TL1
Strategic Planning TL1
- Provide one example, with supporting evidence, of an initiative in nursing practice that is consistent with the organization’s mission statement.
- Provide a copy of the organization’s mission statement.
Example a: Initiation of Quiet Time by Maternity Clinical Nurses and the Healing Environment Council
The Yale New Haven Health System (YNHHS) Vision is to “enhance the lives of those we serve by providing access to integrated, high value, patient-centered care in collaboration with others who share our values.” The YNHHS values include “patient-centered; putting patients and families first.” (Evidence TL1-1, Greenwich Hospital Vision, Mission, Values Statement)
In September 2016, Maternity Unit Clinical Nurses Cathleen Walker, MSN, RN, IBCLC and Pamela Lewis-Varon, BSN, RNC noted that maternity patients were exhausted after birth, especially with the constant stream of visitors. New parents often had difficulty telling their visitors to leave, which led to them potentially missing teaching and bonding opportunities. Walker and Lewis-Varon also saw patients delaying their baby's breastfeeding session to entertain guests, and patients had complained about the numerous times staff members entered their room throughout the day.
Walker and Lewis-Varon reviewed the literature and found data supporting a designated Quiet Time in healthcare delivery systems to promote patient healing and rest. Walker and Lewis-Varon believed a Quiet Time would benefit the Maternity population and knew it aligned with Greenwich Hospital’s patient and family-centered care model and the YNHH Vision, Mission and Values. They presented their findings from the literature and proposed a Quiet Time initiative to Patricia Basciano, BSN, RNC, Maternity Nurse Manager, who supported them to proceed with a unit-based study.
At the same time, the Healing Environment Council was exploring a Quiet Time initiative. The clinical nurse-led Healing Environment Council, part of the Professional Governance structure at Greenwich Hospital, meets monthly with members including clinical nurses from inpatient and ambulatory units. Its purpose is to create, implement and evaluate strategies to enhance the healing environment and promote a positive patient and family experience. The Healing Environment Council’s accountabilities are as follows:
- Develops approaches to care that allow patients and families to participate in clinical decisions
- Promotes a collaborative approach to accommodate patients’ cultural and diverse needs to allow for the best patient and family experience.
- Provides educational opportunities for staff as it relates to the patient and family experience
- Evaluates and makes recommendations related to new technology and its application to the patient and family experience
- Incorporates best evidence when evaluating potential solutions to items influencing the patient experience.
- Provides staff and leadership with ongoing respectful and healthy work environment facilitated by a commitment to your co-workers.
Walker and Lewis-Varon Collaborate with the Healing Environment Council
In September 2016, Walker and Lewis-Varon attended the Healing Environment Council meeting to present their literature review and recommendation of Quiet Time on the Maternity Unit and to collaborate on the Quiet Time initiative.
Over the next several months, Maternity Unit clinical nurses designed a pre-pilot survey that the lactation consultants would give to patients at their postpartum visit when they return to the hospital two to three days after discharge for a checkup by registered nurses. The survey revealed that 90% of patients would have participated in Quiet Time during their hospitalization. (Evidence TL1-2, Pre-Pilot Survey)
Members of the Healing Environment Council measured the decibels and number of patient interruptions before the Quiet Time pilot on Maternity. The Greenwich Hospital Marketing and Communications department created marketing materials, including a patient pamphlet and unit signage, for patient and staff education. Quiet Time education was also disseminated internally to areas associated with the Maternity Unit, such as Environmental Services, Food Services, Lab, IV Team and Blood Bank. The education included working with these departments to avoid direct patient care or services during Quit Time hours unless essential. (Evidence TL1-3, Quiet Time Pamphlet; Healing Environment Council Minutes, January 2017)
Clinical Nurses Implement Quiet Time Pilot
A one-month Quiet Time pilot was implemented on Maternity in April 2017, with designated Quiet Time hours from 1-3 p.m. every day. Quiet Time signage was displayed on the unit, lights were dimmed, interruptions were limited and decreased noise and visitation were promoted. Healing Environment Council members collected pilot and post-pilot implementation data from clinical nurses, included measurements of decibels, number of interruptions and patient surveys.
Post-implementation, in May 2017, 92% of Maternity patients surveyed reported that Quiet Time was beneficial. Patients’ comments indicated that they valued Quiet Time predominantly for rest, infant bonding and limited interruptions. Patients wrote, for example, that “It’s nice to have a time when other folks aren't on the floor. It promotes sleep and bonding with the baby,” and “It was nice knowing that there was a designated time to just rest without any visitors or constant nurse check-ins. I'm a fan of Quiet Time!”
Quiet Time Nursing Practice Initiative Incorporated Throughout Greenwich Hospital
After a successful pilot implementation and study of Quiet Time, Maternity clinical nurses believed it would be valuable to patients throughout the hospital. Sue Brown, MSN, RN, Senior Vice President Patient Care Services/Chief Nursing Officer (at the time), invited Walker, Lewis-Varon and the Healing Environment Council clinical nurses to give a presentation on Quiet Time to Nursing Leadership, the Steering Committee and the Coordinating Council, all of which approved the initiation of a hospital-wide Quiet Time. Unit-based education was disseminated internally to all hospital departments using the PowerPoint created by Walker and Lewis-Varon and introduced by an elevator speech created by the Healing Environment Council. (Evidence TL1-4, Nursing Leadership Minutes, March 2017; Coordinating Council, January 2017; Steering Meeting Agenda, January 2017, Quiet Time Education PowerPoint)
In September 2017, the nursing practice initiative of Quiet Time was implemented in all Greenwich Hospital inpatient units to promote rest, healing and patient satisfaction based on the literature review and positive patient response from the Maternity Unit’s pilot and study. Walker wrote an abstract that was accepted for a poster presentation at the Connecticut Research Alliance’s Annual Evidence-Based Practice Conference on October 12, 2018. (Evidence TL1-5, Quiet Time CT Nursing Research Alliance Conference acceptance, Quiet Time Poster)
National Quiet Time Day was September 14, 2018, which also marked the one-year anniversary of the implementation of Quiet Time at Greenwich Hospital. The Healing Environment Council members promoted Greenwich Hospital’s Quiet Time in an ongoing interactive presentation in the hospital cafeteria atrium on this day.
Quiet Time Nursing Practice Initiative Supports YNHHS Mission
The designated Quiet Time is a nursing practice initiative that aligns with the YNHHS mission statement to promote patient healing and rest. Clinical nurses believed that Quiet Time would benefit the Maternity population and knew it aligned with Greenwich Hospital’s patient and family-centered care model and the YNHH Vision, Mission and Values. The YNHHS Vision is to “enhance the lives of those we serve by providing access to integrated, high value, patient-centered care in collaboration with others who share our values.” The YNHHS values include “patient-centered; putting patients and families first.” This initiative was well-received by patients and staff members and has been instituted hospital-wide.
The implementation of Quiet Time led to an improvement in the Press Ganey patient satisfaction question, “Maternity noise level in and around room.” This score was 91.2 in 2016 and 90.8 in 2017 (the intervention period). Following its implementation, this score increased to 92.4 in 2018 and 93.2 in 2019 (to date).