Nocturnal care interactions with patients in critical care units.
BACKGROUND
Sleep deprivation is common in critically ill patients and may have long-term effects on health outcomes and patients' morbidity. Clustering nocturnal care has been recommended to improve patients' sleep.


OBJECTIVE
To (1) examine the frequency, pattern, and types of nocturnal care interactions with patients in 4 critical care units; (2) analyze the relationships among these interactions and patients' variables (age, sex, acuity) and site of admission to the intensive care unit; and (3) analyze the differences in patterns of nocturnal care activities among the 4 units.


METHODS
A randomized retrospective review of the medical records of 50 patients was used to record care activities from 7 PM to 7 AM in 4 critical care units.


RESULTS
Data consisted of interactions during 147 nights. The mean number of care interactions per night was 42.6 (SD 11.3). Interactions were most frequent at midnight and least frequent at 3 AM. Only 9 uninterrupted periods of 2 to 3 hours were available for sleep (6% of 147 nights studied). Frequency of interactions correlated significantly with patients' acuity scores (r = 0.32, all Ps < .05). A sleep-promoting intervention was documented for only 1 of the 147 nights, and 62% of routine daily baths were provided between 9 PM and 6 AM.


CONCLUSIONS
The high frequency of nocturnal care interactions left patients few uninterrupted periods for sleep. Interventions to expand the period around 3 AM when interactions are least common could increase opportunities for sleep.
Tamburri
Linda M
LM
Robert Wood Johnson University Hospital, New Brunswick, NJ, USA.
DiBrienza
Roseann
R
Zozula
Rochelle
R
Redeker
Nancy S
NS
D000368:Aged; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009551:Night Care / Q000706:statistics & numerical data*; D009723:Nurse-Patient Relations; D009741:Nursing Staff, Hospital; D012189:Retrospective Studies; D012892:Sleep Deprivation / Q000209:etiology*; D014481:United States