Environmental noise in hospitals: a systematic review

Knowledge, attitude, and practices towards occupational noise among maintenance and administration workers of selected health facilities in Modimolle-Mookgopong Municipality, South Africa

This study aimed to determine knowledge, attitude, and practices towards Noise-Induced Hearing Loss among maintenance and administration workers in selected health facilities in the Modimolle-Mookgopong Municipality. Non-probability convenient sampling was used to select 250 participants. Maintenance workers were populated within the age range of 26-35 years, being more than administrative personnel (COR 1.59, CI 0.8-3.16). Maintenance workers showed more knowledge of noise being an unwanted sound (COR 1.04, CI 0.29-3.73), an ear infection (COR 4.65, CI 1.48-14.58) and poor hearing of speech as a sign of hearing loss (AOR 0.25, CI 0.07-0.86). Thirty-four percent (34%) of maintenance workers believed that ear screening and assessments are important while 17.9% believed not to be important. Forty-eight percent (58%) of maintenance workers suggested that they could not use hearing protectors effectively without training while 13.7% suggested training is needed.

An Interruption Management Education Bundle: Feasibility Testing With Nursing Students

BACKGROUND

Interruptions and distractions are pervasive in health care settings, increase risks for errors, and decrease task efficiency. Researchers recommend the use of strategies to mitigate their negative effects.

PURPOSE

The purpose was to assess the feasibility and acceptability of (1) an education bundle that included an interruption management strategy and (2) simulated scenarios with embedded interruptions and distractions.

METHODS

Nineteen undergraduate nursing students participated in this repeated-measures, multimethods feasibility study. Data on interruption management behaviors were collected across 3 timepoints via direct observation of individual-simulated medication administration. Participants' perceptions of the education bundle were explored via semistructured interviews.

RESULTS

Participants described the simulated scenarios as realistic and interruption management strategy as easy to use and remember. Participants voiced increased confidence in handling interruptions after learning the strategy. The strategy averaged 4 seconds to apply.

CONCLUSIONS

Findings support the feasibility and acceptability of the bundle and need for studies to investigate the impact of the strategy on errors and task durations.

A Systematic Review of Research Gaps in the Built Environment of Inpatient Healthcare Settings

OBJECTIVE

This study utilized the evidence-gap map method and critically examined the scope, methodologies, and focus of the studies that investigated the influence of the built environment on inpatient healthcare settings over a decade (2010-2021).

METHODS

We conducted a systematic review per the preferred reporting items for systematic reviews and meta-analyses guidelines and surveyed 406 articles, primarily from North America and Europe.

RESULTS

Our findings revealed a dominant focus on architectural features (73%), such as room design and ward layout. Comparatively, there was less emphasis on interior-, ambient-, social-, and nature-related features. Most previous studies explored multiple environmental features, which indicated the intricacy of this field. Research outcomes were diverse, with person-centered care (PCC) being the most frequently investigated, followed by safe care, emotional well-being, activity, and behavior. Furthermore, research methods varied considerably based on the study's outcomes and features. Clinical outcomes and safe care favored quantitative methods, activity and behavior favored mixed methods, and PCC favored qualitative research.

CONCLUSION

This review provides an in-depth overview of the existing studies on healthcare design research and sheds light on the current trends and methodological choices. The insights garnered can guide future research, policy-making, and the development of healthcare facilities.

Assessment and mapping of noise pollution in recreation spaces using geostatistic method after COVID-19 lockdown in Turkey

Increased use of recreational areas after the lifting of COVID-19 pandemic restrictions has led to increased noise levels. This study aims to determine the level of noise pollution experienced in recreational areas with the increasing domestic and international tourism activities after the lifting of pandemic lockdowns, to produce spatial distribution maps of noise pollution, and to develop strategic planning suggestions for reducing noise pollution in line with the results obtained. Antalya-Konyaaltı Beach Recreation Area, the most important international tourism destination of Turkey, is determined as the study area. To determine the existing noise pollution, 31 measurement points were marked at 100 m intervals within the study area. Noise measurements were taken during the daytime (07:00-19:00), evening (19:00-23:00), and nighttime (23:00-07:00) on weekdays (Monday, Wednesday, Friday) and weekends (Sunday) over 2 months in the summer when the lockdown was lifted. In addition, the sound level at each measurement point was recorded for 15 min, while the number of vehicles passing through the area during the same period was determined. The database created as a result of measurements and observations was analyzed using statistical and geostatistical methods. After the analysis of the data, it was found that the co-kriging-stable model showed superior performance in noise mapping. Additionally, it was revealed that there is a high correlation between traffic density and noise intensity, with the highest equivalent noise level (Leq) on weekdays and weekend evenings due to traffic and user density. In conclusion, regions exposed to intense noise pollution were identified and strategic planning recommendations were developed to prevent/reduce noise sources in these identified regions.

Effects of Ambient Noise Isolation on Illness Severity and Mental Health Among Hospitalized Children with Asthma: Retrospective Study

OBJECTIVE

This study investigated the effects of ambient noise isolation on disease severity and mental health among hospitalized children with asthma.

METHODS

A retrospective analysis was conducted on the clinical data of 187 hospitalized children with asthma admitted from May 2021 to May 2023. Among them, 92 cases were categorized in the control group (conventional management) and 95 in the observation group (environmental noise isolation). Ambient noise level, disease severity, mental health, and sleep quality were observed and compared between the two groups.

RESULTS

Weekly time, the noise value of the observation group was lower than that of the control group (P < 0.05). Before the management, modified Tal scoring system, cough symptom score, and Spence Children's Anxiety Scale-Short Version (SCAS-S) were recorded. SCAS-S and Sleep Disturbance Scale for Children (SDSC) had no significant difference (P > 0.05). Weekly time, no differences in the score of social fear dimension of SCAS-S, score of excessive sweating dimension of SDSC, Tal score, and cough symptom score were found between the observation and control groups (P > 0.05). The scores of other dimensions of SCAS-S and SDSC were lower in the observation group than those in the control group (P < 0.05).

CONCLUSIONS

Environmental noise isolation for hospitalized children with asthma can effectively improve their mental health and sleep status, but this strategy cannot improve their disease.

