Time for Quiet Reducing Nighttime Interruptions in the ICU (TURN IN-ICU): Evaluation and Implementation of a Nonpharmacological Sleep Bundle to Improve Sleep Quality, Delirium, and Nighttime Sedation Requirements
School of Nursing
Date of Degree
Doctor of Nursing Practice (DNP)
Karen Kesten, DNP, APRN, CCNS, CNE, CCRN-K, FAAN; Cathaleen Ley, PhD, RN
Background: Undisturbed, restful sleep is essential for physiological as well as psychological well-being. For critically ill patients, sleep deprivation caused by frequent nighttime interruptions is associated with poor sleep quality and negative patient outcomes.
Objectives: The purpose of this Quality Improvement (QI) project was to promote uninterrupted sleep between the hours of 10 PM and 5 AM. Outcomes for evaluation consisted of the following three components: (1) sleep quality, (2) incidence of delirium, and (3) nighttime sedation requirements. Except for sleep quality, these variables were compared before and after the intervention.
Methods: A descriptive, before and after design for data collection and analysis was utilized. Quantitative data was obtained via the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), and the Richards-Campbell Sleep Questionnaire (RCSQ). The nurse-driven, non-pharmacological ICU Sleep Checklist contained nine interventions reducing noise, light, and iatrogenic sleep disturbances.
Results: Seventy-four patients received the intervention and completed the RCSQ. For all RCSQ items, patients scores indicated a tendency towards a favorable (mean, [SD], 51.78, [24.64]) and perceived nighttime noise levels were low (73.58, [26.93]. No incidences of ICU-acquired delirium were noted. A chi-square test determined a statistically significant relationship between CAM-ICU scores pre- and post-intervention (p
Conclusions: We identified an association between people who report better sleep quality and those who receive less medications during the night. An improvement in the rate of ICU delirium in this population suggests that by promoting sleep, ICU nurses can prevent the onset of delirium. It is feasible to apply this intervention with a minimal amount of extra work for nurses. An improvement in the rate of ICU delirium in this population suggests that by promoting sleep, ICU nurses can prevent the onset of delirium.
©2020 Christina Junker. All rights reserved.
Junker, MSN, RN, CCRN, C. (2020). Time for Quiet Reducing Nighttime Interruptions in the ICU (TURN IN-ICU): Evaluation and Implementation of a Nonpharmacological Sleep Bundle to Improve Sleep Quality, Delirium, and Nighttime Sedation Requirements. , (). Retrieved from https://hsrc.himmelfarb.gwu.edu/son_dnp/63