Level I Evidence Paper

The findings found that nurses felt irritated with inappropriate alarm settings and the high volume of noise on unit, resulting in delays in response times. False alarms were the main culprit in the nurses' opinions. The interventions supplied by the article were individualizing alarm limits, buddying systems, a charge nurse making rounds, and the development of smart alarms with algorithms that cover multiple conditions (Christensen et al., 2014).

Alarm fatigue is out of control, and patients are being harmed, if not killed. Alarm fatigue is a disturbing subject in healthcare and primarily in the acute care setting in all institutions. In the acute care setting, alarm fatigue is the constant barrage of noise consisting of an excessive amount of information being communicated by medical devices such as blood pressure, intravenous pumps, and electrocardiogram machines. Alarm fatigue is a nationwide concern and the Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience database received 566 details of patient deaths related to medical device alarms between 2005 and 2008 (Bai et al., 2014). Deaths are normally attributed to the physiological or chronic health of the individual, not alarm fatigue. In 2010, an analysis exposed 73 alarm-related deaths with 33 directly linked to physiologic monitors (Cvach, 2013). Routinely alarms are intended to warn the clinician to situations that deviate from what is conceived as ‘normal’ for the patient, not a stressful, irritating barrage of noise.

The inability to sleep is a source of anxiety and stress for patients in the intensive care unit (ICU); this inability can lead to cardiorespiratory disturbances, immune system dysfunction, impaired wound healing, hormonal and metabolic imbalances, cognitive changes, and delirium. Through the use of quiet times and nursing actions that encourage sleep, or, sleep hygiene bundles, nurses can assist in improving sleep quality in the ICU. These bundles include noise and light reduction, scheduling routine procedures outside of reserved sleep times, the use of earplugs and eye masks, and the grouping of nursing care activities to minimize sleep interruptions. The aim of this proposal, therefore, will be to implement a nurse-driven, sleep hygiene protocol, in order to improve patient care by promoting quality sleep in ICU patients. Barriers to implementation include staff resistance to the concept, concerns regarding patient care during sleep times and difficulties in coordinating care with other units. Studies used to gather information for this proposal were published between the years of 2011 and 2016 and were found in several databases: Academic Search Complete, Medline, and OVID Journals.

Alarm fatigue is a critical problem in health care setting. Nurses may not respond to alarms because they know that most of them are false or non-actionable. Sometimes, the alarms become the noises that nurses no longer hear because they are heard all the time. In addition to ignore alarms, nurses may also reduce audible alarm levels, change alarm limits, and inappropriately silence or deactivate alarms (Cvach, 2012). The alarm fatigue has led to sentinel events and deaths of patients (Cvach, 2012). Therefore, the alarm fatigue problem has to be fixed in order to improve patient safety. This paper will introduce interventions based on evidence-based practices and leadership theories related to alarm fatigue prevention.

The title of this study “Sleep Quality in Nurses: A Randomized Clinical Trial of Day and Night Shift Workers” appropriately portrays the information of the article. It describes the design of the study, a randomized trial, as well as the topic, sleep quality of nurses. Overall it gives a good picture of what the article includes.

Universal to every human from birth to death, sleep is a necessary function to survival, productivity, and happiness. While most fall asleep at night with ease, it is estimated that 50-70 million Americans battle sleep or wakefulness disorders. Although sleep disorders do not immediately present with a threat comparable to other common disorders such as depression, bipolar, or schizophrenia, sleep disorders prove very disruptive to one’s quality of life. Insufficient sleep may result in difficulty concentrating, difficulty with memory, trouble with personal care such as hygiene, driving, or managing finances, and poor performance in the workplace. While there is a wide array of sleep related illnesses that may plague any given individual,

I have always been enchanted by the idea of sleep. As a child, I laid in bed attempting to understand why I was unable to fall asleep. I knew I wasn’t the only one, but the snoring of my family convinced me otherwise. Biology taught me to understand genetics and environmental cues, but they were unable to explain to me how my sleep pattern was different. Unable to figure the cause of my sleep problems, I delved into self-treatments instead. Curiosity for knowledge in sleep therapy prompted my interest in understanding sleep consequences and health.

