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Introduction for Evidence-Based Practice

Introduction

The paradigm of evidence-based practice in clinical research has now become one of the central notions in terms of implementing quality clinical practices and meaningful interventions. The notion of evidence-based practice is commonly defined as the process of applying scholarly findings to the daily clinical practice (Wilson & Austria, 2021). The patients’ sleep and rest, being among the most significant contributors to their recovery, belong to the nurses’ scopes of responsibility for one’s well-being on the hospital premises. According to Tester and Foss (2018), the perception of sleep in the context of rehabilitation and health promotion has now shifted from an activity to an occupation domain that affects one’s health and recovery potential. Regarding such an attitude to the patients’ sleep patterns, it is imperative for healthcare professionals to define the existing limitations in the way of securing proper rest within the facilities. The present paper investigates the current scholarly evidence on the matter of patients’ perception of sleep, satisfaction with the current sleep conditions in the hospitals, and the areas for further improvement of the sleeping patterns.

Annotated Bibliography

Delaney, L. J., Currie, M. J., Huang, H.-C. C., Lopez, V., and Van Haren, F. (2018) ‘They can rest at home’: an observational study of patients’ quality of sleep in an Australian hospital. BMC Health Services Research [online], 18 (524), pp. 1-9. Web.

The authors of the present article all belong to a community of professors in clinical nursing, and their publications mostly tackle the concepts of patient satisfaction and nursing competence. The authors are based in Canberra, Australia, and the study itself is conducted in an Australian hospital. BMC Health Services Research is an open-access source for publishing peer-reviewed health care studies, so the source is credible.

According to the authors, the primary objective of the research was ‘to investigate the perceived duration and quality of patient sleep and identify any environmental factors associated with patient-reported poor sleep in hospital’ (Delaney et al., 2018, p. 1). The underlying method used within the research is a cross-sectional study, which stands for an observational study that does not aim at manipulating the variables and focuses on the respondents’ perception at a given time. The method of the study conduction is quantitative by nature. The observations were recorded with the help of patient sleep interview forms, nurses’ self-report forms, and environmental monitoring forms (Delaney et al., 2018, p. 2). The sample recruited for the study included both patients and nursing staff, with the respondents being chosen by means of non-probability convenience sampling.

The primary inclusion criterion for the study was the patients’ and nurses’ availability for the time of study conduction. The exclusion criteria for the patients included them being intubated, receiving palliative care, having dementia, florid psychosis, and confusion (Delaney et al., 2018, p. 2). The final version of the sample included 144 patients admitted to one of the fifteen clinical units and 81 nursing staff. A significant aspect of data collection along with the sample interviewing was the recording of environmental factors such as noise, luminance, and temperature by the research assistants.

The researchers indicate that one of the major strengths of the research in question is the multiplicity of data collection tools employed within the research, including the patient interview form, the nurses’ self-report form, the environmental sleep observation form, and the environmental monitoring devices (Delaney et al., 2018, p. 2).

However, the study obtains several limitations, with the first being the approach to sampling, as convenience sampling, while cost- and time-efficient, increases the research’s predisposition to biases. The study was conducted during nighttime for only two nights, which means that the data collected shall not be considered exhaustive and may only become a starting point for more extensive research on the matter.

The findings of the study in question should be regarded from three major perspectives: the patients’ perception of sleep quality, the nurses’ attitude to the situation, and the environmental monitoring results. The monitoring outcomes demonstrated that the noise level on the hospital premises was higher than the recommendations outlined by the World Health Organization by 36% to 82% (Delaney et al., 2018, p. 1). As far as the sleep disruption factors are concerned, the perceptions of patients and nurses differ. Thus, both patients and nurses agreed that noise and clinical care, when combined, negatively affect the patient sleeping patterns (Delaney et al., 2018, p. 5). However, the deviations in the perception were also observed, with nurses outlining such factors as light and other patients and patients mentioning the factors of pain and cohort rooms (Delaney et al., 2018, p. 5).

Goeren, D., John, S., Meskill, K., Iacono, L., Wahl, S., and Scanlon, K. (2018) Quiet time: a noise reduction initiative in a neurosurgical intensive care unit. Critical Care Nurse [online], 38 (4), pp. 38-45. Web.

