Noise control: a nursing team's approach to sleep promotion

Effect of a Noise Reduction Program on a Medical— Surgical Unit

This quasi-experimental study tested an intervention to reduce sound levels in an acute care hospital. A parallel pre- and posttest design with control group was used; patients and employees completed the Topf Adapted Sound Disturbance Scales, and environmental sound levels were recorded on a Quest 2900 Sound Level Meter. Treatment interventions included an educational PowerPoint presentation for employees, minor environmental acoustical alterations, and the use of a Quest 261 Sound Detector/Controller for behavioral modification. None of these interventions produced statistically significant changes in sound levels. Patients and employees reported slightly less disturbance due to noise postintervention on the treatment unit. The findings of this study support Philbin and Gray's suggestion that the use of sound-absorbing materials in the hospital's physical structure may be the most effective measure to reduce sound levels in the hospital setting.

A Review of the Research Literature on Evidence-Based Healthcare Design

Objective:

This report surveys and evaluates the scientific research on evidence-based healthcare design and extracts its implications for designing better and safer hospitals.

Background:

It builds on a literature review conducted by researchers in 2004.

Methods:

Research teams conducted a new and more exhaustive search for rigorous empirical studies that link the design of hospital physical environments with healthcare outcomes. The review followed a two-step process, including an extensive search for existing literature and a screening of each identified study for the relevance and quality of evidence.

Results:

This review found a growing body of rigorous studies to guide healthcare design, especially with respect to reducing the frequency of hospital-acquired infections. Results are organized according to three general types of outcomes: patient safety, other patient outcomes, and staff outcomes. The findings further support the importance of improving outcomes for a range of design characteristics or interventions, including single-bed rooms rather than multibed rooms, effective ventilation systems, a good acoustic environment, nature distractions and daylight, appropriate lighting, better ergonomic design, acuity-adaptable rooms, and improved floor layouts and work settings. Directions for future research are also identified.

Conclusions:

The state of knowledge of evidence-based healthcare design has grown rapidly in recent years. The evidence indicates that well-designed physical settings play an important role in making hospitals safer and more healing for patients, and better places for staff to work.

Noise levels in a general intensive care unit: a descriptive study

The aim of this small-scale study was to measure, analyse and compare levels of acoustic noise, in a nine-bedded general intensive care unit (ICU). Measurements were undertaken using the Norsonic 116 sound level meter recording noise levels in the internationally agreed 'A' weighted scale. Noise level data were obtained and recorded at 5 min over 3 consecutive days. Results of noise level analysis indicated that mean noise levels within this clinical area was 56.42 dB(A), with acute spikes reaching 80 dB(A). The quietest noise level attained was that of 50 dB(A) during sporadic intervals throughout the 24-h period. Parametric testing using analysis of variance found a positive relationship (p <or= 0.001) between the nursing shifts and the day of the week. However, Scheffe multiple range testing showed significant differences between the morning shift, and the afternoon and night shifts combined (p <or= 0.05). There was no statistical difference between the afternoon and night shifts (p >or= 0.05). While the results of this study may seem self-evident in many respects, what it has highlighted is that the problem of excessive noise exposure within the ICU continues to go unabated. More concerning is that the prolonged effects of excessive noise exposure on patients and staff alike can have deleterious effect on the health and well-being of these individuals.

Quieting Weinberg 5C: a case study in hospital noise control

Weinberg 5C of Johns Hopkins Hospital is a very noisy hematological cancer unit in a relatively new building of a large medical campus. Because of the requirements for dealing with immuno-suppressed patients, options for introducing sound absorbing materials are limited. In this article, a case study of noise control in a hospital, the sound environment in the unit before treatment is described, the chosen noise control approach of adding custom-made sound absorbing panels is presented, and the impact of the noise control installation is discussed. The treatment of Weinberg 5C involved creating sound absorbing panels of 2-in.-thick fiberglass wrapped in an anti-bacterial fabric. Wallpaper paste was used to hold the fabric to the backing of the fiberglass. Installation of these panels on the ceiling and high on corridor walls had a dramatic effect. The noise on the unit (as measured by the equivalent sound pressure level) was immediately reduced by 5 dB(A) and the reverberation time dropped by a factor of over 2. Further, this drop in background noise and reverberation time understates the dramatic impact of the change. Surveys of staff and patients before and after the treatment indicated a change from viewing the unit as very noisy to a view of the unit as relatively quiet.

