Week 10 assignment

Walden University

Running head: LITERATURE REVIEW 8

Introduction

Literature review represents very integral aspects of the research process. It is aimed at deriving out the current knowledge on the selected topic including the common patterns, contradictions, and gaps and, as a result, aid in determining what needs to be done by future researchers. In the present paper, the aim is to analyze and synthesize studies that have been conducted focusing on ICU Quiet time and more particularly, the effects of strict enforcement of scheduled hours of rest time on multiple incidences of delirium in adult critical-care patients in the ICU.

History

The onset of ICU Quiet time has been reported as dating back in the 1960s. It originated in the North America and, in particular, Quebec, Canada. It took place as a result of the natural continuation of creativity and innovations that occurred in Quebec. The period saw the introduction of the Hospital Insurance and Diagnostic Services Act, which brought rise to the concept and practice of public health insurance. This triggered the implementation of varied infrastructural projects in the health care. It is in the course of these changes that quiet time in ICUs was introduced with the aim of speeding up the healing of the patients. This practice prevails even in the modern day times.

Current Evidence

For a considerable period, research on ICU Quiet time has been rampant. Most of the frequent cited studies include Gardner, Collins, Osborne, Henderson, and Eastwood (2008), Maidl, Leske, and Garcia (2013), Olson, Borel, Laskowitz, Moore, and McConnell (2001), Richardson, Thompson, Coghill, Chambers, and Turnock (2009), Taylor (2008) and Weinhouse et al. (2009).

In their study, Gardner, Collins, Osborne, Henderson, and Eastwood (2008) used a sample of 299 participants. The sample received a scheduled quiet time intervention. In the process, the researchers evaluated the levels of noise, the rest of the inpatients, their sleep behaviors, and their well-being. It was concluded that the majority of the ICU patients are not usually concerned with noise. However, they often prefer a period in which they are not exposed to noise. The researchers also identified that nurses also see a great value in ICU Quiet time. In another study by Maidl, Leske, and Garcia (2013), the researchers carried out a set of non-randomized, uncontrolled quiet time trials in ICUs. The intervention involved a reduction of the environmental stressors and enhanced patient rest prior to the onset of the trials. It was determined that ICU patients often prefer quiet time. Also, according to the researchers, the nursing practitioners that work in the ICUs also value quiet time as they are allowed to chart and, as a result, reduce their levels of stress. In the process, better care is facilitated.

In another study by Olson, Borel, Laskowitz, Moore, and McConnell (2001), a sample of 239 ICU patients were subjected to a number of observations. As such, they were observed at least eight times each day prior and after the implementation of quiet time protocol. It was identified that the implementation of quiet time is of central importance as it reduces not only sound but also the levels of light. In addition to this, it was determined that the patients are more likely to fall asleep during quiet time as opposed to those who are exposed to noise and light. Richardson, Thompson, Coghill, Chambers, and Turnock (2009) also conducted a study on quiet time in ICUs. The aim was to decrease the levels of noise. The researchers came up with a primary clinical guideline that was constituted of pre-assessment, education, as well as, the implementation of the intervention. It was identified that noise reduction programs are very effective in reducing the levels of noise in an ICU. It was also concluded that patients often recover at a faster rate in ICUs where the levels of noise have been reduced. This is especially due to the notion that they tend to fall asleep more. This, according to the researchers, should be the case for the ICU patients.

A similar study was conducted by Taylor (2008). The aim was to investigate the best visiting practices. To do this, the researcher implemented a naturalistic intervention involving visitors, ICU patients, and the nurses. From the results of the study, the researchers concluded that all the participants valued visiting times. However, each of them saw quiet time as an essential intervention in ICUs. Weinhouse et al. (2009), on their part, conducted a review of literature in which the intention was to investigate the clinical and neurobiological effects of the deprivation of sleep. The researchers also investigated the potential association that prevails between the deprivation of sleep and delirium in ICU patients. It was identified that, experimentally and clinically, the deprivation of sleep compares closely with delirium. The researchers also named some of the similarities where they defined them as deficits in memory and attention, poor processing of thoughts, along with alterations in the mental status of the ICU patients. The researchers concluded that delirium had negative effects on patient sleep in ICU.

