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Acharya R, Blackwell S, Simoes J, Harris B, Booth L, Bhangu A, Glasbey J. Non-pharmacological interventions to improve sleep quality and quantity for hospitalized adult patients-co-produced study with surgical patient partners: systematic review. BJS Open 2024; 8:zrae018. [PMID: 38597159 PMCID: PMC11004792 DOI: 10.1093/bjsopen/zrae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/10/2024] [Accepted: 01/21/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Hospitalized patients experience sleep disruption with consequential physiological and psychological effects. Surgical patients are particularly at risk due to surgical stress and postoperative pain. This systematic review aimed to identify non-pharmacological interventions for improving sleep and exploring their effects on sleep-related and clinical outcomes. METHODS A systematic literature search was performed in accordance with PRISMA guidelines and was preregistered on the Open Science Framework (doi: 10.17605/OSF.IO/EA6BN) and last updated in November 2023. Studies that evaluated non-pharmacological interventions for hospitalized, adult patients were included. Thematic content analysis was performed to identify hypothesized mechanisms of action and modes of administration, in collaboration with a patient partner. Risk of bias assessment was performed using the Cochrane Risk Of Bias (ROB) or Risk Of Bias In Non-Randomized Studies - of Interventions (ROBINS-I) tools. RESULTS A total of 59 eligible studies and data from 14 035 patients were included; 28 (47.5%) were randomized trials and 26 included surgical patients (10 trials). Thirteen unique non-pharmacological interventions were identified, 17 sleep measures and 7 linked health-related outcomes. Thematic analysis revealed two major themes for improving sleep in hospital inpatients: enhancing the sleep environment and utilizing relaxation and mindfulness techniques. Two methods of administration, self-administered and carer-administered, were identified. Environmental interventions, such as physical aids, and relaxation interventions, including aromatherapy, showed benefits to sleep measures. There was a lack of standardized sleep measurement and an overall moderate to high risk of bias across all studies. CONCLUSIONS This systematic review has identified several sleep interventions that are likely to benefit adult surgical patients, but there remains a lack of high-quality evidence to support their routine implementation.
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Affiliation(s)
- Radhika Acharya
- National Institute of Health and Care Research (NIHR) Global Health Research Unit on Global Surgery, University of Birmingham, Institute of Translation Medicine, Birmingham, UK
| | - Sue Blackwell
- Patient Liaison Group (PLG), Association of Coloproctology of Great Britain and Ireland, London, UK
| | - Joana Simoes
- National Institute of Health and Care Research (NIHR) Global Health Research Unit on Global Surgery, University of Birmingham, Institute of Translation Medicine, Birmingham, UK
| | - Benjamin Harris
- National Institute of Health and Care Research (NIHR) Global Health Research Unit on Global Surgery, University of Birmingham, Institute of Translation Medicine, Birmingham, UK
| | - Lesley Booth
- Patients and Researchers Together (PART), Bowel Research UK, London, UK
| | - Aneel Bhangu
- National Institute of Health and Care Research (NIHR) Global Health Research Unit on Global Surgery, University of Birmingham, Institute of Translation Medicine, Birmingham, UK
| | - James Glasbey
- National Institute of Health and Care Research (NIHR) Global Health Research Unit on Global Surgery, University of Birmingham, Institute of Translation Medicine, Birmingham, UK
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Showler L, Ali Abdelhamid Y, Goldin J, Deane AM. Sleep during and following critical illness: A narrative review. World J Crit Care Med 2023; 12:92-115. [PMID: 37397589 PMCID: PMC10308338 DOI: 10.5492/wjccm.v12.i3.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/13/2023] [Accepted: 03/22/2023] [Indexed: 06/08/2023] Open
Abstract
Sleep is a complex process influenced by biological and environmental factors. Disturbances of sleep quantity and quality occur frequently in the critically ill and remain prevalent in survivors for at least 12 mo. Sleep disturbances are associated with adverse outcomes across multiple organ systems but are most strongly linked to delirium and cognitive impairment. This review will outline the predisposing and precipitating factors for sleep disturbance, categorised into patient, environmental and treatment-related factors. The objective and subjective methodologies used to quantify sleep during critical illness will be reviewed. While polysomnography remains the gold-standard, its use in the critical care setting still presents many barriers. Other methodologies are needed to better understand the pathophysiology, epidemiology and treatment of sleep disturbance in this population. Subjective outcome measures, including the Richards-Campbell Sleep Questionnaire, are still required for trials involving a greater number of patients and provide valuable insight into patients’ experiences of disturbed sleep. Finally, sleep optimisation strategies are reviewed, including intervention bundles, ambient noise and light reduction, quiet time, and the use of ear plugs and eye masks. While drugs to improve sleep are frequently prescribed to patients in the ICU, evidence supporting their effectiveness is lacking.
