• Sleep is necessary for healing, restoration, and normal daily functions. Sleep is increasingly important during times of stress, such as during periods of illness. Patients often do not experience adequate, restorative sleep while hospitalized. Environmental factors play a role in preventing sleep (Jones & Dawson, 2012). The project leader expected patient sleep to improve when modifications to the hospital environment were made. Targeted interventions would result in deeper, uninterrupted sleep for patients. Various departments were engaged to eliminate sources of sleep disruptions, as well as create an environment that was conducive to sleep. Patient care staff perceptions of the importance of sleep, and their practices in relation to the sleep environment before and after implementation were examined.
• The advanced scholarly project was conducted at Heartland Regional Medical Center (HRMC) in Marion, Illinois. A pre-test evaluating nurse knowledge and practices regarding sleep was administered to staff present at monthly staff meetings. Education was provided regarding the importance of patient sleep and planned practice changes to improve the sleep environment. Practice changes were implemented on a 20-bed hallway of a three- hallway medical surgical unit. Evidence based sleep environment alterations performed on the intervention hallway included new beds, dimmed lighting at night, quiet conversations, clustered care, lowering alarm volumes, and adhering to vital signs protocols. Comfort measures to deter sleep interruptions included; offering toileting, pain medications as appropriate, room temperature adjustments, and allowing patients to wear their own pajamas. Patients in the intervention hallway had the option of choosing additional sleep aids or modifications to the environment as well. Options included ear plugs, ear buds for white noise or music, wearing their own pajamas as appropriate, closing blinds to darken the room, extra blankets, shutting the door if safe, and eye masks. Patients in the remaining two hallways served as the control group and received no special interventions and no practice changes were implemented. Participating patients in all hallways were requested to complete the Richards Campbell Sleep Questionnaire (RCSQ) each morning. Patient care staff were requested to complete a patient sleep questionnaire at the completion of the project.
• Staff pre and posttest results indicated nurses believe sleep is important for patient healing. Pre and post scores varied, with post scores representing decreased satisfaction with the sleep environment (from 53.9% to 10%), improved workflow to decrease disruptions, an increase in white noise availability, and better multi-disciplinary collaboration. Post-test results also included a slight decrease in lights being turned down at night, and environmental adjustments being made. Scores from patient participants (N=14) illustrated the respondents from the intervention hallway B (N=4) responded with higher RCSQ ratings. All patients who received interventions rated their sleep the night before as a good night’s sleep and deep sleep. Seventy-five percent of patients on the intervention hall reported falling asleep quickly compared to 64.3% in the control group. Patients on the intervention hallway (75%) also reported they were awake very little compared to 42.9% in the control group. Patient sleep should be a priority to nursing staff and recommendations to sustain the project are reviewed.
• Measures to ensure sustainability were implemented throughout and at the completion of the project. Patient sleep aids were provided in supply rooms and remained on the unit upon completion of the project. As a result of project implementation, materials management and purchasing evaluated various options for maintaining a supply of patient sleep aids including kits with earplugs, eye masks, and fans. Infection control personnel researched protocols regarding fans and reached out to other hospitals in the area to inquire about policies and procedures in regards to fan use. Administrative staff, management, and patient care staff voiced concern for the patient sleep environment and a commitment to continuing to provide an environment conducive to patient sleep.
|Commitee:||Wiegmann, Janice, Langley, Stephanie|
|Department:||School of Nursing and Health Professions|
|School Location:||United States -- Illinois|
|Source:||DAI-B 81/10(E), Dissertation Abstracts International|
|Keywords:||Deprivation, Environment, Hospital, Night, Patient, Sleep|
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