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Orhan C, Yilmazer S. The Neonatal Intensive Care Unit (NICU) Context and the Perceived Soundscape: A Grounded Theory Approach. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024:19375867241229652. [PMID: 38373898 DOI: 10.1177/19375867241229652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
BACKGROUND Studies address excessive sound levels and their adverse effects on infants in neonatal intensive care units (NICUs). However, objective measurements represent merely one aspect of the acoustic environment, and investigations into staff's perceptions of the acoustic environment remain scarce in the NICU context. A holistic approach, soundscape, is needed to explore the acoustic environment in-depth. AIM This study aims to (1) contribute to indoor soundscape literature and inform decision-makers of future NICU design and research by focusing on staff members' perceptions of the soundscape and (2) explore whether there is a relationship between staff members' perceptions of soundscapes and the built and acoustic environments of one NICU. METHODS Following the ISO/TS 12913-2/3 protocols, semi-structured interviews were conducted with 10 NICU staff members and analyzed using the grounded theory to generate a conceptual framework for NICU soundscapes. RESULTS The results indicated that the task-related sounds, including false alarms, were neutrally responded to as they evoked acceptance and adaptation behaviors. The sound sources perceived as irrelevant were responded to negatively. NICU staff indicated that although they expect to hear alarms clearly, specific features of alarms caused several physiological and psychological problems. CONCLUSIONS The findings of the study revealed the importance of conducting a soundscape approach to investigate NICU acoustic environment in detail. The study showed that staff members' perceptions and responses primarily depend on the context rather than on sound levels.
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Affiliation(s)
- Cemre Orhan
- Department of Interior Architecture and Environmental Design, Faculty of Art, Design and Architecture, I.D. Bilkent University, Ankara, Turkey
| | - Semiha Yilmazer
- Department of Interior Architecture and Environmental Design, Faculty of Art, Design and Architecture, I.D. Bilkent University, Ankara, Turkey
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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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Haslbeck FB, Mueller K, Karen T, Loewy J, Meerpohl JJ, Bassler D. Musical and vocal interventions to improve neurodevelopmental outcomes for preterm infants. Cochrane Database Syst Rev 2023; 9:CD013472. [PMID: 37675934 PMCID: PMC10483930 DOI: 10.1002/14651858.cd013472.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
BACKGROUND Preterm birth interferes with brain maturation, and subsequent clinical events and interventions may have additional deleterious effects. Music as therapy is offered increasingly in neonatal intensive care units aiming to improve health outcomes and quality of life for both preterm infants and the well-being of their parents. Systematic reviews of mixed methodological quality have demonstrated ambiguous results for the efficacy of various types of auditory stimulation of preterm infants. A more comprehensive and rigorous systematic review is needed to address controversies arising from apparently conflicting studies and reviews. OBJECTIVES We assessed the overall efficacy of music and vocal interventions for physiological and neurodevelopmental outcomes in preterm infants (< 37 weeks' gestation) compared to standard care. In addition, we aimed to determine specific effects of various interventions for physiological, anthropometric, social-emotional, neurodevelopmental short- and long-term outcomes in the infants, parental well-being, and bonding. SEARCH METHODS We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, RILM Abstracts, and ERIC in November 2021; and Proquest Dissertations in February 2019. We searched the reference lists of related systematic reviews, and of studies selected for inclusion and clinical trial registries. SELECTION CRITERIA We included parallel, and cluster-randomised controlled trials with preterm infants < 37 weeks` gestation during hospitalisation, and parents when they were involved in the intervention. Interventions were any music or vocal stimulation provided live or via a recording by a music therapist, a parent, or a healthcare professional compared to standard care. The intervention duration was greater than five minutes and needed to occur more than three times. DATA COLLECTION AND ANALYSIS Three review authors independently extracted data. We analysed the treatment effects of the individual trials using RevMan Web using a fixed-effects model to combine the data. Where possible, we presented results in meta-analyses using mean differences with 95% CI. We performed heterogeneity tests. When the I2 statistic was higher than 50%, we assessed the source of the heterogeneity by sensitivity and subgroup analyses. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included 25 trials recruiting 1532 infants and 691 parents (21 parallel-group RCTs, four cross-over RCTs). The infants gestational age at birth varied from 23 to 36 weeks, taking place in NICUs (level 1 to 3) around the world. Within the trials, the intervention varied widely in type, delivery, frequency, and duration. Music and voice were mainly characterised by calm, soft, musical parameters in lullaby style, often integrating the sung mother's voice live or recorded, defined as music therapy or music medicine. The general risk of bias in the included studies varied from low to high risk of bias. Music and vocal interventions compared to standard care Music/vocal interventions do not increase oxygen saturation in the infants during the intervention (mean difference (MD) 0.13, 95% CI -0.33 to 0.59; P = 0.59; 958 infants, 10 studies; high-certainty evidence). Music and voice probably do not increase oxygen saturation post-intervention either (MD 0.63, 95% CI -0.01 to 1.26; P = 0.05; 800 infants, 7 studies; moderate-certainty evidence). The intervention may not increase infant development (Bayley Scales of Infant and Toddler Development (BSID)) with the cognitive composition score (MD 0.35, 95% CI -4.85 to 5.55; P = 0.90; 69 infants, 2 studies; low-certainty evidence); the motor composition score (MD -0.17, 95% CI -5.45 to 5.11; P = 0.95; 69 infants, 2 studies; low-certainty evidence); and the language composition score (MD 0.38, 95% CI -5.45 to 6.21; P = 0.90; 69 infants, 2 studies; low-certainty evidence). Music therapy may not reduce parental state-trait anxiety (MD -1.12, 95% CI -3.20 to 0.96; P = 0.29; 97 parents, 4 studies; low-certainty evidence). The intervention probably does not reduce respiratory rate during the intervention (MD 0.42, 95% CI -1.05 to 1.90; P = 0.57; 750 infants; 7 studies; moderate-certainty evidence) and post-intervention (MD 0.51, 95% CI -1.57 to 2.58; P = 0.63; 636 infants, 5 studies; moderate-certainty evidence). However, music/vocal interventions probably reduce heart rates in preterm infants during the intervention (MD -1.38, 95% CI -2.63 to -0.12; P = 0.03; 1014 infants; 11 studies; moderate-certainty evidence). This beneficial effect was even stronger after the intervention. Music/vocal interventions reduce heart rate post-intervention (MD -3.80, 95% CI -5.05 to -2.55; P < 0.00001; 903 infants, 9 studies; high-certainty evidence) with wide CIs ranging from medium to large beneficial effects. Music therapy may not reduce postnatal depression (MD 0.50, 95% CI -1.80 to 2.81; P = 0.67; 67 participants; 2 studies; low-certainty evidence). The evidence is very uncertain about the effect of music therapy on parental state anxiety (MD -0.15, 95% CI -2.72 to 2.41; P = 0.91; 87 parents, 3 studies; very low-certainty evidence). We are uncertain about any further effects regarding all other secondary short- and long-term outcomes on the infants, parental well-being, and bonding/attachment. Two studies evaluated adverse effects as an explicit outcome of interest and reported no adverse effects from music and voice. AUTHORS' CONCLUSIONS Music/vocal interventions do not increase oxygen saturation during and probably not after the intervention compared to standard care. The evidence suggests that music and voice do not increase infant development (BSID) or reduce parental state-trait anxiety. The intervention probably does not reduce respiratory rate in preterm infants. However, music/vocal interventions probably reduce heart rates in preterm infants during the intervention, and this beneficial effect is even stronger after the intervention, demonstrating that music/vocal interventions reduce heart rates in preterm infants post-intervention. We found no reports of adverse effects from music and voice. Due to low-certainty evidence for all other outcomes, we could not draw any further conclusions regarding overall efficacy nor the possible impact of different intervention types, frequencies, or durations. Further research with more power, fewer risks of bias, and more sensitive and clinically relevant outcomes are needed.