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Affiliation(s)
- Laurie Showler
- Intensive Care Medicine, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia
| | - Yasmine Ali Abdelhamid
- Intensive Care Medicine, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia
| | - Jeremy Goldin
- Sleep and Respiratory Medicine, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia
| | - Adam M Deane
- Intensive Care Medicine, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia
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3
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Lam MTY, Malhotra A, LaBuzetta JN, Kamdar BB. Sleep in Critical Illness. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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4
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Beltrami FG, John ÂB, de Macedo BR, Corrêa Júnior V, Nguyen XL, Pichereau C, Maury E, Fleury B, Gus M, Fagondes SC. A multi-intervention protocol to improve sleep quality in a coronary care unit. Eur J Cardiovasc Nurs 2021; 21:464-472. [PMID: 34935040 DOI: 10.1093/eurjcn/zvab099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/17/2020] [Accepted: 01/18/2021] [Indexed: 11/14/2022]
Abstract
AIMS Poor sleep is a frequent occurrence in the critical illness. Evaluate sleep quality and test the effect of a multi-intervention sleep care protocol in improving sleep quality in a coronary care unit (CCU). METHODS AND RESULTS Quasi-experimental study, carried out in two phases. During the first phase, the control group (n = 58 patients) received usual care. Baseline sleep data were collected through the Richards-Campbell Sleep Questionnaire (RCSQ) and the Sleep in the Intensive Care Unit Questionnaire (SICUQ). During the second phase (n = 55 patients), a sleep care protocol was implemented. Interventions included actions to promote analgesia, reduce noise, brightness, and other general measures. Sleep data were collected again to assess the impact of these interventions. The intervention group had better scores in overall sleep depth [median (interquartile range)] [81 (65-96.7) vs. 69.7 (50-90); P = 0.046]; sleep fragmentation [90 (65-100) vs. 69 (42.2-92.7); P = 0.011]; return to sleep [90 (69.7-100) vs. 71.2 (40.7-96.5); P = 0.007]; sleep quality [85 (65-100) vs. 71.1 (49-98.1); P = 0.026]; and mean RCSQ score [83 (66-94) vs. 66.5 (45.7-87.2); P = 0.002] than the baseline group. The main barriers to sleep were pain [1 (1.0-5.5)], light [1 (1.0-5.0)], and noise [1 (1.0-5.0)]. The most rated sources of sleep-disturbing noise were heart monitor alarm [3 (1.0-5.25)], intravenous pump alarm [1.5 (1.0-5.00)]. and mechanical ventilator alarm [1 (1.0-5.0)]. All were significantly lower in the intervention group than in the baseline group. CONCLUSION A multi-intervention protocol was feasible and effective in improving different sleep quality parameters and reducing some barriers to sleep in CCU patients.
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Affiliation(s)
- Flávia Gabe Beltrami
- Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Ramiro Barcelos, 2350,90035-003, RS, Brazil
| | - Ângela Beatriz John
- Laboratório do Sono, Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Room 2050, 90035-003 Porto Alegre, RS, Brazil
| | - Bruno Rocha de Macedo
- Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Ramiro Barcelos, 2350,90035-003, RS, Brazil
| | - Vicente Corrêa Júnior
- Ambulatório de Hipertensão do Hospital de Clínicas de Porto Alegre, Porto Alegre, Ramiro Barcelos, 2350,90035-003, RS, Brazil
| | - Xuân-Lan Nguyen
- Unité de Somnologie et Fonction Respiratoire, Département de Physiologie Respiratoire et Sommeil, Hôpital Saint-Antoine, Paris, France
| | - Claire Pichereau
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Paris, France
| | - Eric Maury
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Paris, France
| | - Bernard Fleury
- Collège de Médecine des Hôpitaux de Paris, Département de Physiologie Respiratoire et Sommeil, Hôpital Saint-Antoine, Paris, France
| | - Miguel Gus
- Unidade de Cuidados Cardiovasculares, Serviço de Cardiologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Programa de Pós-Graduação em Cardiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Simone Chaves Fagondes
- Laboratório do Sono, Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Room 2050, 90035-003 Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Ramiro Barcelos, 2350,90035-003, RS, Brazil
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Jun J, Kapella MC, Hershberger PE. Non-pharmacological sleep interventions for adult patients in intensive care Units: A systematic review. Intensive Crit Care Nurs 2021; 67:103124. [PMID: 34456110 DOI: 10.1016/j.iccn.2021.103124] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/02/2021] [Accepted: 06/21/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To synthesize and evaluate current non-pharmacological sleep interventions for critically ill adult patients in intensive care units and provide recommendations for future studies of non-pharmacological means of improving this population's sleep quality. RESEARCH METHODOLOGY/DESIGN The literature search was conducted following PRISMA guidelines. Seven databases CINAHL, PsycINFO, Embase, Medline, Cochrane Library, Web of Science, and Scopus and three keywords, sleep, intervention and intensive care unit were employed. All possible combinations of the keywords and similar words were considered. Included studies were primary studies, involved adult intensive care unit patients, focused on non-pharmacological sleep interventions, measured subjective and/or objective sleep quality and were published in English between January 2010 and September 2020. RESULTS The 20 included studies examined different types of non-pharmacological sleep interventions involving use of earplugs, an eye mask, white noise, music, aromatherapy, massage, acupressure, light intensity, a sleep hygiene protocol, quiet time and minimization of nursing care. Of 18 studies employing an experimental design, most reported that non-pharmacological interventions improved sleep quality. All these interventions involved environmental factors or complementary relaxation strategies. CONCLUSIONS Non-pharmacological sleep interventions can have a positive influence on sleep quality in critically ill patients, but more research is needed to determine their effectiveness.
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Affiliation(s)
- Jeehye Jun
- University of Illinois at Chicago, College of Nursing, 845 South Damen Avenue, Chicago, IL 60612, USA.
| | - Mary C Kapella
- University of Illinois at Chicago, College of Nursing, 845 South Damen Avenue, Chicago, IL 60612, USA.
| | - Patricia E Hershberger
- University of Illinois at Chicago, College of Nursing, 845 South Damen Avenue, Chicago, IL 60612, USA.