The authors of the present research are a team of intensive care nurses, a chief nursing manager, and a critical care nurse educator (Goeren et al., 2018, p. 39). The study was conducted in a neurosurgical intensive care unit (NSCU) at the North Shore University Hospital. The publication initially appeared in the issue of Critical Care Nurse, a peer-reviewed nursing journal. The primary objective of the research in question was to measure how the implementation of quiet hours within NSCU could decrease the overall noise levels on the premises. Researchers also questioned what intervention should be introduced to lessen the noise on a regular basis (Goeren et al., 2018, p. 38). Considering the study design, the research may be described as an experimental study that presents the hypothesis of quiet hours introduction being a beneficial factor in reducing noise levels within the NSCU as a baseline. The experimental nature of the research justifies its affiliation to the quantitative method paradigm. The variable of noise levels measured by the decibel meter was manipulated for several hours during the day. The results of the intervention were measured with the help of a paired t-test comparing results prior to the intervention and after the quiet time implementation.

Since the venue for the study was a 16-bed neurosurgical intensive care unit, there was no ability to work directly with the patient population during their condition. Moreover, as the primary goal was to define whether the introduction of quiet hours affected the overall noise levels, there was no need for a patient sample as such. Hence, the emphasis was placed on the decibel measurement prior to and after the education and quiet time implementation within the unit. The unit staff included eight registered nurses, two intensivists, two physician assistants, two critical care specialists, and a charge nurse. The highest concentration of staff communication in terms of noise was recorded at the nurses’ station in the centre of the unit (Goeren et al., 2018, p. 40).

The primary strength of the study in question is the empirical approach to the investigation and the timeframe of the research. Indeed, the results were recorded both eight days before and sixty days after the educational intervention (Goeren et al., 2018, p. 38). Moreover, the researchers managed to identify at least three tangible interventions to reduce noise in ICUs that could be employed with limited resources. However, as far as the limitations are concerned, it is necessary to outline that the study did not address the issue of the overall noise reduction, focusing solely on the peak hour noise levels. Moreover, it is also necessary to mention that authors warn about the so-called ‘Hawthorne effect.’ It means that the participants of the study were fully aware of the experiment conducted and, hence, might have subconsciously altered their behaviour to benefit the study outcomes.

The findings of the experiment define that the issue of noise reduction remains an extremely relevant case in the context of intensive medical care. The disruption of quiet within the facility affects one’s recovery, pain perception, and overall ability to rest. During the experiment, the noise levels proved to reduce after the education intervention, especially in the areas of the nurses’ station left and bed nine entrance (Goeren et al., 2018, p. 38). Insignificant changes were also noted at the nurses’ station left and bed four entrance (Goeren et al., 2018, p. 38).

Despite the recorded changes, the overall results of the experiment were not satisfactory when applied to the noise framework presented by the World Health Organization and the Environmental Protection Agency. However, it is appropriate for ICUs due to their workload and ongoing patient interventions (Goeren et al., 2018, p. 44). The most valuable finding of the study in question is the authors’ ability to outline tangible measures to reduce the noise levels in NSCUs, including ‘installing automation on the rear entrance… and identifying different time and space for physicians to conduct teaching sessions’ (Goeren et al., 2018, p. 44).

Ritmala‐Castren, M., Salanterä, S., Holm, A., Heino, M., Lundgrén‐Laine, H. and Koivunen, M. (2021) Sleep improvement intervention and its effect on patients’ sleep on the ward. Journal of Clinical Nursing [online], pp. 1-8. 

The present study is conducted in Finland, and the authors of the article are either professors in the sphere of clinical nursing or are the directors of nursing in the medical facilities of Finland. The Journal of Clinical Nursing is an American monthly peer-reviewed scholarly journal specialising in nursing. The authors of the research identify both the aim and the objective of the study in question. Hence, according to Ritmala‐Castren et al. (2021), the aim of the study is ‘to investigate how the sleep improvement interventions developed for the wards were associated with patients’ sleep’ (p. 1), whereas the objective is ‘to promote patients’ sleep’ (p. 1).

The present study is an example of a two-group intervention study with intervention and control groups observed with no explicit interference in terms of sleep quality and quantity, and the study itself is quantitative. The primary tool for the intervention assessment is using the five-item Richards-Campbell Sleep Questionnaire that was analysed statistically during the research (Ritmala‐Castren et al., 2021, p. 1). The overall sample comprised 209 participants from four hospital wards: a 46-bed surgical, 19-bed neurological, 20-bed pulmonary, and 35-bed medical, all located in an acute care medical facility (Ritmala‐Castren et al., 2021, p. 3). The sample was randomly allocated between the intervention group (n=105) and the control group (n=104).

