Management Strategy to Improve Patient Sleep

Kirsten Rasmussen

Leadership Management Paper

Nighttime noise and interrupted sleep is a common problem in hospitals and efforts to reduce these started with Florence Nightingale (Jones & Dawson, 2012). Call bells, monitor alarms, and talking are some of the most common causes of nighttime noise (Murphy, Bernardo, & Dalton, 2013). This paper will discuss different leadership and management theories and strategies hospitals can use to decrease nighttime noise and improve sleep in patients.

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Three management strategies to reduce excess noise on a unit at night are providing tools to promote rest in patients, assessing the noise level of the unit and establishing an acceptable noise level, and initiating quiet hours. These strategies can be carried out by giving patients ear plugs and eye masks to wear at night upon their admission to the hospital. A study showed that when patients used eye masks and earplugs they experienced more REM sleep than patients who did not wear them (Jones & Dawson, 2012). Another strategy is to assess the noise levels on the unit and plan noise reduction strategies depending on the results. A unit used a handheld noise dosimeter to measure the noise level from 1800 to 0800 and the data showed that the noise level on the unit was equivalent to heavy truck traffic (Murphy, Bernardo, & Dalton, 2013). Once the noise level of the unit was established, the unit installed a dosimeter near the nurse’s desk that flashed yellow when the noise level reached peak level and flashed red when the acceptable noise level was surpassed (Murphy, Bernardo, & Dalton, 2013). The management theory that would best help facilitate these changes is Mary Parker Follett’s participative management theory. This theory states the managers should have authority with their employees not over them, this allows for improved communication and an improved working relationship between the two sides (Marquis & Huston, 2015).

Leadership Strategies

Three leadership strategies that would help reduce noise on units at night are involving the entire staff, educating about noise reduction techniques and modeling such behavior, and reminding the staff of quiet hours and encouraging them to keep their voices at a low level. To reduce noise at night, the whole night shift staff must be on board. A hospital unit arranged meetings for night shift nurses, patient care technicians, and even environmental services to come up with ideas and strategies for reducing noise at night (Murphy, Bernardo, & Dalton, 2013). Some of the interventions the night shift staff came up with included dimming hallway lights at 2100, having the staff use mini flashlights to check on patients rather than turning on overhead lights, minimizing interruptions during rounds, and attending to alarms in a timely manner (Murphy, Bernardo, & Dalton, 2013). A neonatal and pediatric unit stated that some interventions to help remind them to keep their voices lowered were having a family present at bedside, a sleeping child often encouraged staff to whisper at the bedside, a dosimeter to measure sound levels, and creating a whisper policy (Disher et al., 2017). A relational leadership style, like democratic leadership, would best facilitate these changes on a unit. This type of leadership has been shown to be effective in groups where coordination and cooperation is necessary and these things are needed if a unit is going to make changes to reduce noise levels at night (Marquis & Huston, 2015). If hospital staff can work together to reduce noise and promote rest in patients, patients give the hospital higher scores on their HCAHPS and the hospital receives a bonus which can benefit the staff. Nurses also reported that they liked some of the interventions used to decrease noise, for example nurses reported that they preferred using the mini flashlights to check on patients rather than turning on an overhead light (Murphy, Bernardo, & Dalton, 2017). Involving the entire staff helped hospitals achieve their goal of reducing noise because the staff was able to work together and come up with a plan that would work best and benefit everyone (Murphy, Bernardo, & Dalton, 2017).

Literature Review. One research article studied noise levels on a pediatric and neonatal intensive care unit, and the participants were the unit staff and parents of children in the hospital (Disher et al., 2017). Using a 3M SPDL-1-1/3 SoundPro sound level meter, the noise levels for one 24-hour period and one 4-hour period were measured and it was discovered that those levels exceeded the recommended level of 45 A-weighted decibels (dBA) L_eq set by the American Academy of Pediatrics (Disher et al., 2017). The most common cause of the excessive noise was talking followed by monitor alarms (Disher et al., 2017). Interrupted sleep can cause sleep apnea in premature infants, reduced attention span in toddlers, delirium in pediatric patients, and workplace mistakes in staff (Disher et al., 2017). To reduce noise and nighttime interruptions the staff implemented a whisper policy and reduced the volume level on monitor alarms to more acceptable levels (Disher et al., 2017).