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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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7
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Bae G, Lim F. The Impact of Nonpharmacological Interventions on Sleep Quality Among Older Adult Patients in the Intensive Care Unit. Crit Care Nurs Q 2021; 44:214-229. [PMID: 33595968 DOI: 10.1097/cnq.0000000000000355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sleep is a basic human need that is required for good health and overall well-being. Adequate sleep is critical for cognitive functioning, memory consolidation, and emotional regulation by rejuvenating the body. Sleep may not be of significant concern unless it becomes lacking or disturbed as it alters the immune function, neurological processes, and intellectual and decision making of individuals. Hospitalized older adults are particularly vulnerable for the negative impact of poor sleep due to reduced physiological reserve and comorbidities. The purpose of this review is to appraise current evidence on nonpharmacological sleep interventions to promote better sleep quality and overall health outcomes among the general adult and older patients in the intensive care unit compared with no intervention at all. The findings of this integrative review will be useful in designing and implementing interdisciplinary plans of care that promote the use of nonpharmacological sleep protocols within the hospital setting.
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Affiliation(s)
- Grace Bae
- Keck Medical Center of USC, Los Angeles, California (Ms Bae) and New York University Meyers College of Nursing (Dr Lim)
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8
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Abstract
Sleep is fundamental for everyday functioning, yet it is often negatively impacted in critically ill patients by the intensive care setting. With a focus on the neurological intensive care unit (NeuroICU), this narrative review summarizes methods of measuring sleep and addresses common causes of sleep disturbance in the hospital including environmental, pharmacological, and patient-related factors. The effects of sleep deprivation on the cardiovascular, pulmonary, immune, endocrine, and neuropsychological systems are discussed, with a focus on short-term deprivation in critically ill populations. Where evidence is lacking in the literature, long-term sleep deprivation studies and the effects of sleep deprivation in healthy individuals are also referenced. Lastly, strategies for the promotion of sleep in the NeuroICU are presented.
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9
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Graham K, Ogbuji G, Williams Z, Crain M, Rolin B, Juala J, Larbi I, Bernard N, Oster CA, Baird M, Gullatte MM. Challenges of Implementing the Choosing Wisely Guideline to Promote Sleep and Rest at Night for Hospitalized Patients. J Nurs Care Qual 2021; 36:50-56. [PMID: 32618811 DOI: 10.1097/ncq.0000000000000494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Evidence suggests that a lack of sleep among patients during hospitalization can impact their health and well-being. LOCAL PROBLEM On inpatient units, patients experience lack of sleep due to noise and multiple interruptions at night. METHODS A pilot intervention to support the initiative, "Don't wake the patient for routine care unless the patient's condition or care specifically requires it," was implemented on 3 units in 3 hospitals. All the 3 units had experienced patient concerns about lack of sleep at night. INTERVENTIONS Nurses implemented the project using a purposeful strategy of sleep masks, earplugs, noise detectors, and bundling care. RESULTS Positive experiences of those patients who participated in the sleep intervention. CONCLUSIONS There was multidisciplinary support to promote a better patient experience of nighttime sleep. The experiences across the 3 hospital units were positive for providers, patients, and patients' families.
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Affiliation(s)
- Kimberly Graham
- Emory Healthcare, Atlanta, Georgia (Drs Graham, Oster, and Gullatte); Emory University Hospital Midtown, Atlanta, Georgia (Mss Ogbuji and Williams); Emory University Hospital, Magnet Designated, Atlanta, Georgia (Mss Crain and Larbi); Emory Johns Creek Hospital, Magnet Designated, Atlanta, Georgia (Mss Rolin and Juala); UCHealth Longs Peak Hospital, Longmont, Colorado (Dr Bernard); and Emory Decatur Hospitals, Atlanta, Georgia (Ms Baird)
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Richards KC, Wang YY, Jun J, Ye L. A Systematic Review of Sleep Measurement in Critically Ill Patients. Front Neurol 2020; 11:542529. [PMID: 33240191 PMCID: PMC7677520 DOI: 10.3389/fneur.2020.542529] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 10/06/2020] [Indexed: 02/05/2023] Open
Abstract
Background: Clinical trialists and clinicians have used a number of sleep quality measures to determine the outcomes of interventions to improve sleep and ameliorate the neurobehavioral consequences of sleep deprivation in critically ill patients, but findings have not always been consistent. To elucidate the source of these consistencies, an important consideration is responsiveness of existing sleep measures. The purpose of an evaluative measure is to describe a construct of interest in a specific population, and to measure the extent of change in the construct over time. This systematic literature review identified measures of sleep quality in critically ill adults hospitalized in the Intensive Care Unit (ICU), and assessed their measurement properties, strengths and weaknesses, clinical usefulness, and responsiveness. We also recommended modifications, including new technology, that may improve clinical usefulness and responsiveness of the measures in research and practice. Methods: CINAHAL, PubMed/Medline, and Cochrane Library were searched from January 1, 2000 to February 1, 2020 to identify studies that evaluated sleep quality in critically ill patients. Results: Sixty-two studies using polysomnography (PSG) and other electroencephalogram-based methods, actigraphy, clinician observation, or patient perception using questionnaires were identified and evaluated. Key recommendations are: standard criteria are needed for scoring PSG in ICU patients who often have atypical brain waves; studies are too few, samples sizes too small, and study duration too short for recommendations on electroencephalogram-based measures and actigraphy; use the Sleep Observation Tool for clinician observation of sleep; and use the Richards Campbell Sleep Questionnaire to measure patient perception of sleep. Conclusions: Measuring the impact of interventions to prevent sleep deprivation requires reliable and valid sleep measures, and investigators have made good progress developing, testing, and applying these measures in the ICU. We recommend future large, multi-site intervention studies that measure multiple dimensions of sleep, and provide additional evidence on instrument reliability, validity, feasibility and responsiveness. We also encourage testing new technologies to augment existing measures to improve their feasibility and accuracy.