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Affiliation(s)
| | - Katharina Mueller
- Zentrum für Kinder und Jugendmedizin, University Freiburg, Freiburg, Germany
| | - Tanja Karen
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Joanne Loewy
- Mount Sinai Health System, The Louis Armstrong Center for Music & Medicine, New York City, USA
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
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Ruettgers N, Naef AC, Rossier M, Knobel SEJ, Jeitziner MM, Grosse Holtforth M, Zante B, Schefold JC, Nef T, Gerber SM. Perceived sounds and their reported level of disturbance in intensive care units: A multinational survey among healthcare professionals. PLoS One 2022; 17:e0279603. [PMID: 36584079 PMCID: PMC9803129 DOI: 10.1371/journal.pone.0279603] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 12/09/2022] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The noise levels in intensive care units have been repeatedly reported to exceed the recommended guidelines and yield negative health outcomes among healthcare professionals. However, it is unclear which sound sources within this environment are perceived as disturbing. Therefore, this study aimed to evaluate how healthcare professionals in Germany, Switzerland, and Austria perceive the sound levels and the associated sound sources within their work environment and explore sound reduction strategies. MATERIAL AND METHODS An online survey was conducted among 350 healthcare professionals working in intensive care units. The survey consisted of items on demographic and hospital data and questions about the perception of the sound levels [1 (strongly disagree) to 5 (strongly agree)], disturbance from sound sources [1 (not disturbing at all) to 5 (very disturbing)], and implementation potential, feasibility, and motivation to reduce sound reduction measures [1 (not high at all) to 5 (very high)]. RESULTS Approximately 69.3% of the healthcare professionals perceived the sound levels in the ICUs as too high. Short-lasting human sounds (e.g. moans or laughs) [mean (M) ± standard deviation (SD) = 3.30 ± 0.81], devices and alarms (M ± SD = 2.67 ± 0.59), and short-lasting object sounds (M ± SD = 2.55 ± 0.68) were perceived as the most disturbing sounds. Reducing medical equipment alarms was considered to have greater implementation potential [M ± SD = 3.62 ± 0.92, t(334) = -7.30, p < 0.001], feasibility [M ± SD = 3.19 ± 0.93, t(334) = -11.02, p < 0.001], and motivation [M ± SD = 3.85 ± 0.89, t(334) = -10.10, p < 0.001] for reducing the sound levels. CONCLUSION This study showed that healthcare professionals perceive short-lasting human sounds as most disturbing and rated reducing medical equipment alarms as the best approach to reduce the sound levels in terms of potential, feasibility, and motivation for implementation.
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Affiliation(s)
- Nicole Ruettgers
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Aileen C. Naef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Marilyne Rossier
- 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
| | - 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
- Psychosomatic Medicine, Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Clinical Psychology and Psychotherapy, 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
- * E-mail:
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Darbyshire JL, Duncan Young J. Variability of environmental sound levels: An observational study from a general adult intensive care unit in the UK. J Intensive Care Soc 2022; 23:389-397. [PMID: 36751355 PMCID: PMC9679913 DOI: 10.1177/17511437211022127] [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] [Indexed: 11/17/2022] Open
Abstract
Background Intensive care units are significantly louder than WHO guidelines recommend. Patients are disturbed by activities around them and frequently report disrupted sleep. This can lead to slower recovery and long-term health problems. Environmental sound levels are usually reported as LAeq24, a single daily value that reflects mean sound levels over the previous 24-h period. This may not be the most appropriate measure for intensive care units (ICUs) and other similar areas. Humans experience sound in context, and disturbance will vary according to both the individual and acoustic features of the ambient sounds. Loudness is one of a number of measures that approximate the human perception of sound, taking into account tone, duration, and frequency, as well as volume. Typically sounds with higher frequencies, such as alarms, are perceived as louder and more disturbing. Methods Sound level data were collected from a single NHS Trust hospital general adult intensive care unit between October 2016 and May 2018. Summary data (mean sound levels (LAeq) and corresponding Zwicker calculated loudness values) were subsequently analysed by minute, hour, and day. Results The overall mean LAeq24 across the study duration was 47.4 dBA. This varied by microphone location. We identified a clear pattern to sound level fluctuations across the 24-h period. Weekends were significantly quieter than weekdays in statistical terms but this reduction of 0.2 dB is not detectable by human hearing. Peak loudness values over 90 dB were recorded every hour. Conclusions Perception of sound is sensitive to the environment and individual characteristics and sound levels in the ICU are location specific. This has implications for routine environmental monitoring practices. Peak loudness values are consistently between 90 and 100 dB. These may be driven by alarms and other sudden high-frequency sounds, leading to more disturbance than LAeq24 sound levels suggest. Addressing sounds with high loudness values may improve the ICU environment more than an overall reduction in the 24-h mean decibel value.
