Philosophiae Doctor - PhD / Background: Palliative care is specialised health care to support people living with a terminal illness, and their families. Palliative care aims to prevent and relieve suffering, to help people to live as well as possible until they die, and to support the processes of dying and bereavement. Palliative care is holistic care provided by Emergency and Oncology Nurses caring for cancer patients. Palliative care protocols for Professional Nurses working in Emergency Units and Oncology Departments are not always posted or in full view in the government hospitals of the Western Cape. The researcher had noted that the development of a palliative care protocol would be unique in its use at the three targeted government hospitals. Aims and Objectives: This study focused on the development and implementation of palliative care protocols for Emergency and Oncology Nurses in the targeted government hospitals of the Western Cape, i.e., protocols could be beneficial for cancer patients and their families. The overall aim of the research was to develop applied palliative care protocols for Emergency and Oncology Nurses to provide best practice palliative care nursing for Oncology Patients who may present at any one of three Western Cape Provincial Hospitals.

Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2007.

Approximately 20% of congestive heart failure (CHF) patients are readmitted within 30 days of hospital discharge, a rate which may be affected by in-hospital and post-discharge care. Reducing this rate is important to hospitals, both to improve outcomes and to avoid reductions in Medicare reimbursement. Assessing outcomes within a short post-discharge window best measures the impact of the care, planning, and followup of that admission; but most research on the effects of changes in CHF care has measured outcomes over periods longer than 30 days, adding the unpredictable long-term course of CHF to the factors affecting the outcome. As well, almost no studies to date have included the appreciable effects of CHF comorbidities in their analyses. This study addresses these needs by measuring rates of 30-day all-cause readmission, and by adjusting for comorbidities and demographic factors in our analysis. We hypothesize that an improved CHF care protocol including both in-hospital and post-discharge components will reduce the risk of readmission, and may alter the rate of change of that risk. We have analyzed as an interrupted time series data on 2764 discharges of CHF patients from a hospital that implemented such a change to assess the effect of the new protocol on the readmission risk and on the trend in that risk, comparing outcomes in the 22 months preceding introduction of the new protocol to those in the first 31 months of full implementation. Using multiple logistic regression, we have tested for an association between the new protocol and both the unadjusted risk of readmission, and that risk in a model including comorbidities and demographic factors as covariates. Neither model found a statistically significant association between introduction of the protocol and log-odds of readmission (unadjusted p = 0.847, adjusted p = 0.755) or between introduction of the protocol and change in risk of readmission over time (unadjusted p = 0.437, adjusted p = 0.313). These results, in comparison with other published results, can clarify what changes to care protocols have been shown to be effective. Further, post hoc power analysis of this study can inform study design for further research.

Introduction: Research has shown that Postpartum Depression (PPD) occurs in 10-20% of new mothers. Symptoms of PPD include excessive sadness, increased anxiety, guilt, and possible suicidal ideation. PPD can increase a mother’s risk for health and psychological dysfunction including future psychiatric illnesses, substance abuse, and decrease her adaptive functioning. PDD can also have negative implications on child safety practices and a child’s psychosocial and developmental wellbeing. Treatments for PPD, such as medication and psychotherapy, have been shown to be effective at reducing the number and severity of a mother’s symptoms, and generally improving their lives and the lives of their families. Unfortunately, many mothers do not receive treatment due to fears of stigma, inadequate screening practices and an inability to access care. Thus, early detection and improved access to care is critical and literature suggests formal screening practices increases the rate of detection. Pediatrician’s offices serve as ideal locations to screen mothers and connect them to appropriate services because of frequent contact with the mother. Methods: Recognizing this public health concern, the American Academy of Pediatrics developed PPD screening guidelines. ETSU Pediatrics, a local pediatric primary care clinic, adhered to these guidelines, assembled an interdisciplinary health care