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Tronstad O, Patterson S, Zangerl B, Flaws D, Holdsworth R, Irvine L, Yerkovich S, Pearse I, Fraser JF. The introduction of a sound reduction bundle in the intensive care unit and its impact on sound levels and patients. Aust Crit Care 2024; 37:716-726. [PMID: 38604917 DOI: 10.1016/j.aucc.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 02/18/2024] [Accepted: 02/18/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND ICU outcomes are continuing to improve. However, this has not been matched by similar improvements of the ICU bedspace environment, which can detrimentally impact on patient outcomes. Excessive sound and noise, especially, has been linked with adverse and potentially preventable patient outcomes and staff errors. There are many sources of sound in the ICU, with alarms from bedside equipment frequently listed as a main source. The number of alarms is increasing in parallel with the introduction of new and more sophisticated technologies to monitor and support patients. However, most alarms are not accurate or critical and are commonly ignored by staff. OBJECTIVE The objective of this study was to evaluate the impact of a sound reduction bundle on sound levels, number of alarms, and patients' experience and perceived quality of sleep in the ICU. METHODS This was a pre-post, quasi-experimental study investigating the impact of three study interventions implemented sequentially (staff education, visual warnings when sound levels exceeded the preset levels, and monitor alarm reconfigurations). Effects of staff education were evaluated using pre-education and post-education questionnaires, and the impact on patients was evaluated via self-report questionnaires. A sound-level monitor was used to evaluate changes in sound levels between interventions. Alarm audits were completed before and after alarm reconfiguration. RESULTS Staff knowledge improved; however, sound levels did not change across interventions. The number of monthly monitor alarms reduced from 600,452 to 115,927. No significant differences were found in patients' subjective rating of their experience and sleep. CONCLUSION The interventions did not lead to a sound-level reduction; however, there was a large reduction in ICU monitor alarms without any alarm-related adverse events. As the sources of sound are diverse, multidimensional interventions, including staff education, alarm management solutions, and environmental redesign, are likely to be required to achieve a relevant, lasting, and significant sound reduction.
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Affiliation(s)
- Oystein Tronstad
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia; Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia.
| | - Sue Patterson
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; School of Dentistry, University of Queensland, Brisbane, Australia
| | - Barbara Zangerl
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Dylan Flaws
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Department of Mental Health, Metro North Mental Health, Caboolture Hospital, Caboolture, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Robert Holdsworth
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Lacey Irvine
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Stephanie Yerkovich
- Menzies School of Health Research and Faculty of Health, Qld University of Technology, Brisbane, Australia
| | - India Pearse
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia; Intensive Care Unit, St. Andrews War Memorial Hospital, Brisbane, Australia
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Xu L, Zhang Z, Du P. Enhancing Postanesthesia Care Unit Management Based on Noise Reduction Strategies Grounded in Comfort Theory. J Perianesth Nurs 2024:S1089-9472(24)00117-5. [PMID: 39078358 DOI: 10.1016/j.jopan.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 07/31/2024]
Abstract
PURPOSE To explore the management improvement measures and application effects of reducing noise in postanesthesia care unit (PACU) based on Comfort Theory. DESIGN Randomized controlled clinical trial. METHODS A total of 1,300 patients who underwent general anesthesia or combined nerve block anesthesia and were transferred to the PACU in May and August 2021 were divided into a control group (630 cases) and a study group (670 cases) based on time. The control group received routine PACU management, and management based on Comfort Theory to reduce the noise in the PACU was implemented with the study group, including physiological comfort, psychological and spiritual comfort, social and cultural comfort, and environmental comfort. The overall noise level in PACU, retention time in PACU, incidence of nursing adverse events, and patient satisfaction were compared before and after implementation. FINDINGS In the observation group, the noise values of the four time periods in the PACU were significantly decreased, the retention time was (59.92 ± 22.0) minutes, the incidence of nursing adverse events and vomiting was 0.1%, and the patient satisfaction was 99.8%, which were significantly better than those in the control group, and the differences were statistically significant (P < .05). CONCLUSIONS The management of noise reduction in PACU based on Comfort Theory can significantly reduce the noise level in PACU, effectively shorten the PACU retention time, reduce the incidence of nursing adverse events, and improve the nursing satisfaction of patients.
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Affiliation(s)
- Lingling Xu
- The Postanesthesia Care Unit (PACU),Department of Anesthesiology and Surgery, Nanjing Drum Tower Hospital, Affiliated with Nanjing University, Nanjing, China
| | - Zhuanyun Zhang
- The Postanesthesia Care Unit (PACU),Department of Anesthesiology and Surgery, Nanjing Drum Tower Hospital, Affiliated with Nanjing University, Nanjing, China
| | - Ping Du
- The Postanesthesia Care Unit (PACU),Department of Anesthesiology and Surgery, Nanjing Drum Tower Hospital, Affiliated with Nanjing University, Nanjing, China.
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Tronstad O, Zangerl B, Patterson S, Flaws D, Yerkovich S, Szollosi I, White N, Garcia-Hansen V, Leonard FR, Weger BD, Gachon F, Brain D, Lavana J, Hodgson C, Fraser JF. The effect of an improved ICU physical environment on outcomes and post-ICU recovery-a protocol. Trials 2024; 25:376. [PMID: 38863018 PMCID: PMC11167845 DOI: 10.1186/s13063-024-08222-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Intensive care medicine continues to improve, with advances in technology and care provision leading to improved patient survival. However, this has not been matched by similar advances in ICU bedspace design. Environmental factors including excessive noise, suboptimal lighting, and lack of natural lights and views can adversely impact staff wellbeing and short- and long-term patient outcomes. The personal, social, and economic costs associated with this are potentially large. The ICU of the Future project was conceived to address these issues. This is a mixed-method project, aiming to improve the ICU bedspace environment and assess impact on patient outcomes. Two innovative and adaptive ICU bedspaces capable of being individualised to patients' personal and changing needs were co-designed and implemented. The aim of this study is to evaluate the effect of an improved ICU bedspace environment on patient outcomes and operational impact. METHODS This is a prospective multi-component, mixed methods study including a randomised controlled trial. Over a 2-year study period, the two upgraded bedspaces will serve as intervention beds, while the remaining 25 bedspaces in the study ICU function as control beds. Study components encompass (1) an objective environmental assessment; (2) a qualitative investigation of the ICU environment and its impact from the perspective of patients, families, and staff; (3) sleep investigations; (4) circadian rhythm investigations; (5) delirium measurements; (6) assessment of medium-term patient outcomes; and (7) a health economic evaluation. DISCUSSION Despite growing evidence of the negative impact the ICU environment can have on patient recovery, this is an area of critical care medicine that is understudied and commonly not considered when ICUs are being designed. This study will provide new information on how an improved ICU environment impact holistic patient recovery and outcomes, potentially influencing ICU design worldwide. TRIAL REGISTRATION ACTRN12623000541606. Registered on May 22, 2023. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385845&isReview=true .
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Affiliation(s)
- Oystein Tronstad
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Rode Road, Chermside, Brisbane, Qld, 4032, Australia.
- Faculty of Medicine, University of Queensland, Brisbane, Australia.
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia.
| | - Barbara Zangerl
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Rode Road, Chermside, Brisbane, Qld, 4032, Australia
| | - Sue Patterson
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Rode Road, Chermside, Brisbane, Qld, 4032, Australia
- School of Dentistry, University of Queensland, Brisbane, Australia
| | - Dylan Flaws
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Rode Road, Chermside, Brisbane, Qld, 4032, Australia
- Department of Mental Health, Metro North Mental Health, Caboolture Hospital, Caboolture, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Stephanie Yerkovich
- Menzies School of Health Research and Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Irene Szollosi
- Sleep Disorders Centre, The Prince Charles Hospital, Brisbane, Australia
| | - Nicole White
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Rode Road, Chermside, Brisbane, Qld, 4032, Australia
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Veronica Garcia-Hansen
- School of Architecture and Built Environment, Faculty of Engineering, Queensland University of Technology, Brisbane, Australia
| | - Francisca Rodriguez Leonard
- School of Architecture and Built Environment, Faculty of Engineering, Queensland University of Technology, Brisbane, Australia
| | - Benjamin D Weger
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - Frédéric Gachon
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - David Brain
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Jayshree Lavana
- Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Carol Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Division of Clinical Trial and Cohort Studies, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Physiotherapy Department, Alfred Hospital, Melbourne, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Rode Road, Chermside, Brisbane, Qld, 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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Imbriaco G, Capitano M, Rocchi M, Suhan A, Tacci A, Monesi A, Sebastiani S, Samolsky Dekel BG. Relationship between noise levels and intensive care patients' clinical complexity: An observational simulation study. Nurs Crit Care 2024; 29:555-563. [PMID: 37265028 DOI: 10.1111/nicc.12934] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/27/2023] [Accepted: 05/03/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Noise pollution in intensive care units is a relevant problem, associated with psychological and physiological consequences for patients and healthcare staff. Sources of noise pollution include medical equipment, alarms, communication tools, staff activities, and conversations. AIMS To explore the cumulative effects of noise caused by an increasing number and type of medical devices in an intensive care setting on simulated patients with increasing clinical complexity. Secondly, to measure medical device alarms and nursing activities' sound levels, evaluating their role as potentially disruptive noises. STUDY DESIGN Observational simulation study (reported according to the STROBE checklist). Using an electronic sound meter, the sound levels of an intensive care room in seven simulated clinical scenarios were measured on a single day (09 March 2022), each featuring increasing numbers of devices, hypothetically corresponding to augmented patients' clinical complexity. Secondly, noise levels of medical device alarms and specific nursing activities performed at a distance of three meters from the sound meter were analysed. RESULTS The empty room's mean baseline noise level was 37.8 (±0.7) dBA; among the simulated scenarios, noise ranged between 45.3 (±1.0) and 53.5 (±1.5) dBA. Alarms ranged between 76.4 and 81.3 dBA, while nursing tasks (closing a drawer, opening a saline bag overwrap, or sterile packages) and speaking were all over 80 dBA. The noisiest activity was opening a sterile package (98 dBA). CONCLUSION An increased number of medical devices, an expression of patients' higher clinical complexity, is not a significant cause of increased noise. Some specific nursing activities and conversations produce higher noise levels than medical devices and alarms. This study's findings suggest further research to assess the relationships between these factors and to encourage adequate noise reduction strategies. RELEVANCE TO CLINICAL PRACTICE Excessive noise level in the intensive care unit is a clinical issue that negatively affects patients' and healthcare providers' well-being. The increase in baseline room noise from medical devices is generally limited. Typical nursing tasks and conversations produce higher noise levels than medical devices and alarms. These findings could be helpful to raise awareness among healthcare professionals to recognize noise sources. The noisiest components of the environment can be modified by staff behaviour, promoting noise reduction strategies and improving the critical care environment.
