Hospital staff and patients agreed that pain, vital signs and tests were top sleep disrupters. However, pain was associated with the greatest objective sleep loss, highlighting the need for proactive screening and management of patient pain to improve sleep in hospitals.

A lthough sleep is critical to patient recovery in the hospital, hospitalization is not restful, 1,2 and inpatient sleep deprivation has been linked to poor health outcomes. 1-4 The American Academy of Nursing's Choosing Wisely ® campaign recommends nurses reduce unnecessary nocturnal care. 5 However, interventions to improve inpatient sleep are not widely implemented. 6 Targeting routine disruptions, such as overnight vital signs, by changing default settings in the electronic health record (EHR) with "nudges" could be a cost-effective strategy to improve inpatient sleep. 4,7 We created Sleep for Inpatients: Empowering Staff to Act (SI-ESTA), which pairs nudges in the EHR with interprofessional education and empowerment, 8 and tested its effectiveness on objectively and subjectively measured nocturnal sleep disruptors. METHODS Study Design Two 18-room University of Chicago Medicine general-medicine units were used in this prospective study. The SIESTA-enhanced unit underwent the full sleep intervention: nursing education and empowerment, physician education, and EHR changes. The standard unit did not receive nursing interventions but received all other forms of intervention. Because physicians simultaneously cared for patients on both units, all internal medicine residents and hospitalists received the same education. The study population included physicians, nurses, and awake English-speaking patients who were cognitively intact and admitted to these two units. The University of Chicago Institutional Review Board approved this study (12-1766; 16685B).

Background: Proning intubated intensive care unit patients for the management of acute respiratory distress syndrome is an accepted standard of practice. We examined the nursing climate in 4 units and its impact on implementing a novel self-proning protocol to treat COVID-19 patients outside the intensive care unit. Local Problem: Nursing units previously designated for medical/surgical populations had to adjust quickly to provide evidence-based care for COVID-19 patients attempting self-proning. Methods: Nurses from 4 nursing units were surveyed about the implementation process on the self-proning protocol. Their perception of unit implementation was assessed via the Implementation Climate Scale. Interventions: A new self-proning nursing protocol was implemented outside the intensive care unit. Results: Consistent education on the protocol, belief in the effectiveness of the intervention, and a strong unit-based climate of evidence-based practice contributed to greater implementation of the protocol. Conclusions: Implementation of a new nursing protocol is possible with strong unit-based support, even during a pandemic.