Noise levels in an urban hospital and workers' subjective responses

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

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

Automated Relative Fundamental Frequency Algorithms for Use With Neck-Surface Accelerometer Signals

OBJECTIVE

Relative fundamental frequency (RFF) has been suggested as a potential acoustic measure of vocal effort. However, current clinical standards for RFF measures require time-consuming manual markings. Previous semi-automated algorithms have been developed to calculate RFF from microphone signals. The current study aimed to develop fully automated algorithms to calculate RFF from neck-surface accelerometer signals for ecological momentary assessment and ambulatory monitoring of voice.

METHODS

Training a set of 2646 /vowel-fricative-vowel/ utterances from 317 unique speakers, with and without voice disorders, was used to develop automated algorithms to calculate RFF values from neck-surface accelerometer signals. The algorithms first rejected utterances with poor vowel-to-noise ratios, then identified fricative locations, then used signal features to determine voicing boundary cycles, and finally calculated corresponding RFF values. These automated RFF values were compared to the clinical gold-standard of manual RFF calculated from simultaneously collected microphone signals in a novel test set of 639 utterances from 77 unique speakers.

RESULTS

Automated accelerometer-based RFF values resulted in an average mean bias error (MBE) across all cycles of 0.027 ST, with an MBE of 0.152 ST and -0.252 ST in the offset and onset cycles closest to the fricative, respectively.

CONCLUSION

All MBE values were smaller than the expected changes in RFF values following successful voice therapy, suggesting that the current algorithms could be used for ecological momentary assessment and ambulatory monitoring via neck-surface accelerometer signals.

Literature Review: Evidence-Based Health Outcomes and Perceptions of the Built Environment in Pediatric Hospital Facilities

PROBLEM

The current knowledge of evidence-based design for adults is not always implemented when hospital buildings are designed. Scientific data are sparse on the effects of hospital design in pediatric settings on health outcomes in children, parents, and staff. The objective of this review is to determine the evidence-based impact of the built environment in pediatric hospital facilities on health outcomes in children, parents, and staff.

ELIGIBILITY CRITERIA

A systematic literature review was carried out on the electronic databases Cochrane Library, Embase, Medline and CINAHL from the period of 2008 to 2019. The review considered studies using either quantitative, qualitative, or mixed methodologies.

SAMPLE

Out of 1414 reviewed articles the result is based on eight included articles.

RESULTS

Two of these eight articles included health outcomes. The other six articles presented results on measures of perceptions and/or satisfaction for children, parents or staff with the built environment when transitioning to a new or renovated facility. These were generally higher for the new compared to the old facility.

CONCLUSIONS

Given the small number of studies addressing the question posed in this review, no firm conclusions can be drawn.

IMPLICATIONS

The review illustrates the need for more research in the pediatric setting assessing the evidence-based health outcomes of aspects of physical environmental design in pediatric hospitals or units in children, parents and staff.

Noise in Maternity Wards: A Research on Its Contributors and Sources

AIMS

This research aimed to investigate the major user behavior patterns of noise sources in healthcare environments and summarize such information as evidence that can inform the design of maternity wards for indoor noise control and patients' well-being.

METHODS

Field investigations were conducted to identify users' behaviors as the major contributors of noises in the maternity wards of a typical hospital. A control experiment was set to test the feasibility of a noise control system that consisted of smart bracelets, mobile terminals, and monitors. Comparative studies were designed for statistical analysis of patients' sleep quality and satisfaction. Finally, a follow-up interview was conducted among the experts who were from the fields of healthcare environment design, medical treatments, and hospital administration to shed an insight into their concerns on the findings.

RESULTS

The enclosed waiting areas, instead of open ones that were often seen in hospitals, around the entrances of operation rooms, were considered as the appropriate design strategy for maternity wards in China. Such a design could keep patients from being exposed to the excessive noises generated by visitors during nighttime, although it would occupy the floor area of wards and lead to a reduction of beds. Moreover, the statistical information of patients' behaviors could be used to moderate visitors' behaviors.

CONCLUSIONS

It was necessary to include user behavior information in building information management and then make a good trade-off between the proportions of wards and enclosed waiting rooms in order to achieve a balance of medical efficiency and environmental satisfaction.

The Influence of Evidence-Based Design on Staff Perceptions of a Supportive Environment for Person-Centered Care in Forensic Psychiatry

This prospective longitudinal study aimed to examine the relocation of three forensic psychiatric hospitals in Sweden into new facilities. The research focused on the effects of the physical and psychosocial environment and other staff-related parameters on the delivery of person-centered care after relocation. In forensic psychiatry, most relocations to new environments are to support a person-centered approach and to promote patients' rehabilitation and reintegration into society. Hopefully, this is undertaken in accordance with an evidence-based design strategy allowing improvement in staff satisfaction and working conditions as well as their capacity to provide individualized care. All staff members working on the wards of the facilities in question were invited to participate in the study. Data were collected prospectively between 2010 and 2014, before and after relocation of the forensic psychiatric clinics to new buildings. Structured validated questionnaires were employed. Staff members' job satisfaction and perceptions of a person-centered physical and psychosocial environment increased after relocation and provide evidence that staff perceptions of ward atmosphere in forensic psychiatric clinics are susceptible to factors in the physical and psychosocial environment. The importance of always taking the environmental factors into consideration, to achieve greater staff well-being and capacity to accomplish goals in forensic psychiatry, is emphasized.

