"They can rest at home": an observational study of patients' quality of sleep in an Australian hospital

Lori J Delaney, Marian J Currie, Hsin-Chia Carol Huang, Violeta Lopez, Frank Van Haren, Lori J Delaney, Marian J Currie, Hsin-Chia Carol Huang, Violeta Lopez, Frank Van Haren

Abstract

Background: Poor sleep is known to adversely affect hospital patients' recovery and rehabilitation. The aim of the study was to investigate the perceived duration and quality of patient sleep and identify any environmental factors associated with patient-reported poor sleep in hospital.

Method: A cross-sectional study was conducted involving 15 clinical units within a 672-bed tertiary-referral hospital in Australia. Semi-structured interviews to determine perceptions of sleep quantity and quality and factors that disturb nocturnal sleep were conducted with patients and nursing staff. Environmental noise, light and temperature were monitored overnight, with concurrent logging of noise sources by observers.

Results: Patients reported a mean reduction in hospital sleep duration, compared to home, of 1.8 h (5.3 vs. 7.1 h; p < 0.001). The proportions of patients reporting their sleep quality to be poor/very poor, fair and of good quality were 41.6, 34.2 and 24.2% respectively. Patients reported poorer sleep quality than nurses (p < 0.05). Patients, nurses and observers all reported the main factors associated with poor sleep as clinical care interventions (34.3%) and environmental noise (32.1%). Noise levels in all 15 clinical areas exceeded WHO recommended levels of < 30 dB [A] by 36.7 to 82.6%, with peak noise levels of 51.3 to 103.3 dB (A).

Conclusion: Hospital in-patients are exposed to factors which reduce the duration and quality of their sleep. These extrinsic factors are potentially modifiable through behaviour change and reconfiguration of the clinical environment. The findings from this study provided the foundation for a quality improvement project currently underway to improve patients' sleep.

Keywords: Clinical care; Environmental stressor; Hospital; Medical; Noise; Nursing; Sleep; Sleep disturbance.

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the institution’s Human Research Ethics Committee (ETHLR.12.253) and conducted in accordance with the principles outlined in the Declaration of Helsinki. The HREC approved the consent procedures for participation in the study which included; verbal consent sought from patients prior to the interviews, and implied consent related to the completion and return of the Nurses’ Self-report Form undertaken by nursing staff.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Comparison of Nursing Staff and Patients’ self-reported sleep quality in Hospital. Legend: Nursing staff observational assessment of patient sleep quality did not reflect patients self-reported sleep quality, indicating considerable discordance and as a surrogate assessment may not be reflective of the patients experience
Fig. 2
Fig. 2
Comparison of Nursing Staff and Patients’ identified factors contributing to sleep disturbance. Legend: The core themes identified by nursing staff and patients as factors that contributed to sleep distance. The combination of clinical care and noise was acknowledge by staff as a disruptive factor and an issue reported by patients. Factors such as pain and cohort rooms were identified by patients as issues that impacted on sleep, but not reported by nursing staff as issues impacting on sleep
Fig. 3
Fig. 3
Mean noise levels recorded per monitoring location in the clinical wards. Legend: Noise levels had a similar pattern throughout the clinical areas, with single patient rooms having comparable noise levels to shared patient rooms. Nursing stations within all clinical wards was identified as being the site of considerable noise over the monitoring period
Fig. 4
Fig. 4
Mean luminance levels recorded per monitoring location. Legend: Exposure to light over the monitoring period displayed a consistent pattern of higher artificial light levels between 22:00 h to 24:00 and again from 05:00 h to 07:00 h. This is consistent with the changeover of staff between the shifts and increased clinical activity

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