Ssshhh…Healing Brains at Rest
Marlienne Goldin, RN, BSN, MPA
Director, Neuro Surgical ICU, Moses Cone Health Care System, Greensboro, NC
Faculty Associate, Watson Caring Science Institute, Boulder, CO
Abstract
Visiting hours in the ICU have shifted
from an hour twice a day, to 15 minutes
every two hours, to open visiting 24
hours a day, and every combination in
between. In our desire to
accommodate the need for families to
be at their loved one’s bedside, have
we acted in our patient’s best
interests? In order to heal, patients
need rest. That need is even greater
for brain injured patients. Sleep
disruption and deprivation are
particularly prevalent in the critical care
environment. Several studies over the
past twenty years have demonstrated
that critically ill patients have frequent
awakenings and arousals, and little to
no REM sleep. At a time when critical
patients need the most rest, the ICU
environment deprives them of it. It is a
common perception that the loss of
sleep increases an individual’s risk for
infection and disease. Optimizing
patient comfort and ensuring that
patients get the rest they need is a
difficult task in the ICU.
Scope of Problem
Effects of environmental stimuli on sleep
disruption in ICUs has never been
examined in a large scale study.
 Rest is essential to healing.
 40 to 50% of sleep in the ICU occurs
during the day.
 Deprivation causes physical and
psychological stress.
 Impedes recovery.
 Most studies used small, non random,
samples.
 Lack of research and evidence, is a
barrier to delivery of evidenced based
sleep promotion interventions.
 Predominance of stage 1 and 2 sleep.
 Decreased or absent stage 3, 4 and
REM
 Frequent arousals and sleep
fragmentation.
 Decreased immune function - impaired
defenses
.
 Increase serum cortisol.
 Decrease growth hormone, decreased
healing.
 Poor quality of life.
 PTSD.
 Delirium.
 Decreased electrolytes.
 Increased metabolic rate.

Methods
Conclusion
Instituted daily two hour quiet time from 2 to
4 PM.
 Families advised of Quiet Time upon
admission.
 Patient – ventilator synchrony, RT
Rounding.
 Pain therapy.
 Relaxation techniques, music therapy.
 Communication with other departments.
 Signage.
 Decreased lighting
 Physician awareness and communication.
 Appropriate pharmacological interventions.
 Noise levels, phones, staff conversation.
 Adequate length of time.
 Culture change, patient centered.
Efforts to promote rest in our ICUs need
to be ongoing if we truly strive to create
a healing environment.

“It may seem a strange
principle to enunciate as the
very first requirement in a
hospital that it should do
the sick no harm”…
Florence Nightingale
Results
Families appreciate the break from the
bedside.
 Patients get 2 hours of uninterrupted
rest.
 RNs get caught up on documentation.
 Everyone appreciates the change in
environment.
 Spread to other ICUs in the hospital.
 Implemented system wide to all 5
hospitals.

Marlienne.goldin@mosescone.com
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