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Affiliation(s)
- Guglielmo Imbriaco
- Centrale Operativa 118 Emilia Est, Prehospital Emergency Dispatch Center, Helicopter Emergency Medical Service, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
- Critical Care Nursing Master Course, University of Bologna, Bologna, Italy
| | - Martina Capitano
- Emergency Department, Maggiore Hospital Carlo Alberto Pizzardi, Azienda USL di Bologna, Bologna, Italy
| | - Margherita Rocchi
- Intensive Care Unit, Nuovo San Giovanni di Dio hospital, AUSL Toscana Centro, Florence, Italy
| | - Aglaia Suhan
- Medical Department (COVID-19), Madre Teresa di Calcutta hospital, Padova, Italy
| | - Alice Tacci
- Neonatal Intensive Care Unit, Maggiore Hospital, AOU Parma, Parma, Italy
| | - Alessandro Monesi
- Critical Care Nursing Master Course, University of Bologna, Bologna, Italy
- Intensive Care Unit, Maggiore hospital Carlo Alberto Pizzardi, Azienda USL di Bologna, Bologna, Italy
| | - Stefano Sebastiani
- Critical Care Nursing Master Course, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Boaz Gedaliahu Samolsky Dekel
- Critical Care Nursing Master Course, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
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Armbruster C, Walzer S, Witek S, Ziegler S, Farin-Glattacker E. Noise exposure among staff in intensive care units and the effects of unit-based noise management: a monocentric prospective longitudinal study. BMC Nurs 2023; 22:460. [PMID: 38057790 DOI: 10.1186/s12912-023-01611-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023] Open
Abstract
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.
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Affiliation(s)
- Christoph Armbruster
- Institute of Medical Biometry and Statistics (IMBI), Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, 79106, Germany.
| | - Stefan Walzer
- Faculty of Health, Safety and Society, Care and Technology Lab, Furtwangen University, 78120, Furtwangen, Germany
| | - Sandra Witek
- Center of Implementing Nursing Care Innovations Freiburg, Medical Center - University of Freiburg, 79106, Freiburg, Germany
| | - Sven Ziegler
- Center of Implementing Nursing Care Innovations Freiburg, Medical Center - University of Freiburg, 79106, Freiburg, Germany
| | - Erik Farin-Glattacker
- Institute of Medical Biometry and Statistics (IMBI), Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, 79106, Germany
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Ismail A, Imam A, Raguini M, Hassan D, Ali A, Alkhotani A. Impact of Quiet Time on Psychological Outcomes of Neonatal Intensive Care Unit Nurses in Jeddah, Saudi Arabia: A Cross-Sectional Study. Cureus 2023; 15:e50307. [PMID: 38205456 PMCID: PMC10777254 DOI: 10.7759/cureus.50307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 01/12/2024] Open
Abstract
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.
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Affiliation(s)
- Ahmad Ismail
- Neonatal Intensive Care, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Ashwag Imam
- Neonatal Intensive Care, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Minerva Raguini
- Neonatal Intensive Care, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Dina Hassan
- Neonatal Intensive Care, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Aziza Ali
- Neonatal Intensive Care, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Abdulaziz Alkhotani
- Pediatrics, Umm Al-Qura University, Makkah, SAU
- Pediatrics, Dr. Soliman Fakeeh Hospital, Jeddah, SAU
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Tronstad O, Flaws D, Patterson S, Holdsworth R, Garcia-Hansen V, Rodriguez Leonard F, Ong R, Yerkovich S, Fraser JF. Evaluation of the sensory environment in a large tertiary ICU. Crit Care 2023; 27:461. [PMID: 38012768 PMCID: PMC10683296 DOI: 10.1186/s13054-023-04744-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/18/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND ICU survival is improving. However, many patients leave ICU with ongoing cognitive, physical, and/or psychological impairments and reduced quality of life. Many of the reasons for these ongoing problems are unmodifiable; however, some are linked with the ICU environment. Suboptimal lighting and excessive noise contribute to a loss of circadian rhythms and sleep disruptions, leading to increased mortality and morbidity. Despite long-standing awareness of these problems, meaningful ICU redesign is yet to be realised, and the 'ideal' ICU design is likely to be unique to local context and patient cohorts. To inform the co-design of an improved ICU environment, this study completed a detailed evaluation of the ICU environment, focussing on acoustics, sound, and light. METHODS This was an observational study of the lighting and acoustic environment using sensors and formal evaluations. Selected bedspaces, chosen to represent different types of bedspaces in the ICU, were monitored during prolonged study periods. Data were analysed descriptively using Microsoft Excel. RESULTS Two of the three monitored bedspaces showed a limited difference in lighting levels across the day, with average daytime light intensity not exceeding 300 Lux. In bedspaces with a window, the spectral power distribution (but not intensity) of the light was similar to natural light when all ceiling lights were off. However, when the ceiling lights were on, the spectral power distribution was similar between bedspaces with and without windows. Average sound levels in the study bedspaces were 63.75, 56.80, and 59.71 dBA, with the single room being noisier than the two open-plan bedspaces. There were multiple occasions of peak sound levels > 80 dBA recorded, with the maximum sound level recorded being > 105 dBA. We recorded one new monitor or ventilator alarm commencing every 69 s in each bedspace, with only 5% of alarms actioned. Acoustic testing showed poor sound absorption and blocking. CONCLUSIONS This study corroborates other studies confirming that the lighting and acoustic environments in the study ICU were suboptimal, potentially contributing to adverse patient outcomes. This manuscript discusses potential solutions to identified problems. Future studies are required to evaluate whether an optimised ICU environment positively impacts patient outcomes.
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Affiliation(s)
- Oystein Tronstad
- Critical Care Research Group, Level 3 Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Chermside, QLD, 4032, Australia.
- Faculty of Medicine, University of Queensland, Brisbane, Australia.
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia.
| | - Dylan Flaws
- Critical Care Research Group, Level 3 Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Chermside, QLD, 4032, Australia
- Department of Mental Health, Metro North Mental Health, Caboolture Hospital, Caboolture, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Sue Patterson
- Critical Care Research Group, Level 3 Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Chermside, QLD, 4032, Australia
- School of Dentistry, University of Queensland, Brisbane, Australia
| | - Robert Holdsworth
- Critical Care Research Group, Level 3 Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Chermside, QLD, 4032, Australia
| | - Veronica Garcia-Hansen
- School of Architecture and Built Environment, Faculty of Engineering, Queensland University of Technology, Brisbane, Australia
| | - Francisca Rodriguez Leonard
- School of Architecture and Built Environment, Faculty of Engineering, Queensland University of Technology, Brisbane, Australia
| | - Ruth Ong
- School of Architecture and Built Environment, Faculty of Engineering, Queensland University of Technology, Brisbane, Australia
| | - Stephanie Yerkovich
- Menzies School of Health Research and Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - John F Fraser
- Critical Care Research Group, Level 3 Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Chermside, QLD, 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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Al-Bsheish M, Jarrar M, Al-Mugheed K, Samarkandi L, Zubaidi F, Almahmoud H, Ashour A. The association between workplace physical environment and nurses' safety compliance: A serial mediation of psychological and behavioral factors. Heliyon 2023; 9:e21985. [PMID: 38027940 PMCID: PMC10663910 DOI: 10.1016/j.heliyon.2023.e21985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Aim This study describes Jordanian intensive care unit nurses' satisfaction with their physical environment and investigates the association between workplace physical environment and nurses' safety compliance. Additionally, the study offers serial mediation analyses of psychological and behavioral factors between satisfaction with the workplace physical environment and nurses' safety compliance. Introduction Compliance with safety measures is a vital indicator of safety performance, as less compliance directly reflects undesirable safety outcomes among nurses, like occupational accidents, injuries, and fatalities. Social cognitive theory and the safety triad model contribute to understanding safety compliance behaviors to safety procedures. Thus, enhancing safety compliance in healthcare organizations remains a challenge and concern. Methods A quantitative research method was used based on cross-sectional and descriptive data from eight governmental hospitals in Jordan. The population included all intensive care unit nurses in the Ministry of Health's hospitals (n = 1104). A cluster sampling technique selected 285 nurses to participate. Empirical results were obtained through structural equation modeling (i.e., Smart PLS-SEM), which has become popular in this kind of research. Results The mean of Jordanian ICU nurses' satisfaction with the workplace physical environment was 3.36, which is moderate. Although the Smart PLS findings did not support the direct association between the workplace physical environment and nurses' safety compliance, serial mediation of safety participation in the workplace physical environment and nurses' safety compliance and perceived safety management commitment confirm the indirect association in the study model. Conclusion This study fills a gap in available safety and nursing literature, especially when considering the scarce studies that investigated the physical elements in the workplace and both safety compliance and safety participation. The findings are valuable for academicians, health providers, and policymakers and may trigger creative ideas and interventional solutions to improve nurses' safety compliance in healthcare organizations.
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Affiliation(s)
- Mohammad Al-Bsheish
- Health Management Department, Batterjee Medical College, Jeddah, Saudi Arabia
- Al-Nadeem Governmental Hospital, Ministry of Health, Amman, Jordan
| | - Mu'taman Jarrar
- Medical Education Department, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
- Vice Deanship for Quality for Development and Community Partnership, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Khalid Al-Mugheed
- Adult Health Nursing Department, College of Nursing, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Lujain Samarkandi
- Health Management Department, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Faraj Zubaidi
- Health Management Department, Batterjee Medical College, Asser, Saudi Arabia
| | - Hanin Almahmoud
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Abdallah Ashour
- College of Nursing, Irbid National University, Irbid, Jordan
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9
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Tronstad O, Flaws D, Patterson S, Holdsworth R, Fraser JF. Creating the ICU of the future: patient-centred design to optimise recovery. Crit Care 2023; 27:402. [PMID: 37865760 PMCID: PMC10589962 DOI: 10.1186/s13054-023-04685-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/13/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Intensive Care survival continues to improve, and the number of ICU services is increasing globally. However, there is a growing awareness of the detrimental impact of the ICU environment on patients, families, and staff. Excessive noise and suboptimal lighting especially have been shown to adversely impact physical and mental recovery during and after an ICU admission. Current ICU designs have not kept up with advances in medical technology and models of care, and there is no current 'gold-standard' ICU design. Improvements in ICU designs are needed to optimise care delivery and patient outcomes. METHODS This manuscript describes a mixed-methods, multi-staged participatory design project aimed at redesigning and implementing two innovative ICU bedspaces. Guided by the action effect method and the consolidated framework for implementation research, the manuscript describes the processes taken to ensure the patient-centred problems were properly understood, the steps taken to develop and integrate solutions to identified problems, and the process of implementation planning and rebuilding in a live ICU. RESULTS Two innovative ICU bedspaces were rebuilt and implemented. They feature solutions to address all identified problems, including noise reduction, optimisation of lighting, access to nature via digital solutions, and patient connectivity and engagement, with solutions developed from various specialty fields, including IT improvements, technological innovations, and design and architectural solutions. Early evaluation demonstrates an improved lighting and acoustic environment. CONCLUSIONS Optimising the ICU bedspace environment and improving the lighting and acoustic environment is possible. The impact on patient outcomes needs to be evaluated.
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Affiliation(s)
- Oystein Tronstad
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Chermside, QLD, 4032, Australia.