team, and developed a stepped care protocol to not only screen all new mothers but connect them with immediate, onsite behavioral health services. The protocol consisted of four distinct phases: 1) distribution of the Edinburgh Postnatal Depression Scale (EPDS), an evidence- based tool screening for depression in new mothers, to every mother of infants 0 to 6 months at their well- child visit; 2) appropriate documentation of the EPDS score and plan of action noted within the electronic medical record (EHR); 3) brief behavioral health intervention conducted by the on-site behavioral health consultant, and/or referral to outside provider; 4) phone call follow up with mother and referred provider. The aim of the study is to evaluate components of intervention feasibility based upon the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance), which stems from the Dissemination and Implementation Science field. This particular project extends past previous pilot studies to include EHR chart review from an entire year and evaluates the protocol’s feasibility by examining Adoption and Maintenance domains. Results: Results were collected from EHR and billing records of all patients, 0 to 6 months of age, seen at the clinic from February 26, 2014 to February 25, 2015 (n = 755) for their well-child visit (n = 2,459). Adoption will examine feasibility by noting the percentage of mothers who were administered the EPDS as well as the general trend in administration across the year. Maintenance will examine feasibility from a financial perspective and reveal the amount of reimbursement accrued by billing for the EPDS. Conclusions: The anticipated results will have implications on the

Thesis (MPhil)--Stellenbosch University, 2009. / A research assignment submitted in partial fulfilment of the requirements of the degree Master of Philosophy (MPhil) in rehabilitation at Stellenbosch University / ENGLISH ABSTRACT: Introduction: Stroke is a growing healthcare problem in South Africa. It contributes significantly to the burden of disease and is the largest cause of disability. Rehabilitation can significantly improve recovery and outcomes of stroke survivors particularly if implemented in the correct manner and through using certain approaches. The aim of this study was to examine the practice of doctors with regards to stroke rehabilitation in private acute-care hospitals in the Western Cape Metropole. In particular, attention has been given to the degree to which doctors in the private health care sector shared information with first time stroke patients. The study design was retrospective and descriptive in nature. Data collection was primarily of a quantitative nature although some qualitative data has been collected to elaborate on quantitative findings. Two self-designed questionnaires were used to collect data. Data from doctor-participants were collected to examine the use of care protocols. Data from both groups of participants were collected to determine which practices were prefered. In particular it was sought to ascertain what team work approach was favoured by doctors. To do this the method of communication among team members was examined. It was also sought to ascertain how information regarding diagnosis, prognosis, risk factors, post–acute rehabilitation options and discharge planning was shared. In total thirty-five doctors and forty-eight patients were interviewed. Quantitative data was captured on an excel spreadsheet and analysed with the help of a STATISTICA software package. A p value of less than 0.05 was deemed statistically significant. Results showed that none of the doctor participants had any formal rehabilitation qualification. It was found that stroke care protocols were used by 46% of doctor participants, while 89% acknowledged the advantages of a set protocol. The majority of doctors (57%) operated as part of a multidisciplinary team. Communication between team members regarding the patient’s management plan was done on a very informal basis with only 11% of doctors using ward rounds and none using team meetings for this purpose. Opinions differed between the two study groups on the frequency of information sessions (p = .00039). Only six % of doctors included the patient and family in the rehabilitation team. A large discrepancy was seen when it came to opinions on sharing information regarding diagnosis, prognosis, stroke risk factors, post-acute rehabilitation and discharge planning. P values ranging from 0.00013 to 0.0041 showed that the difference between the opinions of patients and doctors on these issues was statistically significant. Opinions also differed between the two groups when the frequency of information sessions was compared (p = 0.00039). Only 28% of patient participants were included in the decisionmaking process regarding further post-acute rehabilitation and in most cases the final decision was made by the doctor or the medical insurance company. Qualitative