Nurses Showcase Studies at BWH Research Day 

Alexandra Vilmenay, left, and Senior Nurse Scientist Patricia Dykes, PhD, MA, RN, (at podium) look on as Bertha Lee answers a question during Research Day.

According to patients, what is the most common cause of sleep disruption during a hospital stay?

The answer is not the one clinicians thought most obvious - the sounds of alarms on medical devices. Rather, patients on Tower 15AB who answered a survey said that the checking of vital signs throughout the night was the single most disruptive factor to sleep. Alarm sounds didn't rank at all in patients' list of factors causing sleep disruption.

"It shows how important it is to talk to patients about their needs and perceptions, which may be different from what we think," said Ruth McGrotty, BSN, RN, of Tower 15AB.

McGrotty shared this interesting fact while presenting a study on sleep deprivation during the second annual BWH Research Day last month. During "Improving Outcomes for Hospitalized Vulnerable Patient Populations," four nurses presented riveting data and findings to a packed Bornstein Amphitheater. The studies were made possible through the Haley Nurse Scientist Program established with the Department of Nursing and the Boston College William F. Connell School of Nursing through the generosity of Steven and Kathleen Haley.

McGrotty's study included surveys of patients and key stakeholders about 40 factors, such as environment, emotional factors and nocturnal care activities. One hundred thirty-one clinicians and 105 patients answered the survey. Both groups felt strongly that sleep is a fundamental need and important to recovery.

The goal of the study was to establish a sleep promotion program led by nursing staff to improve sleep for patients through various interventions. 

During a three-month period, the program focused on staff education, interprofessional communication with Pharmacy, Environmental Services and Sleep Medicine, and integrating a sleep assessment tool into practice. "We also encouraged the use of nightlights, ear plugs and eye masks, and developed a brochure for patients and families about sleep," said McGrotty. "We hope more nurses will join us in this effort."

Feliza Hormillosa, RN, of Shapiro 6 West, also presented her study on sleep, which focused on sleep disturbance and its impact on delirium in ICU patients. "Approximately 50 percent of general medical patients complain of sleep disruption, and this can be worse in patients in the ICU," she said. "The high frequency of nocturnal care activities left ICU patients with few opportunities to sleep."

Preliminary analyses of the study data support that interventions to minimize unnecessary nocturnal interactions are critical to expand the period for uninterrupted sleep, which may ultimately reduce the incidence of delirium in the ICU.  Data collection and recruitment for Hormillosa's study is ongoing.

Ruth McGrotty presents research on sleep disruption.

Alexandra Vilmenay, MS, RN, FNP-BC, of the Connors Center for Women and Newborns, presented on depression in hospitalized pregnant women. "One in 5 women have symptoms of depression during pregnancy, and when untreated, this can cause serious risks for a woman and her baby," she said. "We found that little is known about this, and that this patient population is often excluded from research samples."

A retrospective medical review of 454 hospitalized women showed that 1 in 3 had a previous diagnosis of depression or anxiety, and that about 10 percent developed a new diagnosis of depression or anxiety while in the hospital.

Vilmenay is working to put interventions in place to address this gap in care, including depression screening, a strong partnership among Nursing, Psychiatry and Social Work, and an educational campaign to train providers on perinatal mood disorders. "The inpatient period offers an opportunity for nurses to intervene on behalf of these patients," she said.

Lastly, Bertha Lee, BSN, RN, of Tower 14CD, presented her work on the impact of regionalization on care plan concordance between patients and nurses. "Regionalization means that there is one team on one unit that focuses on the patient and family, and we wanted to learn whether this is improving the relationship between care providers, specifically nurses, and patients," she said.

In examining seven aspects of the care plan, Lee shared preliminary findings of the study, which suggest that there is strong concordance on some aspects of the plan, including diagnosis, tests and procedures, but improvement is needed in communication about other aspects of the plan of care.