I chose an article from the magazine Critical Care Nurse, published by the AACN (American Association of Critical Care Nursing). The article discusses a study where post-operative cardiac surgery patients were given sleep masks in the ICU for 3 nights. The purpose of the study was to determine if providing a sleep mask to inpatient adult cardiac surgery patients would help reduce post-operative pain through the improvement of sleep quality. The findings of this study indicated that the use of nighttime eye masks may help improve sleep quality in postoperative cardiac patients and therefore contribute to decreases in perceived pain and analgesic needs. This study is relevant to my practice as an ICU nurse recovering fresh open-heart surgery patients. Due to the nature of the surgery, nearly all patients have complaints of pain post-operatively. This can inhibit them from wanting to cough, deep breathe, and ambulate as much as they should. In addition to this, some patients who encounter issues after surgery might not get extubated right away or have a longer stay in the ICU. A portion of these patients tend to develop some type of ICU delirium. Most cardiac surgery patients complain about not getting good sleep, whether it’s from noise, the ICU bed, pain, or from sleep interruption due to care that is provided during the night. Improving patient sleep quality could help with postoperative pain and prevention of ICU delirium. Also, sleep masks do not require special training to use. It is a low-cost intervention.
Mahran, G., Leach, M., Abbas, M., Abbas, A., & Ghoneim, A. (2020). Effect of eye masks on pain and sleep quality in patients undergoing cardiac surgery: a randomized controlled trial. Critical Care Nurse, 40(1), 27–35. doi: 10.4037/ccn2020709
ICU delirium is such a difficult side effect to prevent. The patient’s in the ICU seem as though they often become disoriented due to the interruption of their circadian rhythm and the inability to see the difference from day and night due to lights in the room, lack of windows, and the sedation many of the patients are in and out of. It seems as though this is a good intervention to at least try to see if it will help prevent delirium in some patients.
Hi there,
There are some ways to attempt to prevent ICU delirium, although, like you say, it can be difficult. At work, we try to attempt to imitate circadian rhythms by opening the blinds, turning on the lights, and turning on the TV in the room during daytime hours (if appropriate for that particular patient). At night, we turn off the TV, lights, and attempt to keep things as quiet as possible. We try to encourage family visitation during daytime hours and urge families to let the patient rest during the night.
An article I found mentions that increasing the family visiting hours can actually help delirium and cut rates of delirium in half (Karon, 2017). However, the article also states later on in the writing that this will only work as long as the family members don’t cause the patient anxiety or interfere with their sleep.
Karon, A. (2017, November 15). Simple steps help prevent ICU delirium. Retrieved February 24, 2020, from https://acphospitalist.org/archives/2017/11/simple-steps-help-prevent-icu-delirium.htm
That is an interesting article. It seems as though it would be very beneficial for the patient to have familiar interactions with family to prevent confusion. It is so hard on an ICU to reduce stimuli as there are often other patients with alarms going off, staff walking around outside of the patient room, and often the door has to remain open for the safety of the patient. It is seems to be a very difficult state of mind to prevent the patient from falling into. It is great that the literature supports and suggests family support for patient recovery.
What a great article that you can relate to what you do daily! What a rewarding job you have to take and guide people through a very vulnerable time of your life. Good sleep really dose do the body good. It’s no secret that ICU patients are exposed to noise, ringing, and weird lightening – which leads to delirium – very scary for the patient’s family to observe. The study I read discussed how some patients refused ear plugs and masks, because it was uncomfortable and they could not see. Overall, patients who agreed to wear the mask, ear plugs, and listen to music reported decreased pain and better sleep patterns.
Richardson A, Crow W, Coghill E, Turnock C. A comparison of sleep assessment tools by nurses and patients in critical care. J Clin Nurs. 2007;16:1660–8. doi: 10.1111/j.1365-2702.2005.01546.x. [PubMed] [CrossRef] [Google Scholar]
Hi “nahendrix”,
In the article I cited above, there was a mention of a few patients who were ruled out of the study because they refused to wear a sleep mask. Discomfort was the main reason for this. The study did not utilize ear plugs or music. However, I’m sure that when I delve into further research, I will probably find studies that have utilized these methods to help patients obtain better sleep. Thank you for your post!
I almost choose this same article for my assignment last week. Getting adequate and quality sleep is a common problem in the ICUs I work at. Kawai, et al. (2019) cited studies that have found an association between quality of sleep and clinical outcomes, with better quality of sleep associated with better patient outcomes, and a possible “link between disregulated sleep and development of delirium in the adult population” (p.387). Their research cited many studies that indicated that the PICU patients have frequently poor quality of sleep due to noise pollution and other factors. Because children require more sleep than adults, there could be even more severe consequences to not getting adequate or quality sleep in the PICU and “delirium occurs frequently in the pediatric population” with serious consequences even after the patient has been discharged (Kawai, et al., 2019). Their study sought to reduce noise pollution by having nurses use a checklist three times a day that included steeps that the nurse could easily take to help reduce noise in the patient’s room. They called this intervention the non-pharmacological delirium bundle checklist, and by using this list patient rooms were significantly quieter.
Reference
Kawai,Y., Weatherhead, J., Traube, C., Owens, T., Shaw, B., Fraser, E., Scott, A., Wojczynski, M., Slaman, K., Cassidy, P., Baker, L., Shellhaas, R., Dahmer, M., Shever, L., Malas, N., Niedner, M. (2019). Quality improvement initiative to reduce pediatric intensive care unit noise pollution with the use of a pediatric delirium bundle. Journal of Intensive Care Medicine, 34(5) 383-390. doi: 10.1177/0885066617728030 journals.sagepub.com/home/jic
Hi “mtrogers3”,
Great minds think alike! I went through many articles before deciding on this one, but now that I’m looking through the literature, I’m glad I decided on the topic of sleep and the ICU. Delirium is only one side effect of not getting good sleep. I plan to look deeper into pain levels and how they might correlate with disrupted sleep.
Do you work in a PICU? I have never dealt with the pediatric population. That is a good point you make about how the pediatric patients require even more sleep than adults, so they might feel the effects at an even higher level. Did the literature discuss delirium only, or was there mention of pain levels and the pediatric critical care population relating this to sleep?