Date of Award

Summer 2022

Project Type

Thesis

College or School

UNHM

Department

Nursing

Degree Name

Master of Science

First Advisor

Pamela Kallmerten

Abstract

Background: Noise has been linked to negative impacts on patient’s rest, length of stay (LOS), the immune system’s ability to fight infections, pain and anxiety levels, and readmission rates. Quality improvement projects in non-intensive care units are needed to determine major causes of noise and factors which impact patients’ rest, perception of noise, and satisfaction with medical-surgical unit care.

Aim: The global aim of this quality improvement project was to increase medical-surgical patients’ satisfaction by reducing the impact of noise in their inpatient stay. The specific aim was to increase the percent of patients, who responded Always to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPs) question, how often was the area around your room quiet at night? from the baseline of 62% by at least 1% to meet the national percentage.

Methods: The process began by conducting an inpatient survey, adapted from HCAHPs, to gauge patients’ satisfaction with different aspects of care on the medical-surgical unit. From the survey, 19% of patients noted noise as an area for improvement. For two weeks, a Plan-Do-Study-Act framework was used measuring patient’s rest, use of sleep aid tools and satisfaction with a modified version of Applebaum et al. (2016) and HCAHPs surveys. Patients were eligible to participate if they could make their own health decisions and were not legally defined as deaf. Patients were provided with the modified survey, ear plugs and/or the Bedtime Fan application, and scripted education on how to use tools and required nursing care. After 48 hours, patients took the modified survey again to determine any changes to patient’s rest and satisfaction.

Results: The two-week intervention revealed nighttime as the least noisy time. The Likert-Scale questions, with ranges 1-5, had increased means from pre-survey to post-survey. The mean and standard deviation (SD) for patient’s satisfaction with the impacts on noise on rest increased presurvey, 3.75 (SD 0.5, Range 1-5) to 4 (SD 0, 1-5) post survey. The quality of patient’s rest mean score increased from 3.5 (SD 0.6, Range 1-5) to 4 (SD 0, Range 1-5) and the quantity of their rest, increased from 3.75 (SD 0.5, Range 1-5) to 4 (SD 0, Range 1-5)—the higher number indicating greater satisfaction. There was no statistical significance from use of sleep aid tools nor patient education on patients’ satisfaction with rest related to noise. Patients reported they did not feel noise was a problem on the unit during and after the intervention. One out of four participants used ear plugs and no participants used the Bedtime Fan application; there were no changes to patient’s rest with the use of sleep aid tools. The peak time of noise was in the morning and the major cause of noise was other patients.

Conclusions: Limitations included a small number of participants (n=4). However, the inclusion of patients’ perception of noise guided the quality improvement project to identify peak noise times and major causes of noise in the microsystem. There were positive findings for providing scripted patient education, especially scripts on nurse required care which increased the mean scores of patient’s rest and satisfaction.

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