The effects of non-pharmacological interventions consisting of earplugs and eye masks, reducing environmental factors to improve self-reported sleep quality in ICU Patients

Background: Intensive Care Units (ICU) are noisy environments that hinder sleep. Sleep disruption may have negative affects in ICU patients’ recovery. Aims/Objectives The aim was to determine the feasibility, patient’s comfort level, and the effects of ear plugs, eye masks, and limiting nursing interventions on self-reported sleep quality during ICU stay. Methods: This quality improvement project was conducted in a community hospital using a quasiexperimental design. Patients in the intervention group wore earplugs and eye masks with limited nursing interventions during nighttime hours compared to patients in the control group who received routine care. Patients subjective sleep quality was measured using a validated sleep scale and openended questions were used to assess factors that effected sleep. Results: 38 patients (21 in the control group, and 17 in the intervention group) participated in the project. No statistically significant differences were found between groups. However, the effect sizes were moderate for several sleep items, showing that patients in the intervention group reported higher quality of sleep than those in the control group. Patients reported that ear plugs, and eye masks were comfortable and improved their sleep. Both groups reported that noise, equipment, and nursing intervention were factors that hindered their sleep. Conclusion: Our study demonstrated that non-pharmacological interventions had a clinically meaningful, moderate effects in improving ICU patients’ sleep in the first 24-48 hours. Using ear plugs and eye masks, and controlling environmental noise are low-cost strategies that can improve sleep in ICU patients NON-PHARMACOGICAL INTERVENTIONS TO IMPROVE SLEEP 5 Background and Significance The noise level and the amount of light exposure during nighttime hours has been cited to cause sleep disruption for patients admitted in the ICU setting (Demoule, et al., 2017; Hu, et al.,2015; Litton, et al.,2017 & Yarzdannik, et al., 2017). There is a correlation between noise and sound levels in the suppression of the Rapid Eye Movement (REM) stage of sleep, increased patient awakenings, and reduced sleep time (Demoule et al., 2017). Environmental factors that have led to sleep disruption include alarms and the amount light exposure during prime sleeping hours. However, lights are required to obtain accurate assessments, patient observations, medication administration, and nursing care interventions. Strategies that have been used to control noise and light exposure in the ICU include quiet time protocols, minimizing care activities, and limiting visitors during the highest probability when sleep can occur have been effective. These interventions have improved sleep, noise and light levels; however, there are still factors that affect patient’s sleep quality while in the ICU. A strategy that has the greatest opportunity to improve sleep quality for ICU patients include, application of earplugs and eye masks while limiting environmental factors. Sleep disruption has been studied in healthy and critically ill subjects and found to cause several adverse effects. Adverse effects from sleep disruption have led to increased oxygen and carbon dioxide production, reduction in attention, short term memory, and problem solving (Richardson, et al., 2007). Also, sleep disruption in the critical care setting has substantial consequences that have been shown to cause respiratory failure and immune system suppression making patients more susceptible to infection (Richardson, et al., 20012). Another impact from sleep disruption is the onset of delirium. Several studies have hypothesized that sleep disruption is a significant factor for the onset of delirium (Patel, et NON-PHARMACOGICAL INTERVENTIONS TO IMPROVE SLEEP 6 al., 2014; Von Pompey et al., 2012). Incidences for delirium in the ICU setting range from 20% and highest up to 80% (Von Rompaey, et al., 2012). Delirium is characterized by a variation in thinking, changes in level of consciousness, and confusion. Although, sleep disruption and onset of delirium have been inconclusive to date, we wanted to determine if interventions to reduce environmental stimuli such as utilizing eye masks and earplugs may provide benefit to improve sleep quality and have the potential to limit the onset of delirium.