Sleep disruption is commonly identified as a feature of admission to critical care units. The environment,
level of intervention, and patient morbidity are understood to influence patients’ poor experiences of sleep in critical care. This study discusses the impact of the built environment on Intensive Care Unit (ICU) patients’ sleep.
The objectives of this study were to evaluate the quantity and quality of sleep that patients perceived they experienced in the critical care setting; identify factors preventing sleep; identify factors promoting sleep; and evaluate the usefulness of eye masks and earplugs as an intervention to improve sleep in the critical care environment.
The study design was a prospective pre/post-service evaluation over 2008/2009 based on a prior investigation into the efficacy of eye masks and earplugs.
Sample
A convenience sample of 100 patients was identified to participate in the evaluation.
Setting
This service evaluation took place in a 17-bed teaching hospital’s general ICU. The unit is divided into an 11-bed horseshoe-shaped area with an adjacent six-bed nightingale style ward. The unit provides care for emergency medical and surgical patients and elective surgical patients from a range of specialities.
Metrics and Measurement
The data collection tool comprising of three elements was adapted from a prior study. The first element used hospital charts and medical notes to gather data relating to age, gender, bed location, specialty,length of stay, and level of care/dependency. The second element asked participants to rate the quantity and quality of sleep using 5-point Likert scales. The third element of the data collection tool was
a four-item data collection sheet comprising of one closed- and three open-ended questions, designed to investigate the factors helping them to sleep and preventing them from sleeping.
Confounding Variables
None were identified.
Data Analysis
Quantitative data was analysed using Excel 2007 (Microsoft Corp., Redmond, Washington,
USA). Qualitative data was transcribed verbatim; the transcripts were analysed using content analysis.
This service evaluation demonstrated that patients reported sleeping for longer periods using earplugs and eye masks; however, there was no reported improvement in patients’ perception of quality of sleep. This suggests that although patients may have reported longer periods of sleep, sleep may have been fragmented or disturbed.
Noise was identified as a sleep-disturbing factor in both groups, although the significance of noise as a sleep-disturbing factor in the literature is unclear. Both groups also identified observation/intervention, light, discomfort, and environment as sleep-disturbing factors.
The small sample size, reliance on patient recall, and the study design limit the generalizability. There are a number of disadvantages associated with using a large number of inexperienced investigators. This includes the possibility of greater variation among interviews than would be found in a study using fewer interviewers.
During the project, the unit underwent a three-week period of refurbishment, resulting in an alteration in the environment that participants were exposed to. The environment experienced by the two cohorts may have been inconsistent in terms of the type and distribution of light to which patients were exposed. Another important limitation is that we have not controlled for the patients’ location in the critical care unit. A patient attempting to sleep in a side room will not experience the same range of disturbances experienced by patients being cared for on the ICU or High-Dependency Unit (HDU).
The evaluation also had a clear focus on the high-dependency patient. The experiences of this group of patients may not be representative of wakeful intensive care patients.