Review of literature

Comfort in healthcare is a widely explored topic. Although there is a considerable amount of scientific literature focused on comfort as a macroconception, there is little research focused on the specific case of environmental comfort in the context of the person in critical condition. Nursing interventions related to the management of environmental factors conditioning the comfort of the critically ill person are also little explored.

The hostile context of the intensive care unit and the emergency service has a major impact on the sleep of the critically ill person. They are life-promoting contexts, but they are also adverse environments. It is important to understand the concept of comfort as a whole in order to build a care intervention plan that is appropriate to the needs of the patient. When approaching comfort, the same is understood as a feeling of absence or relief from a discomfort or any other factor that conditions tranquility and satisfaction (^{Herdman & Kamitsuru, 2018}). There are, according to Katharine Kolcaba's Theory of Comfort, three dimensions when approaching comfort (relief, tranquility and transcendence), referring to four contexts (physical, psychosocial, environmental and social) (^{González Gómez et al., 2017}). Having said that, the relevance of exploring the dimensions as well as the different contexts of the comfort of the person in critical situation arises, in particular the dimension of environmental comfort. Quality of sleep is defined as a feeling of well-being or tranquility in and with the environment itself (^{Cardoso et al., 2020}). While this is undoubtedly an important nursing focus (^{Silva, 2019}), there are limited studies addressing sleep in the specific context of the critically ill and examining the role of the nurse in improving it through the promotion of environmental comfort.

There are several environmental factors that can affect sleep quality in critical care context. In critical care units for the critically ill, including emergency care and intensive care, patients develop disorders of the standard and quality of sleep so there may be a worsening of their clinical situation, confusion, feelings of frustration and depression (^{Valente, 2019}). It is therefore essential to promote the sleep the critical patient’s sleep to contribute to their quality of life in order to control the problems arising from the change in sleep quality. Many of these conditioners are modifiable and should be addressed by the nursing team through a set of interventions. Although factors inherent to the condition of health or disease have a significant impact on one's sleep and rest, environmental factors should also be monitored as to their effect on the pattern, duration and quality of sleep (^{Aydın Sayılan et al., 2021}).

Being the quality and quantity of sleep related to the patient’s recovery, it becomes, by its restorative effects, an aspect of great relevance to the nurse's intervention plan (^{Valente, 2019}).

The person in critical situation presents several changes as a result of the process of adaptation to the unit where he is inserted, since he is in an unknown environment, deprived of his usual routine, subjected to constant factors that will alter sleep" (^{Valente, 2019}). The pattern of sleep is conditioned by circadian rhythm. This plays a central role in regulating the sleep-wake cycle. The replacement of sleep allows, therefore, that it is possible to manage the health/disease process with greater concentration and energy, being fundamental for resting and the recovery/rehabilitation of the person (^{Valente, 2019}). Sleep is promoted by the behaviours and interventions adopted by the professionals, it favours the obtaining of the state of comfort, which in turn aims for the gain of health, being on the other hand, favoured with the promotion of an adequate environment, in response to the need of environmental comfort (^{Silva, 2019}). Therefore, it is crucial that the nurse promotes a favourable environment to the person, as a welcoming environment that provides relief, safety, protection and well-being (^{Biazim et al., 2020}).

Strategies based on carefully reflected interventions harbor health gains, not only for the person but also for the health institutions themselves. A quiet and peaceful environment enhances the person's adherence to treatment, which allows better outcomes (Goode, 2017). Due to the small amount of literature addressing the specificity of environmental comfort and nursing interventions that promote sleep in the context of urgency and/or intensive care, the scope of this type of review favours the exploration of an unfamiliar theme (^{Munn et al., 2018}). Having said that, we opted for a scoping review as it allows us to map poorly studied areas of knowledge (^{Mun et al, 2018}).

Sample

The Scoping Review uses PCC (Population, Concept and Context) mnemonics to construct the guiding question of the research (^{Munn et al., 2018}). This way it is possible to construct a clear title for a review within the Joanna Briggs Institute, facilitating the clear definition of the central and objective issues of Scoping Review (^{Munn et al., 2018}). Therefore, in this review it has been defined as "P," Population, any studies concerning adults in critical situation of illness or critically ill adult person in intensive care units and/or emergency services; "C," Concept, studies that address nursing interventions that contribute to environmental comfort and promote sleep and "C," Context, studies conducted in intensive care and emergency services. The eligibility criteria were defined in accordance with the methodology of JBI (^{Peters et al., 2020}), including studies available in full text, in Portuguese, English or Spanish, focusing on adult inpatients in the context of intensive care or in a critical situation in the emergency service. No time limit will be set not to restrict search and data collection.

Exclusion criteria will be applied to all outcomes of the population under 18 years of age, pregnant, people with psychiatric conditions and people at the end of life or in palliative care. Letters to the editor, posters, conference summaries and review protocols will not be included because they include little information for this review.

Data collection instruments and procedures

The research will be conducted in the CINAHL Complete databases, COCHRANE Library Plus, PUBMED, JBI Evidence Synthesis, SciELO and as sources of grey literature it will include, OpenGrey, RCAAP and DART-Europe, with the use of the combination of several terms "Hospital Emergency Service" OR "Critical Care" AND "Sleep" NOT "Children" AND Nurs*. This mesh terms were used to focus the topic under research. Table 1 represents a example of the research done in 17 e 18 of february of 2022, as recommended by the methodology of JBI (^{Peters et al., 2020})

Table 1 Example of searching strategy in the CINAHL database (via EBSCO) 

Primary and secondary, qualitative and quantitative studies will be considered. Therefore, experimental and quasi-experimental scientific studies, randomized and non-randomized studies and observational, analytical and cohort studies will be considered. Qualitative studies that focus on qualitative data, projects based on phenomenology, qualitative description and research-action will also be considered. Literature reviews, including systematic or supplementary reviews and opinion articles, will also be included.

ZOTERO 5.0.94 (^{Corporation for Digital Scholarship and Roy Rosenzweig Center for History and New Media, 2021}) will be used to collect and manage the research and results obtained by removing duplicates. The results of the research and the selection of studies will be schematically presented in table format. Subsequently, the titles and summaries will be reviewed by two independent reviewers in order to determine whether they meet inclusion criteria for the review. Any disagreement will be resolved by consensus or by a third auditor (^{Peters et al., 2020}).

To clearly organize and analyze the results, an example table (table 2) was developed for extracting data from the articles selected by the search strategy.

Table 2 Example of data extraction table 

The selection of studies should be based on inclusion and exclusion criteria. The reasons for excluding sources of evidence that do not meet the inclusion criteria will be mentioned in the review. It should be noted that the results of the study and the study eligibility process will be described.

Statiscal analysis

There will be no place for statistical analysis, a content analysis will be done on the articles. To presente results you can use the same table or, as you mention, other resources All data resulting from the literature review process will be presented respecting the scoping review’s objectives. They will be used, whenever necessary, as resources that allow the clear interpretation of the evidence extracted through tables and/or schemes.