaç
- Department of Nursing, Gümüşhane University Faculty of Health Sciences, Gümüşhane, Turkey
| | - Samet Sayılan
- Kirklareli Government Hospital, Internal Medicine Clinic, Kırklareli, Turkey
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Khater W, Masha'al D, Al-Sayaheen A. Sleep assessment and interventions for patients living with cancer from the patients' and nurses' perspective. Int J Palliat Nurs 2020; 25:316-324. [PMID: 31339821 DOI: 10.12968/ijpn.2019.25.7.316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Difficulty sleeping is a common symptom for patients living with cancer that significantly affects their lives. However, although sleep disorders are common, it is an overlooked problem in cancer care. PURPOSE This study assessed the prevalence of sleep disturbances among patients living with cancer, and assessed the adequacy of sleep assessment and intervention for patients from both nurses' and patients' perspectives. METHOD Descriptive, cross-sectional and correlational design was used in this study. A convenience sample of 129 patients with cancer and 113 registered nurses working with cancer patients was recruited. A structured face-to-face interview was used to complete the patients' questionnaires and a self-administered questionnaire was given to nurses. FINDINGS The majority of patients with cancer reported having poor sleep quality (69.8%). About 86.7% (n=98) of nurses reported that they have never screened patients with cancer for any sleep problems, and 76.7% (n=99) of the patients reported that they have never been assessed for sleep problems by the nursing staff during hospitalisation. Only 8% of patients with cancer who reported having problems sleeping to a nurse received interventions to promote better sleep. CONCLUSION Assessment of sleep disturbances in patients with cancer should be unified using a comprehensive reliable valid instrument, as well as providing evidence-based interventions according to patient's need. A written policy should be introduced to encourage sleep documentation and to make sleep care for patients part of routine nursing care.
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Affiliation(s)
- Wejdan Khater
- Associate Professor, Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology
| | - Dina Masha'al
- Associate Professor, Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology
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Leoni-Scheiber C, Mayer H, Müller-Staub M. Übereinstimmung des Advanced Nursing Process mit Beobachtungen, Interviews und Pflegedokumentationen im Akutspital. Pflege 2020; 33:3-12. [DOI: 10.1024/1012-5302/a000704] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Hintergrund: Pflegefachpersonen mit guter klinischer Entscheidungsfindungskompetenz stellen genauere Pflegediagnosen, setzen wirksamere Pflegeinterventionen um und erzielen bessere pflegesensitive Patientenergebnisse. Studien haben gezeigt, dass die Inhalte der Pflegedokumentationen manchmal nicht mit den Berichten von Patientinnen und Patienten und Pflegefachpersonen übereinstimmen. Fragestellung: Inwieweit stimmen die dokumentierten Pflegediagnosen, -interventionen und ‑ergebnisse mit beobachteten Pflegesituationen und Patientenaussagen überein? Methoden: Eine „multiple case study“ wurde mittels strukturierter Beobachtungen, leitfadengestützter Patienteninterviews und Dokumentenanalysen durchgeführt. Bei 24 Patientinnen und Patienten wurde die Übereinstimmung von Pflegediagnosen, ‑interventionen und ‑ergebnissen zwischen den drei Quellen durch „within-case-“ und „cross-case-analyses“ untersucht. Ergebnisse: Von 114 identifizierten Pflegediagnosen waren 66 dokumentiert, 37 gingen aus den Beobachtungen und elf aus den Interviews hervor. Eine hohe Übereinstimmung zwischen den drei Quellen zeigte sich in 59 % der dokumentierten Pflegediagnosen, in 41 % der Pflegeinterventionen und in 33 % der Pflegeergebnisse. Fast allen dokumentierten Pflegediagnosen (89 %) waren die meisten Codes aus allen drei Quellen zugeordnet. Schlussfolgerungen: Um die Übereinstimmung der drei Perspektiven zu erhöhen, sollte die pflegerische Entscheidungsfindungskompetenz unterstützt werden, damit Pflegefachpersonen wirksamere Pflegeinterventionen wählen, die zu besseren Ergebnissen führen. Die Partizipation der Patientinnen und Patienten sollte gefördert werden.