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Affiliation(s)
- Kathy C Richards
- University of Texas at Austin School of Nursing, Austin, TX, United States
| | - Yan-Yan Wang
- University of Texas at Austin School of Nursing, Austin, TX, United States.,West China Hospital, Sichuan University, Chengdu, China
| | - Jeehye Jun
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, United States
| | - Lichuan Ye
- School of Nursing, Bouve College of Health Sciences, Northeastern University, Boston, MA, United States
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Miranda-Ackerman RC, Lira-Trujillo M, Gollaz-Cervantez AC, Cortés-Flores AO, Zuloaga-Fernández Del Valle CJ, García-González LA, Morgan-Villela G, Barbosa-Camacho FJ, Pintor-Belmontes KJ, Guzmán-Ramírez BG, Bernal-Hernández A, Fuentes-Orozco C, González-Ojeda A. Associations between stressors and difficulty sleeping in critically ill patients admitted to the intensive care unit: a cohort study. BMC Health Serv Res 2020; 20:631. [PMID: 32646516 PMCID: PMC7346515 DOI: 10.1186/s12913-020-05497-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/01/2020] [Indexed: 01/14/2023] Open
Abstract
Background Patients admitted to the intensive care unit (ICU) experience sleep disruption caused by a variety of conditions, such as staff activities, alarms on monitors, and overall noise. In this study, we explored the relationship between noise and other factors associated with poor sleep quality in patients. Methods This was a prospective cohort study. We used the Richards–Campbell Sleep Questionnaire to explore sleep quality in a sample of patients admitted to the ICU of a private hospital. We measured the noise levels within each ICU three times a day. After each night during their ICU stay, patients were asked to complete a survey about sleep disturbances. These disturbances were classified as biological (such as anxiety or pain) and environmental factors (such as lighting and ICU noise). Results We interviewed 71 patients; 62% were men (mean age 54.46 years) and the mean length of stay was 8 days. Biological factors affected 36% and environmental factors affected 20% of the patients. The most common biological factor was anxiety symptoms, which affected 28% of the patients, and the most common environmental factor was noise, which affected 32.4%. The overall mean recorded noise level was 62.45 dB. Based on the patients’ responses, the environmental factors had a larger effect on patients’ sleep quality than biological factors. Patients who stayed more than 5 days reported less sleep disturbance. Patients younger than 55 years were more affected by environmental and biological factors than were those older than 55 years. Conclusions Patient quality of sleep in the ICU is associated with environmental factors such as noise and artificial lighting, as well as biological factors related to anxiety and pain. The noise level in the ICU is twice that recommended by international guides. Given the stronger influence of environmental factors, the use of earplugs or sleeping masks is recommended. The longer the hospital stay, the less these factors seem to affect patients’ sleep quality.
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Affiliation(s)
| | | | | | | | | | | | | | - Francisco José Barbosa-Camacho
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Avenida Belisario Domínguez # 1000 Col. Independencia, 44340, Guadalajara, Jalisco, Mexico
| | - Kevin Josue Pintor-Belmontes
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Avenida Belisario Domínguez # 1000 Col. Independencia, 44340, Guadalajara, Jalisco, Mexico
| | - Bertha Georgina Guzmán-Ramírez
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Avenida Belisario Domínguez # 1000 Col. Independencia, 44340, Guadalajara, Jalisco, Mexico
| | - Aldo Bernal-Hernández
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Avenida Belisario Domínguez # 1000 Col. Independencia, 44340, Guadalajara, Jalisco, Mexico
| | - Clotilde Fuentes-Orozco
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Avenida Belisario Domínguez # 1000 Col. Independencia, 44340, Guadalajara, Jalisco, Mexico
| | - Alejandro González-Ojeda
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Avenida Belisario Domínguez # 1000 Col. Independencia, 44340, Guadalajara, Jalisco, Mexico.
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12
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Beck Edvardsen J, Hetmann F. Promoting Sleep in the Intensive Care Unit. SAGE Open Nurs 2020; 6:2377960820930209. [PMID: 33415285 PMCID: PMC7774495 DOI: 10.1177/2377960820930209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 04/27/2020] [Accepted: 05/02/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction Intensive care nurses face several challenges to facilitating sleep in their
critically ill patients. With its high noise levels, hectic around-the-clock
activity and constant artificial lights, the intensive care environment does
not foster sleep. Intensive care unit patients have significant alterations
in their sleep architecture with frequent awakenings and lighter sleep; up
to 50% of this sleep also occurs during the daytime. Sleep loss increases
the risk of developing delirium (especially in elderly patients) and immune
system impairment, which prolongs healing. The aim of this article was to
develop an evidence-based bundle of nursing care activities that promote
adult intensive care patients’ sleep. Methods A broad search was conducted in PubMed, CINAHL, Cochrane Library, and
McMaster plus using search words and Medical Subject Headings terms, such as
sleep, intensive care unit, intensive care, critical care nursing, sleep
promotion, music, white noise, earplugs, pain relief, absence of pain,
nonpharmacological intervention, and mechanical ventilation. Eight
recommendations emerged from this review: reduce noise, use earplugs and eye
masks, use music, promote a natural circadian rhythm, manage pain, use quiet
time, cluster nursing care activities at night, and optimize ventilator
modes. Conclusion Promoting sleep within this patient population needs to be a higher priority
for intensive care nurses. Sleep should be a focus throughout the day and
night, in order to sustain patients’ natural circadian rhythms. Novel
research in this field could change the strength of these recommendations
and add new recommendations to the bundle.
