NURS 4300 Week 4 Capstone Literature Review Example

Course	NURS 4300 BSN Capstone
Week	Week 4
Paper type	Capstone literature review
Length	About 1,300 words, 7 pages
Format	APA 7 student paper
School	Walden University
Program	Bachelor of Science in Nursing (BSN)
Updated	October 2026

Free sample paper for NURS 4300 Week 4

Capstone Literature Review: Overnight Disruption, Sleep-Promoting Care and Sleep in Hospitalized Adults

Student Name

College of Nursing, Walden University

NURS 4300: BSN Capstone

Instructor Name

Month Day, Year

What this page is doingOrganized by what the studies found rather than by who wrote them, so each theme can compare sources directly.

Capstone Literature Review: Overnight Disruption, Sleep-Promoting Care and Sleep in Hospitalized Adults

The review serves the Week 2 PICOT question: on a medical unit caring for people aged 65 and over, would gathering routine night care into planned rounds, set against the present one-task-at-a-time routine, raise the sleep quality patients report over their first three nights?

The Week 3 search of CINAHL and PubMed retained nine sources. They are discussed below under four themes: where overnight disruption comes from, what bundled interventions have achieved, how inpatient sleep is measured, and how sleep relates to delirium. Each source's Johns Hopkins evidence level and quality rating (Dang et al., 2022) appears in the appendix table, and sources are cited there by number.

Sources of Overnight Disruption

Two nonexperimental studies, from very different settings, agree that hospitals wake patients often and that staff are a large part of the cause. In the intensive care units studied by Tamburri et al. (2004), records from 147 nights showed patients averaging just under 43 care contacts a night, most often around midnight, with only 6% of nights containing an uninterrupted stretch of two to three hours. On general wards, the Dutch multicenter survey by Wesselius et al. (2018) of 2,005 patients, with a median age of 68, found that patients slept 83 minutes less in hospital than at home and woke 3.3 times a night compared with 2.0 at home; 35.8% reported being woken by hospital staff. The most common disturbing factors were noise from other patients, medical devices, pain and trips to the toilet.

The two studies differ in method and in what they can show. Tamburri counted documented care, which captures planned interruptions but misses noise and alarms; Wesselius asked patients, which captures their experience but depends on memory the next morning. Taken together they suggest that both planned care and the ward environment matter, and that the planned part is the portion nurses can most directly change.

Bundled Interventions

The intervention literature is strongest in intensive care and is mostly about bundles rather than single changes. Patel et al. (2014) introduced a bundle of noise and light reduction and fewer overnight disturbances in medical and surgical intensive care; after the change, sound and light levels fell, care-related awakenings dropped from a mean of 11.0 to 9.0 a night, the sleep efficiency index rose, and the incidence of delirium fell from 33% to 14%. Because outcomes were compared before and after the change on the same units, the delirium result may reflect other changes over time. On general medicine units, Arora et al. (2019) combined electronic prompts to skip nighttime vital signs and medications with staff education; on the unit where nurses also received coaching and built the program into huddles, nighttime room entries fell by 44% and patients more often reported no disruption for vital signs or medications than on the comparison unit.

Single components have been tested in randomized trials, with mixed results. Van Rompaey et al. (2012) assigned 136 intensive care patients at random to earplugs at night or none, and found a lower incidence of confusion and better self-reported sleep after the first night in the earplug group. Demoule et al. (2017), in a trial of 64 intensive care patients using earplugs and an eye mask, found that the primary outcome, the proportion of deep sleep, did not differ significantly between groups, though patients who tolerated the devices all night had more deep sleep and fewer long awakenings; 30% did not keep them in all night. The Cochrane review by Hu et al. (2015) pooled small trials and found that earplugs or eye masks were associated with less delirium and more sleep, but rated the quality of that evidence as low.

No retained study tested clustering overnight care as a single intervention on a general medical unit for older adults. Clustering appears in these studies as part of a bundle, which makes its separate effect impossible to isolate.

What this page is doingStudies are compared inside the theme, and the earplug trials that disagree are reported side by side with their designs.

Measuring Inpatient Sleep

The studies measured sleep in at least four ways, and the choice affects what can be compared. Polysomnography, used by Demoule et al. (2017), is the reference standard but requires equipment and staff that a medical unit does not have. The Richards-Campbell questionnaire, five visual analog items answered each morning, was tested against polysomnography in 70 alert critically ill men; it showed high internal consistency, and its total score accounted for about a third of the variance in polysomnographic sleep efficiency (Richards et al., 2000). Wrist actigraphy, used by Todd et al. (2017), estimates sleep from movement and needs no patient effort but tends to count still wakefulness as sleep. Patient diaries and standardized item banks, used by Wesselius et al. (2018), capture experience across a whole population but depend on recall.

For a unit project, a brief morning questionnaire is the most practical measure. Its limitation is that only patients alert enough to answer can be included, which excludes some of the older patients most at risk.