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, QLD, Australia.
| | - Dylan Flaws
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Chermside, QLD, 4032, Australia
- Department of Mental Health, Metro North Mental Health, Caboolture Hospital, Caboolture, QLD, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sue Patterson
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Chermside, QLD, 4032, Australia
- School of Dentistry, University of Queensland, Brisbane, QLD, Australia
| | - Robert Holdsworth
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Chermside, QLD, 4032, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Chermside, QLD, 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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10
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Naef AC, Knobel SEJ, Ruettgers N, Rossier M, Jeitziner MM, Zante B, Müri RM, Schefold JC, Nef T, Gerber SM. Characterization of sound pressure levels and sound sources in the intensive care unit: a 1 week observational study. Front Med (Lausanne) 2023; 10:1219257. [PMID: 37521352 PMCID: PMC10382019 DOI: 10.3389/fmed.2023.1219257] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/13/2023] [Indexed: 08/01/2023] Open
Abstract
Background Exposure to elevated sound pressure levels within the intensive care unit is known to negatively affect patient and staff health. In the past, interventions to address this problem have been unsuccessful as there is no conclusive evidence on the severity of each sound source and their role on the overall sound pressure levels. Therefore, the goal of the study was to perform a continuous 1 week recording to characterize the sound pressure levels and identify negative sound sources in this setting. Methods In this prospective, systematic, and quantitative observational study, the sound pressure levels and sound sources were continuously recorded in a mixed medical-surgical intensive care unit over 1 week. Measurements were conducted using four sound level meters and a human observer present in the room noting all sound sources arising from two beds. Results The mean 8 h sound pressure level was significantly higher during the day (52.01 ± 1.75 dBA) and evening (50.92 ± 1.66 dBA) shifts than during the night shift (47.57 ± 2.23; F(2, 19) = 11.80, p < 0.001). No significant difference was found in the maximum and minimum mean 8 h sound pressure levels between the work shifts. However, there was a significant difference between the two beds in the based on location during the day (F(3, 28) = 3.91, p = 0.0189) and evening (F(3, 24) = 5.66, p = 0.00445) shifts. Cleaning of the patient area, admission and discharge activities, and renal interventions (e.g., dialysis) contributed the most to the overall sound pressure levels, with staff talking occurring most frequently. Conclusion Our study was able to identify that continuous maintenance of the patient area, patient admission and discharge, and renal interventions were responsible for the greatest contribution to the sound pressure levels. Moreover, while staff talking was not found to significantly contribute to the sound pressure levels, it was found to be the most frequently occurring activity which may indirectly influence patient wellbeing. Overall, identifying these sound sources can have a meaningful impact on patients and staff by identifying targets for future interventions, thus leading to a healthier environment.
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Affiliation(s)
- Aileen C. Naef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse, Bern, Switzerland
| | - Samuel E. J. Knobel
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse, Bern, Switzerland
| | - Nicole Ruettgers
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse, Bern, Switzerland
| | - Marilyne Rossier
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse, Bern, Switzerland
| | - Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
- Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse, Basel, Switzerland
| | - Bjoern Zante
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - René M. Müri
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse, Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Joerg C. Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse, Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Stephan M. Gerber
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse, Bern, Switzerland
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Alegria L, Brockmann P, Repetto P, Leonard D, Cadiz R, Paredes F, Rojas I, Moya A, Oviedo V, García P, Bakker J. Improve sleep in critically ill patients: Study protocol for a randomized controlled trial for a multi-component intervention of environment control in the ICU. PLoS One 2023; 18:e0286180. [PMID: 37228142 DOI: 10.1371/journal.pone.0286180] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION In critically ill patients, sleep and circadian rhythms are greatly altered. These disturbances have been associated with adverse consequences, including increased mortality. Factors associated with the ICU environment, such as exposure to inadequate light and noise levels during the day and night or inflexible schedules of daily care activities, have been described as playing an essential role in sleep disturbances. The main objective of this study is to evaluate the impact of the use of a multifaceted environmental control intervention in the ICU on the quantity and quality of sleep, delirium, and post-intensive care neuropsychological impairment in critically ill patients. METHODS This is a prospective, parallel-group, randomized trial in 56 critically ill patients once they are starting to recover from their acute illness. Patients will be randomized to receive a multifaceted intervention of environmental control in the ICU (dynamic light therapy, auditory masking, and rationalization of ICU nocturnal patient care activities) or standard care. The protocol will be applied from enrollment until ICU discharge. Baseline parameters, light and noise levels, polysomnography and actigraphy, daily oscillation of plasma concentrations of Melatonin and Cortisol, and questionnaires for the qualitative evaluation of sleep, will be assessed during the study. In addition, all patients will undergo standardized follow-up before hospital discharge and at 6 months to evaluate neuropsychological impairment. DISCUSSION This study is the first randomized clinical trial in critically ill patients to evaluate the effect of a multicomponent, non-pharmacological environmental control intervention on sleep improvement in ICU patients. The results will provide data about the potential synergistic effects of a combined multi-component environmental intervention in ICU on outcomes in the ICU and long term, and the mechanism of action. TRIAL REGISTRATION ClinicalTrials.gov, NCT. Registered on January 10, 2023. Last updated on 24 Jan 2023.
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Affiliation(s)
- Leyla Alegria
- Intensive Care Medicine Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Brockmann
- Division of Pediatrics, Department of Pediatric Pulmonology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Pediatric Sleep Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paula Repetto
- School of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Douglas Leonard
- School of Design, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Cadiz
- Faculty of Arts, Music Institute, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Electrical Engineering, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fabio Paredes
- Faculty of Mathematics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Idalid Rojas
- Intensive Care Medicine Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ana Moya
- Pediatric Sleep Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Vanessa Oviedo
- Intensive Care Medicine Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Patricio García
- Department of Health Sciences, School of Kinesiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jan Bakker
- Intensive Care Medicine Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Pulmonology and Critical Care, Columbia University Medical Center, New York, New York, United States of America
- NYU School of Medicine Langone, New York, New York, United States of America
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Ziabari SMZ, Andalib E, Faghani M, Roodsari NN, Arzhangi N, Khesht-Masjedi MF, Leyli EK. Evidence-Based Design in the Hospital Environment: A Staff's Burnout Study in the COVID-19 Era. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:236-249. [PMID: 36691323 DOI: 10.1177/19375867221148168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE This study aimed to evaluate the evidence-based design of the hospital physical space effect on the burnout of nurses and physicians during COVID-19. The research question was to identify the connection between daylight, nature-view windows, and hospital staff burnout during Covid-19. BACKGROUND The evidence-based design in the hospital environment affects the health of the medical staff. The promotion of the hospital environment has a significant effect on healthcare system improvement. METHODS This cross-sectional study was performed on 406 nurses and physician's burnout in Guilan province in 2020. Three questionnaires were used: demographic, physical space of the hospital, daylight, nature-view windows, and Maslach Burnout Inventory. Logistic regression (LR) analysis was used to determine the association between burnout and the hospital environment. The significance level was considered with p < .05. RESULTS The results showed statistically significant correlations between patient units and the environmental characteristics of the hospitals with staff's burnout (p < .001). Of note, 62.9% of physicians and 71.9% of nurses had moderate work-related burnout. The highest burnout score was seen among staffs of emergency departments adjusted multivariate LR model revealed that 27.1% of work-related burnout in nurses and physicians was predictable with age, light, marital status, and hospitals. Our results showed that accessing more daylight could reduce burnout (p = .018, odds ratio [OR] = 0.910). CONCLUSION Based on the result, the daylight impact on burnout reduction is more significant than other factors. It is suggested that adequate lighting, proper environmental design, and nature-view windows could create appropriate space for enhancing medical staff satisfaction and reducing burnout.
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Affiliation(s)
- Seyyed Mahdi Zia Ziabari
- Department of Emergency Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Elham Andalib
- Department of Emergency Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Masoumeh Faghani
- Department of Anatomical Sciences, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Nazanin Noori Roodsari
- Department of Emergency Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Nima Arzhangi
- Department of Emergency Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Ehsan Kazemnezhad Leyli
- Department of Biostatistics, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
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Vreman J, Lemson J, Lanting C, van der Hoeven J, van den Boogaard M. The Effectiveness of the Interventions to Reduce Sound Levels in the ICU: A Systematic Review. Crit Care Explor 2023; 5:e0885. [PMID: 36998528 PMCID: PMC10047617 DOI: 10.1097/cce.0000000000000885] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
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.
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14
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Yousofnejad Y, Afsari F, Es’haghi M. Dynamic risk assessment of hospital oxygen supply system by HAZOP and intuitionistic fuzzy. PLoS One 2023; 18:e0280918. [PMID: 36821562 PMCID: PMC9949673 DOI: 10.1371/journal.pone.0280918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 01/12/2023] [Indexed: 02/24/2023] Open
Abstract
Events such as oxygen leakage in the oxygen generation systems can have severe consequences, such as fire and explosion. In addition, the disruption in the oxygenation systems can lead to a threat to patients' lives. Thus, this study aimed to identify the significant deviations in the oxygen supply system as critical equipment at hospitals based on the Hazard and Operability (HAZOP) method. Despite the advantages of risk assessment techniques, hazard identification techniques are still being utilized with deterministic and unreliable values and have a completely static nature. Therefore, using dynamic techniques to overcome intrinsic ambiguity in the risk assessment process through fuzzy sets has been recommended. Additionally, we proposed the HAZOP methodology to integrate with the intuitionistic fuzzy system for assessing the medical oxygen supply system using Pressure Swing Absorbance technology as a proactive approach. The results showed that the intuitionistic fuzzy approach, combined with the risk assessment method, is a suitable tool to eliminate uncertainty, improve decision-making, and result in more detailed and accurate findings. The approach adopted in this study can be used as a needs assessment tool to optimize maintenance programs and provide the necessary training for the staff, maintenance operators, and medical equipment managers.
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Affiliation(s)
- Yeganeh Yousofnejad
- Student Research Committee, Faculty of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Afsari
- Department of Computer Engineering, Faculty of Engineering, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Mahboubeh Es’haghi
- Department of Occupational Health Engineering and Safety at Work, Faculty of Public Health, Kerman University of Medical Sciences, Kerman, Iran
- * E-mail:
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15
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Dogbla L, Gouvenelle C, Thorin F, Lesage FX, Zak M, Ugbolue UC, Charbotel B, Baker JS, Pereira B, Dutheil F. Occupational Risk Factors by Sectors: An Observational Study of 20,000 Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3632. [PMID: 36834326 PMCID: PMC9967294 DOI: 10.3390/ijerph20043632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE We aimed to assess the prevalence of exposure by sector and the sectors of activity most exposed to each exposure, using routine occupational health data, and to quantify the risk of being exposed. METHOD Occupational risk factors were assessed by workers followed by the Occupational Health Service of Cher, using self-reported questionnaires. The sectors of activity were grouped into seven sectors, and the risks were grouped into six occupational exposure groups. Comparisons were made using the Chi-squared test and Cramer's V, and the odds ratios were calculated by using logistic regression. RESULTS We included 19,891 workers. The construction sector had the highest prevalence (p < 0.05 vs. all other sectors) of exposure to physical (76%) and biomechanical factors (82%), as well as chemical risks (75%). Human health and social work was the sector with the highest prevalence of exposure to biological factors (69%), psychosocial factors (90%), and atypical working hours (61%). With workers from administrative and support sectors as the reference, construction workers had more chance of declaring exposure to physical factors (OR = 3.28, 95%CI = 2.89 to 3.72), biomechanical factors (1.82, 1.58 to 2.09), and chemical agents (3.83, 3.38 to 4.33). Workers from the human health and social sectors had more chance of being exposed to biological agents (13.4, 11.9 to 15.2), atypical working hours (1.93, 1.75 to 2.14), and psychosocial factors (2.74, 2.38 to 3.16). CONCLUSION Psychosocial risk factors were commonly reported in all sectors. Workers in the construction, human health, and social sectors seem to report more exposures than those in other sectors. The analysis of occupational exposures is a necessary basis to build an efficient preventive strategy for occupational health.
