Intensive care unit (ICU) environment has a very strong and unavoidable negative impact on patients' sleep. Sleep deprivation in ICU patients has been already studied and negative effects on their outcome (prolonged ICU stay, decreased recovery) and complication rates (incidence of delirium, neuropsychological sequels of critical illness) discussed. Several interventions potentially improving the sleep disturbance in ICU (sleep-promotion strategies) have been assumed and tested for clinical practice. We present a review of recent literature focused on chosen types of non-pharmacological interventions (earplugs and eye mask) analysing their effect on sleep quality/quantity. From the total amount of 82 papers found in biomedical databases (CINAHL, PubMed and SCOPUS) we included the 19 most eligible studies meeting defined inclusion/exclusion criteria involving 1 379 participants. Both experimental and clinical trials, either ICU and non-ICU patient populations were analysed in the review. Most of the reviewed studies showed a significant improvement of subjective sleep quality when using described non-pharmacological interventions (objective parameters were not significantly validated). Measuring the sleep quality is a major concern limiting the objective comparison of the studies' results since non-standardised (and mainly individual) tools for sleep quality assessment were used. Despite the heterogeneity of analysed studies and some common methodological issues (sample size, design, outcome parameters choice and comparison) earplugs and eye mask showed potential positive effects on sleep quality and the incidence of delirium in ICU patients.

Aim: The aim of this study was to compare the perception of selected stressors acting on the Czech intensive care unit (ICU) of Czech patients, their families and attending nurses. Design: A descriptive comparative study. Methods: Stressor perception was measured by a Czech version of the standardised questionnaire, The Environmental Stressor Questionnaire (ESQ). The sample group consisted of 90 people. Data were obtained via pairing (patientrelativenurse). The family and the attending nurses evaluated stressors by empathising with the patient. Results: When evaluating the data obtained, it was ascertained that the relatives and attending nurses perceive stressors acting on the ICU as worse than patients themselves do. The overall level of stressor perception in the relatives was statistically significantly higher than in the patients (z = -3.72; p < 0.001). A statistically significant difference was also confirmed with regard to perception of stressors between attending nurses and patients (z = -2.23; p < 0.001). Conclusion: Both the relatives and attending nurses perceive stressors in the intensive care unit as worse than the patients themselves do. The negative impacts of stressors can be reduced by implementing new approaches in nursing care.

Patients staying in the intensive care unit (ICU) require constant monitoring and numerous nursing interventions performed as needed, irrespective of daytime or night‐time. The disturbing effect of nocturnal nursing interventions and their contribution to sleep disruptions are unclear. The review analysed nocturnal nursing interventions, and their character, frequency and effects on sleep quality. The databases CINAHL, PubMed and Scopus were searched to identify and subsequently evaluate 19 studies (1,531 patients) meeting the algorithm used. Although nocturnal nursing interventions provided to ICU patients were frequent and varied, they were responsible for only a minority of observed sleep disruptions. The most frequent nocturnal intervention was Vital signs monitoring (Nursing Interventions Classification, 6,680). Implementation of sleep protocols, of which an integral part is clustering and planning of nocturnal interventions, appears to be effective. The review suggests that nursing interventions are not the main cause of sleep disruptions in the ICU. In an effort to improve the quality of sleep in ICU patients, other factors causing disturbance need to be addressed as well. The current trend is more careful planning of nursing care, clustering of interventions and minimizing nocturnal disruptions to allow patients at least one uninterrupted sleep cycle (90 min).

Introduction: There are many scales of assessment and prediction of risk of delirium, but they are little known and rarely used by professionals. Recognition of delirium by nurses continues to be limited. Design: The prospective observational study included 50 consecutive non-intubated patients staying in the ICU for more than 24 hours. Setting: Department of anesthesiology and intensive care medicine (5 beds) of AGEL Hospital in Valašské Meziříčí, between September 2020 and March 2021. Methods: Primary outcome was to compare the presence of delirium in non-intubated ICU patients with two simultaneously used assessment tools: the Neelon and Champagne (NEECHAM) Confusion Scale, and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). A secondary outcome was to verify the NEECHAM Confusion Scale reliability in the Czech ICU setting.Results: The study found that the incidence rates detected by the CAM-ICU (32%) and NEECHAM Confusion Scale (28%) were comparable. Nearly a third of CAM-ICU-negative patients were found to belong to the mild confusion or at-risk NEECHAM Confusion Scale groups. The internal consistency of the NEECHAM Confusion Scale assessed with Cronbach's α was 0.703. There was a statistically significant relationship between delirium and two of the studied patient parameters (GCS score and use of antipsychotics). Conclusions: Delirium is common in ICU patients, but it often remains undiagnosed. Various tools have been developed to help identify delirium patients. Their use has been shown to result in better outcomes. Both studied tools (the CAM-ICU and NEECHAM Confusion Scale) appear to be suitable and convenient.