Sleep and Delirium in Older Inpatients

Several studies report associations between disrupted sleep and delirium, but none shows that improving sleep prevents delirium in older medical patients. Following 101 patients aged 65 or more through elective arthroplasty, Todd et al. (2017) found that sleep disruption at home before surgery was strongly associated with postoperative delirium, and that disruption measured in hospital was associated with delirium in some but not all models. Patel et al. (2014) reported that higher sleep efficiency was associated with lower odds of delirium, and the earplug trial by Van Rompaey et al. (2012) found less confusion with earplugs. These findings point the same way, but they come from surgical and intensive care patients, use different delirium measures, and cannot separate the effect of sleep from the effect of the other changes in each bundle.

The Open Question

The literature leaves a gap that this capstone can address. Disruption is common and partly caused by planned care; bundles that reduce it have improved sleep measures, mainly in intensive care; and brief questionnaires can measure patient-reported sleep. What has not been tested is whether clustering routine overnight care on a general medical unit improves the sleep that older patients report in their first nights after admission. That is the question the synthesis and proposal will take up.

Appendix: Evidence Table

Table 1

Retained Sources With Johns Hopkins Level and Quality

#	Source	Study type	Who and where	Main result	JH level	JH quality
1	Tamburri et al. (2004)	Retrospective record review	50 patients, 147 nights, four intensive care units	Mean 42.6 care interactions per night; few uninterrupted periods	III	B
2	Wesselius et al. (2018)	Multicenter cross-sectional survey	2,005 ward patients, 39 Dutch hospitals	83 minutes less sleep than at home; staff among causes of waking	III	A
3	Patel et al. (2014)	Before-and-after quasi-experimental	338 medical and surgical intensive care patients	Bundle improved sleep efficiency; delirium fell from 33% to 14%	II	B
4	Arora et al. (2019)	Pre-post with comparison unit	Two general medicine units	Room entries fell 44% on coached unit; fewer reported disruptions	II	B
5	Van Rompaey et al. (2012)	Randomized controlled trial	136 intensive care patients	Earplugs lowered confusion incidence; better sleep perception	I	B
6	Demoule et al. (2017)	Randomized controlled trial	64 intensive care patients	No significant difference in deep sleep proportion; benefit when tolerated	I	B
7	Hu et al. (2015)	Cochrane systematic review	Trials of non-drug sleep interventions in intensive care	Earplugs or eye masks associated with less delirium; low-quality evidence	I	B
8	Richards et al. (2000)	Instrument development	70 critically ill men	Five-item questionnaire reliable; related to polysomnography	III	B
9	Todd et al. (2017)	Prospective cohort	101 adults 65+ having arthroplasty	Home sleep disruption strongly linked to delirium; hospital link weaker	III	B

References

Arora, V. M., Machado, N., Anderson, S. L., Desai, N., Marsack, W., Blossomgame, S., Tuvilleja, A., Ramos, J., Francisco, M. A., LaFond, C., Leung, E. K., Valencia, A., Martin, S. K., Meltzer, D. O., Farnan, J. M., Balachandran, J., Knutson, K. L., & Mokhlesi, B. (2019). Effectiveness of SIESTA on objective and subjective metrics of nighttime hospital sleep disruptors. Journal of Hospital Medicine, 14(1), 38-41. https://doi.org/10.12788/jhm.3091

Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2022). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.

Demoule, A., Carreira, S., Lavault, S., Pallanca, O., Morawiec, E., Mayaux, J., Arnulf, I., & Similowski, T. (2017). Impact of earplugs and eye mask on sleep in critically ill patients: A prospective randomized study. Critical Care, 21(1), Article 284. https://doi.org/10.1186/s13054-017-1865-0

Hu, R.-F., Jiang, X.-Y., Chen, J., Zeng, Z., Chen, X. Y., Li, Y., Huining, X., Evans, D. J., & Wang, S. (2015). Non-pharmacological interventions for sleep promotion in the intensive care unit. Cochrane Database of Systematic Reviews, (10), Article CD008808. https://doi.org/10.1002/14651858.CD008808.pub2

Patel, J., Baldwin, J., Bunting, P., & Laha, S. (2014). The effect of a multicomponent multidisciplinary bundle of interventions on sleep and delirium in medical and surgical intensive care patients. Anaesthesia, 69(6), 540-549. https://doi.org/10.1111/anae.12638

Richards, K. C., O'Sullivan, P. S., & Phillips, R. L. (2000). Measurement of sleep in critically ill patients. Journal of Nursing Measurement, 8(2), 131-144. https://doi.org/10.1891/1061-3749.8.2.131

Tamburri, L. M., DiBrienza, R., Zozula, R., & Redeker, N. S. (2004). Nocturnal care interactions with patients in critical care units. American Journal of Critical Care, 13(2), 102-112. https://doi.org/10.4037/ajcc2004.13.2.102

Todd, O. M., Gelrich, L., MacLullich, A. M., Driessen, M., Thomas, C., & Kreisel, S. H. (2017). Sleep disruption at home as an independent risk factor for postoperative delirium. Journal of the American Geriatrics Society, 65(5), 949-957. https://doi.org/10.1111/jgs.14685