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Affiliation(s)
- Luther Dogbla
- Physiological and Psychosocial Stress, CNRS UMR 6024, LaPSCo, University Clermont Auvergne, CHU Clermont-Ferrand, Occupational Medicine, 63000 Clermont-Ferrand, France
- Occupational Health Service of Cher (APST18), 18000 Bourges, France
| | - Cédric Gouvenelle
- Occupational Health Service of Cher (APST18), 18000 Bourges, France
- CNRS, Acté, University Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Florence Thorin
- Occupational Health Service of Cher (APST18), 18000 Bourges, France
| | | | - Marek Zak
- Faculty of Medicine and Health Sciences, Institute of Physiotherapy, The Jan Kochanowski University, 25-369 Kielce, Poland
| | - Ukadike Chris Ugbolue
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, Glasgow G72 0LH, UK
| | - Barbara Charbotel
- UMRESTTE, Domaine Rockefeller, University Lyon 1, 69373 Lyon, France
| | - Julien S. Baker
- Centre for Health and Exercise Science Research, Hong Kong Baptist University, Hong Kong 999077, China
| | - Bruno Pereira
- Clinical Research and Innovation Direction, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Frédéric Dutheil
- Physiological and Psychosocial Stress, CNRS UMR 6024, LaPSCo, University Clermont Auvergne, CHU Clermont-Ferrand, Occupational Medicine, WittyFit, 63001 Clermont-Ferrand, France
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16
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Stadler C, Luger M, Schauer B, Stevoska S, Gotterbarm T, Klasan A. Failed Attempt to Recommend Noise Cancelling Headphones for Knee Arthroplasty Surgeons-Results of a Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020320. [PMID: 36837521 PMCID: PMC9965943 DOI: 10.3390/medicina59020320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/23/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023]
Abstract
Background and Objectives: Noise exposure during total knee arthroplasty (TKA) has been demonstrated to exceed thresholds that are deemed as over-exposure by industry noise level standards. With orthopedic surgeons being at risk of suffering from Noise Induced Hearing Loss, the purpose of this pilot study was to evaluate the viability of the use of industry grade active noise cancelling headphones (ANCH) during TKA. Material and Methods: In this prospective pilot study, 10 TKA were performed. In five of these cases, surgeon, assistant, scrub nurse and anesthetist wore ANCH with automatic noise level dependent noise attenuation above 82 dB. A validated 14-item questionnaire was used after each case to evaluate the quality of communication, performance, teamwork and mental load. In seven cases a calibrated sound level meter was used to measure the operating theatre noise. Peak sound level (LApeak), A-weighted continuous sound level (LAeq) and A-weighted noise exposure averaged for an 8-h time-period (LEPd) were calculated. Results: There was no perceived benefit of ANCH for the surgeons (p = 0.648), assistants (p = 0.908) and scrub nurses (p = 0.251). There was an overall improvement observed by anesthetists (p = 0.001). A worse communication while wearing ANCH was reported by surgeons but not by the rest of the team. Average LApeak was 90.6 ± 3.2 dB(C), LAeq was 61.9 ± 1.0 dB(A) and LEPd was 53.2 ± 1.2 dB(A). Conclusions: Industry grade ANCH seem to provide no benefit for surgeons, assistants and scrub nurses during TKA, while anesthesiologists seem to benefit from the use of ANCH during TKA. Due to the limitations of this pilot study, further studies with larger study populations are necessary to adequately investigate the use of ANCH during TKA.
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Affiliation(s)
- Christian Stadler
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital, Krankenhausstr. 9, 4020 Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040 Linz, Austria
- Correspondence:
| | - Matthias Luger
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital, Krankenhausstr. 9, 4020 Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040 Linz, Austria
| | - Bernhard Schauer
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital, Krankenhausstr. 9, 4020 Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040 Linz, Austria
| | - Stella Stevoska
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital, Krankenhausstr. 9, 4020 Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040 Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital, Krankenhausstr. 9, 4020 Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040 Linz, Austria
| | - Antonio Klasan
- Johannes Kepler University Linz, Altenberger Str. 96, 4040 Linz, Austria
- AUVA Trauma Hospital Styria Graz, Göstinger Str. 24, 8020 Graz, Austria
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Althahab AQJ, Vuksanovic B, Al-Mosawi M, Machimbarrena M, Arias R. Noise in ICUs: Review and Detailed Analysis of Long-Term SPL Monitoring in ICUs in Northern Spain. SENSORS (BASEL, SWITZERLAND) 2022; 22:9038. [PMID: 36501740 PMCID: PMC9738928 DOI: 10.3390/s22239038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 06/17/2023]
Abstract
Intensive care units (ICUs) are busy and noisy areas where patients and professional staff can be exposed to acoustic noise for long periods of time. In many cases, noise levels significantly exceed the levels recommended by the official health organisations. This situation can affect not only patient recovery but also professional staff, making ICUs unhealthy work and treatment environments. To introduce the measures and reduce the acoustic noise in the ICU, acoustic noise levels should first be measured and then appropriately analysed. However, in most studies dealing with this problem, measurements have been performed manually over short periods, leading to limited data being collected. They are usually followed by insufficient analysis, which in turn results in inadequate measures and noise reduction. This paper reviews recent works dealing with the problem of excessively high noise levels in ICUs and proposes a more thorough analysis of measured data both in the time and frequency domains. Applied frequency domain analysis identifies the cyclic behaviour of the measured sound pressure levels (SPLs) and detects the dominant frequency components in the SPL time series. Moreover, statistical analyses are produced to depict the patterns and SPLs to which patients in ICUs are typically exposed during their stay in the ICU. It has been shown that the acoustic environment is very similar every night, while it can vary significantly during the day or evening periods. However, during most of the observed time, recorded SPLs were significantly above the prescribed values, indicating an urgent need for their control and reduction. To effectively tackle this problem, more detailed information about the nature of noise during each of the analysed periods of the day is needed. This issue will be addressed in the continuation of this project.
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Affiliation(s)
- Awwab Qasim Jumaah Althahab
- School of Energy and Electronic Engineering, Faculty of Technology, University of Portsmouth, Portsmouth PO1 3DJ, UK
- Department of Electrical Engineering, College of Engineering, University of Babylon, Hillah 51001, Iraq
| | - Branislav Vuksanovic
- School of Energy and Electronic Engineering, Faculty of Technology, University of Portsmouth, Portsmouth PO1 3DJ, UK
| | - Mohamed Al-Mosawi
- School of Energy and Electronic Engineering, Faculty of Technology, University of Portsmouth, Portsmouth PO1 3DJ, UK
| | - Maria Machimbarrena
- School of Architecture, Applied Physics Department, University of Valladolid, 47014 Valladolid, Spain
| | - Roi Arias
- Proceso Digital de Audio S.L., 09001 Burgos, Spain
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Song Z, Lee PJ, Hampton T. Acoustic environments of intensive care units during the COVID-19 pandemic. APPLIED ACOUSTICS. ACOUSTIQUE APPLIQUE. ANGEWANDTE AKUSTIK 2022; 199:109037. [PMID: 36158734 PMCID: PMC9482849 DOI: 10.1016/j.apacoust.2022.109037] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/06/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
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.
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Affiliation(s)
- Ziwei Song
- Acoustics Research Unit, School of Architecture, University of Liverpool, Liverpool, United Kingdom
| | - Pyoung-Jik Lee
- Acoustics Research Unit, School of Architecture, University of Liverpool, Liverpool, United Kingdom
| | - Thomas Hampton
- ENT Department, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Gyllensten K, Fredriksson S, Widen S, Söderberg M, Waye KP. Nurses’ and preschool teachers’ experiences of taking part in a participatory intervention project in communication-intense working environments. Work 2022; 73:857-869. [DOI: 10.3233/wor-211009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Noise is a common workplace problem that can affect health and performance. High sound levels have been found in sectors that largely has been overlooked in noise research such as health care and education. In these communication-intense environments the work requires speech communication, thus making it difficult to wear hearing protection. OBJECTIVE: To explore nurses’ and preschool teachers’ experiences of taking part in a participatory intervention project aiming to improve the sound environment and the psychosocial work environment. METHODS: One preschool and one obstetrics ward took part in the study, and a qualitative design was used to evaluate the experience of the participatory intervention approach. RESULTS: Five main themes were found in the analysis: Awareness, Taking control of the sound environment, Influence of the building and interior design, Circumstances influencing the intervention process and Motivation to maintain change. CONCLUSIONS: Despite demanding working situations and lack of financial resources, preschool and obstetrics staff described being creative in planning and implementing several different solutions to improve the sound environment at their workplaces, while interventions specifically improving the psychosocial work environment were fewer. Hence, our study suggest that a participatory intervention approach may facilitate participation and motivation, but resources and support are needed for a comprehensive and effective implementation.
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Affiliation(s)
- Kristina Gyllensten
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sofie Fredriksson
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Stephen Widen
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Mia Söderberg
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Kerstin Persson Waye
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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Naef AC, Knobel SEJ, Ruettgers N, Jeitziner MM, Holtforth MG, Zante B, Schefold JC, Nef T, Gerber SM. Methods for Measuring and Identifying Sounds in the Intensive Care Unit. Front Med (Lausanne) 2022; 9:836203. [PMID: 35733869 PMCID: PMC9207602 DOI: 10.3389/fmed.2022.836203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Despite many studies in the field examining excessive noise in the intensive care unit, this issue remains an ongoing problem. A limiting factor in the progress of the field is the inability to draw conclusions across studies due to the different and poorly reported approaches used. Therefore, the first goal is to present a method for the general measurement of sound pressure levels and sound sources, with precise details and reasoning, such that future studies can use these procedures as a guideline. The two procedures used in the general method will outline how to record sound pressure levels and sound sources, using sound level meters and observers, respectively. The second goal is to present the data collected using the applied method to show the feasibility of the general method and provide results for future reference. Methods The general method proposes the use of two different procedures for measuring sound pressure levels and sound sources in the intensive care unit. The applied method uses the general method to collect data recorded over 24-h, examining two beds in a four-bed room, via four sound level meters and four observers each working one at a time. Results The interrater reliability of the different categories was found to have an estimate of >0.75 representing good and excellent estimates, for 19 and 16 of the 24 categories, for the two beds examined. The equivalent sound pressure levels (LAeq) for the day, evening, and night shift, as an average of the sound level meters in the patient room, were 54.12, 53.37, and 49.05 dBA. In the 24-h measurement period, talking and human generated sounds occurred for a total of 495 (39.29% of the time) and 470 min (37.30% of the time), at the two beds of interest, respectively. Conclusion A general method was described detailing two independent procedures for measuring sound pressure levels and sound sources in the ICU. In a continuous data recording over 24 h, the feasibility of the proposed general method was confirmed. Moreover, good and excellent interrater reliability was achieved in most categories, making them suitable for future studies.
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Affiliation(s)
- Aileen C. Naef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Samuel E. J. Knobel
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Nicole Ruettgers
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Martin grosse Holtforth
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
- Psychosomatic Medicine, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bjoern Zante
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joerg C. Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan M. Gerber
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- *Correspondence: Stephan M. Gerber
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Vilén L, Atosuo J, Putus T. Prevalence of Hoarseness in Primary Health Care and Hospitals-Associations With Different Work Tasks and Environmental Factors Among Nurses. J Voice 2022:S0892-1997(22)00063-7. [PMID: 35365386 DOI: 10.1016/j.jvoice.2022.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/07/2022] [Accepted: 02/24/2022] [Indexed: 11/21/2022]
Abstract
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.