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Affiliation(s)
- Julie L Darbyshire
- Julie L Darbyshire, Nuffield
Department of Clinical Neurosciences, University of Oxford, Oxford UK.
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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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Lam MTY, Malhotra A, LaBuzetta JN, Kamdar BB. Sleep in Critical Illness. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_19] [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: 11/28/2022]
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Nilius G, Richter M, Schroeder M. Updated Perspectives on the Management of Sleep Disorders in the Intensive Care Unit. Nat Sci Sleep 2021; 13:751-762. [PMID: 34135650 PMCID: PMC8200142 DOI: 10.2147/nss.s284846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/19/2021] [Indexed: 12/28/2022] Open
Abstract
Sleep disorders and circadian dysrhythmias are extremely prevalent in critically ill patients. Impaired sleep has a variety of etiologies, exhibits a wide range of negative effects and, moreover, might deteriorate the patient's prognosis. Despite a number of scientific findings and increased awareness, the importance of sleep optimization is still lower on the list of priories in the intensive care unit (ICU). The techniques of measuring and the evaluation of sleep quantity and quality are a great challenge in the ICU setting. The subjective and objective tools of sleep validation continue to suffer from deficiencies. Treatment approaches to improve the critically ill patient's sleep have focused on non-pharmacologic and pharmacologic strategies with some promising results. But pharmacological interventions alone could not provide sufficient patient benefit. Being aware and knowing of sleep problems and the beneficial effect of the necessary therapies in ICU patients requires greater acceptance. The application of available methods and the development of new methods to prevent sleep disorders in the ICU offer the potential to improve the critically ill patient's outcome.
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Affiliation(s)
- Georg Nilius
- Kliniken Essen Mitte, Department of Pneumology, Essen, Germany
- Witten/Herdecke University, Department of Internal Medicine, Witten, Germany
| | | | - Maik Schroeder
- Kliniken Essen Mitte, Department of Pneumology, Essen, Germany
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Contribution of alarm noise to average sound pressure levels in the ICU: An observational cross-sectional study. Intensive Crit Care Nurs 2020; 61:102901. [PMID: 32660883 DOI: 10.1016/j.iccn.2020.102901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 05/25/2020] [Accepted: 06/03/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To explore sound levels, alarm frequencies and the association between alarms and sound levels. DESIGN A single center observational cross-sectional study. SETTING Four intensive care units. MAIN OUTCOME MEASURES Contribution of alarms: red (life threatening), yellow (indicate excess of limits) and blue (technical) to sound pressure levels dB(A) at nursing stations. RESULTS Mean sound pressure levels differed significantly between day (56.1 ± 5.5), evening (55.1 ± 5.7) and night periods 53.6 ± 5.6; p < 0.01. 175,996 alarms were recorded of which 149,764 (85%) were yellow, 18,080 (10%) were red and 8,152 (5%) were blue. The mean sound levels without alarms (background) is 56.8 dB(A), with only red: 56.0 dB(A), only yellow: 55.6 dB(A), only blue: 56.0 dB(A) and mixed alarms: 56.3 dB(A). Yellow alarms (b = -0.93; 95% CI: -1.26 to -0.6; p < 0.001) were weakly but significantly associated with mean sound levels and lead to a slight decrease in noise level (1 dB), Red alarms (b = -0.3; 95% CI: -1.237 to 0.63; p = 0.52). The R Square of the model with all alarms was 0.01 (standard error of estimate, 6.9; p < 0.001). CONCLUSIONS Sound levels were high during all day-periods. Alarms exceeding limits occurred most frequently. However, the contribution of alarms to sound levels measured at the nursing station is clinically limited.
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Miranda-Ackerman RC, Lira-Trujillo M, Gollaz-Cervantez AC, Cortés-Flores AO, Zuloaga-Fernández Del Valle CJ, García-González LA, Morgan-Villela G, Barbosa-Camacho FJ, Pintor-Belmontes KJ, Guzmán-Ramírez BG, Bernal-Hernández A, Fuentes-Orozco C, González-Ojeda A. Associations between stressors and difficulty sleeping in critically ill patients admitted to the intensive care unit: a cohort study. BMC Health Serv Res 2020; 20:631. [PMID: 32646516 PMCID: PMC7346515 DOI: 10.1186/s12913-020-05497-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/01/2020] [Indexed: 01/14/2023] Open
Abstract
Background Patients admitted to the intensive care unit (ICU) experience sleep disruption caused by a variety of conditions, such as staff activities, alarms on monitors, and overall noise. In this study, we explored the relationship between noise and other factors associated with poor sleep quality in patients. Methods This was a prospective cohort study. We used the Richards–Campbell Sleep Questionnaire to explore sleep quality in a sample of patients admitted to the ICU of a private hospital. We measured the noise levels within each ICU three times a day. After each night during their ICU stay, patients were asked to complete a survey about sleep disturbances. These disturbances were classified as biological (such as anxiety or pain) and environmental factors (such as lighting and ICU noise). Results We interviewed 71 patients; 62% were men (mean age 54.46 years) and the mean length of stay was 8 days. Biological factors affected 36% and environmental factors affected 20% of the patients. The most common biological factor was anxiety symptoms, which affected 28% of the patients, and the most common environmental factor was noise, which affected 32.4%. The overall mean recorded noise level was 62.45 dB. Based on the patients’ responses, the environmental factors had a larger effect on patients’ sleep quality than biological factors. Patients who stayed more than 5 days reported less sleep disturbance. Patients younger than 55 years were more affected by environmental and biological factors than were those older than 55 years. Conclusions Patient quality of sleep in the ICU is associated with environmental factors such as noise and artificial lighting, as well as biological factors related to anxiety and pain. The noise level in the ICU is twice that recommended by international guides. Given the stronger influence of environmental factors, the use of earplugs or sleeping masks is recommended. The longer the hospital stay, the less these factors seem to affect patients’ sleep quality.
