Enter any healthcare facility and you will likely be bombarded by the sounds of screeching pharmacy carts, beeping patient-monitoring equipment, and incessant overhead pages.
Add in the chatter of staff members, families, and visitors echoing through the hallways, ringing call lights, and rumbling ice machines and it is no wonder the pediatric unit at UC Davis Medical Center in Sacramento, CA, is embracing its new daily, one-hour quiet time program.
"There is an actual transformation of the environment when the lights are turned down," says Angie Marin, RN-C, MSNc, nurse manager of the pediatric unit about the program that was implemented in September. "There is an immediate calmness that comes over everyone."
Marin says both patients and staff have welcomed the program, which is creating a more relaxing environment during the designated quiet time from 1:30 to 2:30 every afternoon. To achieve peace in the unit, each day at this time, staff:
- Dim the lights
- Lower patients' TV volume
- Set IVs so they don't beep unless necessary
- Speak in low voices
- Encourage patients' parents to rest in sleep chairs or grab lunch in the cafeteria
- Discourage visitors other than patients' parents
- Close the unit's playroom
- Prohibit the use of pharmacy and food carts
- Discourage unnecessary nurse and physician patient visits
- Cluster care when possible, to limit disturbances to patients and families (e.g., change dressings and check vital signs at the same time)
It took six months to coordinate all hospital staff schedules working in the unit and nursing programs around the slated quiet time. Now, lunch trays are picked up before the start of the hour, housekeeping staff do the bulk of their cleaning in the morning, and linen pickup now occurs an hour later. Despite the changes, staff emphasize patient care isn't compromised.
"We don't stop patient flow or necessary procedures," says Ellen Kissinger, RN-C, MSNc, assistant nurse manager in the unit. "We just try to take control of what we can."
Marin says physicians originally feared the program would affect workflow, but thinks it has instead created some unexpected efficiencies in the unit due to staff planning their care around quiet time. "I haven't had staff come to me and say something didn't get done because they didn't have the access," says Marin.
Still, Kissinger says it was a learning process in the beginning. To get everyone on the same page, a letter was sent out before launching the program to educate physicians, staff, and patients' families about the goals of quiet time.
"It is amazing how loud a cart is that you normally wouldn't notice, but because it is quiet time, it sounds like a train," Kissinger says. Pharmacy staff, who perform hourly deliveries, now hand carry medications during quiet time. She says staff occasionally needed to be reminded to keep their voices down, as well.
"I don't think we were aware of our noises until we started listening to them," says Marin, adding that she is now even mindful of the sound her shoes make.
Both Marin and Kissinger note seeing lower stress levels in staff with the program in place and will perform a formal evaluation this month to gauge staffs' perspectives on the success of the program. And patients and families frequently express their appreciation for being granted one hour of uninterrupted quiet time, sometimes saying it should be longer.
Marin says parents are often grateful for the structure of the program and the boundaries it sets for visitors frequenting patients' rooms "It's helped promote some of that permission to not always have everybody here with you."
"All of us have just incorporated it into what we do every day," says Marin, adding that the unit wants to extend the period to 90 minutes to reap more benefits from the program, such as napping, which promotes physical healing and growth.
Following the pediatric unit's lead, Marin says afternoon quiet time is being considered by other units within the facility, such as trauma areas. The neurosurgical intensive care unit is looking into implementing a morning quiet time program, in which naps could enhance brain restoration, growth, and emotional healing in patients.
"No one would have ever thought turning down the lights and lowering your voices would do so much for so many," she says. "It makes you think about your day and plan your care accordingly, and I think that it has helped a lot of nurses."