Healthcare Leadership Course: Patient and Family Centered Care PowerPoint

CREATING A RESTFUL HEALING ENVIRONMENT

BY KEVIN BLACKMAN RN BSCN

Highlights1. Describe the specific behaviors providers should practice to

respect their patients’ need for a quiet, restful environment.

2. In particular, describe the specific behaviors providers should practice to

respect their patients’ need for rest at night.

3. Analyze a variety of clinical situations to assess how well providers are – or are not – respecting their patients’ needs for a restful and healing

Section 1: The Importance of Creating a Restful EnvironmentPatients in the hospital need rest and a calming, peaceful environment – but hospitals are often the exact opposite: noisy, bright, and intrusive. And the worst times are often at night; when patients most need their sleep, they are awakened for nonessential procedures that often suit the needs of providers at the expense of the needs of patients. In this lesson, you’ll learn basic behaviors you can practice to respect your patients’ needs for restfulness and healing.

Patients need rest to get well. But if you’ve ever spent a night in the hospital, you know that it’s typically not the best place to sleep. Caregivers work around the clock and often wake patients at odd times that suit their own schedules, rather than their patients’ schedules. 

A patient-centered approach, however, puts the needs of the patient first. This means taking extra care to be quiet when patients are sleeping and combining tasks efficiently in order to minimize interruptions. 

(Rupert et al, 2001)

Historical Perspectives Florence Nightingale was famed for her focus on

sanitation and other aspects of the environment that contribute to the health and healing of the patients. She was not only a leader in improving sanitation and ventilation, but was also instrumental in bringing forth the body-and-mind connection.

Nightingale Identified these factors as being important:Noise, light, Air quality, and colors

(Rupert et al, 2001)

FACTORS EFFECTING THE RESTFUL ENVIRONMENT: NOISE

Noise is one of the most known environmental stressors found in the hospital environment. In the critical care unit, where patients require more frequent and more intensive monitoring, noise can be the most powerful stressor. On any ward, noises can include: the hum of medical equipment, bubbling of chest tubes, pagers and intercom systems, ringing of telephones, opening and closing of doors, cabinets, and supply carts, and even the clattering sounds from the wheels of a passing cart, and ongoing construction. They also mentioned the noise staff made, including the nursing staff during shift changes, the environmental services staff during routine cleaning, and the large care team present on the unit at all times of the day and night as major factors.

(Heidi Boehm and Stacy Morast, 2009)

LIGHT

Light, like sound, can have both positive and negative influences on the human body and mind. All living things need light to exist, and light contrasted with darkness guides the tempo of the body’s 24-hour circadian rhythm.

(Rupert et al, 2001).

RESEARCH ON ENVIRONMENTAL FACTORS: NOISE AND LIGHT

Petterson (2000) conducted a survey of the medical critical care staffs’ perception of noise levels at Henry Ford Hospital and compared the results with baseline decibel readings on the medical ICU. Although the decibel reading and staffs’ perception of noise were found to be correlated, staff members were unaware of the types and times of noise. Kahn et al. (1998) measured the noise level in two ICUs. They found a peak noise level of 80 decibels and almost 50% of noxious noise generated in the ICU was created by human behavior (Rupert et al, 2001).

RESEARCH RESULTS

1) Studies show that noise levels higher than 50 decibels cause physiologic changes that decrease healing and recovery and can increase length of stay

2) Disturbed sleep can affect a patient’s ability to heal and can increase morbidity.

3) Excess noise can increase gastric acid secretion, stimulate the cardiovascular system, and impair the ability to fight infections

4) Medical and nursing personnel produce between 30% and 60% of the noise on a hospital unit.

5) High levels of noise can increase the stress that staff feel when providing care, which could increase the risk of medical errors. (Rupert et al, 2001)

SOLUTIONS: PATIENTS NEED CONTROL

Patients need to feel that they have some sense of control over the environment so as to reduce their stress. Empowering patients by giving them control over temperature, lighting, privacy, visitation, and the type and volume of music decreases stress and improves healing. Rollins (2004) reports that patients were more satisfied with their care, slept better, had lower blood pressure, and were less likely to be readmitted when hospitals took measures to reduce the hospital environmental stressors.

(Rupert et al, 2001)

SOLUTIONS: PATIENTS NEED QUIET TIMEThe goal of quiet time was to provide patients with an hour of uninterrupted rest during the day.  What one-hour period during the day would least interfere with their work? Together we decided that 12:30 PM to 1:30 PM was best for the team. During this time, staff were encouraged to stay out of patient rooms unless entering was absolutely necessary. Before 12:30 PM patients were toileted, given fresh water, and made comfortable. Patientadmissions, discharges, and essential tests and procedures were permitted during quiet time.

