By Jennifer Larson, contributor
“There is a time for many words, and there is also a time for sleep.”--Homer, “The Odyssey”
December 9, 2013 - Hospitals are inherently noisy places. Alarms clang. Pages blare overhead. Doors open and close. TVs drone. And, of course, people talk. Nurses discuss their patients at shift change, and visitors chat with their loved ones.
Unfortunately, noisy places make it difficult for patients to get enough sleep, and researchers have noted in a number of studies the detrimental effect that hospital noise and interrupted sleep can have on a patient’s recovery. The challenge: how to make the hospital less noisy.
“Not only is sleep critical to the physical functioning and emotional well-being of patients, but brief or fragmented sleep has negative effects on the immune system, the healing process and general health,” wrote Gina Murphy, BSN, RN, Anissa Bernardo, LCSW, and Joanne Dalton, PhD, RN, in a new article in the December issue of the American Journal of Nursing (AJN).
The three are among a growing number of researchers who are examining the nurse’s role in addressing the problem of hospital noise. For example, a 2011 article in the Journal of Nursing Care Quality examined the effect of nighttime noises that interrupted the sleep of post-surgery cardiac patients, and the researchers noted that behavioral and structural noise reduction interventions were necessary.
Murphy, Bernardo and Dalton examined the opportunity for nurses to make a major impact on noise reduction in the hospital. Given their central role in caring for and educating patients and their families, nurses can and should play a starring role in noise reduction efforts, too.
“This is something that nursing can totally own and make the environment better for their patients,” said Murphy. “This is something that should be part of our practice and something that’s important. We are making sure our patients have as quiet an environment as physically possible.”
Their AJN article details a quality initiative project called Quiet at Night that was created at Beth Israel Deaconess Medical Center. The effort was launched during the summer of 2011 in response to team members’ concerns about Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey responses from patients about the noise at night.
“I think we’re all really immune to how noisy our environment is,” said Murphy. “Because we’re so immune to it, the noise to us doesn’t seem loud at all, when in fact it’s hugely disruptive to the patients. We hear from the patients all the time how noisy we are.”
How it worked
The hospital’s patient satisfaction steering committee examined the HCHAPS survey results and set a goal of raising the percent of patients who responded that the area around their room was “always” quiet at night from 48 percent to 59 percent.
They chose a 44-bed medical–surgical unit on which to launch a pilot project aimed at reducing noise and noisy interruptions at night. They designated a nurse manager and the hospital’s patient satisfaction improvement coordinator to lead the effort. The improvement team reviewed the relevant literature about improving the auditory environment in hospitals, and adopted a seven-step approach developed by Susan Mazer.
Two factors were especially important to the success of Quiet at Night: the nurse champion and the contributions from staff. A nurse champion was designated to spearhead the effort and keep everyone motivated and on track. The team leading the initiative asked the staff, including the night-shift nurses, to provide input on strategies to minimize nighttime disruptions to sleep.
“The staff brought forward some really great ideas,” said Murphy.
One nurse suggested that nurses responsible for separate patients in a semi-private room coordinate their nighttime visits to the room, instead of alternating them, thus reducing the number of interruptions to both patients. Another person asked for tiny flashlights that they could use in the night to check vital signs and perform other tasks, so they wouldn’t need to turn on the bright overhead lights.
Some physical changes to the building were necessary, too. For example, they repaired door bumpers and padded the pneumatic tube system with thicker foam to reduce the noise, and they had to make sure that the air-conditioning and heating systems were working appropriately.
But many important changes that were made were cultural changes. Newly implemented “quiet hours” began at 9 p.m. Nurses began to close the doors to patient rooms, pagers were set to vibrate and the overhead paging system was temporarily suspended.
Nurses began to educate patients and their families, introducing the initiative upon admission. They also gently reminded them about the quiet hours each evening, which had the benefit of encouraging some family members to go home and get some much-needed rest, Murphy noted.
It worked. The response from patients was positive. While no hospital unit will ever be silent, and it’s not always possible to provide private rooms for every patient, Bernardo and Murphy said the Quiet at Night initiative has proven that it is possible to minimize noise and disruptions that can impede healing.
The Visitor Top 5 poster at Beth Israel Deaconess explains to hospital visitors how they can contribute to a restful, healing environment for patients.
“It’s so important for someone’s health and well-being,” Bernardo said. “It really is.”
The Quiet at Night work group continues to meet monthly and analyze HCAHPS scores, patient feedback and staff suggestions. They also continue to work on ways to help patients and families understand how they can contribute.
For example, the team recently posted in patient rooms and waiting areas a list of the top five ways that visitors can contribute to the positive environment. The list included: (1) Wash your hands; (2) Help us promote a healing, quiet environment; (3) Respect the space and privacy of the other patient; (4) Consider who is visiting and when; and (5) Take care of yourself. The poster includes some specific suggestions about taking cell phone calls to the waiting areas and not using the patients’ bathrooms during a visit.
Since it was successful, the effort will go on, noted Bernardo.
“It’s a key focus in our hospital,” she said.
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