Urban noise assessment in hospitals: measurements and mapping in the context of the city of Sorocaba, Brazil

Noise pollution has become a public health problem in several countries worldwide. Noise maps are tools used in many cities, mainly on the European continent. In other regions, they are used in smaller areas, and few studies focus on hospital areas, considered noise-sensitive zones. In this context, this study aimed to perform sound measurements and noise maps for the day and night periods in the surroundings of three hospitals in Sorocaba, Brazil. Sound measurements occurred around the three hospitals based on NBR 10151 and ISO 1996 standards. The noise maps were drawn up using a calculation model based on ISO 9613-2. Results showed that the sound measurement points around the hospitals had levels above those recommended by the Brazilian standard for sensitive areas (LAeq 50 and 45 dB for day and night, respectively). The acoustic maps showed high sound levels on all faces of the hospital buildings, both during the day and at night. The worst scenario concerned the vicinity of the roads with the highest flow and speed of vehicles. We concluded that three different hospitals in the city have high sound levels in their surroundings above the recommended for sensitive areas.

Noise levels and annoyance among staff in a tertiary care hospital in North India: A cross-sectional study

Hospital noise has remained a low priority problem in India. An area of not less than 100 meters around a hospital is considered a silence zone, with guidelines restricting noise levels at 50dBA during daytime and 40dBA during the night. World Health Organization (WHO) guidelines also stipulate an average of 30dBA and a maximum of 40dbA. Annoyance is a known effect of noise exposure. However, very few studies have attempted to explore the hospital soundscape and the annoyance among staff related to it. Noise data was collected from 30 sites, using a Digital Integrating Sound Level Meter, LutronSL-4035SD (ISO-9001,CE,IEC1010) meeting IEC61672 standards. Stratified random sampling of staff was done on basis of noise exposure. A pre-designed, semi-structured questionnaire collected information on sociodemographic and work profile. Annoyance was defined as a stress reaction to environmental noise and was measured using standardized general purpose noise reaction questionnaire (ISO-TS/15666). Data was analyzed in SPSS. The mean LAeq 24 h across all the sites was 69.5dBA (SD ±5.8dBA) for the weekdays and 66.2dBA (SD ±4.6dBA) for the weekends. Noise levels were higher during the day than during the night, and higher during the weekdays as compared to the weekends. 332(73.8%) study participants were found to be annoyed due to hospital noise. Annoyance among study participants was significantly associated with LAeq 24 h > 80 dBA during the weekdays [aOR = 5.08 (1.17-22.06)] and LAeq 24 h of 65-80 dBA during the weekends [aOR = 2.71 (1.46-5.01)]. Noise levels in the hospital far exceeded WHO and Central Pollution Control Board (CPCB) guidelines recommended for indoor hospital noise, as well as the national guidelines for sensitive zones. Almost three-fourth of the study participants were annoyed due to hospital noise. Significant association was found between annoyance among staff and higher noise levels of their workplace. Similar studies need to be conducted in hospitals across India to generate evidence on the current situtation and identify solutions.

Smartphone applications for measuring noise in the intensive care unit: A feasibility study

PURPOSE

This study aims to explore the suitability of using smartphone applications with low-cost external microphones in measuring noise levels in intensive care units.

METHODS

Four apps and two external microphones were tested in a laboratory by generating test signals at five noise levels. The average noise levels were measured using the apps and a professional device (i.e. a sound level meter). A field test was performed in an intensive care unit with two apps and one microphone. Noise levels were measured in terms of average and maximum noise levels according to the World Health Organisation's guidance. All the measurements in both tests were conducted after acoustic calibration using a sound calibrator.

RESULTS

Overall, apps with low-cost external microphones produced reliable results of averaged noise levels in both the laboratory and field settings. The differences between the apps and the sound level meter were within ±2 dB. In the field test, the best combination of app and microphone showed negligible difference (< 2 dB) compared to the sound level meter in terms of the average noise level. However, the maximum noise level measured by the apps exhibited significant differences from those measured by the sound level meter, ranging from -0.9 dB to -4.7 dB.

CONCLUSION

Smartphone apps and low-cost external microphones can be used reliably to measure the average noise level in the intensive care unit after acoustic calibration. However, professional equipment is still necessary for accurate measurement of the maximum noise level.

The efficacy of earplugs and eye masks for delirium severity and sleep quality in patients undergoing coronary artery bypass grafting in cardiac intensive care units: A single-blind, randomised controlled trial

BACKGROUND AND PURPOSE

Delirium is a neuropsychiatric syndrome with a wide range of possible causes and multiple complications in patients admitted to intensive care units. It is, therefore, necessary to seek appropriate and safe strategies to prevent and manage delirium. This study is intended to examine the efficacy of eye masks and earplugs for delirium severity and sleep quality in patients with coronary artery bypass grafting in a cardiac intensive care unit.

MATERIALS AND METHODS

This single-blind, randomised controlled trial was conducted on 114 patients who were consecutively enrolled and randomly assigned to either the experimental group or the control group. The experimental group received routine care plus eye masks and earplugs, and the control group received only routine care. The delirium severity and sleep quality were measured with the Neelon and Champagne confusion scale and the Verran and Snyder-Halpern sleep scale.

RESULTS

The mean delirium severity score differed significantly between the two groups on the second, third, and fourth postoperative days (p < 0.001). Although the trend of changes in the mean delirium severity score from the first postoperative day (before the intervention) to the second, third, and fourth postoperative days was downward in the two groups (trending towards higher delirium severity), the control group experienced greater changes than the experimental group. An intragroup analysis of delirium severity detected a statistically significant difference in both the experimental and control groups (p < 0.001). The sleep quality domains (sleep disturbance, sleep effectiveness, sleep supplementation) showed a statistically significant difference between the two groups across the three intervention days (p < 0.001).

CONCLUSION

The overnight use of eye masks and earplugs were found to have positive effects on sleep quality domains (sleep disturbance, sleep effectiveness, sleep supplementation) and delirium severity in coronary artery bypass grafting patients admitted to the cardiac intensive care unit for several days. It was also found that a significant interaction effect between the sleep disturbance subscale and delirium severity exists.

CLINICAL TRIAL REGISTRATION NUMBER

(https://en.irct.ir): IRCT20210523051370N2.

