• Background Sleep deprivation is common in critically ill patients and may have long-term effects on health outcomes and patients’ morbidity. Clustering nocturnal care has been recommended to improve patients’ sleep.• Objectives To (1) examine the frequency, pattern, and types of nocturnal care interactions with patients in 4 critical care units; (2) analyze the relationships among these interactions and patients’ variables (age, sex, acuity) and site of admission to the intensive care unit; and (3) analyze the differences in patterns of nocturnal care activities among the 4 units.• Methods A randomized retrospective review of the medical records of 50 patients was used to record care activities from 7 PM to 7 AM in 4 critical care units.• Results Data consisted of interactions during 147 nights. The mean number of care interactions per night was 42.6 (SD 11.3). Interactions were most frequent at midnight and least frequent at 3 AM. Only 9 uninterrupted periods of 2 to 3 hours were available for sleep (6% of 147 nights studied). Frequency of interactions correlated significantly with patients’ acuity scores (r = 0.32, all Ps < .05). A sleep-promoting intervention was documented for only 1 of the 147 nights, and 62% of routine daily baths were provided between 9 PM and 6 AM.• Conclusions The high frequency of nocturnal care interactions left patients few uninterrupted periods for sleep. Interventions to expand the period around 3 AM when interactions are least common could increase opportunities for sleep.

Adverse events may cause a patient serious harm or death; the patient becomes the first victim of these events. The health care providers who become traumatized by the events are the second victims. These second victims experience feelings such as guilt, shame, sadness, and grief, which can lead to profound personal and professional consequences. An organizational culture of blame and a lack of support can intensify the provider's suffering. Second victims, as they move through predictable stages of recovery, can be positively influenced by a supportive organizational culture and the compassionate actions of peers, managers, advanced practice nurses, educators, and senior leaders. The American Association of Critical-Care Nurses Healthy Work Environment standards provide a framework for specific actions health care professionals should take to support colleagues during their recovery from adverse events.

The purpose of this study was to examine relationships among selected endogenous factors and sleep patterns during hospitalization in patients with cardiac disease. Participants included 33 male and female patients with myocardial infarction and unstable angina. Wrist actigraph recordings and a computerized sleep algorithm demonstrated that the participants slept for a mean of 424.55 min (SD = 114.52), had a mean sleep efficiency of 77.30% (SD = 15.80), and experienced from 5 to 32 awakenings each night (M = 13.94, SD = 6.29). The mean duration of nighttime awakenings was 9.24 min (SD = 5.60). Self-reports of sleep efficiency, sleep supplementation, and sleep disturbance, using the Verran and Snyder-Halpern (1990) sleep scale, were better than normative data reported for hospitalized patients. The combination of age, gender, New York Heart Association Functional Classification scores (NYHA Criteria Committee, 1964), and prehospitalization sleep loss explained 29% of the variance in objectively measured sleep efficiency and 46% of the variance in duration of nighttime awakenings. These findings suggest the importance of prehospitalization variable as predictors of sleep patterns in hospitalized cardiac patients and provide baseline data for future study.