Defining an EBP Question
The Evidence-Based Practice was developed to provide high-quality patient care. According to Dang and Dearholt (2017), “EBP integrates the best available scientific evidence with the best available experiential (patient and practitioner) evidence” (p. 4). Many problems could be examined and solved with the help of the EBP approach. One of them relates to the variables and outcomes of patent recovery in intensive care units (ICU).
A typical ICU environment is highly specific, and such specificity could be considered as problematic. Unnatural light and loud noise can lead to a sleep loss and disturbed circadian rhythm, and together with lack of orientation, isolation and invasive treatment they can contribute to the onset of delirium (Delaney, Van Haren, & Lopez, 2015). The light exclusively has been defined as a significant factor contributing to the overall patient distress. For example, it has been measured that light conditions in the current ICU practice are abnormal throughout the day, and that simple provision of eye masks can improve sleep characteristics (Pisani et al., 2015). Also, the episodes of delirium are more common in ICUs with no windows (Meenakumari, 2017). Therefore, it might be beneficial to implement cycled lighting in the ICU environment.
There has been designed a unique format for constructing an answerable EBP question called PICO. According to Dang and Dearholt (2017), PICO requires the definition of the following blocks: patient (P), intervention (I), comparison (C), and outcome (O) (p. 75). In this context, P-block would be patients in ICUs, I-block – cycled lighting, C-block – standard ICU lighting, and O-block – greater positive changes in patient health compared to the control condition. Therefore, the foreground question formulated according to EBP approach is, “Does the use of cycled lighting in intensive care units lead to a greater positive effect on patient recovery?”
Search Strategy Development
The defined EBP question requires the comparison of two conditions: cycled lighting and non-cycled lighting. The examined group contains patients undergoing medical treatment in ICUs, and the outcome of interest is an increased positive effect on patient recovery compared to the control condition. It is a therapy question, so the evidence should be acquired from randomized controlled trials and clinical trials. Therefore, the chosen research papers should be credible and relevant; they should contain data regarding the blocks listed earlier; finally, they should provide quantitative data leading to a definite conclusion.
Research Evidence Analysis
Study 1. Lighting, Sleep and Circadian Rhythm
The research “Lighting, sleep and circadian rhythm: An intervention study in the intensive care unit” (Engwall, Fridh, Johansson, Bergbom, & Lindahl, 2015) is an intervention study with II level of evidence. Although the authors implemented some randomization, the research design could not be considered experimental because the condition was sometimes selected based on the patients’ health status. Therefore, it has a quasi-experimental character due to a developed range of exclusion criteria. Besides, the degree of participants’ similarity regarding sex, age, etc., was proved to be the same. The data collected during the trial were both qualitative and quantitative with a good quality rating.
The research procedure was executed in two parts in an eight-bed general ICU in a Sweden hospital. The aim of the first part was to assess patients’ experience in different types of hospital rooms – with and without cycled lighting – using a questionnaire. The second part was designed to describe the patients’ experience in the intervention condition. The first part was a comparative, descriptive study with quantitative results, and the second was explorative, providing data for qualitative and quantitative content analysis. The results revealed differences in patients’ experience in both conditions. The perception of daytime brightness and the reported level of sleep pleasantness were greater in the intervention group. The authors concluded that cycled lighting in combination with daylight supported the patients’ circadian rhythm.
The title of the paper represents the article content, but it does not indicate that cycled lighting is used as an intervention condition. The abstract is informative and includes a relevant literature review; the existing problem is clearly presented. Due to the practical nature of the problem, the theoretical framework is replaced by existing evidence regarding sleep and the role circadian rhythm plays in human health. Reliability was tested; the questionnaire was previously used in other research work. The results were presented in tables and categories. The research data were discussed within the context of related studies; the limitations were also specified. Therefore, the study applies to the defined EBP question.
