Abstract
Background: Sleep is a complex process influenced by biological and environmental factors. Circadian rhythm and sleep disturbances are common in intensive care patients and have significant psychophysiological effects, prolong recovery and increase complications and mortality.
Aim/research question: This integrative review aimed to extract and examine the available evidence on factors that affect sleep in ICU patients and explore how nurses can promote circadian rhythm and sleep in critically ill patients in the ICU. Therefore, the following research question was developed to address the question: What are the nurses' roles in promoting circadian rhythm and sleep in critically ill patients in the intensive care units (ICU)?
Methodology/Methods: An integrative review was selected as the most appropriate methodology due to its capacity to include various methodologies for a comprehensive understanding of a phenomenon. The author systemically searched for published articles from January 2013 to January 2023 in Google Scholer, PubMed, OVID Medline, OVID Embase, Ovid Emcare and CINAHL databases. Research articles that met the inclusion criteria underwent critical appraisal using the JBI critical appraisal tools (Joanna Briggs Institute [JBI], 2014), followed by data extraction and data synthesis using Braun and Clarke's (2006) six phases of the thematic analysis approach.
Results: Fourteen research studies were selected, critically appraised, and analysed. As a result, three main themes were developed: Barriers to patient sleep, non-pharmacological interventions that promote sleep, and sleep-related staff education. The literature review findings indicated that various environmental factors (such as frequent in-room disruptions, noise and light) and non-environmental factors (such as discomfort, stress and anxiety) were barriers that negatively affected the quality of sleep in ICU patients. Non-pharmacological interventions that promote patient sleep include environmental modification (such as minimising sleep disturbances, noise and light reduction strategies), sleeping aids (such as eye masks and ear plugs), internal strategies (such as stress and anxiety management strategies and relaxation interventions), and bundle interventions (the use of multi-component sleep promotion interventions). Sleep-related staff education includes nursing assessment and evaluations of sleep, the importance of sleep, and sleep promotion strategies.
Conclusion: Recommendations include incorporating routine sleep assessment as part of the overnight nursing assessment to evaluate patient sleep, providing evidence-based information regarding the clinical impact of sleep deprivation, and providing training on noise and light reduction strategies to ICU nurses to facilitate patients ' sleep quality. In addition, it is recommended to consider developing and implementing an ICU sleep promotion bundle to guide nurses in promoting patient sleep and explore other sleep promotion initiatives, including developing pre-assembled sleep promotion kits containing sleep-protective items such as eye masks and earplugs. Sleep promotion initiatives could influence ICU patients' overall health outcomes and hospitalisation experiences and should be integrated into future high-quality clinical practices. Future research is required to identify and target the needs of ICU patients in New Zealand (NZ) and to evaluate the effectiveness of multi-faceted sleep promotion interventions on ICU patients' quality of sleep.