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Affiliation(s)
| | | | | | | | | | | | | | - Francisco José Barbosa-Camacho
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Avenida Belisario Domínguez # 1000 Col. Independencia, 44340, Guadalajara, Jalisco, Mexico
| | - Kevin Josue Pintor-Belmontes
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Avenida Belisario Domínguez # 1000 Col. Independencia, 44340, Guadalajara, Jalisco, Mexico
| | - Bertha Georgina Guzmán-Ramírez
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Avenida Belisario Domínguez # 1000 Col. Independencia, 44340, Guadalajara, Jalisco, Mexico
| | - Aldo Bernal-Hernández
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Avenida Belisario Domínguez # 1000 Col. Independencia, 44340, Guadalajara, Jalisco, Mexico
| | - Clotilde Fuentes-Orozco
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Avenida Belisario Domínguez # 1000 Col. Independencia, 44340, Guadalajara, Jalisco, Mexico
| | - Alejandro González-Ojeda
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Avenida Belisario Domínguez # 1000 Col. Independencia, 44340, Guadalajara, Jalisco, Mexico.
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Effectiveness of a visual noise warning system on noise levels in a surgical ICU: A quality improvement programme. Eur J Anaesthesiol 2020; 36:857-862. [PMID: 31261169 DOI: 10.1097/eja.0000000000001038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The effects of noise are harmful to patients in the ICU environment, and the latter are particularly noisy places. High noise levels seem to be a factor in sleep disturbance, which can, in turn, result in increased morbidity. LOCAL PROBLEM High noise levels are a recognised problem in ICUs worldwide. OBJECTIVE(S) The goal was to estimate the effect of a visual noise-warning system on noise levels in a surgical ICU before and after its implementation. DESIGN A quality improvement initiative. SETTING A 12-bedded surgical ICU in a tertiary care university hospital. PATIENTS A total of 148 adult nonintubated and nonsedated patients completed the study, during a 6-week period. INTERVENTION Noise levels were continuously recorded using a Type II sound level meter for 6 weeks. The study was divided into three phases. The first 2 weeks, baseline noise levels were measured (phase I). In week 3 of the study, a visual noise warning system (SoundEar II) that changed colour depending on noise levels within the ICU was installed and implemented (phase II). The alarm system was set to light up green at levels below 55 dBA, orange at levels between 55 and 60 dBA and red at levels above 60 dBA. The device was switched off at the beginning of week 5 and the sound level meter continued recording noise levels for another 2 weeks (phase III). RESULTS Mean night-time noise level was 55.98 dBA in the preintervention phase, 54.14 dB during the intervention, and 54.98 dBA in the postintervention phase. Mean noise level was reduced statistically significantly by 1.35 dBA, and there was a sustained reduction of 0.86 dBA from the baseline noise level 2 weeks after SoundEar II was switched off. CONCLUSION Visual noise warning systems can be effective in achieving a reduction in noise levels in critical care units.
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Kamdar BB, Simons KS, Spronk PE. Can ICUs create more sleep by creating less noise? Intensive Care Med 2020; 46:498-500. [PMID: 31654080 DOI: 10.1007/s00134-019-05834-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/16/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Biren B Kamdar
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, San Diego, La Jolla, CA, USA
| | - Koen S Simons
- Department of Intensive Care Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Peter E Spronk
- Department of Intensive Care Medicine, Gelre Hospitals Apeldoorn, Albert Schweitzerlaan 31, 7334 DZ, Apeldoorn, The Netherlands.
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13
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Haslbeck FB, Karen T, Loewy J, Meerpohl JJ, Bassler D. Musical and vocal interventions to improve neurodevelopmental outcomes for preterm infants. Hippokratia 2019. [DOI: 10.1002/14651858.cd013472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Tanja Karen
- University Hospital Zürich; Department of Neonatology; Frauenklinikstrasse 10 Zürich Switzerland
| | - Joanne Loewy
- The Louis Armstrong Center for Music and Medicine; Beth Israel Medical Center New York City USA
| | - Joerg J Meerpohl
- Medical Center - University of Freiburg, Faculty of Medicine; Institute for Evidence in Medicine (for Cochrane Germany Foundation); Breisacher Str. 153 Freiburg Germany D-79110
| | - Dirk Bassler
- University Hospital Zürich; Department of Neonatology; Frauenklinikstrasse 10 Zürich Switzerland
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14
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Alsulami G, Rice AM, Kidd L. Prospective repeated assessment of self-reported sleep quality and sleep disruptive factors in the intensive care unit: acceptability of daily assessment of sleep quality. BMJ Open 2019; 9:e029957. [PMID: 31227541 PMCID: PMC6596998 DOI: 10.1136/bmjopen-2019-029957] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Despite the importance of sleep, the assessment of sleep quality does not form part of standard clinical care in intensive care unit (ICU). Continuous assessment of self-reported quality of ICU patients' sleep has been strongly recommended. Prior to implementing such an assessment in the ICU, it is important to assess the acceptability of this method of assessment to the ICU's patients. The aims of this study were to assess the acceptability to ICU patients of completing daily self-reports on sleep quality during their ICU stay and to assess ICU patients' self-reported sleep quality and sleep disruptive factors during their time in ICU. METHODS An observational prospective-repeated assessment was conducted on n=120 patients in an ICU in Saudi Arabia. The participants were both intubated and non-intubated. OUTCOMES MEASURES Over a 3-month period, sleep quality was assessed using the Arabic version of the Richards-Campbell Sleep Questionnaire (RCSQ-A), and self-reported sleep disruptive factors were identified. Clinical factors, such as ICU interventions, and previously administered sedatives were also examined. The patients' acceptance of completing daily RCSQ-A reports was assessed using various indicators of acceptability. RESULTS A total of 381 self-reports (RCSQ-A) were collected for this analysis. The patients reported 34.4±5.60, indicating that sleep quality was poor on average. The group of intubated patients reported much poorer sleep quality during intubation than after extubation. In the multivariate analysis, factors which most significantly affected sleep (exp(b), p value) were midazolam (-6.424, p<0.0005), propofol (-3.600, p<0.05), noise (-1.033, p<0.05), gender (1.836, p<0.05), daytime sleepiness (0.856, p<0.05) and the presence of mechanical ventilation (-1.218, p<0.05). CONCLUSION The acceptability and feasibility of using daily RCSQ-A for sleep quality assessment was demonstrated. Sleep quality was reported as poor by all participants and the factors affecting sleep were varied. This study provided various recommendations for healthcare providers and researchers in terms of evaluating and improving sleep quality in ICU patients.
