Sleep is an important aspect in healing. In a healthy individual, poor sleep can lead to harmful changes in the immune system, as well as other organ systems. This means that our healing populations in the hospital are already at a disadvantage. Poor sleep can lead to longer hospital stays, and increased morbidity (Waller-Wise & Maddox, 2019). Sleep is also recommended for the management of pain (Goeren et al, 2018). Yet, hospitals are noisy places, with one study saying the average noise in a critical care unit was 62.2 to 62.7 dB (Waller-Wise & Maddox, 2019). In fact, sleep deprivation has been shown to be a challenge in ICU’s, with more than 60% of the patients reporting sleep deprivation or sleep disorders occurring during their stay (Chamanzari et al, 2016). And it’s not just the high acuity areas that have issues with noise and sleeplessness. One study in a postpartum floor showed 53 interruptions of a new mother within a 12 hour period (Adatia, Law & Haggerty, 2014). With the World Health Organization recommended sound levels being lower than 45 dB during the day, and 35 dB the highest at night, this is an issue that needs to be tackled (Waller-Wise & Maddox, 2019).
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This leads to the question this paper plans to answer. In hospitalized patients, does a designated quiet time as opposed to no designated quiet time improve patients perception of care during a one month period? A designated quiet time will be defined as a period, or multiple periods of time where interruptions to the patient will be limited, with exceptions for emergency situations. During this quiet time, the noise level of staff in the hallways will be moderated as well.
Many hospitals have a vertical structure, meaning decisions are made from the top down (Finkelman, 2016). This means that if the top can be convinced of the benefits of a project, those underneath, even if they disagree with the project, need to comply. However, the top must first agree to a change. That means, even if everyone on the floor is on board with implementing a change, if those in charge do not support the change, it will not happen.
Quiet Time is the Best Practice
Quiet time has been shown to improve not only the patient experience, but the nursing experience as well (Feldman & Sobrino-Bonilla, 2014). Nurses in hospitals where quiet time has been implemented show improved job satisfaction, potentially due to being able to rest and catch up on charting. Patients self report increased rest, due to quiet time, and satisfaction scores have improved, as well (Feldman & Sobrino-Bonilla, 2014). “Considering the effectiveness of the quiet time protocol on the adjustment of environmental factors through environmental and behavioral changes, it is recommended that this simple, cost-efficient standard care procedure be employed in hospitals” (Chamanzari et al, 2016).
The PDSA cycle is a model used for improvements. Once an improvement has been identified, it is tested in the workplace, “by planning it, trying it, observing the results, and acting on what is learned” (Institute for Healthcare Improvement, n.d.).
In the planning phase, an outline for this process needs to be determined. Will quiet time occur on all floors of the hospital, or only a few? How will training of the employees on this new method occur? For the purpose of this paper, we will plan on one floor implementing this change. For this floor, we will have an online training module regarding the change. We will also schedule multiple mandatory Q & A sessions with nurses to inform them of the upcoming change, giving ample time for them to ask any questions they may have. We will have flyers made up regarding this change, and ensure other staff, such as dining, know of the change, to ensure no interruption of the patient during the quiet times. We will also have posters made to ensure patients know of a change in their healthcare routine. Nurses are also encouraged to inform patients and their family members that quiet time will be occurring, the times, and answer any questions the patient may have regarding the change to their care. Planning will include how to plan patient care around quiet time.
The day quiet time is implemented, we will ensure all staff is prepared. Any last minute questions will be answered. Posters will be posted in the hallways, ensuring patients and staff passing know quiet time is being implemented. Any care that had been previously scheduled will be double checked to ensure it is outside quiet time hours. A ten minute warning will be announced on the floor prior to quiet time, to ensure staff is able to finish up any last minute care, and patients are premedicated if needed for pain. The floor will be monitored to ensure the decibel levels fall within acceptable standards. An announcement will occur at the ending, as well. Staff with any questions during the process are directed to management.
Peak noise levels will be monitored every 30 minutes during the day for the first two weeks. After, peak noise levels will be monitored before quiet time, during quiet time, then after quiet time. Patient surveys, will be collected upon leaving the facility, to verify if higher patient satisfaction scores are achieved due to the quiet time intervention. Nurses will also be asked to fill out surveys regarding their satisfaction levels, and their ability to complete patient care activities during the day. During this evaluation period, we will evaluate the data we collected regarding the noise volume during quiet time, as well as patient and nurse satisfaction scores.
During this stage we will make any changes to quiet time necessary. For example, if we plan quiet time from 2pm-4pm, however, we think it would work better directly after lunch, say 1pm-3pm, this would be the time to make those changes. We would then complete the exercise, including noise volume monitoring, and satisfaction surveys. The cycle would continue until optimal scores are found, and the final implementation would begin.
● What did you learn from this exercise? What is your plan to model high-impact leadership behaviors in practice?
- Adatia, S., Law, S., & Haggerty, J. (2014). Room for improvement: Noise on a maternity ward. BMC Health Services Research, 14(1). doi:10.1186/s12913-014-0604-3
- Chamanzari, H., Moghadam, M. H., Malekzadeh, J., Shaker, M. T., Hojjat, S. K., Hosseini, S. M., & Kianian, T. (2016). Effects of a quiet time protocol on the sleep quality of patients admitted in the intensive care unit. Medical – Surgical Nursing Journal, 5(1), 43-40. Retrieved from file:///home/chronos/u-4219a3910d6739b6b8c1ce3f929c82f206523b86/ Downloads/07hesari.29-8-95.pdf.
- Feldman, V., & Sobrino-Bonilla, Y. (2014). Dim down the lights: Implementing quiet time in the Coronary Care Unit. Critical Care Nurse, 34(6), 74-75. doi:10.4037/ccn201425
- Finkelman, A. (2016). Leadership and management for nurses: Core competencies for quality care (3rd ed.).Boston, MA.
- Goeren, D., John, S., Meskill, K., Iacono, L., Wahl, S., & Scanlon, K. (2018). Quiet Time: A Noise Reduction Initiative in a Neurosurgical Intensive Care Unit. Critical Care Nurse, 38(4), 38–44. https://doi-org.uiulibrary.idm.oclc.org/10.4037/ccn2018219
- Institute for Healthcare Improvement. (n.d.). Science of Improvement: Testing Changes. Retrieved from http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementTestingChanges.aspx
- Waller-Wise, R., & Maddox, B. (2019). Implementing a Quiet Time Intervention in a Labor-Delivery-Recovery-Postpartum Unit. International Journal of Childbirth Education, 34(1), 27–31. Retrieved from https://search-ebscohost-com.uiulibrary.idm.oclc.org/login.aspx?direct=true&db=rzh&AN=133869712&site=ehost-live&scope=site
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