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To trial the identified interventions, the team used Lean QI methods, based on plan-do-study-act (PDSA), to focus on increasing value for the customer (patients), decreasing waste in the process, and developing team members by teaching them how to apply Lean methods. Our project used A3 thinking, a method that provides a framework for conceptualizing a problem, potential solutions, and outcomes. (See A3 thinking.) Wilson C, Whiteman K, Stephens K, Swanson-Biearman B, LaBarba J. Improving the patient’s experience with a multimodal quiet-at-night initiative. J Nurs Care Qual. 2017;32(2):134-40. A warm bath or shower before bedtime was impractical to implement on a broad scale in a hospital setting. However, EVS team members suggested a creative approach: Offer warm washcloths to the patients in the evening, which became part of the next experiment and PDSA cycle. Noise level
quiet night - Spanish translation – Linguee quiet night - Spanish translation – Linguee
Patel J, Baldwin J, Bunting P, Laha S. The effect of a multicomponent multidisciplinary bundle of interventions on sleep and delirium in medical and surgical intensive care patients. Anaesthesia. 2014;69(6):540-9. The project team established process measures to assess adherence to the interventions. Outcome measures included monthly HCAHPS Top Box scores on the quietness of hospital environment and the sources of noise survey scores. The team set a goal of 5% improvement in HCAHPS and a 20% decrease in bothersome sources of noise. God destined us to obtain salvation through our Lord Jesus Christ, so that whether we wake or sleep we might live with him. At the University of North Carolina Medical Center (UNCMC), a Magnet ®-recognized 803-bed level I trauma center, we receive impressive Hospital Consumer Assessment of Health- care Providers and Systems (HCAHPS) scores. However, patients’ responses to the question “During your hospital stay, how often was the area around your room quiet at night?” often fell short. Although specific sources of noise weren’t identified, two facts are certain: Noise levels in acute-care settings have increased significantly over the years, and sleep disturbance among hospitalized patients can impair healing and contribute to functional and psychological impairments. Based on these data, national attention on the role of sleep in health and well-being, and the fact that sleep quality is amenable to nursing intervention, the UNCMC division of nursing identified sleep promotion and noise reduction as annual goals. Evidence-based review Antiphon: Preserve us, O Lord, while waking, and guard us while sleeping, that awake we may watch with Christ, and asleep we may rest in peace. PRAYERS CollectThe results of the HCAHPS scores, sources of noise survey, and the sleep menu responses suggest that perceived quality of sleep, perception of noise, and overall satisfaction with care can be improved in our setting using simple solutions. However, clinical nurses play an essential role in encouraging a culture of quiet by modeling quiet behaviors. Antiphon: Preserve us, O Lord,* while waking, and guard us while sleeping, that awake we may watch with Christ, and asleep we may rest in peace. Murphy G, Bernardo A, Dalton J. Quiet at night: Implementing a Nightingale principle. Am J Nurs. 2013;113(12):43-51.
A Quiet Night At Home Lyrics - Genius Bare: The Musical – A Quiet Night At Home Lyrics - Genius
Tainter CR, Levine AR, Quraishi SA, et al. Noise levels in surgical ICUs are consistently above recommended standards. Crit Care Med. 2016;44(1):147-52. The authors work at the University of North Carolina Medical Center in Chapel Hill. Christine Hedges is the director of nursing quality and research. Erica Wolak is a senior clinical quality management engineer in nursing quality and research. Cheryl A. Smith-Miller is a nurse-scientist in nursing quality and research. Turkeisha Brown is nurse manager, adult medicine acute care unit. Selected references Clark A, Mills M. Can a sleep menu enhance the quality of sleep for the hospitalized patient? Medsurg Nurs. 2017;26(4):253-7. Barnes CM, Drake CL. Prioritizing sleep health: Public health policy recommendations. Perspect Psychol Sci. 2015;10(6):733-7.
Solutions and experiments
translation: "The Traitor Dong Zhuo Secretly Harbours a Deposition Plan", from Romance of the Three Kingdoms