Assessment Of Ambient-Noise Exposure Among Female Nurses In Surgical Cardiac Intensive Care Unit

PURPOSE

To measure noise levels in the Saud Albabtain Cardiac Center cardiac surgical intensive-care unit (CSICU) at different locations to find out the prevalence of noise-induced hearing loss among female nurses.

METHODS

Ambient CSICU noise was measured using a sound-level meter and personal noise dosimeter during morning and night shifts (12 hours each) for 30 days. An audiometry test and questionnaire were used to test nursing responses to noise levels.

RESULTS

Mean 12-hour average noise levels at the station during night shift were 60.3±7.1 dB(A) and inside rooms 62.48±8.02 dB(A). However, during morning shift 64.1±8.4 dB(A) in the rooms was recorded, while 68.8±8.2 dB(A) was recorded at the station, with a significant difference between the shifts (p<0.0001). ICU monitors recorded the highest noise-source levels of 82.7±5.3 dB(A). The lowest significant source was the suction machines, with an average of 67.1±12.5 dB(A). A significant correlation between decibel loss and nurse experience was observed.

CONCLUSION

Noise levels in the CSICU at Saud Albabtain Cardiac Center were higher than World Health Organization standards. CSICU nurses are exposed to noise levels that can affect their hearing capacity. Further research isneeded for effective medical device-alarm management.

Medida do nível de ruído hospitalar e seus efeitos em funcionários a partir do relato de queixas

RESUMO Objetivos: avaliar o nível de ruído em diversos ambientes de um Hospital Público e analisar seus efeitos em funcionários a partir do relato de queixas. Métodos: estudo quantitativo, descritivo e transversal. Utilizou-se para levantamento dos dados um decibelímetro Minipa(r) ajustado na escala de 40 a 130 decibels posicionado em diferentes setores do hospital em turnos diferentes, durante uma semana, e um questionário adaptado que foi aplicado aos funcionários. Resultados: o nível de ruídos apresentou valor mínimo de 52,5 decibels na Unidade de Terapia Intensiva (UTI) Neonatal e máximo de 85 decibels na Enfermaria Feminina com diferença significativa entre os diferentes dias da semana durante o mesmo turno. O mesmo ocorreu no Pronto Socorro, mas não apresentou significância nos demais setores. Os funcionários sentem desconforto a sons fortes, 74,4%, e 35,5 % sentem mal estar e cansaço devido ao estresse provocado pelo ruído que é produzido por vários dispositivos combinados com os sons de alarmes, obras, horários de visitas e conversação entre os funcionários do hospital. Conclusão: os níveis de ruído estão acima do recomendado nos diferentes setores e os profissionais manifestam desconforto e queixa de zumbido antes e após à sua exposição.

Assessment of noise pollution in and around a sensitive zone in North India and its non-auditory impacts

Noise pollution in hospitals is recognized as a serious health hazard. Considering this, the current study aimed to map the noise pollution levels and to explore the self reported non-auditory effects of noise in a tertiary medical institute. The study was conducted in an 1800-bedded tertiary hospital where 27 sites (outdoor, indoor, road side and residential areas) were monitored for exposure to noise using Sound Level Meter for 24h. A detailed noise survey was also conducted around the sampling sites using a structured questionnaire to understand the opinion of the public regarding the impact of noise on their daily lives. The equivalent sound pressure level (Leq) was found higher than the permissible limits at all the sites both during daytime and night. The maximum equivalent sound pressure level (Lmax) during the day was observed higher (>80dB) at the emergency and around the main entrance of the hospital campus. Almost all the respondents (97%) regarded traffic as the major source of noise. About three-fourths (74%) reported irritation with loud noise whereas 40% of respondents reported headache due to noise. Less than one-third of respondents (29%) reported loss of sleep due to noise and 8% reported hypertension, which could be related to the disturbance caused due to noise. Noise levels in and around the hospital was well above the permissible standards. The recent Global Burden of Disease highlights the increasing risk of non communicable diseases. The non-auditory effects studied in the current work add to the risk factors associated with non communicable diseases. Hence, there is need to address the issue of noise pollution and associated health risks specially for vulnerable population.

Noise pollution levels in the pediatric intensive care unit

Patients and staff may experience adverse effects from exposure to noise.

OBJECT

This study assessed noise levels in the pediatric intensive care unit and evaluated family and staff opinion of noise.

DESIGN

Noise levels were recorded using a NoisePro DLX. The microphone was 1 m from the patient's head. The noise level was averaged each minute and levels above 70 and 80 dBA were recorded. The maximum, minimum, and average decibel levels were calculated and peak noise level great than 100 dBA was also recorded. A parent questionnaire concerning their evaluation of noisiness of the bedside was completed. The bedside nurse also completed a questionnaire.

