A Nurse-driven Sleep Protocol for Inpatient Stroke Rehabilitation

PURPOSE: The impact of a novel protocol containing a bundle of best practices from the literature, combined with electronic medical record integration on nightly sleep duration of adult patients with stroke in an inpatient rehabilitation facility over a 10-night inpatient stay was investigated. DESIGN AND METHODS: This quality improvement project used hourly rounding observations from nursing staff combined with Insomnia Severity Index scores to assess the impact of nonpharmacological interventions on the number of hours patients slept per night and patients' subjective perception of sleep. Nurses' confidence in using the new interventions and knowledge of sleep promotion were assessed using a pre-test and post-test. RESULTS: A statistically significant decrease in Insomnia Severity Index scores from admission to 10-nights post-admission was noted; however, only 35% of patients achieved the average nightly sleep duration goal of seven hours minimum. This value remained unchanged from before the intervention. CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING: Post-stroke-related deficits contribute to and complicate the assessment of sleep disruption in inpatient rehabilitation facilities. Rehabilitation nurses play a key role in the identification and management of sleep disturbances to support patient recovery. CONCLUSIONS: As sleep disturbances among patients with stroke contribute to worse outcomes, nurse-driven nonpharmacological interventions should be considered for all patients as clinically appropriate, regardless of presentation, as a matter of best practice.