Evaluation on the Effect of Ward-Noise Reduction Management Combined with Monitoring-Training-Planning Management Mode in Hospitalized Patients with Heart Failure

BACKGROUND

Noise from medical institutions such as hospitals usually exceeds the level recommended by the World Health Organization. This study aimed to explore the application effect of ward-noise reduction management combined with monitoring-training-planning (MTP) management mode in hospitalized patients with heart failure.

MATERIALS AND METHODS

Among the 168 research objects, 55 patients with heart failure receiving ward-noise reduction management combined with MTP management mode from April 2022 to March 2023 were included in group A, 52 patients with heart failure who underwent MTP management mode from March 2021 to March 2022 were selected as group B, and 61 patients who underwent routine management measures from March 2020 to February 2021 served as the control group. The vital signs, Self-rating Anxiety Scale (SAS) scores, Self-rating Depression Scale (SDS) scores, physical function indices, sleep quality score, and satisfaction degree of patients in the three groups were compared before and after management.

RESULTS

After 1 month of management, group A had lower heart rate, diastolic blood pressure, systolic blood pressure, and respiratory rate compared to group B and the control group (P < 0.001). The SAS score, SDS score, and Pittsburgh Sleep Quality Index score after management in group A were lower than those in group B and the control group (P < 0.001). Group A had a higher 6-Minute Walk Distance than group B and the control group (P < 0.001). Group A had a higher satisfaction degree after management compared to group B (P < 0.01) and the control group (P < 0.001). Group A had lower noise level than group B and the control group (P < 0.001), and there was no significant difference in noise level between group B and the control group (P > 0.05).

CONCLUSION

Ward-noise reduction management combined with MTP management mode can reduce the noise level in the ward and improve the psychological state and sleep quality of patients with heart failure.

Application Effect of Comprehensive Noise Reduction Technology in Outpatients with Vitiligo: A Retrospective Study

OBJECTIVE

Noise is a kind of perceived public nuisance that is closely related to people's subjective feelings and lives. This study explores the clinical application effect of comprehensive noise reduction technology in outpatients with vitiligo.

METHODS

A total of 76 patients with vitiligo were selected in the Department of Dermatology at Baoding No. 2 Central Hospital from January 2020 to January 2021, as the control group (CG), receiving 5S management mode, and 80 patients with vitiligo from February 2021 to October 2022 were selected as the study group (SG), receiving comprehensive noise reduction technology combined with the 5S management mode for this retrospective study. The effects of different management modes on these patients were observed.

RESULTS

SG had higher nursing quality scores in service attitude, service initiative, communication skills, environmental management and item management and overtly a lower noise level than CG (all P < 0.001). The Hamilton Anxiety Scale (HAMA) scores of the two groups at the end of treatment were significantly lower than those on admission (P < 0.05), with SG showing a lower score than CG (P < 0.001). Correlation analysis showed that noise levels and HAMA scores had a positive correlation (r = 0.423, P < 0.001). Patients with negative feelings about medical treatment caused by various noise sources in SG were obviously less than those in CG (P < 0.05). Both the groups had a statistical difference in overall satisfaction (P < 0.05).

CONCLUSION

The investigation and data analysis demonstrated that comprehensive noise reduction in outpatients with vitiligo had a considerable effect. This technology can standardise the behaviour of medical staff, enhance nursing quality, reduce noise levels and alleviate patients' anxiety and improve their satisfaction. It has great benefits for the outpatient environment and patients.

A challenge to the evidence behind noise guidelines for UK hospitals

BACKGROUND

Teams assessing hospital noise against international guidelines regularly find that noise exceeds perceived safe levels in clinical settings. The care of sick people may be inherently noisy but recent efforts to tackle the problem propose a wider scope to identify sources and qualities of noise as well as more precision with noise recording.

AIMS

We sought to challenge the scientific evidence cited in the four major documents pertaining to hospital noise in the UK to clarify if evidence of harm from noise included in guidelines is available, contemporary and of high quality.

METHODS

Our team of hearing-health clinicians, acoustic scientists and acoustic engineers have conducted a narrative scoping review focused on critically appraising four of the most cited guidelines against which noise is measured in healthcare settings in the UK.

RESULTS

There is a lack of high-quality evidence for commonly accepted consequences of noise cited in current guidelines.

CONCLUSIONS

The current evidence base for noise guidelines in a healthcare setting is largely based on subjective heterogeneous and inconclusive research. Whilst reduced noise is not disputed as potentially beneficial for patient care, further hypothesis-driven research and interventions assessing the benefits or outcomes of any such intervention should be sought to produce high-quality evidence of relevance on the clinical coalface.

Latoszek B, Hunter EJ. Clinical Utility and Validation of the Acoustic Voice Quality and Acoustic Breathiness Indexes for Voice Disorder Assessment in English Speakers

BACKGROUND

While several acoustic voice metrics are available for clinical voice assessment, there remains a significant need for reliable and ecologically valid tools. The Acoustic Voice Quality Index version 03.01 (AVQI-3) and Acoustic Breathiness Index (ABI) hold potential due to their comprehensive assessment approach, incorporating diverse voice aspects. However, these tools still need to be validated in English-speaking populations.

METHODS

This study assessed the discriminatory accuracy and validity of AVQI-3 and ABI in 197 participants, including 148 with voice disorders. Voice samples were collected, followed by AVQI-3 and ABI calculations. Additionally, auditory-perceptual assessments were conducted by a panel of speech-language pathologists.

RESULTS

AVQI-3 and ABI effectively identified disordered voice quality, evidenced by high accuracy (AUCs: 0.84, 0.89), sensitivity, and specificity (thresholds: AVQI-3 = 1.17, ABI = 2.35). Strong positive correlations were observed with subjective voice quality assessments (rs = 0.72, rs = 0.77, p < 0.001).

CONCLUSIONS

The study highlights AVQI-3 and ABI as promising instruments for clinically assessing voice disorders in U.S. English speakers, underscoring their utility in clinical practice and voice research.

Noise exposure among staff in intensive care units and the effects of unit-based noise management: a monocentric prospective longitudinal study

BACKGROUND

Intensive care units (ICUs) are often too noisy, exceeding 70-80 dBA, which can have negative effects on staff. The corresponding recommendation of the World Health Organization (average sound pressure level below 35 dBA) is often not achieved. To date there is a lack of intervention studies examining the extent to which unit-based noise management in ICUs contributes to a reduction in noise exposure for the staff. The study therefore aims to provide answers to 1) how unit-based noise management sustainably reduces the subjective noise exposure among staff, and 2) how this intervention affects other noise-related topics.

