Nurses' autonomy in sleep management improves patients' sleep quality: A cross-sectional study

Abstract

Background: The current literature indicates that intensive care (ICU) patients' sleep quality is generally poor, which is associated with serious physical and psychological consequences.

Aims and objectives: To describe the practices nurses use to provide good-quality sleep to adult ICU patients and assess nurses' perceptions of patients' sleep quality and nurses' professional autonomy in sleep management.

Design: A descriptive-correlational, cross-sectional study.

Methods: A total of 232 ICU nurses from four hospitals in Poland were recruited. Data were collected between May and August 2019 using a previously developed questionnaire and analysed using descriptive statistics and non-parametric tests.

Results: A total of 119 nurses took part in the study (response rate: 51%). On average, nurses rated patients' sleep quality as moderate (4.44 ± 2.23, scale 0-10). Most of the respondents (95.8%) said they did not use any sleep protocol. Various strategies to improve patients' sleep were used sporadically (2.64 ± 1.55, scale 1-5). The use of sleep quality assessment methods was positively correlated with patients' sleep quality (rho = 0.22, P = .02). Nurses' professional autonomy regarding sleep management was assessed as average (4.34 ± 2.43, scale 0-10) and was correlated with the patients' sleep quality (rho = 0.25, P < .01). Nurses who rated their autonomy in patients' sleep management more highly (rho = 0.29, P < .01) and more often influenced patients' sleep decisions (rho = 0.24, P < .01) used more methods to improve patients' sleep.

Conclusions: Strengthening the professional autonomy of ICU nurses and creating a reliable sleep assessment and improvement tool, which would describe strategies nurses can implement independently could increase sleep quality among ICU patients.

Relevance to clinical practice: Addressing organizational problems, which hamper the patients' sleep management by ICU nurses could result in using more strategies to provide good-quality sleep to ICU patients. There is a need for clinical guidelines regarding patients' sleep management to help educate and guide nurses how to independently use sleep improvement methods.

Keywords: autonomy; critical care; intensive care; nursing; sleep; sleep disturbances.