Quiet time: a nursing intervention to promote sleep in neurocritical care units

Abstract

Patients in intensive care units are often sleep deprived, yet little research exists on the impact of nursing care on promoting sleep. To determine if implementing a "quiet time" protocol to reduce external environmental stimuli is associated with increased frequency of sleep among patients in a neurocritical care unit. Patients were observed 8 times each day before and after implementation of a protocol in which environmental sounds and lights were decreased from 2 AM to 4 AM and from 2 PM to 4 PM. Data collected at 2:45 AM, 3:30 AM, 2:45 PM, and 3:30 PM on patients with scores of 10 or greater on the Glasgow Coma Scale were analyzed. A total of 2975 observations were made on a total of 239 patients: 1446 observations on 118 patients in the control group and 1529 observations on 121 patients in the intervention group. The percentage of patients observed asleep was significantly higher during the months the quite-time period was implemented than during the control period before the intervention was started. The increase in sleep behavior was associated with decreased sound and light levels achieved during the quiet time. Patients observed during the intervention period were 1.6 times more likely to be asleep during the quiet time than were patients observed during the control period (P < .001). A concentrated effort by staff to reduce environmental stimuli at discrete preset intervals increases the likelihood of sleep during scheduled quiet time in the neurocritical care unit.