Use of sleep care guidelines in a surgical intensive care unit reduces noise levels and improves patient-reported sleep quality
- 1Royal District Nursing Service, St Kilda, Victoria, Australia
- 2Queens University Belfast, Belfast, Northern Ireland
- Correspondence to: Susan Koch
Royal District Nursing Service, 31 Alma Road, St Kilda, VIC 3182, Australia;
Implications for practice and research
▪ Nurses need to be aware of the impact that care delivery has on sleep quality and the importance of sleep for recuperation.
▪ Changes to routine care may have a positive impact on sleep quality from the perception of the patient.
▪ Further studies to examine patients' perception of sleep quality throughout a hospital stay are required.
▪ Observational studies are needed to observe how staffs apply guidelines in practice to reduce noise and light to promote patients' sleep during a hospital stay.
Critical care nurses have traditionally adopted a biomedical and technological approach to caring for their patients. As a result, the physical and technical aspects of patient care are prioritised, and the sleep experience of the patient may not be considered. Poor sleep quality places critically ill patients at greater risk for infections, complications and mortality.1 Sleep disturbances effect cognition and emotions along with cardiac, respiratory and immune function.2 The main reason for sleep interruption is noise with major sources from monitors at the bedside, alarms, conversations, moving equipment. Frequent care activities such as position changes, feeding and suction also disrupt sleep along with light exposure, which can cause deviations in a patients' circadian clock.3 The study aimed to test the efficacy of sleep care guidelines for minimising night-time noise and improving the quality of sleep of patients in an intensive care unit (ICU) in Taiwan.
The study was a quasi-experimental design, with two phases of 3 months each. In the first phase, the control group (n=27) received usual care. In phase II, the guidelines for modifying nurses' behaviour related to lighting and noise reduction were implemented with the experimental group (n=28). A decibel metre was used to monitor noise levels. After both phases, data on quality of sleep and noise levels were collected using the Sleep in the Intensive Care Unit (SICUQ) and the Richards Campbell Sleep Questionnaire. Sixty patients were recruited and 55 completed the study. Exclusion criteria included those with a head injury, convulsions, mental health problems or hearing loss. Alcoholics were excluded along with those receiving sedatives, opioids or sleeping pills.
All staffs were trained to follow the guidance with the focus of training being to introduce the importance of sleep for patients in the ICU. Data were analysed using SPSS, version 15.0. Percentages, means and SD were used to describe the demographics and characteristics of patients. To compare changes between the two groups, a generalised estimation equation was used. Tests for statistical significance between the two groups took place to assess intervention effects.
The results indicate that there was less noise for the experimental group than in the control group at the bedside and the nurses' station. The patients perceived the noise was significantly lower in the experimental group than in the control group, and, more interestingly, the nurses rated the environmental noise as higher for the experimental than for the control. In both groups, interruptions from nursing care activities and diagnostic testing were perceived to be as disturbing to sleep, as were environmental noises.
There are some limitations to this study. For noise pollution, a decibel metre was used, but it is unclear if any measurement apart from patients' perception was used to monitor light pollution. Considering the guidelines being used with the experimental group were for noise and light reduction, it would seem that data should have been collected in phase I regarding light pollution levels. Although the authors record that education and training for consistency of data collection was provided, it is unclear what education was provided regarding the effect of noise pollution on patients in an ICU. It would have been interesting to explore staff's reaction to the guidelines and their usefulness. Although the selected tools for the study are well recognised and have been tested for reliability and validity, the SICUQ Instrument (perceived level of sleep interruptions) was changed with some items deleted, and it is unclear why this occurred.
It is not surprising that the study findings confirm previous research results that ICU patients perceived sleep quality was significantly poorer than baseline sleep at home. Perhaps, the authors could have been bolder and attempted a person-centred approach to improving sleep quality rather than implementing guidelines. Talerico and colleagues4 defined person-centred care as “an evidence-based approach to care giving that uses care giving recipients unique personal preferences and needs to guide providers as they customize health care.” Patient care decisions are made in collaboration with the patient, prioritising their needs above the needs of the hospital, department or staff. Key features of the model include recognising the person as an individual; responding to the unique individual; providing meaningful care which respects the person's values, preferences and needs; and identifying care recipients as biopsychosocial beings.4
It would be useful to consider following patients through their hospital experience and receiving their perceptions at the various transitional points of care. Perhaps, the more the nurses understand the individual's perception of sleep quality and his or her experiences during a hospital stay, the better they will be equipped to assist them in recovery.