Aitken Leanne M, Elliott Rosalind, Mitchell Marion, Davis Chelsea, Macfarlane Bonnie, Ullman Amanda, Wetzig Krista, Datt Ashika, McKinley Sharon
School of Nursing and Midwifery, Griffith University, Queensland, Australia; NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Australia; Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; School of Health Sciences, City University London, United Kingdom.
Faculty of Health, University of Technology Sydney, Australia; Intensive Care Unit, Royal North Shore Hospital, Sydney, Australia.
Aust Crit Care. 2017 Mar;30(2):59-66. doi: 10.1016/j.aucc.2016.04.001. Epub 2016 Apr 17.
Sleep disruption is common in intensive care unit (ICU) patients, with reports indicating reduced quality and quantity of sleep in many patients. There is growing evidence that sleep in this setting may be improved.
To describe ICU patients' self-report assessment of sleep, examine the relationship between patients' self-reported sleep and their reported sleep by the bedside nurse, and describe the strategies suggested by patients to promote sleep.
An exploratory descriptive study was undertaken with communicative adult patients consecutively recruited in 2014-2015. Patients reported sleep using the Richards-Campbell Sleep Questionnaire (score range 0-100mm; higher score indicates better sleep quality), with nursing assessment of sleep documented across a five level ordinal variable. Patients were asked daily to describe strategies that helped or hindered their sleep. Ethical approval for the study was gained. Descriptive statistical analysis was performed [median (interquartile range)]; relationships were tested using Spearman's rank correlation and differences assessed using the Kruskal-Wallis test; p<0.05 was considered significant.
Participants (n=151) were recruited [age: 60 (46-71) years; ICU length of stay 4 (2-9) days] with 356 self-reports of sleep. Median perceived sleep quality was 46 (26-65) mm. A moderate relationship existed between patients' self-assessment and nurses' assessment of sleep (Spearman's rank correlation coefficient 0.39-0.50; p<0.001). Strategies identified by patients to improve sleep included adequate pain relief and sedative medication, a peaceful and comfortable environment and physical interventions, e.g. clustering care, ear plugs.
Patients reported on their sleep a median of 2 (1-3) days during their ICU stay, suggesting that routine use of self-report was feasible. These reports revealed low sleep quality. Patients reported multiple facilitators and barriers for sleep, with environmental and patient comfort factors being most common. Interventions that target these factors to improve patient sleep should be implemented.
睡眠中断在重症监护病房（ICU）患者中很常见，报告显示许多患者的睡眠质量和睡眠时间均有所下降。越来越多的证据表明，这种情况下的睡眠状况可能会得到改善。
描述ICU患者对睡眠的自我报告评估，检查患者自我报告的睡眠与床边护士报告的睡眠之间的关系，并描述患者提出的促进睡眠的策略。
对2014年至2015年连续招募的有沟通能力的成年患者进行了一项探索性描述性研究。患者使用理查兹-坎贝尔睡眠问卷报告睡眠情况（评分范围为0-100毫米；分数越高表明睡眠质量越好），护士对睡眠的评估记录在一个五级有序变量中。每天询问患者描述有助于或阻碍其睡眠的策略。该研究获得了伦理批准。进行了描述性统计分析[中位数（四分位间距）]；使用斯皮尔曼等级相关性检验关系，使用克鲁斯卡尔-沃利斯检验评估差异；p<0.05被认为具有显著性。
招募了151名参与者[年龄：60（46-71）岁；ICU住院时间4（2-9）天]，有356份睡眠自我报告。感知睡眠质量的中位数为46（26-65）毫米。患者的自我评估与护士对睡眠的评估之间存在中等程度的关系（斯皮尔曼等级相关系数为0.39-0.50；p<0.001）。患者确定的改善睡眠的策略包括充分缓解疼痛和使用镇静药物、营造安静舒适的环境以及进行身体干预，如集中护理、使用耳塞。
患者在ICU住院期间报告睡眠情况的中位数为2（1-3）天，这表明常规使用自我报告是可行的。这些报告显示睡眠质量较低。患者报告了多种促进和阻碍睡眠的因素，其中环境和患者舒适度因素最为常见。应实施针对这些因素的干预措施以改善患者睡眠。
