Quiet Time, Healing Brains at Rest

Sunday, November 1, 2009

Marlienne Goldin, RN, BSN, MPA
Neuro Intensive Care Unit, Moses Cone Memorial Hospital, Greensboro, NC

Learning Objective 1: relate factors in the the ICU environment that contribute to sleep disruption.

Learning Objective 2: relate loss of sleep to delayed healing.

Purpose: Visiting hours in the ICU have shifted from an hour twice a day, to 15 minutes every two hours, to open visiting 24 hours a day, and every combination in between.  In our desire to accommodate the need for families to be at their loved one’s bedside have we acted in our patient’s best interests?  In order to heal, patients need rest.  That need is even greater for brain injured patients.  Sleep disruption and deprivation are particularly prevalent in the critical care environment.  Several studies over the past twenty years have demonstrated that critically ill patients have frequent awakenings and arousals and little to no REM sleep. At a time when critical patients need the most rest, the ICU environment deprives them of it.  It is a common perception that the loss of sleep increases an individual’s risk for infection and disease.   Optimizing patient comfort and ensuring that patients get the rest they need is a difficult task in the ICU.  Lighting, medications, noise, voices, procedures, assessments all contribute to sleep disruption. 

Description: In an effort to promote rest and healing the Neuro ICU at Moses Cone instituted a two hour quiet time from 2 to 4 PM every afternoon.  Lights are dimmed, voices hushed, visitors are asked to leave, and other departments are asked to respect our patients’ need for rest. 

 Results: The results have been very positive, Visitors welcome the break from being at the bedside and use the time to eat, make phone calls and rest.  Nurses get caught up on their documentation, and best of all patients get 2 hours of undisturbed rest every afternoon.  Efforts to promote rest in our ICUs need to be ongoing if we truly strive to create a healing environment.