METHODS

We performed a monocentric prospective longitudinal study with three measurement points in a German university hospital in three ICUs. We collected data from different healthcare professionals and other professional groups between October 2021 and August 2022 using an online questionnaire. Data were analyzed using descriptive and inference statistics.

RESULTS

A total of n = 179 participants took part in the surveys. The majority of participants were nurses or pediatric nurses. Most participants worked more than 75% full-time equivalent. Staff on the three ICUs reported high levels of noise exposure. No significant changes in noise exposure over time were observed. Participants were already aware of the topic and believed that a behavior change could positively influence the noise environment.

CONCLUSIONS

This study provides an initial insight into how a unit-based noise management could contribute to a reduction in the subjective noise exposure among staff in ICUs. The results of this study highlight the importance of this topic. Future studies should aim to research aspects of adherence and their facilitators or barriers, which promote the sustained implementation of noise-reducing measures by staff.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS): DRKS00025835; Date of registration: 12.08.2021.

Impact of Quiet Time on Psychological Outcomes of Neonatal Intensive Care Unit Nurses in Jeddah, Saudi Arabia: A Cross-Sectional Study

BACKGROUND AND OBJECTIVE

Although quiet time is implemented in neonatal intensive care units (NICUs) for the benefit of infants, it may also positively impact the psychological outcomes of healthcare professionals. Several studies have examined the impact of quiet-time implementation on patients; however, there is a paucity of research assessing its impact on the psychological outcomes of NICU nurses, particularly in Saudi Arabia.

OBJECTIVE AND METHODS

This study aimed to assess the impact of quiet time on the psychological outcomes (stress, anxiety, and depression) of NICU nurses in Jeddah, Saudi Arabia. A cross-sectional design was used for this study. A total of 87 NICU nurses from two hospitals participated in this study. One group did not practice quiet time, while the second group did. A questionnaire survey assessed participants' demographic characteristics, and their depression, anxiety, and stress were assessed using the depression, anxiety, and stress scale-21 (DASS-21). The data were analyzed for frequency, percentage, mean, and standard deviation (SD). Bivariate analysis, independent t-tests, and one-way analysis of variance were used to test the differences between variables and groups. Pearson's correlation coefficient (r) was used to analyze the relationships between continuous variables and perceived stress, anxiety, and depression.

RESULTS

A substantial number of NICU nurses perceived stress, anxiety, and depression; however, there were no significant differences in perceived stress, anxiety, and depression between the nurses who worked in NICUs that applied quiet time and NICUs that did not (P ≤ 0.05).

CONCLUSION

This study found no statistically significant relationship between quiet-time implementation and perceived stress, anxiety, or depression among NICU nurses. Further research with a larger sample size or increased quiet-time implementation may be required.

Influence of single-room accommodation on nursing care: A realistic evaluation

Nowadays, it is common that newly built hospitals are designed with single-room accommodation, unlike in the past, where shared accommodation was the favoured standard. Despite this change in hospital design, very little is known about how single-room accommodation affects nurses' work environment and nursing care. This study evaluates how the single-room design affects nurses and nursing care in the single-room hospital design. Nurses working in the single-room design predominantly work alone with little opportunity for peer training, interaction and reflection. In addition, the single-room design affects the nurses' work environment due to changes in sensory stimulation and increased walking distances. Furthermore, a change in the discourse, namely, regarding the single room as the patient's home, makes the nurses react to queries, demands and tasks in a new way. Overall, the new hospital design forces the nurses into a more reactive role and affect their way of providing nursing care. Despite this, the nurses find single-room accommodation beneficial for the patients and their nursing care.

Effects of the Noise Reduction and Communication Management Headset System SLOS on Noise and Stress of Medical Laboratory Workers

OBJECTIVE

To investigate the effects of the Silent Laboratory Optimization System (SLOS), a technical-noise reduction and communication-management system, on noise load and stress among medical-laboratory workers.

METHODS

We conducted a quasiexperimental field study (20 days with SLOS as the experimental condition, and 20 days without SLOS as the control condition) in a within-subjects design. Survey data from 13 workers were collected before and after the shift. Also, a survey was conducted after the control and experimental conditions, respectively. Noise was measured in dBA and as a subjective assessment. Stress was operationalized via a stress composite score (STAI and Perkhofer Stress Scale), the Perceived Stress Scale (PSS), an exhaustion score (Leipziger StimmungsBogen in German [LSB]), and salivary cortisol values in µg/L.

RESULTS

SLOS users perceived significantly less noise (V = 76.5; P =.003). Multilevel models revealed a stress reduction with the SLOS on the composite score, compared with a stress increase in the control condition (F[1, 506.99] = 6.00; P = .01). A lower PSS score (F[1,13] = 4.67; P = .05) and a lower exhaustion level (F[1, 508.72] = 9.057; P = .003) in the experimental condition were found, whereas no differences in cortisol (F[1,812.58.6] = 0.093; P = .76) were revealed.

CONCLUSION

The workers showed reduced noise perception and stress across all criteria except cortisol when using SLOS.

Relating clustered noise data to hospital patient satisfaction

Hospital noise can be problematic for both patients and staff and consistently is rated poorly on national patient satisfaction surveys. A surge of research in the last two decades highlights the challenges of healthcare acoustic environments. However, existing research commonly relies on conventional noise metrics such as equivalent sound pressure level, which may be insufficient to fully characterize the fluctuating and complex nature of the hospital acoustic environments experienced by occupants. In this study, unsupervised machine learning clustering techniques were used to extract patterns of activity in noise and the relationship to patient perception. Specifically, nine patient rooms in three adult inpatient hospital units were acoustically measured for 24 h and unsupervised machine learning clustering techniques were applied to provide a more detailed statistical analysis of the acoustic environment. Validation results of five different clustering models found two clusters, labeled active and non-active, using k-means. Additional insight from this analysis includes the ability to calculate how often a room is active or non-active during the measurement period. While conventional LAeq was not significantly related to patient perception, novel metrics calculated from clustered data were significant. Specifically, lower patient satisfaction was correlated with higher Active Sound Levels, higher Total Percent Active, and lower Percent Quiet at Night metrics. Overall, applying statistical clustering to the hospital acoustic environment offers new insights into how patterns of background noise over time are relevant to occupant perception.