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Affiliation(s)
- Ghaida Alsulami
- Nursing, University of Glasgow School of Veterinary Medicine, Glasgow, UK
- Nursing, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ann Marie Rice
- University of Glasgow School of Medicine Dentistry and Nursing, Glasgow, UK
| | - Lisa Kidd
- School of Medicine Dentistry and Nursing, University of Glasgow, Glasgow, UK
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15
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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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16
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Cho WH, Jeong CH, Chang JH, Lee SH, Park MK, Suh MW, Han JJ. Noise and Room Acoustic Conditions in a Tertiary Referral Hospital, Seoul National University Hospital. J Audiol Otol 2019; 23:76-82. [PMID: 30989997 PMCID: PMC6468283 DOI: 10.7874/jao.2018.00269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/17/2018] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives Noise levels and room acoustic parameters at a tertiary referral hospital, Seoul National University Hospital (SNUH) in Korea, are investigated. Materials and Methods Through a questionnaire, acoustically problematic rooms are identified. Noise levels in emergency rooms (ERs) and intensive care units (ICUs) are measured over about three days. Acoustically critical and problematic rooms in the otolaryngology department are measured including examination rooms, operating rooms, nurse stations, receptions, and patient rooms. Results The A-weighted equivalent noise level, LAeq, ranges from 54 to 56 dBA, which is at least 10 dB lower than the noise levels of 65 to 73 dBA measured in American ERs. In an ICU, the noise level for the first night was 66 dBA, which came down to 56 dBA for the next day. The noise levels during three different ear surgeries vary from 57 to 62 dBA, depending on the use of surgical drills and suctions. The noise levels in a patient room is found to be 47 dBA, while the nurse stations and the receptions have high noise levels up to 64 dBA. The reverberation times in an operation room, examination room, and single patient room are found to be below 0.6 s. Conclusions At SNUH, the nurse stations and receptions were found to be quite noisy. The ERs were quieter than in the previous studies. The measured reverberation times seemed low enough but some other nurse stations and examination rooms were not satisfactory according to the questionnaire.
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Affiliation(s)
- Wan-Ho Cho
- Division of Physical Metrology, Korea Research Institute of Standards and Science, Daejeon, Korea
| | - Cheol-Ho Jeong
- Acoustic Technology, Electrical Engineering Department, Technical University of Denmark, Lyngby, Denmark
| | - Ji-Ho Chang
- Division of Physical Metrology, Korea Research Institute of Standards and Science, Daejeon, Korea
| | - Seong-Hyun Lee
- Department of System Dynamics, Korea Institute of Machinery & Materials, Daejeon, Korea
| | - Moo Kyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Myung-Whan Suh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jae Joon Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
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17
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Goeren D, John S, Meskill K, Iacono L, Wahl S, Scanlon K. Quiet Time: A Noise Reduction Initiative in a Neurosurgical Intensive Care Unit. Crit Care Nurse 2018; 38:38-44. [PMID: 30068719 DOI: 10.4037/ccn2018219] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND High noise levels in intensive care units are common. Increased noise levels can lead to sleep deprivation, increased pain perception, and delirium. The most common cause of reducible noise in intensive care units often is attributed to staff conversations. OBJECTIVES In January 2015, the neurosurgical intensive care unit staff identified noise as a problem, referencing complaints from other disciplines and family members. Quiet times from 3 am to 5 am and from 3 pm to 5 pm were agreed upon. An improvement plan was developed with a goal to decrease noise levels by 10 decibels in 6 months. METHODS Using a decibel meter, noise data were collected in 4 locations every 30 minutes during the chosen times for 8 days. Quiet time was implemented 1 week after staff, patient, and family education was completed. Decibel data were collected and evaluated after 60 days. RESULTS There were statistically significant reductions in noise levels at nurses' station left (P = .04) and the bed 9 entrance (P = .02). Noise levels were lower, but not significantly so, for nurses' station right (P = .12) and the bed 4 entrance (P = .06). Noise levels during quiet time decreased to an average of 10 to 15 decibels lower than baseline data. CONCLUSIONS Sharing baseline data was effective to heighten noise awareness. During quiet time, limiting conversations, eliminating environmental noise, and dimming the lights as a reminder to be quiet are 3 simple strategies that can be implemented to lessen noise.
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Affiliation(s)
- Danielle Goeren
- Danielle Goeren is a clinical ladder III staff nurse in the neurosurgical intensive care unit at North Shore University Hospital, Manhasset, New York.,Sherley John is a clinical ladder III staff nurse in the neurosurgical intensive care unit at North Shore University Hospital.,Katie Meskill is a clinical ladder III staff nurse in the neurosurgical intensive care unit at North Shore University Hospital.,Laura Iacono is a nurse manager in the neurosurgical intensive care unit at North Shore University Hospital.,Stacy Wahl is a night shift critical care nurse educator at North Shore University Hospital.,Kerri Scanlon is chief nursing officer at North Shore University Hospital
| | - Sherley John
- Danielle Goeren is a clinical ladder III staff nurse in the neurosurgical intensive care unit at North Shore University Hospital, Manhasset, New York.,Sherley John is a clinical ladder III staff nurse in the neurosurgical intensive care unit at North Shore University Hospital.,Katie Meskill is a clinical ladder III staff nurse in the neurosurgical intensive care unit at North Shore University Hospital.,Laura Iacono is a nurse manager in the neurosurgical intensive care unit at North Shore University Hospital.,Stacy Wahl is a night shift critical care nurse educator at North Shore University Hospital.,Kerri Scanlon is chief nursing officer at North Shore University Hospital
| | - Katie Meskill
- Danielle Goeren is a clinical ladder III staff nurse in the neurosurgical intensive care unit at North Shore University Hospital, Manhasset, New York. .,Sherley John is a clinical ladder III staff nurse in the neurosurgical intensive care unit at North Shore University Hospital. .,Katie Meskill is a clinical ladder III staff nurse in the neurosurgical intensive care unit at North Shore University Hospital. .,Laura Iacono is a nurse manager in the neurosurgical intensive care unit at North Shore University Hospital. .,Stacy Wahl is a night shift critical care nurse educator at North Shore University Hospital. .,Kerri Scanlon is chief nursing officer at North Shore University Hospital.
