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All Journal Caring : Indonesian Journal of Nursing Science Journal of Applied Nursing and Health
Hersinta Retno Martani
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Biochemistry, Genetics & Molecular Biology Chemistry Dentistry Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health Veterinary

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Nurses’ Perspectives on Sleep Promotion Practices in Indonesian ICUs: A Multicenter Cross-Sectional Study Setiyarini, Sri; Listyaningrum, Desy; Hersinta Retno Martani; Sujalmo, Purwadi; Kusumawati, Happy Indah
Journal of Applied Nursing and Health Vol. 7 No. 2 (2025): Journal of Applied Nursing and Health
Publisher : Chakra Brahmanda Lentera Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55018/janh.v7i2.311

Abstract

Background: Critically ill patients commonly experience sleep disturbance, which has the potential to increase mortality and morbidity. Therefore, implementing interventions to enhance sleep quality is crucial. This study aimed to explore Indonesian nurses' perceptions of patients' sleep and to investigate the relationship between sleep promotion practices and the quality of sleep of patients in the Intensive Care Unit (ICU). Methods: : A cross-sectional study design was used. A total of 211 nurses working in 10 ICU settings across 14 hospitals in Indonesia were involved using convenience sampling. The SLEEPii questionnaire was used to collect data from nurses who work in ICU for a minimum of one year.  Data was analyzed using frequency, mean (±SD), Median (±IQR), the Spearman Rank test, Kendal tau, and Kruskal-Wallis test. This study was reported in accordance with the STROBE guidelines. Results: 211 nurses from 14 hospitals in Indonesia reported that critically ill patients had sleep duration less than four hours (46.4%) and had fair sleep quality (58.8%). Sleep duration had significant differences between hospital status (p=0.004), and general hospital classification (0.002). Significant differences were also reported between sleep quality with ICU number of each Hospital (p=0.023), hospital status (p=0.047), and general hospital classification (0.032). Even though all participant reported that none of the ICU have protocol to promote sleep, this study found that duration of sleep correlate with control environmental noise levels (p=0.036), receiving medications for sleep (p=0.021), and activity to keeping ICU rooms dark at night (p=0.043), adhere to a clustered sleep protocol designed (p=0.001) and create conditions for a dedicated sleeping (p=0.004). Controlling environmental noise levels also correlated with sleep quality. Conclusion: Most of the critically ill patients had fair sleep quality. Findings suggest the urgent need for standardized sleep promotion protocols in Indonesian ICUs.
Navigating Do-Not-Resuscitate Orders in the Emergency Department: a Case Report on Ethical Decision Making Hersinta Retno Martani; Rizki Puji Agustin; Ninuk Dian Kurniawati; Suis Galischa Wati; Sriyono
Caring: Indonesian Journal of Nursing Science Vol. 7 No. 2 (2025): Vol 7 No 2 2025 Caring: Indonesia Journal of Nursing
Publisher : Talenta Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/ijns.v7i2.22427

Abstract

A patient with Chronic Kidney Disease Stage V presented to the Emergency Department (ED) with severe shortness of breath, caused by pulmonary edema resulting from non-compliance with fluid restriction. The patient and her husband consented to the use of a mechanical ventilator and dialysis; however, they declined to authorise cardiac and pulmonary resuscitation in the event of cardiac arrest or to establish a Do-Not-Resuscitate (DNR) order. This presents a dilemma, as patients with requiring ventilatory support typically necessitate ICU admission; nevertheless, patients with DNR orders are generally not admitted to ICU. The situation worsened when the extended family opposed the DNR Order established by the patient and her husband. This case report aimed to provide solutions for nurses addressing ethical dilemmas concerning the determination of DNR orders. This case report follows the CARE Case Report Guidelines. Following immediate and continuous care in the emergency department and intensive care unit, the patient demonstrated significant improvement. The nurse resolved ethical issues by organizing a family conference that included the patient’s family and care team, discussing the treatment plan on the basis of the most recent assessment results. Nurses’ proactive engagement of multiple stakeholders in patient care within the hospital effectively addresses Do-Not-Resuscitate order-associated ethical dilemmas. To effectively address ethical conflicts, nurses should improve their emphatic communication skills, prioritizing patient interests. Keyword: Do-Not-Resuscitate, Ethical dilemmas, Decision making, Advance care planning, Case report
Co-Authors Desy Listyaningrum, Desy Happy Indah Kusumawati Kurniawati, Ninuk Dian Purwadi Sujalmo Rizki Puji Agustin SRI SETIYARINI, SRI Sriyono Suis Galischa Wati