NUR 300 Module 1 Short Paper example

Why Patients Cannot Sleep on a Medical Unit: Evaluating Three Sources on Inpatient Sleep Disruption

[Student Name]

Southern New Hampshire University

NUR 300: Scholarly Inquiry

Module One Short Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Why Patients Cannot Sleep on a Medical Unit: Evaluating Three Sources on Inpatient Sleep Disruption

On the 30-bed medical unit where I work nights, the routine between midnight and 6:00 a.m. is familiar to every nurse on the floor. Vital signs are due at midnight and again at 4:00 a.m., laboratory draws arrive at 4:30 a.m., the intravenous pumps alarm when a bag runs dry, and the patient in the next bed calls out for the bathroom. By morning, patients often tell the day nurse that they did not sleep at all. The question that started this search was simple: how much sleep do hospitalized adults actually lose, what disturbs it, and which of those disturbances are within nursing control?

This paper evaluates three sources found through the Shapiro Library databases using the terms inpatient sleep, sleep disruption, and hospitalized adults. For each source it asks four questions: what kind of publication is this, who wrote it and for whom, how was the evidence produced, and how much weight can a nurse place on it. The aim is not to summarize the sources but to decide what each one is good for.

Source One: A Multicenter Survey Study

Wesselius et al. (2018) surveyed about 2,000 adult patients admitted to general wards in 39 hospitals in the Netherlands and asked them to compare their sleep in the hospital with their usual sleep at home. The study was published in JAMA Internal Medicine, a peer-reviewed medical journal, and the author group included physicians and sleep researchers from academic hospitals. Patients reported sleeping substantially less in the hospital than at home, more than an hour less per night, and waking earlier and more often. The factors they most often blamed were noise from other patients, noise from medical equipment, pain, trips to the toilet, and being woken by hospital staff.

This is primary research: the authors collected new data and analyzed it. Its strengths are its size and its spread across many hospitals, which makes it less likely that the findings reflect one unusual ward. Its limits are just as clear. Sleep was measured by patient report, not by an objective device, so patients who slept poorly may have remembered their nights as worse than they were. The design was cross-sectional, so it shows association rather than cause. For a nurse, the study is strong enough to say that inpatient sleep loss is common and that staff activity is one of the reported causes, but not strong enough to say that any single change would fix it.

Source Two: A Systematic Review of Interventions

Miller et al. (2019) conducted a systematic review of nonpharmacological interventions meant to improve sleep in hospitalized patients, published in General Hospital Psychiatry. A systematic review follows a stated search strategy across several databases, applies inclusion rules decided in advance, and appraises the quality of every study it includes. The interventions in the included studies ranged from earplugs and eye masks to relaxation techniques, music, and changes to the timing of nighttime care.

The review is a higher level of evidence than a single study because it gathers and weighs many studies at once. Its conclusions, however, were cautious. Several interventions showed promise, but the included trials were often small, used different measures of sleep, and were at risk of bias, so the authors could not name one approach as clearly effective. That caution is itself useful. It tells a nurse that simple measures such as offering earplugs are reasonable and low in risk, while warning against promising patients a result the evidence does not yet show. Under the Johns Hopkins hierarchy, a systematic review of mixed designs sits above a single survey study, but its rating also depends on the quality of what it includes (Dang et al., 2022).

Source Three: An Invited Commentary

Growdon and Inouye (2018) wrote an invited commentary that appeared alongside the survey study in the same journal issue. Both authors are established researchers in hospital care of older adults, and the piece passed editorial review. It is still not research. The authors did not collect data; they interpreted the findings of others, placed them in the context of delirium and recovery in older patients, and argued that hospitals should treat sleep as part of routine care rather than as a comfort measure.

A commentary is valuable for framing. It explains why a finding matters and points toward practical responses, such as grouping nighttime tasks so that a patient is woken once rather than four times. What a commentary cannot do is serve as the evidence for a practice change, because its claims rest on other sources that must be read and judged directly. In a scholarly paper, this source would support a sentence about why inpatient sleep deserves nursing attention, while the claims about how often sleep is disrupted would be cited to the survey study itself.

Comparing the Sources

Placed side by side, the three sources do different work. The systematic review carries the most weight for any question about what helps, even though its answer is uncertain. The survey study carries the most weight for describing the size and causes of the problem in general wards. The commentary carries the least weight as evidence but the most as argument, because it connects sleep loss to outcomes that matter to nurses, such as confusion in older patients. A fourth source found during the search, a quality improvement project that restructured nighttime clinical work on medicine units (Holleck et al., 2023), shows how a single hospital acted on this problem. Quality improvement reports describe local change rather than generalizable findings, so it would be read as an example of what is possible, not as proof that the same change would work on my unit.

Two habits shaped these judgments. First, the type of publication was identified before its conclusions were read, so a persuasive argument could not be mistaken for data. Second, each source was asked what it could support, not only what it said. A strong paper later in this course will need both habits, because the final project depends on sources chosen and weighed in exactly this way.

Conclusion

Hospitalized adults lose meaningful sleep, and patients themselves point to noise and staff activity as causes. The evidence about what fixes the problem is still modest, and the most persuasive writing on the subject is commentary rather than research. For a nurse on a night shift, that combination supports a careful position: routine nighttime interruptions deserve review, low-risk measures are reasonable, and any unit change should be measured rather than assumed to work. Knowing which source supports which part of that position is the skill this assignment is designed to build.

References

Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2022). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.

Growdon, M. E., & Inouye, S. K. (2018). Minimizing sleep disruption for hospitalized patients. JAMA Internal Medicine, 178(9), 1208-1209. https://doi.org/10.1001/jamainternmed.2018.2679

Holleck, M. E., Tikkanen, K., Holleck, J. L., Frank, C., Falco, N., Cosentino, D., & Chang, J. J. (2023). Reducing nighttime interruptions and improving sleep for hospitalized patients by restructuring nighttime clinical workflow. Journal of General Internal Medicine, 38(9), 2091-2097. https://doi.org/10.1007/s11606-022-08005-2

Miller, M. A., Renn, B. N., Chu, F., & Torrence, N. (2019). Sleepless in the hospital: A systematic review of non-pharmacological sleep interventions. General Hospital Psychiatry, 59, 58-66. https://doi.org/10.1016/j.genhosppsych.2019.05.006

Wesselius, H. M., van den Ende, E. S., Alsma, J., ter Maaten, J. C., Schuit, S. C. E., Stassen, P. M., de Vries, O. J., Kaasjager, K. H. A. H., Haak, H. R., van Doormaal, F. F., Hoogerwerf, J. J., Terwee, C. B., van de Ven, P. M., Bosch, F. H., van Someren, E. J. W., & Nanayakkara, P. W. B. (2018). Quality and quantity of sleep and factors associated with sleep disturbance in hospitalized patients. JAMA Internal Medicine, 178(9), 1201-1208. https://doi.org/10.1001/jamainternmed.2018.2669