According to the sample data collection, the majority of the patients were older than 60 years and placed inwards of two or three patients (Ritmala‐Castren et al., 2021, p. 5). The inclusion criteria for the participation in the study addressed such aspects as age (18 and older), ability to speak and write Finnish, the sleeping period at ward being no less than two nights, and the willingness to participate (Ritmala‐Castren et al., 2021, p. 3).

According to the researchers, the article obtains a series of contributions to the clinical practice. First, the study addresses the issue of poor sleep quality among patients, and this problem, while of paramount importance in the context of rapid and quality recovery, is frequently undermined by the professionals. Second, the collection of background information on the patients contributes to the identification of factors that affect the quality of one’s sleep. Furthermore, the information tackled in the article is beneficial for the nurses whose aim is to secure comfort and steady recovery for the patient. Finally, the dialogue with patients on the matter of sleep quality may serve as the first step towards efficient collaboration between patients and practitioners for the sake of hospital environment improvement (Ritmala‐Castren et al., 2021, p. 2). However, as far as the study’s limitations are concerned, the primary drawback concerns the lack of data on the number of interventions realised during the study (Ritmala‐Castren et al., 2021, p. 6). Furthermore, the limited sample of the study prevents the study from providing exhaustive evidence in order to implement immediate changes to the sleep quality of patients.

The major outcome of the study in question is the fact that the interventions presented by the authors did not result in considerable differences in terms of sleep quality improvement. However, patients within the intervention group experienced slight yet steady improvements in all the aspects of sleep quality, including depth of sleep, falling asleep, awakenings, general sleep quality, and sleep index (Ritmala‐Castren et al., 2021, p. 6). The statistics revealed that the sleep promotion intervention was more effective for males, which means that the further implications of the research should tackle both individual and gender perceptions of sleep in order to secure more significant outcomes (Ritmala‐Castren et al., 2021, p. 5). Hence, it may be concluded that the present study has value for future research on the matter of sleep quality improvement among patients. The major conclusion drawn from the study is the fact that improving sleep quality is a highly individual matter, and the interventions for sleep improvement should be developed in collaboration with patients.

Aparício, C., and Panin, F. (2020) Interventions to improve inpatients’ sleep quality in intensive care units and acute wards: a literature review. British Journal of Nursing [online], 29 (13), pp. 770-776. 

The article is written by a lecturer and a professional doctorate student from Cambridge University who specialise in medicine and social care. The British Journal of Nursing is a peer-reviewed journal that collects articles about various aspects of nursing practice. Hence, it is a trustworthy source of information. The aim of the article in question is ‘to summarise the strategies of sleep promotion in both ICU and acute ward settings by reviewing the literature (Aparício and Panin, 2020, p. 770). The objectives, for their part, concerned identification and comparison of different strategies for sleep promotion in ICUs currently presented in the scholarly literature (Aparício and Panin, 2020, p. 770). The method employed for the research is a systematic review, which focuses on the assessment and analysis of the previously published scholarly evidence. It is rather difficult to estimate whether the research is qualitative or quantitative, as the systematic review included both types of research. Yet, the authors claim to be more interested in the examination of quality of the evidence, making the research more qualitative (Aparício and Panin, 2020, p. 771).

The sample for the research included scholarly articles related to sleep improvement interventions among the patients admitted to the ICUs. According to Aparício and Panin (2020), the inclusion criteria for the review included randomised controlled trials, cross-sectional, cohort, and qualitative studies as well as the studies on adults older than 18 years admitted to the ICUs and acute care units on the matter of sleep improvement strategies (p. 770). The choice of the studies was conducted with the help of the PRISMA framework, which aimed at finding articles with the help of keywords and then filtering them by reviewing abstracts and removing duplicates. As a result, from 29, 308 studies identified in the initial search, eight articles were included in the final review (Aparício and Panin, 2020, p. 771). The strengths identified by the authors include the adherence to the PRISMA and CASP frameworks, which exclude the potential research biases (Aparício and Panin, 2020, p. 775). The limitations of the study, on the other hand, address the exclusion of unpublished literature on the topic.

