Intensive care nurse on how will help give patients a rest

knew we had to change. I had a whole different empathy for patients. It completely changed how I nursed.”

Senior staff nurse Shona describes herself as a problem solver, something she credits to her background in farming.

“I grew up in a farming background but I wasn’t really interested in doing that,” she said. “I always wanted to do nursing.

“I’m fascinated by the sickest patients because I like a challenge. I grew up as a farmer’s daughter so I know all about challenge.

“We’re a family of problem solvers.” Shona began to develop her idea by asking patients in her ward the things disturbing their sleep.

She and her colleagues were convinced pain would top the list. The results, however, were surprising.

“We found our patients slept lightly and poorly,” she added. “As we investigated, we discovered 20% of the causes of sleep deprivation were down to doctors and nurses.

“More than chatter, more than alarms, more than even the telephone ringing. In fact, the telephone only caused 1% of disturbances.

“Just by doing things like observing, taking blood pressure, blood-sugar tests – in other words, normal, routine examinations – doctors and nurses were the biggest cause of disturbed sleep. They were a bigger cause than pain. “We were shocked to find we were the main cause of sleep disturbance,” said Shona. “We had to have a really good look at what we were doing, why we were doing it, and when we were doing it.”

Shona began to develop practical steps for ensuring patients slept well.

As part of her initiative, doctors and nurses try to carry out routine procedures when patients are naturally awake, rather than rouse them from a slumber.

“If a patient wakes in the middle of the night, then we’ll do every routine procedure we possibly can at that time. That’s a window of opportunity,” she said. “We’ll only waken them again as necessary.

“Then there are simple things, like earplugs and eye masks. In wards, it’s a case of checking things that can be missed, like turning down the volume of the telephone and the alarms on the machines.

“It was very simple stuff. There were bins banging against the wall when they were opened. We moved the bins.

“One patient complained about a flapping noise. We worked out it was nurses exuberantly flapping their aprons when they go to work. Now they carefully unroll their aprons.”

Other measures include practical relaxation techniques, like simple Youtube videos that can be viewed on mobile phones, or even arranging for patients to have hand massages.

Patients were asked about the effect Shona’s measures had. The results were startling. Doctors and nurses’ went from the most likely cause of sleep disturbance to one of the least likely.

Patients described their sleep improving massively, and Shona’s scheme has won an award within the NHS for improvements it has made to patient care.

“In critical care, sleep has been under-appreciated,” said Shona. “The sleep bundle has caught on because it’s appreciated by nurses because it was a practical thing – it wasn’t another tickbox exercise. It’s something they can do, hands-on.

“It was taken on positively and has had great results. “When we asked the patients, that’s what they wanted – to sleep better. With the sleep bundle, they did.”

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Doctors and nurses were the biggest cause of disturbed sleep for patients. More than pain, more than anything