Designated Quiet Times: A Therapeutic Nursing Intervention

Designated Quiet Times: A Therapeutic Nursing Intervention

Abstract

The purpose of this research is to collect data on designated quiet times as a therapeutic nursing intervention for patients in the acute care setting by comparing two research studies done by Applebaum (2016) and Gardner (2008).  Each study utilized noise reduction measures, designated specific quiet time, and collected patient reported outcomes related to rest and overall patient satisfaction.  Each study yielded overall positive patient outcomes, with data showing increased rest and overall patient satisfaction.  Gardner’s (2008) study was conducted on a larger scale in a more systematic manner with a designated control and experimental group.  Both research studies also required input from staff and education as well as staff compliance to ensure study success.

Designated Quiet Times: An Improvement in Patient Health

The acute care setting in most hospital environments is typically busy and subsequently noisy.  In addition to the constant alarms and buzzing of medical equipment, patients are subjected to healthcare provider rounding, continuous patient care interventions such as vital sign monitoring, pain assessments, medication administration, and patient visitors.   Indirectly patients are also exposed to outside noise generated by the nurse’s station and other hospital staff, all which directly affect the patient’s ability to obtain adequate and quality sleep.  According to Applebaum (2016) the initiation of designated quiet hours during both the day and night shift proved positive in increasing overall patient satisfaction as well as the patient’s ability to categorize their sleep both acceptable and restful.  

Of all the environmental stressors that patients are exposed to, noise is the most common and constant, and affects the body’s ability to heal both physiologically and psychologically.  Could noise reduction then be a reasonable therapeutic intervention?  With the ultimate goal being quality patient care and patient recovery, noise reduction and rest is of paramount importance.  This line of thought is not new, however.  The nursing professions very first nurse, Florence Nightingale, once said that “unnecessary noise is the most cruel absence of care, which can be inflicted on either the sick or well.  Unnecessary noise injures a sick person much more than necessary noise.”  (Applebaum 2016)   One can argue that the current patient population is exposed to unnecessary noise around the clock during their hospital stay.  Policy on rest periods for patients vary from hospital to hospital, with a large number implementing unrestricted visiting hours and virtually minimal time for therapeutic rest.  Patient care in all forms occurs at all times of day and night.  The proposed change for the current nursing practice is to assess the implementation of designated quiet times as a therapeutic intervention to achieve a more rested patient, resulting in better patient outcomes and improving patient satisfaction.

Search Strategy

To conduct research for this review, Boolean phrases such as “quiet times”, “acute care setting” and “patient wellbeing” were processed using the EBSCOhost databases.  Narrowing the search, additional phrases “hospitalized patients”, “noise” and “interventions” were used.  Criteria for the search included peer reviewed articles with one author as nurse available in pdf full text since 2005.  Additional results were generated by allowing search for like terms and in-text search for terminology.  Google scholar and the TRIP database were first used to identify relevant studies but did not yield the intended results.  PubMed returned results that needed to be narrowed and then EBSCOhost/CINAHL database was effectively utilized.

Literature Review

 In Gardner’s study (2008), research was conducted using a multi-center design, with 299 participants enrolled over a five-month period.  Patients were enrolled into either a control or experimental group, where each facility’s quiet time intervention included designated midday hours between 2pm and 3:30pm.  During this time, total restriction of patient visitation, treatment activities, dimmed lighting, and minimal use of lighting and television/radio, and conversation in common areas were employed.   Pain management and comfort measures were offered prior to quiet time.  According to the study, these hours were selected based on literature that states that the body is naturally at rest during this timeframe based on circadian rhythms (Plowright, 1998; Loer et al., 2002).  Data was collected using validated digital sound level meters,  a 3 point recorded sleep observation, and standardized questionnaires (Epworth Sleepiness Scale and SF12 V2) that were completed on admission, discharge, and one-week post discharge. Additionally, a sample of eighty health providers were also asked to complete satisfaction surveys at predetermined time points throughout the study.   The demographics for the experimental and control groups were comparable, as well as patient condition.  At study’s end, the data showed that patients in the experimental group felt more rested.   The study concluded that even at the lowest recorded daily average, the decibel (dB) level in the experimental group, was still 0.35dB above the Environmental Protection Agency’s recommended noise level of 45dB.  But, interestingly, the difference in mean between the control and experimental group was 10.3dB, which is equal to a difference of 2 to1, which concludes that experimental group was exposed to only half the sound that the control group received.    Research also supported that the patients in the experimental group were more than twice as likely as those in the control group to actually be asleep during the intervention hours.   Fifty three of the eighty health professionals, of which twenty-seven were nurses, that completed the survey also reported the quiet hours did not negatively affect their work or ability to provide quality care. 

 Applebaum (2016), examined patients in a single acute care unit, with 80 volunteers, 40 of which were examined prior to the implementation of the quiet time intervention for comparability.   Between similar hours of 3pm and 4pm, patients’ doors were closed, with the exception of those that were a risk for falls, lights were dimmed, and signage was posted throughout the floor and patient rooms.  However, in the Applebaum (2016) study, there were no restrictions on patient care activities or visitation during this designated timeframe.  Nurse researchers developed the Patient Survey on Noise During Hospital Stay (PSNDHS) to be used as a tool to measure noise levels and rate patient satisfaction.  In this survey, patients were asked seven items on sleep quality and disturbances in a 5-point “strongly agree” to “strongly disagree” format.  Data reflected that, for the patients that were evaluated prior to quiet time intervention, 62% of patients reported that their quality of sleep was unacceptable as compared to the 40% that was reported post implementation.  Seventy percent of the patients reported the intervention to be overall effective, while 60% reported that the one hour of quiet helped to maintain a more restful environment for the remainder of the day.  When analyzing individual outcomes per the PSNDHS, only 2 of the 7 items showed statistical significance, rating quality of sleep as acceptable (P=.009) and quantity of sleep as acceptable (P=.002) post quiet time intervention.

Limitations

Gardner’s (2008) study were low response rates on the one-week post discharge survey, which prevented the study from further testing if overall health improved after discharge.  In Applebaum’s (2016) study, the validity and reliability of the PSNDHS survey needs to be further evaluated as this is mainly a patient reported outcome as well as all interdisciplinary teams being included in the intervention.   

Conclusion

Research has shown that there are clear benefits of allowing patients to rest and recover. Nurse driven interventions such as quiet time for patients is proving to be beneficial for patients even beyond designated time frames.  Patients are not opposed to such interventions and accommodations can be arranged to ensure that all aspects of patient care are taken into account, in turn, promoting overall improved patient outcomes.

References

• Gardner G, Collins C, Osborne S, Henderson A, & Eastwood M. (2009). Creating a therapeutic environment: a non-randomised controlled trial of a quiet time intervention for patients in acute care. International Journal of Nursing Studies, 46(6), 778–786. https://doi.org/10.1016/j.ijnurstu.2008.12.009
• Applebaum, D., Calo, O., & Neville, K. (2016). Implementation of Quiet Time for Noise Reduction on a Medical-Surgical Unit. Journal of Nursing Administration, 46(12), 669–674. https://doi.org/10.1097/NNA.0000000000000424