| | - Laura Iacono
- Danielle Goeren is a clinical ladder III staff nurse in the neurosurgical intensive care unit at North Shore University Hospital, Manhasset, New York.,Sherley John is a clinical ladder III staff nurse in the neurosurgical intensive care unit at North Shore University Hospital.,Katie Meskill is a clinical ladder III staff nurse in the neurosurgical intensive care unit at North Shore University Hospital.,Laura Iacono is a nurse manager in the neurosurgical intensive care unit at North Shore University Hospital.,Stacy Wahl is a night shift critical care nurse educator at North Shore University Hospital.,Kerri Scanlon is chief nursing officer at North Shore University Hospital
| | - Stacy Wahl
- Danielle Goeren is a clinical ladder III staff nurse in the neurosurgical intensive care unit at North Shore University Hospital, Manhasset, New York.,Sherley John is a clinical ladder III staff nurse in the neurosurgical intensive care unit at North Shore University Hospital.,Katie Meskill is a clinical ladder III staff nurse in the neurosurgical intensive care unit at North Shore University Hospital.,Laura Iacono is a nurse manager in the neurosurgical intensive care unit at North Shore University Hospital.,Stacy Wahl is a night shift critical care nurse educator at North Shore University Hospital.,Kerri Scanlon is chief nursing officer at North Shore University Hospital
| | - Kerri Scanlon
- Danielle Goeren is a clinical ladder III staff nurse in the neurosurgical intensive care unit at North Shore University Hospital, Manhasset, New York.,Sherley John is a clinical ladder III staff nurse in the neurosurgical intensive care unit at North Shore University Hospital.,Katie Meskill is a clinical ladder III staff nurse in the neurosurgical intensive care unit at North Shore University Hospital.,Laura Iacono is a nurse manager in the neurosurgical intensive care unit at North Shore University Hospital.,Stacy Wahl is a night shift critical care nurse educator at North Shore University Hospital.,Kerri Scanlon is chief nursing officer at North Shore University Hospital
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18
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Dying in the Intensive Care Unit: A Candle Vigil Using Illustrations. MAYO CLINIC PROCEEDINGS: INNOVATIONS, QUALITY & OUTCOMES 2018; 2:378-381. [PMID: 30560240 PMCID: PMC6260492 DOI: 10.1016/j.mayocpiqo.2018.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 08/29/2018] [Accepted: 09/04/2018] [Indexed: 11/29/2022] Open
Abstract
With death and dying in intensive care units, there should be bereavement support for families. We propose placing an illustration of a candle on the door of an unresponsive dying patient, with additional illustrations of votive candles at the nurses’ station opposite to the door as a neutral way of identifying these rooms with patients who transitioned to comfort care or who have died. The candle illustrations encourage staff members to modify their words, silence themselves, and reflect. After a 1-year tryout in the neurointensive care unit with a strong positive experience for staff and families, it can be perceived as a symbol of tranquility.
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19
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Simons KS, Verweij E, Lemmens PMC, Jelfs S, Park M, Spronk PE, Sonneveld JPC, Feijen HM, van der Steen MS, Kohlrausch AG, van den Boogaard M, de Jager CPC. Noise in the intensive care unit and its influence on sleep quality: a multicenter observational study in Dutch intensive care units. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:250. [PMID: 30290829 PMCID: PMC6173893 DOI: 10.1186/s13054-018-2182-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/10/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND High noise levels in the intensive care unit (ICU) are a well-known problem. Little is known about the effect of noise on sleep quality in ICU patients. The study aim is to determine the effect of noise on subjective sleep quality. METHODS This was a multicenter observational study in six Dutch ICUs. Noise recording equipment was installed in 2-4 rooms per ICU. Adult patients were eligible for the study 48 h after ICU admission and were followed up to maximum of five nights in the ICU. Exclusion criteria were presence of delirium and/or inability to be assessed for sleep quality. Sleep was evaluated using the Richards Campbell Sleep Questionnaire (range 0-100 mm). Noise recordings were used for analysis of various auditory parameters, including the number and duration of restorative periods. Hierarchical mixed model regression analysis was used to determine associations between noise and sleep. RESULTS In total, 64 patients (68% male), mean age 63.9 (± 11.7) years and mean Acute Physiology And Chronic Health Evaluation (APACHE) II score 21.1 (± 7.1) were included. Average sleep quality score was 56 ± 24 mm. The mean of the 24-h average sound pressure levels (LAeq, 24h) was 54.0 dBA (± 2.4). Mixed-effects regression analyses showed that background noise (β = - 0.51, p < 0.05) had a negative impact on sleep quality, whereas number of restorative periods (β = 0.53, p < 0.01) and female sex (β = 1.25, p < 0.01) were weakly but significantly correlated with sleep. CONCLUSIONS Noise levels are negatively associated and restorative periods and female gender are positively associated with subjective sleep quality in ICU patients. TRIAL REGISTRATION www.ClinicalTrials.gov, NCT01826799 . Registered on 9 April 2013.