data highlighted some patients’ dissatisfaction regarding the post-acute rehabilitation process and indicated a problem with regard to the recognition of early stroke warning signs by general practitioners and the emergency treatment of these. The conclusion was that there is a great need for further motivation and education of doctors with respect to advanced research projects, further specialisation as well as the implementation of important rehabilitation modalities. It is also important that the patient himself acts as a fully-fledged team member. Recommendations were that administrators in both, the private and public health care sectors as well as non-government organisations and government welfare organisations identify the reasons for doctors’ hesitation to implement existing knowledge; that they make stroke rehabilitation training available and that they ensure that doctors implement the existing and new knowledge on all aspects of acute and post-acute stroke rehabilitation i.e. use of set care protocols, team work approach and sharing information on diagnosis, prognosis, risk factors, post–acute rehabilitation options and discharge planning when managing stroke patients. It was also recommended to promote more research projects which are implemented in the private health care sector. / AFRIKAANSE OPSOMMING: Beroerte is reeds die grootste enkele oorsaak van gestremdheid in Suid Afrika en steeds aan die toeneem in insidensie. Navorsing het bewys dat rehabilitasie geskoei op wetenskaplik bewese metodes die uitkomste van beroerte lyers beduidend kan verbeter. Daarom was dit die doel van die studie om vas te stel tot watter mate dokters, werksaam in die privaat sektor in die Wes Kaapse Metropool, bewese rehabilitasie metodes implimenteer tydens behandeling van akute beroerte pasiënte. Spesifieke areas waaraan aandag geskenk is, was die gebruik van beroerte protokolle, die volg van die interdissiplinêre spanwerk benadering, kommunikasie metodes tussen spanlede en die deurgee van inligting met betrekking tot die diagnose, prognose, risiko faktore, opvolg rehabilitasie en ontslag beplanning aan pasiënte na `n eerste beroerte. Die studie was retrospektief en beskrywend van aard. Daar was primêr kwantitatiewe data ingesamel met behulp van twee self ontwerpde vraelyste. ‘n Klein hoeveelheid kwalitatiewe data is aanvullend ingesamel om kwantitatiewe bevindings toe te lig. 35 dokters en 48 pasiënte het aan die studie deelgeneem. ‘n STATISTICA sagteware pakket is gebruik vir die analise van kwalitatiewe data. ‘n P waarde van minder as 0.05 is as statisties beduidend beskou. Nie een van die dokters wat aan die studie deelgeneem het, het nagraadse opleiding in rehabilitasie gehad nie. 46% van dokters het beroerte protokolle gebruik in hulle praktyke, terwyl 89% gevoel het dat die gebruik van protokolle voordele inhou. Waar spanwerk gebruik was (57% van dokters), is die multidissiplinêre benadering gevolg. Kommunikasie tussen spanlede het meesal op `n informele basis geskied. Geen dokter het spanvergaderings gehou nie. 11% van dokters het saalrondtes gehou waartydens met spanlede gekommunikeer is. 6% van dokters het die pasiënt en familie ingesluit in die rehabilitasie span. Volgens dokters was daar beduidend meer inligting sessies met pasiënte gehou as volgens pasiënte (p = 0.00039). Die verskil in mening tussen die twee groepe is ook waargeneem met betrekking tot die hoeveelheid inligting wat verskaf is oor diagnose, prognose, risiko faktore, post akute rehabilitasie en onslag beplanning (P waardes het gewissel van 0.00013 tot 0.0041). 25% van pasiënte het deelgeneem aan die besluitnemings proses oor opvolg rehabilitasie. Die finale besluit hieroor was in die meerderheid van gevalle deur die dokter en die mediese versekeringsskema geneem. Dit het uit die kwalitatiewe data geblyk dat van die pasiënte ongelukkig was met die opvolg rehabilitasie wat hulle ontvang het. Voorts het pasiënte gevoel dat algemene praktisyns beter ingelig behoort te wees oor die vroeë waarskuwingstekens van beroerte sowel as die noodbehandling van die tekens. Die navorser het tot die gevolgtrekking gekom dat dokters oortuig moet word van die belang van verdere navorsing, spesialisasie in rehabilitasie en die implementasie van bewese beroerte rehabilitasie metodes. Sy beveel aan dat administrateurs van beide die privaat en staatssektor sowel as verteenwoordigers van nie regerings organisasies betrokke raak om bogenoemde te bewerkstellig. Daar moet vasgestel word waarom dokters huiwerig is om bestaande kennis te implemteer. Beroerte rehabilitasie opleiding moet beskikbaar gestel word aan dokters en dokters moet aangemoedig word om bewese kennis soos die gebruik van protokolle, interdissiplinêre spanwerk en verskaffing van inligting oor diagnose, prognose, risiko faktore, opvolg rehabilitasie en ontslag beplanning toe te pas in die praktyk. Die doen van meer navorsing in die privaat sektor word ook aangemoedig.