FEEDBACK:Patients have made many positive comments, both during their stays and on patient satisfaction surveys.One patient wrote, “I really liked the quiet hour. It gave time for my husband to go eat without fear ofmissing the doctor. It also gave me the quiet I needed to rest.” The standard states the purpose of quiet time and gives examples of activities that can and cannot take place during it. Prohibited activities include routine tests and therapies, routine housekeeping services, public address system announcements and pages, and deliveries from the gift shop or flower shop. However, essential tests and therapies, emergency housekeeping services and public address system announcements, and dietary tray deliveries are permitted.

(Heidi Boehm and Stacy Morast, 2009)

SOLUTIONS: STAFF NEED TO USE STRATEGIES(These are strategies working in ICU Settings)

Social Environment

Create a family friendly program Include the family in the plan of care Establish a liberal visiting policy Offer options to give the patient control over

temperature, lighting, music, visitors, and privacy Design the area to accommodate families

Optimal Patient Outcomes

• Decreased environmental noise • Increased air quality • Implementation of open/unrestricted family visitation • Physical comfort in expected range • Decreased signs and symptoms of stress.

(Rupert et al, 2001)

Physical Environment

Reduce environmental stress caused by noise, offensive

light, and odor Establish an official policy on noise standards and

evaluate noise levels Use a mini-workstation to disperse staff Use sound-absorbent materials such as acoustical

ceilings and carpeting in high-traffic areas Construct single rooms with televisions with

headphones Test equipment for noise impact and implement a

maintenance program Use natural light when possible Provide full-spectrum light Provide periods of low light for sleep Position the patient to appreciate the view Utilize calming color schemes such as blues,

greens, and violet Incorporate nature and artwork

How To Create a Restful Peaceful Environment Here are some basic things you can do to create a restful and healing environment

for patients: Think about how much noise you are making when the patient or family members are sleeping (either at night or during a nap).

When possible, bundle services that need to happen during the night, such as taking vital signs and administering pain medication, at the same time.

Suspend the “knock before entering” practice at night. At night, use lighting judiciously so that you can safely provide care while limiting

disruption to the patient. Perform as many nonessential services as possible during waking hours – 6:00 AM

to 9:00 PM. If you must enter a room after 9:00 PM, switch to your “silent mode” and perform the task as quietly as you can.

Be proactive, when you can, to limit equipment alarms. For example, plan to hang new IV fluids or medication bags before they run out to avoid setting off the alarm.

Listen for squeaks from doors or rumbling from food or linen carts, and request they be repaired to limit noise.

Take everything you need into a room when you enter to limit the number of times you open the door.

When staff gather at the nurses’ station or in the hallways, be conscious of your voice levels. Move to a room with a door for lengthy conversations, if possible.

If a colleague is speaking loudly, ask him or her to lower the volume.

 

WATCH VIDEO “WATCH VIDEO AND REFLECT: Healthcare Healing Environments | Terry

Newmyer, St. Helena Hospital President  VIDEO LINK: https://www.youtube.com/watch?v=vuLcy8UWEC0  Reflection  What have we learned in this video regarding creating a restful environment for

patients?

Think about when you were once a patient in a hospital, what factors inconvenienced you during times of rest?

What could that facility have done to improve your patient experience?

If you do not have a story of the past, think of a family member or even a television program you watched, where the patient was inconvenienced during times of rest.

 

REFERENCESHeidi Boehm and Stacy Morast (2009). American Journal of Nursing. Quit Time. Volume 109; Issue 11. Retrieved from http://journals.lww.com/ajnonline/Fulltext/2009/11001/Quiet_Time.8.aspx

Institute of Healthcare Improvement. (2014). First Impressions. Retrieved From:http://app.ihi.org/lms/lessonpageworkflow.aspx?CatalogGuid=4cc435f0-d43b-4381-84b8-899b35082938&CourseGuid=8eb52137-21d7-4b30-afcd-fd781de6d6d5&LessonGuid=3598321d-17c3-48ee-9170-b4c7954a8026

Petterson, M. (2000). Reduced noise levels in ICU promote rest and healing. Critical Care Nurse, 20 (5), 104.

Rupert, R., Long, L., and Hutchinson, M. (2001). Creating a healing environment in the ICU. Retrieved from: http://www.jblearning.com/samples/0763738638/38638_CH03_027_040.pdf