Nurses’ Perspectives on Sleep Promotion Practices in Indonesian ICUs: A Multicenter Cross-Sectional Study
DOI:
https://doi.org/10.55018/janh.v7i2.311Keywords:
Intensive Care Units, Nurse, sleep duration, sleep qualityAbstract
Background: Critically ill patients commonly experience sleep disturbance, which has the potential to increase mortality and morbidity. Therefore, implementing interventions to enhance sleep quality is crucial. This study aimed to explore Indonesian nurses' perceptions of patients' sleep and to investigate the relationship between sleep promotion practices and the quality of sleep of patients in the Intensive Care Unit (ICU).
Methods: : A cross-sectional study design was used. A total of 211 nurses working in 10 ICU settings across 14 hospitals in Indonesia were involved using convenience sampling. The SLEEPii questionnaire was used to collect data from nurses who work in ICU for a minimum of one year. Data was analyzed using frequency, mean (±SD), Median (±IQR), the Spearman Rank test, Kendal tau, and Kruskal-Wallis test. This study was reported in accordance with the STROBE guidelines.
Results: 211 nurses from 14 hospitals in Indonesia reported that critically ill patients had sleep duration less than four hours (46.4%) and had fair sleep quality (58.8%). Sleep duration had significant differences between hospital status (p=0.004), and general hospital classification (0.002). Significant differences were also reported between sleep quality with ICU number of each Hospital (p=0.023), hospital status (p=0.047), and general hospital classification (0.032). Even though all participant reported that none of the ICU have protocol to promote sleep, this study found that duration of sleep correlate with control environmental noise levels (p=0.036), receiving medications for sleep (p=0.021), and activity to keeping ICU rooms dark at night (p=0.043), adhere to a clustered sleep protocol designed (p=0.001) and create conditions for a dedicated sleeping (p=0.004). Controlling environmental noise levels also correlated with sleep quality.
Conclusion: Most of the critically ill patients had fair sleep quality. Findings suggest the urgent need for standardized sleep promotion protocols in Indonesian ICUs.
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References
Ahn, Y. H., Lee, H. Y., Lee, S. M., & Lee, J. (2023). Factors influencing sleep quality in the intensive care unit: a descriptive pilot study in Korea. Acute and Critical Care, 38(3), 278–285. https://doi.org/10.4266/acc.2023.00514
Alegria, L., Brockmann, P., Repetto, P., Leonard, D., Cadiz, R., Paredes, F., Rojas, I., Moya, A., Oviedo, V., García, P., & Bakker, J. (2023). Improve sleep in critically ill patients: Study protocol for a randomized controlled trial for a multi-component intervention of environment control in the ICU. PLoS ONE, 18(5 May), 1–16. https://doi.org/10.1371/journal.pone.0286180
Andrews, J. L., Louzon, P. R., Torres, X., Pyles, E., Ali, M. H., Du, Y., & Devlin, J. W. (2021). Impact of a Pharmacist-Led Intensive Care Unit Sleep Improvement Protocol on Sleep Duration and Quality. Annals of Pharmacotherapy, 55(7), 863–869. https://doi.org/10.1177/1060028020973198
Ashghab, A., Vahedian-Azimi, A., Vafadar, Z., Mollahadi, M., & Sepandi, M. (2024). Nursing Interventions to Improve the Sleep Quality of Hospitalized Patients: A Systematic Review and Meta-analysis. Intensive Care Research, 4(1), 55–71. https://doi.org/10.1007/s44231-024-00056-9
Beck Edvardsen, J., & Hetmann, F. (2020). Promoting Sleep in the Intensive Care Unit. SAGE Open Nursing, 6. https://doi.org/10.1177/2377960820930209
Darby, A., Northam, K., Austin, C. A., Chang, L., & Campbell-Bright, S. (2022). Development and Implementation of a Multicomponent Protocol to Promote Sleep and Reduce Delirium in a Medical Intensive Care Unit. Annals of Pharmacotherapy, 56(6), 645–655. https://doi.org/10.1177/10600280211043278
