The Strength of Presented Evidence
The articles analyzed in the previous paper examined the influence of cycled lighting on the health outcomes of patients’ treatment in intensive care units (ICUs). Hospital conditions, especially in ICUs, could impact patients’ recovery due to experienced sleep disturbance and disrupted circadian rhythm. Changing lighting to a more natural day/night cycle proved to be beneficial to overall well-being and even lead to earlier hospital discharge (Ritchie, Ellen, & Kenneth, 2015). Therefore, light management appears to be a valid method for the improvement of the ICU environment.
All the reviewed articles were interventional and/or experimental studies with II or I level of evidence. The research question was clearly presented, and the need for the investigation was explained in a comprehensive discussion of existing scientific literature. Three studies out of five had a randomization procedure, and within all five the exclusion criteria were developed and used according to sample characteristics. Not all articles included the testing for reliability and validity; however, all of them provided quantitative data in tables and graphs and its analysis. Four research papers presented significant quantitative results to support the use of cycled lighting, and the last one had less evident findings still leading to the same conclusion.
First two studies, conducted by Engwall, Fridh, Johansson, Bergbom, and Lindahl (2015) and Patel, Baldwin, Bunting, and Laha (2014), investigated adult patients’ experience in general ICUs. Both studies examined the effect of cycled lighting introduced as an intervention condition on patients’ well-being compared to usual ICU lighting. Second research also evaluated noise levels and implemented other methods of improvement, such as dimming the monitor screens and the use of eye masks. The authors of these two experiments came to a similar conclusion: cycled lighting promotes sleep efficiency and supports patients’ circadian rhythm.
Other papers by Farahani, Nourian, Ahmadi, and Kazemian (2018), Reyhani and Sanadgol (2016), and Brandon, Silva, Park, Malcolm, Kamhawy, and Holditch-Davis (2017) described the implementation of cycled lighting in neonatal intensive care units (NICUs). All three studies applied a randomization procedure and controlled for characteristics of compared groups of participants. Also, the analyzed data related to infants’ weight gain which could be measured more efficiently.
Two of three experiments displayed a significant weight gain among infants in intervention groups, and the last one had results which were not statistically significant but still could be valuable for clinical practice. Therefore, the findings of these three studies should be considered as compelling evidence of the benefit of cycled lighting implementation in NICUs. In conclusion, all of the five reviewed articles supported the assumption that cycled lighting could be a useful tool for promoting a greater positive effect on patient recovery.
Implications for Changes in Nursing Practice
The evidence presented in discussed articles points at the need of the change of ICU lighting to a more natural condition. Standard ICU environment could be perceived by patients as very disturbing, impeding necessary rest and delaying their recovery. Even a common evening exposure to a light-emitting device such as an eBook affects the circadian clock and suppresses melatonin excretion among healthy people (Chang, Aeschbach, Duffy, & Czeisler, 2014). Therefore, the lighting in ICUs, including neonatal ICUs, should resemble a natural day/night cycle.
The patients’ experience with improved conditions was addressed in studies conducted by Engwall et al. (2015) and Patel et al. (2014) through questionnaires. Participants in both experiments reported better sleep efficiency and more pleasant feelings during their stay in ICUs. The second article also reported a reduced incidence of delirium. NICUs studies could evaluate the effects of cycled lighting only through a weight gain measurement. All three experiments demonstrated greater weight gain among infants in intervention groups.
The study conducted by Engwall et al. (2015) provided a detailed description of lighting management used as an intervention condition. The paper by Patel et al. (2014) introduced a multicomponent bundle of interventions for ICU environment manipulation. The practical information from these articles could be used to create more beneficial conditions to improve clinical outcomes for adult patients.
The three NICUs studies implemented 12 or 11-hour shifts of day/night lighting and described the intervention procedures in details. For example, in the experiment conducted by Farahani et al. (2018) the light was changed in two shifts: normal lighting from 07:00 to 19:00 and reduced lighting from 19:00 to 07:00. Researchers used a sheet of acrylic glass covered by a cotton material to create the night condition. Such modification could be easily replicated in any NICU. Therefore, the proposed change of ICU lighting is feasible and could be achieved with the help of relevant research work and provided instructions.
The issue of health care expenditures was mentioned in four articles. In the paper by Brandon et al. (2017) hospital costs were evaluated as a secondary outcome: “As expected, lower birthweight and longer hospitalization significantly increased total hospital costs” (p. 307). Farahani et al. (2018) also stated that changes in NICUs lighting could prevent prolonged stay in NICUs, which “can impose heavy costs on both neonates’ families and health-care systems” (p. 98).
Moreover, a strategy of creating artificial day and night was characterized as noninvasive and incurring no cost (Reyhani, & Sanadgol, 2016). Patel et al. (2014) considered indirect effects of lighting modification relating to negative outcomes among adult patients: “Both ICU and overall hospital costs are increased in the presence of delirium” (p. 547). Therefore, although cycled lighting implementation would require some financial investment, ultimately it could lead to a significant reduction in health care costs.
The experiments conducted in all five studies involved certain changes in unit operations. They required not only spare ICUs for intervention groups and some technical work for lighting modification, but also notable differences in nurses’ schedule and responsibilities. Nurses were provided with instructions and learning lessons; basically, they had to learn new operational habits. These changes could be considered undesirable at least by some members of hospital staff.
However, if previous arguments about patients’ benefits and health care expenditures reduction are taken into account, such a transition appears to be a significant improvement in hospital treatment in general.
The reviewed articles investigated the effects of cycled lighting on the outcomes of medical treatment in intensive care units of different age groups – adult people and newborns. The presented evidence leads to a unified conclusion: cycled lighting could be used to improve patients’ experience in ICUs and the clinical outcomes of their treatment. Cycled lighting should be implemented in hospitals all over the country with the help of the latest research findings and practical information they provide. These changes will require some additional expense and staff training, but eventually, they will facilitate the reduction of health care expenditures, promote patients’ recovery, and positively impact current nursing practice.
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. Web.
Chang, A.-M., Aeschbach, D., Duffy, J. F., & Czeisler, C. A. (2014). Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. Proceedings of the National Academy of Sciences of the United States of America, 112 (4), 1232-1237.
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.
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.
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. Web.
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.
Ritchie, H. K., Ellen, R. S., & Kenneth, P. W. (2015). Entrainment of the human circadian clock to the light-dark cycle and its impact on patients in the ICU and nursing home settings. Current Pharmaceutical Design, 21(24), 3438-3442. Web.