Against the stream: intermittent nurse observations of in-patients at night serve no purpose and cause sleep deprivation

Veale, David

doi:10.1192/bjb.2018.116

Cited by 16 publications

(16 citation statements)

References 16 publications

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“…In fact, some have even suggested that, given their negative impact on patient care, intermittent nursing observations, in their current form, should be abandoned. 19 Artificial intelligence (AI) could provide a solution to these issues, 20 but its introduction in mental healthcare requires careful evaluation and implementation. 21…”

Section: Introductionmentioning

confidence: 99%

Introducing artificial intelligence in acute psychiatric inpatient care: qualitative study of its use to conduct nursing observations

Barrera

Gee

Wood

et al. 2020

Evid Based Mental Health

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BackgroundAll patients admitted to an acute inpatient mental health unit must have nursing observations carried out at night either hourly or every 15 minutes, to ascertain that they are safe and breathing. However, while this practice ensures patient safety, it can also disturb patients’ sleep, which in turn can impact negatively on their recovery.ObjectiveThis article describes the process of introducing artificial intelligence (‘digitally assisted nursing observations’) in an acute mental health inpatient ward, to enable staff to carry out the hourly and the 15 minutes observations, minimising disruption of patients’ sleep while maintaining their safety.FindingsThe preliminary data obtained indicate that the digitally assisted nursing observations agreed with the observations without sensors when both were carried out in parallel and that over an estimated 755 patient nights, the new system has not been associated with any untoward incidents. Preliminary qualitative data suggest that the new technology improves patients’ and staff’s experience at night.DiscussionThis project suggests that the digitally assisted nursing observations could maintain patients’ safety while potentially improving patients’ and staff’s experience in an acute psychiatric ward. The limitations of this study, namely, its narrative character and the fact that patients were not randomised to the new technology, suggest taking the reported findings as qualitative and preliminary.Clinical implicationsThese results suggest that the care provided at night in acute inpatient psychiatric units could be substantially improved with this technology. This warrants a more thorough and stringent evaluation.

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Section: Introductionmentioning

confidence: 99%

Introducing artificial intelligence in acute psychiatric inpatient care: qualitative study of its use to conduct nursing observations

Barrera

Gee

Wood

et al. 2020

Evid Based Mental Health

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“…These night-time intrusions have been shown to further worsen sleep and potentially increase the patient's sensitivity to light, noise or other disturbances (Park 2018). Moreover, these in-patients are likely to be exposed to increased lux at night-time (because lights are repeatedly switched on to enable observation), which is potentially countertherapeutic (Veale 2019). However, a system that requires no direct patient contact but allows staff to closely and continuously monitor individual patients uses ultra-wideband radar technology that is built into the ceiling of patients' rooms.…”

Section: Major Innovationmentioning

confidence: 99%

Let there be blue-depleted light: in-patient dark therapy, circadian rhythms and length of stay

Scott¹,

Langsrud²,

Goulding³

et al. 2020

BJPsych advances

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SUMMARY Light is the most important environmental influence (zeitgeber) on the synchronization of the circadian system in humans. Excess light exposure during the evening and night-time affects secretion of the hormone melatonin, which in turn modifies the temporal organization of circadian rhythms, including the sleep–wake cycle. As sleep disturbances are prominent in critically ill medical and psychiatric patients, researchers began to examine the impact of light exposure on clinical outcomes and length of hospitalization. In psychiatric inpatients, exposure to bright morning light or use of blue blocking glasses have proved useful interventions for mood disorders. Recently, knowledge about light and the circadian system has been applied to the design of inpatient facilities with dynamic lighting systems that change according to time of day. The installation of ‘circadian lighting’ alongside technologies for monitoring sleep–wake patterns could prove to be one of the most practical and beneficial innovations in inpatient psychiatric care for more than half a century.

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“…All treated had either paranoid schizophrenia, psychosis or depressive disorder, reflecting the typical case mix of the two wards. Mean insomnia severity index before treatment was 18 (range 6-28), and completion insomnia severity index was 14 (range [6][7][8][9][10][11][12][13][14][15][16].…”

Section: Cbtimentioning

confidence: 99%

“…Understandable concern about patient safety is one reason for frequent physical checks, despite no direct evidence that fixed timing checks reduces risk. 7,8 After review of current observation policy across a large mental health trust, a pilot scheme to enhance sleep was introduced (the SleepWell programme). This was a package including reduction of overnight noise and light, formal staff education about sleep and sleep disorders, a protected sleep period for those deemed safe and screening for sleep apnoea and restless legs syndrome for all in-patients.…”

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confidence: 99%

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Feasibility and utility of enhanced sleep management on in-patient psychiatry wards

et al. 2020

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Aims and method Sleep disturbance is common in psychiatry wards despite poor sleep worsening mental health. Contributory factors include the ward environment, frequent nightly checks on patients and sleep disorders including sleep apnoea. We evaluated the safety and feasibility of a package of measures to improve sleep across a mental health trust, including removing hourly checks when safe, sleep disorder screening and improving the ward environment. Results During the pilot there were no serious adverse events; 50% of in-patients were able to have protected overnight sleep. Hypnotic issuing decreased, and feedback from patients and staff was positive. It was possible to offer cognitive–behavioural therapy for insomnia to selected patients. Clinical implications Many psychiatry wards perform standardised, overnight checks, which are one cause of sleep disruption. A protected sleep period was safe and well-tolerated alongside education about sleep disturbance and mental health. Future research should evaluate personalised care rather than blanket observation policies.

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Against the stream: intermittent nurse observations of in-patients at night serve no purpose and cause sleep deprivation

Cited by 16 publications

References 16 publications

Introducing artificial intelligence in acute psychiatric inpatient care: qualitative study of its use to conduct nursing observations

Introducing artificial intelligence in acute psychiatric inpatient care: qualitative study of its use to conduct nursing observations

Let there be blue-depleted light: in-patient dark therapy, circadian rhythms and length of stay

Feasibility and utility of enhanced sleep management on in-patient psychiatry wards

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