RESULTS

The average maximum dB for all patients was 82.2. The average minimum dB was 50.9. The average daily bedside noise level was 62.9 dBA. The average % time where the noise level was higher than 70 dBA was 2.2%. The average percent of time that the noise level was higher than 80 dBA was 0.1%. Patients experienced an average of 115 min/d where peak noise was greater than 100 dBA. The parents and staff identified the monitors as the major contribution to noise.

CONCLUSION

Patients experienced levels of noise greater than 80 dBA. Patients experience peak noise levels in excess of 100 dB during their pediatric intensive care unit stay.

Noise Affects Performance on the Montreal Cognitive Assessment

L’objectif était d’investiguer l’impact de la présence d’un bruit de fond sur la performance au Montreal Cognitive Assessment (MoCA). Deux versions du MoCA ont été administrées, utilisant écouteurs, avec des niveaux bas et élevés de bruit de fond à deux groupes de personnes âgées (un groupe présentant une audition cliniquement normale, le second présentant une perte d’audition) ainsi qu’à un groupe de jeunes adultes. Les niveaux d’intensité utilisés pour présenter la parole et le bruit étaient personnalisés en fonction des habiletés des participants présentant une perte de l’ouïe, et ce en vue de créer un niveau de difficulté uniforme à travers les participants dans la condition de bruit plus élevé. Les deux groupes de personnes âgées ont obtenu des scores plus faibles au MoCA en comparaison aux jeunes adultes. Il est également important de souligner que tous les participants ont obtenu des scores plus faibles au MoCA lorsque le test était administré dans un contexte de bruit élevé (M = 22,7/30), en comparaison à un contexte de bruit faible (M = 25,7/30, p < .001). Ces résultats suggèrent que le bruit de fond présent dans un contexte d’évaluation devrait être pris en considération au moment de l’administration de tests cognitifs ainsi que dans l’interprétation des résultats, en particulier lors de l’essai des adultes plus âgés.

Voice Relative Fundamental Frequency Via Neck-Skin Acceleration in Individuals With Voice Disorders

PURPOSE

This study investigated the use of neck-skin acceleration for relative fundamental frequency (RFF) analysis.

METHOD

Forty individuals with voice disorders associated with vocal hyperfunction and 20 age- and sex-matched control participants were recorded with a subglottal neck-surface accelerometer and a microphone while producing speech stimuli appropriate for RFF. Rater reliabilities, RFF means, and RFF standard deviations derived from the accelerometer were compared with those derived from the microphone.

RESULTS

RFF estimated from the accelerometer had slightly higher intrarater reliability and identical interrater reliability compared with values estimated with the microphone. Although sensor type and the Vocal Cycle × Sensor and Vocal Cycle × Sensor × Group interactions showed significant effects on RFF means, the typical RFF pattern could be derived from either sensor. For both sensors, the RFF of individuals with vocal hyperfunction was lower than that of the controls. Sensor type and its interactions did not have significant effects on RFF standard deviations.

CONCLUSIONS

RFF can be reliably estimated using an accelerometer, but these values cannot be compared with those collected via microphone. Future studies are needed to determine the physiological basis of RFF and examine the effect of sensors on RFF in practical voice assessment and monitoring settings.

Restorative Design Features for Hospital Staff Break Areas

Objectives:

The study investigated the main restorative components of staff break areas in healthcare facilities, by assessing usage patterns, verbal/visual preferences, and perceived restorative qualities of specific design features found in break areas for hospital staff.

Background:

Nurses are extremely important to the healthcare industry, and maintaining the quality of nursing care is a central concern for healthcare administrators. While healthcare leaders are concerned about improving nurses’ satisfaction, performance, and job retention, they may overlook the importance of respite for nurses and underestimate the value of designing staff break areas to maximize their restorative potential.

Methods:

A multi-method approach combined qualitative explorations (focused interviews and narrative survey questions) with quantitative measurements (discrete survey questions and a visual ranking of break-room spaces), and the results were compared and triangulated.

Results:

It was found that staff break areas are more likely to be used if they are in close proximity to nurses’ work areas, if they have complete privacy from patients and families, and if they provide opportunities for individual privacy as well as socialization with coworkers. Having physical access to private outdoor spaces (e.g., balconies or porches) was shown to have significantly greater perceived restorative potential, in comparison with window views, artwork, or indoor plants.

Conclusions:

The results of this empirical study support the conclusion that improvements in the restorative quality of break areas may significantly improve nurses’ satisfaction and stress reduction, potentially leading to improved care for the patients they serve.

The Influence of Flooring on Environmental Stressors

Objective:

Three flooring materials, terrazzo, rubber, and carpet tile, in patient unit corridors were compared for absorption of sound, comfort, light reflectance, employee perceptions and preferences, and patient satisfaction.

Background:

Environmental stressors, such as noise and ergonomic factors, effect healthcare workers and patients, contributing to increased fatigue, anxiety and stress, decreased productivity, and patient safety and satisfaction.

Methods:

A longitudinal comparative cohort study comparing three types of flooring assessed sound levels, healthcare worker responses, and patient Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings over 42 weeks. A linear mixed model analysis was conducted to determine significant differences between the means for participant responses and objective sound meter data during all three phases of the study.