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Affiliation(s)
- Liisa Vilén
- Department of Clinical Medicine, Environmental Medicine and Occupational Health, University of Turku, Turku, Finland; Clinical Research Unit TROSSI, University of Turku, Turku, Finland.
| | - Janne Atosuo
- Clinical Research Unit TROSSI, University of Turku, Turku, Finland; Department of Biotechnology, The Laboratory of Immunochemistry, University of Turku, Turku, Finland
| | - Tuula Putus
- Department of Clinical Medicine, Environmental Medicine and Occupational Health, University of Turku, Turku, Finland; Clinical Research Unit TROSSI, University of Turku, Turku, Finland
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Abstract
INTRODUCTION Sleep deprivation is a relevant problem among patients hospitalized in ICUs. Further, noise is the most critical disruptive factor according to patients. OBJECTIVE To implement scientific evidence-based best practices for noise control in an adult ICU. METHODS This was an evidence-based implementation project of best practices in noise control, conducted in a high-complexity hospital's adult ICU. The intervention consisted of three steps: baseline audit and identification of barriers, implementation of best practices, and a follow-up audit. RESULTS No compliance with best practices was detected in the baseline audit. After the implementation phase, the unit reached compliance levels of 78-88% for most of these criteria only one criterion related to noise level did not match the expected compliance. CONCLUSION Adherence to best practices regarding noise control was satisfactory, achieving more than 70% compliance in the six audit criteria. Only the noise level did not reach the threshold recommended by the WHO - a difficulty reported in other studies. RELEVANCE TO CLINICAL PRACTICE Best practices related to noise control are essential for managing sleep deprivation in ICUs and include changes in the behaviour of involved professionals.
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Theuerkauf NU, Putensen C, Schewe JC. [Noise Reduction on the ICU]. Anasthesiol Intensivmed Notfallmed Schmerzther 2022; 57:14-26. [PMID: 35021237 DOI: 10.1055/a-1477-2300] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Noise pollution in the intensive care unit is not only an omnipresent but also a considerable problem, both for patients and healthcare staff. There are a number of significant sources of noise that are at least partially responsible for the frequent and serious sleep disorders of intensive care unit patients. This has a negative impact on the recovery of intensive care patients and favours the occurrence of delirium, which can be associated with increased overall mortality. This article provides a summary of the current evidence on the occurrence of noise-associated consequences and possible options for reducing noise exposure in the intensive care unit and offers perspectives for improving treatment of intensive care patients.
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ALAN H, TİRYAKİ ŞEN H, BİLGİN O, POLAT Ş. Alarm Fatigue Questionnaire: Turkish Validity and Reliability Study. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2021. [DOI: 10.38079/igusabder.981451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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McCullagh MC, Xu J, Dickson VV, Tan A, Lusk SL. Noise Exposure and Quality of Life Among Nurses. Workplace Health Saf 2021; 70:207-219. [PMID: 34915786 DOI: 10.1177/21650799211044365] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this study was to describe the relationship between noise exposure, selected health conditions, and well-being among nurses. METHODS A secondary analysis was performed on data obtained from 3,818 U.S. nurses who responded to a survey regarding noise exposure, health conditions, stress, professional quality of life, and workplace support. FINDINGS Those who reported high noise exposure reported more health conditions, higher stress and burnout scores, and lower supportive environments. High noise exposure was significantly associated with lower professional quality of life. CONCLUSION/APPLICATION TO PRACTICE Noise may impact the health and quality of professional life of nurses. Occupational health nurses should advocate for the regular monitoring of nurses' exposure to hazardous noise at work, compare it to OSHA permissible levels, and collaborate with the occupational health team to ensure safe noise levels are maintained. Occupational health nurses should advocate for expanded research on effects of noise on health.
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Beck M, Engelke E, Birkelund R, Martinsen B. Aesthetics sets patients 'free' to recover during hospitalization with a neurological disease. A qualitative study. Int J Qual Stud Health Well-being 2021; 16:1992843. [PMID: 34747349 PMCID: PMC8583855 DOI: 10.1080/17482631.2021.1992843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Patients with neurological symptoms are particularly sensitive to the quality of the sensory impressions to which they are exposed to during hospitalization. AIM To understand the meaning of aesthetic experiences to patients afflicted with neurological diseases during hospitalization on a neurological unit. METHOD Fifteen patients were invited to "walk and talk" supplemented by semi-structured interviews conducted in newly established aesthetic tableaus within the neurology unit. Data analysis was inspired by the hermeneutic phenomenological methodology of van Manen. RESULT The data analysis identified three overarching themes that unfolded in the patients' experiences of a more aesthetic environment. The themes were: 1) A safe place to avoid noisiness, 2) An invitation to homey activities, 3) A thoughtful consideration for being ill. CONCLUSION Aesthetic elements can enable a thoughtful and needed consideration that withholds momentarily imaginative and hopeful experiences to patients in a vulnerable situation. Thus, aesthetics, together with peace and quietness, can set vulnerable patients free to retreat and recover from the symptoms of neurological diseases.
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Affiliation(s)
- Malene Beck
- Department of Neurology,Zealand University Hospital, Roskilde, Denmark
| | - Eileen Engelke
- College of Health Professions, Lienhard School of Nursing, Pace Universityr, Teachers College, Columbia University, New York City, NY, USA
| | - Regner Birkelund
- Department of Regional Health Research, Institute of Health Service Research (IRS), University of Southern Denmark, Odense, Denmark
| | - Bente Martinsen
- Institute of Health, Department of Nursing Science, Aarhus University, Campus Emdrup, Copenhagen, NV, Denmark
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Abstract
Communication is a critical component of patient-centered care. Critically ill, mechanically ventilated patients are unable to speak and this condition is frightening, frustrating, and stressful. Impaired communication in the intensive care unit (ICU) contributes to poor symptom identification and restricts effective patient engagement. Older adults are at higher risk for communication impairments in the ICU because of pre-illness communication disorders and cognitive dysfunction that often accompanies or precedes critical illness. Assessing communication disorders and developing patient-centered strategies to enhance communication can lessen communication difficulty and increase patient satisfaction.
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The relationship between sensory stimuli and the physical environment in complex healthcare settings: A systematic literature review. Intensive Crit Care Nurs 2021; 67:103111. [PMID: 34247937 DOI: 10.1016/j.iccn.2021.103111] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/28/2021] [Accepted: 05/29/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This systematic review presented the current status of literature on the outcomes resulted from sensory stimuli in critical care environments as well as the environmental interventions that can improve or impede the impact of such sensory stimuli. METHODS Articles found through a systematic search of PsycINFO, Web of Science, and PubMed databases, in combination with a hand search, were reviewed for eligibility by two independent coders. Reporting and quality appraisals were based on PRISMA and MMAT guidelines. RESULTS Out of 1118 articles found, and only 30 were eligible. Final articles were comprised of issues related to noise, lighting, and temperature. Identified sensory stimuli resulted in psychological and physiological outcomes among both patients and staff. Examples include impacts on stress, delirium, sleep disturbances, poor performance and communication. The environmental factors that influence sensory stimuli included layout, room size, artificial lighting, presence of windows and acoustical interventions. CONCLUSION Literature on the impact of sensory stimuli on staff is scarce compared to patients. Studies on environmental interventions are inadequate and lack structure. The physical environment can impact the patient and staff outcome resulting from noise, lighting, and temperature. When applied strategically, sensory stimuli can result in positive outcomes among patients and staff.
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Clinton-McHarg T, Paul C, Sanson-Fisher R, Turon H, Butler M, Lindeman R. Are the Physical Environments of Treatment Centres Meeting Recommendations for Patient-Centred Care? Perceptions of Haematological Cancer Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094892. [PMID: 34064433 PMCID: PMC8125011 DOI: 10.3390/ijerph18094892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 11/16/2022]
Abstract
The physical environment of a treatment centre may impact the well-being of patients and their perceptions of care. Outpatients with haematological cancer may be in contact with the treatment centre over long periods and could be particularly affected. This study aimed to identify haematological cancer patients' perceptions of supportive design elements in the hospital they attended and associations with self-reported mood or well-being. Outpatients from three large metropolitan hospitals in Australia were mailed a self-report questionnaire and responded to statements about the treatment centre concerning their sense of control over the physical surroundings; access to social support; and access to positive distractions. Participants also reported whether they felt the overall environment affected their mood or wellbeing. Of the outpatients who returned the questionnaire (n = 165), almost one-quarter (24%) agreed that the physical environment of the hospital affected their mood or well-being. Patients who disagreed that the hospital was a comfortable temperature or agreed that waiting rooms were crowded had significantly higher odds of reporting that the treatment environment affected their mood or wellbeing. Implementing systems to reduce overcrowding in waiting rooms and increasing patient control over personal temperature in clinics may be the most effective strategies to improve patient wellbeing.
