Date of Award

2025

Document Type

Doctor of Nursing Practice (DNP)

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

Committee Chair

Lenora Smith

Subject(s)

Cerebrovascular disease--Patients--Nursing, Sleep--Health aspects, Sleep disorders--Treatment

Abstract

This quality improvement project investigated the impact of using best practices from the literature to implement a novel protocol consisting of the Insomnia Severity Index (ISI) and an electronic medical record (EMR)-integrated automatic order into the workflow of nurses employed on a 41-bed stroke and cardiac unit of an inpatient rehabilitation facility. The project aimed to increase the number of adult patients recovering from stroke who received a minimum average of seven hours of sleep each night over a 10-day inpatient stay. The project used hourly rounding observations from nursing staff combined with ISI scores to assess the impact of nonpharmacological interventions on quantity of hours slept her night and patients’ subjective quality of sleep. In addition to patient outcomes, a pre and posttest on nursing confidence using the new interventions and a set of knowledge questions were implemented immediately prior to launch and at the end of the project. The authors found most patients (n = 30, or 91%) did not self-report a high enough score (≥15) to trigger the protocol even though they were not achieving the healthy minimum standard of seven hours of sleep per night. This suggests either the ISI was unable to accurately capture the status of the patient’s sleep, the patient was inaccurately self-reporting, or the patient’s subjective perception of their sleep did not match the nurses’ observations. The intervention was successful in achieving a high rate of compliance among nurses; over 95% of patients admitted to the unit were captured, and the median compliance rates were over 90%. The two pre and post-education survey questions most reflective of the new interventions had the most statistically significant differences in scores, suggesting nurses felt more competent helping patients with sleep hygiene and the use of the ISI as a result of the education. Given that sleep disturbances are common among patients recovering from stroke and contribute to poorer outcomes in terms of cognitive function, mood, and overall quality of life, nurse-driven nonpharmacological interventions should be considered for all patients regardless of self-report of sleep disturbance as a matter of caution and best practice.

Available for download on Monday, February 01, 2027

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