References

Aitken LM, Elliott R, Mitchell M Sleep assessment by patients and nurses in intensive care: an exploratory, descriptive study. Aust Crit Care.. 2017; 30:(2)59-66 https://doi.org/10.1016/j.aucc.2016.04.001

Altman MT, Pulaski C, Mburu F, Pisani MA, Knauert MP. Non-circadian signals in the intensive care unit: point prevalence morning, noon and night. Heart Lung.. 2018; 47:(6)610-615 https://doi.org/10.1016/j.hrtlng.2018.07.011

Aveyard H, Payne S, Preston N. A post-graduate's guide to doing a literature review in health and social care.Maidenhead: Open University Press/McGraw Hill Education; 2016

Bagheri-Nesami M, Gorji MA, Rezaie S, Pouresmail Z, Cherati JY. Effect of acupressure with valerian oil 2.5% on the quality and quantity of sleep in patients with acute coronary syndrome in a cardiac intensive care unit. J Tradit Complement Med.. 2015; 5:(4)241-247 https://doi.org/10.1016/j.jtcme.2014.11.005

Guidelines for community noise. 1999. https://apps.who.int/iris/handle/10665/66217 (accessed 23 June 2020)

Brainard GC, Rollag MD, Hanifin JP. Photic regulation of melatonin in humans: ocular and neural signal transduction. J Biol Rhythms.. 1997; 12:(6)537-546 https://doi.org/10.1177/074873049701200608

Chhangani BS, Roehrs TA, Harris EJ Pain sensitivity in sleepy pain-free normals. Sleep.. 2009; 32:(8)1011-1017

Cooke M, Mitchell M, Tiralongo E, Murfield J. Complementary and alternative medicine and critical care nurses: a survey of knowledge and practices in Australia. Aust Crit Care.. 2012; 25:(4)213-223 https://doi.org/10.1016/j.aucc.2011.12.055

Critical Appraisal Skill Programme (CASP). CASP checklist. 2018. https://casp-uk.net/casp-tools-checklists/ (accessed 23 June 2020)

Delaney LJ, Currie MJ, Huang HC, Lopez V, Van Haren F. ‘They can rest at home’: an observational study of patients' quality of sleep in an Australian hospital. BMC Health Serv Res.. 2018; 18:(1) https://doi.org/10.1186/s12913-018-3201-z

Dobing S, Dey A, McAlister F, Ringrose J. Non-pharmacologic interventions to improve sleep of medicine inpatients: a controlled study. J Community Hosp Intern Med Perspect.. 2017; 7:(5)287-295 https://doi.org/10.1080/20009666.2017.1379845

Dolan R, Huh J, Tiwari N, Sproat T, Camilleri-Brennan J. A prospective analysis of sleep deprivation and disturbance in surgical patients. Ann Med Surg (Lond).. 2016; 6:1-5 https://doi.org/10.1016/j.amsu.2015.12.046

D'Souza OL, Alvares TRI, Baliga SM. Factors affecting quality of sleep in hospitalized patients: a cross-sectional survey in a tertiary care hospital. Indian Journal of Medical Specialities. 2019; 10:201-206

EBSCO Connect. Searching with Boolean operators. 2018. https://tinyurl.com/ydh9ehxq (accessed 23 June 2020)

Eliassen KM, Hopstock LA. Sleep promotion in the intensive care unit-a survey of nurses' interventions. Intensive Crit Care Nurs.. 2011; 27:(3)138-142 https://doi.org/10.1016/j.iccn.2011.03.001

Finan PH, Goodin BR, Smith MT. The association of sleep and pain: an update and a path forward. J Pain.. 2013; 14:(12)1539-1552 https://doi.org/10.1016/j.jpain.2013.08.007

Foreman B, Westwood AJ, Claassen J, Bazil CW. Sleep in the neurological intensive care unit: feasibility of quantifying sleep after melatonin supplementation with environmental light and noise reduction. J Clin Neurophysiol.. 2015; 32:(1)66-74 https://doi.org/10.1097/WNP.0000000000000110

Ganz FD. Sleep and immune function. Crit Care Nurse.. 2012; 32:(2) https://doi.org/10.4037/ccn2012689

Garside J, Stephenson J, Curtis H, Morrell M, Dearnley C, Astin F. Are noise reduction interventions effective in adult ward settings? A systematic review and meta analysis. Appl Nurs Res.. 2018; 44:6-17 https://doi.org/10.1016/j.apnr.2018.08.004

Hu RF, Jiang XY, Zeng YH, Cheng X, Zhang Y. Effects of earplugs and eye masks on nocturnal sleep, melatonin and cortisol in a simulated intensive care unit environment. Crit Care.. 2010; 14:(2) https://doi.org/10.1186/cc8965

Jacobs S, Mowbray C, Cates LM Pilot study of massage to improve sleep and fatigue in hospitalized adolescents with cancer. Pediatr Blood Cancer.. 2016; 63:(5)880-886 https://doi.org/10.1002/pbc.25902

Seven steps to the perfect PICO search: evidence-based nursing practice. EBESCO Health Notes. 2018. https://tinyurl.com/ya9yevuy (accessed 23 June 2020)