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Affiliation(s)
- Tara Clinton-McHarg
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; (C.P.); (R.S.-F.); (H.T.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- School of Psychology, The University of Newcastle, Callaghan, NSW 2308, Australia
- Correspondence:
| | - Christine Paul
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; (C.P.); (R.S.-F.); (H.T.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Rob Sanson-Fisher
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; (C.P.); (R.S.-F.); (H.T.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Heidi Turon
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; (C.P.); (R.S.-F.); (H.T.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Michelle Butler
- Hunter New England Population Health, Wallsend, NSW 2287, Australia;
| | - Robert Lindeman
- Department of Haematology, Prince of Wales Hospital, Randwick, NSW 2031, Australia;
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Stremler R, Micsinszki S, Adams S, Parshuram C, Pullenayegum E, Weiss SK. Objective Sleep Characteristics and Factors Associated With Sleep Duration and Waking During Pediatric Hospitalization. JAMA Netw Open 2021; 4:e213924. [PMID: 33792731 PMCID: PMC8017466 DOI: 10.1001/jamanetworkopen.2021.3924] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Children's sleep may be affected by hospitalization, yet few objective determinations of sleep patterns are reported for children in intensive care or general medicine units. There is limited research on relationships between sleep in hospital and child (eg, age, pain), treatment (eg, medications, nurse presence), or environmental (eg, noise, light, type of unit) factors. OBJECTIVE To determine sleep quantity and patterns in hospitalized children and determine factors associated with sleep quantity and nighttime waking for children in hospital. DESIGN, SETTING, AND PARTICIPANTS This was a prospective cross-sectional study of children admitted to a general pediatric unit or a pediatric intensive care unit at a pediatric quaternary teaching hospital in Toronto, Ontario, Canada, from October 2007 to July 2008. Participants included children aged 1 to 18 years who were expected to stay in hospital for at least 2 nights. Demographic data, information about the hospital stay and illness, and usual sleep habits were collected. Children wore an actigraph for 1 to 3 consecutive days and nights and completed a sleep diary. Sound and light meters were placed at the bedside. Data analyses took place in April 2009. MAIN OUTCOMES AND MEASURES The primary outcome was the mean number of minutes of child nighttime sleep from 7:30 pm to 7:29 am. Sleep variables were averaged over days and nights recorded (mean [SD] days and nights of wear, 2.54 [0.71]) and examined for associations with sleep quantity and patterns, as well as hazard of waking in the night. RESULTS Of 124 eligible children approached for inclusion, 69 children consented (35 [51%] female; 20 [29%] aged 1-3 years, 10 [14%] aged 4-7 years, 17 [24%] aged 8-12 years, and 22 [32%] aged 13-18 years; 58 [84%] in the general pediatric unit). Children aged 1 to 3, 4 to 7, 8 to 12, and 13 to 18 years obtained a mean (SD) of 444 (132), 475 (86), 436 (114), and 384 (83) minutes of nighttime sleep, respectively; mean (SD) number of night awakenings was 14 (3), 18 (3), 14 (8), and 12 (6), respectively. Children on general pediatric units slept 258 minutes more per night than children sleeping in the pediatric intensive care unit (95% CI, 165.16-350.56 minutes; P < .001), children admitted for planned surgery slept 123 minutes more than children admitted for exacerbations of chronic illness (95% CI, 49.23-196.01 minutes; P < .01), and children sleeping in rooms with other patients slept 141 minutes fewer than children in private rooms (95% CI, -253.51 to -28.35 minutes; P = .01). Sound events greater than 80 dB were significantly associated with increased risk of instantaneous waking (hazard ratio [HR], 1.35; 95% CI, 1.02-1.80; P = .04), as were light events greater than 150 lux (HR, 1.17; 95% CI, 1.01-1.36; P = .03), receiving a medication that promoted sleep (HR, 1.04; 95% CI, 1.00-1.08; P = .03), and having a nurse in the room for most or all of the night (HR, 1.08; 95% CI, 1.03-1.13; P = .003). Sleeping on the general pediatrics unit was significantly associated with decreased risk of instantaneous waking (HR, 0.81; 95% CI, 0.77-0.85; P < .001), as was being admitted for planned surgery (HR, 0.95; 95% CI, 0.91-0.99; P = .04), receiving a medication that promoted wakefulness (HR, 0.96; 95% CI, 0.93-0.995; P = .02), and sharing a room with another patient (HR, 0.78; 95% CI, 0.72-0.84; P < .001). CONCLUSIONS AND RELEVANCE In this cross-sectional study of hospitalized children, children experienced considerable nighttime waking and sleep restriction to levels below national clinical recommendations at a time when they most needed the benefits of sleep. Given light and noise were the greatest contributors to nighttime waking in hospital, clinicians, administrators and hospital design experts should work together for solutions.
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Affiliation(s)
- Robyn Stremler
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Samantha Micsinszki
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Sherri Adams
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | | | | | - Shelly K. Weiss
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
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Weaver J. The sound of medicine. BMJ 2020; 371:m4682. [PMID: 33318064 DOI: 10.1136/bmj.m4682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- James Weaver
- EPSRC and AHRC Centre for Doctoral Training in Media and Arts Technology, Queen Mary University of London, UK
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Kebapcı A, Güner P. "Noise Factory": A qualitative study exploring healthcare providers' perceptions of noise in the intensive care unit. Intensive Crit Care Nurs 2020; 63:102975. [PMID: 33277155 DOI: 10.1016/j.iccn.2020.102975] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/21/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study aimed to explore healthcare providers' perceptions of noise in the intensive care unit. DESIGN A qualitative exploratory study was conducted using group interviews. SETTING The setting comprised a total of 15 participants (five physicians and ten registered nurses) working in an 18-bed medical surgical intensive care unit at a teaching hospital in Istanbul, Turkey. Semi-structured questions were formulated and used in focus group interviews, after which the recorded interviews were transcribed by the researchers. Thematic analysis was used to identify significant statements and initial codes. FINDINGS Four themes were identified: the meaning of noise, sources of noise, effects of noise and prevention and management of noise. It was found that noise was an inevitable feature of the intensive care unit. The most common sources of noise were human-induced. It was also determined that device-induced noise, such as alarms, did not produce a lot of noise; however, when staff were late in responding, the sound transformed into noise. Furthermore, it was observed that efforts to decrease noise levels taken by staff had only a momentary effect, changing nothing in the long term because the entire team failed to implement any initiatives consistently. The majority of nurses stated that they were now becoming insensitive to the noise due to the constant exposure to device-induced noise. CONCLUSION The data obtained from this study showed that especially human-induced noise threatened healthcare providers' cognitive task functions, concentration and job performance, impaired communication and negatively affected patient safety. In addition, it was determined that any precautions taken to reduce noise were not fully effective. A team approach should be used in managing noise in intensive care units with better awareness.
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Affiliation(s)
- Ayda Kebapcı
- Koç University School of Nursing, Istanbul, Turkey.
| | - Perihan Güner
- Istanbul Bilgi University School of Health Sciences, Istanbul, Turkey
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Cvach MM, Stokes JE, Manzoor SH, Brooks PO, Burger TS, Gottschalk A, Pustavoitau A. Ventilator Alarms in Intensive Care Units: Frequency, Duration, Priority, and Relationship to Ventilator Parameters. Anesth Analg 2020; 130:e9-e13. [PMID: 30234538 DOI: 10.1213/ane.0000000000003801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ventilator alarms have long been presumed to contribute substantially to the overall alarm burden in the intensive care unit. In a prospective observational study, we determined that each ventilator triggered an alarm cascade of up to 8 separate notifications once every 6 minutes. In 1 intensive care unit with different ventilator manufacturers, the distribution of high-priority alarms was manufacturer dependent with 8.6% of alarms from 1 type and 89.8% of alarms from another type of ventilator. Alarm limits were not a function of patient-specific ventilator settings.
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Affiliation(s)
- Maria M Cvach
- From the *Department of Integrated Healthcare Delivery, Johns Hopkins Health System, Baltimore, Maryland †Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
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Abstract
Communication is a critical component of patient-centered care. Critically ill, mechanically ventilated patients are unable to speak and this condition is frightening, frustrating, and stressful. Impaired communication in the intensive care unit (ICU) contributes to poor symptom identification and restricts effective patient engagement. Older adults are at higher risk for communication impairments in the ICU because of pre-illness communication disorders and cognitive dysfunction that often accompanies or precedes critical illness. Assessing communication disorders and developing patient-centered strategies to enhance communication can lessen communication difficulty and increase patient satisfaction.
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Affiliation(s)
- JiYeon Choi
- Yonsei University College of Nursing, Mo-Im Kim Nursing Research Institute, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul 03722, Korea
| | - Judith A Tate
- Center of Healthy Aging, Self-Management and Complex Care, Undergraduate Nursing Honors Program, The Ohio State University College of Nursing, 386 Newton Hall, 1585 Neil Avenue, Columbus, OH 43210, USA.
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Doing time in an Australian ICU; the experience and environment from the perspective of patients and family members. Aust Crit Care 2020; 34:254-262. [PMID: 32943306 DOI: 10.1016/j.aucc.2020.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 06/11/2020] [Accepted: 06/30/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The intensive care environment and experiences during admission can negatively impact patient and family outcomes and can complicate recovery both in hospital and after discharge. While their perspectives based on intimate experiences of the environment could help inform design improvements, patients and their families are typically not involved in design processes. Rather than designing the environment around the needs of the patients, emphasis has traditionally been placed on clinical and economic efficiencies. OBJECTIVE The main objective was to inform design of an optimised intensive care bedspace by developing an understanding of how patients and their families experience the intensive care environment and its impact on recovery. METHODS A qualitative descriptive study was conducted with data collected in interviews with 17 intensive care patients and seven family members at a large cardiothoracic specialist hospital, analysed using a framework approach. RESULTS Participants described the intensive care as a noisy, bright, confronting and scary environment that prevented sleep and was suboptimal for recovery. Bedspaces were described as small and cluttered, with limited access to natural light or cognitive stimulation. The limited ability to personalise the environment and maintain connections with family and the outside world was considered especially problematic. CONCLUSIONS Intensive care patients described features of the current environment they considered problematic and potentially hindering their recovery. The perspective of patients and their families can be utilised by researchers and developers to improve the design and function of the intensive care environment. This can potentially improve patient outcomes and help deliver more personalised and effective care to this vulnerable patient population and their families.
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Tronstad O, Flaws D, Lye I, Fraser JF, Patterson S. The intensive care unit environment from the perspective of medical, allied health and nursing clinicians: A qualitative study to inform design of the 'ideal' bedspace. Aust Crit Care 2020; 34:15-22. [PMID: 32684406 DOI: 10.1016/j.aucc.2020.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 06/01/2020] [Accepted: 06/14/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND While the impact of the intensive care environment on patients' experiences and outcomes has been extensively studied, relatively little research has examined the impact on clinicians and their provision of care in the intensive care unit (ICU). Understanding staff experience and views about the environment is needed to optimise the ICU environment, patient outcomes and staff wellbeing. OBJECTIVE The objective of this study was to inform design of an optimised intensive care bedspace by describing clinicians' views about the current environment, including experience, impact on performance of clinical duties, and experience and outcomes of patients and family members. METHODS A pragmatic, qualitative descriptive study was conducted, with data collected in focus groups and interviews with 30 intensive care clinicians at a large cardiothoracic specialist hospital and analysed using the framework approach. RESULTS Participants acknowledged that the busy and noisy ICU provided a suboptimal healing environment for patients, was confronting for visiting families and exposed clinicians to risk of psychological injury. The bedspace, described as small and cluttered, hindered provision of clinical care of various kinds and contributed to an increased risk of staff physical injuries. Participants noted that the bland, sterile environment, devoid of natural light and views of the outside world, negatively affected both staff and patients' mood and motivation. Aware of the potential benefits of natural light, cognitive stimulation and visually appealing environments for patients and families, clinicians were frustrated by their inability to personalise the bedspace. Some participants, while acknowledging the importance of family contact for patients, were concerned about the impact of visitors on care delivery, particularly within already crowded bedspaces, suggesting restrictions on visiting. CONCLUSIONS Intensive care clinicians perceive that the current intensive care environment is suboptimal for patients, their families and staff and may contribute to suboptimal patient outcomes. The intensive care bedspaces need to be redesigned to ensure they are built around the needs of the people using them. Optimisation is dependent on engaging all stakeholders in future design processes.
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Affiliation(s)
- Oystein Tronstad
- Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia; Northside Medical School, University of Queensland, Brisbane, Australia; Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia.
| | - Dylan Flaws
- Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia; Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.
| | - India Lye
- Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia; Menzies Health Institute QLD, Griffith University, Gold Coast, Australia.
| | - John F Fraser
- Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia; Northside Medical School, University of Queensland, Brisbane, Australia.
| | - Sue Patterson
- Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia; School of Dentistry, University of Queensland, Brisbane, Australia.
