A Sleep Promotion Toolkit for Hospitalized Patients

During periods of illness, adequate sleep is critical to optimizing recovery. Inpatient sleep disturbance has been linked to detrimental outcomes such as delirium and falls. Routine assessment, open dialogue with patients, collaborative care planning, and tailored interventions are key to patient-centered care to improve sleep for hospitalized patients.

This research developed and pilot-tested a sleep promotion toolkit (SLEEPkit) for hospitalized patients. Designed as an application (app) downloaded to a patient’s personal device, patients are prompted to complete a daily assessment to facilitate routine sleep assessment and serve as the basis for an individualized plan for sleep promotion. With assessment findings, a patient can more comfortably discuss any sleep issues with his or her nurse at bedside. The app contains tailored messages for both patients and clinicians to facilitate communication and contribute to the collaborative effort of sleep promotion.

The specific aims of this research were as follows:

• Refine iteratively a patient-centered sleep promotion toolkit (SLEEPkit) for hospitalized patients. 
• Pilot-test the SLEEPkit, including its effectiveness on patient’s sleep during hospitalization, as well as the perceived usefulness, ease of use, user control, implementation, and maintenance in the acute care hospital setting. 

To inform the app development process, researchers conducted one-on-one interviews and focus groups with patients, care partners, and clinicians, and conducted bedside testing with 20 patients. In addition, researchers developed the Factors Affecting Inpatient Sleep (FAIS) scale, a tool covering the most significant sleep-disturbing factors perceived by patients. These identified factors could be used to facilitate more discussion of sleep, leading to individualized sleep promotion plans and education for supporting them.

One hundred and twenty-six patients were randomized to either: 1) the intervention group using the SLEEPkit or 2) a control group receiving usual care for sleep during hospitalization. Researchers collected patient self-reported perceptions related to sleep quality, alertness, and tiredness. Patients wore wrist sensors to measure their sleep patterns. Finally, patient and clinician feedback was sought on the feasibility of using SLEEPkit in the acute care hospital setting.

Researchers found it challenging to achieve adequate use of the tool, particularly with those patients who were very sick. It was difficult to know how patients used the SLEEPkit and engaged in bedside conversations with their care providers. As such, the researchers identified the need for a clinician interface that may help support better engagement of the clinician in sleep promotion with the patients.