Depuis de nombreuses années, le déploiement des TIC dans la prise en charge médicale de pathologies chroniques joue un rôle majeur notamment dans l’évolution des pratiques de santé et l’amélioration du bien-être du patient. Les pathologies chroniques sont de nature longue et évolutive et nécessitent un suivi régulier effectué par une équipe pluridisciplinaire où différents acteurs interviennent auprès du patient. Le patient à son tour, est amené à respecter à domicile, un protocole de soins défini et personnalisé par cette équipe. Cependant, la forme dans la quelle le contenu du protocole est représenté n’est pas forcément complète ni facile à comprendre par les patients. De plus, chaque patient est unique, et la définition du protocole de soins doit être personnalisée et appropriée à ses soins et traitements individuels, parfois même à ses souhaits et contraintes personnelles. L’expertise du patient sur sa maladie chronique est une information précieuse que nous souhaitons intégrer dans un protocole de soins personnalisé afin d’améliorer la prise en charge médicale, le suivi à distance de la maladie chronique et à terme améliorer la connaissance de la pathologie chronique. Pour ce faire,nous avons proposé (i) un langage de représentation informatisée de protocole de soins personnalisé, destiné aux professionnels de santé et aux patients,suffisamment simple,intuitif et facile à comprendre.(ii) une ontologie de l’expertise patient (tirée de son vécu avec la pathologie) permettant de signaler des imprévus dans le déroulement du protocole (actions non prévus ou évènements non prévus). / For several years, the deployment of information and communication technologyintothemanagementofchronicalpathologiesistakingaconsiderableplace, more particularly in the evolution of health’s practices and in the improvement of the well-being of the patient Chronical pathologies are of long duration and they need to be under a regular monitoring of the healthcare professional, composed of multidisciplinary or different actors in charge with the patients. On the other side the patients are alsochargedoffollowingahealthcareprotocolathomepreviouslydefinedbythe health care team. Nevertheless, the different forms of representing the contests of this protocol, it is not always complete and comprehensible for the patients. Furthermore, each one of the patients is unique and a proper definition of the health care protocol must be personalised and conform to his individual treatment and even to his personal wishes or constraints. But this is not the case of information guides or medical references that are supplied in general. With the intent to improve the interaction between the patient and the healthcareprofessionalsrelatedtothehealthcareprotocol,wepropose(i)alanguagefor the computerised representation of the healthcare protocol, sibling the healthcare professionals and the patients, enough simple, intuitive and easy to understand, (ii) an ontology for the patient expertise (based on his experience on the disease) allowingsotheinteractionofthepatientwithhishealthcareprotocolbyreporting all the unexpected behaviours. These behaviours are events that are not defined in the initial health care protocol.

Submitted by JOSIANE SANTOS DE OLIVEIRA (josianeso) on 2018-08-07T15:34:17Z No. of bitstreams: 1 Mariana Postingher_.pdf: 540542 bytes, checksum: c91f8529aee6ff76c3a25a5d7054e562 (MD5) / Made available in DSpace on 2018-08-07T15:34:17Z (GMT). No. of bitstreams: 1 Mariana Postingher_.pdf: 540542 bytes, checksum: c91f8529aee6ff76c3a25a5d7054e562 (MD5) Previous issue date: 2018-04-20 / Nenhuma / O atendimento às mulheres com diagnóstico de aborto requer uma atenção segura e humanizada. O abortamento, independente de sua etiologia, é um evento vivenciado por mulheres em crescente índice no Brasil, e se não bem manejado, apresenta riscos e complicações, como a mortalidade. Poucos são os estudos que apresentam a preocupação com os sentimentos e necessidades de saúde dos envolvidos no abortamento. Neste sentido, o presente estudo visou construir e propor a implantação de um protocolo assistencial multiprofissional para mulheres com diagnóstico de aborto, investigando como ocorre a assistência multiprofissional prestada às mulheres com diagnóstico de abortamento. Trata-se de um olhar qualitativo, descritivo e exploratório sendo utilizada a pesquisa ação como meio de entender o atendimento às mulheres com diagnóstico de abortamento, considerando a tríade das práticas baseadas em evidências. Para este, foram entrevistadas dez mulheres que vivenciaram pelo menos um atendimento hospitalar por abortamento no ano de 2017, buscando as preferências das mulheres e a realização da técnica de grupo focal com nove profissionais da saúde que atuavam há mais de dois anos na instituição de escolha da pesquisa, discutindo as evidências clínicas e habilidades clínicas. Mediante análise das evidências e discussão dos dados do estudo, foi possível a construção do protocolo de atendimento a mulheres em situação de abortamento. Os resultados mostram que há necessidade de capacitações com as equipes de saúde, como também de sistematizar o atendimento do abortamento, buscando a individualização de cada caso devido às necessidades de saúde da mulher, desde o diagnóstico do aborto até o posterior planejamento reprodutivo ou contraceptivo. / The care for women diagnosed with abortion requires a safe and humanized attention. Abortion independent of its etiology and is an event experienced by women in an increased index in Brazil, and if not well carried, presents risks and complications such as mortality. Few are the studies that show concern with the feelings and health needs of those involved in abortion. In this sense, the present study aimed to build and propose the implementation of a multiprofessional care protocol for women diagnosed with abortion, investigating how multiprofessional care provided to women with a diagnosis of abortion happens. It´s a qualitative, descriptive and exploratory look which uses action research as a way to understand the care of women with a diagnosis of abortion, considering the triad of evidence-based practices. For this one, ten women who had experienced at least one hospitalization per abortion in the year 2017 were interviewed, seeking the women's preferences and the realization of the focus group technique with nine health professionals who had been working for more than two years at the institution of research choice, discussing the clinical evidence and clinical skills. Through analysis of the evidence and discussion of the study data, it was possible to construct the protocol of assistance to women in situations of abortion. The results show that there is a need for training with health teams and systematizing abortion care, looking for the individualization of each case due to women's health needs, from the diagnosis of abortion to subsequent reproductive or contraceptive planning.

