Document Type : Original Article


1 Behavioral Sciences Research Center and Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran

2 Department of Nursing, Nursing Faculty and Student’s Research Committee, Baqiyatallah University of Medical Science, Tehran, Iran

3 Department of Midwifery, School of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran


BACKGROUND: Sleep disturbances as a major health problem are common in patients hospitalized 
in critical care units. This study examined the effects of a team‑based care plan on the quality of sleep 
in patients hospitalized in a cardiac surgery intensive care unit (CSICU) of a multidisciplinary hospital.
MATERIALS AND METHODS: In this clinical trial, 100 patients with cardiac surgery were selKMected 
through convenience sampling and then nonrandomly allocated to the intervention and or the control 
group. A plan of care with the recommendation of all intensive care unit care teams was designed 
and then applied. In this study, the Richards‑Campbell Sleep Questionnaire was used to evaluate 
sleep quality. Patients in the intervention group received the care plan for two consecutive nights. 
The study’s national approval code is IRCT2017091915512N2. Collected data were analyzed using 
SPSS software (v. 21), and by paired, independent t, Chi‑square, and Fisher’s exact tests.
RESULTS: Quality of sleep in patients admitted to the CSICU is significantly improved by noise 
reduction both in the first and second nights. Moreover, the team‑based care plan requires good 
coordination between all team members taking care of cardiac surgery patients admitted to the 
CSICU (P < 0.001).
CONCLUSIONS: The team‑based care plan significantly improves the quality of sleep. It may be 
due to the close coordination between all team members to avoid sleep disturbances.


