| Description |
Background: Poor sleep quality in the intensive care unit (ICU) can cause hormone imbalances, decreased energy, alterations in metabolic function, and impaired ventilation (Darby et al., 2022). Sleep disturbances can contribute to delirium and may lead to prolonged hospital lengths of stay, increased mortality, and post-ICU cognitive impairment (Baumgartner et al., 2019). Unstable patients in the ICU are at an increased risk for poor sleep quantity and quality (Dalton, 2018). Local Problem: Intensive care nurses are essential to elicit change in sleep hygiene among their patients; however, their practices, attitudes, and perceptions of sleep hygiene are poorly understood (Hahn, 2018). A change in attitudes and culture is needed in the ICU to promote sleep for patients (Sundstrom et al., 2021). At the time in which this manuscript was written, there was no sleep-wake bundle (SWB) in the ICU of the tertiary care hospital where this project took place. There was also a lack of emphasis on sleep in the ICU; therefore, we proposed developing and implementing a SWB to improve patients' sleep. Methods: A SWB was developed and implemented at a tertiary care hospital on a 16-bed ICU. This quality improvement (QI) project consisted of four phases: 1) assessment of nursing staff (registered nurses and health care assistants) knowledge, attitudes, interests, and currently used sleep-wake interventions; 2) development of an evidence-based SWB; 3) implementation of the SWB, and 4) evaluation of the number of new sleep-wake strategies used pre-to-post implementation of the SWB. In addition, feasibility, usability, and satisfaction were evaluated. Intervention: Nursing staff completed a pre-implementation survey to assess knowledge and attitudes regarding a SWB (Appendix A). Through research of evidence-based practice and feedback from medical doctors, advanced practice clinicians, and nursing staff, the SWB was developed. A PowerPoint presentation (Appendix E) was presented to nursing staff regarding ICU and SWB sleep hygiene. The SWB comprised of checklists (Appendix D) of sleep and wake interventions, was distributed to nursing staff for use during their shifts. Education materials were displayed in the break room, and flyers (Appendix F) were placed throughout the unit. The SWB was implemented for 6 weeks. Nursing staff tracked sleep-wake interventions completed for each shift using the printed checklists. At the end of the SWB implementation, data from the checklists were analyzed, and a post-intervention survey (Appendix C) was completed by nursing staff to assess the change in the number of sleep-wake interventions and to obtain feedback on usability, feasibility, and satisfaction. Results: Forty nursing staff participated in pre-implementation surveys, and 38 nursing staff participated in post-implementation surveys. The use of sleep-wake interventions increased by 25%, and 17 new sleep-wake interventions were used by nursing staff. Improved sleep for patients was noted by 97.4% of nursing staff, and 89.5% thought that the SWB was a useful tool in the ICU. Conclusion: Implementing a SWB resulted in a significant increase in the number of new sleep- wake interventions and previously used interventions. Nursing staff felt the SWB intervention increased their knowledge of sleep in the ICU and provided practical tools to empower them to promote sleep for their patients. Ke |
