BACKGROUND Sleep is a vital part to healing and recovery, hence poor sleep during hospitalizations is highly undesirable. Few studies have assessed interventions to optimize sleep among hospitalized patients. OBJECTIVE To assess the effect of sleep‐promoting interventions on sleep quality and duration among hospitalized patients. DESIGN Quasi‐experimental prospective study. SETTING Academic medical center. PARTICIPANTS Adult patients on the general medicine ward. INTERVENTION Nurse‐delivered sleep‐promoting interventions augmented by sleep hygiene education and environmental control to minimize sleep disruption. MEASUREMENTS Objective and subjective measurement of sleep parameters using validated sleep questionnaires, daily sleep diary, and actigraphy monitor. RESULTS Of the 112 patients studied, the mean age was 58 years, 55% were female, the mean body mass index was 32, and 43% were in the intervention group. Linear mixed models tested mean differences in 7 sleep measures and group differences in slopes representing nightly changes in sleep outcomes over the course of hospitalization between intervention and control groups. Only total sleep time, computed from sleep diaries, demonstrated significant overall mean difference of 49.6 minutes (standard error [SE] = 21.1, P < 0.05). However, significant differences in average slopes of subjective ratings of sleep quality (0.46, SE = 0.18, P < 0.05), refreshing sleep (0.54, SE = 0.19, P < 0.05), and sleep interruptions (−1.6, SE = 0.6, P < 0.05) indicated improvements during hospitalization within intervention patients compared to controls. CONCLUSION This study demonstrated that there is an opportunity to identify patients not sleeping well in the hospital. Sleep‐promoting initiatives, both at the unit level as well as individualized offerings, may improve sleep during hospitalizations, particularly over the course of the hospitalization. Journal of Hospital Medicine 2016;11:467–472. © 2016 Society of Hospital Medicine
An innovative approach, Integrated Care Transitions Approach (ICTA), is proposed that incorporates the best practices of the four models discussed in this article and factors identified as essential for an effective care transition while addressing limitations of existing transitional care models. ICTA's four key characteristics and seven key elements are unique and stem from factors that help achieve effective care transitions.
Study purposeDistrust of the healthcare system is longstanding in the black community. This may especially threaten the health of the population when a highly contagious infection strikes. This study aims to compare COVID-19-related perspectives and behaviours between hospitalised black patients who trust versus distrust doctors and healthcare systems.Study designCross-sectional study at a tertiary care academic hospital in Baltimore, Maryland. Hospitalised adult black patients without a history of COVID-19 infection were surveyed between November 2020 and March 2021 using an instrument that assessed COVID-19-related matters. Analyses compared those who trusted versus mistrusted doctors and healthcare systems.Results37 distrusting hospitalised black patients were compared with 103 black patients who trusted doctors and healthcare systems. Groups had similar sociodemographics (all p>0.05). Distrustful patients were less likely to think that they were at high risk of contracting COVID-19 (54.0% vs 75.7%; p=0.05), less likely to believe that people with underlying medical conditions were at higher risk of dying from the virus (86.4% vs 98.0%; p=0.01) and less likely to be willing to accept COVID-19 vaccination (when available) (51.3% vs 77.6%; p<0.01) compared with those who were trusting.ConclusionHealthcare distrustful hospitalised black patients were doubtful of COVID-19 risk and hesitant about vaccination. Hospitalisations are concentrated exposures to the people and processes within healthcare systems; at these times, seizing the opportunity to establish meaningful relationships with patients may serve to gain their trust.
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