1. Seyedfatemi N, Mohammadi N, Hashemi S. Promoting patients 
health in intensive care units by family members and nurses: 
A literature review. J Educ Health Promot 2020;9:114.
2. Chamanzari H, Moghadam MH, Malekzadeh J, Taghi M, 
Shakeri SK, Hosseini SM, et al. Effects of a quiet time protocol on 
the sleep quality of patients admitted in the intensive care unit. 
Med‑Surg Nurs J 2016;3:16‑7.
3. Yuan Y, Li J, Jing Z, Yu C, Zhao D, Hao W, et al. The role of 
mental health and physical activity in the association between 
sleep quality and quality of life among rural elderly in China: 
A moderated mediation model. J Affect Disord 2020;273:462‑7.
4. Nasiri Lari Z, Hajimonfarednejad M, Riasatian M, 
Abolhassanzadeh Z, Iraji A, Vojoud M, et al. Efficacy of inhaled 
Lavandula angustifolia mill. Essential oil on sleep quality, quality 
of life and metabolic control in patients with diabetes mellitus 
type II and insomnia. J Ethnopharmacol 2020;251:112560.
5. Ghanbarabadi R, Mirhosseini Z, Rakhshani MH, Estaji Z, Rad M. 
The effects of cool dialysate on quality of sleep among patients 
undergoing hemodialysis: A randomized clinical trial. J Educ 
Health Promot 2019;8:56.
6. Singleterry LR, Caulfield SL. Holistic approaches to support sleep 
in the intensive care unit patient. Crit Care Nurs Clin North Am 
7. Mzoughi K, Mansouri S, Aissa I, Ben Mrad I, Zairi I, Kraiem S. 
Nursing management of anxiety and sleep disorders in patients 
hospitalized in a cardiac intensive care unit. Eur J Prev Cardiol 
2021;28, Suppl 1:387.
8. Pisani MA, Friese RS, Gehlbach BK, Schwab RJ, Weinhouse GL, 
Jones SF. Sleep in the intensive care unit. Am J Respir Crit Care 
Med 2015;191:731‑8.
9. Choshen‑Hillel S, Ishqer A, Mahameed F, Reiter J, Gozal D, 
Gileles‑Hillel A, et al. Acute and chronic sleep deprivation 
in residents: Cognition and stress biomarkers. Med Educ 
10. Bahramnezhad F, Afshar PF, Zolfaghari M. Improvement of 
nursing care practices on sleeping quality of patients admitted 
to coronary care units. Med Surg Nurs J 2013;2:101‑6.
11. Bihari S, Doug McEvoy R, Matheson E, Kim S, Woodman RJ, 
Bersten AD. Factors affecting sleep quality of patients in intensive 
care unit. J Clin Sleep Med 2012;8:301‑7.
12. Wang S, Xin HN, Chung Lim Vico C, Liao JH, Li SL, Xie NM, et al.
Effect of an ICU diary on psychiatric disorders, quality of life, 
and sleep quality among adult cardiac surgical ICU survivors: 
A randomized controlled trial. Crit Care 2020;24:81.
13. Fard ZR, Azadi A, Veisani Y, Jamshidbeigi A. The association 
between nurses’ moral distress and sleep quality and their 
influencing factor in private and public hospitals in Iran. J Educ 
Health Promot 2020;9:268.
14. Daou M, Telias I, Younes M, Brochard L, Wilcox ME. Abnormal 
sleep, circadian rhythm disruption, and delirium in the ICU: Are 
they related? Front Neurol 2020;11:549908.
15. Li SY, Wang TJ, Vivienne Wu SF, Liang SY, Tung HH. Efficacy of 
controlling night‑time noise and activities to improve patients’ 
sleep quality in a surgical intensive care unit. J Clin Nurs 
16. Ardila CM, Gómez‑Restrepo ÁM. Frequency of physical inactivity 
and insufficient sleep, and their mixed effects on academic 
achievement in ethnic minority students: A matched case‑control 
study in a dental school. J Educ Health Promot 2020;9:138.
17. Zolfaghari M, Afshar PF, Noghabi AA, Khameslou MA. 
Modification of environmental factors on quality of sleep among 
patients admitted to CCU. J Hayat 2013;18:61‑8.
18. Neyse F, Daneshmandi M, Sharme MS, Ebadi A. The effect 
of earplugs on sleep quality in patients with acute coronary 
syndrome. Iran J Crit Care Nurs 2011;4:127‑34.
19. Mahfoozpour S, Mojdekar R. Attitudes of health care providers 
toward teamwork, safety climate and knowledge. J Shahid 
Beheshti Sch Nurs Midwifery 2012;22:35‑41.
20. Kamdar BB, Yang J, King LM, Neufeld KJ, Bienvenu OJ, 
Rowden AM, et al. Developing, implementing, and evaluating a 
multifaceted quality improvement intervention to promote sleep 
in an ICU. Am J Med Qual 2014;29:546‑54.
21. Richards KC, O’Sullivan PS, Phillips RL. Measurement of sleep 
in critically ill patients. J Nurs Meas 2000;8:131‑44.
22. Nasari M, Ghezeljeh T, Haghani H. Effects of nature sounds on 
sleep quality among patients hospitalized in coronary care units: 
A randomized controlled clinical trial. Nurs Midwifery Stud 
23. Fakhr‑Movahedi A, Mirmohammadkhani M, Ramezani H. Effect 
of milk‑honey mixture on the sleep quality of coronary patients: 
A clinical trial study. Clin Nutr ESPEN 2018;28:132‑5.
24. Hu RF, Jiang XY, Hegadoren KM, Zhang YH. Effects of earplugs 
and eye masks combined with relaxing music on sleep, melatonin 
and cortisol levels in ICU patients: A randomized controlled trial. 
Crit Care 2015;19:115.
25. Singh S, Sharma S, Bishnoi S, Saini S, Jose S, Sharma R, et al. Sleep 
quality index and factors influencing sleep of patients in tertiary 
care hospital: A cross‑sectional study. Sleep Vigil 2021:1‑8.
26. Kim J, Choi D, Yeo MS, Yoo GE, Kim SJ, Na S. Effects of 
patient‑directed interactive music therapy on sleep quality in 
postoperative elderly patients: A randomized‑controlled trial. 
Nat Sci Sleep 2020;12:791‑800.
27. Fang CS, Wang HH, Wang RH, Chou FH, Chang SL, Fang CJ. 
Effect of earplugs and eye masks on the sleep quality of intensive 
care unit patients: A systematic review and meta‑analysis. J Adv 
Nurs 2021;77:1‑11.
28. Mashayekhi F, Arab M, Abazari F, Rafati F, Rafiei H. The effects 
of earplug on perception of sleep in patients of coronary care unit 
educations. Middle East J of Nurs 2013;7:3‑8.
29. Scotto CJ, McClusky C, Spillan S, Kimmel J. Earplugs improve 
patients’ subjective experience of sleep in critical care. Nurs Crit 
Care 2009;14:180‑4.
30. Chalk BS, Pratt NV, Venkatachalam CA, Romito MB. The impact 
of earplugs and eye masks on sleep quality in surgical ICU 
patients at risk for frequent awakenings. Crit Care Med 2021;4:19.