Primary Children’s Hospital surgical nurses Julianne (July) Mathias and Brianna (Bri) Peterson dread the late-night ritual of waking young patients and their parents to monitor vital signs.
“No parent is thrilled to be woken up at midnight and then again at 4 a.m. for vital signs, and then it takes a long time for their child to settle down,” said July. “By the time they get back to sleep, we're going back in there again, so they don't get much sleep.”
“The importance of sleep is crucial, especially in children and healing. It seems counterintuitive, as a nurse, to interrupt their sleep constantly all night when we're trying to help them heal and get better,” added Bri.
July and Bri have found that waking up stable patients for this ritual usually reveals what they already know—just providing reassurance that their vitals are fine, as expected.
If checking vital signs every four hours through the night is disruptive to a sleeping child, and rarely yields new information, why do it?
“It's the way it's always been done,” explained July and Bri’s mentor, Leandra Bitterfeld, a Research Nurse Coordinator for Intermountain Health. “When we were looking for evidence about why we do that, it's pretty slim, but it's been in practice for so long.”
Overnight vital signs monitoring is a pervasive medical practice but contradicts American Academy of Nursing guidance against waking patients for routine care.
While working lots of night shifts, July and Bri raised the question of whether overnight vital signs monitoring was even necessary. Their research uncovered evidence that minimizing overnight vital signs may be safe for clinically stable children. Informed by these findings, multidisciplinary teams at Primary Children’s Hospital are discussing criteria to determine which patients need overnight vital signs monitoring and which patients could go without and enjoy a better night’s sleep. It’s an initiative that fits well into Intermountain CEO Rob Allen’s recent call for caregivers to simplify the work.
The team is making their findings accessible to nurses in pediatric hospitals across the country, so others won’t have to do “the big dig” Bri and July did. Their scoping review, authored by Leandra, July, Bri, and Clare Kranz, Evidence-Based Practice/Quality Improvement Specialist, Primary Children's Hospital, was recently published in the Journal of Pediatric Nursing.
"I’m just so happy that Primary Children's and Intermountain is supporting bedside nurses in research,” said July. “We want to provide good care at the bedside, but also impact the bigger picture of how we can improve processes and Intermountain supports nurses to do that. …It leads to happier nurses. We feel like we can make a big difference.”
“If there are other nurses working bedside who have burning questions, please reach out to us because we're happy to support more projects,” said Leandra. “I don't want it to stop just with this one.”
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