Feasibility study of comfort with and use of sleep visualisation data from non‐wearable actigraphy among psychiatric unit staff

Abstract

Sleep disorders are a common factor in many psychiatric disorders, and objective observation and assessment of sleep states are important. However, observing the sleep of hospitalised patients in psychiatry units is complex. Polysomnography (PSG), the gold standard for objective sleep observation, is invasive and uncomfortable for the patient because of the sensors attached to the body. In addition, understanding the correct use of PSG systems is often difficult for observers. Wrist-worn actigraphy is an effective tool that is simpler and less invasive than PSG. However, there are unique problems associated with using wrist-worn actigraphy in a psychiatric unit. For patients with psychiatric illnesses, various issues are likely to occur, such as unexpected behaviour caused by hallucinations or cognitive decline that can result in the patient’s inability to correctly wear the device, or a lack of cooperation. Consequently, observation in psychiatric units is often limited to visual checks by nurses, which are considered to have low validity and can interfere with patient sleep. Nemuri Scan (Paramount Bed, Tokyo, Japan) is a non-wearable actigraphy system designed to avoid some of these difficulties. Because the thickness of the Nemuri Scan system is only 1.5 cm and it is placed under a mattress, it is difficult for the user to detect the device under their mattress. Therefore, the Nemuri Scan allows the continuous monitoring of their activities. The sensitivity, specificity, and concordance rate of the Nemuri Scan to PSG are equivalent to those of wearable actigraphy. This device can retrospectively collect and visualise sleep data during hospitalisation and show the patient’s current sleep state via a personal computer in the nurses’ station connected to a local area network using a function called Real-time monitor. However, little attention has been paid to how psychiatrists and psychiatric nurses utilise this technology. The current study aimed to clarify the level of interest in visualised sleep data among healthcare staff, and to explore the ways in which these data are used in a psychiatric unit. The setting of this survey was a 50-bed psychiatric unit in a general hospital with approximately 1000 beds in a major city in western Japan. This psychiatric unit contains an open ward and a closed ward. Nemuri Scan was introduced in all patients’ beds of the open ward and all private patients’ beds of the closed ward. The staff comprised 52 doctors and 25 nurses. The unit has a 10:1 nursing care system and double shifts, with three nurses working the night shift. In this investigation, a questionnaire was distributed three times: first, when the scan was introduced; second, after 3 months; and third, after 9 months. The items in the questionnaire included participants’ basic demographic information (age, gender, and clinical ladder level for nurses only), whether they believed that the data obtained from Nemuri Scan were useful, their motivations for accessing the device and its data, and the daily information resources they use to observe their patients’ sleep states. The questionnaire was completed using a tablet placed in the psychiatric unit, and the doctors and nurses in the unit were asked to respond to the questionnaire. The responses were divided into two groups (doctors and nurses) and summarised by time in a table. Table 1 shows the questionnaire results. In the first survey, 85% of nurses saw the visualised data on paper, and 35% reported that the data were not useful. Although only 30% of doctors saw the data, they all reported that the information was worthwhile. The number of staff who saw the data decreased after