Health care worker attitudes and identified barriers to patient sleep in the medical intensive care unit

Abstract

Objective: To identify barriers to sleep for intensive care unit (ICU) patients. Design: A qualitative study using semi-structured interviews. Subjects: Nurses and physicians who had experience working the night shift. Interventions: None. Measurements and main results: Multiple environmental barriers to sleep in the ICU were identified when participants were directly asked about factors affecting sleep. Responses highlighted healthcare system-based barriers related to hospital/ICU policy and workflow. Implicit barriers to sleep were found when participants responded to open-ended questions. These included attitudinal barriers such as the uncertainty about the significance of sleep, the tension between providing protocol-driven ICU care and allowing uninterrupted patient sleep, and lack of consensus regarding interventions to promote sleep. Conclusions: This qualitative study suggests that health care worker attitudes, methods of sleep promotion, hospital institutional policies and workflow may contribute to sleep disruption in the ICU. These barriers provide additional targets for intervention in studies designed to improve sleep in the ICU.