Introdução: Sono de qualidade ruim é uma situação frequentemente descrita em pacientes críticos. A etiologia das alterações do sono nesta população é multifatorial. Dentre os fatores modificáveis citam-se ruído, iluminação, dor, interações decorrentes dos cuidados ao paciente e medicamentos. O sono de má qualidade pode relacionar-se com mudanças no metabolismo, na função endócrina, em disfunção do sistema imunológico e ventilatório e em distúrbios cardiovasculares. Também acarreta consequências psicológicas como disfunção cognitiva e delírio. Objetivo: Avaliar o efeito de um protocolo para promoção da qualidade do sono em pacientes internados em uma unidade de cuidados coronarianos (UCC). Metodologia: Este estudo consistiu em um estudo quase-experimental, realizado em duas fases. Durante a primeira fase, o grupo controle (n = 58 pacientes) recebeu cuidados habituais e informações relativas ao sono foram coletadas por meio do Questionário do Sono de Richards-Campbell (RCSQ) - escala analógica visual de 100 mm, com pontuações mais altas representando sono de melhor qualidade - e do Questionário do Sono na Unidade de Cuidados Intensivos (SICUQ) - escala discreta de 10 pontos, com maiores escores indicando maior interrupção do sono. Durante a segunda fase (n = 55 pacientes), um protocolo para promoção do sono foi implementado. As intervenções incluíram ações para redução do ruído e luminosidade, cuidados com analgesia, além de medidas gerais. Os dados relativos ao sono foram novamente coletados para avaliar o impacto dessas intervenções. Resultados: As principais barreiras ao sono identificadas pelo SICUQ foram dor 1 (1-5,5), luminosidade 1 (1-5) e ruído 1 (1-5). Dentre as fontes de ruído, as que apresentaram maiores escores foram alarmes dos monitores cardíacos 3 (1- 5,25), alarmes das bombas de infusão intravenosa 1,5 (1- 5) e alarmes dos ventiladores mecânicos 1 (1-5). Estas últimas significativamente reduzidas no grupo intervenção. Em relação ao RCSQ, o grupo intervenção obteve melhorias nos escores de profundidade do sono 81 (65-96,7) vs. 69,7 (50-90); p=0,046); fragmentação do sono 90 (65-100) vs. 69 (42,2-92,7); p=0,011); tempo para retomada do sono 90 (69,7 - 100] vs. 71,2 (40,7-96,5); p=0,007); qualidade do sono 85 (65-100) vs. 71,1 (49-98,1); p=0,026) e no escore global de qualidade do sono 83 (66-94) vs. 66,5 (45,7-87,2); p=0,002 em relação ao grupo controle. Conclusão: A implementação de um protocolo para promoção do sono foi factível e eficaz na melhora de vários parâmetros de qualidade do sono e na redução de algumas de suas barreiras em pacientes internados em uma UCC. / Introduction: Poor sleep is a frequent occurrence in the acute care unit. The etiology of disrupted sleep in this population is thought to be multifactorial. Modifiable factors include noise, light, pain, patient care interactions and medications. Disrupted sleep can be related to changes in metabolism and endocrine function, immune system dysfunction, ventilatory and cardiovascular disturbances and also psychological consequences like cognitive dysfunction and delirium. Objective: To evaluate the effect of a multi-intervention sleep care protocol in improving sleep quality in coronary care unit (UCC) patients. Methodology: This trial consisted in a quasi-experimental study, carried out in two phases. During the first phase the control group (n=58 patients) received usual care, and baseline sleep data was collected through the Richards-Campbell Sleep Questionnaire (RCSQ) - visual analog scale of 100 mm, with higher scores