Good Shepherd Hospital

Presentation Notes

Quality Improvement poster presented at Nursing Passion: Re-Igniting the Art & Science, Advocate Aurora Health Nursing & Research Conference 2022; November 9, 2022; virtual.


Background: In an Intensive Care Unit (ICU) a patient’s sleep is known to be interrupted every 20 minutes. Sleep deprivation increases sympathetic activity, weakens the immune response, suppresses respirations, heightens sensitivity to pain, reduces glucose tolerance and results in delirium. Sleep deprivation leads to falls, restraints and medication administration thereby disrupting recovery.

Purpose: To promote patient sleep in a cardiovascular (CV) and medical/surgical ICU.

Implementation Plan: A HUSHH campaign was developed by the Nursing Shared Governance Committee. Pre-implementation, nurses asked patients to rate their sleep using a Likert scale and collected information on what could have made their sleep better. Patients meeting inclusion and exclusion criteria had a HUSHH sign placed on their door and were observed hourly to promote safety. Nurses were educated on interventions to improve sleep, including clustering care, dimming lights, using earplugs, minimizing hallway conversations, adjusting medication times, and avoiding interruptions between midnight and 4:00 am. Interdisciplinary support was coordination with radiology, respiratory and lab. Day shift nurses promoted the sleep/awake cycle. Patients were asked to complete the same pre-implementation questions post-implementation.

Outcomes: A total of 207 questionnaires were completed pre-implementation and 222 post-implementation. The mean score on a five-point Likert scale improved from 3.74 to 4.04 in CVICU and from 3.88 to 4.04 in ICU. While not statistically significant, promoting sleep is meaningful. Patients’ comments on what could have improved their sleep included medications for pain/sleep, assisting with anxiety, decreasing noise, and a more comfortable bed/pillow. Fourteen patients reported the need for less interruptions pre-implementation and only two patients reported this post-implementation.

Implications for Practice: Patients have multiple suggestions to improve hospital sleep. A HUSHH campaign to address sleep is a start to improve the patient’s perception of sleep. An interdisciplinary approach with multiple interventions is necessary to meet the patient’s needs.

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