Sleep promotion for hospitalised children: Developing an evidence-based guideline for nurses

Elijeshca C Crous,Natasha North

doi:10.4102/curationis.v44i1.2219

Abstract

BackgroundAdequate sleep in hospitalised children is important for a variety of physiological and psychological processes associated with growth, development, and recovery from illness and injury. Hospitalisation often prioritises clinical care activities at the expense of age-appropriate sleep. Nurses and the wider healthcare team contribute to this paradox. However, through conscious practice and partnering with mothers, nurses are able to enact change and promote sleep.ObjectivesTo adopt, adapt or contextualise existing guidelines to develop an evidence-based practice guideline to promote sleep-friendly ward environments and routines facilitated by nurses, and in partnership with mothers.MethodA six-step methodology for guideline adaptation was followed, as recommended by the South African Guidelines Excellence project: (1) existing guidelines and protocols were identified and (2) appraised using the AGREE II instrument; (3) an evidence base was developed; (4) recommendations were modified, (5) assigned levels of evidence and grades of recommendation; and (6) end user guidance was developed. Expert consultation was sought throughout.ResultsExisting relevant guidance comprised 61 adult-centric recommendations. Modification of the evidence base led to six composited recommendations that facilitate sleep in hospitalised children: (1) prioritising patient safety; (2) collaborating with the mother or caregiver to promote sleep; (3) coordinating ward routine and (4) environment to improve sleep; (5) work with clinical and non-clinical staff; and (6) performing basic sleep assessments. Practice recommendations were aligned to the South African regulatory framework for nursing.ConclusionHospitalisation is a time of physiological and psychological dysregulation for children, which is amplified by poor sleep in a hospital. Nurses have the opportunity to promote sleep during hospitalisation by implementing this African-centric guideline in partnership with mothers.

Highlights

Sleep is crucial to the developmental processes of children (Beebe 2011; Davis, Parker & Montgomery 2004; Grigg-Damberger 2016), and is important in regulating emotion, behaviour, coping and perceptions of pain (Bevan et al 2019; Jimenez et al 2018; Stickland et al 2016)
One guideline was identified (The Royal Children’s Hospital Melbourne 2015) as well as two published articles (Elliott & McKinley 2014; Knauert et al 2018) which met the criteria for inclusion and were subjected to full text screening and searching of reference lists
The authors of the above sources were contacted and provided additional information that led to the identification of Elliott (2012) and the Naptime Registered Nurse (RN) checklist (Knauert 2013), which were included as a subset of the Naptime protocol (Knauert et al 2018)

Summary

Introduction

Sleep is crucial to the developmental processes of children (Beebe 2011; Davis, Parker & Montgomery 2004; Grigg-Damberger 2016), and is important in regulating emotion, behaviour, coping and perceptions of pain (Bevan et al 2019; Jimenez et al 2018; Stickland et al 2016). Sleep regulates vital signs (Dennis et al 2010), improves immunity and supports recovery from illness and injury (DeKeyser Ganz 2012; Gamaldo, Shaikh & McArthur 2012). Length of stay is adversely affected by in-hospital sleep disruption (Morse & Bender 2019). Adequate sleep in hospitalised children is important for a variety of physiological and psychological processes associated with growth, development, and recovery from illness and injury. Through conscious practice and partnering with mothers, nurses are able to enact change and promote sleep

Objectives

Methods

Results

Discussion

Conclusion