Sleep Deprivation in the Intensive Care Patient.

TOPIC: Sleep deprivation in the intensive care unit setting. CLINICAL RELEVANCE: The Society of Critical Care Medicine has identified sleep deprivation as a significant contributor to the development of delirium in adult patients in the intensive care unit. Thus, preventing and managing sleep deprivation is important in reducing the incidence of delirium in this patient population. A multifaceted and multidisciplinary approach to promoting sleep in the intensive care unit setting that includes sleep hygiene routines, nursing care plans, and appropriate medication regimens may improve patient outcomes, including reducing delirium. PURPOSE OF ARTICLE: To review the current literature on sleep deprivation in the intensive care unit setting and present care guidelines in a concise format. This information may be helpful in the development of clinical tools and may guide future quality improvement projects aimed at reducing delirium through sleep promotion in critical care patients. CONTENT COVERED: A review of current literature and national organization recommendations revealed consistent themes in addressing the problem of sleep deprivation in the intensive care unit. Modifiable and nonmodifiable risk factors included frequent care interactions, light, noise, medication effects, and preexisting sleep problems.

Addressing the Social Determinants of Health: A Call to Action for School Nurses.

Social determinants of health (SDOH), the conditions in which children are born, grow, live, work or attend school, and age, impact child health and contribute to health disparities. School nurses must consider these factors as part of their clinical practice because they significantly and directly influence child well-being. We provide clinical guidance for addressing the SDOH when caring for children with three common health problems (obesity, insufficient sleep, and asthma). Given their unique role as school-based clinical experts, care coordinators, and student advocates, school nurses are well suited to serve as leaders in addressing SDOH.

Nurses Perceptions of a Novel Protocol Addressing Uniform Periods of Minimum Assessment Times.

AIMS AND OBJECTIVES: This quality improvement project aimed to understand the impact of a quiet time protocol on nurses and patients in the neurocritical care unit (NCCU) by comparing pretest and posttest outcomes, taking decibel readings, and abstracting chart information. BACKGROUND: Sleep is essential for maintaining a healthy life. Patients in the NCCU often do not get adequate amounts of sleep. Quiet time studies have focused on implementing periods of reduced noise levels to improve patient sleep. However, the perceptions of the caregivers about the protocols have not been taken into consideration, leading to difficulty in implementing these protocols if it impedes with the routine work of the caregivers. METHODS: This was a prospective quality improvement project, with a quiet time protocol in the novel setting of the NCCU with caregiver feedback on the protocol. The quiet protocol involved decreasing light, noise, and patient interactions between 11:30 PM and 2:30 AM. There were 16 nurses who consented to the study and provided feedback via self-report questionnaires. RESULTS: Implementation of this protocol did not suggest a decrease in nurse enjoyment with their job (P = .51). There were significant improvements in patient sleep quality and quantity (P < .0001). In addition, there was some evidence of decrease in the noise level and number of patient disruptions. CONCLUSIONS: The results of this single-site project suggest that, by implementing a quiet time protocol in the NCCU, patients obtained higher levels of sleep quality and quantity. The implementation of this protocol did not impact nurses' job satisfaction, suggesting that the quiet time protocol is possible, improves patients care, and does not hinder nurses' job satisfaction.

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

The desire for families to be physically present to support their loved ones in the intensive care unit, and guidelines in favor of this open visitation approach, require that clinicians consider both patient and family sleep. This article reviews the causes of poor sleep for patients and their family members in the intensive care unit as well as the expected changes in cognition and emotion that can result from sleep deprivation. Measures are proposed to improve the intensive care unit environment to promote family sleep. A framework to educate family members and engage them in preservation of their and their loved one's circadian rhythm is also presented. Although further research is needed, the proposed framework has the potential to improve outcomes for patients and their families in the intensive care unit.

'Sorry, were you sleeping? Nurses' role in the promotion of sleep for critically ill patients.

BACKGROUND: During critical illness sleep is important for immune function and restorative processes. Despite theoretical evidence and scientific understanding of the effects of sleep deprivation in the critically ill, research is yet to be entirely translated into institutional practices and department cultural norms. OBJECTIVES: This article was adapted from an undergraduate essay that considered the nurse's role in addressing fragmented sleep in critical care patients'. METHOD: The databases, PubMed, CINAHL and Science Direct were searched using the keywords sleep, critical care and nurs* resulting in the inclusion of 15 journal articles. Also utilised were nursing prescribed texts and professional websites. RESULTS: Sleep deprivation has a multitude of intrinsic and extrinsic factors, however the healthcare environment has been established as the most common cause of sleep fragmentation. CONCLUSIONS: A paradigm shift in nursing and institutional culture is required to implement sleep promotion research and strategies to minimise adverse outcomes for patients.

Sleep, Depression, and Fatigue in Late Postpartum.

