Efforts to improve sleep quality in a medical intensive care unit: effect of a protocol of non-pharmacological interventions

Purpose This study aimed to evaluate the effect of a protocol of nonpharmacological interventions to improve sleep quality in the intensive care unit (ICU). Due to its close relationship with sleep quality, the effects of the same interventions on noise levels and delirium rates were also evaluated in this study. Methods This pretest-posttest design with a control group was carried out in a medical ICU over 8 months. Data were collected using Acute Physiology and Chronic Health Evaluation II, the Glasgow Coma Scale, the Richmond Agitation-Sedation Scale, the Richards-Campbell Sleep Questionnaire (RCSQ), the Confusion Assessment Method for the Intensive Care Unit, and noise measurement devices. In the first phase of the study, patients receiving standard care in the ICU were followed. After the first stage, a training session was held for nurses to raise awareness and information. Then, the sleep-promoting protocol created by the researchers was applied. The ambient noise level was measured continuously. Results A total of 78 patients with a mean age of 70.0 +/- 13.2 years were followed in the ICU for an average of 7.3 +/- 3.8 days. With protocol implementation, the ambient noise level in the ICU was reduced from 70.9 +/- 3.8 dB(A) to 62.7 +/- 3.5 dB(A) (p < 0.01); the RCSQ scores of the patients increased from 48.3 +/- 1.4 to 62.1 +/- 1.8 (p < 0.01). Although statistically nonsignificant, efforts to improve sleep quality also reduced the development of delirium by 15%. Conclusion It is possible to improve sleep quality and reduce noise levels in an ICU with a protocol consisting of multicomponent nonpharmacological interventions.