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Hughes Driscoll CA, Cleveland M, Gurmu S, Crimmins S, El-Metwally D. Research: Replacing Overhead Paging with Smartphones to Reduce Hospital Noise. Biomed Instrum Technol 2020; 54:251-257. [PMID: 33171501 DOI: 10.2345/0899-8205-54.4.251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Hospital noise is associated with adverse effects on patients and staff. Communication through overhead paging is a major contributor to hospital noise. Replacing overhead paging with smartphones through a clinical mobility platform has the potential to reduce transitory noises in the hospital setting, though this result has not been described. The current study evaluated the impact of replacing overhead paging with a smartphone-based clinical mobility platform on transitory noise levels in a labor and delivery unit. Transitory noises were defined as sound levels greater than 10 dB above baseline, as recorded by a sound level meter. Prior to smartphone implementation, 77% of all sound levels at or above 60 dB were generated by overhead paging. Overhead pages occurred at an average rate of 3.17 per hour. Following smartphone implementation, overhead pages were eliminated and transitory noises decreased by two-thirds (P < 0.001). The highest recorded sound level decreased from 76.54 to 57.34 dB following implementation. The percent of sounds that exceeded the thresholds recommended by the Environmental Protection Agency and International Noise Council decreased from 31.2% to 0.2% following implementation (P < 0.001). Replacement of overhead paging with a clinical mobility platform that utilized smartphones was associated with a significant reduction in transitory noise. Clinical mobility implementation, as part of a noise reduction strategy, may be effective in other inpatient settings.
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Casey L, Fucile S, Flavin M, Dow K. A two-pronged approach to reduce noise levels in the neonatal intensive care unit. Early Hum Dev 2020; 146:105073. [PMID: 32470765 DOI: 10.1016/j.earlhumdev.2020.105073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/05/2020] [Accepted: 05/12/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of this study was to assess the efficacy of a visual noise feedback system and "quiet time" in reducing noise levels in the neonatal intensive care unit (NICU). DESIGN A prospective cross-sectional study was performed in a combined level II/III NICU at a Canadian tertiary care hospital. Noise levels were recorded continuously for three weeks without and then three weeks with visual noise feedback system. Noise levels were compared after one year of using visual feedback, and subsequently with the addition of two "quiet times." RESULTS Visual feedback reduced noise levels from 54.2 dB (95% CI 53.8-54.7 dB) to 49.4 dB (95% CI 48.9-49.8 dB; P < 0.0001) and increased the amount of time spent under 45 dB from 0 to 25% (P < 0.0001) after three weeks of use. However, this effect was not sustained at one year of visual feedback, with noise levels at 54.7 dB (95% CI 54.5-55.0 dB, P = 0.55). Quiet Time did not further reduce daily noise in the NICU (average noise levels 54.7, 95% CI 54.4-55.0 dB, P = 0.836). CONCLUSIONS While visual noise feedback system reduced noise levels in the short term, these effects were not sustainable at one year and could not be remediated with the addition of a Quiet Time initiative. Continuing education regarding the detrimental effects of noise is paramount to ensure persistent noise reduction in the NICU.
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Affiliation(s)
- Lara Casey
- Department of Pediatrics, School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Sandra Fucile
- Department of Pediatrics, School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.
| | - Michael Flavin
- Department of Pediatrics, School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Kimberly Dow
- Department of Pediatrics, School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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Assessment of Noise Exposure and Its Characteristics in the Intensive Care Unit of a Tertiary Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134670. [PMID: 32610521 PMCID: PMC7370148 DOI: 10.3390/ijerph17134670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/20/2020] [Accepted: 06/26/2020] [Indexed: 12/02/2022]
Abstract
Noise generated in the intensive care unit (ICU) adversely affects both critically ill patients and medical staff. Recently, several attempts have been made to reduce ICU noise levels, but reliable and effective solutions remain elusive. This study aimed to provide evidence on noise distributions in the ICU to protect patient health. For one week, we measured noise levels in isolated rooms, open units, and nursing stations in medical, surgical, and pediatric ICUs, respectively. We additionally analyzed the noise generated by medical equipment that is frequently used in ICUs. The median (interquartile range) noise exposure level (dBA) of all ICU units was 54.4 dB (51.1–57.5) over 24 h. The highest noise exposure was noted in the surgical ICU’s daytime open unit at 57.6 dB (55.0–61.1). Various ICU medical devices continuously generated low-frequency noise. Mechanical noise levels ranged from a minimum of 41 dB to a maximum of 91 dB. It was also confirmed that patient-monitoring devices generated loud, high-frequency noise at 85 dB. ICU noise levels were much higher than expected. Noise reduction that focuses on behavior modification of medical staff has limited potential; instead, structural improvements should be considered to reduce the transmission of noise.
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Pelter MM, Suba S, Sandoval C, Zègre-Hemsey JK, Berger S, Larsen A, Badilini F, Hu X. Actionable Ventricular Tachycardia During In-Hospital ECG Monitoring and Its Impact on Alarm Fatigue. Crit Pathw Cardiol 2020; 19:79-86. [PMID: 32102049 PMCID: PMC7413570 DOI: 10.1097/hpc.0000000000000216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ventricular tachycardia (V-tach) is the most common lethal arrhythmia, yet 90% of alarms are false and contribute to alarm fatigue. We hypothesize that some true V-tach also causes alarm fatigue because current criteria are too sensitive (i.e., ≥6 beats ≥100 beats/min [bpm]). PURPOSE This study was designed to determine (1) the proportion of clinically actionable true V-tach events; (2) whether true actionable versus nonactionable V-tach differs in terms of heart rate and/or duration (seconds); and (3) if actionable V-tach is associated with adverse outcomes. METHODS This was a secondary analysis in 460 intensive care unit (ICU) patients. Electronic health records were examined to determine if a V-tach event was actionable or nonactionable. Actionable V-tach was defined if a clinical action(s) was taken within 15 minutes of its occurrence (i.e., new and/or change of medication, defibrillation, and/or laboratory test). Maximal heart rate and duration for each V-tach event were measured from bedside monitor electrocardiography. Adverse patient outcomes included a code blue event and/or death. RESULTS In 460 ICU patients, 50 (11%) had 151 true V-tach events (range 1-20). Of the 50 patients, 40 (80%) had only nonactionable V-tach (97 events); 3 (6%) had both actionable and nonactionable V-tach (32 events); and 7 patients (14%) had only actionable V-tach (23 events). There were differences in duration comparing actionable versus nonactionable V-tach (mean 56.19 ± 116.87 seconds vs. 4.28 ± 4.09 seconds; P = 0.001) and maximal heart rate (188.81 ± 116.83 bpm vs. 150.79 ± 28.26 bpm; P = 0.001). Of the 50 patients, 3 (6%) had a code blue, 2 died, and all were in the actionable V-tach group. CONCLUSIONS In our sample, <1% experienced a code blue following true V-tach. Heart rate and duration for actionable V-tach were much faster and longer than that for nonactionable V-tach. Current default settings typically used for electrocardiographic monitoring (i.e., ≥6 beats ≥100 bpm) appear to be too conservative and can lead to crisis/red level nuisance alarms that contribute to alarm fatigue. A prospective study designed to test whether adjusting default settings to these higher levels is safe for patients is needed.
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Affiliation(s)
- Michele M Pelter
- From the University of California, San Francisco, School of Nursing
| | - Sukardi Suba
- From the University of California, San Francisco, School of Nursing
| | - Cass Sandoval
- University of California, San Francisco, Medical Center
| | | | - Sarah Berger
- University of California, San Francisco, Medical Center
| | - Amy Larsen
- University of California, San Francisco, Medical Center
| | - Fabio Badilini
- From the University of California, San Francisco, School of Nursing
| | - Xiao Hu
- Duke University School of Nursing
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Cvach M, Doyle P, Wong SY, Letnaunchyn K, Dell D, Mamaril M. Decreasing Pediatric PACU Noise Level and Alarm Fatigue: A Quality Improvement Initiative to Improve Safety and Satisfaction. J Perianesth Nurs 2020; 35:357-364. [PMID: 32362515 DOI: 10.1016/j.jopan.2020.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To describe how a pediatric postanesthesia care unit used a two-phased approach of bundled interventions to reduce unit noise levels and improve staff perceptions of their work environment. DESIGN Pre/post design. METHODS Postanesthesia care unit sound levels and monitor alarms were measured at baseline and after implementing both project phases. Nursing staff members were surveyed at baseline and after completion of the project. FINDINGS Monitor alarms were reduced by more than 50% after Phase I. However, noise measurement data did not reflect a difference in sound levels between baseline and intervention phases. Despite this, staff perceived the unit as much quieter. CONCLUSIONS The reduction in monitor alarms did not cause an appreciable change in sound levels as measured by noise dosimeters in either intervention phase. Despite these findings, nurses perceived a quieter and more pleasant workplace. These impressions might have resulted from subjective expectations versus actual volume levels, or they might owe to the reduction in incidence of alarms themselves, which they had viewed as nuisance sounds.
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Affiliation(s)
- Maria Cvach
- Department of Integrated Healthcare Delivery, Johns Hopkins Health System, Baltimore, MD.
| | - Peter Doyle
- Department of Clinical Engineering, The Johns Hopkins Hospital, Baltimore, MD
| | - Sereniti Young Wong
- Department of Nursing, The Johns Hopkins Hospital-The Charlotte R. Bloomberg Children's Center, Baltimore, MD
| | - Kimberly Letnaunchyn
- Department of Nursing, The Johns Hopkins Hospital-The Charlotte R. Bloomberg Children's Center, Baltimore, MD
| | - Deborah Dell
- Department of Nursing, The Johns Hopkins Hospital-The Charlotte R. Bloomberg Children's Center, Baltimore, MD
| | - Myrna Mamaril
- Department of Nursing, The Johns Hopkins Hospital-The Charlotte R. Bloomberg Children's Center, Baltimore, MD
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Alanazi AA, Atcherson SR, Franklin CA, Bryan MF. Frequency Responses of Conventional and Amplified Stethoscopes for Measuring Heart Sounds. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2020; 8:112-117. [PMID: 32587492 PMCID: PMC7305673 DOI: 10.4103/sjmms.sjmms_118_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 11/14/2019] [Accepted: 03/02/2020] [Indexed: 12/02/2022]
Abstract
Background: Frequencies of normal and abnormal heart sounds have previously been reported, but the acoustic analyses of the frequency responses of conventional and amplified stethoscopes for different heart sounds have not yet been reported. Objectives: To compare the acoustic analysis of frequency responses of three stethoscopes (conventional and amplified) for measuring simulated heart sounds. Materials and Methods: This exploratory study used Starkey SLI-ST3, Cardionics E-Scope II (both electronic) and Littmann Classic S.E. II (conventional) stethoscopes, as they share the same basic design with twin ear tubes coupled to ear tips and chest piece options (bell vs. diaphragm modes). Acoustic analyses using the diaphragm were performed in a soundproof booth and frequency response curves at 85 (the largest), 250, 400, 550 and 1050 Hz were compared for three different digitized heart sound simulations: normal, aortic valvular stenosis (AVS) and pulmonic valvular stenosis. Results: Amplified stethoscopes provided the most amplification of normal and abnormal heart sounds across all five frequencies compared with the conventional stethoscope. The Starkey SLI-ST3 stethoscope was better at amplifying normal heartbeats than the Cardionics E-Scope II and Littman Classic S.E. II; however, it came last for amplifying normal heartbeats of ~85 Hz. Cardionics E-Scope II had advantages in amplifying abnormal heartbeats (i.e., aortic valvular stenosis and pulmonic valvular stenosis) over the other two stethoscopes. Conclusion: This study showed that amplified stethoscopes provided better amplification of normal and abnormal heart sounds across the five measured frequencies. Therefore, health professionals should interpret manufacturer claims regarding gain (dB) and frequency (Hz) with caution, and those with hearing loss should carefully investigate the “audio performance” of the stethoscopes. Future research should focus on these effects through coupling with hearing aids.
