Earplugs Improve Patients Subjective Experience of Sleep in Critical Care

Earplugs improve patients’ subjective experience of sleep in critical care
Laboure College
Nursing 202
March 8, 2013

The purpose of this study is to see if earplugs improve sleep in patients in critical care areas. It is to see if the use of earplugs will improve patient outcomes by decreasing noise levels during sleeping hours. The problem statement is that patients will get better quicker if they get uninterrupted sleep. The literature review summarizes the topic and its findings. According to the article, noise can have a negative affect on patients outcomes like; sleep disturbances (Honkus, 2003; Redeker, 2003), increase in the stress response (Kam et al., 1994; Moore et al., 1998; Lower et al., 2002), and reduced patient satisfaction (Lower & Bonsack, 2002). Different interventions were tried to decrease noise levels, but unfortunately, patients’ needs came first therefore abandoning those interventions like quiet time. Quiet time protocols were implemented by restricting care activities and visiting at sleep hours (Moore et al., 1998; Olson et al., 2001; Kellman, 2002; Lower & Bonsack, 2003). Wallace et al. (1998) studied the effect of earplugs worn during normal sleeping hours by 12 intensive care patients receiving mechanical ventilation and reported an increase in REM sleep during earplug use. This study was qualitative because it had the test subjects use subjective data about the use of earplugs and the decrease in noise level by using The Verran-Snyder-Halpern Sleep Scale. The fit between the research question and methods are inconclusive because it is based on subjective data and not all the test subjects finished the study. The sample is the test subjects in the study. The participants included men and women over the age of 18 who were admitted to critical care units at a Midwestern US teaching hospital (Scotto, McClusky, Spillan, & Kimmel, 2009). The criteria consisted of subjects who were alert and oriented, able to understand the study, able to give informed consent and mark the tool (Scotto et al., 2009). The data was collected by having the 100 participants randomly assigned to the earplug intervention or control group. The intervention group was giving instructions on the use of the earplugs during regular sleep hours for one night only removing them briefly for less than 10 minutes at a time for communication purposes (Scotto et al., 2009). The data was compiled by having the participants complete the Verran-Snyder-Halpern Sleep Scale the day following the study. The sleep scale scores were then kept in a locked box until data was entered into an SPSS spreadsheet for analysis to be seen by the research team. The instruments used were soft foam earplugs and the Verran-Snyder-Halpern Sleep Scale. The sleep scale measures subjective response to sleep in hospitalized adults (Snyder-Halpern & Verran, 1987). The tool is an eight-item visual analogue instrument that takes about 10 minutes or less to complete (Snyder-Halpern & Verran, 1987; Richardson, 1997). The pilot study received approval from the Summa Health System internal review board and had an equivalent group post-test-only design (Scotto et al., 2009). The weakness of the study is the limitation of test subjects and that the data is qualitative. The findings showed that the participants using earplugs during normal sleeping hours fell asleep easier, woke up less, decrease tossing and turning, slept deeper and woke up feeling refreshed. Out of the six different types of earplugs, used patients preferred foam earplugs because they were more comfortable and easier to insert (Chisholm et al., 2004). I would rate this article a three in difficulty. The overall contribution the study makes to patient care is finding ways to improve patients REM sleep therefore improving outcomes for patients well being. I think that earplug use on all types of floors in a hospital setting would be beneficial to help improve the overall health of the patient.

References
Chisholm E, Kuchai R, McPartlin D. (2004). An objective evaluation of the waterproofing qualities, ease of insertion, and comfort of commonly available earplugs. Clinical Otolaryngology; 29: 128-132.
Honkus V. (2003). Sleep Deprivation in critical care units. Critical Care Nurse; 26: 179-189.
Kam P, Kam A, Thompson J. (1994). Noise pollution in the anesthetic and intensive care environments. Anesthesia; 49: 982-986.
Kellman N. (2002). Noise in the intensive care nursery. Neonatal Network; 21: 35-41.
Lower J, Bonsack C. (2002). High-tech high touch: mission possible? Dimensions of Critical Care; 21: 201-205.
Moore M, Nguyen D, Nolan S, Robinson S, Ryals B, Imbries J, Spotnitz W. (1998). Interventions to reduce decibel levels on patient care units. The American Surgeon; 64: 894-899.
Olson D, Borel C, Laskowitz D, Moore D, McConnell E. (2001). Quiet time: a nursing intervention to promote sleep in neuro-critical care units. American Journal of Critical Care; 10: 74-78
Redeker N. (2003). Sleep in acute care settings: an integrative review. Journal of Nursing Scholarship; 32: 31-38
Richardson S. (1997). A comparison of tools for the assessment of sleep pattern disturbances in critically ill adults. Dimensions of Critical Care Nursing; 16: 226-242.
Scotto C, McClusky C, Spillan S, Kimmel J (2009). Earplugs improve patients’ subjective experience of sleep in critical care. Nursing in Critical Care, 14(4).
Snyder-Halpern R, Verran J. (1987). Instrumentation to describe subjective sleep characteristics in healthy subjects. Nursing in Research and Health; 10: 155-163.
Wallace C, Robins J, Alvord L, Walker J. (1998). The effects of earplugs in critically ill patients. Sleep; 21(Suppl.): 234.

References: Chisholm E, Kuchai R, McPartlin D. (2004). An objective evaluation of the waterproofing qualities, ease of insertion, and comfort of commonly available earplugs. Clinical Otolaryngology; 29: 128-132. Honkus V. (2003). Sleep Deprivation in critical care units. Critical Care Nurse; 26: 179-189. Kam P, Kam A, Thompson J. (1994). Noise pollution in the anesthetic and intensive care environments. Anesthesia; 49: 982-986. Kellman N. (2002). Noise in the intensive care nursery. Neonatal Network; 21: 35-41. Lower J, Bonsack C. (2002). High-tech high touch: mission possible? Dimensions of Critical Care; 21: 201-205. Moore M, Nguyen D, Nolan S, Robinson S, Ryals B, Imbries J, Spotnitz W. (1998). Interventions to reduce decibel levels on patient care units. The American Surgeon; 64: 894-899. Olson D, Borel C, Laskowitz D, Moore D, McConnell E. (2001). Quiet time: a nursing intervention to promote sleep in neuro-critical care units. American Journal of Critical Care; 10: 74-78 Redeker N Richardson S. (1997). A comparison of tools for the assessment of sleep pattern disturbances in critically ill adults. Dimensions of Critical Care Nursing; 16: 226-242. Scotto C, McClusky C, Spillan S, Kimmel J (2009). Earplugs improve patients’ subjective experience of sleep in critical care. Nursing in Critical Care, 14(4). Snyder-Halpern R, Verran J. (1987). Instrumentation to describe subjective sleep characteristics in healthy subjects. Nursing in Research and Health; 10: 155-163. Wallace C, Robins J, Alvord L, Walker J. (1998). The effects of earplugs in critically ill patients. Sleep; 21(Suppl.): 234.