Results:

A significant difference was found for sound levels between flooring type for equivalent continuous sound levels. Carpet tile performed better for sound attenuation by absorption, reducing sound levels 3.14 dBA. Preferences for flooring materials changed over the course of the study. The HCAHPS ratings aligned with the sound meter data showing that patients perceived the noise levels to be lower with carpet tiles, improving patient satisfaction ratings.

Conclusions:

Perceptions for healthcare staff and patients were aligned with the sound meter data. Carpet tile provides sound absorption that affects sound levels and influences occupant’s perceptions of environmental factors that contribute to the quality of the indoor environment. Flooring that provides comfort underfoot, easy cleanability, and sound absorption influence healthcare worker job satisfaction and patient satisfaction with their patient experience.

The influence of APACHE II score on the average noise level in an intensive care unit: an observational study

Background

Noise levels in hospitals, especially in intensive care units (ICUs) are known to be high, potentially affecting not only the patients’ well-being but also their clinical outcomes. In an observational study, we made a long-term measurement of noise levels in an ICU, and investigated the influence of various factors on the noise level, including the acute physiology and chronic health evaluation II (APACHE II) score.

Methods

The average noise level was continuously measured for three months in all (eight) patient rooms in an ICU, while the patient data were also registered, including the APACHE II score. The 24-hour trend of the noise level was obtained for the patients of length-of-stay (LOS) ≥1 day, which was compared to the timeline of the ICU routine events. For the patients with LOS ≥4 days, the average noise levels in the first four days were analyzed, and regression models were established using the stepwise search method based on the Akaike information criterion.

Results

Features identified in the 24-hour trends (n = 55) agreed well with the daily routine events in the ICU, where regular check-ups raised the 10-minute average noise level by 2~3 dBA from the surrounding values at night, and the staff shift changes consistently increased the noise level by 3~5 dBA. When analyzed in alignment with the patient’s admission (n=22), the daytime acoustic condition improved from Day 1 to 2, but worsened from Day 2 to 4, most likely in relation to the various phases of patient’s recovery. Regression analysis showed that the APACHE II score, room location, gender, day of week and the ICU admission type could explain more than 50 % of the variance in the daily average noise level, L_Aeq,24h. Where these factors were argued to have causal relations to L_Aeq,24h, the APACHE II score was found to be most strongly correlated: L_Aeq,24h increased by 1.3~1.5 dB when the APACHE II score increased by 10 points.

Conclusions

Patient’s initial health condition is one important factor that influences the acoustic environment in an ICU, which needs to be considered in observational and interventional studies where the noise in healthcare environments is the subject of investigation.

Evaluation of physically and mentally fatiguing tasks and sources of fatigue as reported by registered nurses

AIMS

To identify fatiguing tasks and develop a model of sources of fatigue in nursing work.

BACKGROUND

Research has identified multiple factors contributing to occupational fatigue; however, comprehensive consideration of diverse factors identified by nurses as contributing to fatigue in nursing work systems is lacking.

METHODS

Content and frequency analyses were performed on previously unpublished data from an online survey of registered nurses. Responses from 100 registered nurses to questions related to the most fatiguing tasks in their work and factors that cause those tasks to be most fatiguing were analysed.

RESULTS

Physically demanding patient care tasks, and organisation, management and logistics tasks, respectively, were listed as the most frequent physically and mentally fatiguing. Time and multitasking demands were listed frequently as sources of both fatigue dimensions.

CONCLUSIONS

Registered nurses reported working in environments that include physically and mentally fatiguing tasks. They identified factors related to work content demands, including physical and mental task demands as well as time and multitasking demands, as most frequently contributing to fatigue.

IMPLICATIONS FOR NURSING MANAGEMENT

This work and our conceptual model of sources of fatigue provide a framework to support nurses, nursing managers and administrators to develop strategies to reduce fatigue among RNs.

The role of flooring as a design element affecting patient and healthcare worker safety

OBJECTIVE

The objective of this study was to review, identify, and synthesize the literature on patient and healthcare worker safety related to flooring. The topic of flooring in the design of healthcare facilities is complex: healthcare associated infections, push/pull limitations, falls and fall injuries, and noise as a contributing factor to quality of care.

BACKGROUND

Most hospitals have not been explicitly designed to enhance patient safety. Recommendations from the Agency for Healthcare Research and Quality (AHRQ) include preventing patient falls, reducing infections, and preventing medication errors as the areas of emphasis of evidence-based design to improve patient safety and quality of care.

METHODS

A review of the literature was conducted through search engines using a predefined list of keywords to identify studies about flooring and the safety of patients and healthcare workers. Inclusion criteria included peer-reviewed theoretical and empirical studies published in English from 1982 to 2012. Final inclusion was obtained based on an analysis of research design.

RESULTS

Of those 27 articles that met inclusion, 7 focused on healthcare associated infections; 9 focused on slips, trips and falls; 7 articles focused on noise; and 4 focused on fatigue. The studies are profiled in tables and organized by environmental variable.

CONCLUSIONS

Though a limited number of studies met the criteria for this review, the evidence base is emerging to design for safety. Recommendations for future research and practical application of design are provided.