Clearly, the current body of research is consistent. As it can be seen, each of the study that has focused on the incidences of delirium and ICU Quiet time seem to come to a similar conclusion; that ICU patients value ICU Quiet time and reduced delirium. Most of the researchers, however, focus on the ICU patients. It must be understood that visitors and nurses are also important stakeholders. Thus, it is imperative to determine their perceptions regarding the issue. From the review, the only studies that focus on visitors and nurses are that by Weinhouse et al. (2009) and Maidl, Leske, and Garcia (2013). There is indeed consistency with the findings of the two studies given that they report the same findings. While this is the case, there is a need for further research, not only to increase the knowledge of the same but also to confirm the validity and the reliability of such findings.

Another notable thing about the present studies is the idea that they all focus on noise alone as the source of delirium. In a study by Xie, Kang, and Mills (2009), the researchers identified that noise is not the sole factor that disrupts sleep. As such, there are a series of other influences that cause the same effect. The researchers also identified that sound masking is the most appropriate approach for improving the sleep of ICU patients. This study clearly suggest that a discrepancy with the current research exists. It shows that the current knowledge is limited and construed. There is a need to expand the scope by covering other types of stressors. On top of this, the current body of research clearly fails to acknowledge on what interventions should be implemented in order to improve on ICU Quiet time. This is also an area that should be considered in future research.

Conclusion

Although there is consistency in findings, ICU quiet time needs further review given the limited nature of comparative research. There are several gaps that can be attributed to the present body of research. The larger part of the research has focused on the ICU patients. They have utterly failed to consider the perceptions of other interested groups and these include visitors and staff. In addition to this, there is a gap in that current studies see noise as the sole stressor. Besides, most studies do look at the possible interventions to guarantee ICU Quiet Time. In order to expand the body of knowledge, there is a need to focus on other environmental stressors.

Summary

A review of literature was carried out with the aim of assessing the current evidence to aid in investigating the effects of strict enforcement of scheduled hours of rest time on multiple incidences of delirium in adult critical-care patients in the ICU. The studies reviewed clearly evidenced that ICU patients usually value quiet time. However, they seem not to focus on the perceptions of other stakeholders such as the staff and the visitors. Also, they do not focus on other stressors aside from noise. Besides, not one the studies focused on the appropriate interventions. These gaps call for further research.

References

Gardner, G., Collins, C., Osborne, S., Henderson, A., & Eastwood, M. (2009). Creating a therapeutic environment: A non-randomised controlled trial of a quiet time intervention for patients in acute care. International journal of nursing studies, 46(6), 778-786.

Maidl, C. A., Leske, J. S., & Garcia, A. E. (2014). The influence of “quiet time” for patients in critical care. Clinical nursing research, 23(5), 544-559.

Olson, D. M., Borel, C. O., Laskowitz, D. T., Moore, D. T., & McConnell, E. S. (2001). Quiet time: A nursing intervention to promote sleep in neurocritical care units. American Journal of Critical Care, 10(2), 74-78.

Richardson, A., Thompson, A., Coghill, E., Chambers, I., & Turnock, C. (2009). Development and implementation of a noise reduction intervention programme: a pre‐and postaudit of three hospital wards. Journal of clinical nursing, 18(23), 3316-3324.

Taylor, A. (2008). Exploring patient, visitor and staff views on open visiting. Nursing Times, 104(40), 30-33.

Weinhouse, G. L., Schwab, R. J., Watson, P. L., Patil, N., Vaccaro, B., Pandharipande, P., & Ely, E. W (2009). Bench-to-bedside review: Delirium in ICU patients - importance of sleep deprivation. Critical Care, 13(6), 234-241.

Xie, H., Kang, J., & Mills, G. H. (2009). Clinical review: The impact of noise on patients’ sleep and the effectiveness of noise reduction strategies in intensive care units. Critical Care, 13(2), 208-215.

Literature Review Summary Table

NURS 6052