Evaluation of Multisensory Interactions Between the Healing Built Environment and Nurses in Healthcare Nursing Stations: Case Study of Tehran Hospitals

BACKGROUND

Nursing stations are important features of medical centers that are constantly in use. As nursing is an inherently stressful occupation, nursing stations should be designed to minimize stress on those who must spend time there.

AIM

This study evaluated the effect of environmental design factors on mitigating the stress levels on nurses in nursing stations by determining the environmental factors that most influence the perceptual senses that affect physical and psychological comfort.

METHODS

A quantitative approach was used to evaluate the parameters that affect the sensory perceptions of nurses in nursing stations at four hospitals in Tehran. A survey was conducted to identify environmental design parameters that affect the visual, auditory, tactile, kinesthetic, and olfactory senses.

RESULTS

The results revealed that the olfactory category scored highest, followed by the auditory, visual and tactile categories, which had similar scores, and kinesthetic was ranked last.

CONCLUSION

A connection was revealed between the educational level of the nurses and environmental factors affecting their sensory perception in terms of materials, aesthetics and the appropriate number of windows as a visual sense, and ergonomics as a kinesthetic sense. Significantly, the gender variable differed in the Furniture variable based on comfort of seating with respect structure. Based on the results of this study, a combination of olfactory, visual, and auditory factors should be required at the nursing stations to decrease the stress level of nurses.

Nurses' experiences of using falls alarms in subacute care: A qualitative study

Bed and chair alarms have been included in many multifaceted falls prevention interventions. None of the randomised trials of falls alarms as sole interventions have showed significant effect on falls or falls with injury. Further, use of bed and chair alarms did not change patients' fear of falling, length of hospital stay, functional status, discharge destination or health related quality of life. The aim of this study was to explore nurses' experiences of using bed and chair alarms. A qualitative descriptive study using semi-structured interviews with a purposive sample of 12 nurses was conducted on a 32-bed Geriatric Evaluation and Management ward in Melbourne, Australia. Participants were interviewed between 27 January and 12 March 2021.Transcribed audio-recordings of interviews were analysed using inductive thematic analysis. NVIVO 12.6 was used to manage the study data. Three major themes and four subthemes were constructed from the data: i) negative impacts of falls alarms (subthemes: noisy technology, imperfect technology), ii) juggling the safety-risk conflict, and iii) negotiating falls alarm use (subthemes: nurse decision making and falls alarm overuse). Nurses' experience of using falls alarms was predominantly negative and there was tension between falls alarms having limited impact on patient safety and risks associated with their use. Nurses described a need to support nurse decision making related to falls alarms use in practice and policy, and a desire to be empowered to manage falls risk in other ways.

Increased relaxation, less boredom, and a faster passage of time during a period of silence in the forest

INTRODUCTION

There is growing evidence of the beneficial effects of exposure to nature on health and well-being. Time spent in nature can decrease stress, anxiety, depression, and improve mood. In the present study, we compared the experience of a short period of silence in the natural environment of a forest with the same amount of silence in a seminar room.

METHODS

We applied an intra-subject design with two 6:30-min sessions of silence in two different environments (forest, seminar room). The participants (n=41) were assigned to four groups. Two groups started with the indoor condition and two groups with the outdoor condition. After 1 week, the two groups were exposed to the other condition. Participants filled out personality-trait scales on meaning in life and belief in oneness with the world, as well as state scales assessing emotional reactions, relaxation, boredom, and the subjective sense of self, time, and space.

RESULTS

Participants felt significantly more relaxed and less bored in the forest compared to indoors. They experienced time less intensely, judging it to pass faster and to last shorter in the forest. Regarding trait variables, the higher the search for meaning, the higher oneness beliefs in participants. The higher oneness beliefs, the more positive participants felt during silence in the forest.

DISCUSSION

Interest in nature-assisted therapy is increasing in the healthcare sector. Exposure to silence in the natural setting of a forest could prove to be an effective complement to interventions applied in nature-assisted therapy, such as forest therapy.

The Effectiveness of the Interventions to Reduce Sound Levels in the ICU: A Systematic Review

Excessive noise is ubiquitous in the ICU, and there is growing evidence of the negative impact on work performance of caregivers. This study aims to determine the effectiveness of interventions to reduce noise in the ICU.

DATA SOURCES

Databases of PubMed, EMBASE, PsychINFO, CINAHL, and Web of Science were systematically searched from inception to September 14, 2022.

STUDY SELECTION

Two independent reviewers assessed titles and abstracts against study eligibility criteria. Noise mitigating ICU studies were included when having at least one quantitative acoustic outcome measure expressed in A-weighted sound pressure level with an experimental, quasi-experimental, or observational design. Discrepancies were resolved by consensus, and a third independent reviewer adjudicated as necessary.

DATA EXTRACTION

After title, abstract, and full-text selection, two reviewers independently assessed the quality of each study using the Cochrane's Risk Of Bias In Nonrandomized Studies of Interventions tool. Data were synthesized according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, and interventions were summarized.

DATA SYNTHESIS

After screening 12,652 articles, 25 articles were included, comprising either a mixed group of healthcare professionals (n = 17) or only nurses (n = 8) from adult or PICU settings. Overall, the methodological quality of the studies was low. Noise reduction interventions were categorized into education (n = 4), warning devices (n = 3), multicomponent programs (n = 15), and architectural redesign (n = 3). Education, a noise warning device, and an architectural redesign significantly decreased the sound pressure levels.

CONCLUSIONS

Staff education and visual alert systems seem promising interventions to reduce noise with a short-term effect. The evidence of the studied multicomponent intervention studies, which may lead to the best results, is still low. Therefore, high-quality studies with a low risk of bias and a long-term follow-up are warranted. Embedding noise shielding within the ICU-redesign is supportive to reduce sound pressure levels.