KEYWORDS

Evidence-based design, literature review, patients, safety, staff.

Sound Levels, Staff Perceptions, and Patient Outcomes During Renovation Near the Neonatal Intensive Care Unit

Objective:

Sound levels, staff perceptions, and patient outcomes were evaluated during a year-long hospital renovation project on the floor above a neonatal intensive care unit (NICU).

Background:

Construction noise may be detrimental to NICU patients and healthcare professionals. There are no comprehensive studies evaluating the impact of hospital construction on sound levels, staff, and patients.

Methods:

Prospective observational study comparing sound measures and patient outcomes before, during, and after construction. Staff were surveyed about the construction noise, and hospital employee satisfaction scores are reported.

Results:

Equivalent sound levels were not significantly higher during construction. Most staff members (89%) perceived the renovation period as louder, and 83% reported interruptions of their work. Patient outcomes were the same or more positive during construction. Very low birth weight (VLBW infants were less likely to require 24+ hours' mechanical ventilation during construction: 54% vs. 59% before ( OR = 1.6, p = 0.018) and 62% after ( OR = 1.48, p = 0.065); and they required a shorter total period of mechanical ventilation: 3.6 days vs. 8.0 before ( p = 0.011) and 9.5 after ( p = 0.001). VLBW newborns' differences in ventilation days were mostly in the upper extremes; medians were similar in all periods: 0.6 days vs. 1 day preconstruction and 2 days postconstruction.

Conclusions:

Construction above the NICU did not cause substantially louder sound levels, but staff perceived important changes in noise and work routines. No evidence suggested that patients were negatively affected by the renovation period. Meticulous construction planning remains necessary to avoid interference with patient care and caregiver work environments.

Physicians' perceptions of background noise in a pediatric emergency department

OBJECTIVE

The objectives of this study were to measure noise levels in a tertiary care pediatric emergency department (ED) and to identify attending staff physicians' and first-year residents' perceptions of background noise levels and its impact on communication and teaching.

METHODS

A mixed methodology was used in this study. A sound level meter measuring 30 to 140 dB was placed in the ED for a week. All consenting staff physicians and first-year residents were surveyed using a semistructured questionnaire during the study period to assess their perceptions of background noise and its impact. Descriptive statistics were used for quantitative analysis. Narrative answers were coded and analyzed using the method of meaning condensation to assess the impact of background noise on both communication and teaching.

RESULTS

The average noise level in the ED is 68.73 dB for a 24-hour period. The number sound peaks higher than 80 dB, with an average of 309 dB/d (minimum, 193 dB; maximum, 461 dB). Only 35% of staff physicians' surveys and 22% of residents' surveys identified the noise levels to be uncomfortable. However, background noise in the ED was perceived as stressful, affecting interaction, communication, and teaching between residents and staff physicians. Staff physicians and residents stated that they feel helpless when it is too noisy and did not have good strategies to reduce background noise in the ED.

CONCLUSIONS

The high background noise levels in a pediatric ED are perceived as stressful and interfering with communication and teaching. Noise levels in EDs should be measured, and noise reduction strategies should be implemented because physicians are not consistent in identifying excessive noise levels.

Centralized vs. decentralized nursing stations: effects on nurses' functional use of space and work environment

OBJECTIVE

Evidence-based findings of the effects of nursing station design on nurses' work environment and work behavior are essential to improve conditions and increase retention among these fundamental members of the healthcare delivery team. The purpose of this exploratory study was to investigate how nursing station design (i.e., centralized and decentralized nursing station layouts) affected nurses' use of space, patient visibility, noise levels, and perceptions of the work environment.

BACKGROUND

Advances in information technology have enabled nurses to move away from traditional centralized paper-charting stations to smaller decentralized work stations and charting substations located closer to, or inside of, patient rooms. Improved understanding of the trade-offs presented by centralized and decentralized nursing station design has the potential to provide useful information for future nursing station layouts. This information will be critical for understanding the nurse environment "fit."

METHODS

The study used an exploratory design with both qualitative and quantitative methods. Qualitative data regarding the effects of nursing station design on nurses' health and work environment were gathered by means of focus group interviews. Quantitative data-gathering techniques included place- and person-centered space use observations, patient visibility assessments, sound level measurements, and an online questionnaire regarding perceptions of the work environment.

RESULTS

Nurses on all units were observed most frequently performing telephone, computer, and administrative duties. Time spent using telephones, computers, and performing other administrative duties was significantly higher in the centralized nursing stations. Consultations with medical staff and social interactions were significantly less frequent in decentralized nursing stations. There were no indications that either centralized or decentralized nursing station designs resulted in superior visibility. Sound levels measured in all nursing stations exceeded recommended levels during all shifts. No significant differences were identified in nurses' perceptions of work control-demand-support in centralized and decentralized nursing station designs.

CONCLUSIONS

The "hybrid" nursing design model in which decentralized nursing stations are coupled with centralized meeting rooms for consultation between staff members may strike a balance between the increase in computer duties and the ongoing need for communication and consultation that addresses the conflicting demands of technology and direct patient care.

