Reducing Unnecessary Sleep Disruption for Neonatal Patients

2017

Cognition, Technology & Work, 2004

Neonatal intensive care units (NICUs), like other intensive care units, are intended to provide immediate responses to any change in the patient's condition. Patient-monitoring alarms and alarms from other medical equipment are very common in these units, and most alarms have no clinical significance. This study addresses the question of how alarms affect nurses' actions by measuring the occurrence of alarms from different causes in a NICU, recording the nurses' reactions, and analyzing the relationship between the alarms and the actions. The results show that nurses often do not respond directly to alarms, but, rather, use them as additional sources of information in their ongoing flow of actions. The probabilities for their responding to an alarm depend on the causes of the alarm, its duration, and the characteristics of the patient. These findings support the view that experienced nurses dynamically adjust their activities according to the information they receive from alarm systems and other sources, and that they combine their reactive actions with the periodic performance of routine tasks.

2018

Early Human Development, 2017

Throughout the animal kingdom sleep plays an important functional role. Sleep has been linked to body temperature regulation, energy saving, memory consolidation and brain plasticity. In mammals sleep deprivation can have severe health consequences and 'rebound sleep' (attempts to regain the lost sleep) is seen when mammals are sleep-deprived. Although the functions of neonatal sleep are still thought to be largely unknown, increasing evidence over the past decade suggests that sleep plays a major role in the development of neural pathways in the neonatal brain. During late fetal and early neonatal stages of human development, the primary activity of the brain is to sleep. Both clinical and basic neuroscience insights on this topic have led to a growing interest in sleep medicine and today 'chronomedicine' is becoming increasingly established in adult healthcare. In our current practice protecting neonatal sleep is also considered an important part of optimal care for high risk infants admitted to the neonatal intensive care unit (NICU). Although many different interventions have been reported to promote sleep in infants on the NICU, there is great heterogeneity across studies: the targeted sleep behaviors, the methods of sleep assessment and the study populations vary significantly across published reports. In this special edition a systematic review of the literature by van den Hoogen et al. concludes there still seems to be insufficient evidence to recommend any new intervention to promote neonatal sleep on the NICU. Therefore it stresses the importance of high quality future neonatal sleep studies on this topic. To promote and protect neonatal sleep identification of sleep-wake states is necessary. Sleep-wake states can be distinguished both through clinical observation, EEG analysis and algorithms distracting sleep wake stages from vital signs (e.g. breathing rate and heart rate). Dereymaeker et al. provides a clear overview on sequential EEG-sleep analysis in preterm infants. This review provides insights into the pre-programmed process of sleep ontogenesis during the neonatal period. Werth et al. demonstrate how heart rate variability retrieved from electrocardiography can be used for unobtrusive assessment of neonatal sleep states. Having highlighted the importance of neonatal sleep for optimal brain development, it is important to realize that sleep is also a state in which neonatal breathing difficulties can be prominent. In the review by Joosten et al. indications for different clinical entities to perform sleep studies (polysomnography) and the consequences for further treatment and follow-up are described. Finally, beyond the neonatal period there is increasing recognition that sleep plays a critical role in child health and development. As we enter the age of chronomedicine, where the interaction between biological rhythms, medicine and drugs are explored, sleep should be considered as part of optimal neurorehabilitation. Verschuren et al. report on how optimal sleep is emerging as an essential component of a triad of healthy behaviors: sleep, healthy diet and physical activity.

Acta Paediatrica, 2020

To address alarm fatigue, a new alarm management system which ensures a quicker delivery of alarms together with waveform information on nurses' handheld devices was implemented and settings optimized. The effects of this clinical implementation on alarm rates and nurses' responsiveness were measured in an 18-bed single-family rooms neonatal intensive care unit (NICU).

Advances in Neonatal Care, 2012

International Journal of Environmental Research and Public Health

Sleep is a crucial factor for the psychological and physiological well-being of any human being. In Neonatal Intensive Care Units, preterm newborns’ sleep may be at risk due to medical and nursing care, environmental stimuli and manipulation. This review aims to identify the nurses’ interventions that promote sleep in preterm newborns in the Neonatal Intensive Care Units. An integrative review was conducted following Whittemore and Knafl’s methodology and the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The research was carried out on the electronic databases PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ScienceDirect, with a timeframe from 2010 to 2021. A total of 359 articles were initially identified. After selection and analysis, five studies were included in the sample. Interventions by nursing staff that promote sleep in preterm newborns in the Neonatal Intensive Care Units fa...