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Affiliation(s)
- Jorunn Beck Edvardsen
- Department of Postoperative and Critical Care, Division of Emergencies and Critical Care, Oslo University Hospital
| | - Fredrik Hetmann
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University
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Abstract
BACKGROUND A quiet environment promotes rest and healing but is often challenging to provide in a busy acute care setting. Improving quiet in the hospital for designated hours improves patient satisfaction. Such efforts have typically been the primary responsibility of the nursing staff. LOCAL PROBLEM Two medical units with consistently low Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) "always quiet" scores were chosen for this study. METHODS A multidisciplinary team used Lean methods and the Model for Improvement to test interventions for quiet time (QT) and used HCAHPS "always quiet" scores as the primary outcome measure. INTERVENTIONS The team instituted nighttime and afternoon QT supported by rounding and scripting, dimming lights, lowering staff voices, offering a sleep menu at night, and replacing noisy wheels. RESULTS Quiet scores improved on both units after 11 months. CONCLUSIONS Noise in hospitals is often beyond the scope of nurse-driven improvement; however, a QT protocol led by nurses, developed by multiple stakeholders, and focused on changing expectations for quiet can lead to measurable improvements in patient perception of quiet.
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Brito RA, do Nascimento Rebouças Viana SM, Beltrão BA, de Araújo Magalhães CB, de Bruin VMS, de Bruin PFC. Pharmacological and non-pharmacological interventions to promote sleep in intensive care units: a critical review. Sleep Breath 2019; 24:25-35. [PMID: 31368029 DOI: 10.1007/s11325-019-01902-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 05/08/2019] [Accepted: 07/15/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Although it is generally recognized that poor sleep is common in the intensive care unit (ICU), it is still unclear which interventions can effectively improve sleep in this setting. In this review, we critically analyze the various pharmacological and non-pharmacological measures that have been proposed to tackle this problem. METHODS A search of MEDLINE/PubMed, SciELO, and the Brazilian Virtual Library in Health (LILACS and BNDEF) databases was performed. Results were reviewed and 41 articles on pharmacological and non-pharmacological interventions to promote sleep in ICU were analyzed. RESULTS Non-pharmacological interventions including eye mask and earplugs, bundles to reduce noise and lighting, and organization of patient care were shown to improve subjective and objective sleep quality, although the level of evidence was considered low. Assist-control ventilation was associated with a greater objective sleep quality than spontaneous modes, such as pressure support ventilation and proportional assist ventilation. Among pharmacological interventions, a moderate level of evidence was found for oral melatonin, with increases in both objective and subjective sleep quality. Continuous nocturnal infusion of dexmedetomidine was reported to increase sleep efficiency and favorably modify the sleep pattern, although evidence level was moderate to low. CONCLUSIONS Several non-pharmacological and pharmacological measures can be helpful to improve sleep in critical patients. Further high-quality studies are needed to strengthen the evidence base.
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Affiliation(s)
| | | | - Beatriz Amorim Beltrão
- Walter Cantidio University Hospital, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | | | - Pedro Felipe Carvalhedo de Bruin
- Laboratory of Sleep and Biological Rhythms, Federal University of Ceará, Fortaleza, Ceará, Brazil.
- Department of Medicine, Federal University of Ceará, Fortaleza, CE, 60430-140, Brazil.
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15
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What's all that noise-Improving the hospital soundscape. J Clin Monit Comput 2018; 33:557-562. [PMID: 30390171 DOI: 10.1007/s10877-018-0215-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 10/30/2018] [Indexed: 10/28/2022]
Abstract
Hospital noise levels regularly exceed those recommended by the World Health Organization (WHO). It is uncertain whether high noise levels have adverse effects on patient health. High levels of noise increase patient sleep loss, anxiety levels, length of hospital stay, and morbidity rates. Staff conversation and auditory medical alarms are amongst the leading noise producing stimuli, with combinations of stimuli accounting for much of the high noise levels. The Hospital Consumer Assessment of Healthcare Providers and Systems survey shows a slight improvement in overall hospital noise levels in the United States, indicating a minor reduction in noise levels. Alarm ambiguity, alarm masking and inefficient alarm design contributes to a large portion of sounds that exceed the environmental noise level in the hospital. Improving the hospital soundscape can begin by training staff in noise reduction, enforcing noise reduction programs, reworking alarm design and encouraging research to evaluate the relative effects of noise producing stimuli on the hospital soundscape.
