Patient-nurse agreement on inpatient sleep and sleep disturbing factors

Background

Sleep is vital for recovery during hospital stay. Many sleep-promoting interventions have been investigated in the past. Nurses seem to overestimate their patients sleep and their perspective is needed for these interventions to be successfully implemented.

Objectives

To assess the patient's and nurse's agreement on the patient's sleep and factors disturbing sleep.

Methods

The instruments used included 1) five Richard-Campbell Sleep Questionnaire (RCSQ) items plus a rating of nighttime noise and 2) the Consensus Sleep Diary (CSD). The mean of the five RCSQ items comprised a total score, which reflects sleep quality. Once a week, unannounced, nurses and patients were asked to fill in questionnaires concerning last night's sleep. Neither nurses nor patients knew the others' ratings. Patient-nurse agreement was evaluated by using median differences and Bland-Altman plots. Reliability was evaluated by using intraclass correlation coefficients.

Results

Fifty-five paired patient-nurse assessments have been completed. For all RCSQ subitems, nurses' scores were higher (indicating “better” sleep) than patients’ scores, with a significantly higher rating for sleep depth (median [IQR], 70 [40] vs 50 [40], P = .012). The Bland-Altman plots for the RSCQ Total Score (r = 0.0593, P = .008) revealed a significant amount of variation (bias). The intra-class correlation coefficient (ICC) indicated poor reliability for all 7 measures (range −0.278 – 0.435). Nurses were relatively overestimating their own role in causing sleep disturbances and underestimating patient-related factors.

Conclusions

Nurses tend to overestimate patients’ sleep quality as well as their own role in causing sleep disturbances.