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Affiliation(s)
| | - Hanna Mayer
- Institut für Pflegewissenschaft, Universität Wien
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11
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Patient-related factors may influence nursing perception of sleep in the Intensive Care Unit. PLoS One 2020; 15:e0226323. [PMID: 31905204 PMCID: PMC6944385 DOI: 10.1371/journal.pone.0226323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/09/2019] [Indexed: 11/19/2022] Open
Abstract
Objective There exist conflicting data regarding the accuracy of ICU nurses accurately assessing patient sleep using validated questionnaires. Using the Richards-Campbell Sleep Questionnaire (RSQ), we hypothesize that patient factors might influence nursing perception of their sleep. Methods Patients in the ICU who met the inclusion criteria were asked to complete the sleep questionnaire, as were their nurses and intraclass correlation analysis was done. Results 38 paired patient-nurse surveys were included for analysis. The mean difference in total average score of the RSQ was not significantly different between patients and nurses. There was fair intraclass correlation by patient age, black race, and admission for respiratory illnesses. A good intraclass correlation existed for non-blacks and admission for non-respiratory reasons. Most striking was the intraclass correlation by sex, with poor intraclass correlation for women compared to an excellent correlation for men. Conclusion The results of our study confirm that patients in our ICU have poor sleep with a fair intraclass correlation. When examined by patient related factor, the greatest divergence between patient and nursing perception of sleep in the ICU using the RCSQ was patient female sex. More research is needed in this area to better understand the divergence and improve sleep in the ICU.
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Alsulami G, Rice AM, Kidd L. Prospective repeated assessment of self-reported sleep quality and sleep disruptive factors in the intensive care unit: acceptability of daily assessment of sleep quality. BMJ Open 2019; 9:e029957. [PMID: 31227541 PMCID: PMC6596998 DOI: 10.1136/bmjopen-2019-029957] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Despite the importance of sleep, the assessment of sleep quality does not form part of standard clinical care in intensive care unit (ICU). Continuous assessment of self-reported quality of ICU patients' sleep has been strongly recommended. Prior to implementing such an assessment in the ICU, it is important to assess the acceptability of this method of assessment to the ICU's patients. The aims of this study were to assess the acceptability to ICU patients of completing daily self-reports on sleep quality during their ICU stay and to assess ICU patients' self-reported sleep quality and sleep disruptive factors during their time in ICU. METHODS An observational prospective-repeated assessment was conducted on n=120 patients in an ICU in Saudi Arabia. The participants were both intubated and non-intubated. OUTCOMES MEASURES Over a 3-month period, sleep quality was assessed using the Arabic version of the Richards-Campbell Sleep Questionnaire (RCSQ-A), and self-reported sleep disruptive factors were identified. Clinical factors, such as ICU interventions, and previously administered sedatives were also examined. The patients' acceptance of completing daily RCSQ-A reports was assessed using various indicators of acceptability. RESULTS A total of 381 self-reports (RCSQ-A) were collected for this analysis. The patients reported 34.4±5.60, indicating that sleep quality was poor on average. The group of intubated patients reported much poorer sleep quality during intubation than after extubation. In the multivariate analysis, factors which most significantly affected sleep (exp(b), p value) were midazolam (-6.424, p<0.0005), propofol (-3.600, p<0.05), noise (-1.033, p<0.05), gender (1.836, p<0.05), daytime sleepiness (0.856, p<0.05) and the presence of mechanical ventilation (-1.218, p<0.05). CONCLUSION The acceptability and feasibility of using daily RCSQ-A for sleep quality assessment was demonstrated. Sleep quality was reported as poor by all participants and the factors affecting sleep were varied. This study provided various recommendations for healthcare providers and researchers in terms of evaluating and improving sleep quality in ICU patients.