PURPOSE: To study the relation of infant characteristics and home environment on maternal sleep, depression, and fatigue in late postpartum. STUDY DESIGN AND METHODS: Forty-two healthy mother-infant dyads completed a home-based study at infant age 32 weeks. Maternal measures included Patient Reported Outcomes Measurement Information System (PROMIS) sleep and wake disturbance, depression, and fatigue scales. Home regularity was assessed using the Confusion, Hubbub, and Order Scale (CHAOS). Infant sleep and regulation were measured respectively by the Brief Infant Sleep Questionnaire (BISQ) and Infant-Toddler Symptom Checklist (ITSC). RESULTS: Significant correlations among maternal sleep and wake disturbance, fatigue, and depression were detected (r = .519 to .746, p < .01), but not with infant variables. Home regularity was significantly related with maternal variables (r = .597 to .653, p < .01). CLINICAL IMPLICATIONS: Regularity of the home environment appears to contribute to maternal sleep, depression, and fatigue. Implications for intervention include establishment of daily routines and household management to improve regularity and consequently improve maternal outcomes.

Nursing knowledge of physiological and psychological outcomes related to patient sleep deprivation in the acute care setting.

In this study, nurses' knowledge regarding sleep quality outcomes in the acutely ill patient population was assessed. Also evaluated was the possible impact of nurses' knowledge of the effects of quality sleep on their choice of activities to promote patient rest.

Understanding sleep during adolescence.

Adolescents have unique sleep behaviors related to physiological and developmental differences. Research suggests that sleep debt related to these adolescent differences contributes to risk for accidents, behavioral changes, and other health concerns. In addition, the impact of pain related to trauma, surgery, and chronic illness can further alter the sleep patterns of this age group. Limited normative parameters describe the sleep of healthy adolescents. A comparative study of 26 adolescents from 12 through 18 years of age was designed to describe the sleep patterns of two groups of adolescents. Sleep parameters, including actual sleep time, sleep efficiency, nighttime awakenings, and other sleep patterns of adolescents following post-operative tonsillectomy and adenoidectomy (T & A), were compared with an age and gender-matched sample of healthy adolescents. All adolescents wore wrist-actigraphy and documented sleep information in a diary for three continuous days. Healthy adolescents had significantly less (p = 0.003) actual hours of night time sleep and significantly less (p = 0.039) sleep efficiency than adolescents in the post-operative sample during the three days. None of the adolescents in this study had sufficient actual hours of nighttime sleep. Findings support the need for nurses to assess adolescent sleep patterns and to educate teens and their families about the importance of adequate sleep. Further research is needed to establish sleep interventions that will improve the sleep hygiene of both healthy adolescents and those who experience sleep disruption due to painful conditions.

How do clinicians assess, communicate about, and manage patient sleep in the hospital?

OBJECTIVE: The objective of this study was to characterize how clinicians assess, communicate about, and manage patient sleep, with the focus on identifying existing barriers and facilitators to sleep promotion in clinical practice. BACKGROUND: Sleep is a critical need for improving for hospitalized patients. METHODS: Content analysis was used to interpret descriptive data from 4 group interviews with a total of 62 clinicians. RESULTS: Clinicians reported they did not formally assess for patient sleep, which led to largely unmanaged sleep disruption during hospitalization. Major barriers to effective sleep management were limited understanding of the importance of sleep, lack of a standardized tool for assessment, and inadequate communication. Facilitators included collaborative communication with patients and the healthcare team and customized patient-centered interventions. CONCLUSIONS: It is critical to inform clinicians on the importance of sleep, to standardize sleep assessment, and to facilitate collaboration among caregivers to promote sleep for hospitalized patients.

The experience of a diagnosis of advanced lung cancer: sleep is not a priority when living my life.

PURPOSE/OBJECTIVES: To describe common practices and shared meanings of sleep-wake disturbances in individuals with newly diagnosed non-small cell lung cancer (NSCLC) before treatment and evaluate their preexisting sleep disturbances. RESEARCH APPROACH: Open-ended interviews of patients newly diagnosed with lung cancer. SETTING: A Veterans Administration hospital and a comprehensive cancer center in the northeastern United States. PARTICIPANTS: 26 patients newly diagnosed with NSCLC who chose chemotherapy treatment. METHODOLOGIC APPROACH: Interpretive phenomenology based on Heideggarian hermeneutics. MAIN RESEARCH VARIABLES: Meaning of diagnosis on life experiences and sleep practices. FINDINGS: Participants described four related themes: (a) the diagnosis as devastating yet not surprising, (b) treatment as hope for more time, (c) keeping life normal, and (d) sleep patterns as long lived. CONCLUSIONS: Although participants did not complain about sleep difficulties, they described a history of sleep disturbances and poor sleep hygiene. Participants focused their trust on the treatment, giving them more time to follow their priorities and ignoring the effects of sleep deprivation on their quality of life. INTERPRETATION: Healthcare professionals may design interventions to encourage keeping life as normal as possible, focusing on improving sleep, which may ultimately prolong patients' lives.

Sleep duration and overweight/obesity in children: review and implications for pediatric nursing.

PURPOSE: The purpose of this study was to review evidence from the last 5 years (2006-2011) regarding a relationship between sleep duration and childhood overweight/obesity. CONCLUSIONS: Among the 25 studies selected from PubMed and Web of Knowledge databases, all indicated significant associations between short sleep duration and childhood overweight/obesity. Studies explored a range of pediatric populations, methodologies, and potential contributing factors. PRACTICE IMPLICATIONS: Childhood sleep duration may be a modifiable risk factor in preventing obesity. In addition to identifying and assessing patients' sleep habits, nurses play important roles as educators regarding the importance of adequate sleep and promoting it in children.