Date of Graduation

Summer 8-7-2018

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions

First Advisor

Nancy Taquino



Problem: Providing a quiet environment is essential in patient’s healing and recovery. Last year, the October 15 through May 17 survey period resulted at a 2 Star Rating for the hospital, which is below the top 25th percentile. This result along with the patient population, telemetry designation, and unit size prompted the selection of the inpatient telemetry unit in Northern California for the change strategy plan.

Context: The microsystem is a 24-bed adult inpatient telemetry unit in Northern California. Assessment of the unit shows that inconsistencies exist when it comes to bundling care at night. Doors are kept open and lights are not dimmed during the nighttime hours. This initiative focuses on patient-centered care and buy-in from front line staff by involvement, education, and shared governance.

Intervention: A team was formed to assess, evaluate and plan for implementation of the project. The test of change consists of establishing quiet time, designing a visual management, and standardizing the care at night.

Measures: Process measures include patient rounding feedback and staff adherence to interventions and maintenance of quiet time. Balancing measures include staff engagement and patient participation.

Results: Data from the post intervention patient questionnaire shows an improvement in the patient’s perception of the nighttime noise level after the project intervention was implemented. The results show an improvement of 50% to 78% (scale 4 and 5 combined) who responded, “Always and Frequently” to question “Do you feel like your room and hallway were quiet between 10 pm and 6 am?”.

Conclusion: This project increased staff awareness about the impact of noise on patient’s sleep. When staff become aware through presentation of patient feedback, they are motivated to act. The structure of the Unit Practice Counsel (UPC) provided a mechanism to channel staff action and engagement to improve care for their patients. Plans for sustainability of results include continuous monitoring of quiet times, weekly patient surveys, overhead announcement, and slow-close door brackets to reduce noise from slamming doors. Further education should also be implemented with other ancillary departments such as Environmental Services, Radiology, and Laboratory.