The psychological effects of the physical healthcare environment on healthcare personnel

BACKGROUND

The physical healthcare environment is capable of affecting patients. This concept of 'healing environments' refers to the psychological impact of environmental stimuli through sensory perceptions. It excludes more physiological effects such as those produced by ergonomic (i.e. fall prevention) or facilitative (i.e. hygiene-related) variables. The importance of an atmosphere in the healthcare environment that promotes the health and well-being of patients is evident, but this environment should not negatively affect healthcare personnel. The physical healthcare environment is part of the personnel's 'workscape'. This can make the environment an important determinant of subjective work-related outcomes like job satisfaction and well-being, as well as of objective outcomes like absenteeism or quality of care. In order to effectively build or renovate healthcare facilities, it is necessary to pay attention to the needs of both patients and healthcare personnel.

OBJECTIVES

To assess the psychological effects of the physical healthcare environment on healthcare personnel.

SEARCH STRATEGY

We searched the Cochrane EPOC Group Specialised Register; Cochrane Central Register of Controlled Trials; Database of Abstracts and Reviews of Effects; MEDLINE; EMBASE; CINAHL; Civil Engineering Database and Compendex. We also searched the reference lists of included studies.

SELECTION CRITERIA

We included randomised controlled trials (RCT), controlled clinical trials (CCT), controlled before and after studies (CBA), and interrupted time series (ITS) of psychological effects of the physical healthcare environment interventions for healthcare staff. The outcomes included measures of job satisfaction, satisfaction with the physical healthcare environment, quality of life, and quality of care.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed studies for eligibility, extracted data, and assessed methodological quality.

MAIN RESULTS

We identified one study, which adopted a CBA study design to investigate the simultaneous effects of multiple environmental stimuli. Staff mood improved in this study, while no effects were found on ward atmosphere or unscheduled absences.

AUTHORS' CONCLUSIONS

One study was included in this review. This review therefore indicates that, at present, there is insufficient evidence to support or refute the impact of the physical healthcare environment on work-related outcomes of healthcare staff. Methodological shortcomings, particularly confounding with other variables and the lack of adequate control conditions, partially account for this lack of evidence. Given these methodological issues, the field is in need of well-conducted controlled trials.

Decreasing noise level in our NICU: The impact of a noise awareness educational program

BACKGROUND

The literature demonstrates that most NICUs exceed the standard recommendations for noise levels and that high noise levels have a negative impact on patients and staff.

OBJECTIVE

The objective of this research was to measure baseline noise level in an NICU, compare it to recommendations of international bodies, and evaluate the impact of a noise awareness educational program (NAEP) as a strategy to decrease it.

DESIGN/METHODS

Means of hourly average noise levels in decibels (dB) were compared with the recommendations and pre- and postintervention (P = .05).

RESULTS

Mean noise-level preintervention was significantly higher than recommended (58.15 vs 45 dB; P < 0.001). The participation rate in NAEP was excellent and most participants thought that the content was relevant and would change their practice. Overall, at first glance, the impact of the NAEP was not as expected: the noise levels increased nonsignificantly postintervention (58.15 vs 58.46 dB; P < .181). However, a significant increase in activity level (number of nurses and patient) was thought to be responsible for the lack of significance postintervention. After controlling for these variables, it was demonstrated that the noise level did significantly decrease postintervention (6.33 vs 5.42 dB per RN & 4.68 vs 4.08 dB per patient, P < .000).

CONCLUSION

Although the efficacy of the program was significantly limited by an increase in general activity, it raised staff awareness and had important effects reflected by the significant decrease in mean noise level after standardization and the participant's comments.

The Effect of Environmental Design on Reducing Nursing Errors and Increasing Efficiency in Acute Care Settings

Physical environment is an important component in the acute care setting that can affect nursing and medication accuracies, as any inadequacy in physical environment would contribute to staff fatigue, stress, and burnout and result in errors. The article discusses a study conducted involving an extensive review and analysis of the literature on this topic and focus groups with various categories of staff members at three hospitals. The review demonstrates that the following environmental variables can contribute to errors in acute care settings: noise levels, ergonomics/furniture/equipment, lighting, and design/layout. Focus groups address the role of the physical environment on medication ordering, storage, delivery, dispensation, preparation, administration, and possible design responses to reduce errors. Integrating the major issues identified and the key findings from the focus groups, four design-related principles are recommended: balance between patient accessibility and reduction of disruptions, automation, minimize staff fatigue, and promoting a culture of safety.

Nurses' perceptions of how physical environment affects medication errors in acute care settings

The work that nurses perform in hospital environments is physically and psychologically intense, with the potential for burnout and stress. This issue is compounded by crowded and poorly designed work spaces in nursing units that can contribute to medical mistakes, including medication errors. This article is based on a study that examined the nurses' perception of how the physical environment in hospitals affects medication errors. Literature suggests that reduction of staff stress can be achieved through physical environmental considerations, such as improved air quality, acoustics, and lighting. However, there is no empirical study specifically exploring the relationship between aspects of the physical environment and medication errors. In this study, a cross-sectional survey was conducted with nursing staff (N = 84) in four hospitals in the Pacific Northwest region of the United States. The survey included questions on nursing unit design, medication room configurations, perceived incidence of errors, and adverse events. Respondents noted several physical environmental factors that are potentially problematic in the nursing station area and can lead to medication, documentation, and other types of nursing errors. These factors include inadequate space in charting and documentation area, lengthy walking distances to patient rooms, insufficient patient surveillance opportunity/lack of visibility to all parts of the nursing unit, small size of the medication room, inappropriate organization of medical supplies, high noise levels in nursing unit, poor lighting, and lack of privacy in the nursing stations. As administrators in acute care facilities consider strategies for organizational and staff interventions to reduce medication errors, it is important to consider physical environmental factors to have a comprehensive understanding of the issue.