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Affiliation(s)
- Ghaida Alsulami
- Nursing, University of Glasgow School of Veterinary Medicine, Glasgow, UK
- Nursing, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ann Marie Rice
- University of Glasgow School of Medicine Dentistry and Nursing, Glasgow, UK
| | - Lisa Kidd
- School of Medicine Dentistry and Nursing, University of Glasgow, Glasgow, UK
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Gellerstedt L, Medin J, Kumlin M, Rydell Karlsson M. Nursing care and management of patients' sleep during hospitalisation: A cross-sectional study. J Clin Nurs 2019; 28:3400-3407. [PMID: 31091343 DOI: 10.1111/jocn.14915] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/16/2019] [Accepted: 05/02/2019] [Indexed: 01/19/2023]
Abstract
AIM To explore and describe how patients' sleep is addressed at acute-care hospitals in Sweden with regard to nursing care, management and the development of knowledge in this area. BACKGROUND Sleep is a basic human need and thus important for health and health maintenance. Patients describe sleeping in hospital as a stressor, and research shows that nurses tend to underestimate patients' perceived problems with sleep during hospitalisation. How do nursing staff at acute hospitals address patients' sleep and the development of knowledge in this area? DESIGN/METHOD A cross-sectional descriptive study was conducted based on data collected through a web survey. Head nurses, registered nurses, nursing care developers and local training supervisors at 36 randomised acute-care hospitals in Sweden were invited to participate. This study was executed and reported in accordance with SQUIRE 2.0. RESULTS The results of the survey (53 responses from 19 wards at 15 acute-care hospitals) showed that no policy documents exist and no current training addresses sleep during hospital stay. All participants agreed that sleep should be considered a nursing topic and that it is important for hospitalised patients. CONCLUSION Patients' sleep during hospitalisation is undermanaged at acute-care hospitals. Nurses, health care managers and organisations face challenges if they are to achieve better outcomes. RELEVANCE TO CLINICAL PRACTICE This study shows that nurses do consider patients' sleep important and addressing sleep as part of nursing care. Future studies in the area should focus on what kinds of support and education are needed in the clinical context.
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Affiliation(s)
- Linda Gellerstedt
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden.,Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jörgen Medin
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden.,Swedish Red Cross University, Huddinge, Sweden
| | - Maria Kumlin
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden.,Unit for Experimental Asthma and Allergy Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Monica Rydell Karlsson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Ersta Sköndal Bräcke University College, Stockholm, Sweden
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14
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Pagnucci N, Tolotti A, Cadorin L, Valcarenghi D, Forfori F. Promoting nighttime sleep in the intensive care unit: Alternative strategies in nursing. Intensive Crit Care Nurs 2019; 51:73-81. [DOI: 10.1016/j.iccn.2018.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/05/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
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15
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Scholes J, Trapani J. What's in this issue? Nurs Crit Care 2017. [PMID: 28632978 DOI: 10.1111/nicc.12307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Julie Scholes
- Professor of Nursing, Editor of Nursing in Critical Care
| | - Josef Trapani
- Lecturer in Nursing, Intern in Nursing in Critical Care
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16
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Krotsetis S, Richards KC, Behncke A, Köpke S. The reliability of the German version of the Richards Campbell Sleep Questionnaire. Nurs Crit Care 2017; 22:247-252. [PMID: 28168810 DOI: 10.1111/nicc.12275] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 08/30/2016] [Accepted: 11/14/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The assessment of sleep quality in critically ill patients is a relevant factor of high-quality care. Despite the fact that sleep disturbances and insufficient sleep management contain an increased risk of severe morbidity for these patients, a translated and applicable instrument to evaluate sleep is not available for German-speaking intensive care settings. AIM This study aimed to translate the Richards Campbell Sleep Questionnaire (RCSQ), a simple and validated instrument eligible for measuring sleep quality in critically ill patients, and subsequently to evaluate the internal consistency of the German version of the RCSQ. Furthermore, it also aimed to inquire into the perception of sleep in a sample of critically ill patients. METHODS The RCSQ was translated following established methodological standards. Data were collected cross-sectionally in a sample of 51 patients at 3 intensive care units at a university hospital in Germany. RESULTS The German version of the RCSQ showed an overall internal consistency (Cronbach's alpha) of 0·88. The mean of the RSCQ in the sample was 47·00 (SD ± 27·57). Depth of sleep was rated the lowest and falling asleep again the highest of the RCSQ sleep items. CONCLUSION The study demonstrated very good internal consistency of the German version of the RCSQ, allowing for its application in practice and research in German-speaking countries. Quality of sleep perception was generally low in this sample, emphasizing the need for enhanced care concepts regarding the sleep management of critically ill patients. Relevance to clinical practice Assessment of self-perception of sleep is crucial in order to plan an individually tailored care process.