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16
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Delaney LJ, Currie MJ, Huang HCC, Lopez V, Van Haren F. "They can rest at home": an observational study of patients' quality of sleep in an Australian hospital. BMC Health Serv Res 2018; 18:524. [PMID: 29976191 PMCID: PMC6034217 DOI: 10.1186/s12913-018-3201-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 05/10/2018] [Indexed: 02/02/2023] Open
Abstract
Background Poor sleep is known to adversely affect hospital patients’ recovery and rehabilitation. The aim of the study was to investigate the perceived duration and quality of patient sleep and identify any environmental factors associated with patient-reported poor sleep in hospital. Method A cross-sectional study was conducted involving 15 clinical units within a 672-bed tertiary-referral hospital in Australia. Semi-structured interviews to determine perceptions of sleep quantity and quality and factors that disturb nocturnal sleep were conducted with patients and nursing staff. Environmental noise, light and temperature were monitored overnight, with concurrent logging of noise sources by observers. Results Patients reported a mean reduction in hospital sleep duration, compared to home, of 1.8 h (5.3 vs. 7.1 h; p < 0.001). The proportions of patients reporting their sleep quality to be poor/very poor, fair and of good quality were 41.6, 34.2 and 24.2% respectively. Patients reported poorer sleep quality than nurses (p < 0.05). Patients, nurses and observers all reported the main factors associated with poor sleep as clinical care interventions (34.3%) and environmental noise (32.1%). Noise levels in all 15 clinical areas exceeded WHO recommended levels of < 30 dB [A] by 36.7 to 82.6%, with peak noise levels of 51.3 to 103.3 dB (A). Conclusion Hospital in-patients are exposed to factors which reduce the duration and quality of their sleep. These extrinsic factors are potentially modifiable through behaviour change and reconfiguration of the clinical environment. The findings from this study provided the foundation for a quality improvement project currently underway to improve patients’ sleep.
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Affiliation(s)
- Lori J Delaney
- Faculty of Nursing, University of Canberra, Canberra, Australia. .,College of Health and Medicine, Australian National University, Canberra, Australia. .,Faculty of Health, Discipline of Nursing and Midwifery, University of Canberra, Canberra, ACT, 2601, Australia.
| | - Marian J Currie
- Faculty of Nursing, University of Canberra, Canberra, Australia.,College of Health and Medicine, Australian National University, Canberra, Australia
| | | | - Violeta Lopez
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Frank Van Haren
- College of Health and Medicine, Australian National University, Canberra, Australia.,Intensive Care Unit, Canberra Hospital, Garran, Australia
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Schlesinger JJ, Baum Miller SH, Nash K, Bruce M, Ashmead D, Shotwell MS, Edworthy JR, Wallace MT, Weinger MB. Acoustic features of auditory medical alarms-An experimental study of alarm volume. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2018; 143:3688. [PMID: 29960450 PMCID: PMC6910025 DOI: 10.1121/1.5043396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/04/2018] [Accepted: 06/04/2018] [Indexed: 05/20/2023]
Abstract
Audible alarms are a ubiquitous feature of all high-paced, high-risk domains such as aviation and nuclear power where operators control complex systems. In such settings, a missed alarm can have disastrous consequences. It is conventional wisdom that for alarms to be heard, "louder is better," so that alarm levels in operational environments routinely exceed ambient noise levels. Through a robust experimental paradigm in an anechoic environment to study human response to audible alerting stimuli in a cognitively demanding setting, akin to high-tempo and high-risk domains, clinician participants responded to patient crises while concurrently completing an auditory speech intelligibility and visual vigilance distracting task as the level of alarms were varied as a signal-to-noise ratio above and below hospital background noise. There was little difference in performance on the primary task when the alarm sound was -11 dB below background noise as compared with +4 dB above background noise-a typical real-world situation. Concurrent presentation of the secondary auditory speech intelligibility task significantly degraded performance. Operator performance can be maintained with alarms that are softer than background noise. These findings have widespread implications for the design and implementation of alarms across all high-consequence settings.
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Affiliation(s)
- Joseph J Schlesinger
- Department of Anesthesiology, Vanderbilt University School of Medicine, 1211 21st Avenue South, Medical Arts Building, Suite 422, Nashville, Tennessee 37212, USA
| | - Sarah H Baum Miller
- Department of Psychology, University of Washington, Main Office Mailbox 357270, T-471 Health Sciences Center, Seattle, Washington 98195, USA
| | - Katherine Nash
- Department of Neuroscience, Vanderbilt University, 2201 West End Avenue, Nashville, Tennessee 37212, USA
| | - Marissa Bruce
- Department of Molecular Cell and Biology, Vanderbilt University, 2201 West End Avenue, Nashville, Tennessee 37212, USA
| | - Daniel Ashmead
- Department of Hearing and Speech Sciences, Vanderbilt University, 1211 21st Avenue South, Medical Center East, South Tower, Nashville, Tennessee 37212, USA
| | - Matthew S Shotwell
- Department of Biostatistics, Vanderbilt University, 2525 West End Avenue, Nashville, Tennessee 37212, USA
| | - Judy R Edworthy
- Department of Psychology, Plymouth University, Drake Circus, Plymouth PL4 8AA, United Kingdom
| | - Mark T Wallace
- Department of Neuroscience, Vanderbilt University, 465 21st Avenue South, Nashville, Tennessee 37232, USA
| | - Matthew B Weinger
- Department of Anesthesiology, Vanderbilt University, 1211 21st Avenue South, Medical Arts Building, Suite 706, Nashville, Tennessee 37212, USA
