Sleep Disturbance
Conditions
Keywords
Critical Care Nursing, Environmental Stressors, Intensive Care Unit, Sleep Quality, Quiet Night Protocol
Brief summary
This study aims to evaluate the effect of a nurse-led Environmental Stressor Reduction Package on perceived environmental stress and sleep quality among adult patients in the intensive care unit (ICU). The Environmental Stressor Reduction Package is a structured, multicomponent nursing intervention designed to reduce potentially disturbing environmental stimuli during nighttime care. The package focuses on reducing unnecessary noise, optimizing nighttime lighting, supporting thermal comfort, limiting nighttime visitor activity, and organizing nursing care to minimize avoidable sleep interruptions while maintaining patient safety and essential clinical care. Participants in the intervention group will receive the Environmental Stressor Reduction Package during their ICU stay, while participants in the control group will receive standard ICU care. The study will assess whether the nurse-led intervention reduces perceived environmental stress and improves self-reported sleep quality compared with standard care. Perceived environmental stress will be assessed using the Intensive Care Unit Environmental Stressor Scale (ICUESS), and sleep quality will be assessed using the Richards-Campbell Sleep Questionnaire (RCSQ).
Detailed description
This semi-experimental study will evaluate a nurse-led Environmental Stressor Reduction Package designed to modify potentially stressful environmental conditions during nighttime care in the intensive care unit (ICU). The intervention is structured around environmental management strategies addressing noise, lighting, thermal comfort, nighttime visitor activity, and the organization of nursing care. During the intervention period, environmental noise will be monitored and unnecessary alarms and conversations will be minimized. Nighttime lighting will be reduced while maintaining patient safety, and external light exposure will be limited when appropriate. Thermal comfort will be supported according to individual patient needs. Nighttime visitor activity will be restricted, and essential staff communication will be conducted as quietly as possible during rest periods. Routine nursing activities will be organized, whenever clinically feasible, to minimize unnecessary sleep interruptions between 22:00 and 06:00. Implementation of the intervention will be monitored using a structured Quiet Night Checklist developed by the research team. The checklist will be completed at 22:00, 02:00, and 06:00 to assess adherence to the intervention components. Each item will be rated on a three-point scale (1 = not implemented, 2 = partially implemented, and 3 = fully implemented). Clinical care and patient safety will take priority at all times, and necessary medical and nursing interventions will not be delayed or withheld for study purposes.
Interventions
BEHAVIORALEnvironmental Stressor Reduction Package
A structured, nurse-led protocol implemented in the ICU to reduce environmental stressors that negatively affect patients' sleep quality. It combines noise reduction, circadian lighting adjustment, thermal comfort, visitor traffic regulation, and adjustment of care activities. Nurses use a standardized checklist ("Quiet Night Checklist") at three time points (22:00, 02:00, and 06:00) to ensure consistency and adherence.
Sponsors
Fenerbahce University
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Masking description
No parties are masked in this trial. The intervention (environmental stressor reduction package, including noise and light adjustment, eye mask use, and night-time care regulation) is directly observable by patients and healthcare providers. Therefore, participants, care providers, and outcome assessors are aware of group assignments. Data entry and statistical analyses will be performed independently to reduce potential bias.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults aged 18 years and older * Admitted to the intensive care unit (ICU) * Awake and able to communicate * Not receiving sedation or invasive mechanical ventilation * Expected to remain in the ICU for at least 2 consecutive nights * Willing to participate and provide written informed consent
Exclusion criteria
* Younger than 18 years of age * Diagnosed with delirium or severe cognitive impairment * Presence of a psychiatric condition that may substantially affect sleep or perceived environmental stress * Receiving continuous sedative or opioid infusion * Discharged from the ICU or deceased before completion of the required study assessments
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in environmental stress perception | Baseline and Day 5 | Environmental stress perception will be assessed using the Intensive Care Unit Environmental Stressor Scale (ICUESS), Turkish validated version (Toptaş, Yıldız, \& Khorshid, 2018). The ICUESS consists of 42 items rated on a 4-point Likert scale ranging from 0 (not stressful) to 3 (very stressful), yielding a total score range of 0 to 126. Higher total scores indicate greater perceived environmental stress. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in sleep quality | Baseline and Day 5 | Sleep quality will be assessed using the Richards-Campbell Sleep Questionnaire (RCSQ), Turkish validated version (Demir, Zaybak, \& Erdoğan, 2021). The RCSQ consists of 5 items rated on a visual analog scale ranging from 0 to 100 mm. The total score is calculated as the mean of the five items, yielding a score range of 0 to 100. Higher scores indicate better subjective sleep quality. |
| Correlation between environmental stress perception and sleep quality | Day 5 (end of intervention) | The association between ICUESS total scores and RCSQ mean scores will be analyzed to determine the relationship between perceived environmental stressors and subjective sleep quality. |
Countries
Turkey (Türkiye)
Contacts
CONTACTöznur BALKAN, Research Assistant
CONTACTADNAN AYDENİZZ
Outcome results
None listed