Stress effects of personal control over hospital noise

The effect of disruptions during counseling on recall of genetic risk information: the case of cystic fibrosis

Genetic counseling is a communication process with two main functions: information provision and supportive counseling. The information transmission function may be compromised by disruptions that occur during counseling. At least two mediators are possible: (a) disruptions may interfere with memory by creating distractions and divided attention during encoding or (b) disruptions may degrade the flow of interaction which requires that participants engage in conversation repair rather than the task at hand. This study examined both alternatives in a group of parents (N=20 families, 40 individual parents) whose infant had received a newborn screening for cystic fibrosis (CF). Upon arrival at the hospital, each parent completed a questionnaire designed to assess his or her knowledge of CF. Their interaction with the genetic counselor was videotaped and coded for the presence of disruptions. Six weeks after the counseling, parents again completed the knowledge measure. The data showed a direct negative effect for disruptions during counseling on memory for CF-related risk information six weeks later. Disruptions also produced the anticipated effect on conversation, but counter to expectations, interruptions of conversation flow was positively associated with knowledge at time 2.

Interactive relationships between hospital patients' noise-induced stress and other stress with sleep

OBJECTIVE

The purpose of this study was to test the hypothesis that hospital noise-induced subjective stress would interact with other subjective environmental and personal stress in a relationship with poorer patient sleep.

METHODS

A secondary data analysis was done using correlations and hierarchical multiple regression. Ninety-seven cardiac patients participated after transfer from critical care to a general unit. The independent variables were assessed with Topf's 24-item Disturbance Due to Hospital Noise Scale and 5-point items for other environmental stress (ie, bed, lights) and personal stress (ie, pain, anxiety). Sleep was evaluated with the Verran and Snyder-Halpern Sleep Scale.

RESULTS

Hierarchical multiple regression led to a multiple R of 0.435 (P <.01). An interaction term, subjective noise stress x subjective bed stress x subjective pain x subjective anxiety accounted for a significant amount of sleep variance (12%, F = 13.63, P =.000). Subjective bed stress x subjective pain accounted for an additional 5% (F = 6.4, P =.013).

CONCLUSIONS

Studies using research designs that assess relationships between multiple patient stress variable interactions and sleep or other stress-related outcomes may produce more accurate results than studies on the independent effects of different types of stress.

Hospital noise pollution: an environmental stress model to guide research and clinical interventions

Hospital noise pollution: an environmental stress model to guide research and clinical interventions This commentary provides an expanded environmental stress model. Conceptual relationships between ambient stressors, ambient stress, and health are detailed. A three-part intervention, enhancement of person-environment compatibility, is specified. Details are provided on how this approach to reducing environmental pollution/hazards and sustaining these changes may be influenced by sociopolitical values, technological advances, and motivation for control over hazards. Personal variables thought to mediate the impact of environmental stress on health, including intrinsic sensitivity to specific hazards, personality, restricted capacities, other stress, culture, personal preferences, stage of life, gender, and perceived social support, are highlighted. Research results on the stress and health effects of hospital noise on patients and nurses are summarized to provide support for the model. Future directions for research are recommended. Implications of the model for nursing, including an environmental activist role in an interdisciplinary effort to plan and implement noise abatement interventions, are described.

Ambient sound levels in a state psychiatric hospital

High environmental and psychosocial stress contribute to the onset and relapse of major psychiatric disorders. High sound levels in general hospitals are common and may be indirectly associated with negative physical effects because of increased physiological stress on the body. Excessive sound also interferes with cognitive functioning, especially affecting prefrontal cortical processes, but no information about sound levels in psychiatric hospitals was available. This study critically examines literature on sound stress and reports findings from an exploratory study of sound levels in a tertiary care psychiatric hospital. An overall mean sound level of 75.68 dB was found, with peak sound levels as high as 85 to 90 dB, in the range that causes hearing loss. These levels, higher than sound levels on medical, surgical, and intensive care units, suggest the need for more attention to the effect that environmental sound has on the behavior of patients hospitalized with acute psychiatric symptoms.

The nighttime environment and incontinence care practices in nursing homes

OBJECTIVES

To determine the variability in noise, light, and incontinence care practices between nursing homes (NHs) and the association between these factors and residents' nighttime sleep.

DESIGN

Prospective descriptive study of a sample of incontinent NH residents.

SETTING

Ten nursing homes.

SUBJECTS

Two hundred twenty-five incontinent NH residents.

MAIN OUTCOME MEASURES

Measurements of residents' sleep by wrist actigraphs, bed mobility by pressure sensitive Kynar strips, and environmental noise and light changes were recorded by bedside monitors in consecutive 2-minute intervals for two 10-hour nighttime data collection periods (7 PM to 5 AM).

RESULTS

Forty-two percent of waking episodes lasting 4 minutes or longer were associated with noise, light, or incontinence care events. Twenty-two percent of waking episodes of 4 minutes or longer were associated with noise alone, 10% with light or light + noise, and 10% with incontinence care routines. Seventy-six percent of all incontinence care practices resulted in awakenings. There was variability between the 10 NHs, with the percentage of waking episodes associated with environmental events (noise, light, or incontinence care events) ranging from 23.6 to 66.0%.

CONCLUSION

Noise and incidents of incontinence care practices were associated with a substantial amount of sleep disruption in residents in all 10 nursing homes, even though there was variability between homes. Interventions minimizing such environmental events are needed to promote better sleep in incontinent NH residents.

A CQI approach to the investigation of noise levels within the intensive care unit environment

In February 1991, the Intensive Care Unit (ICU) at Liverpool Hospital was extended and relocated to a larger area. It soon became apparent that noise levels within the newly renovated unit were particularly worrying to patients, staff and relatives. A Continuous Quality Improvement (CQI) group was formed to investigate, and develop measures to reduce these noise levels. Through the implementation of various CQI tools a study plan was developed to investigate the noise problem. The study plan included: a patient, relative and staff questionnaire; a literature search; identification of levels of noise using a sound level meter; contracting a noise consultant to visit and review the ICU environment. The results of the CQI investigations revealed that there was an inappropriately high level of noise in the ICU. Several key contributing factors were also identified. These findings provided the basis for several positive measures to be undertaken including: the installation of sound absorbing ceilings; removal of rubbish bin lids; revision of the telephone ringing system; revision of the mobile x-ray machine; prioritisation of audible machine alarms; education of staff in noise level awareness; The application of the Continuous Quality Improvement (CQI) process to the noise problem facilitated the exploration of the source of noise, the effects on staff and patients, and ways to reduce noise levels in the intensive care environment.

Theoretical considerations for research on environmental stress and health

Research on hospital noise may have implications for the usefulness of stress theory as a framework for the study of environmental stress and stress-related health outcomes. In this article, the results of hospital noise research are described. It is argued that noise-induced stress in hospitals is largely uncontrollable by individual coping and that stress theory may therefore need to be supplemented for the reduction of reactivity. Three concepts are proposed for this purpose. Primary among these is an intervention concept--enhancement of person-environment compatibility. Others are ongoing societal and technological development, and intrinsic sensitivity to specific stressors in the environment. Future research should attempt to reveal whether these concepts are consistently effective in the management of hospital noise and other environmental stressors.