The effect of nocturnal nursing care interventions and noise on sleep quality of neurosurgical intensive care patients

Patients who receive treatment and care in intensive care units (ICU) experience severe sleep problems that affect their cognitive functions and increase the risk of delirium. In limited studies that focused on sleep problems of neurosurgical ICU patients, it has been stated that noise and nocturnal nursing care interventions negatively affect sleep, but only one study investigated sleep quality in those patients. In the study, it was aimed to evaluate the effect of nocturnal nursing care interventions and noise on sleep quality of neurosurgical ICU patients. This descriptive and correlational study was conducted in the Neurosurgical ICU of Necmettin Erbakan University Meram Medical Faculty in Konya, Turkey. 186 patients who received treatment and care at least one night, who were not diagnosed with sleep disorders, who were not sedated, and whose Glasgow Coma Scale score is above 13 constituted the sample of the study. Prior to the study, ethics committee approval and institutional permissions were obtained. Data were collected between April 2021-January 2023 through data collection form and Richard-Campbell Sleep Questionnaire (RCSQ). The ambient noise level in the first night of the patients' stay at ICU was measured hourly with decibel meter between 20:00-07:00, and the factors that cause noise and the patient's sleep status were evaluated. Nursing care interventions and frequency applied to the patient in the first ICU night were recorded from nurse forms. In the analysis of the data, Independent Samples t test, One-Way Analysis of Variance (ANOVA), Pearson Correlation test, and multilinear regression analysis were used. 95.7% of the patients reported that their nighttime sleep patterns were changed during intensive care process, and the sleep problems they experienced were being unable to fall asleep (46.2%) and insomnia (45.7%). In all times between 20:00-07:00 when noise level was high, the rate of patients who were awake was significantly higher than those who were asleep. It was determined that there was a negative and significant (r=0.179; p=0.014) relationship between average noise level in ICU between 20:00-07:00 and RCSQ total score, and that as the ambient noise level increased, sleep quality of the patients decreased. The primary analysis results showed that the care interventions that affect nighttime sleep quality of the patients were pupil check frequency, urination frequency, drug administration frequency, position giving frequency, and urine bag emptying frequency. When the effect of independent factors on sleep quality was evaluated with multilinear regression analysis, it was found that RCSQ noise level and the number of medical equipment attached to the patient significantly affected sleep quality by 43%. In conclusion, the findings of the study showed that ambient noise in ICU, the number of medical equipment, the frequency of nursing care interventions affected nighttime sleep and sleep quality of critical neurosurgery patients. In line with these findings, it is recommended to make arrangements for preventing nighttime noise levels in ICU, to apply nursing interventions excluding emergency and basic care needs in daytime, and to arrange intervention and intervention frequency considering the status of the patient.