Van Rompaey, B., Elseviers, M. M., Van Drom, W., Fromont, V., & Jorens, P. G. (2012). The effect of earplugs during the night on the onset of delirium and sleep perception: A randomized controlled trial in intensive care patients. Critical Care, 16(3), Article R73. https://doi.org/10.1186/cc11330

Wesselius, H. M., van den Ende, E. S., Alsma, J., ter Maaten, J. C., Schuit, S. C. E., Stassen, P. M., de Vries, O. J., Kaasjager, K. H. A. H., Haak, H. R., van Doormaal, F. F., Hoogerwerf, J. J., Terwee, C. B., van de Ven, P. M., Bosch, F. H., van Someren, E. J. W., & Nanayakkara, P. W. B. (2018). Quality and quantity of sleep and factors associated with sleep disturbance in hospitalized patients. JAMA Internal Medicine, 178(9), 1201-1208. https://doi.org/10.1001/jamainternmed.2018.2669

The Walden NURS 4300 Week 4 instructions

Week 4 of NURS 4300 usually asks for a literature review for your capstone question. You organize sources by theme, compare findings across studies, identify gaps and include an evidence table with levels. Faculty mark synthesis most heavily, so one paragraph per article is marked down. All nine sources go in APA 7, and the hierarchy used is named once. Eight to twelve sources is common. Studies from related settings can be included if applicability is discussed. The review should end with the open question your project addresses. NURS 4300 faculty want each theme heading to pull together several studies, an evidence table with levels and a closing open question.

How the NURS 4300 Week 4 example is put together

Five to six pages with an evidence table as an appendix. A short introduction restates the PICOT question and names the search that produced the sources. Four themed sections follow. The first gathers studies describing sources of overnight disruption, from vital sign timing to hallway noise. The second covers bundled interventions, typically combining clustered care, dimmed lighting and noise reduction, most tested in intensive care. The third examines measurement, comparing patient-reported questionnaires with wearable devices. The fourth reports associations between fragmented sleep and delirium in older inpatients, framed strictly as associations. Within each theme, sources are compared rather than summarized in sequence. The appendix table lists every source with design, sample, setting, key finding, its Johns Hopkins level and quality grade.

Where the marks sit in the NURS 4300 Week 4 rubric

Synthesis across sources is the row literature reviews are most often marked down on. A review that devotes one paragraph to each article, however accurate, is an annotated bibliography under another heading and misses the comparative credit, so the themed structure is doing graded work. Appraisal carries the second concentration: each source leveled and graded under a named model, applied consistently. Relevance to the PICOT question is checked theme by theme, and sources that drift toward adjacent topics dilute it. Faculty in capstone courses also watch for overstatement, and the review's refusal to turn associations into effects protects the evidence row. Currency within the rubric's window, a sufficient source count and APA formatting of headings, table and references take the remaining points.

Common NURS 4300 Week 4 mistakes, and how to avoid them

Literature reviews lose credit when they summarize one article per paragraph. Write by theme. Another common gap is ignoring differences in setting, such as ICU versus medical unit. Comment on applicability. Writers also skip the gap. Name the open question. Avoid an evidence table that does not match the text. Use one hierarchy consistently. Report measurement tools for sleep. Close with how the gap sets up the synthesis. Writers also forget to compare how each study measured sleep, which affects comparisons. Note the tools. Another frequent slip is a review that never mentions delirium, the main harm. Include it. Check that each table entry matches the text.

Get a NURS 4300 Week 4 example written to your instructions

Share the literature review instructions, the rubric, your PICOT question and the sources your search retained. A custom review comes back organized by theme, with each source leveled under the hierarchy your course teaches, and the first one is free in 24-48h. Sources are cited only as they report, with no finding stretched past its design.

More NURS 4300 papers and BSN samples

NURS 4300 Week 4 questions, answered

Johns Hopkins or Melnyk: which hierarchy fits the review?

Whichever the course teaches. The Johns Hopkins model pairs a level with a separate quality grade, which suits an appendix table. Melnyk's hierarchy ranks designs in a single pyramid from systematic reviews of randomized trials down to expert opinion. The sample uses Johns Hopkins, but its structure works under either, provided one model rates every source and the reference list cites it.

How many sources should the review include?

The prompt sets the number, and capstone prompts vary widely. The sample uses nine because four themes need at least two sources each to allow comparison. Reviews with too few sources cannot synthesize; reviews with too many tend to thin each theme into a list. When a theme has only one source, the review states that openly, since a thin theme tells the reader something about the field.

Can the review include ICU studies when my project is on a medical unit?

Yes, provided the setting is named and its limits acknowledged. Intensive care studies dominate the hospital sleep literature, and excluding them would leave very little evidence to review. The sample includes them and marks the transfer question each time. What weakens a review is presenting critical care findings as though they came from a general floor, which hides a real gap from the reader.

Where can I find a free NURS 4300 Week 4 sample paper?

The overnight disruption literature review is reproduced here with four themes, the open question and the evidence table appendix.

What themes organize the NURS 4300 Week 4 review?

Sources of overnight disruption, bundled sleep interventions, how sleep is measured and the link to delirium.