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Affiliation(s)
- Ahmad A Alanazi
- Department of Audiology and Speech Pathology, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Samuel R Atcherson
- Department of Audiology and Speech Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Clifford A Franklin
- Department of Audiology and Speech Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Melinda F Bryan
- The Speech and Hearing Center, School of Communication, Louisiana Tech University, Ruston, Louisiana, USA
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An assessment of nurses' knowledge regarding noise in intensive care units in Jordan. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2020. [DOI: 10.1016/j.ijans.2019.100183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Youn S, Lee S, Kim C, Chung S. The Effect of a Sleep Education and Hypnotics Reduction Program on Hypnotics Prescription Rate for the Hospitalized Patients with Cancer at a General Hospital. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2019; 17:542-546. [PMID: 31671493 PMCID: PMC6852672 DOI: 10.9758/cpn.2019.17.4.542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 11/18/2022]
Abstract
Objective We aimed to investigate whether the sleep education and hypnotics reduction program (the i-sleep program), developed for all hospitalized patients and medical personnel, help reducing the hypnotics prescriptions rate among hospitalized cancer patients in a general hospital. Methods Patient data such as hypnotics prescribed at the time of admission and discharge during prior to (year of 2014) and after (year of 2015) initiation of the i-sleep program were collected and compared. Also, hypnotics prescription rate at the first day of each month of 2014 and 2015 were estimated and compared. Results All of 12,382 patients in 2014 and 12,313 patients in 2015 were admitted to the Department of Oncology of the hospital. In 2014, 782 (6.3%) of 12,382 inpatients were already taking hypnotics at the time of admission, and 594 (76.0%) of the 782 patients were still taking sleeping pills at the time of discharge. Following initiation of the i-sleep program (2015), 792 (6.4%) of 12,313 inpatients were already taking hypnotics at the time of admission, and 553 (69.8%) of the 792 inpatients were still taking them at the time of discharge (relative risk, 0.92; 95% confidence interval, 0.87–0.98). On the first day of each month of 2014, 7.3% to 12.6% (mean, 10.0%) of inpatients had prescriptions for hypnotics. Following initiation of the program, the rate of hypnotic prescription was significantly reduced (3.2–10.8%; mean, 8.0%; p = 0.03). Conclusion Our date showed that the i-sleep program may help to reduce the hypnotic prescription rate in hospitalized cancer patients.
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Affiliation(s)
- Soyoung Youn
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suyeon Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Changnam Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Ray JM, Berg R, Sudikoff SN. PROcess for the Design of User-Centered Environments (PRODUCE): Guiding Change in the Health Care Environment. Adv Health Care Manag 2019; 18:19-33. [PMID: 32077651 DOI: 10.1108/s1474-823120190000018002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Changes in the physical environments of health care settings have become increasingly common to meet the evolving needs of the health care marketplace, new technologies, and infrastructure demands. Physical environment change takes many forms including new build construction, renovation of existing space, and relocation of units with little to no construction customization. The interrelated nature of the complex socio-technical health care system suggests that even small environmental modifications can result in system-level changes. Environmental modifications can lead to unintended consequences and introduce the potential for latent safety threats. Engaging users throughout the change lifecycle allows for iterative design and testing of system modifications. This chapter introduces a flexible process model, PROcess for the Design of User-Centered Environments (PRODUCE), designed to guide system change. The model was developed and refined across a series of real-world renovations and relocations in a large multihospital health care system. Utilizing the principles of user-centered design, human factors, and in-situ simulation, the model engages users in the planning, testing, and implementation of physical environment change. Case studies presented here offer exemplars of how to modify the model to support individual project objectives and outcomes to assess at each stage of the project.
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Lim HP, Sanderson P. A comparison of two designs for earcons conveying pulse oximetry information. APPLIED ERGONOMICS 2019; 78:110-119. [PMID: 31046941 DOI: 10.1016/j.apergo.2019.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/20/2018] [Accepted: 01/27/2019] [Indexed: 06/09/2023]
Abstract
We performed a randomised controlled trial comparing two kinds of earcons that could provide intermittent pulse oximetry information about a patient's oxygen saturation (SpO2) and heart rate (HR). Timbre-earcons represented SpO2 levels with different levels of timbre, and pitch-earcons with different levels of pitch. Both kinds of earcons represented HR with tremolo. Participants using pitch-earcons identified SpO2 levels alone, and both SpO2 plus HR levels, significantly better than participants using timbre-earcons: p < .001 in both cases. However, there was no difference between earcon conditions in how effectively HR was identified, p = .422. For both kinds of earcons, identification of SpO2 levels was more compromised by simultaneous changes in HR than identification of HR levels was compromised by simultaneous changes in SpO2, suggesting asymmetric integrality. Overall, pitch-earcons may provide a better intermittent auditory pulse oximetry display than timbre-earcons, especially for clinical contexts when quiet is needed.
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Affiliation(s)
- Hai-Ping Lim
- School of Psychology, The University of Queensland, St Lucia, QLD, 4072, Australia
| | - Penelope Sanderson
- School of Psychology, The University of Queensland, St Lucia, QLD, 4072, Australia; School of Information Technology and Electrical Engineering, The University of Queensland, St Lucia, QLD, Australia; School of Clinical Medicine, The University of Queensland, St Lucia, QLD, 4072, Australia.
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Klueber S, Wolf E, Grundgeiger T, Brecknell B, Mohamed I, Sanderson P. Supporting multiple patient monitoring with head-worn displays and spearcons. APPLIED ERGONOMICS 2019; 78:86-96. [PMID: 31046963 DOI: 10.1016/j.apergo.2019.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 06/09/2023]
Abstract
In hospitals, clinicians often need to monitor several patients while performing other tasks. However, visual displays that show patients' vital signs are in fixed locations and auditory alarms intended to alert clinicians may be missed. Information such as spearcons (time-compressed speech earcons) that 'travels' with the clinician and is delivered by earpiece and/or head-worn displays (HWDs), might overcome these problems. In this study, non-clinicians monitored five simulated patients in three 10-min scenarios while performing a demanding tracking task. Monitoring accuracy was better for participants using spearcons and a HWD (88.7%) or a HWD alone (86.2%) than for participants using spearcons alone (74.1%). Participants using the spearcons and HWD (37.7%) performed the tracking task no differently from participants using spearcons alone (37.1%) but participants using the HWD alone performed worse overall (33.1%). The combination of both displays may be a suitable solution for monitoring multiple patients.
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Affiliation(s)
- Sara Klueber
- Institute Human-Computer-Media, University of Würzburg, Germany.
| | - Erik Wolf
- Institute Human-Computer-Media, University of Würzburg, Germany
| | | | - Birgit Brecknell
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Ismail Mohamed
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Penelope Sanderson
- School of Psychology, The University of Queensland, Brisbane, Australia; School of Medicine and School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
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Inoue S, Hatakeyama J, Kondo Y, Hifumi T, Sakuramoto H, Kawasaki T, Taito S, Nakamura K, Unoki T, Kawai Y, Kenmotsu Y, Saito M, Yamakawa K, Nishida O. Post-intensive care syndrome: its pathophysiology, prevention, and future directions. Acute Med Surg 2019; 6:233-246. [PMID: 31304024 PMCID: PMC6603316 DOI: 10.1002/ams2.415] [Citation(s) in RCA: 246] [Impact Index Per Article: 49.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 03/11/2019] [Indexed: 12/21/2022] Open
Abstract
Expanding elderly populations are a major social challenge in advanced countries worldwide and have led to a rapid increase in the number of elderly patients in intensive care units (ICUs). Innovative advances in medical technology have enabled lifesaving of patients in ICUs, but there remain various problems to improve their long-term prognoses. Post-intensive care syndrome (PICS) refers to physical, cognition, and mental impairments that occur during ICU stay, after ICU discharge or hospital discharge, as well as the long-term prognosis of ICU patients. Its concept also applies to pediatric patients (PICS-p) and the mental status of their family (PICS-F). Intensive care unit-acquired weakness, a syndrome characterized by acute symmetrical limb muscle weakness after ICU admission, belongs to physical impairments in three domains of PICS. Prevention of PICS requires performance of the ABCDEFGH bundle, which incorporates the prevention of delirium, early rehabilitation, family intervention, and follow-up from the time of ICU admission to the time of discharge. Diary, nutrition, nursing care, and environmental management for healing are also important in the prevention of PICS. This review outlines the pathophysiology, prevention, and future directions of PICS.
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Affiliation(s)
- Shigeaki Inoue
- Department of Disaster and Emergency and Critical Care Medicine Kobe University Graduate School of Medicine Kobe Hyogo Japan
| | - Junji Hatakeyama
- Department of Emergency and Critical Care Medicine Yokohama City Minato Red Cross Hospital Yokohama Kanagawa Japan
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine Juntendo University Urayasu Hospital Urayasu Chiba Japan
| | - Toru Hifumi
- Emergency and Critical Care Medicine St. Luke's International Hospital Tokyo Japan
| | - Hideaki Sakuramoto
- Department of Adult Health Nursing College of Nursing Ibaraki Christian University Hitachi Japan
| | - Tatsuya Kawasaki
- Department of Pediatric Critical Care Shizuoka Children's Hospital Shizuoka Japan
| | - Shunsuke Taito
- Department of Clinical Practice and Support Division of Rehabilitation Hiroshima University Hospital Hiroshima Japan
| | - Kensuke Nakamura
- Department of Emergency and Critical Care Medicine Hitachi General Hospital Hitachi Ibaraki Japan
| | - Takeshi Unoki
- Department of Adult Health Nursing School of Nursing Sapporo City University Sapporo Japan
| | - Yusuke Kawai
- Department of Nursing Fujita Health University Hospital Toyoake Aichi Japan
| | - Yuji Kenmotsu
- Department of Nursing Tokai University Hachioji Hospital Hachioji Tokyo Japan
| | - Masafumi Saito
- Department of Disaster and Emergency and Critical Care Medicine Kobe University Graduate School of Medicine Kobe Hyogo Japan
| | - Kazuma Yamakawa
- Division of Trauma and Surgical Critical Care Osaka General Medical Center Osaka City Osaka Japan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine Fujita Health University School of Medicine Toyoake Aichi Japan
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YILDIRIM HAVVA, MAYDA ATİLLASENİH. DETERMINATION OF NOISE LEVELS IN THE OUTPATIENT CLINICS OF MEDICAL FACULTY HOSPITAL AT XXX UNIVERSITY. KONURALP TIP DERGISI 2019. [DOI: 10.18521/ktd.434486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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50
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Better Sleep Experience for the Critically Ill: A Comprehensive Strategy for Designing Hospital Soundscapes. MULTIMODAL TECHNOLOGIES AND INTERACTION 2019. [DOI: 10.3390/mti3020036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
In this paper, the sleep phenomenon is considered in relation to critical care soundscapes with the intention to inform hospital management, medical device producers and policy makers regarding the complexity of the issue and possible modes of design interventions. We propose a comprehensive strategy based on soundscape design approach that facilitates a systematic way of tackling the auditory quality of critical care settings in favor of better patient sleep experience. Future research directions are presented to tackle the knowledge deficits in designing for critical care soundscapes that cater for patient sleep. The need for scientifically-informed design interventions for improving patient sleep experience in critical care is highlighted. The value of the soundscape design approach for resolving other sound-induced problems in critical care and how the approach allows for patient-centred innovation that is beyond the immediate sound issue are further discussed.
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