Date of Award

2018

Degree Name

Master of Philosophy (School of Nursing)

Schools and Centres

Philosophy and Theology

First Supervisor

Doctor Tracey Coventry

Second Supervisor

Adjunct Associate Professor Elaine Bennett

Abstract

Empirical evidence suggests that patients treated in the intensive care unit (ICU) experience chronic sleep disturbance, leading to sleep deprivation. Multiple intrinsic and external factors contribute to poor quantity and quality of sleep among critically ill patients. Noise, light and clinical interventions are some of the external factors most disruptive to patient sleep in the ICU. Given that nurses are the gatekeepers to the ICU, understanding their perceptions and practices relating to patient sleep is necessary to elicit change. However, ICU nurses’ attitudes, beliefs and practices relating to sleep are poorly understood.

Using a descriptive survey method, this study investigated the self-reported attitudes, beliefs and practices of ICU nurses in a tertiary hospital in the metropolitan area of Perth, Western Australia. A questionnaire with quantitative and qualitative elements was used as the instrument for data collection. Eighty-four nurses from a target population of 180 participated in this study (47%). Over half of the respondents held postgraduate qualifications and nearly all had worked in other ICU settings, given that the study ICU had only opened in 2014. The majority of respondents had not received any education on patient sleep and had not worked in an ICU with a clinical practice guideline or sleep-promotion protocol.

The findings suggest that the nurses believed it is important for patients to achieve adequate quantity and quality sleep while in the ICU; however, the sleep patients currently experience is insufficient and adversely affects a multitude of patient outcomes, including the development of delirium. The nurses believed that patients are concerned about sleep disturbance; however, they were divided in opinion regarding whether their colleagues were equally concerned. Sleep assessment in this setting is difficult and occurs without the use or knowledge of sleep assessment tools. Most sleep-promotion practices are considered important, yet are not performed consistently. A plethora of barriers to patient sleep were identified, with nurses describing a lack of control in managing these in the ICU setting. A focus on solutions was identified, with respondents unequivocally suggesting that education and routine, policy and culture change is required to better support patient sleep.

The results of this study contribute to the growing body of knowledge on patient sleep in the ICU and the modifiable factors that contribute to sleep disruption. These insights will inform the development of education, policy and protocol to support sleep in the critically ill patient.

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