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

The effect of increasing duration of family members' presence on sleep status in patients with acute coronary syndrome in cardiac care unit: A randomized controlled trial

AIM

To investigate the effect of increasing duration of family members' presence on sleep status in patients with acute coronary syndrome (ACS) admitted to the cardiac care unit.

DESIGN

Randomized controlled trial.

METHODS

Ninety patients with ACS randomly assigned into two groups. No intervention was performed in control group. In the intervention group, the time of family members presence was changed from 1 h per day to 2 h per day from the second to the fourth day. Then, ST Mary's Hospital Sleep Questionnaire was completed by the patients every day during the study.

RESULTS

The patients in the intervention group had statistically significantly better sleep status during the course of intervention compared to the control group.

PATIENT OR PUBLIC CONTRIBUTION

The increasing duration of family members' presence can improve the sleep quality and quantity of ACS patients.

Family Presence and Sleep in the Intensive Care Unit

Sleep is a vital component of health and healing. Hospitalized patients need sleep in order to overcome their illness, and family members of those patients also need restorative sleep. Nurses can assist with both patient's and family member's abilities to obtain nonfragmented sleep. Education is important for families to understand the importance of sleep, and nurses can also supply families with simple comfort measures such as ear plugs, eye masks, and a comfortable sleep location.

Enhancing Family-Centered Care in Cardiothoracic Surgery

The psychological impact of critical illness is far reaching, affecting patients and their loved ones. Family members face a multitude of stressors, ranging from concerns about death or permanent disability to stress over health care costs and lost wages. Patients are at risk for developing post-intensive care syndrome. Professional groups and patient safety organizations have crafted family-centered care (FCC) models that support hospitalized patients and their families. There is a paucity of data on use of FCC in cardiothoracic intensive care units. This article discusses FCC models and why they are beneficial to the needs of families of postoperative cardiothoracic surgery patients.

Patient and Family Engagement in Care in the Cardiac Intensive Care Unit

Hospitalization in the cardiac intensive care unit can be a stressful experience for patients and families. Family members often feel overwhelmed by the severity of their loved one's illness, powerless to affect their care, and struggle to comprehend information regarding their loved one's current health status and treatment plan. Consequently, up to half of family members might develop psychological symptoms (depression, generalized anxiety, and post-traumatic stress disorder) and a syndrome of enduring psychological, cognitive, or emotional disturbances. Patient and family engagement (PFE) is an emerging approach that empowers family members to become essential and active partners in care delivery and research. In the patient care context, the goal of PFE is to improve the care experience and achieve better outcomes for patients and family members. As a result of societal trends, family members increasingly wish to directly participate in their relative's care and be informed and involved in decision-making. There is growing evidence that engaging family members in care improves patient- and family-important outcomes after acute and critical illness. Although the role for PFE in care and research has been explored in the general critical care context, efforts to inform clinicians who manage patients with acute cardiovascular disease about the relevance of PFE are limited. In this review, we describe opportunities for PFE in the cardiac intensive care unit, outline the current evidence base for PFE in patient care, identify barriers to PFE and how to overcome them, and highlight knowledge gaps and areas for future investigations.

Impact of Built Design on Nighttime Family Presence in the Intensive Care Unit

Objective:

Determine whether dedicated family space changes family presence at night in the intensive care unit (ICU).

Purpose:

To measure family presence at night before and after moving to an ICU with in-room family space.

Background:

The safeguarding phenomenon families experience may lead to the desire to sit vigil at the bedside. Lack of dedicated family sleep space may exacerbate sleep deprivation for those who wish to be present at night. Sleep deprivation decreases cognition and capacity for decision-making. Traditionally, ICU rooms have not included dedicated family areas or sleep surfaces. National recommendations include designing new hospital ICU rooms with dedicated family space. It is not known if the built design changes family presence at night.

Method:

Family presence was measured for 30 nights pre- and postmove to a newly built ICU with dedicated family space. The policy for open flexible family presence remained the same before and after the move.

Results:

There was a statistically significant increase in proportion of occupied patient rooms with visitors following the move to the new ICU designed with family space (31% difference, x2= 5.675, 95% CI [5.74, 51.29], p = .0172).

Conclusions:

Families utilize the space when available. Further research is needed to quantify quality and quantity of family sleep and impact on decision-making and interactions with the care team. Sleep deprivation may decrease for families who would have remained in the unit without available family space and sleep surface.

Fair Is Fair: Just Visiting Hours and Reducing Inequities

Although family is an essential unit of every society, many intensive care units continue to impose limitations on families' access to their loved ones. Unlimited family presence is backed both by data and the guidelines of multiple professional societies. We propose that the obligation to protect the integrity and needs of our patients and families extends past our immediate relationship to them at the bedside, and is also a societal imperative. In a society rife with implicit bias, restrictions on family visitation risk selective enforcement of these rules, and further propagate social injustice. Restrictions on family presence, including rigid hours, reflect an arbitrary vision based on increasingly obsolete socioeconomic realities. The time is now to open our intensive care units both on behalf of our patients and families, and for the betterment of our society as a whole.