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Grassley JS, Tivis R, Finney J, Chapman S, Bennett S. Evaluation of a Designated Family Bonding Time to Decrease Interruptions and Increase Exclusive Breastfeeding. Nurs Womens Health 2018; 22:219-227. [PMID: 29885710 DOI: 10.1016/j.nwh.2018.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The purpose of this quality improvement project was to plan and implement a daily family bonding time on our mother/baby care unit and evaluate its effect on interruptions, mothers' perceptions of interruptions, and exclusive breastfeeding rates. DESIGN A separate sample pre-/postintervention design conducted in three phases. SETTING/LOCAL PROBLEM Healthy breastfeeding newborns had double the odds of receiving supplementation before discharge if they stayed more than 1 night or were born at night. Night nurses suggested implementing a daily quiet time as a strategy for limiting interruptions. PARTICIPANTS A convenience sample of 60 postpartum women. INTERVENTION/MEASURES During Phases 1 and 3, data were collected on interruptions (number, duration, and by whom), women's perceptions of interruptions, and exclusive breastfeeding rates. Family bonding time was launched in Phase 2 during the hours of 2 p.m. to 4 p.m. Women were encouraged to rest with their newborns in their rooms; interruptions were limited to those that were urgent, medically necessary, or requested by the women. RESULTS Outcome data were analyzed using descriptive statistics, a repeated-measures analysis of variance, t test, and chi-square test. Analysis of interruptions by the unit nursing staff indicated a decrease in interruptions between 2 p.m. and 4 p.m. that could be attributed to family bonding time (F(1, 58) = 7.50, p = .008). Analysis of interruptions by other hospital staff and visitors indicated a significant interaction of time with interruptions; interruptions decreased in both phases between 2 p.m. and 4 p.m. (F(3, 174) = 4.83, p = .0029; F(3, 174) = 2.95, p = .034). Exclusive breastfeeding rates increased significantly (χ2(4) = 21.27, p = .0003); there were no significant differences in women's perceptions of interruptions. CONCLUSION New mothers experience many interruptions during their hospital stays, particularly when visitors arrive in large groups and stay more than 60 minutes. Documenting sources of interruptions before launching family bonding time helps identify hospital staff who need to be informed. Addressing their concerns before implementation can facilitate project sustainability.
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Abstract
Uncontrolled noise in the hospital setting can have a negative physiological and psychological impact on patients and nurses. To reduce unit noise levels and create a quiet patient and nurse experience, an evidence-based practice project was conducted in 4 progressive care units in a community hospital. The Quiet Time Bundle implementation improved patient satisfaction and patient and nurse perceptions of noise even though the decrease in noise levels may not be discernible.
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20
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Lim R. Benefits of quiet time interventions in the intensive care unit: a literature review. Nurs Stand 2018; 32:41-48. [PMID: 29561076 DOI: 10.7748/ns.2018.e10873] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2017] [Indexed: 12/18/2022]
Abstract
Sleep disturbance is a significant issue for patients in intensive care units (ICUs), which can affect their health and recovery from illness. Therefore, it is important to consider ways to address sleep disturbance in these settings. One strategy that has been suggested is the use of 'quiet time' interventions, which involve a defined period where there is a reduction in controllable light and sound, and where interruptions at the patient's bedside are minimised. AIM To determine the effectiveness of quiet time interventions in improving patients' sleep quality in ICUs; to investigate other potential clinical benefits of quiet time interventions; and to consider the effect of incorporating open visitation when implementing quiet time interventions. METHOD The author conducted a literature review of qualitative and quantitative studies that investigated the effects of quiet time interventions as a primary intervention in adult ICUs, with sleep quality as the outcome. Three databases were searched electronically for articles that met the inclusion criteria, and narrative synthesis was used to identify themes from these articles. FINDINGS A total of seven articles were included in this literature review. Overall, the evidence indicated that quiet time interventions can be effective in improving patients' sleep quality; however, the study findings were variable and inconsistent. Quiet time interventions also appeared to provide some physiological benefits for patients, as demonstrated by reductions in respiratory rates, the administration of sedatives and the incidence of delirium, suggesting that patients are experiencing restfulness. Additionally, nurses reported an increasingly satisfying workplace environment following quiet time interventions. CONCLUSION Quiet time interventions can improve patients' sleep quality and have positive physiological effects for patients, such as improved restfulness. Quiet time interventions may also promote a healthier workplace environment and increase patient and family satisfaction. Considering the potential benefits and lack of evidence of harm, the author recommends that quiet time interventions are implemented in ICUs as part of routine practice.
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Affiliation(s)
- Rimen Lim
- Adult Intensive Care Unit, Prince of Wales Hospital, Randwick, Sydney, Australia
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Perceptions and Practices Regarding Sleep in the Intensive Care Unit. A Survey of 1,223 Critical Care Providers. Ann Am Thorac Soc 2018; 13:1370-7. [PMID: 27104770 DOI: 10.1513/annalsats.201601-087oc] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
RATIONALE Poor sleep affects a majority of critically ill patients and is believed to be associated with adverse intensive care unit (ICU) outcomes such as delirium. While recent guidelines recommend sleep promotion efforts to improve delirium and other ICU outcomes, little is known about critical care providers' beliefs regarding sleep in the ICU. OBJECTIVES To evaluate providers' perceptions and practices regarding sleep in the ICU. METHODS From April to July 2014, the Sleep in the ICU Survey was disseminated to ICU providers via institutional e-mail lists and four international critical care society distribution lists. MEASUREMENTS AND MAIN RESULTS A total of 1,223 surveys were completed by providers from 24 countries. Respondents were primarily nurses (59%) or physicians (39%). Most respondents indicated that ICU patients experienced "poor" or "very poor" sleep (75%) and that poor sleep could affect the ICU recovery process (88%). Respondents also felt that poor sleep was associated with negative ICU outcomes such as the development of delirium (97%), longer length of stay (88%), poor participation in physical therapy (87%), and delayed liberation from mechanical ventilation (83%). The minority (32%) of providers had sleep-promoting protocols; these providers tended to believe their patients slept longer and experienced better sleep quality. CONCLUSIONS Though most clinicians believe that sleep in the ICU is poor and adversely affects patient outcomes, a minority of the ICUs represented by our respondents have sleep promotion protocols. These findings highlight discordant provider perceptions and practices surrounding sleep in the ICU, as well as a possible lack of available evidence-based guidelines for promoting sleep in the ICU.