Furthermore, the broadness of the population of interest with no special recognition to age and health-related conditions of the individuals (Aparício and Panin, 2020, p. 775). The findings of the present literature review indicate both the most widespread sleep-disturbing factors and strategies of their elimination or minimisation. Hence, the most frequently mentioned sleep-disturbing factors include noise, light, temperature, and humidity, condition-related factors such as pain, anxiety, discomfort, and care (Aparício and Panin, 2020, p, 774). The intervention strategies, for their part, include the use of medication, noise reduction, use of earplugs and masks, and educational and behavioural change (Aparício and Panin, 2020, p. 774).

Conclusion

Sleep quality is of paramount significance to clinical practice, as it explicitly contributes to the patients’ recovery and hospital stat satisfaction. The articles presented in the annotated bibliography demonstrate the demand for sleep improvement interventions, especially as far as acute and intensive care facilities are concerned. The interventions discussed in the research include noise reduction through quiet hours introduction and equipment change, use of medication, and better nurse-patient communication. All the studies imply the need to raise nurses’ and clinicians’ awareness of the importance of sleep quality with the help of education and training.

Part II: Reflection

Introduction

When experiencing constant pressure of securing the best clinical experience for the patients, the professionals tend to favour the purely medical aspects of care delivery. Subsequently, they undermine the significance of some of the fundamental human needs, such as rest and nutrition. According to the research findings and patient surveys, sleep deprivation remains one of the most challenging aspects of hospital stay for patients (Xu, Wick, and Makary, 2016; Care Quality Commission (CQC), 2020). Hence, the present research has helped me recognize both the scopes of sleep quality importance for patients and the significance of the evidence-based practice in nursing.

Lessons Taken from Findings

The articles discussed in the annotated bibliography concerned the both theoretical and empirical analysis of various sleep improvement strategies and interventions and the overall significance of sleep. The findings of the research indicate that nurses are responsible for the well-being of patients, and the communication with the patients on the matter of their sleep quality should never be abandoned because of negligence or lack of time (Aparício and Panin, 2020; Ritmala‐Castren et al., 2021; Goeren et al., 2018; Delaney et al., 2018). Thus, the lessons I have learnt from the aforementioned studies may be outlined as follows:

  1. Nurse-patient communication is a key to sleep quality improvement. According to Ritmala‐Castren et al. (2020), the collaboration between nurses and patients in the context of choosing a sleep improvement strategy is highly efficient and, thus, mandatory for the positive patient outcomes (p. 2). For this reason, I now realise that communication should play a critical role in my future interaction with patients, as learning about their sleeping quality triggers and concerns will eventually contribute to their recovery process.
  2. There is no universal approach to sleep quality improvement among patients. The findings from the articles point to various strategies nurses may address when planning sleep improvement interventions. Yet, all of them state that the limitations of the study include the inability to look into specifics of each patient in terms of sleep quality and basic demands to meet when planning an intervention. Hence, I will make sure to remember that every intervention is a highly individualistic matter accounting for age, health state, and collateral peculiarities such as habits or chronic conditions.
  3. The importance of interprofessional communication does not give practitioners the right to disturb patients. According to the findings, the overwhelming majority of patients feel disturbed by high noise levels deriving from communication between staff (Goeren et al., 2018, p. 38; Ritmala‐Castren et al., 2021, p. 2). Considering this, I will by all means avoid loud and inappropriate interactions with the colleagues in order to respect the patients’ right to rest and recover without detrimental interference from the professionals.

Importance for Patient Care

The investigation of the ways to meaningfully contribute to the patients’ sleeping patterns is, undeniably, a significant and beneficial endeavour in terms of enhancing the quality of clinical care. The quality of sleep has been proven to affect the patients’ recovery pace and perception of pain. It means that sleep improvement serves as a catalyst of the patients’ potential rehabilitation and overall health state (Delaney et al., 2018, p. 1). For this reason, the article findings are relevant and important for patient care in my professional setting since they directly affect the duration and quality of the hospital stay.