representing higher quality sleep - and the Sleep in the Intensive Care Unit Questionnaire (SICUQ) - 10-point discrete scale, higher scores indicate greater sleep interruption. During the second phase (n=55 patients), a sleep promoting protocol was implemented. Interventions included actions to promote analgesia, to reduce noise and brightness and other general measures. Sleep data were collected again to assess the impact of these interventions. Results: The main barriers to sleep in the SICUQ were pain [median (interquartile range)] [1 (1.0-5.5)], light [1 (1.0-5.0)] and noise [1 (1.0-5.0)]. The most rated sources of sleep-disturbing noise were heart monitor alarm [3 (1.0-5.25)], intra venous pump alarm [1.5 (1.0-5.00)] and ventilator alarm [1 (1.0-5.0)]. All of the latter were significantly lower in the intervention group than in the baseline group. According to the RCSQ, the intervention group had better scores in overall sleep depth [median (interquartile range)] [81 (65-96.7) vs. 69.7 (50-90); p=0.046]; sleep fragmentation [90 (65-100) vs. 69 (42.2-92.7); p=0.011]; return to sleep [90 (69.7 - 100) vs. 71.2 (40.7-96.5); p=0.007]; sleep quality [85 (65-100) vs. 71.1 (49-98.1); p=0.026] and mean RCSQ score [83 (66-94) vs. 66.5 (45.7-87.2); p=0.002] medians than the baseline group. Conclusion: A multi-intervention protocol was feasible and effective in improving different sleep quality parameters and in reducing some barriers to sleep in CCU patients.

Social work is a profession where documentation about people’s behavior and life circumstances is common. In the beginning of the essay we ask ourselves, if these descriptions about people can be problematic? To explore this, we studied social documentation, from the past. We used a historical source because history can help usunderstand the social work that is being conducted today. The aim of our study was to findout how early welfare work defined and described deviant behavior in child care issues, and how the child care agency handled these issues. Out method was a document analysis off the children’s care protocols in Kalmar, from 1929 to 1937. We present our results along with two illustrative case descriptions. Our theoretical approaches are Howard S Becker and Erwing Goffman´s theories of deviation. Their conclusion is that deviation is created by society, not by individuals or their actions. Since cases of children’s neglect and cases with deviant children were common and well documented we focused our empirical presentation on what was included in these terms. Children’s neglect cases focused on parent’s inability to provide the child with proper food, clothes, housing and similar factors. We also found that they made a distinction between mothers and fathers responsibility in these cases. Regarding the deviant children they also made a distinction between the sexes, identifying different behaviors deviant for girls andboys. Though some factors, such as being a illegitimate child and being unreliable is a definition used on both sexes. Since, according to our theories, deviation is created by our society our conclusion is that both children’s neglect and problem children can be seen as a result of societies expectations, and we present examples of how that can be understood in our analyze. In our final discussion we discuss how the definition of deviant behavior is relevant today. We discuss our findings in relation to BBIC, a Swedish child protection investigation guide. Our conclusion is that we still create deviations through documentation.

