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SEATTLE -- Hospitalized patients slept longer when their nurses straightened patients' sheets and blankets at bedtime or avoided talking at the patients' bedsides when making nighttime rounds, researchers reported here.
SEATTLE, May 7 -- Hospitalized patients slept longer when their nurses straightened patients' sheets and blankets at bedtime or avoided talking at the patients' bedsides when making nighttime rounds, researchers said here.
Moreover, although nursing interventions to improve sleep hygiene were associated with an increase in sleep hours, the use of sleep medications did not increase sleep time, reported Rita LaReau, M.S.N., A.P.R.N., B.C., G.N.P. of Bronson Methodist Hospital in Kalamazoo, Mich., at the American Geriatrics Society meeting.
On the first night in the hospital the median sleep times for 59 patients was six hours, but after consistent application the nurse-intervention protocol sleep time increased to a median of 7.50 hours during the final evening in the hospital (P=0.0469), she said.
Fourteen of the patients in the study requested and used sleep medications and these patients slept an average of 6.33 hours on the first night in the hospital versus 6.25 on the last night, which was not statistically significant.
Likewise there was a small, non-significant increase in the frequency of nightly awakening, from a median of less than one episode per patient on the initial night of hospitalization versus one nightly episode on the final night. The average length of stay in the hospital was fewer than four days.
"The protocol is really just basic nursing skills, but implementing it in a hospital is difficult because nurses frequently report that they don't have time for this protocol," LaReau said.
The nursing interventions included asking patients about their normal bedtime and adhering to that preference, personal hygiene assistance, backrubs, offering warm drinks and or snacks at bedtime, avoiding sleep time bedside talking and/or use of the overhead intercom, darkening the room, learning patient preference for radio or television at bedtime, and controlling the room temperature to a level comfortable for the patient.
The 59 patients in the study were hospitalized in either a 35-bed cardiology unit or a 32-bed adult medical unit, she said. In both units all patient rooms are private, which made implementation of the protocol easier than it would be in semi-private rooms.
Patients were asked to rate their sleep each morning using the five-question Richards/Campbell Sleep Questionnaire. The questionnaire asks patients to rate sleep by placing an "X" on an answer line that connects opposing answers.
For example, first question asks patients to rate the previous night's sleep as "deep sleep" or "light sleep" by placing an "X" closest to the correct answer.
Other questions asked addressed the time needed to fall asleep, about nighttime wakefulness, ability to resume sleep after a nighttime awakening, and, finally, the patients were asked to rate the previous night's sleep as a "good night's sleep" or a "bad night's sleep."
The patients were also asked to indicate which sleep protocols were initiated the previous night and to rank the interventions according to efficacy with "1" indicating the most efficacious followed by "2" and so on.
In general, assisting with personal hygiene, awareness of normal bedtime, darkening the room, and straightening the bed linens received the highest efficacy rankings. LaReau concluded that those interventions, if applied consistently over time, could promote sleep.
In addition to the small sample size, she said the study was also limited by the possibility that daytime sleep may have limited nighttime sleep.