Study 2. The Effect of a Multicomponent Multidisciplinary Bundle of Interventions on Sleep and Delirium in Medical and Surgical Intensive Care Patients
This research conducted by Patel, Baldwin, Bunting, and Laha (2014) is a cohort-based study with an experimental design. It was executed in a 24-bed ICU with mixed surgical/medical adult patients in a teaching hospital. The study evaluated the effect of different environment variables, including manipulation with lighting, on patients’ sleep and the onset of delirium. The procedure contained two stages: before and after the implementation of intervention measures. Changes in ICU lighting included a light reduction according to day/night cycle and dimming or switching off any monitor screens. Measures for noise reduction were also applied. The patients with sleep disturbance were additionally offered eye masks. Light and sound conditions were assessed using environmental meters; quantitative data on sleep and delirium incidence were collected through validated questionnaires. The participants were chosen according to developed inclusion and exclusion criteria. The analysis of both cohorts’ parameters did not reveal any significant difference. A range of statistical methods was used to analyze the information. The results indicated that implemented measures led to increased sleep efficiency and reduced incidence of delirium.
The level of evidence of this study should be recognized as II due to the lack of patients’ randomization. The quality of the data provided is good; all calculations are presented in tables with sufficient explanation of statistical outcomes. Although the title of the paper does not specify the exact lighting schema being used, all structural components – abstract, introduction, methods, results, and discussion – are highly informative. The methods fit the research specification, and the sample size is sufficient. The existing limitations and recommendations were stated along with a definite conclusion. Therefore, the study should be considered applicable to the defined EBP question.
Study 3. Comparing the Effects of Cycled and Constant Lighting on Weight Gain and Length of Stay in Neonatal Intensive Care Unit
This study was developed and executed by Farahani, Nourian, Ahmadi, and Kazemian (2018) in a neonatal intensive care unit (NICU) of Mofid Children’s Hospital in Iran. It is a two-group randomized controlled clinical trial with I level of evidence. The design of this research is experimental; the quality of data collected is high. The investigation aimed to assess the effects of cycled lighting compared to usual constant lighting on infants’ weight gain during their treatment. The patients were chosen according to the criteria corresponding to the main goal of the study. The sample size was determined; the neonates were placed into control and intervention groups randomly. Personal data were received with the help of a questionnaire; weight parameters were recorded daily using a high-precision scale. Cycled lighting was implemented in two 12-hour shifts. The collected quantitative data were statistically analyzed and presented in several tables and one graph. The participants from the two groups did not differ by significant variables except gender. The results of the study indicated a significant weight gain in the intervention group compared to the infants’ in the control group, even when gender was taken into consideration. The authors concluded that statistically significant positive changes in weight in the intervention group should be viewed as an outcome of cycled lighting in the NICU.
The title of the research paper accurately describes the purpose and the general character of the study. The abstract is representative; the introduction contains a comprehensive literature review properly introducing the problem and leading to the primary objective; data collection and statistical analysis methods correspond to the purpose and study conditions. However, there is no information about reliability and validity. The calculated data are clearly explained in the results and discussion parts, which allowed drawing a confident conclusion. Therefore, this study applies to the defined EBP question.
Study 4. Effects of Creating an Artificial Night on the Pattern of Weight Gain among Preterm Neonates
This research was executed by Reyhani and Sanadgol (2016) in the NICU of Qaem hospital in Iran. It is a quasi-experimental study providing II level of evidence. The research aimed to examine the effects of different lighting conditions on weight gain among preterm neonates. The randomization was successfully implemented; participants’ selection was organized due to developed criteria. The quantitative data were collected through a questionnaire and direct observation, and the neonates’ weight was measured daily. After twelve hours from birth, the intervention condition was implemented similarly to the previous study: it involved two shifts of day/night lighting and the covering of the neonates’ incubators. Except for lighting manipulation, other procedures in both groups did not differ. The two groups showed similar characteristics regarding age, gender, calorie intake, and others. The results demonstrated that weight gain in the intervention group was significantly greater than in the control group. The researchers provided a definite conclusion: cycled lighting can be considered as an effective promoting tool in the NICU environment.
The title of the paper specifies the intervention condition as “artificial.” However, the abstract clarifies the lighting manipulation implemented in the research. The problem is comprehensively presented through an extensive literature review; both the questions and hypothesis are absent due to the practical nature of the paper. The sample size could be considered relatively small, but the chosen methods are sufficient. The analytical approach of the research is consistent with the design. The assessment measure reliability and content validity were addressed; the results are displayed in two tables and one graph; statistical outcomes are explained. Despite the lack of any limitations described, this study is applicable to the defined EBP question.