PubMed, 2015

Aim: Sleep is essential for children's physical and mental recovery and it is indispensable for their growth, for endocrine and for immune function, and for the development of cognitive behavioral skills. The purpose of this study is to describe the impact of hospitalization on the sleep patterns of newborns, infants and toddlers, as well as mothers' perceptions of any changes in their children's sleep patterns. Methods: This was a single-centre cross-sectional study. The study included children aged up to 2 years who had been hospitalized for more than two days, selected by accidental sampling. Data were collected using an anonymous questionnaire with open and closed questions administered to mothers. Results: Two hundred and one children aged on average 11.2 months (SD 10.3) were enrolled in the study. The percentage of children who at home used to sleep less than 5 hours a night increased by 4.7% in hospital, while the percentage of children sleeping 9 to 11 hours at home decreased by 5.9% in hospital. In hospital mothers put their children to bed later than at home. Indeed, the number of individuals going to bed between 9 and 10 p.m. decreased by 9.8% in hospital, while the number of children going to bed between 10 and 11 p.m. increased by 10.1%. The number of children who had 2 to 4 awakenings per night increased by 13.9% and the number of those who had 4 to 6 nocturnal awakenings increased by 4.8%; 50.5% of mothers reported that their children's sleep was interrupted by nurses to provide care. Mothers generally perceived their children's sleep as adequate, even if they noticed that their children were more restless and irritable. Mothers with only one child reported that they had more difficulty helping their children fall asleep (P=0.02). Conclusion: The study highlights the need to review the routine in paediatric wards on the basis of the sleep needs of children. Further studies are needed to estimate the effectiveness of the specific measures suggested by mothers.

Behavioral Sleep Medicine

Study Objectives: The purpose of this study is to identify factors associated with Neonatal Intensive Care Unit (NICU) mothers' quality of sleep as measured with the General Sleep Disturbance Scale (GSDS). Methods: Recruitment took place in a level 3 NICU. At enrollment, mothers completed a socio-demographic questionnaire, described their presence in the unit and their breast milk expression behaviour. They also completed online or paper questionnaires about NICU-related stress, symptoms of postpartum depression, family-centered care, perception of noise and light in the unit, and sleep disturbances. Data regarding the infant's clinical condition were collected from their medical file. Pearson correlations were performed to identify associations between mothers' quality of sleep and other study variables. Subsequently, to compare mothers with a clinically significant GSDS score to mothers with a non-significant score, a binary logistic regression model was conducted. Results: 132 mothers participated. Sleep disturbances of mothers with an infant hospitalized in the NICU was positively correlated with stress (r = 0.40; p = 0.00), depressive symptoms (r = 0.51; p = 0.00), and breast milk expression (r = 0.23; p= 0.01). In addition, for mothers with significant levels of depressive symptoms (OR = 1.19; p = 0.00), with greater presence in the unit (OR = 1.36; p = 0.04), or with other children at home (OR = 3.12; p = 0.04), the likelihood of clinically significant sleep disturbances was increased. Conclusions: These results improve our understanding of the factors influencing the quality of sleep of mothers whose premature infant is hospitalized for 2 weeks or more in the NICU. In addition, these results allow the identification of mothers having a higher possibility for sleep disturbance, which enables the implementation of targeted interventions to promote adequate sleep.

Sains Malaysiana, 2020

The critically ill patients' experiences and sleep quality are a crucial aspect of quality care in the critical care setting. The aim of this study was to identify the perceived sleep quality and patients' experiences during their stay in critical care units. Data was collected using validated and reliable self-reported questionnaires by patients on sleep quality in the intensive care unit and intensive care experience (ICEQ) for two months' duration. A random sampling was used in participants' selection and 55 patients who fulfilled the inclusion criteria participated in this study. Descriptive and Inferential analyses were used in data analysis. Mean age of the respondents was 52 with 64% male. More than half (58.2%) patients reported poor sleep quality while in critical care units. Disruption in patients' sleep was mainly due to noises from medical devices alarms (76.36%) and constantly taking vital signs e.g. measuring blood pressure (70.90%). Even though more than half of the patients (54.5%) reported more frightening experiences while in critical care units, but overall their experience was either positive or neutral. Patients (16.36%) who stayed longer in critical care units between 8-12 days reported better sleep quality. Reducing noise by minimizing the alarm sounds and attend to any alarm as soon as possible may help to promote better outcome for patients' sleep quality and experience while in critical care. It is important for nurses to plan and cluster the patient's care to avoid constant disturbance.