Efforts to reduce nighttime noise in hospitals started with Florence Nightingale and have continued to the present day. A hospital in Massachusetts wanted to improve their HCAHPS score by having eleven percent more patients report that their room was “always” quiet at night, thereby reaching a score of 59 percent (Murphy, Bernardo, Dalton, 2013). The entire staff, nurses, patient care technicians, and environmental services met and came up with different ideas to reduce nighttime noise, patient’s doors were closed at night unless it was medically contraindicated, the staff was given flashlights to use instead of turning on overhead lights in rooms, patients were given earplugs to wear, and “quiet hours” were instituted (Murphy, Bernardo, & Dalton, 2013). The “quiet hours” started at 2100 with the hallway lights being turned off and ended at 0600, no overhead pages were used, a dosimeter was installed to alert staff of rising noise levels, and nurses attempted to respond to monitor alarms within one minute (Murphy, Bernardo, & Dalton, 2013). The hospital did not reach their goal of 59 percent on HCAHPS scores, but they did raise the scores from 49 to 51 percent, so perhaps with continued efforts the scores will continue to rise (Murphy, Bernardo, & Dalton, 2017).

A study done in an intensive care unit of a hospital found that even simple interventions like providing patients with eye masks and earplugs promoted improved rest in patients (Jones & Dawson, 2012). For this article 100 patients were studied and half of them were provided earplugs and eye masks and half were not (Jones & Dawson, 2012). Only 20 percent of patients with interventions reporting getting 0-2 hours of sleep whereas 32 percent of pre-intervention patients reported getting 0-2 hours of sleep (Jones & Dawson, 2012). Only 10 percent of patients receiving eye masks and earplugs reported needing additional medication to help them sleep and 26 percent of pre-intervention patients reported needing medication to help them sleep (Jones & Dawson, 2012).

Analysis/Discussion. Mary Parker Follett’s theory of participative management and the behavioral theory of democratic leadership would best facilitate the necessary changes to reduce noise at night because these theories promote staff and managers working together to achieve a goal (Marquis & Huston, 2015). The studies mentioned stated that reducing nighttime noise is a group effort and requires cooperation and coordination from all staff members. Democratic leadership especially has been shown to work best when group cooperation is necessary (Marquis & Huston, 2015). The leadership and management strategies were also shown to be effective in the various research studies. Simply giving patients eye masks and earplugs have shown to be effective in promoting sleep in patients (Jones & Dawson, 2012). Combining those interventions with reducing monitor alarms, dimming hallway lights, and monitoring noise levels on the unit have also shown to be effective (Disher et al., 2017).

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Conclusion. Although nighttime noise is a common problem among patients in hospitals, efforts are in place to try to reduce noise and promote better rest in patients. These goals can be accomplished by using Mary Parker Follett’s participative management theory, democratic leadership, or both. In addition to these theories, simple leadership and management strategies can promote rest. Giving patients eye masks and earplugs, assessing noise levels, and instituting quiet hours have also shown to be effective in reducing nighttime noise (Murphy, Bernardo, & Dalton, 2013).

References    

Disher, T. C., Benoit, B., Inglis, D., Burgess, S. A., Ellsmere, B., Hewitt, B. E., & … Campbell-Yeo, M. L. (2017). Striving for optimum noise-decreasing strategies in critical care. Journal of perinatal & neonatal nursing, 31(1), 58-66. doi:10.1097/JPN.0000000000000229

Jones, C., & Dawson, D. (2012). Eye masks and earplugs improve patient’s perception of sleep. Nursing in critical care, 17(5), 247-254. doi:10.1111/j.1478-5153.2012.00501.x

Marquis, B.L. & Huston C.J. (2015). Organizational structure. In B.L. Marquis & C.J. Huston. Leadership role and management functions in nursing: Theory and application. (8^th ed.) (pp. 260-286). Philadelphia, PA: Wolters Kluwer Health.

Murphy, G., Bernardo, A., & Dalton, J. (2013). Quiet at night: Implementing a Nightingale principle. American journal of nursing, 113(12), 43-51. doi:10.1097/01.NAJ.0000438871.60154.a8