by Dana Lancer
In a decades-long nursing study involving dozens of hospitals and tens of thousands of patients, researchers have determined that hospital patients dislike being awakened during the night for interventions.
The study was led by a team at the College of William & Mary’s School of Nursing in Williamsburg, VA, and included participation from nursing staffs in a wide range of hospital departments nationwide. The results were so conclusive that the study, which was designed to be carried out over 40 years, was ended six years early.
“The consistency and uniformity of the results was astonishing,” said Dr. Ramona Hay, director of the study. “Sure, there was anecdotal evidence to suggest that patients didn’t always appreciate being awakened in the middle of the night, but nobody had ever documented it. We certainly didn’t anticipate anything of this magnitude.”
The results showed little variation even when controlled for the age and ethnicity of the patient, gravity of their illness, nursing philosophy of the staff, or altitude at which the hospital was located.
“We were sure that the oxygen content of the ambient air would make a difference,” said Hay, “Not so. Patients in Flagstaff were just as pissed off as those in New Orleans.” Flagstaff, Arizona is nearly 7,000 feet above sea level.
The most surprising conclusion of the study was the indication that the more physically invasive—and thus the more critical—the intervention, the more tolerant patients tended to be.
“We figured that patients would object more to being probed and jabbed with needles to draw blood tests even when they knew those tests were vital for their care,” said Livermore Hackett, a lead nurse at Anaheim Memorial Hospital in California, one of the participating facilities. “But we found they were less bothered by that than by, say, having an orderly empty the trash at 4 a.m. Who knew?”
Researchers also found that high staffing levels, normally a positive factor in patient recovery rates, were consistent with high levels of patient “botheration,” as nighttime annoyance is referred to in nursing parlance.
“Apparently,” said Hay, “high staffing levels also result in large gaggles of nurses and assistants gathering around nursing stations and swapping ‘war stories.’ The sickest patients—you know, the ones that just lie there, groaning—are the ones that seem most irritated by the racket.”
“You can hardly blame the nurses,” added Hackett. “Do you have any idea how boring night duty can be? Patients need to understand that nurses have to blow off a little steam, especially now that most of us have quit smoking, and the wee hours are the only time we can do it.”
It’s not yet clear how the study may result in changes in nursing practice.
“We still don’t know how an alteration in nighttime service patterns will affect morale among nurses. For that, we need another study,” said Hay.