Noise Reduction in Progressive Care Units

Enhancing Postanesthesia Care Unit Management Based on Noise Reduction Strategies Grounded in Comfort Theory

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.

Effect of Acoustic Environment in Wards on Postoperative Rehabilitation in Patients with Oral Cancer: A Retrospective Study

OBJECTIVE

The increase in patient flow, replacement of medical equipment, and variations in surrounding environments induce increasingly serious acoustic environment problems in hospitals. This study aims to provide additional bases for the formulation of subsequent management plans in clinical practice by analyzing the influence of the acoustic environment in wards and the postoperative rehabilitation effect among patients with oral cancer.

METHODS

The medical records of 210 patients with oral cancer undergoing surgical treatment in Jinan Stomatological Hospital from February 2020 to October 2022 were selected for retrospective analysis. Patients with the acoustic environment in wards >55 and ≤55 dB were classified as groups A and B, respectively, according to the acoustic environment in wards. The effects of the acoustic environment in wards on postoperative blood pressure, blood viscosity, and blood glucose fluctuation (BGF) were observed to further analyze their relationship.

RESULTS

No significant difference was observed in indices such as preoperative systolic pressure (SP), diastolic pressure (DP), cardiac output (CO), postoperative CO, total cholesterol, and low- and high-density lipoproteins between the two groups (P > 0.05). The SP, DP, whole blood low-shear viscosity (WBLSV), whole blood middle-shear viscosity (WBMSV), whole blood high-shear viscosity (WBHSV), and BGF in group B were significantly lower than group A (P < 0.05). Correlation results showed that the total mean value of the acoustic environment in wards was positively correlated with SP, DP, WBLSV, WBMSV, WBHSV, and BGF (P < 0.05).

CONCLUSION

The high acoustic environment in wards is significantly positively correlated with postoperative blood pressure, blood viscosity, and BGF in patients with oral cancer. The hospital should focus on and strengthen the management of the acoustic environment in wards, providing additional schemes to promote the postoperative recovery of patients with oral cancer.

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

BACKGROUND AND OBJECTIVE

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

OBJECTIVE AND METHODS

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

RESULTS

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

CONCLUSION

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

Effects of Comprehensive Noise Reduction Management Combined with Reality Therapy on Anxiety and Depression in Hospitalised Patients with Breast Cancer

Objective

This study was conducted to explore the effects of comprehensive noise reduction management combined with reality therapy on anxiety and depression in hospitalised patients with breast cancer.

Methods

The medical records of 166 inpatients with breast cancer in Tongji Hospital affiliated with Tongji Medical College of Huazhong University of Science and Technology from March 2020 to March 2022 were retrospectively analysed. According to different intervention methods, these patients were divided into group A (n = 58, receiving conventional intervention), group B (n = 55, receiving conventional intervention combined with reality therapy) and group C (n = 53, receiving conventional intervention combined with comprehensive noise reduction management and reality therapy intervention). Patients' anxiety and depression, quality of life and satisfaction degree in the three groups were compared.

Results

Before the intervention, the scores of the Hospital Anxiety and Depression Scale (HADS) and Short-From-36 Health Survey (SF-36) scale did not significantly differ amongst the three groups (P > 0.05). After the intervention, we observed a difference in the pairwise comparison of HADS scores amongst the three groups, in which group C had the lowest score and group A had the highest HADS score (P < 0.001). We also noted a difference in the pairwise comparison of SF-36 scores amongst the three groups, in which group C had the highest SF-36 score and group A had the lowest SF-36 score (P < 0.001). The pairwise comparison of satisfaction revealed a difference amongst the three groups, in which group C had the highest satisfaction (92.45%, 94.34% and 94.34%), and group A had the lowest satisfaction (74.14%, 74.14% and 75.86%; P < 0.05).

Conclusion

Comprehensive noise reduction management combined with reality therapy can effectively relieve the negative emotions of inpatients with breast cancer, as well as improve their survival state of patients. It is suggested that it be included in the clinical intervention system for breast cancer.

Aesthetics sets patients 'free' to recover during hospitalization with a neurological disease. A qualitative study

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.

Conducive environments reduce sleep disturbances and improve sleep quality: a quality improvement project

AIM

The current implementation project aimed to improve patients' sleep quality in a hospital by implementing targeted interventions to reduce sleep disturbances.

METHODS

The Silent Night project was implemented in two general units of an academic tertiary hospital. The project comprised three phases: preimplementation, implementation, and postimplementation. Patient surveys were administered to obtain patients' perspectives on the sources of noise disturbances at night. Noise-monitoring machines were installed in two wards to obtain objective data on noise levels at night. Concurrently, data were collected on noise-generating activities that were observed.

RESULTS

The overall quality of sleep reported by patients improved by 17% (from 73.5 to 88.9%). Patients' survey reported reduced noise disturbances from direct care activities, environmental noise and medical equipment alarms. The mean noise level in the orthopedics unit reduced significantly from 57.04 to 55.22 dB with a corresponding decrease in noise generating activities by 60% (from 362 to 144). In the geriatric unit, the mean noise level increased from 51.36 to 53.12 dB but is within the National Environmental Agency's permissible noise level of 55 dB even though the noise generating activities reduced significantly by 92.2% (from 954 to 74).

CONCLUSION

The 'Silent Night' project has successfully reduced noise disturbances generating from environment and nursing care activities and improved patients' sleep quality in the hospital. Sharing sessions regarding sources of noise and the 'Silent Night' poster promoted the awareness of noise disturbances in healthcare professionals, visitors, and patients.

Improving Quiet at Night on a Telemetry Unit: Introducing a Holistic Sleep Menu Intervention

In a patient's recovery process, restful sleep is crucial. Although the essential role of sleep in healing has long been recognized, excessive noise in hospital environments remains a persistent and pervasive problem. For hospitalized patients, environmental noise can result in sleep deprivation and adverse health outcomes; not surprisingly, hospital noise ranks as a major patient complaint. At a small suburban community hospital, patients responding to a quiet-at-night question in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey gave the hospital's telemetry unit the lowest possible score: 1 out of 5 points. In response, the unit's quality improvement team, coordinated by a clinical nurse leader, introduced a holistic "sleep menu" intervention. The multicomponent intervention subsequently improved patients' care experience and staff engagement. The percentage of patients who self-reported five or more hours of uninterrupted sleep rose from 31% at baseline to 80% during the intervention. This improvement was sustained over the three-month intervention period and led to a quiet-at-night HCAHPS score of 4. The sleep menu initiative resulted in substantial benefits that optimized both patient and organizational outcomes.

Assessment of Noise Exposure and Its Characteristics in the Intensive Care Unit of a Tertiary Hospital

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.

Decreasing Pediatric PACU Noise Level and Alarm Fatigue: A Quality Improvement Initiative to Improve Safety and Satisfaction

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.