Development of Intervention to Promote Healthy Sleep

Sleep is vital to overall health and healing. In a hospital setting sleep can be interrupted by a multitude of internal and external factors. This project is aimed at exploring ways to increase sleep/rest on an acute care unit and decreasing factors that disrupt sleep quality.  Sleep deprivation has serious impacts on health and healing including, less tolerance to pain, slower healing, higher risk of developing co-morbidities (DM II, hypertension, heart attack, obesity), confusion, increased immunosuppression (Dubose, & Hadi, 2016). Florence Nightingale (1860), took a holistic approach to nursing, she warned nurses to be aware of actions and noises that could disturb the patient’s sleep and thus interfere with the body’s natural ability to repair itself (Nightingale, 1860).

There are four stages in the cycle of sleep, stages three and four are the deep sleep stages. During deep sleep, growth hormones, that control cell regeneration are secreted, and the immune system is activated. Healing processes in the body are at their peak during sleep (Robinson et al, 2005). There are many studies documenting poor sleep quality in hospital settings due to staff interruptions, lack of privacy (shared rooms), loud equipment, lighting, noises outside the rooms and unfamiliar environment. Stress, anxiety and depression also can contribute to poor sleep quality (Clark, 2017).

One study conducted in 2014 by Linda Gellerstedt, Jorgen Medin and Monica Karlsson (2014) focused on factors that curb sleep on an acute care unit. Participants were interviewed about factors contributing to disruptions of sleep. “Participants reported physical factors (e.g., pain, bed and pillow support), environmental factors (e.g., hearing beeping sounds, and televisions), and psychological factors (e.g., worry, anxiety) as interfering with rest” (Clark, 2017, p 253).  Patients also noted that being involved in decisions regarding their care and having a nurse/nursing assistant with good bedside manner positively affected their sleep due to feeling a greater sense of security.

Unit 6BT in UNC Chapel Hill had already implemented a sleep menu for each patient, this was a sign in each room that had a checklist of interventions and options to enhance comfort and enhance sleep quality and quantity. After speaking with the HUC on the unit she mentioned that this intervention was not being utilized due to many factors, and that there was some improvement that could be made to implement in a more efficient and useful way (N.Clinard, personal communication, May 29,2019). One of the main reasons it was not successful at this time was that neither the nurse nor the nursing assistant were actively promoting use of the sleep menu, therefore it was just another sign hanging in a room. This topic was chosen because there is a great benefit in having a process in place that promotes better sleep in the inpatient unit and will not interfere with the tasks that the nurse or NA already have, it will just enhance the time spent with the patient. Two of the nurses on the unit had put forth some ideas about quality improvement that could improve patient outcomes, the sleep menu was confirmed as a good project, there was agreement on the fact that it was not being utilized (M. Birdsong and K. Coury, personal communication, May 22, 2019).

First part of the intervention will be to create a “Comfort Cart”, that will house sleep masks, earplugs, sound machines, aromatherapy, extra pillows, and anything else that might promote sleep or comfort. During the night shift assessment, the NA or the nurse, will speak with the patient about sleep measures and introduce the menu to the patient to see if there are any items they would like from the comfort cart or any interventions that will help them get a better night’s sleep. By directly addressing these measures with the patient, rapport is being built along with a good bedside manner and a patient’s involvement is also being addressed. Two factors previously identified as positively affecting sleep. The simple suggestion of extra measures of comfort and calm may help some of the patients’ get better sleep and shorten hospital stay and enhance healing. This is not a reinvention of the wheel, rather it is a more personal and streamlined way to implement an intervention that was already in motion but losing speed.

References

• Clark, A. (2017). Can a Sleep Menu Enhance the Quality of Sleep for the Hospitalized Patient?
  
  MEDSURG Nursing,
  
  26(4), 253-257. Retrieved from
  
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• Dubose, J. R., & Hadi, K. (2016). Improving inpatient environments to support patient sleep.
  
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  28(5), 540-553.
  
  https://doi-org.proxy055.nclive.org/10.1093/intqhc/mzw079
  
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• Gellerstedt, L., Medin, J., & Karlsson, M. R. (2014). Patients’ experiences of sleep in hospital: a qualitative interview study.
  
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  19(3), 176-188. https://doi.org/10.1177/1744987113490415
• Nightingale, F. (1860). Notes on Nursing. Retrieved June 10, 2019, from
  
  http://digital.library.upenn.edu/women/nightingale/nursing/nursing.html
  
• Radtke, K., Obermann, K., & Teymer, L. (2014). Nursing knowledge of physiological and psychological outcomes related to patient sleep deprivation in the acute care setting.
  
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  23(3), 178-184
• Robinson S.B., Weitzel T., and Henderson L. (2005). The Sh-h-h-h Project: nonpharmacological interventions.
  
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  19(6): 263-266.