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Affiliation(s)
- Susanne Krotsetis
- Nursing Directorate, University Hospital Schleswig Holstein, Lübeck, Germany
| | - Kathy C Richards
- Doctoral Programs and Research School of Nursing, George Mason University, Fairfax, VA, USA
| | - Anja Behncke
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Sascha Köpke
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
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17
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Karaman Özlü Z, Özer N. The effect of enhancing environmental factors on the quality of patients’ sleep in a cardiac surgical intensive care unit. BIOL RHYTHM RES 2016. [DOI: 10.1080/09291016.2016.1232462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Aitken LM, Elliott R, Mitchell M, Davis C, Macfarlane B, Ullman A, Wetzig K, Datt A, McKinley S. Sleep assessment by patients and nurses in the intensive care: An exploratory descriptive study. Aust Crit Care 2016; 30:59-66. [PMID: 27094380 DOI: 10.1016/j.aucc.2016.04.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/23/2016] [Accepted: 04/04/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Sleep disruption is common in intensive care unit (ICU) patients, with reports indicating reduced quality and quantity of sleep in many patients. There is growing evidence that sleep in this setting may be improved. AIM To describe ICU patients' self-report assessment of sleep, examine the relationship between patients' self-reported sleep and their reported sleep by the bedside nurse, and describe the strategies suggested by patients to promote sleep. METHODS An exploratory descriptive study was undertaken with communicative adult patients consecutively recruited in 2014-2015. Patients reported sleep using the Richards-Campbell Sleep Questionnaire (score range 0-100mm; higher score indicates better sleep quality), with nursing assessment of sleep documented across a five level ordinal variable. Patients were asked daily to describe strategies that helped or hindered their sleep. Ethical approval for the study was gained. Descriptive statistical analysis was performed [median (interquartile range)]; relationships were tested using Spearman's rank correlation and differences assessed using the Kruskal-Wallis test; p<0.05 was considered significant. RESULTS Participants (n=151) were recruited [age: 60 (46-71) years; ICU length of stay 4 (2-9) days] with 356 self-reports of sleep. Median perceived sleep quality was 46 (26-65) mm. A moderate relationship existed between patients' self-assessment and nurses' assessment of sleep (Spearman's rank correlation coefficient 0.39-0.50; p<0.001). Strategies identified by patients to improve sleep included adequate pain relief and sedative medication, a peaceful and comfortable environment and physical interventions, e.g. clustering care, ear plugs. CONCLUSION Patients reported on their sleep a median of 2 (1-3) days during their ICU stay, suggesting that routine use of self-report was feasible. These reports revealed low sleep quality. Patients reported multiple facilitators and barriers for sleep, with environmental and patient comfort factors being most common. Interventions that target these factors to improve patient sleep should be implemented.
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Affiliation(s)
- Leanne M Aitken
- School of Nursing and Midwifery, Griffith University, Queensland, Australia; NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Australia; Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; School of Health Sciences, City University London, United Kingdom.
| | - Rosalind Elliott
- Faculty of Health, University of Technology Sydney, Australia; Intensive Care Unit, Royal North Shore Hospital, Sydney, Australia
| | - Marion Mitchell
- School of Nursing and Midwifery, Griffith University, Queensland, Australia; NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Australia; Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Chelsea Davis
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Bonnie Macfarlane
- NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Australia
| | - Amanda Ullman
- NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Australia
| | - Krista Wetzig
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Ashika Datt
- Faculty of Science, University of Technology Sydney, Australia
| | - Sharon McKinley
- Intensive Care Unit, Royal North Shore Hospital, Sydney, Australia
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