Attitudes About Artificially Intelligent Interactive Voice Response Systems Using Amazon Alexa in Cardiovascular Clinics: Insights from the VOICE-COVID-19 Study

The acceptability of artificially intelligent interactive voice response (AI-IVR) systems in cardiovascular research settings is unclear. As a result, we evaluated peoples' attitudes regarding the Amazon Echo Show 8 device when used for electronic data capture in cardiovascular clinics. Participants were recruited following the Voice-Based Screening for SARS-CoV-2 Exposure in Cardiovascular clinics study. Overall, 215 people enrolled and underwent screening (mean age 46.1; 55% females) in the VOICE-COVID study and 58 people consented to participate in a post-screening survey. Following thematic analysis, four key themes affecting AI-IVR acceptability were identified. These were difficulties with communication (44.8%), limitations with available interaction modalities (41.4%), barriers with the development of therapeutic relationships (25.9%), and concerns with universality and accessibility (8.6%). While there are potential concerns with the use of AI-IVR technologies, these systems appeared to be well accepted in cardiovascular clinics. Increased development of these technologies could significantly improve healthcare access and efficiency.

Evaluating Therapeutic Healthcare Environmental Criteria: Architectural Designers' Perspectives

This study presents architectural designers’ perception of the importance of healthcare environmental criteria in the implementation of user-centered, therapeutic hospital design. Architectural designers with over three years of professional experience (N = 182) in South Korea were surveyed using an empirical questionnaire. The extensive interviews of 15 hospital design experts followed to interpret the survey results and discuss the barriers and suggestions for the successful delivery of therapeutic healthcare design practice. Among the 27 variables selected from the preliminary literature review, factor analyses revealed seven important therapeutic environmental criteria (i.e., management, interior design, spatial quality, service, nature and rest, ambient indoor comfort, and social program and space; χ2 = 1783.088, df = 300, p < 0.001). Analyses of variance revealed the level of importance among these criteria related to respondents’ personal and professional characteristics. Significant differences were found for the variables from the management, interior design, and spatial quality factors in relation to the respondents sex and age. For the successful delivery of therapeutic healthcare design, the design experts highlighted the implementation of evidence-based design practice that integrates local and international knowledge from various hospital users and multi-disciplinary specialists participating in the healthcare design process.

Living in a box: Understanding acoustic parameters in the NICU environment

Background

In the last years, a significant body of scientific literature was dedicated to the noisy environment preterm-born infants experience during their admission to Neonatal Intensive Care Units (NICUs). Nonetheless, specific data on sound characteristics within and outside the incubator are missing. Therefore, this study aimed to shed light on noise level and sound characteristics within the incubator, considering the following domain: environmental noise, incubator handling, and respiratory support.

Methods

The study was performed at the Pediatric Simulation Center at the Medical University of Vienna. Evaluation of noise levels inside and outside the incubator was performed using current signal analysis libraries and toolboxes, and differences between dB_A and dB_SPL values for the same acoustic noises were investigated. Noise level results were furthermore classed within previously reported sound levels derived from a literature survey. In addition, sound characteristics were evaluated by means of more than 70 temporal, spectral, and modulatory timbre features.

Results

Our results show high noise levels related to various real-life situations within the NICU environment. Differences have been observed between A weighted (dB_A) and unweighted (dB_SPL) values for the same acoustic stimulus. Sonically, the incubator showed a dampening effect on sounds (less high frequency components, less brightness/sharpness, less roughness, and noisiness). However, a strong tonal booming component was noticeable, caused by the resonance inside the incubator cavity. Measurements and a numerical model identified a resonance of the incubator at 97 Hz and a reinforcement of the sound components in this range of up to 28 dB.

Conclusion

Sound characteristics, the strong low-frequency incubator resonance, and levels in dB_SPL should be at the forefront of both the development and promotion of incubators when helping to preserve the hearing of premature infants.

A Survey of the General Hospital Environment: Focusing on Pajama Design in a Japanese University Hospital

This study investigated nurses' and patients' perceptions of hospital room environment and patient pajama design. Nurses working in a Japanese university hospital and patients aged 20 and older were surveyed. Over 75% of patients rated the hospital environment and hospital rooms as "very good" or "good," but less than one in three nurses rated them similarly. Patients were more likely than nurses to rate rental pajamas as "very good" or "good." Contrary to the nurses, only about one in four patients valued wearing well-designed pajamas. Nurses' and patients' perceptions differed regarding hospital pajamas, but not about improving hospital rooms.

Variability of environmental sound levels: An observational study from a general adult intensive care unit in the UK

Background

Intensive care units are significantly louder than WHO guidelines recommend. Patients are disturbed by activities around them and frequently report disrupted sleep. This can lead to slower recovery and long-term health problems. Environmental sound levels are usually reported as LAeq24, a single daily value that reflects mean sound levels over the previous 24-h period. This may not be the most appropriate measure for intensive care units (ICUs) and other similar areas. Humans experience sound in context, and disturbance will vary according to both the individual and acoustic features of the ambient sounds. Loudness is one of a number of measures that approximate the human perception of sound, taking into account tone, duration, and frequency, as well as volume. Typically sounds with higher frequencies, such as alarms, are perceived as louder and more disturbing.

Methods

Sound level data were collected from a single NHS Trust hospital general adult intensive care unit between October 2016 and May 2018. Summary data (mean sound levels (LAeq) and corresponding Zwicker calculated loudness values) were subsequently analysed by minute, hour, and day.

Results

The overall mean LAeq24 across the study duration was 47.4 dBA. This varied by microphone location. We identified a clear pattern to sound level fluctuations across the 24-h period. Weekends were significantly quieter than weekdays in statistical terms but this reduction of 0.2 dB is not detectable by human hearing. Peak loudness values over 90 dB were recorded every hour.

Conclusions

Perception of sound is sensitive to the environment and individual characteristics and sound levels in the ICU are location specific. This has implications for routine environmental monitoring practices. Peak loudness values are consistently between 90 and 100 dB. These may be driven by alarms and other sudden high-frequency sounds, leading to more disturbance than LAeq24 sound levels suggest. Addressing sounds with high loudness values may improve the ICU environment more than an overall reduction in the 24-h mean decibel value.

Reframing Our Health Care System for Patients With Hearing Loss

PURPOSE

Nearly 20% of U.S. Americans report a hearing loss, yet our current health care system is poorly designed and equipped to effectively care for these individuals. Individuals with hearing loss report communication breakdowns, inaccessible health information, reduced awareness and training by health care providers, and decreased satisfaction while struggling with inadequate health literacy. These all contribute to health inequities and increased health care expenditures and inefficiencies. It is time to reframe the health care system for these individuals using existing models of best practices and accessibility to mitigate inequities and improve quality of care.