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

Objective:

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

Background:

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

Methods:

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

Results:

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

Conclusions:

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

The role of the physical environment in crossing the quality chasm

BACKGROUND

Evidence-based design findings are available to help inform hospital decision makers of opportunities for ensuring that quality and safety are designed into new and refurbished facilities.

FRAMEWORK FOR THE EVIDENCE

The Institute of Medicine's six quality aims of patient centeredness, safety, effectiveness, efficiency, timeliness, and equity provide an organizing framework for introducing a representative portion of the evidence. Design improvements include single-bed and variable-acuity rooms; electronic access to medical records; greater accommodation for families and visitors; handrails to prevent patient falls; standardization (room layout, equipment, and supplies for improved efficiencies); improved work process flow to reduce delays and wait times; and better assessment of changing demographics, disease conditions, and community needs for appropriately targeted health care services.

THE BUSINESS CASE

A recent analysis of the business case suggests that a slight, one-time incremental cost for ensuring safety and quality would be paid back in two to three years in the form of operational savings and increased revenues. Hospitals leaders anticipating new construction projects should take advantage of evidence-based design findings that have the potential of raising the quality of acute care for decades to come.

Noise levels in Johns Hopkins Hospital

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

Acoustics and psychosocial environment in intensive coronary care

BACKGROUND

Stress, strain, and fatigue at the workplace have previously not been studied in relation to acoustic conditions.

AIMS

To examine the influence of different acoustic conditions on the work environment and the staff in a coronary critical care unit (CCU).

METHOD

Psychosocial work environment data from start and end of each individual shift were obtained from three shifts (morning, afternoon, and night) for a one-week baseline period and for two four-week periods during which either sound reflecting or sound absorbing tiles were installed.

RESULTS

Reverberation times and speech intelligibility improved during the study period when the ceiling tiles were changed from sound reflecting tiles to sound absorbing ones of identical appearance. Improved acoustics positively affected the work environment; the afternoon shift staff experienced significantly lower work demands and reported less pressure and strain.

CONCLUSIONS

Important gains in the psychosocial work environment of healthcare can be achieved by improving room acoustics. The study points to the importance of further research on possible effects of acoustics in healthcare on staff turnover, quality of patient care, and medical errors.

Comfort on a ward for older people

BACKGROUND

Comfort is often considered to be a central part of nursing, although the value placed on it may have diminished over time. Many views of comfort are expressed in the literature but it still remains a diffuse concept that requires further clarification. Research evidence about older people and comfort is limited, and further work is needed to find out how staff and patients view comfort and how it is achieved in practice.

AIMS

This paper reports a study to investigate what comfort means both to older people in hospital and their health care workers.

RESEARCH METHODS

Ethnography was the methodology chosen, and data were collected using in-depth interviews with 19 older people and 27 staff members, and 130 hours of participant observation, complemented by additional weekly visits to the study ward.

FINDINGS

Three themes were identified: the nature of comfort/discomfort; key determinants of comfort/discomfort; and the underlying factors that influence the achievement of comfort/discomfort.

DISCUSSION

In this hospital setting, the focus of nursing on relief of discomfort suggested a tendency to react to problems, rather than proactively to create an environment that facilitated comfort. Staff were aware of ideals of practice but found these difficult to achieve in reality. In this study comfort was not consistently provided, and some ways of working actively promoted discomfort. As comfort is central to nursing and nursing is central to the care of hospitalized older people, it is crucial that practitioners are enabled to fulfil their potential in this area.

Qualificação e quantificação da exposição sonora ambiental em uma unidade de terapia intensiva geral

