Maslow’s hierarchy of human needs prioritizes sleep as one of the most important factors in maintaining homeostasis and replenishing energy, an essential part of the recovery process for hospitalized patients. Presence Holy Family Medical Center’s DEU has been facing sleep deprivation issues amongst patients due to the number of visits by the nurses with medications and interruptions from external noise. Patients who experienced a lack of quality sleep may lose the restoration process at the cellular level thus affecting cognitive and physical performance as well as patients’ quality of life.
Moreover, sleep loss leads to reduced energy, impaired physical restoration and mobilization, which can result in falls. By observing and gathering information about patient’s satisfaction with their sleep and sleeping environment, it would be easier to identify interrupting factors and set aside time for rest periods without disrupting their sleep cycle.
The nurse manager of the DEU has identified sleep deprivation in critically ill patients to be a recurring problem due to the timing of medication administration, bed alarms, call light alarms and other external noise. Many RNs have identified that patients were awake early in the morning and feeling tired in the afternoon due to lack of sleep. The nurse manager concluded that sleep deprivation is a pertinent issue that must be addressed to improve patient outcome and supports the project.
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Enhancing the time spent asleep and sleep quality is a big component in improving cognitive performance, maintaining homeostasis and facilitating the mobilization and rehabilitation process. Increased restfulness can decrease the risk of falls and benefit the unit and the organization by increasing patient satisfaction and quality of care. Furthermore, the nurses in the DEU can be recognized for the decreased incident reports on falls and overall improvement in quality of patient care.
Increased cortisol levels from the physical stress of an illness in addition to the environmental stressors of a hospital environment creates sleep interruptions and chronic sleep deprivation. Frequent patient care activities, environmental noise, bright lighting and medications interfere with patients’ ability to fall asleep and stay asleep. Extensive research has been conducted which linked how sleep deprivation can negatively affect physical and psychological health of the patient. Some of the major effects of sleep deprivation were increased level of stress, anxiety, decreased strength, immune function and prolonged hospitalization.
Pilkington (2013) conducted a qualitative and quantitative research to determine the factors that affect sleep quality in hospitalized patients and the physiological effects of sleep deprivation. Results showed that the most disruptive causes included pain, noisy environment, stress, and lighting which contributed to increased sleep latency, reduced stage 3 and 4 sleep, increased sympathetic stimulation and altered hemodynamics and immune mechanisms. Cognitively, patients displayed reduced reaction time and cognitive alertness decline, leading to increased risk for falls due to imperfect balance. This study demonstrated that long-term and short-term hospitalized patients are prone to inadequate sleep time leading to negative health outcomes.
A qualitative interview study conducted by Gellerstedt (2014) explored patients’ experiences of sleeping in a hospital and the psychological factors that influenced quality of sleep. Results showed that aside from the physical factors that disturbed sleep, the nursing staff’s bedside manner were associated with quality of sleep and sleep deprivation. Nurses who failed to respond seriously to the patient evoked feelings of sadness, abandonment, and helplessness leading to increased stress level, anxiety and decreased sleep quality.
Nurses who provided compassionate, empathetic care, promoting patient autonomy and dignity contributed to trust and feelings of security by patients, thus decreasing their anxiety and increasing quality sleep. Psychological factors such as preservation of patient’ integrity, involvement in the plan of care and the bedside manner of nurses contributed significantly to patient’s satisfaction with sleep during hospitalization.
