1. Patients’ quality of sleep at Canberra Hospital
L.J. Delaney1,2, J. Parke1, N. Da Fonte1, R. Richardson1 & M. Currie1,3
1. Research Centre for Nursing and Midwifery Practice; ACT Health; 2. Faculty of Health: Disciplines of Nursing and Midwifery, University of Canberra; Australia; 3. Australian National University, Canberra; Australia
Patients’ quality of sleep at Canberra Hospital
Introduction
Results
recommendations
Patients are exposed to a panoply of environmental stimuli within hospitals, which adversely effects sleep. As a result, patients report poor quality of sleep which is highly fragmented1. The pathogenesis for sleep disturbance is often attributed to extrinsic environmental factors such as noise, light, temperature and clinical interactions2. Both sleep deprivation and fragmentation have significant psycho-physiological consequences which in turn can protract recovery and increase mortality1,2.
Aim: To investigate the factors that adversely affect patient quality of sleep at Canberra Hospital.
A total of 144 patients were interviewed across the 15 clinical units. Their mean age was 64.2 years (St Dev = 17.00, range years) with 53.5% being male. The average length of hospital stay at the time of the interview was 15.5 days (St Dev = 34.8, range days).
Figure 1. Patients reported quality of sleep.
Conclusions
STRATEGIES TO PROMOTE SLEEP
Reduce noise
Reduce light
Cluster care and review timing of routine work practices
Better choice and maintenance of equipment
Improve pain management
Judicious use pharmacological interventions
Review physical layout
1. Freedman NS., Gazendam J., Levan L., Pack AI. & Schwab RJ. Abnormal sleep/wake cycles and the effect of environmental noise on sleep disruption in the intensive care unit. American Journal of Respiratory and Critical Care Medicine. 2001, 163;
2. Gabor JY., Cooper AB., Crombach SA., Lee B., Kaikar N., Bettger HE. & Hanly PJ. Contribution of the intensive care unit environmental to sleep disruption in mechanically ventilated patients nd healthy subjects. American Journal of Respiratory and Critical Care Medicine :
3. World Health Organisation (1999) Guidelines for community noise.
References
Acknowledgements:
Author's gratefully acknowledge the Canberra Hospital Foundation for their financial support and the Office of the Chief Nurse: ACT health for supporting the study
Sleep quality amongst patients was reported to be of a poor quality with only 24% of patients reporting good/very good quality of sleep (Figure1). Overall, patients reported a 1.8 hour decrease in total sleep time whilst they were in hospital
(M = 5.3 hours, St. Dev = 2.33 hours, range 0-10 hours).
“ Woken for antibiotics, staff being loud” (patient comment).
“frequent disruptions for medication/observations” (patient comment).
The findings of this study revealed that patients quality of sleep whilst in hospital was poor, with sleep quality being adversely affected by a number of factors which related to noise production attributed primarily to staff. This manifested as a reduction in total sleep time (M= 5.3hours), which is inadequate to promote a sense of rest and well being. The impact of such sleep disturbance on patient recovery has been previously been reported and includes circadian rhythm disturbance, decline in neurocognitive performance, prolonged hospital length of stay and increased patient mortality1-3.
The primary etiological cause of sleep disturbance within the hospital identified via environmental monitoring and reiterated in staff feedback and patient interviews was noise, followed by nocturnal clinical interactions, and ineffective pain management.
Although clinical staff identified noise as a contributor to poor quality of patient sleep, their perception was that noise was an expected and accepted part of being in hospital and the main contributors to the noise were “other patients”.
“Noise is part of the ward/hospital” (nurse comment).
“Cannot be helped. I tell my patients that they can rest at home when they are well”(nurse comment).
Ten recommendations were made to improve patient sleep quality with a view to establish clinical guidelines.
Methods
Noise levels in the clinical environments were 36.2% to 82.6% higher than the World Health Organisation recommended nocturnal noise levels of 30dB3 (Table 1). The predominant sources of noise within the clinical environments were attributed to staff behaviours and monitoring alarms.
Table 1. Noise levels recorded within the clinical divisions.
A cross sectional observational study was conducted involving 15 clinical units inclusive of Surgical, Medical, Aged Care and Rehabilitation Services, and the Intensive Care Unit of Canberra Hospital (Australian Capital Territory) over a 6 month period (May – October 2013).
Data collection involved structured patient interviews regarding sleep quality, and nursing self reports which identified factors that staff perceived to disturbed patient sleep.
Monitoring of clinical environment occurred between 22:00 and 07:00 hours. Sound and light level recordings occurred at 5 second epochs, and temperature was monitored at 30 minute epochs. Disturbing noise sources were logged by two research assistants.
Quantitative data was analysed using IBM SPSS Statistics (version 20), and qualitative data underwent thematic analysis using Nvivo (10QSR) software.
Participants
Clinical Area
Mean (dB(A))
St. Dev
Min. (dB(A))
Max. (dB(A))
ICU
52.85↑
5.89
40.2
98.3↑
Acute Aged Care
45.76
5.02
30.9
83.1
Rehabilitation
42.24
2.37
30↓
79.2
Cardiothoracic
48.3
1.43
38.7
92.8↑
Vascular
45.24
1.52
33.4
102↑
Neurosurgery
47.04
3.81
32.6
91.4
Gastrointestinal
45.11
1.53
82.4
Orthopaedics
44.47
3.43
34.9
86.5
Surgical Assessment & planning unit
36.37↓
3.98
26.8↓
85.4
Respiratory
47.6
5.76
33.3
94.6↑
CCU
47.7
3.64
38.3
86.6
Oncology
45.45
3.72
31.3
93.3↑
Neurology
46.87
1.18
37.3
83.4
Medical Assessment & planning unit
42.43
31.5
84.5
Renal
54.47↑
2.99
34.7
103.3↑
The patterns of elevated light sources were in accordance with the peak activity times of the night shift (Figures 2 and 3). The nursing station was found to be the prominent source of nocturnal light and noise, as staff congregated in this area and it acted as the hub for work activities.
Environmental temperature was found to decrease by 0.3 and 0.5°C between the hours of 01:00-03:00 hours.
Figure 2. Nocturnal light patterns in ICU.
Figure 3. Nocturnal light patterns in the Surgical Division.