Improving critical care patients' sleep quality in a surgical high-dependency unit: An evidence-based practice project.

Abstract

Sleep is an essential basic need. However, patients in critical care often experience poor and fragmented sleep. As such, there is a need to examine strategies to promote sleep in critical care patients. This project aimed to promote sleep in surgical high-dependency patients through the implementation of evidence-based best practice. An evidence-based practice (EBP) project was implemented in May 2015 in a 24-bed surgical high-dependency (progressive care) unit in a public tertiary hospital in Singapore in three phases using the JBI framework. Outcomes measured were sleep quality, using the Richards-Campbell Sleep Questionnaire, and nurses' adherence to sleep promotion activities, using an audit tool adapted from the JBI-Practical Application of Clinical Education System. Data were collected at baseline, 1, 3, 6, and 12months. Getting Research into Practice analysis was done at each time point. A total of 120 patients were surveyed, and 150 observation audits were conducted over 1year. Sleep quality was similar between pre-audit (mean 53, SD 19.89) and month 1 (mean 54, SD 24.40), improved at month 3 (mean 64, SD 19.34), and sustained at month 6 (mean 64, SD 24.13) and 12 (mean 64, SD 19.4). The effect size between pre-audit and month 3 was a medium effect size of 0.49, which continued to improve at month 12, with a medium effect size of 0.56. Nurses' adherence to the EBP generally improved, and the thresholds of 80% were exceeded by month 12. Sleep is an essential basic need and can be improved through simple evidence-based interventions. Best practice for promoting sleep includes grouping nursing activities and reducing light and noise at night.