Introdução: Sono de qualidade ruim é uma situação frequentemente descrita em pacientes críticos. A etiologia das alterações do sono nesta população é multifatorial. Dentre os fatores modificáveis citam-se ruído, iluminação, dor, interações decorrentes dos cuidados ao paciente e medicamentos. O sono de má qualidade pode relacionar-se com mudanças no metabolismo, na função endócrina, em disfunção do sistema imunológico e ventilatório e em distúrbios cardiovasculares. Também acarreta consequências psicológicas como disfunção cognitiva e delírio. Objetivo: Avaliar o efeito de um protocolo para promoção da qualidade do sono em pacientes internados em uma unidade de cuidados coronarianos (UCC). Metodologia: Este estudo consistiu em um estudo quase-experimental, realizado em duas fases. Durante a primeira fase, o grupo controle (n = 58 pacientes) recebeu cuidados habituais e informações relativas ao sono foram coletadas por meio do Questionário do Sono de Richards-Campbell (RCSQ) - escala analógica visual de 100 mm, com pontuações mais altas representando sono de melhor qualidade - e do Questionário do Sono na Unidade de Cuidados Intensivos (SICUQ) - escala discreta de 10 pontos, com maiores escores indicando maior interrupção do sono. Durante a segunda fase (n = 55 pacientes), um protocolo para promoção do sono foi implementado. As intervenções incluíram ações para redução do ruído e luminosidade, cuidados com analgesia, além de medidas gerais. Os dados relativos ao sono foram novamente coletados para avaliar o impacto dessas intervenções. Resultados: As principais barreiras ao sono identificadas pelo SICUQ foram dor 1 (1-5,5), luminosidade 1 (1-5) e ruído 1 (1-5). Dentre as fontes de ruído, as que apresentaram maiores escores foram alarmes dos monitores cardíacos 3 (1- 5,25), alarmes das bombas de infusão intravenosa 1,5 (1- 5) e alarmes dos ventiladores mecânicos 1 (1-5). Estas últimas significativamente reduzidas no grupo intervenção. Em relação ao RCSQ, o grupo intervenção obteve melhorias nos escores de profundidade do sono 81 (65-96,7) vs. 69,7 (50-90); p=0,046); fragmentação do sono 90 (65-100) vs. 69 (42,2-92,7); p=0,011); tempo para retomada do sono 90 (69,7 - 100] vs. 71,2 (40,7-96,5); p=0,007); qualidade do sono 85 (65-100) vs. 71,1 (49-98,1); p=0,026) e no escore global de qualidade do sono 83 (66-94) vs. 66,5 (45,7-87,2); p=0,002 em relação ao grupo controle. Conclusão: A implementação de um protocolo para promoção do sono foi factível e eficaz na melhora de vários parâmetros de qualidade do sono e na redução de algumas de suas barreiras em pacientes internados em uma UCC. / Introduction: Poor sleep is a frequent occurrence in the acute care unit. The etiology of disrupted sleep in this population is thought to be multifactorial. Modifiable factors include noise, light, pain, patient care interactions and medications. Disrupted sleep can be related to changes in metabolism and endocrine function, immune system dysfunction, ventilatory and cardiovascular disturbances and also psychological consequences like cognitive dysfunction and delirium. Objective: To evaluate the effect of a multi-intervention sleep care protocol in improving sleep quality in coronary care unit (UCC) patients. Methodology: This trial consisted in a quasi-experimental study, carried out in two phases. During the first phase the control group (n=58 patients) received usual care, and baseline sleep data was collected through the Richards-Campbell Sleep Questionnaire (RCSQ) - visual analog scale of 100 mm, with higher scores representing higher quality sleep - and the Sleep in the Intensive Care Unit Questionnaire (SICUQ) - 10-point discrete scale, higher scores indicate greater sleep interruption. During the second phase (n=55 patients), a sleep promoting protocol was implemented. Interventions included actions to promote analgesia, to reduce noise and brightness and other general measures. Sleep data were collected again to assess the impact of these interventions. Results: The main barriers to sleep in the SICUQ were pain [median (interquartile range)] [1 (1.0-5.5)], light [1 (1.0-5.0)] and noise [1 (1.0-5.0)]. The most rated sources of sleep-disturbing noise were heart monitor alarm [3 (1.0-5.25)], intra venous pump alarm [1.5 (1.0-5.00)] and ventilator alarm [1 (1.0-5.0)]. All of the latter were significantly lower in the intervention group than in the baseline group. According to the RCSQ, the intervention group had better scores in overall sleep depth [median (interquartile range)] [81 (65-96.7) vs. 69.7 (50-90); p=0.046]; sleep fragmentation [90 (65-100) vs. 69 (42.2-92.7); p=0.011]; return to sleep [90 (69.7 - 100) vs. 71.2 (40.7-96.5); p=0.007]; sleep quality [85 (65-100) vs. 71.1 (49-98.1); p=0.026] and mean RCSQ score [83 (66-94) vs. 66.5 (45.7-87.2); p=0.002] medians than the baseline group. Conclusion: A multi-intervention protocol was feasible and effective in improving different sleep quality parameters and in reducing some barriers to sleep in CCU patients.