Document Type

Presentation

Publication Date

6-2024

Abstract

Background: A stay at the hospital is full of interruptions from family visitors, lab draws, hearing screens, nurses and doctors, social workers, and environmental services. All these interruptions during the postpartum stay negatively affect parents and newborns by interrupting breastfeeding, sleep, and family bonding time. Evidence from AWHONN (Association of Women's Health Obstetric and Neonatal Nurses) research, in the articles referenced, demonstrates overwhelming support of Quiet Time in the Postpartum period. Quiet Time has been shown to improve exclusive breastfeeding rates, decrease emotional and physical exhaustion, enhance shared decision making and set realistic expectations, increase nurse satisfaction, decrease nursing stress and increased patient satisfaction.

Purpose: The purpose of this EPB and QI project is to determine if the initiation of Quiet Time will increase patient satisfaction, increase breast feeding success rates, and increase verbalization of bonding time with baby on a 20 bed LDRP unit in Eastern Washington. The purpose is also to see if there is a reduction in stress on nursing staff and an increase in rest breaks and time to chart.

Method: Prospective pre and post surveys using a scale of zero to five. Press Ganey scores for the focus groups of postpartum patients and nursing staff on a 20-bed LDRP unit were used to determine the success of Quiet Time implementation. Education about Quiet Time was given to all staff and patients and the unit turned down the lights and placed signs on the doors of patients who choose to participate in Quiet Time between the hours of 2-4 AM and PM, all ancillary staff were also educated about Quiet Time on the unit. Signs were also placed in the hospital elevators letting visitors know and reminding all hospital staff that the LDRP unit has Quiet Time between 2-4. The patients who chose to participate were encouraged to not have any visitors and assured that hospital staff would not be entering their room unless called or if medically necessary.

Result: The results of the Quiet time study demonstrated improvement or minimal decline in all areas. There were 42 patient pre surveys collected and 38 post surveys. The number of times patients felt they were interrupted during their stay decreased by over 50%. Uninterrupted bonding time had a 0.1 decrease and exclusive breastfeeding had a 0.2 decrease. Patient overall satisfaction with their stay remained the same. The nursing staff had 34 pre surveys and 38 post surveys returned. Overall stress level of nurses decreased by 1.12, time to chart increases by 0.33, time for staff to take breaks increased by 0.17 and nursing staff felt as if their patients' ability to cope increased by 0.55. However, the nurses who returned the survey had a decrease in the belief the implementation of Quiet Time is beneficial by 0.24. The Press Ganey scores pre and post Quiet time show an increase in patient satisfaction of 1.1% with their nurses' attention to their needs and increase of 2.3% in the friendliness and courtesy of the nurses, and a 6% increase in their concerns being addressed.

Discussion: One of the biggest challenges of this EBP and QI project has been staff buy in. The unit did additional work to best address the concerns of staff e.g., replacing the lighting at the nurse's station with dimmable lights, adjusting the hours of quiet time on nights to allow a better workflow, adding additional signage about Quiet Time in patient rooms. However, even with these accommodations many of the staff are still resistant to change. Many nurses are not letting their patients know about Quiet Time and are not educating them on the benefits of Quiet Time on admission. Hopefully overtime Quiet Time will become a consistent standard on the unit and all nurses and staff will be educating their patients and participating in this EBP implementation. When patients are educated about Quiet Time, they are excited to know they will have a few hours of uninterrupted time to spend with their baby and want to participate.

Implications for Practice: Quiet Time on the unit is here to stay, with the hope that over time it will become more accepted and part of the standard of care that patients receive. Already another unit in the small community hospital has begun the process is instituting a variation of quiet time on their unit with the SHHH (Silent Hospitals Help Healing) campaign. Possibly over time all the inpatient units will be participating in quiet hours to promote healing.

Clinical Institute

Women & Children

Specialty

Obstetrics & Gynecology

Specialty

Nursing

Comments

References:

Church, L. (2020). Quiet time during postpartum hospitalization can improve rest, bonding, and breastfeeding. Nursing for Women's Health, 24(3), 197-201. https://doi.org/10.1016/j.nwh.2020.03.002

Lawrie, C., Highfield, M. E., & Mendelson, S. (2021). Quiet time to increase breastfeeding rates and enhance women’s hospital experiences in the postpartum period. Nursing for Women's Health, 25(3), 170–178. https://doi.org/10.1016/j.nwh.2021.04.002

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