Plus-Hex CLINICAL
There is little research on the quality or quantity of sleep in hospitalised cats and dogs . However , in critically ill humans , circadian rhythm disorders and sleep disturbances are frequently reported [ 7 – 9 ] . In humans , there was a significant reduction in mean sleep duration in hospital : 5.3 hours in hospital compared with 7.1 hours at home [ 10 ] . In the same study , the quality of sleep in hospitals was rated as very poor , but nursing staff rated patient sleep quality as fair [ 10 ] .
Sleep is needed for body repair , growth and homeostasis . Prolonged sleep deprivation can compromise immune function , enhance protein catabolism , lower pain tolerance , impair cognitive abilities and decrease emotional resilience [ 7 , 9 , 11 ] . Sleep disruption can also affect the circulating concentrations of cortisol and noradrenaline [ 10 ] .
This evidence highlights the importance of sleep to hospitalised animals , and the potential impact veterinary professionals can have on the quality and quantity of patient sleep .
The author works in a multidisciplinary referral hospital , leading the inpatient care of cats and dogs housed across surgical , intensive care unit ( ICU ), medical and cattery wards . The author hypothesised that inpatients at the hospital were not receiving adequate rest periods when hospitalised for longer than 24 hours , and determined that a review of the hospital protocols was needed .
This article considers the review findings from an internal audit and focus groups . It also outlines current evidence from the medical and veterinary literature , both of which influenced the design of a new protocol at the author ' s practice . Additionally , the author discusses the barriers encountered while developing and implementing the new protocol .
Materials and methods
The author hypothesised that inpatient rest was compromised in the hospital at which she worked and she decided to investigate the issue . At the time , the hospital had no rest protocols in place or educational resources dedicated to optimising patient rest .
The author held short focus groups to gather the nursing team ' s perceptions of the overarching question : ‘ Do inpatients get enough rest in the wards at this hospital ?’ The author felt this approach would allow the veterinary nurses ( VNs ) to be co-creators of change , which , in turn , would improve engagement with the implementation of any new protocols .
The author transcribed the comments made by the nursing team during the focus groups , and then used an inductive approach to analyse the data and identify any themes or patterns .
A follow-up survey was sent to the focus groups , 3 months after the implementation of the new protocols , enabling the nursing teams to feed back on the use of focus groups to engage with the process .
Results
The areas of concern identified during the focus groups are listed in Table 1 .
Table 1 . Areas of concern identified during the focus groups .
Concern Scheduling of treatment Overnight rest VN empowerment Light levels Noise levels Kennel environment Stress and rest
Discussion
Scheduling of treatment
A perceived lack of forward thinking was thought to be the most common contributing factor in patients being disturbed at the author ' s practice . Prior to this review , checks were performed on inpatients hourly , with no guidance on the scheduling of treatments .
A recent study [ 10 ] suggests that allocating periods of time during which no clinical interactions and procedures are scheduled would benefit patients . However , it was highlighted in the study that clustering treatments may require the reconfiguration of care activities and procedures [ 10 ] .
The author experienced numerous barriers to implementing changes in practice . During the focus groups , the author proposed a new system , in which treatments were standardised to set times ( Table 2 , page 24 ). Each ward was allocated standardised times at which routine checks , treatments , walking and feeding were to be performed . These would need to be started well ahead of the hour and would more than likely finish after the hour – for example , a check scheduled for 10 am might actually take from 9.30 am to 10.30 am .
The main concern raised was how to manage time when working on skeleton-staffed shifts , that is , night or weekend shifts . To overcome this barrier , the timings in each ward were staggered , so the team
Volume 39 ( 5 ) • October 2024
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