Factors contributing to sleep deprivation and nursing strategies to facilitate sleep in intensive care units at Muhimbili National Hospital Dar es salaam, Tanzania

Abstract

Sleep is defined as a periodic, reversible state of cognitive and sensory disengagement from the external environment. It is a complex physiologic and behavioral process essential for rest, repair, well-being, and survival. Sleep deprivation has been identified as a challenge for patients in the intensive care unit and this may lead to a variety of physiological and psychological dysfunctions that affect the recovery process. Studies conducted over the past 30 years indicate that sleep deprivation alters respiratory function, disrupts hormone levels, lowers immune function, and leads to neuro-cognitive changes. The aim of this study was to determine the modifiable factors that affect sleep in intensive care units, assess the nursing strategies practiced in the ICU and assess the actual nursing practice through observation. Methods: Quantitative, descriptive cross sectional study was conducted at the main and open heart surgery ICUs of Muhimbili National Hospital. Thirty three patients admitted to the main MNH ICU were interviewed and 41 nurses working in both the main MNH and Open Heart Surgery ICUs were provided with structured self-administered questionnaire. The main MNH ICU was also assessed for resource availability and actual nursing practice using a checklist. Participants were consented before their participation in the study. Ethical clearance was obtained from MUHAS ethical committee. The study was conducted from April to May, 2013. Data analysis: Data collected from the 33 patients (17 women and 16 men) and 41 nurses (30 women and 11 men) was analyzed using Statistical Package for the Social Sciences (SPSS) software version 20. Descriptive statistical methods including chi-square, Fisher‘s Exact Test, P-value, frequency, and proportions were used. Data collected using an observation check list to assess resource availability and actual practice of ICU nurses was also compiled. Close-ended questions were used to collect information. Each response was numerically coded as viii ―0‖ for no or not observed practice and ―1‖ for yes or observed practice. The data was then entered and analyzed using SPSS soft ware version 20. Frequencies and percentages were used to analyze data and descriptively summarized. Results: Patients reported that pain, noise, thirst and nursing care activities were the major factors impacting sleep in ICU; i.e 64% due to pain, 42% noise, 42% thirst and 39% due to care activities such as restriction of movement from blood pressure cuff and intravenous lines. Pain influenced sleep more in women than men, Fisher‘s Exact Test, p= 0.025. Feeling of thirst also showed high statistical significance difference among sex (p 0.009). Nurses believed stress was the major factor, followed by pain, noise and light, as contributors for sleep deprivation in MNH ICUs. According to the nurse respondents, 76% believed sleep is influenced due to stress related to medical jargon, 73% due to pain, 71% due to noise and 61% due to light. The strategies reported used to promote sleep include 93% reduce noise from monitor alarms, and telephone conversation, 63%, described air conditioner and heater adjustment, 63% participants described feeding patient as prescribed, and 51% reported they address fluid needs based on patient assessment; 42% described they adjust light. Observation results also showed, most nurses were observed reducing monitor and ventilator alarms, administering sedatives, increasing or reduction of clothing and giving warm baths, all nurses feed per ICU schedule, average number address fluid needs as prescribed. However staff telephone conversation in ICU was high. Conclusion: Sleep in the intensive care unit is influenced by care and treatment routines, environmental sources, physiological and psycho-social factors. Pain followed by noise, feeling of thirst and nursing care activities are among the major challenges that influenced sleep in the ICU. Women patients are more susceptible for sleep deprivation due to pain and feeling of thirst than men at MNH ICU. Limited resources used for sleep promoting strategies may have impacted quality care delivery in the ICU.