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milieu therapy, neurocritical care, noise reduction, nursing care, quiet time, sleep promotion



  1. Steaphen, Annamma
  2. Olson, DaiWai M.
  3. Stutzman, Sonja E.


ABSTRACT: Aims and Objectives: This quality improvement project aimed to understand the impact of a quiet time protocol on nurses and patients in the neurocritical care unit (NCCU) by comparing pretest and posttest outcomes, taking decibel readings, and abstracting chart information. Background: Sleep is essential for maintaining a healthy life. Patients in the NCCU often do not get adequate amounts of sleep. Quiet time studies have focused on implementing periods of reduced noise levels to improve patient sleep. However, the perceptions of the caregivers about the protocols have not been taken into consideration, leading to difficulty in implementing these protocols if it impedes with the routine work of the caregivers. Methods: This was a prospective quality improvement project, with a quiet time protocol in the novel setting of the NCCU with caregiver feedback on the protocol. The quiet protocol involved decreasing light, noise, and patient interactions between 11:30 PM and 2:30 AM. There were 16 nurses who consented to the study and provided feedback via self-report questionnaires. Results: Implementation of this protocol did not suggest a decrease in nurse enjoyment with their job (P = .51). There were significant improvements in patient sleep quality and quantity (P < .0001). In addition, there was some evidence of decrease in the noise level and number of patient disruptions. Conclusions: The results of this single-site project suggest that, by implementing a quiet time protocol in the NCCU, patients obtained higher levels of sleep quality and quantity. The implementation of this protocol did not impact nurses' job satisfaction, suggesting that the quiet time protocol is possible, improves patients care, and does not hinder nurses' job satisfaction.