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found no adverse effects of not monitoring vital signs throughout the night [ 12 ] . Although there was a narrow inclusion group , more patients in the standard group rated good or excellent sleep . There was no escalation of care despite vital signs not being monitored [ 12 ] .
Before the review , the nursing team in the author ' s hospital would walk the patients , clean the kennels and record a full set of vital signs between 3 am and 5 am each day . Under the new protocol , vital signs are monitored routinely at 10 am and 10 pm , and patients are walked at 4 am , but only if they are awake . The aim of the new protocol was to maximise patients ' sleep and decrease the workload of the skeleton night team .
VN empowerment
The author acknowledged concerns from the team that delivering high-quality patient care in the absence of light is not possible . Instead , a compromise was made : the lights were to be turned off between checks and dim lights used throughout the night for checks . It is important to acknowledge that this would not be possible without the changes to the previous system , including the standardised treatment times .
Noise levels
Noise levels were also identified by the focus groups as a cause of sleep disruption , with VNs reporting that ‘ wards are too loud ’, ‘ dogs are always barking ’ ( Figure 2 ), ‘ machines and trolleys make a lot of noise ’ and ‘ handovers are noisy ’.
The author aimed to foster a sense of empowerment among VNs by engaging the nursing team via focus groups , to encourage active discussion and debate and to hear multiple perspectives . Feedback obtained via the survey conducted 3 months after implementing the protocol indicated that the focus groups were generally well received by the team . Engagement was further encouraged through the use of posters and handbooks detailing the new protocol , and email reminders . The author also created a webinar highlighting the benefits of patient rest , which was circulated around the hospital .
Light levels
During the focus groups it was noted that ‘ lights are always on ’ and ‘ lights are bright all day and overnight ’.
Light can disrupt the circadian rhythm . In the literature , it is suggested that overnight , artificial light should be limited , or at least dimmed [ 10 ] . This can help minimise sleep disturbance ( Figure 1 ).
Figure 2 . Dogs barking can disrupt the sleep of other patients .
Noise can disrupt sleep and activate stress responses [ 3 ] . High noise levels prevent patients from achieving the critical sleep stages that are vital for physiological healing and psychological wellbeing .
In veterinary ICUs , the sound pressure has been shown to exceed World Health Organization recommendations [ 5 ] . Noise levels have been attributed to machine alarms , heating and cooling systems , telephones and the vocalisation of other patients [ 14 , 15 ] .
Interestingly , in a study looking to identify disruptions to sleep in human hospitals , patients reported staff as the primary source of noise , particularly at clinical nursing stations [ 10 ] . However , nurses perceived that patients ' quality of sleep was affected by other patients [ 10 ] . This replicates the findings from the author ' s focus groups , in which no comments specifically referred to social staff conversation .
Figure 1 . Light can disrupt the circadian rhythm and disturb sleep .
Encouraging the modification of staff behaviour through educational sessions has been suggested , as well as the use of ‘ quiet periods ’ where conversation is muted at certain times of the day [ 14 ] . Other suggestions
Volume 39 ( 5 ) • October 2024
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