Jesson KJ, Matheson L, Lacey MF. Doing literature review: traditional and systematic techniques.London: SAGE Publications; 2011

Kamdar BB, Needham DM, Collop NA. Sleep deprivation in critical illness: its role in physical and psychological recovery. J Intensive Care Med.. 2012; 27:(2)97-111 https://doi.org/10.1177/0885066610394322

Litton E, Elliott R, Ferrier J, Webb SAR. Quality sleep using earplugs in the intensive care unit: the QUIET pilot randomised controlled trial. Crit Care Resusc.. 2017; 19:(2)128-133

Lopez M, Blackburn LB, Springer C. Minimizing sleep disturbances to improve patient outcomes. MedSurg Nursing. 2018; 27:(6)368-371

Macfarlane M, Rajapakse S, Loughran S. What prevent patients sleeping on an acute medical ward? An actigraphy and qualitative sleep study. Sleep Health.. 2019; 5:(6)666-669 https://doi.org/10.1016/j.sleh.2019.06.012

Methley AM, Campbell S, Chew-Graham C, McNally R, Cheraghi-Sohi S. PICO, PICOS and SPIDER: a comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews. BMC Health Serv Res.. 2014; 14 https://doi.org/10.1186/s12913-014-0579-0

Mofredj A, Alaya S, Tassaioust K, Bahloul H, Mrabet A. Music therapy, a review of the potential therapeutic benefits for the critically ill. J Crit Care. 2016; 35:195-199 https://doi.org/10.1016/j.jcrc.2016.05.021

Moher D, Liberati A, Tetzlaff J, Altman DG Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.2009 https://doi.org/10.1371/journal.pmed.1000097

Nursing and Midwifery Council. The code: professional standards of practice and behaviour for nurses, midwives and nursing associates. 2018. https://tinyurl.com/zy7syuo (accessed 23 June 2020)

Pagnucci N, Tolotti A, Cadorin L, Valcarenghi D, Forfori F. Promoting nighttime sleep in the intensive care unit: alternative strategies in nursing. Intensive Crit Care Nurs.. 2019; 51:73-81 https://doi.org/10.1016/j.iccn.2018.11.010

Patel J, Baldwin J, Bunting P, Laha S. The effect of a multicomponent multidisciplinary bundle of interventions on sleep and delirium in medical and surgical intensive care patients. Anaesthesia.. 2014; 69:(6)540-549 https://doi.org/10.1111/anae.12638

Salzmann-Erikson M, Lagerqvist L, Pousette S. Keep calm and have a good night: nurses' strategies to promote inpatients' sleep in the hospital environment. Scand J Caring Sci.. 2016; 30:(2)356-364 https://doi.org/10.1111/scs.12255

Smith MT, Haythornthwaite JA. How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep Med Rev.. 2004; 8:(2)119-132 https://doi.org/10.1016/S1087-0792(03)00044-3

Stages of sleep and sleep cycles. 2019. https://www.tuck.com/stages/ (accessed 23 June 2020)

Zisapel N. New perspectives on the role of melatonin in human sleep, circadian rhythms and their regulation. Br J Pharmacol.. 2018; 175:(16)3190-3199 https://doi.org/10.1111/bph.14116

Interventions to improve inpatients' sleep quality in intensive care units and acute wards: a literature review

09 July 2020
Volume 29 · Issue 13

Abstract

Background:

Sleep is essential for the physical and psychological restoration of inpatients, and lack of sleep results in sleep deprivation and poor sleep quality, with potentially harmful consequences.

Aim:

To summarise sleep-promoting interventions in the Intensive care unit (ICU) and acute ward setting.

Method and results:

Six databases were searched to obtain studies for review and eight studies were selected, appraised, analysed and produced two themes: sleep-disturbing factors and sleep-promoting strategies. Sleep-disturbing factors included environmental factors (such as light and noise), illness-related factors (such as pain, anxiety and discomfort), clinical care and diagnostics. Sleep-promoting strategies included using pharmacological aids (medication) and non-pharmacological aids (reducing noise and disturbances, eye masks, earplugs and educational and behavioural changes).

Conclusion:

The literature review showed that both ICU and acute ward settings affect patients' sleep and both use similar strategies to improve this. Nevertheless, noise and sleep disturbances remain the most critical sleep-inhibiting factors in both settings. The review recommended future research should focus on behavioural changes among health professionals to reduce noise and improve patients' sleep.

Sleep is essential for physical and psychological restoration in all patients (Aitken et al, 2017). Reduced and disturbed sleep leads to a state of sleep deprivation. Sleep deprivation prevents growth hormone secretion and weakens the immune system and is associated with a delay in the healing process (Ganz, 2012; Zakri, 2019) and potentially results in an increased vulnerability to infection (D'Souza et al, 2019).

One of the ways of encouraging a good night's sleep and therefore reducing patients' vulnerability to infection in hospital is by creating quieter wards and fewer disturbances from health professionals. However, to date, there is lack of consensus on the most effective strategy for different care settings. The majority of research has been focused on sleep-promotion strategies to improve patients' sleep in the intensive care unit (ICU) and only a few studies focus on acute ward settings. In this article an acute ward is defined as a non-critical, non-intensive medical or surgical ward.

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