Date of Graduation

Fall 11-29-2018

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Department/Program

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First Advisor

Dr. Cathy Coleman

Abstract

Improving Quiet-at-Night on a Telemetry Unit:

Introducing a Holistic Sleep Menu Intervention

Abstract

Problem

A hospital in San Francisco, California has performed poorly on patient care service as evidenced by low Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. The survey’s lowest score was from the “Quiet at Night” measure.

Context

A Sleep Menu initiative was implemented in the hospital’s telemetry unit. Microsystem assessment and Strengths-Weakness-Opportunities-Threats (SWOT) analysis identified practices that might impede intervention success. Findings showed that benefits and opportunities outweighed costs; cost-benefit analysis estimated an annual net benefit of $6,354. Other benefits included improved patient well-being, higher HCAHPS scores, increased reimbursement, and improved institutional reputation.

Interventions

A clinical nurse leader led the 3-month Sleep Menu practice change project that included several components, including staff education, authentic hourly rounding, mandatory quiet time, and noise mitigation.

Measures

The outcome measure of self-reported hours of sleep was assessed via a pre–post-survey. Process measures included adherence to a small test of change and a patient survey. Balancing outcome measures were evaluated in terms of staff satisfaction.

Results

The project demonstrated that a quiet-at- night intervention improved patient satisfaction and care experience as well as staff satisfaction. Study participants who self-reported increased hours of sleep rose from 30% to 80%. Patients reported a mean increase in hours slept per night from 3.6 to 5.6 for at least 4 weeks during implementation.

Conclusions

A quiet environment can increase patients’ sleep hours and reduce staff work stress. Engagement of unit champions, frontline staff, and patients, as well as support from leadership and management, yielded positive results. The Sleep Menu can potentially improve both patient and organizational outcomes.

Keywords: sleep, hospital noise, quiet-at-night, clinical nurse leader

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