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Affiliation(s)
- Koen S Simons
- Departement of Intensive Care, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, The Netherlands. .,Departement of Intensive Care Research, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Eva Verweij
- Departement of Intensive Care, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, The Netherlands
| | | | - Sam Jelfs
- Philips Research, Eindhoven, The Netherlands
| | - Munhum Park
- Institute of Music, Science and Engineering, King Mongkut's Institute of Technology Ladkrabang, Bangkok, Thailand
| | - Peter E Spronk
- Departement of Intensive Care, Gelre Ziekenhuizen, Apeldoorn, The Netherlands
| | | | - Hilde-Marieken Feijen
- Departement of Intensive Care, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | | | - Armin G Kohlrausch
- Human-Technology Interaction Group, Technische Universiteit Eindhoven, Eindhoven, The Netherlands
| | - Mark van den Boogaard
- Departement of Intensive Care Research, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cornelis P C de Jager
- Departement of Intensive Care, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, The Netherlands
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20
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Kawai Y, Weatherhead JR, Traube C, Owens TA, Shaw BE, Fraser EJ, Scott AM, Wojczynski MR, Slaman KL, Cassidy PM, Baker LA, Shellhaas RA, Dahmer MK, Shever LL, Malas NM, Niedner MF. Quality Improvement Initiative to Reduce Pediatric Intensive Care Unit Noise Pollution With the Use of a Pediatric Delirium Bundle. J Intensive Care Med 2017; 34:383-390. [PMID: 28859578 DOI: 10.1177/0885066617728030] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES: Noise pollution in pediatric intensive care units (PICU) contributes to poor sleep and may increase risk of developing delirium. The Environmental Protection Agency (EPA) recommends <45 decibels (dB) in hospital environments. The objectives are to assess the degree of PICU noise pollution, to develop a delirium bundle targeted at reducing noise, and to assess the effect of the bundle on nocturnal noise pollution. METHODS: This is a QI initiative at an academic PICU. Thirty-five sound sensors were installed in patient bed spaces, hallways, and common areas. The pediatric delirium bundle was implemented in 8 pilot patients (40 patient ICU days) while 108 non-pilot patients received usual care over a 28-day period. RESULTS: A total of 20,609 hourly dB readings were collected. Hourly minimum, average, and maximum dB of all occupied bed spaces demonstrated medians [interquartile range] of 48.0 [39.0-53.0], 52.8 [48.1-56.2] and 67.0 [63.5-70.5] dB, respectively. Bed spaces were louder during the day (10AM to 4PM) than at night (11PM to 5AM) (53.5 [49.0-56.8] vs. 51.3 [46.0-55.3] dB, P < 0.01). Pilot patient rooms were significantly quieter than non-pilot patient rooms at night (n=210, 45.3 [39.7-55.9]) vs. n=1841, 51.2 [46.9-54.8] dB, P < 0.01). The pilot rooms compliant with the bundle had the lowest hourly nighttime average dB (44.1 [38.5-55.5]). CONCLUSIONS: Substantial noise pollution exists in our PICU, and utilizing the pediatric delirium bundle led to a significant noise reduction that can be perceived as half the loudness with hourly nighttime average dB meeting the EPA standards when compliant with the bundle.
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Affiliation(s)
- Yu Kawai
- 1 Division of Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.,2 Division of Pediatric Critical Care Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey R Weatherhead
- 2 Division of Pediatric Critical Care Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA
| | - Chani Traube
- 3 Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - Tonie A Owens
- 4 Pediatric Intensive Care Unit, Department of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Brenda E Shaw
- 4 Pediatric Intensive Care Unit, Department of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Erin J Fraser
- 4 Pediatric Intensive Care Unit, Department of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Annette M Scott
- 4 Pediatric Intensive Care Unit, Department of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Melody R Wojczynski
- 4 Pediatric Intensive Care Unit, Department of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Kristen L Slaman
- 4 Pediatric Intensive Care Unit, Department of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Patty M Cassidy
- 4 Pediatric Intensive Care Unit, Department of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Laura A Baker
- 4 Pediatric Intensive Care Unit, Department of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Renee A Shellhaas
- 5 Division of Pediatric Neurology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA
| | - Mary K Dahmer
- 2 Division of Pediatric Critical Care Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA
| | - Leah L Shever
- 6 Department of Nursing, Nursing Research, Quality, and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Nasuh M Malas
- 7 Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.,8 Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA
| | - Matthew F Niedner
- 2 Division of Pediatric Critical Care Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA
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21
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Chawla S, Barach P, Dwaihy M, Kamat D, Shankaran S, Panaitescu B, Wang B, Natarajan G. A targeted noise reduction observational study for reducing noise in a neonatal intensive unit. J Perinatol 2017; 37:1060-1064. [PMID: 28617421 DOI: 10.1038/jp.2017.93] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/05/2017] [Accepted: 05/11/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Excessive noise in neonatal intensive care units (NICUs) can interfere with infants' growth, development and healing.Local problem:Sound levels in our NICUs exceeded the recommended levels by the World Health Organization. METHODS We implemented a noise reduction strategy in an urban, tertiary academic medical center NICU that included baseline noise measurements. We conducted a survey involving staff and visitors regarding their opinions and perceptions of noise levels in the NICU. Ongoing feedback to staff after each measurement cycle was provided to improve awareness, engagement and adherence with noise reduction strategies. After widespread discussion with active clinician involvement, consensus building and iterative testing, changes were implemented including: lowering of equipment alarm sounds, designated 'quiet times' and implementing a customized education program for staff. INTERVENTIONS A multiphase noise reduction quality improvement (QI) intervention to reduce ambient sound levels in a patient care room in our NICUs by 3 dB (20%) over 18 months. RESULTS The noise in the NICU was reduced by 3 dB from baseline. Mean (s.d.) baseline, phase 2, 3 and 4 noise levels in the two NICUs were: LAeq: 57.0 (0.84), 56.8 (1.6), 55.3 (1.9) and 54.5 (2.6) dB, respectively (P<0.01). Adherence with the planned process measure of 'quiet times' was >90%. CONCLUSIONS Implementing a multipronged QI initiative resulted in significant noise level reduction in two multipod NICUs. It is feasible to reduce noise levels if QI interventions are coupled with active engagement of the clinical staff and following continuous process of improvement methods, measurements and protocols.
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Affiliation(s)
- S Chawla
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
| | - P Barach
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
| | - M Dwaihy
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
| | - D Kamat
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
| | - S Shankaran
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
| | - B Panaitescu
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
| | - B Wang
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
| | - G Natarajan
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
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22
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Sleep in intensive care unit: The role of environment. J Crit Care 2017; 37:99-105. [DOI: 10.1016/j.jcrc.2016.09.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/10/2016] [Accepted: 09/04/2016] [Indexed: 11/19/2022]
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23
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Shield B, Shiers N, Glanville R. The acoustic environment of inpatient hospital wards in the United Kingdom. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2016; 140:2213. [PMID: 27914398 DOI: 10.1121/1.4962276] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Many hospital noise surveys have shown that patients are subject to high levels of noise, in excess of current World Health Organization guidelines. Much of the previous research has focused on areas perceived to be noisy, such as intensive care units and operating theatres. This paper presents the results of a comprehensive noise survey of five general inpatient hospital wards in the UK. The survey involved continuous noise monitoring over several days, including identification of noise sources, in 31 locations representing a range of typical patient accommodations including single rooms and multi-bed bays, and nurse stations. The results were consistent with those of previous studies with daytime levels ranging from 50 to 61 dB LAeq and nighttime levels from 41 to 51 dB LAeq. Noise levels were not correlated with room/bay size, with single rooms having some of the highest levels. Overall levels were related to reverberation times and to the numbers of high level noise events. Analysis of noise sources showed that much of the noise could be eliminated or reduced through improved design of equipment and ward layouts. In general, noise levels in wards built since the year 2000 were lower than those in the older buildings.