METHOD

A review of system-, clinic-, provider-, and patient-level barriers, along with existing and suggested efforts to improve care for individuals with hearing loss, are presented.

RESULTS

These strategies include improving screening and identification of hearing loss, adopting universal design and inclusion principles, implementing effective communication approaches, leveraging assistive technologies and training, and diversifying a team to better care for patients with hearing loss. Patients should also be encouraged to seek social support and resources from hearing loss organizations while leveraging technologies to help facilitate communication.

CONCLUSIONS

The strategies described introduce actionable steps that can be made at the system, clinic, provider, and patient levels. With implementation of these steps, significant progress can be made to more proactively meet the needs of patients with hearing loss. Presentation Video: https://doi.org/10.23641/asha.21215843.

Acoustic environments of intensive care units during the COVID-19 pandemic

This study aims to investigate the typical noise levels and noise sources in an intensive care unit (ICU) during the COVID-19 pandemic. Acoustic experiments were conducted over 24 hrs in patient wards and at nurse stations in four Chinese hospitals. From the measurements, noise levels and sources were analysed in terms of the A-weighted equivalent sound pressure levels (L _Aeq) and A-weighted maximum Fast time-weighted sound pressure levels (L _AFmax) over three different time periods during the day (i.e. day, evening and night). Overall, noise levels (L _Aeq) for 24 hrs in all hospitals exceeded the World Health Organisation's (WHO) guide levels, varying from 51.1 to 60.3 dBA. The highest maximum noise level reached 104.2 dBA. The single-bedded wards (side rooms) were quieter than multi-bedded wards, and night time noise levels were quieter than daytime and evening across all hospitals. It was observed that the most dominant noise sources were talking/voices, door-closing, footsteps, and general activities (e.g. noise from cleaning equipment and cutlery sound). Footsteps became an unexpected dominant noise source during the pandemic because of the staff's disposable shoe covers which made footsteps noisier. Patient alarms and coughing varied significantly between patients. Talking/voices produced the highest maximum median values of the sound exposure level (SEL) and the maximum noise level at all sites. Noise levels in all the patient rooms were more than the WHO guidelines. The pandemic control guidelines had little impact on the noise levels in the ICUs.

A Bayesian network model to predict the role of hospital noise, annoyance, and sensitivity in quality of patient care

Background

Hospital noise can adversely impact nurses’ health, their cognitive function and emotion and in turn, influence the quality of patient care and patient safety. Thus, the aim of this study was to predict the contributing roles of exposure to hospital noise, staff noise-sensitivity and annoyance, on the quality of patient care.

Methods

This descriptive and cross-sectional study was carried out among nurses in an Iranian hospital. To determine nurses’ noise exposure level, the noise was measured in 1510 locations across the hospital in accordance with ISO 9612 standards using KIMO DB 300/2 sound level meter and analyzer. An online survey was used to collect nurses’ individual data. Study questionnaires included demographics, Weinstein noise sensitivity scale, noise annoyance scale, and quality of patient care scale. Finally, to analyze the data, Bayesian Networks (BNs), as probabilistic and graphical models, were used.

Results

For the high noise exposure state, high noise sensitivity, and high annoyance, with the probability of 100%, the probability of delivering a desirable quality of patient care decreased by 21, 14, and 23%, respectively. Moreover, at the concurrently high noise exposure and high noise sensitivity with the probability of 100%, the desirable quality of patient care decreased by 26%. The Bayesian most influence value was related to the association of noise exposure and annoyance (0.636). Moreover, annoyance had the highest association with the physical aspect of quality of care (0.400) and sensitivity had the greatest association with the communication aspect (0.283).

Conclusion

Annoyance induced from environmental noise and personal sensitivity affected the quality of patient care adversely. Moreover, noise and sensitivity had a separate direct adverse effect upon the quality of patient care, and their co-occurrence reduced the potential for delivering quality patient care.

Analysis of the Acoustic Comfort in Hospital: The Case of Maternity Rooms

Hospitals include a variety of different spaces with different requirements and levels of sensitivity to noise but also different activities and equipment that can cause high noise levels. In this article, noise disturbance in hospitals is studied with reference to a case study in a maternity ward. The analysis is carried out by means of sound insulation measurements between bedrooms and between bedroom and corridor. Equivalent sound pressure level measurements were carried out continuously for two days and nights. The number of awakening events is examined for each hour of the two nights. In addition, the results of a questionnaire conducted on more than 100 patients are reported. The results of the study show that the main cause of noise disturbance is activity in the corridors and that this kind of disturbance is usually repeated throughout the night. This is made more critical by the poor acoustic performance of the doors, but also by the habit of keeping doors open or half-open to allow doctors to always control patients. The article proposes some possible solutions to reduce noise intrusion from the corridor to the rooms.

Novice Doctors in the Emergency Department: A Scoping Review

In many emergency departments (EDs), young, inexperienced doctors treat patients who are critically ill. At the start of their career, these novice doctors are not sufficiently qualified to take care of these potentially critically ill patients in the highly demanding environment of an ED. This not only poses a threat to the well-being of the doctor, who feels inadequately prepared and experiences a lot of stress, but also to that of the patients, who may not receive optimal care. Lastly, young doctors may influence the efficiency of the organization, with longer throughput times, more orders of ancillary investigations, and more admissions.

Training novice doctors with regard to simple or complex skills using simulation techniques is part of the solution. However, the transfer of newly learned skills to clinical practice remains unexplored, and not everything can be trained before the actual skill is required. Therefore, it is important to train young doctors in their learning abilities, for instance, teach them how to be adaptive and how to use their skills in new situations. Lastly, the way care is organized is essential. Good supervision, leaving room for the learning processes of young doctors, developing a team with more experienced professionals (paramedics, nurses, and doctors), and well-organized processes, aiming to reduce the complexity of the work, are ways to improve the quality of care, independent of the experience level of the novice doctor.