The nursing tasks include an ongoing interaction with patients, families, and other health care team members. Because of the high involvement with patients, nurses have the utmost responsibility to guard the patient’s safety. However, the American Nurses Association [ANA] (2015) made a valid point in stating that keeping patients safe and well starts by having a healthy nurse working in a safe environment. Additionally, Kieft, De Brouwer, Francke, and Delnoij (2014) also mentioned the study of the direct correlation between the nurses’ working environment and the patients’ quality of care. As such, nurses have to be cognizant of these environmental safety risks – staffing and occupational hazard - and plan interventions for both nurses and patients’ safety.

Conducted a randomized controlled study to answer the question “which format on rounds is preferred by residents and parents beside rounds and conference room rounds? Patients who planned to have two consecutive mornings in the pediatric intensive care unit (PICU) were randomized on day one into either conference room rounds (CCR)or bedside round (BSR). On day two, rounds were conducted on either format. Parents clearly preferred bedside rounds so they could be included in the discussion (81% wished all rounds were at the bedside), and residents were satisfied with either site, with comfort is asking questions slightly higher in the conference room setting. (84% vs

Sleep has a major function in the physical and mental health of an individual. It is important to assess elements of sleep disorders when evaluating for any mental health condition. According to Perese (2012), “Psychiatric disorders characterized by sleep disturbances include anxiety disorders, depression, bipolar disorders, schizophrenia, and Alzheimer’s disease” (pp 222-223). Normal sleep length should be at least 7 or 7.5 hours per night and when poor sleep pattern exists, it could affect alertness, memory, cognition, creativity and quality of life (Perese, 2012). Sleep-wake disorders can be described as any problem with sleeping including; difficulty falling or staying asleep, sleeping too much, sleeping at the wrong time and abnormal behaviors during sleep (MedlinePlus, 2015). According to DSM-5 (2013), “Sleep-wake disorders encompasses 10 disorders or disorder groups: insomnia disorder, hypersomnolence disorder, narcolepsy, breathing-related sleep disorders, circadian rhythm sleep-wake disorders, non-rapid eye movement (NREM) sleep arousal disorders, nightmare disorder, rapid eye movement (REM) sleep behavior disorder, restless leg syndrome, and substance/medication-induced sleep disorder” (p. 361).

Environmental interventions that can be used to orient the client when they are in times of confusion, stress or overstimulation can be to place calendars, clocks, and family pictures in the client’s room. Another possible intervention is for the caregiver to help orient and reduce possible agitation. Sensory overload can also result in patient stress and anxiety, which may be due to environmental noise levels that are particularly high in the ICU. Interventions can include limiting noise in and around the client’s room and helping the client understand noises that cannot be prevented. Conversation can be stressful to hear for some patients, even more so if it is about the client. Stress can be reduced by staff by finding a more appropriate place in the unit away from the client for client related discussion. Decreasing or muting the noise of phones, setting alarms based on client conditions and reducing unnecessary alarms can also help to limit noise. For example, when assessing a client’s blood pressure, making sure to silence the alarm when handling BP devices or invasive lines and remembering to reset them when done help reduce noise levels for the patient. It is useful to remember that pharmacological treatments given to improve delirium may themselves cause delirium or increase sedation. Almost every medication prescribed in the ICU setting can

this study, PhD Liora Kempler at the University of Sydney is  specialized in the sleep disorders and her colleague

Problem Statement: In a survey conducted by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), only 50% patients at Loyola Medical Center said that the area around their room was always quiet at night. This is way below than the Illinois average of 61%, national average of 62% in reported

You also brought up the idea of “comfort rounds.” Is this really implemented in hospitals? Is it becoming a common practice used by nurses? If not, then I think it should be. By taking out the time to make sure all patients are feeling the three states of comfort, including relief, ease, and transcendence as Kolcaba’s theory describes, aims to enhance patient satisfaction and care (Tilton 539). Comfort rounds should be implemented as a daily assignment to all nurses. Active involvement in this aspect shows patients their unbounded concern on how they are feeling at all times. It could also have a huge effect on the environment of the hospital. If comfort needs are met patients are more likely to give off desirable behaviors, making it easier for nurses to do the same. A positive work place for nurses and a positive home/temporary home for patients creates and ideal setting.

When comparing the three hospitals around our area I looked for the lowest percentages and that seemed to be patients who reported that the area around their room was “always” quiet at night. All seemed to be pretty low compared to all other categories with Harrison at 40% St. Joes at 46% and Tacoma General with the highest at 54%. This category is important to me since sleep helps heal the body and with a facility not being quiet enough, especially at night, make it harder for people to heal and start feeling better. This is important to the Department of Health because all overall patient care is important and sleep is another way of being able to provide quality patient care.