Another important aspect of the article findings concerns the emphasis on the importance of nurse-patient collaboration. Paying attention to such aspects as listening to the patient’s concerns about sleep quality is one step towards rebuilding the overall framework of meaningful care and compassion for patients. According to the findings stated by Delaney et al. (2018) and Ritmala-Castren et al. (2021), the investigation of sleep quality patterns among patients leads to a better understanding of the factors contributing to its deterioration or promotion. Simultaneously, it improves the quality of collaboration between the patient and the practitioner. Indeed, if I am curious about the sleep quality of my patients, they will feel more confident about the quality of their treatment and overall care.

Finally, the examination of sleep quality among patients is the first step towards reducing a significant amount of sleep deprivation-related conditions. According to Delaney et al. (2018), sleep disturbance contributes to the rapid deterioration of one’s immune system, increased probability of delirium and stress. Hence, I have discovered that by securing regular sleep improvement interventions, the patients will struggle with fewer health-related issues in the future.

Importance for Professional Competence and Values

As far as professional competence is concerned, I have taken out from the findings that the arguments in favour of sleep quality improvement make the associated interventions an integral part of nursing competence. Indeed, according to Ritmala-Castren et al. (2021), sleep quality assessment and intervention are to become full-scale components of any patient’s care plan in order to promote a beneficial change in clinical practice. In one of the articles reviewed by Aparício and Panin (2020), the authors mentioned the three primary nursing competencies, including safety preservation, patient prioritisation, and safety and trust promotion. Hence, health improvement initiatives explicitly relate to all these aspects, as they prioritise the patients’ need for good sleep, promote collaboration with the patient, and prevent health complications. I have concluded from the articles that including sleep improvement intervention in the patient care agenda should become a priority for my practice in the nearest future.

When it comes to values, it is of paramount importance to account for the nurses’ obligation to serve their patients for the sake of the best possible health outcome. According to Poorchangizi et al. (2019), the core nursing values include “altruism, autonomy, human dignity, integrity, honesty, and social justice” (p. 1). Thus, I am convinced that sacrificing one’s convenience in terms of noise levels and busy hours for the sake of better sleep quality among patients contributes to the manifestation of altruism and integrity. Moreover, starting a dialogue about the patient’s sleeping concerns manifests the nurses’ intention to exercise social justice and honestly discuss the patients’ care options.

Conclusion

Having taken into consideration the notion of sleep quality as a tool for health promotion, it may be concluded that the current paradigm of nursing care is to reconsider the importance of sleep intervention. In the context of today’s patient care planning, sleep improvement is crucial for better patient outcomes. Scholarly evidence presents arguments in favour of sleep interventions, as they are beneficial for both the patients and practitioners. While the former will be able to receive better treatment and care, the latter will have the ability to improve the patients’ well-being and receive treatment insights through personal interaction.

Reference List

Aparício, C., and Panin, F. (2020) Interventions to improve inpatients’ sleep quality in intensive care units and acute wards: a literature review. British Journal of Nursing [online], 29 (13), pp. 770-776.

Care Quality Commission (CQC). (2020) 2019 adult inpatient survey: statistical release [online] Web.

Delaney, L. J., Currie, M. J., Huang, H.-C. C., Lopez, V., and Van Haren, F. (2018) ‘They can rest at home’: an observational study of patients’ quality of sleep in an Australian hospital. BMC Health Services Research [online], 18 (524), pp. 1-9.

Goeren, D., John, S., Meskill, K., Iacono, L., Wahl, S., and Scanlon, K. (2018) Quiet time: a noise reduction initiative in a neurosurgical intensive care unit. Critical Care Nurse [online], 38 (4), pp. 38-45.

Poorchangizi, B., Borhani, F., Abbaszadeh, A., Mirzaee, M. and Farokhzadian, J. (2019) The importance of professional values from nursing students’ perspective. BMC Nursing [online], 18 (1), pp.1-7.

Ritmala‐Castren, M., Salanterä, S., Holm, A., Heino, M., Lundgrén‐Laine, H. and Koivunen, M. (2021) Sleep improvement intervention and its effect on patients’ sleep on the ward. Journal of Clinical Nursing [online], pp. 1-8.

Tester, N. J., and Foss, J. J. (2018) Sleep as an occupational need. American Journal of Occupational Therapy [online], 72.

Wilson, B., and Austria, M.-J. (2021) What is evidence-based practice? [online]. Web.

Xu, T., Wick, E. C., and Makary, M. A. (2016) Sleep deprivation and starvation in hospitalised patients: how medical care can harm patients. BMJ Quality & Safety [online], 25, pp. 311-314.

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