Adding Insult to Injury: Sleep Deficiency in Hospitalized Patients

Sleep deficiency is a common problem in the hospital setting. Contributing factors include preexisting medical conditions, illness severity, the hospital environment, and treatment-related effects. Hospitalized patients are particularly vulnerable to the negative health effects of sleep deficiency that impact multiple organ systems. Objective sleep measurement is difficult to achieve in the hospital setting, posing a barrier to linking improvements in hospital outcomes with sleep promotion protocols. Key next steps in hospital sleep promotion include improvement in sleep measurement techniques and harmonization of study protocols and outcomes to strengthen existing evidence and facilitate data interpretation across studies.

Prevalence of Hoarseness in Primary Health Care and Hospitals-Associations With Different Work Tasks and Environmental Factors Among Nurses

OBJECTIVES

The voice is one of the most essential tools necessary for nurses achieve high care satisfaction and safety. Research on hoarseness has mainly focused on professional speakers, like teachers. The aim of this study was to determine the current prevalence of hoarseness among six subgroups of nurses (registered nurses, primary care nurses, pediatric nurses, laboratory nurses, dental nurses, and midwives) and also to identify potential environmental risk factors in their working environment.

METHODS

The health data was collected in collaboration with two health care professional trade unions. The findings are based on 15,553 returned health questionnaires which were statistically analyzed.

RESULTS

The 1-year prevalence of hoarseness among all participating nurses was 30.2 % in this data, but the variation between different occupational subgroups was significant; ranging from 25 % for laboratory nurses to 38 % for midwives. These findings were in line with perceived environmental problems and the differences between the sub-groups were not explained by the participants suffering from asthma, sinusitis, rhinitis, or common respiratory infections; there were no explanatory differences in the prevalence's of the above-mentioned diseases.

CONCLUSIONS

The variation in prevalence of hoarseness between the different occupational subgroups was significant and the prevalence was found to be in line with perceived environmental problems. The most common problems were stuffiness, dry air, and inadequate ventilation. In addition, both a perceived "sewer odor" and "smell of mold or cellar" in one's own working environment were also found to be significant risk factors for hoarseness. Based on this study, the current indoor air problems in Finnish health care facilities can be verified and are a source of risk to nurses' voices.

Daily reality of violence in a rural emergency department: Is violence becoming the new normal?

OBJECTIVES

Violence in emergency healthcare is a persistent and concerning problem. The objective of the present study was to explore and understand rural nurses' views on the daily experience and impact of violence, and its perpetrators.

METHODS

The present study took a descriptive exploratory approach. Two focus groups were held with nurses from an ED at a rural hospital in New South Wales, Australia.

RESULTS

Violence occurred regularly and had a significant impact on staff. Nurses go to work expecting to search patients for weapons and be physically and verbally abused. Tolerating and being able to manage violence has become a rite of passage.

CONCLUSIONS

The present study shows that rural workers, like metropolitan workers, feel experiences of violence are a routine part of their roles. Violence in healthcare is a societal issue, that cannot be solved without a multifactor approach that considers the characteristics of the perpetrators.

Effect of ambient noise on indoor environments in a health care facility in Oman

Hospital-noise levels can induce physiological responses and affect sleep quality, which could contribute to cardiovascular-related health problems. Till date, high-resolution hospital noise exposure assessment studies have not received much attention in Oman. This study aims at assessing sound pressure levels across hospital wards and intensive care unit (ICU) rooms to determine annoyance and potential health effects based on perception and risk estimates. An indoor exposure assessment using high precision noise sensors was conducted in a female medical ward (FMW), isolated ward (SLW), emergency ward (EMW), and intensive care unit (ICU) in a public hospital in Muscat city, Oman. Self-administered questionnaire was randomly distributed among respondents using both online and field survey approach to ascertain annoyance, health effects, and potential risks associated with exposure. The study found that 24-h noise levels (L_Aeq) ranged from 55.2 to 61.7 dB(A) in the hospital wards and ICU rooms, which exceeded WHO's hospital indoor rooms critical limit of 35 dB(A) by 58-76%. A total of 150 participants took part in the survey. Among the respondents, 53% reported moderate annoyance at the hospital wards, while 56% felt sensitivity to the noise levels. Noise annoyance was reported by the majority of the patients across the various wards and emergency rooms as causing slight annoyance (50%) and intermittent sleep disturbances (49%). The majority (73%) of the medical staff have complained that the current noise levels affect overall work performance (p = 0.004), while 70% of them have further complained of it as a cause of workplace distraction (p = 0.011). Logistic binary regression analysis has revealed that the complaint of noise sensitivity has a positive association with noise levels in VCW (OR: 1.54; 95% CI: 0.92-2.58), and reported loss of concentration by the medical staff also associated with noise levels at the EMW (OR: 1.61; 95% CI: 0.65-4.01). Quantitative risk estimates showed that both the percentages of highly annoyed (HA) persons (16%), and highly sleep-disturbed (HSD) persons (9%) were very high in FMW, while ICU was found to have the lowest risk. However, the greater number of the respondents (87%) believed that there are possibilities of mitigating (p < 0.001) the current noise levels.

The Influence of Face Masks on Verbal Communication in Persian in the Presence of Background Noise in Healthcare Staff

Wearing face masks has resulted in verbal communication being more challenging during the COVID-19 pandemic. This study aimed to investigate the effect of face masks on the speech comprehensibility of Persian nurses in healthcare settings. Twenty female nurses from the governmental hospitals randomly participated in an experiment on seven typical commercial face masks at two background noise levels. Nurses' speech intelligibility from a human talker when wearing each face mask was determined based on the speech discrimination score. The vocal effort of nurses wearing each face mask was determined based on the Borg CR10 scale. Based on the linear mixed model, the speech intelligibility of nurses from a human speaker wearing surgical masks, N95 masks, and a shield with face masks were approximately 10%, 20%, and 40-50% lower, respectively, than no-mask conditions (p < 0.01). The background noise decreased the speech intelligibility of nurses by approximately 22% (p < 0.01). The use of a face shield further decreased speech intelligibility up to 30% compared to using a face mask alone (p < 0.01). The vocal efforts of nurses when wearing surgical masks were not significant compared with the baseline vocal efforts (p > 0.05); however, vocal efforts of nurses when wearing N95 and N99 respirators were at an unacceptable level. The face masks had no considerable effect on the speech spectrum below 2.5 kHz; however, they reduced high frequencies by different values. Wearing face masks has a considerable impact on the verbal communication of nurses in Persian. The level of background noise in the healthcare setting can aggravate the effect sizes of face masks on speech comprehensibility.