Adapting and implementing a staff-led sleep intervention in an acute rehabilitation setting

Abstract

Objective

To adapt and modify the successful SIESTA (Sleep for Inpatients: Empowering Staff to Act) sleep-promoting hospital protocol to an acute stroke rehabilitation setting.

Design

This study utilized a mixed methods design, involving qualitative surveys and interviews. Needs assessment and staff interviews informed the development of the adapted protocol, SIESTA-Rehab.

Setting

Inpatient unit treating persons with neurological injury, primarily stroke, in an acute rehabilitation hospital.

Participants

Nursing staff on the inpatient unit where SIESTA-Rehab was implemented.

Intervention

After identifying needs, we adapted the SIESTA protocol with relevant modifications to SIESTA-Rehab. Protocol adaptations were guided by the Culture, Oversight, Systems Change, Training framework, with a focus on developing nursing education and sleep-enhancing tools. The protocol was implemented over a four-year period, sustained through periodic staff re-education, and nursing staff perceptions of the intervention were evaluated using fidelity interviews.

Main Measures

Qualitative assessments were conducted from a convenience sample of nurses to gauge understanding, recall, ease of implementation, and individual re-education needs for SIESTA-Rehab.

Results

Initial staff feedback indicated limited awareness of sleep disorder screening and sleep optimization practices, highlighting the absence of sleep-based assessments during standard care. Initial unit-wide training was conducted on SIESTA-Rehab for nursing staff (N = 29), with ongoing education for new staff and periodic re-education for existing staff over 4 years of implementation. Fidelity interviews revealed high understanding, recall, and ease of implementing the intervention over survey periods.

Conclusions

SIESTA-Rehab can be successfully implemented in an acute rehabilitation setting, as indicated through positive staff responses.