Impact of a Nursing-Driven Sleep Hygiene Protocol on Sleep Quality

Abstract

The purpose of this study was to evaluate the impact on sleep quality of a nursing-driven sleep hygiene protocol (SHP) instituted in a single burn-trauma intensive care unit. Criteria for eligibility were adult patients admitted to the Burn Service who were not delirious, able to respond verbally, and had not received general anesthesia in the prior 24 hours. Patients were surveyed using the validated Richards-Campbell Sleep Questionnaire prior to implementation ("PRE"; May to December 2010) and following implementation ("POST"; January to August 2011) of a SHP that sought to minimize environmental stimuli and limit disruptions during the night. This analysis includes only initial survey responses from each patient. A total of 130 patients were surveyed, 81 PRE and 49 POST; 60% were burn admissions. There was no significant difference in responses to the questionnaire between burn and nonburn patients. All patients in the POST group were significantly older and more frequently endorsed taking sleep medication at home. Although not significant, POST patients reported falling asleep somewhat more quickly, but no other differences were identified between the two groups. Among patients who reported having sleep difficulties prior to admission, POST patients not only reported a significantly higher pain score than PRE patients, but also reported significant improvement in falling asleep and being able to go back to sleep. Frequency of complaints of sleep disruption was unchanged between PRE and POST patients. POST patients did complain significantly less than PRE patients about sleep disruptions by clinicians. Implementation of the SHP permitted acutely injured or ill patients in our intensive care unit to fall asleep more quickly and to experience fewer sleep disruptions. A sleep protocol may be helpful in improving sleep and overall well-being of burn center patients.

Pain Level in Critical Patients With Sleep Hygiene Care In Intensive Care Unit

“…Sleep hygiene is a modification of the environment when the patient sleeps at night. Environmental modification in the form of temperature, noise and lighting settings (Dakin & Margarson, 2010;Faraklas, 2013). Based on the results of the study obtained secondary data that the mean variable with an abnormal value is temperature (38.9 o C), blood pressure (119.64 / 74.56 mmHg), pulse frequency (107.58 times/minute), and breathing frequency (26.34 times/minute).…”

Intervention for Patients Intubated and Conscious to decrease Peritraumatic Distress (IPIC-PTD) – Acceptability and feasibility

“…Since its benefits are not directly observable by interventionists or patients during mechanical ventilation, the logical link with the objective of the IPIC-PTD is unclear for this specific component, and this might decrease their engagement (Sidani & Braden, 2011). This barrier to implementation was underlined in other implementation studies conducted in ICU (Cho et al, 2015;Egerod et al, 2007;Faraklas et al, 2013). Moreover, patients completed the acceptability questionnaire only 24 hours after being extubated, which means they might not have had used the diary yet.…”

Sleep and Sleep Disordered Breathing in Hospitalized Patients

“…Current guidelines emphasize the use of a multifaceted, bundled approach aimed at addressing modifiable disruptors of nighttime sleep in the inpatient setting. These interventions include environmental noise and light reduction via "quiet time" protocols 87,88,[167][168][169][170][171] and clustering of patient care activities. 123 Earplugs and/or eye masks should also be considered, and have been demonstrated to improve subjective sleep in ICU settings, [172][173][174][175] and sleep recorded via PSG in simulated ICU settings.…”

“…Several barriers must be considered for any hospital-based sleep promoting intervention, including challenges in measuring sleep, 3,88,[168][169][170][171]182,183 mixed buy-in from staff, 87,169,171,182,184 patient acceptance of interventions (i.e., earplugs and eye masks), 3 and lack of proven strategies for intervention sustainability. Nevertheless, given recent investigations demonstrating decreased rates of delirium following interventions to improve sleep in both ICU 3,185 and general medical settings, 186 sleep promotion continues to gain attention as part of efforts to understand and improve patients' recovery from illness and posthospital outcomes.…”