Impact of nurse-led sleep hygiene education on postoperative recovery outcomes

Thesis Abstract

Postoperative recovery is significantly influenced by sleep quality, yet traditional postoperative care often overlooks sleep hygiene as a modifiable determinant of outcomes. This study investigates whether nurse-led sleep hygiene education (NL-SHE) delivered preoperatively and postoperatively can improve recovery trajectories among adult surgical patients, reducing insomnia, pain intensity, delirium risk, length of stay, and patient-reported satisfaction. The aim is to determine the effectiveness of NL-SHE on objective and subjective recovery outcomes and to elucidate the mechanisms by which sleep health influences postoperative rehabilitation. Specific objectives are to (1) compare postoperative sleep quality between patients receiving NL-SHE and standard care; (2) assess differences in pain scores, analgesic consumption, delirium incidence, and functional recovery at 24, 48, and 72 hours post-surgery and at discharge; (3) evaluate length of hospital stay and patient satisfaction with care; (4) explore patient adherence to sleep hygiene practices and its association with recovery metrics; and (5) examine patients’ perceptions of nurse-led education via qualitative interviews to contextualize quantitative findings. The study adopts a parallel-group, randomized controlled trial embedded within a mixed-methods design, guided by the Information-Motivation-Behavioral Skills (IMB) theoretical framework and the biopsychosocial model of sleep. The population comprises adults aged 18–75 undergoing elective abdominal or peripheral orthopedic surgery at a tertiary university hospital. A sample size of 240 participants (120 per arm) was calculated to detect a medium effect size (Cohen’s d = 0.5) on primary outcomes with 80% power at a 5% significance level, accounting for 15% attrition. Randomization is computer-generated with allocation concealment; blinding of participants is not possible due to the nature of the intervention, but outcome assessors are blinded. Data collection instruments include the Pittsburgh Sleep Quality Index (PSQI) for sleep quality, Actigraphy for objective sleep parameters, the Visual Analog Scale for pain, the Numeric Rating Scale for analgesic use, the Confusion Assessment Method (CAM) for delirium, the Functional Recovery Index for daily activities, and the Client Satisfaction Questionnaire. The NL-SHE intervention consists of a standardized 20-minute nurse-led education session delivered preoperatively and reinforced on postoperative day 1, supplemented by an evidence-based sleep hygiene booklet, environmental optimization recommendations (noise/light reduction, room temperature), and a 7-day discharge follow-up call. Validity and reliability of instruments are established in prior studies with reported Cronbach’s ? ranging from 0.75 to 0.92. Data analysis employs intention-to-treat principles. Quantitative data will be analyzed using mixed-effects linear models to assess changes in sleep quality and recovery outcomes over time, with fixed effects for group, time, and their interaction, and random intercepts for participants. For binary outcomes such as delirium incidence and discharge status, generalized linear mixed models with logit/link function will be used. Mediation analyses will test whether improvements in sleep quality mediate effects on pain and recovery using bootstrapped confidence intervals. The qualitative component comprises semi-structured interviews with a purposive subsample of 30 participants from the NL-SHE arm to explore perceived facilitators and barriers to sleep hygiene adherence; thematic analysis will be conducted following the COREQ checklist. It is anticipated that the NL-SHE group will exhibit significantly better sleep quality (lower PSQI scores, longer total sleep time, higher sleep efficiency) and improved recovery markers, including reduced pain intensity, lower analgesic consumption, decreased delirium risk, shorter hospital stays, and higher satisfaction scores, compared with standard care. The study is expected to demonstrate that sleep health is a modifiable, high-impact determinant of postoperative recovery and that nurse-led interventions are a feasible, scalable approach to enhancing patient outcomes. Contributions to knowledge include empirical evidence on the effectiveness of NL-SHE in surgical populations, integration of sleep hygiene within perioperative nursing practice, and a theoretically informed model linking sleep health to recovery via pain and functional outcomes. The main conclusion anticipated is that incorporating structured sleep hygiene education into routine perioperative care yields meaningful improvements in both clinical and patient-centered outcomes, with sustained benefits observed at discharge and during early postoperative follow-up. Recommendations include adopting NL-SHE as a standard perioperative protocol, integrating sleep assessment into electronic health records, providing ongoing nurse training in sleep health communication, and extending research to diverse surgical populations and settings to assess generalizability.