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. 2025 Dec;22(6):e70077.
doi: 10.1111/wvn.70077.

The Effect of Implementing a Sleep Care Bundle on Sleep Quality and Delirium Among Critically Ill Patients: A Quasi-Experimental Study

Ayat Mohamed Fahmy  1 , Tamer Awad El-Sayed  2 , Hala Ahmed Mohamed Abdelrahman  1 , Hend El-Sayed Mansour  1
Affiliations

The Effect of Implementing a Sleep Care Bundle on Sleep Quality and Delirium Among Critically Ill Patients: A Quasi-Experimental Study

Ayat Mohamed Fahmy et al. Worldviews Evid Based Nurs. 2025 Dec.

Abstract

Background: Sleep disturbances and delirium are prevalent problems in the intensive care unit. Evidence suggests that these conditions negatively impact patient outcomes by increasing the length of hospital stays, delaying recovery, and raising healthcare costs.

Aim: This study aimed to investigate the effect of implementing a sleep care bundle on sleep quality and delirium among critically ill patients.

Methods: A quasi-experimental research design was used. A purposive sample of 66 patients was divided equally into two groups: a bundle group that received a sleep care bundle and a control group that received routine unit care in the chest intensive care units at Mansoura University in Egypt. Data were collected using the critically ill patients' outcome evaluation tool based on the Richards-Campbell Sleep Questionnaire Scale and the Intensive Care Delirium Screening Checklist.

Results: Compared to the control group, the bundle group demonstrated statistically significant improvements across all sleep quality domains measured by the Richards-Campbell Sleep Questionnaire by Day 3. Specifically, sleep depth improved from 1.24 ± 0.44 to 1.82 ± 0.39 (effect size = 0.600), ability to fall asleep from 1.21 ± 0.42 to 1.91 ± 0.29 (effect size = 0.703), number of awakenings from 1.27 ± 0.45 to 1.79 ± 0.42 (effect size = 0.483), sleep efficiency from 1.24 ± 0.44 to 1.76 ± 0.44 (effect size = 0.600), and overall sleep quality from 1.24 ± 0.44 to 1.85 ± 0.36 (effect size = 0.600). In addition, the occurrence of delirium on Day 3 was significantly lower in the bundle group (0.0%) compared with the control group (15.2%) (χ2 = 7.471, p = 0.023). Subsyndromal delirium was observed in 6.1% of the bundle group and 15.2% of the control group. The overall percentage of patients without delirium was significantly higher in the bundle group (93.9%) compared to the control group (69.7%).

Linking evidence to action: Implementing a sleep care bundle enhances sleep quality and reduces the occurrence of delirium in critically ill patients. Therefore, it can be integrated as an adjunctive intervention alongside routine care for these patients. To strengthen future applications, incorporating fidelity monitoring is recommended to ensure consistent implementation of the sleep care bundle and to optimize its effectiveness in clinical practice.

Keywords: critically ill patients; delirium; sleep care bundle; sleep quality.

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