Os níveis de ruído hospitalares encontram-se excessivamente elevados, especialmente no ambiente de UTI, em decorrência dos inúmeros alarmes e equipamentos, além da conversação da própria equipe hospitalar. Diante disso, esse ambiente, que deveria ser silencioso e tranqüilo, torna-se ruidoso, transformando-se em um grande fator de estresse e podendo gerar distúrbios fisiológicos e psicológicos tanto nos pacientes como nos funcionários dessa unidade. OBJETIVO: O objetivo deste estudo foi verificar o nível de pressão sonora equivalente em uma UTI geral, procurando estabelecer o período de maior exposição e comparando os resultados com as recomendações nacionais e internacionais. FORMA DE ESTUDO: Estudo observacional. MATERIAL E MÉTODO: Medição do ruído ambiental da UTI do Hospital São Paulo através do analisador de ruído modelo 2260 (Brüel & Kjaer), em período total de 6.000 minutos e aferições a cada 27 segundos, configurado da seguinte forma: tempo de resposta rápido (Fast), medindo em decibel o nível de pressão sonora e usando a ponderação em freqüência A, de setembro de 2001 a junho de 2002 e sem o conhecimento dos funcionários do setor. RESULTADOS: O nível de pressão sonora equivalente (Leq) apresentou média de 65,36 dB(A) variando de 62,9 a 69,3 dB(A). Durante o período diurno a média do Leq foi de 65,23 dB(A) e para o período noturno, 63,89 dB(A). O L FMax encontrado foi de 108,4 dB(A) e o L FMin de 40 dB(A). CONCLUSÕES: O nível de ruído encontrado nessa UTI está acima do recomendado pela literatura em todos os períodos analisados. Dessa forma, as fontes produtoras de ruído excessivo precisam ser melhor identificadas para que possam ser tomadas as devidas medidas para atenuação desse ruído e tornar esse ambiente um local mais silencioso, beneficiando a função laborativa dos profissionais e a recuperação dos pacientes.

Cognitive and behavioral deficits in premature graduates of intensive care

A substantial number of VLBW graduates of intensive care develop cognitive and behavioral problems, even in the absence of neuroimaging abnormalities. Although this article has highlighted the potential, important, contributing role of medical and stressful, neonatal, environmental conditions to the development of these deficits, it is not all-encompassing, and there are additional prenatal (ie, in utero stress, drug exposure) and neonatal (ie, infectious) contributing factors. The long-term, outcome data presented in this article are pertinent to the more mature, VLBW infant, and it remains unclear and critically important to delineate the long-term, neurobehavioral outcome of those extremely low birth-weight survivors born at the cutting limit of viability.

Noise in the postanaesthesia care unit

BACKGROUND

Although the postanaesthesia care unit (PACU) can be noisy, the effect of noise on patients recovering from anaesthesia is unknown. We studied the sources and intensity of noise in the PACU and assessed its effect on patients' comfort.

METHODS

We measured noise in a five-bed PACU with a sound level meter. Noise levels were obtained using an A-weighted setting (dBA) and peak sound using a linear scale (dBL). Leq (average noise level at 5-s intervals), maximum Leq (LeqMax), minimum Leq (LeqMin) and noise peaks (Lpc) were calculated. During recording, an independent observer noted the origin of sounds from alarms and noise above 65 dB intensity (P65dB). Two hours after leaving the PACU, patients were asked about their experience and to rank their complaints on a visual analogue scale (VAS) using unstructured and structured questionnaires.

RESULTS

We made 20,187 measurements over 1678 min. The mean Leq, LeqMax and LeqMin were 67.1 (SD 5.0), 75.7 (4.8) and 48.6 (4.1) dBA respectively. The mean Lpc was 126.2 (4.3) dBL. Five per cent of the noise was at a level above 65 dBA. Staff conversation caused 56% of sounds greater than 65 dB and other noise sources (alarm, telephone, nursing care) were each less than 10% of these sounds. Five patients reported disturbance from noise. There was no significant difference in Leq measured for patients who found the PACU noisy and those who did not [59.5 (3.1) and 59.4 (2.4) dBA respectively]. Stepwise multiple logistic regression indicated that only pain was associated with discomfort.

CONCLUSIONS

Even though sound in the PACU exceeded the internationally recommended intensity (40 dBA), it did not cause discomfort. Conversation was the most common cause of excess noise.

Neurobehavioral deficits in premature graduates of intensive care--potential medical and neonatal environmental risk factors

There is growing evidence that a large number of very low birth weight infants are exhibiting neurobehavioral problems in the absence of cerebral palsy at follow-up that has extended into school age and adolescence. Many clinical factors (ie, chronic lung disease, recurrent apnea and bradycardia, transient hypothyroxemia of prematurity, hyperbilirubinemia, nutritional deficiencies, glucocorticoid exposure), as well as stressful environmental conditions, including infant-provider interaction, constant noise, and bright light, may act in combination to impact on the developing brain, even in the absence of overt hemorrhage and/or ischemia. Any potential intervention strategy designed to prevent cognitive and behavioral problems has to account for the numerous biological and clinical conditions and/or interventions, as well as postdischarge social and environmental influences.

Reducing noise pollution in the hospital setting by establishing a department of sound: a survey of recent research on the effects of noise and music in health care

A proposal for a solution to reduce stress and anxiety in the hospital setting by combining the problems of excess noise in a hospital setting with the efficacy of music therapy is supported through an analysis of research in the field of noise, hospital noise pollution, and music medicine. Included in this overview are articles describing the effects of noise on health, the problems of noise pollution in the health care setting, and the benefits of replacing noise with music to reduce heart rate, blood pressure, breathing rate, emotional anxiety, and pain. By combining these areas of research, the authors propose the establishment of a department assigned to (1) control the amount of noise in a hospital and (2) provide a center of music therapy for all individuals in the hospital setting, including in-patients, out-patients, doctors, and staff. Due to the large specificity of these areas, this unifying source, or "Department of Sound," is suggested to aid in thoroughly addressing and combining these two concepts most effectively.