Cardiac post-surgery inpatients lack the amount and quality of sleep needed for optimal recovery. I aimed to investigate the non-pharmacological sleep promotion practices used by nurses and the factors that influence their use. Guided by the Theoretical Domains Framework, I developed and administered a survey to registered nurses working in the Cardiac Intensive Care Unit and the cardiac surgery ward in one cardiac centre. Findings revealed that common sleep promotion practices included orientating inpatients to the room (n=88, 96.7%), and providing additional bedding (n=86, 96.6%). The most common enablers were knowledge regarding its benefits (n=72, 100%) and an understanding of its importance (n=77, 98.7%); the most common barriers were an absence of recognition from important healthcare professionals (n=61, 85.9%) and having competing priorities (n=60, 83.3%). These findings can be used in the development of interventions to promote nurses’ use of sleep promotion practices and to improve inpatients’ sleep quality.

"Objective: The purpose of this Doctoral of Nursing Practice (DNP) project was to conduct a survey to evaluate nurses’ knowledge, perceptions, attitudes, and beliefs regarding sleep promotion in the ICU. Background: Critically ill patients admitted into the Intensive Care Unit (ICU) are introduced into unfamiliar environments with numerous interruptions that interfere with proper sleep. Sleep deprivation among critically ill patients can have detrimental consequences for the patient and organization. Competing nursing priorities, lack of knowledge, opposing perceptions, and lack of resources prevent the implementation of strategies to promote patient sleep. Methods: This project used a descriptive design to conduct the assessment. A web-based survey was distributed to assess nurses’ knowledge, beliefs, attitudes and perceptions regarding sleep promotion in the ICU to help identify areas for improvement and barriers to implement an effective quality improvement plan. Setting: A 30-bed ICU at an academic medical center with 268 licensed beds in Phoenix, AZ with medical-surgical, cardiac, neurological, vascular, and transplant patient populations. Participants: Sample of 57 out of 175 critical care nurses who work in this project’s ICU setting. Findings: ICU nurses demonstrated concern for lack of sleep among critically ill patients, but it is difficult to promote due to competing priorities and tasks. Nurses overall understood the negative effects of sleep disruption among critically ill patients, but discussed the importance of maintaining staff accountability, working collaboratively with the interdisciplinary team, promoting consistency in care, and obtaining support and resources from administration to implement effective interventions. Implementation: Identified barriers and gaps should be utilized to direct quality improvement efforts that help promote uninterrupted sleep among critically ill patients."

Sleep deprivation is a multifactorial phenomenon, occurring frequently in the intensive care unit (ICU) and linked to adverse patient healthcare outcomes. The key practice question of this project focused on determining if retiming of routine laboratory and imaging testing outside of the designated “quiet time” can improve sleep quality among adult patients in the ICU. The purpose was to evaluate the effectiveness of implementing an evidence-based intervention to improve sleep quality in the ICU setting. The theoretical framework was the plan-do-study-act model, which offered a process for implementing a practice change and reevaluation of the intervention’s sustainability within the organization. A thorough literature search of over 100 scholarly journal articles, book references, and expert scholarly reports was completed to gain an understanding of this phenomenon in the ICU setting. The Richards-Campbell Sleep Questionnaire (RCSQ) was the data collection tool used to measure improvement in sleep quality. There were 72 participants that are included in the project. The Wilcoxon rank sum and chi square tests were used for the statistical analysis. The findings did not show statistical significance in the improvement in the RCSQ scores after implementation of the intervention. The recommendations include sleep deprivation training for nursing staff and providers, routine use of the RCSQ for data collection, and repeating the study with an increased number of participants and redefined inclusion and exclusion criteria to be more representative of the ICU patient population. The implication for social change is that this project empowers nursing to embrace a leadership role in using evidence-based practice to change clinical guidelines and improve patient outcomes.

Bakgrund: Sömn är ett grundläggande behov och avgörande för människans fysiska samt psykosociala återhämtningsförmåga. Sömnens betydelse underskattas dock och försummas oftast hos både friska och kritiskt sjuka individer. God sömnkvalitet är en ständig utmaning i en intensivvårdsmiljö och problemet är komplext då vårdmiljön såväl som patientens känslomässiga upplevelse påverkar sömnen och sömnkvalitet. Sjuksköterskans ansvar är att tillgodose människans grundläggande behov vilket utgör grunden för omvårdnad. Därmed är det sjuksköterskans uppgift att tillämpa sömnfrämjande omvårdnadsåtgärder och främja patientens hälsa och välbefinnande. Syfte: Sammanställa och beskriva omvårdnadsåtgärder för att främja sömnkvalitet för patienter som vårdas på en intensivvårdsavdelning. Metod: Systematisk litteratursammanställning genomfördes med en kvantitativ metod och deduktiv ansats. 24 studier har granskats, analyserats och skapat ett resultatunderlag som presenteras i en narrativ sammanställning. Resultat: Det framkom att öronproppar, ögonmask, musik, aromaterapi, akupressur, massage och meditation främjar intensivvårdspatienters sömn och sömnkvalitet. Omvårdnadsåtgärderna kan definieras i två främjande aspekter: yttre och inre påverkan. Resultatet visa att omvårdnadsåtgärderna kan ha god effekt både när de används separat och i kombination med varandra. Slutsats: Det finns ett flertal omvårdnadsåtgärder intensivvårdssjuksköterskan kan använda för att främja patientens sömn. Flertalet av omvårdnadsåtgärderna är okonstlade, kräver ingen utbildning och kan vara lätta att etablera i sjukvården. Detta bör bidra till att de relativt enkelt kan implementeras inom intensivvården. / Background: Sleep is a fundamental need and decisive for human physical and psychosocial recovery. However, the importance of sleep is underestimated and often neglected in both healthy and critically ill individuals. Good sleep quality is a constant challenge in an intensive care unit environment and the problem is complex, related to the care unit environment as well as the patient's emotional experience affect sleep and sleep quality. The nurse's responsibility is to take care of the basic human needs that fulfill the basis of nursing. Therefore, it is the nurse's task to apply sleep-promoting nursing interventions and promote the patient's health and well-being. Objective: Compile and describe interventions to promote sleep quality among patients cared for in an intensive care unit. Method: Systematic literature compilation was carried out using a quantitative method with a deductive approach. 24 studies have been reviewed, analyzed, and presented in a narrative compilation. Results: It has emerged that earplugs, eye mask, music, aromatherapy, acupressure, massage, and meditation improve intensive care patients' sleep and sleep quality. Nursing interventions can be defined in two promoting aspects: external and internal influence. The results show that the nursing interventions can have a good effect both when they are used separately and in combination with each other. Conclusion:  There are several nursing interventions the intensive care nurse can use to promote the patient's sleep. Most of the nursing interventions are simple, require no training and can be easily established in healthcare. This should help ensure that they can be implemented relatively easily in intensive care.