- UTS Nursing student Felicity Dick-Smith's article has been published in the “Student Corner” section of the acclaimed academic journal Contemporary Nurse.
- Felicity’s article was adapted from an undergraduate essay examining the role of nurses in addressing fragmented sleep in Intensive Care Units (ICUs)
High-achieving UTS Nursing student Felicity Dick-Smith has been published in an academic journal, months before her graduation ceremony for her Bachelor of Nursing. In August 2016, Felicity submitted an adapted undergraduate essay to Contemporary Nurse on the role nurses play in addressing fragmented sleep in ICUs. Three months later, Contemporary Nurse published Felicity’s article in their “Student Corner” section under the title ‘Sorry, were you sleeping?’ Nurses’ role in the promotion of sleep for critically ill patients.
Felicity’s four-page article begins with a succinct explanation of the importance of sleep for patients recovering from critical illness.
“Sleep is important for wellbeing, immune function and restorative processes during critical illness,” she writes. “However, hospitalisation, especially in ICUs, can increase patients’ vulnerability to fragmented and unconventional sleep architecture. Despite the theoretical evidence and scientific understanding of sleep hygiene for the critically ill, the implementation of this research is yet to translate into institutional practices and department cultural norms.”
According to Felicity, nurses are “in a unique position to not only diagnose, but to reduce the extrinsic factors of sleep deprivation…” by “implementing evidence-based practice in order to provide holistic professional standards of care.”
Sleep deprivation can cause immune system dysfunction; impaired wound healing; reduced inspiratory insurance; hyperglycaemia; neuropsychiatric sequelae (e.g. anxiety); cardiovascular disturbances; intensified stress and pain responses; and even an increased risk of the pathogenesis of delirium. Patients often attribute sleep disturbance to environmental factors such as early morning awakenings; invasive and persistent clinical interventions and noise (including alarms and staff conversations). Other environmental factors such as invasive and non-invasive ventilation; dialysis; and sedative and opioid administration also contribute to abnormal sleep architecture in the critically ill.
Felicity’s article concludes by offering recommendations for best practice when it comes to improving patient sleep in ICUs.
“Aside from patient-centered, judicious and appropriate use of pain management and sedative pharmacological agents, nurses should consider the implementation of patient-focused and nonpharmacological interventions to promote sleep in the ICU,” she writes. Strategies include controlling and regulating lighting throughout the day; regulating temperature; reducing noise with the use of quiet shoes and quiet conversation; restriction of cleaning to daylight hours; and the use of ‘white noise’ to ameliorate peak sound levels.
According to latest research, nurses should pursue ‘individualised approaches’ to improve the sleep patterns of each patient, paying attention to the particularities of individualised sleep assessments. Nurses should also try to emulate normal routines, mobilising patients in the morning, providing mental stimulation during the daytime and ensuring light levels and blinds are appropriate for melatonin metabolism. Nurses can also optimize sleep by minimising disruptions during nocturnal hours. Strategies include reducing alarm volumes, preparing intraveneous and medication pumps in a timely manner and clustering care to allow patients longer periods of undisturbed sleep. Other comfort measures and communication strategies such as offering warm drinks prior to nocturnal hours, providing guided relaxation, therapeutic massage, warmth and music therapy can all reduce anxiety and improve sleep quality.
“To ensure that the application of such complementary therapies in nursing practice is responsive, individualised and therapeutic, nurses must be competent communicators to respond to the uniqueness of each ICU-patient and available institutional resource,” writes Felicity.
Felicity is currently working in an Emergency Department for Northern Sydney Local Health Network where she continues to apply and extend her research of the critical care patient. She is due to graduate with a Bachelor of Nursing in May 2017, and this year will also undertake an Honours degree under the supervision of UTS Nursing lecturer Dr Tamara Power, who supported Felicity with her article submission to Contemporary Nurse.
Byline: Jack Schmidt