Sense or no-sense: The nurse as embodied ethnographer

Researching in familiar environments brings about challenges as nurses are learned to tune out their senses to give expert nursing care, and contemporary nursing research using observations has been criticized for being disembodied--not often using senses other than sight. This article draws on experiences from a fieldwork study of palliative and aged care environments to show how a deliberate use of the senses can enhance the richness of nursing research and open up new avenues for investigation. Examples from a reflexive fieldwork journal are presented to demonstrate how sensate experiences was used in a reflexive process that led into areas that otherwise might have remained unexplored. The authors argue that the interplay between sensate experiences and analytical logic can bring the background to the foreground and provide new ways of making the familiar unfamiliar. In making sense of what residing in health care environments might mean, an embodied research activity is fruitful.

Light measurement in the hospital: A comparison of two methods

Disrupted sleep in hospitalized patients is widely reported, and ambient environmental lighting may be both a contributor to and a modifier of sleep/wake patterns. This is the first study to examine the congruence between two types of light meters, a wrist-worn device and a stand-alone device, and their respective light intensity measurements. The study sample included 20 light trials in 17 patients for a total of 480 paired light measurements. Descriptive data analysis indicated that both light meters dependably recorded changes in light levels, and Bland Altman plots demonstrated congruence between data from the two types of light meters. The results provide promising data on how to measure patient exposure to ambient light dependably in the continuously changing and unpredictable clinical setting.

Impacting Patient Outcomes Through Design

To succeed in today's challenging healthcare environment, hospitals must examine their impact on customers--patients and families--staff and physicians. By using competitive facility design and incorporating evidence-based concepts such as the acuity adaptable care delivery model and the universal room, the hospital will realize an impact on patient satisfaction that will enhance market share, on physician satisfaction that will foster loyalty, and on staff satisfaction that will decrease turnover. At the same time, clinical outcomes such as a reduction in mortality and complications and efficiencies such as a reduction in length of stay and minimization of hospital costs through the elimination of transfers can be gained. The results achieved are dependent on the principles used in designing the patient room that should focus on maximizing patient safety and improving healing. This article will review key design elements that support the success of an acuity adaptable unit such as the use of a private room with zones dedicated to patients, families, and staff, healing environment, technology, and decentralized nursing stations that support the success of the acuity adaptable unit. Outcomes of institutions currently utilizing the acuity adaptable concept will be reviewed.

Noise levels in Johns Hopkins Hospital

This article presents the results of a noise survey at Johns Hopkins Hospital in Baltimore, MD. Results include equivalent sound pressure levels (L(eq)) as a function of location, frequency, and time of day. At all locations and all times of day, the L(eq) indicate that a serious problem exists. No location is in compliance with current World Health Organization Guidelines, and a review of objective data indicates that this is true of hospitals throughout the world. Average equivalent sound levels are in the 50-60 dB(A) range for 1 min, 1/2, and 24 h averaging time periods. The spectra are generally flat over the 63-2000 Hz octave bands, with higher sound levels at lower frequencies, and a gradual roll off above 2000 Hz. Many units exhibit little if any reduction of sound levels in the nighttime. Data gathered at various hospitals over the last 45 years indicate a trend of increasing noise levels during daytime and nighttime hours. The implications of these results are significant for patients, visitors, and hospital staff.

Your patient--my child: seven priorities for improving pediatric care from the parent's perspective

Parents and professional caregivers, although united in their shared goal of returning a sick child to health, do not always view the caregiving situation from the same frame of reference. This article describes the perspectives of more than 50,000 parents whose child experienced a hospitalization. It outlines the greatest opportunities for improving the pediatric inpatient experience from the parent's perspective. In addition, practical tips and strategies for planning improvements in care from the patient/family perspective are offered.

Promoting quality sleep in older people: the nursing care role

Sleep is a basic activity of living. Its restorative properties in healthcare settings--both hospital and community--should be considered by healthcare workers. Its significance in gerontological nursing should not be underestimated. As older people are prone to multiple pathology, disease processes may mask their need for effective sleep and rest. "Sleep architecture" is a term that applies to the mechanics of sleep or its stages and clinicians may fail to identify when this is disrupted. "Sleep hygiene" refers to measures or interventions used to promote sleep and a person-centred approach is necessary, with support from specialist agencies to achieve effective sleep hygiene. The need for long periods of sleep may diminish owing to ageing. However, the quality of the sleep experiences, i.e. feeling rested and refreshed, should be the same. Several factors have been identified in the causation of insomnia. In healthcare settings, environmental factors such as noise and light pollution are the commonest features. Other issues that may be present in both healthcare and community settings are related to varied perspectives, such as physiological, psychological and spiritual-religious. Providing a climate conducive to health sleep in all settings becomes a requisite in the planning of care.