Study 5. Timing for the Introduction of Cycled Light for Extremely Preterm Infants
This is a randomized controlled trial executed by Brandon, Silva, Park, Malcolm, Kamhawy, and Holditch-Davis (2017) at Duke University Hospital. The design of the study is experimental; the level of evidence provided is I; the provided data are quantitative. The participants were recruited among infants according to developed criteria and then randomly assigned to either early cycled light (ECL) or late cycled light (LCL). The lighting management was similar to previous studies, but there was an hour window in the morning and evening with no specific light condition. The quantitative data were collected regarding weigh changes, length of hospitalization, sleep development, and hospital costs. The ECL group had more boys than the LCL group; other than that, both groups’ parameters did not differ. Daily medical records were analyzed, and data were presented in multiple tables and figures. The results regarding weight improvement were not statistically significant, although could be considered valuable for clinical practice.
The paper title represents the content accurately. The abstract is informative and contains a hypothesis; the introduction includes a detailed literature review and a proper exposition of the problem. The sample size is noted as one weakness of the study; other limitations have not been described. Validity was not evaluated, and reliability was addressed only for the sleep development measurement. The chosen statistical tools are consistent with the hypothesis; the calculations displayed in various tables and figures are explained by the authors. The discussion block considers the results within the context of previous findings. Although the research investigates the lighting manipulation in the NICU environment, both conditions involve intervention. Therefore, the study should be defined as less applicable to the EBP question.
The Significance of Cycled Lighting Implementation
Current assessment of the research evidence includes data from different age groups (adults and infants) and ICU conditions (standard and neonatal). The lighting management itself is also arranged according to certain demands depending on the sample characteristics. Every lighting condition is implemented to support the patients’ circadian rhythm, foster sleep efficiency, and contribute to overall health improvement, and despite the mentioned differences, the results confirm its practical usefulness. The evidence from the assessed articles leads to a confident conclusion: the cycled lighting is an effective tool for promoting a greater positive effect on patient recovery.
References
Brandon, D. H., Silva, S. G., Park, J., Malcolm, W., Kamhawy, H., & Holditch-Davis, D. (2017). Timing for the introduction of cycled light for extremely preterm infants: A randomized controlled trial. Research in Nursing and Health, 40(4), 294-310.
Dang, D., & Dearholt, S. L. (Eds.). (2017). Johns Hopkins Nursing Evidence-Based Practice: Model and guidelines (3rd ed.). Indianapolis, IN: Sigma Theta Tau International.
Delaney, L. J., Van Haren, F., & Lopez, V. (2015). Sleeping on a problem: The impact of sleep disturbance on intensive care patients – A clinical review. Annals of Intensive Care, 5(3), 1-10.
Engwall, M., Fridh, I., Johansson, L., Bergbom, I., & Lindahl, B. (2015). Lighting, sleep and circadian rhythm: An intervention study in the intensive care unit. Intensive and Critical Care Nursing, 31(6), 325-335. Web.
Farahani, E. A., Nourian, M., Ahmadi, F., & Kazemian M. (2018). Comparing the effects of cycled and constant lighting on weight gain and length of stay in neonatal intensive care unit among premature neonates: A two-group randomized controlled clinical trial. Nursing and Midwifery Studies, 7, 93-99. Web.
Meenakumari, P. (2017). The effects and impact of light on patients and staffs in hospitals. International Journal of Engineering Technology, Management and Applied Sciences, 5(6), 470-475.
Patel, J., Baldwin, J., Bunting, P., & Laha, S. (2014). The effect of a multicomponent multidisciplinary bundle of interventions on sleep and delirium in medical and surgical intensive care patients. Anaesthesia, 69(6), 540-549.
Pisani, M. A., Friese, R. S., Gehlbach, B. K., Schwab, R. J., Weinhouse, G. L., & Jones, S. F. (2015). Sleep in the intensive care unit. American Journal of Respiratory and Critical Care Medicine, 191(7), 731-738.
Reyhani, T., & Sanadgol, V. (2016). The effects of creating an artificial night on the pattern of weight gain among preterm neonates. Modern Care Journal, 13(1), 1-6. Web.