Darbyshire, J. L., Borthwick, M., Edmonds, P., Vollam, S., Hinton, L., & Young, J. D. (2020). Measuring sleep in the intensive care unit: Electroencephalogram, actigraphy, or questionnaire? Journal of the Intensive Care Society, 21(1), 22–27. https://doi.org/10.1177/1751143718816910
Devlin, J. W., Skrobik, Y., Gélinas, C., Needham, D. M., Slooter, A. J. C., Pandharipande, P. P., Watson, P. L., Weinhouse, G. L., Nunnally, M. E., Rochwerg, B., Balas, M. C., Van Den Boogaard, M., Bosma, K. J., Brummel, N. E., Chanques, G., Denehy, L., Drouot, X., Fraser, G. L., Harris, J. E., … Alhazzani, W. (2018). Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. In Critical Care Medicine (Vol. 46, Issue 9). https://doi.org/10.1097/CCM.0000000000003299
El Arab, R. A., Alzghoul, H., Abu-Mahfouz, M. S., Aldarwish, Z., Abbadi, M., Ghashi, E., Alsaffar, G., Alasmkh, W., & Seweid, M. M. (2025). Nurses’ Perspectives on the Sleep Quality of Hospitalized Patients in Al Ahsa, Saudi Arabia. Nursing Reports, 15(2), 1–18. https://doi.org/10.3390/nursrep15020054
Elías, M. N. (2021). Assessment and Monitoring of Sleep in the Intensive Care Unit. Critical Care Nursing Clinics of North America, 33(2), 109–119. https://doi.org/10.1016/j.cnc.2021.01.008
Erkoc, A., Polat Dunya, C., & Uren, S. (2024). Night-time sleep of intensive care patients: A qualitative study. Nursing in Critical Care, December 2023, 1316–1324. https://doi.org/10.1111/nicc.13133
Grimm, J. (2020). Sleep deprivation in the intensive care patient. Critical Care Nurse, 40(2), e16–e24. https://doi.org/10.4037/ccn2020939
Jun, J., Kapella, M. C., & Hershberger, P. E. (2021). Non-pharmacological sleep interventions for adult patients in intensive care Units: A systematic review. Intensive and Critical Care Nursing, 67, 103124. https://doi.org/10.1016/j.iccn.2021.103124
kamdar-2016. (n.d.).
Locihová, H., Axmann, K., Žiaková, K., & Šerková, D. (2020). Effect of a Multicomponent Sleep Protocol on Sleep Quality in Conscious Patients in the Intensive Care Unit. Journal of Turkish Sleep Medicine, 7(3), 140–148. https://doi.org/10.4274/jtsm.galenos.2020.08208
Martinez, F. E., Poulter, A. L., Seneviratne, C., Chrimes, A., Havill, K., Balogh, Z. J., & Paech, G. M. (2022). ICU Patients’ Perception of Sleep and Modifiable versus Non-Modifiable Factors That Affect It: A Prospective Observational Study. Journal of Clinical Medicine, 11(13). https://doi.org/10.3390/jcm11133725
Nilius, G., Richter, M., & Schroeder, M. (2021). Updated perspectives on the management of sleep disorders in the intensive care unit. Nature and Science of Sleep, 13, 751–762. https://doi.org/10.2147/NSS.S284846
Razali, M., Fauzi, R., & Hamzah, S. S. C. (2023). Critical Care Nurses’s Knowledge and Attitude Towards Sleep Promoting Interventions Among Critically Ill Patients in Intensive Care Unit. Malaysian Journal of Medicine and Health Sciences, 19(4), 93–102. https://doi.org/10.47836/mjmhs.19.4.15
Shih, C. Y., Wang, A. Y., Chang, K. M., Yang, C. C., Tsai, Y. C., Fan, C. C., Chuang, H. J., Thi Phuc, N., & Chiu, H. Y. (2023). Dynamic prevalence of sleep disturbance among critically ill patients in intensive care units and after hospitalisation: A systematic review and meta-analysis. Intensive and Critical Care Nursing, 75(November 2022), 103349. https://doi.org/10.1016/j.iccn.2022.103349
Souza, R. C. da S., Calache, A. L. S. C., Oliveira, E. G., Nascimento, J. C. do, Silva, N. D. da, & Poveda, V. de B. (2022). Noise reduction in the ICU: a best practice implementation project. JBI Evidence Implementation, 20(4), 385–393. https://doi.org/10.1097/XEB.0000000000000311
Sundstrøm, M., Sverresvold, C., & Trygg Solberg, M. (2021). Factors contributing to poor sleep in critically ill patients: A systematic review and meta-synthesis of qualitative studies. In Intensive and Critical Care Nursing (Vol. 67). https://doi.org/10.1016/j.iccn.2021.103108
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