Lesson 5 - Dis3165

Resource 1

PICOT question: Among adults who are clinically stable (ages 18-65 years), with acute nontraumatic and uncomplicated low back pain admitted to an observation unit, does a sleep-protected overnight vital sign protocol (compared to routine q4h vital signs overnight) improve patient self-reported measures of sleep quality and pain scores within 24 hours? Within my observation unit, one of the most common clinical issues encountered is routine ordering of q4h vital signs among patients who are clinically stable; for instance, those being treated for acute back pain. Many times, when patients do not show any abnormal vital signs, neurological deficits, or evidence of clinical deterioration, they still are awakened multiple times overnight. Several patients demonstrate frustration and relate that interrupted sleep exacerbates their pain condition, thus slowing their recovery process. This is important because sleep supports healing and overall physical and mental health (Centers for Disease Control and Prevention [CDC], 2024).

P: Stable adults 18–65 with acute uncomplicated low back pain in observation I (Intervention/Treatment): Sleep-protected vitals overnight (reduced frequency/held unless symptomatic or abnormal parameters) C: Routine q4h overnight vitals with no modifications O: Primary—sleep quality; Secondary—pain scores and patient satisfaction T: Overnight/within 24 hours

Best study method: A randomized controlled trial (RCT) comparing both protocols.

In the clinically stable patient (ages 18–65, in observation unit admission for acute, non-traumatic, uncomplicated low back pain, normal baseline vital signs, no neurologic deficits), does the sleep-protected overnight vital sign protocol (as compared to q4h vital signs overnight as in the treatment group) improve patient-reported sleep quality and pain in 24 hours? This PICOT question represents something that I regularly observe in the observation unit. Several of our patients with back pain are stable; however, they are still required to have vital signs q4h at night. It is puzzling because these patients will be resting comfortably and finally drift off to sleep only to be aroused again and again. Many have expressed to us that they are exhausted and irritable and that they feel they are in more pain because they are not being allowed to sleep. To find research to support my question, I created keywords related to every element within the PICOT and included key words to ensure strong studies weren’t overlooked. Synonyms (OR): Population/Problem: observation unit OR clinical decision unit OR short-stay; acute low back pain OR back pain; stable OR low-risk Intervention: sleep-protected vitals OR reduced vital signs OR nighttime vital reduction OR “do not disturb” OR sleep protocol Comparison: q4h vital signs OR routine vital signs OR standard monitoring OR usual care Outcome: sleep quality OR sleep disruption; pain score OR pain intensity; patient satisfaction After testing different combinations, I focused on results that looked at reducing nighttime interruptions, “quiet time” approaches, or changing monitoring routines for stable patients. I paid the most attention to stronger study types (like reviews and trials), but I also kept studies that looked like real-life unit changes because that’s what this topic feels like in practice.

Reference: Centers for Disease Control and Prevention. (2024). About sleep. https://www.cdc.gov/sleep/about/index.htmlLinks to an external site.