ICU patients 'missing restorative sleep'

  1. http://www.nzherald.co.nz/section/st...ectid=10481745

    While I don't work in ICU, I have always maintained that sleep is important for the healing process, and have questioned the reason behind why we wake people in the middle of the night to do their observations, especially when they are clinically stable.

    The article specifies a study in the ICU, however the logic can just as well be used in other units as well.
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  2. 12 Comments

  3. by   oramar
    Quote from Djuna
    http://www.nzherald.co.nz/section/st...ectid=10481745

    While I don't work in ICU, I have always maintained that sleep is important for the healing process, and have questioned the reason behind why we wake people in the middle of the night to do their observations, especially when they are clinically stable.

    The article specifies a study in the ICU, however the logic can just as well be used in other units as well.
    Oh you are so right. There are times when I worked nights that I did things like allow a stable person going home the next day to sleep all night even though that is not "by the book". Honestly, I never did it out of laziness. Always, I would stand by their bed repeatedly listening to their breathing and normal sleep movement. Believe me I would be able to tell if something is wrong. I have good instincts and I could just feel in my bones how badly they needed the sleep. Also, the "by book" nurses would wake everyone up at midnight to do their assessment. My self, I would watch closely and when the person woke up for something else I would assess them then. Almost every ill person will wake up on there own during the night several times, I figured why disturbe them an extra moment. There are many people who would read me the riot act for doing this and I may even get some negative feed back but believe me I knew what I was doing. I am talking about med/surg, rehab and telemetry. As for ICU I really think it is hard to be quiet in there.
  4. by   lpnstudentin2010
    Alot of the nurses at the hospital I am a patient try to do your vitals when you are still asleep. then with me they freak out because my bp PLUMITS at night and so they wake me to make sure i am alive :wink2:
  5. by   ElvishDNP
    This drives me crazy about hospitals. We want people to get well, so what do we do? Wake them up a zillion times a night to make sure they're still ok. Knock on their door at 0200 to take out their trash.

    I work postpartum and these people are already so sleep-deprived it's crazy. If they are stable, I tell them to just call me when they wake up with the baby so I can check mom and baby at the same time. Sometimes I leave a note in the baby's crib to that effect so they'll be sure to see it. I don't knock at night, and I warn them about that and ask if they'd like me to. I promise them I won't take their baby without waking them, but if I'm just coming in to make sure everyone's still breathing, I just open the door, peek, and leave.

    I can only imagine what it's like in an ICU where there are constant monitors, alarms, codes, and assessments going on. I know NICU is bad.
  6. by   snowfreeze
    I am an advocate of giving hospitalized patients in any department a minimum of 4 hours of uninterrupted sleep.
  7. by   Retired R.N.
    Quote from snowfreeze
    I am an advocate of giving hospitalized patients in any department a minimum of 4 hours of uninterrupted sleep.
    Absolutely! Why do we all too often deliberately ignore the restorative powers of sleep?

    What part of A & P did we miss because we fell asleep in class?
  8. by   MarySunshine
    Heaven help you if you're a NEURO patient who might be woken up every 1-2 hours for up to TWO WEEKS (vasospasm watch, etc) if your nurse actually follows the order set. I would LOVE to do a study on which patients fare better in the end -- q 4 h checks or q 1 h checks at night. Hmmm.

    I am a HUGE advocate of patients getting their sleep at night. I would do my utmost to get all of my work done by 2200 on the night shift and stay out of the patient's rooms except when absolutely necessary. And no, I'm not at all lazy. It's about what I believe is right for the patient.
  9. by   ElvishDNP
    When we have a long term antepartum patient, I do my best to get my night stuff done by 2200 also. These people are with us long-term, they are sometimes on q4 temps even at night....the least I can do is ensure they get at least the option of going to sleep at a reasonable time.
  10. by   psalm
    Yeah, it is difficult to wake the pt. for a BP check because the doc ordered around the clock BP meds IVP. If we don't they may go sky-high, if we do, we may be causing them some hypertensive moments...
  11. by   snowfreeze
    I have already stated my view on sleep, I do understand the fear of night nurses for the cardiac events that seem to occur between 4am and 5am, as an advocate of the 4 hours of uninterrupted sleep I know thatI can offer that sleep in the early morning or just as easily in the evening. Once every 24 hours everyone needs to get the uninterrupted sleep period....In the evening loving family members are there for a visit, educate them on the need for sleep and make them the guardian of that. They will be vigilant guardians for you and the patient.
  12. by   sinagbayan
    I can relate with all of your concerns. I have been an ICU nurse for two weeks now and in many cases, patients' sleep hours are cut short by a lot of interruptions. Among them are the alarms on the monitors that may be triggered simply by the patient turning or the sensor being pressed upon.

    In my hospital, its usually during the night (10pm - 6am) that bedbath, bedshampoo and bed linen changing are done. We don't of course rouse our patients when they are sound asleep but as soon as they do wake up during the night we ask them if we could do the bedbath. This is for me one major disruption, for intubated-comatose patients, needless to say, we do the procedure as soon as the linen supply arrives. For the rest, we have to wait until they expressly agree.

    Generally, we don't disturb patients when taking vital signs since all values are displayed on the monitor. Except perhaps temperature. We have to take it using an electronic thermometer.
  13. by   wendeRN
    I am an ICU/CCU nurse and we do this ALL the time. Waking perfectly stable pts up in the middle of the night for assessments, and BATHS of all things! Please, this is why we monitor out pts with tele and pulse ox. We need to start being more concious of the powers of getting good sleep vs. causing our pts sleep deprivation!
  14. by   pickledpepperRN
    I think a great advantage of 12 hour nights is that we can truly assess our patients before usual sleep times.
    I always tell my patients that I have to listen to lungs or shine a light in their eyes and why. I ask them to use the call light if they wake up so I don't have to wake them.
    Anything I can do while letting them keep their eyes closed helps them go back to sleep.
    If a patient is awake I give them the option of a bath.
    Then if days asked why I didn't bathe a patient I can tell them the patient didn't want a bath in the middle of the night. It is so very nice to bathe someone who wants the bath.

    We draw our morning labs if the patient doesn't have an A-line so I warn them of this and draw them anytime they are awake after about 2:00 am.

    It was not good when working 11:00 pm to 7:30 am. Having to wake a patient for an assessment after they went to sleep is not good for them and awful for the nurse too.

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