ICU Nurses Compare Weighted and Warm Blankets for Treating Anxiety and Agitation

For critically ill patients, the intensive care unit (ICU) can be an overwhelming environment. Unfamiliar surroundings, invasive procedures and disrupted sleep can complicate recovery by contributing to or worsening anxiety and agitation.

A new nurse-led study at Cleveland Clinic sought to determine whether a simple comfort measure could improve the ICU experience. Investigators compared weighted blankets with warm, cotton-weave blankets — a hospital standard — to evaluate their impact on perceived anxiety and agitation in nonsedated, critically ill adults.

“Critical care nurses are always looking for ways to improve the patient experience and minimize unnecessary interventions,” says Nancy Hodge, MSN, RN, an Assistant Nurse Manager in the ICU at Cleveland Clinic South Pointe Hospital. “We wanted to know whether a low-cost, nonpharmacologic approach could enhance comfort by having a calming effect on some of our most vulnerable patients.”

Comparing two comfort measures

Weighted blankets, which have gained commercial popularity in recent years, are thought to activate the parasympathetic nervous system and help promote relaxation by providing gentle, evenly distributed pressure across the body. Although researchers have demonstrated the benefits of weighted blankets in mental health, pediatric and occupational therapy settings, study methodologies and patient populations are varied. In addition, evidence supporting the benefit of weighted blankets in the ICU setting is limited.

Warm, nonweighted cotton blankets have long been a staple of hospital nursing care for their ability to help reduce pain and agitation in some populations. Recognizing that both interventions showed promise, Hodge and her team designed a randomized crossover study to compare the two approaches.

Each participant received both an 8.5-pound medical-grade weighted blanket and a warmed hospital blanket during separate 30-minute treatment periods. The order of the interventions was randomized, and a two-hour washout period separated each treatment to minimize carryover effects. Researchers then evaluated patients’ level of anxiety and agitation using the Visual Analog Scale for Anxiety and the Richmond Agitation-Sedation Scale. Investigators also collected data on physiologic parameters and relevant patient factors.

“The crossover design allowed every participant to serve as their own control,” Hodge explains. “That gave us greater confidence that any differences we observed would be related to the intervention itself rather than differences between individual patients.”

Findings support existing nursing practice

After 35 patients were enrolled and completed interventions and data collection, Hodge and her collaborators, including Roman Saini, MSN, RN, and Karen Distlehorst, PhD, APRN, GCNS-BC, conducted an interim analysis. There were no differences in participants’ anxiety and agitation scores 30 minutes after they received either a weighted blanket or a warm blanket.

Importantly, both interventions were well tolerated. Physiologic measures remained stable during both interventions, and only one participant chose to discontinue weighted blanket use, saying it “felt restrictive.”

Because the interim analysis met predetermined futility criteria, researchers ended the study early, concluding that the enrollment of additional patients was unlikely to change the overall findings.

Although weighted blankets did not outperform warm blankets, Hodge says the results still provide valuable guidance for clinical nurses.

“Neutral findings are just as important as positive or negative results because they enable us to make informed decisions about patient care,” she says. “The study suggests that the warm blankets already available on our units may meet patient needs without additional expense.”

Looking ahead

Hodge hopes to pursue additional research focused on patients with higher-than-average baseline anxiety or agitation, larger and more diverse ICU populations, and combinations of nonpharmacologic interventions like music therapy, aromatherapy and guided relaxation.

For now, she says her latest study reinforces an important message about nursing care.

“Research doesn’t always confirm what we expect, but it always has something to teach us,” she adds. “This project highlights the importance of the usual-care interventions that nurses use every day. Simple comfort measures deserve rigorous study because they shape the patient experience and allow us to deliver evidence-based care.”