Sleep Fragmentation in the ICU: Exploring the Relationship Between Bundled Care, Environment and Patient Outcomes

2.50
Hdl Handle:
http://hdl.handle.net/10755/303872
Category:
Abstract
Type:
Presentation
Title:
Sleep Fragmentation in the ICU: Exploring the Relationship Between Bundled Care, Environment and Patient Outcomes
Author(s):
Megginson, Lucy
Lead Author STTI Affiliation:
Pi Nu
Author Details:
Lucy Megginson, PhD, RN, lmegginson@floyd.org
Abstract:

Session presented on: Tuesday, July 23, 2013

Purpose:

The architecture of an ICU is designed to provide care to critically ill patients. An equal and opposing force in the design of critical care is the intersection of environment with frequent care. Noise, light, mechanical ventilation, assessment, phlebotomy, tests, medications, and nursing care create a cacophony of stimuli leading to sleep fragmentation with 40-60 interruptions each night. Sleep fragmentation contributes to physiological consequences such as hypoxia, impaired tissue repair and weakened immunity as well as neurocognitive consequences such as delirium. Duration of delirium is one of the strongest independent predictors of risk for death, LOS, cost of care, and long-term cognitive impairment. Thus, the purpose of this research is to explore the relationship between environment, care delivery and patient outcomes. The research question is: In adult ICU patients, does the use of bundled care, noise reduction, and visual reduction, in comparison to standard care, affect delirium (CAM-ICU scores), LOS, and falls?

Methods:

A quasi-experimental design guides evaluation of the impact of interventions on patient outcomes. Power analysis based on intervention and control groups with expected replication of groups produced a sample size of 64. IRB approval was obtained. Upon patient consent, adult ICU participants were randomized into intervention and control groups. Collaboration with invested specialties including respiratory, phlebotomy, radiology, and medicine created a solid plan for bundling care. Conceptual and operational definitions of bundled care, noise reduction, visual reduction, delirium, LOS, and falls created valid and reliable measurements for variables. Inter-rater reliability was established through intensive education for all clinical staff including RNs, RRTs, and MDs.

 Results:  

The research study is currently in progress. Data will be analyzed via full factorial analysis to look at individual impact of interventions as well as combinations of interventions on selected patient outcomes.

Conclusion:

Conclusions will be reported upon data analysis.

Keywords:
environment; bundled care; sleep fragmentation
Repository Posting Date:
22-Oct-2013
Date of Publication:
22-Oct-2013
Conference Date:
2013
Conference Name:
24th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International, the Honor Society of Nursing
Conference Location:
Prague, Czech Republic
Description:
24th International Nursing Research Congress Theme: Bridge the Gap Between Research and Practice Through Collaboration. Held at the Hilton Prague Hotel.
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleSleep Fragmentation in the ICU: Exploring the Relationship Between Bundled Care, Environment and Patient Outcomesen_GB
dc.contributor.authorMegginson, Lucyen_GB
dc.contributor.departmentPi Nuen_GB
dc.author.detailsLucy Megginson, PhD, RN, lmegginson@floyd.orgen_GB
dc.identifier.urihttp://hdl.handle.net/10755/303872-
dc.description.abstract<p>Session presented on: Tuesday, July 23, 2013</p><b>Purpose: </b> <p>The architecture of an ICU is designed to provide care to critically ill patients. An equal and opposing force in the design of critical care is the intersection of environment with frequent care. Noise, light, mechanical ventilation, assessment, phlebotomy, tests, medications, and nursing care create a cacophony of stimuli leading to sleep fragmentation with 40-60 interruptions each night. Sleep fragmentation contributes to physiological consequences such as hypoxia, impaired tissue repair and weakened immunity as well as neurocognitive consequences such as delirium. Duration of delirium is one of the strongest independent predictors of risk for death, LOS, cost of care, and long-term cognitive impairment. Thus, the purpose of this research is to explore the relationship between environment, care delivery and patient outcomes. The research question is: In adult ICU patients, does the use of bundled care, noise reduction, and visual reduction, in comparison to standard care, affect delirium (CAM-ICU scores), LOS, and falls? <p><b>Methods: </b> <p>A quasi-experimental design guides evaluation of the impact of interventions on patient outcomes. Power analysis based on intervention and control groups with expected replication of groups produced a sample size of 64. IRB approval was obtained. Upon patient consent, adult ICU participants were randomized into intervention and control groups. Collaboration with invested specialties including respiratory, phlebotomy, radiology, and medicine created a solid plan for bundling care. Conceptual and operational definitions of bundled care, noise reduction, visual reduction, delirium, LOS, and falls created valid and reliable measurements for variables. Inter-rater reliability was established through intensive education for all clinical staff including RNs, RRTs, and MDs. <p> <b>Results: </b>  <p>The research study is currently in progress. Data will be analyzed via full factorial analysis to look at individual impact of interventions as well as combinations of interventions on selected patient outcomes. <p><b>Conclusion: </b> <p>Conclusions will be reported upon data analysis.en_GB
dc.subjectenvironmenten_GB
dc.subjectbundled careen_GB
dc.subjectsleep fragmentationen_GB
dc.date.available2013-10-22T20:24:52Z-
dc.date.issued2013-10-22-
dc.date.accessioned2013-10-22T20:24:52Z-
dc.conference.date2013en_GB
dc.conference.name24th International Nursing Research Congressen_GB
dc.conference.hostSigma Theta Tau International, the Honor Society of Nursingen_GB
dc.conference.locationPrague, Czech Republicen_GB
dc.description24th International Nursing Research Congress Theme: Bridge the Gap Between Research and Practice Through Collaboration. Held at the Hilton Prague Hotel.en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.en_GB
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