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Iyendo TO. Sound as a supportive design intervention for improving health care experience in the clinical ecosystem: A qualitative study. Complement Ther Clin Pract 2017; 29:58-96. [PMID: 29122270 DOI: 10.1016/j.ctcp.2017.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/17/2017] [Accepted: 08/22/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Most prior hospital noise research usually deals with sound in its noise facet and is based merely on sound level abatement, rather than as an informative or orientational element. This paper stimulates scientific research into the effect of sound interventions on physical and mental health care in the clinical environment. METHODS Data sources comprised relevant World Health Organization guidelines and the results of a literature search of ISI Web of Science, ProQuest Central, MEDLINE, PubMed, Scopus, JSTOR and Google Scholar. RESULTS Noise induces stress and impedes the recovery process. Pleasant natural sound intervention which includes singing birds, gentle wind and ocean waves, revealed benefits that contribute to perceived restoration of attention and stress recovery in patients and staff. CONCLUSIONS Clinicians should consider pleasant natural sounds perception as a low-risk non-pharmacological and unobtrusive intervention that should be implemented in their routine care for speedier recovery of patients undergoing medical procedures.
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Jeffs EL, Darbyshire JL. Measuring Sleep in the Intensive Care Unit: A Critical Appraisal of the Use of Subjective Methods. J Intensive Care Med 2017. [PMID: 28631532 DOI: 10.1177/0885066617712197] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To collate and appraise the use of subjective measures to assess sleep in the intensive care unit (ICU). DESIGN A systematic search and critical review of the published literature. DATA SOURCES Medline, Scopus, and Cumulative Index to Nursing and Allied Health Literature were searched using combinations of the key words "Sleep," "Critical Care," "Intensive Care," and "Sleep Disorders," and this was complemented by hand searching the most recent systematic reviews on related topics. STUDY ELIGIBILITY CRITERIA Papers were limited to non-gray English-language studies of the adult population, published in the last 10 years. OUTCOME MEASURES Primary outcomes were the number and categorization of quantitative studies reporting measures of sleep, the number of participants for each data collection method, and a synthesis of related material to appraise the use of survey tools commonly used for sleep measurement in the ICU. RESULTS Thirty-eight papers reported quantitative empirical data collection on sleep, 17 of which used a primary method of subjective assessment of sleep by the patient or nurse. Thirteen methods of subjective sleep assessment were identified. Many of these tools lacked validity and reliability testing. CONCLUSIONS Research using questionnaires to assess sleep is commonplace in light of practical barriers to polysomnography or other measures of sleep. A methodologically sound approach to tool development and testing is crucial to gather meaningful data, and this robust approach was lacking in many cases. Further research measuring sleep subjectively in ICU should use the Richards Campbell Sleep Questionnaire, and researchers should maintain a commitment to transparency in describing methods.
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Affiliation(s)
- Emma L Jeffs
- 1 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Julie L Darbyshire
- 1 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Nursing Interactions With Intensive Care Unit Patients Affected by Sleep Deprivation: An Observational Study. Dimens Crit Care Nurs 2017; 35:154-9. [PMID: 27043401 DOI: 10.1097/dcc.0000000000000177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Patients in intensive care units (ICUs) often experience sleep deprivation due to different factors. Its consequences are damaging both physiologically and psychologically. This study focuses particularly on nursing interactions as the main factor involved in sleep deprivation issues. OBJECTIVES The aims of this study were to examine the frequency, pattern, and types of nocturnal care interactions with patients in the respiratory and cardiology ICUs; analyze the relationship between these interactions and patients' variables (age, sex, recovery diagnosis, and acuity of care); and analyze the differences in patterns of nocturnal care interactions among the units. METHODS This is an observational retrospective study that analyzes the frequency, pattern, and types of nocturnal care interactions with patients between 7 PM and 6 AM recording data in the activity data sheets. RESULTS Data consisted of 93 data assessment sheets. The mean number of care interactions per night was 18.65 (SD, 3.71). In both ICUs, interactions were most frequent at 7 PM, 10 PM, and 6 AM. Only 8 uninterrupted sleep periods occurred. Frequency of interactions correlated significantly with patients' acuity scores and the number of nurse interventions in both ICUs. CONCLUSIONS Patients in ICUs have fragmented sleep patterns. This study underlines the need to develop new management approaches to promote and maintain sleep.
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25
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DuBose JR, Hadi K. Improving inpatient environments to support patient sleep. Int J Qual Health Care 2016; 28:540-553. [DOI: 10.1093/intqhc/mzw079] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 06/17/2016] [Accepted: 06/21/2016] [Indexed: 02/04/2023] Open
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27
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Kamdar BB, Kamdar BB, Needham DM. Bundling sleep promotion with delirium prevention: ready for prime time? Anaesthesia 2014; 69:527-31. [PMID: 24813131 DOI: 10.1111/anae.12686] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- B B Kamdar
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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