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Affiliation(s)
- Bridget Shield
- School of Built Environment and Architecture, London South Bank University, London SE1 7JQ, United Kingdom
| | - Nicola Shiers
- School of Built Environment and Architecture, London South Bank University, London SE1 7JQ, United Kingdom
| | - Rosemary Glanville
- School of Built Environment and Architecture, London South Bank University, London SE1 7JQ, United Kingdom
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24
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Abstract
RÉSUMÉL’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.
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Luetz A, Weiss B, Penzel T, Fietze I, Glos M, Wernecke KD, Bluemke B, Dehn AM, Willemeit T, Finke A, Spies C. Feasibility of noise reduction by a modification in ICU environment. Physiol Meas 2016; 37:1041-55. [DOI: 10.1088/0967-3334/37/7/1041] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Hu RF, Hegadoren KM, Wang XY, Jiang XY. An investigation of light and sound levels on intensive care units in China. Aust Crit Care 2016; 29:62-7. [DOI: 10.1016/j.aucc.2015.08.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 07/18/2015] [Accepted: 08/08/2015] [Indexed: 01/22/2023] Open
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Lange K, Nowak M, Lauer W. A human factors perspective on medical device alarms: problems with operating alarming devices and responding to device alarms. BIOMED ENG-BIOMED TE 2016; 61:147-64. [PMID: 25427057 DOI: 10.1515/bmt-2014-0068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/24/2014] [Indexed: 11/15/2022]
Abstract
Medical devices emit alarms when a problem with the device or with the patient needs to be addressed by healthcare personnel. At present, problems with device alarms are frequently discussed in the literature, the main message being that patient safety is compromised because device alarms are not as effective and safe as they should - and could - be. There is a general consensus that alarm-related hazards result, to a considerable degree, from the interactions of human users with the device. The present paper addresses key aspects of human perception and cognition that may relate to both operating alarming devices and responding to device alarms. Recent publications suggested solutions to alarm-related hazards associated with usage errors based on assumptions on the causal relations between, for example, alarm management and human perception, cognition, and responding. However, although there is face validity in many of these assumptions, future research should provide objective empirical evidence in order to deepen our understanding of the actual causal relationships, and hence improve and expand the possibilities for taking appropriate action.
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Kol E, Aydın P, Dursun O. The effectiveness of environmental strategies on noise reduction in a pediatric intensive care unit: creation of single-patient bedrooms and reducing noise sources. J SPEC PEDIATR NURS 2015; 20:210-7. [PMID: 25943006 DOI: 10.1111/jspn.12116] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 03/27/2015] [Accepted: 03/27/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE Noise is a substantial problem for both patients and healthcare workers in hospitals. This study aimed to determine the effectiveness of environmental strategies (creating single-patient rooms and reducing noise sources) in noise reduction in a pediatric intensive care unit. DESIGN AND METHODS Noise measurement in the unit was conducted in two phases. In the first phase, measurements aimed at determining the unit's present level of noise were performed over 4 weeks in December 2013. During the month following the first measurement phase, the intensive care unit (ICU) was moved to a new location and noise-reducing strategies were implemented. The second phase, in May 2014, measured noise levels in the newly constructed environment. RESULTS The noise levels before and after environmental changes were statistically significant at 72.6 dB-A and 56 dB-A, respectively (p < .05). PRACTICE IMPLICATIONS Single-patient rooms and noise-reducing strategies can be effective in controlling environmental noise in the ICU.
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Affiliation(s)
- Emine Kol
- Faculty of Nursing, Akdeniz University, Antalya, Turkey
| | - Perihan Aydın
- Pediatric Intensive Care Unit, Akdeniz University Hospital, Antalya, Turkey
| | - Oguz Dursun
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Intensive Care, Akdeniz University, Antalya, Turkey
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Park M, Vos P, Vlaskamp BNS, Kohlrausch A, Oldenbeuving AW. The influence of APACHE II score on the average noise level in an intensive care unit: an observational study. BMC Anesthesiol 2015; 15:42. [PMID: 25861240 PMCID: PMC4389973 DOI: 10.1186/s12871-015-0019-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/28/2015] [Indexed: 11/15/2022] Open
Abstract
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, LAeq,24h. Where these factors were argued to have causal relations to LAeq,24h, the APACHE II score was found to be most strongly correlated: LAeq,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.
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Affiliation(s)
- Munhum Park
- Brain, Cognition & Perception Group, Philips Research, High Tech Campus 36, AE Eindhoven, 5656 The Netherlands
| | - Pieter Vos
- Department of Intensive Care Medicine, St. Elisabeth Hospital, P.O. Box 90151, LC Tilburg, 5000 The Netherlands
| | - Björn N S Vlaskamp
- Brain, Cognition & Perception Group, Philips Research, High Tech Campus 36, AE Eindhoven, 5656 The Netherlands
| | - Armin Kohlrausch
- Brain, Cognition & Perception Group, Philips Research, High Tech Campus 36, AE Eindhoven, 5656 The Netherlands ; Human-Technology Interaction Group, Technische Universiteit Eindhoven, P.O. Box 513, MB Eindhoven, 5600 The Netherlands
| | - Annemarie W Oldenbeuving
- Department of Intensive Care Medicine, St. Elisabeth Hospital, P.O. Box 90151, LC Tilburg, 5000 The Netherlands
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Simons KS, Park M, Kohlrausch A, van den Boogaard M, Pickkers P, de Bruijn W, de Jager CPC. Noise pollution in the ICU: time to look into the mirror. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:493. [PMID: 25184539 PMCID: PMC4145538 DOI: 10.1186/s13054-014-0493-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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