Sleep is an important part of the healing journey; the clinical nurses actively participating in the Nurses Improving Care for Healthsystem Elders (NICHE) wanted to create an initiative that would promote sleep and rest. According to Burger et al., hospitalized patients sleep an average of 1.3-3.2 fewer hours than the official recommendation, and 6% of patients reported inadequate sleep during their hospitalization. Obtaining adequate sleep in the hospital can be challenging for patients for a variety of reasons.
In March 2025, clinical nurses from the NICHE team created a call to action. The team felt it was imperative to improve patient satisfaction scores for Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) “Quiet at Night” and patient reported sleep quality scores. Sleep loss can also put patients at increased risk for adverse outcomes, including cardio-metabolic derangements and increased risk of delirium (Stewart & Arora, 2018).
The NICHE Committee, led by clinical nurse LaKetah “Key” Harper, MSHI, BSN, RN, Chair, and Marissa Clark, MSN, RN, CCRN, GERO-BC, Co-Chair, reviewed the evidence within the literature and identified inadequate rest and sleep in the geriatric population as a major contributing factor to delirium. Patient verbatim comments from HCAHPS survey demonstrated an opportunity to reduce noise at night. Upon completing a fishbone diagram, various causes were identified such increased voice volume during staff handoffs, labs/tests in the middle of the night, bed changes overnight, loud noises from carts, beds, and alarms. An impact effort matrix was used to determine quick wins in the high-impact, low-effort category as part of the phase one PSDA cycle.
The interventions occurred in April and May and included the CALM 1.0 bundle, including sleep aids such as aromatherapy, teas, eye masks, and ear plugs, the healthy hospital routine flyer. New interventions, such as a tuck-in service before bedtime, in which clinical teams assist patients with toileting and ambulation and assess and manage pain using both pharmacologic and non-pharmacologic methods. The goal of the tuck-in service is to reduce interruptions and address needs proactively, so patients are not left waiting for call lights or hesitant to request help. Additionally, overhead lights are dimmed in each patient room and hallway, alarm volumes are checked, computers are plugged in, and noise is minimized with visual cues at the nursing station, including a stoplight noise tracker. Another aspect of CALM 2.0 was aligning signage and visuals to promote a calming environment, in line with Dr. Jean Watson’s Ten Caritas Processes®. Messages include “Please help us co-create a healing environment by being mindful of noise, volume, and energy,” inviting mindfulness and presence. The hospital operators also make an overhead announcement every evening to remind visitors, staff, and patients about quiet hours. These interventions serve as gentle invitations to pause, breathe, and foster a space open to healing and miracles.
By August 2025, the percent top box score HCAHPS: Quiet at Night increased from baseline 3.3 to 29.2. The NICHE team then began to apply these learnings from the 4th floor to the 5th floor. Preliminary data from the patient reported satisfactory sleep demonstrates improvement each week. In November 2025, the CALM 2.0 initiative was introduced to the 3West telemetry unit, where the team is looking forward to seeing the impact.
