Abstract

Introduction

Improving sleep for patients with stroke is vital due to the importance of sleep for neuroplasticity and functional recovery. While sleep interventions have been successful in reducing nocturnal disruptions for hospitalized patients, few interventions have been tested for patients with stroke in an acute rehabilitation setting. We aimed to adapt the successful hospital protocol SIESTA (Sleep for Inpatients: Empowering Staff to Act) to an acute stroke rehabilitation setting.

Methods

Surveys and focus groups with nurses caring for patients with stroke on inpatient floors at Shirley Ryan AbilityLab informed the development of the adapted protocol, SIESTA-Rehab. The protocol included educational video modules for nurses regarding sleep hygiene and sleep apnea screening, sleep enhancing measures (eye masks, quiet signs), a nurse badge card with a checklist reinforcing protocol components, and advocacy for patient sleep at shift handoff. Two nurse champions were recruited to monitor protocol implementation. Periodic re-education was conducted to account for nurse turnover. Ongoing fidelity interviews using the Consolidated Framework for Implementation Research (CFIR) framework assessed intervention perceptions.

Results

We initially trained 27 (93%) nurses using the training module. Fidelity interviews of over 20 nurses in the years post-implementation demonstrated over 57% of nurses recalled sleep masks and “cluster care” as part of the protocol. Moreover, more than 75% of nurses considered the protocol to be “straightforward” and “part of the workflow.” Nurses perceived the protocol positively, noting it “could be really beneficial for patients and their long-term health,” and have incorporated behavioral changes into their routine since being educated on sleep hygiene. Nurses also reported understanding the importance of sleep for stroke patients, stating sleep “helps in their recovery and feeling well rested for the day so that they can participate in therapy” and understood “how [they] affect that in [their] roles” as nurses.

Conclusion

The SIESTA protocol can be successfully adapted to an acute rehabilitation setting for stroke patients, as evidenced by positive staff responses to sleep-promoting interventions, ease of protocol incorporation, and high staff compliance. Ongoing work is investigating patient perceptions and outcomes following implementation of this sleep protocol.

Support (if any)

 

Issue Section:
XI. Healthcare Delivery, Implementation, and Education
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