Noise Exposure and Quality of Life Among Nurses

The introduction of a sound reduction bundle in the intensive care unit and its impact on sound levels and patients

BACKGROUND

ICU outcomes are continuing to improve. However, this has not been matched by similar improvements of the ICU bedspace environment, which can detrimentally impact on patient outcomes. Excessive sound and noise, especially, has been linked with adverse and potentially preventable patient outcomes and staff errors. There are many sources of sound in the ICU, with alarms from bedside equipment frequently listed as a main source. The number of alarms is increasing in parallel with the introduction of new and more sophisticated technologies to monitor and support patients. However, most alarms are not accurate or critical and are commonly ignored by staff.

OBJECTIVE

The objective of this study was to evaluate the impact of a sound reduction bundle on sound levels, number of alarms, and patients' experience and perceived quality of sleep in the ICU.

METHODS

This was a pre-post, quasi-experimental study investigating the impact of three study interventions implemented sequentially (staff education, visual warnings when sound levels exceeded the preset levels, and monitor alarm reconfigurations). Effects of staff education were evaluated using pre-education and post-education questionnaires, and the impact on patients was evaluated via self-report questionnaires. A sound-level monitor was used to evaluate changes in sound levels between interventions. Alarm audits were completed before and after alarm reconfiguration.

RESULTS

Staff knowledge improved; however, sound levels did not change across interventions. The number of monthly monitor alarms reduced from 600,452 to 115,927. No significant differences were found in patients' subjective rating of their experience and sleep.

CONCLUSION

The interventions did not lead to a sound-level reduction; however, there was a large reduction in ICU monitor alarms without any alarm-related adverse events. As the sources of sound are diverse, multidimensional interventions, including staff education, alarm management solutions, and environmental redesign, are likely to be required to achieve a relevant, lasting, and significant sound reduction.

Reducing Noise in the NICU

BACKGROUND

In the neonatal intensive care unit (NICU), elevated noise negatively impacts the neurodevelopmental environment, interrupts sleep, and can affect brain development in neonates. The American Academy of Pediatrics recommends that noise levels in the NICU should not exceed 45 dB.

PURPOSE

The project aims were to: (1) decrease average noise level by 10% from baseline and (2) decrease exposure to severe noise (>65 dB) to <5% of the time.

METHODS

This quality improvement project was conducted during 2021-2022 as a pre/post observational design in a Level IV NICU in New York City. We monitored sound levels for 20-24 h, 5 d/wk. Quality improvement interventions included: novel approaches to staff education, visual cues for when noise thresholds were exceeded, parent education, including access to personal decibel meters, technical improvements to vital sign monitors and entry doors, and defined quiet times (HUSH) for 2 h each 12-hour shift.

RESULTS

Education efforts and technical improvements successfully reduced median noise levels within the stepdown unit ( P < .001), though not in the acute care NICU. In contrast, the implementation of 2-hour periods of enforced "quiet time" every 12 h effectively reduced both median noise levels and the incidence of severe noise (>65 dB) in both locations.

IMPLICATIONS FOR PRACTICE AND RESEARCH

The HUSH strategy may be a sustainable way to decrease noise in the NICU. Future projects should prioritize education and dedicated quiet times to align with recommended standards, while research should explore the long-term developmental impacts of excessive noise levels on neonatal growth.

Effects of Ward Noise Management on Mental Health and Hip Function in Elderly Patients Undergoing Total Hip Arthroplasty

OBJECTIVE

The aim of this study was to explore the influence of ward noise management on the mental health and hip joint function of elderly patients post-total hip arthroplasty.

METHODS

The retrospective analysis involved the medical records of 160 elderly patients who underwent total hip arthroplasty at Nanchang First Hospital from March 2021 to January 2023. The observation group received ward noise management (n = 75) and the control group received perioperative routine management (n = 85). The noise level, Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), the Generic Quality of Life Inventory-74 (GQOLI-74), Harris Hip Score (HHS) system, and satisfaction scale were used to evaluate patients. T test and chi-square tests were used for statistical analysis.

RESULTS

The observation group exhibited a significantly lower noise level compared to the control group (P < 0.05). No significant differences were observed in the general information and preoperative SDS, SAS, HHS, and GQOLI-74 scores between the two groups (P > 0.05). No significant differences were observed in the SDS and HHS between the two groups 7 days after the operation (P > 0.05). The observation group presented a significantly lower SAS score than the control group 7 days after the operation (P < 0.05). The score of the observation group 7 days after the operation was lower than that before the operation (P < 0.05). At 7 days after the operation, the observation group showed a higher score in the "social function" dimension of GQOLI-74 compared to the control group (P < 0.05), and the satisfaction of the observation group was significantly higher than that of the control group (94.67 vs. 77.65%, P < 0.05).

CONCLUSIONS

Ward noise management can help reduce anxiety among elderly patients after total hip arthroplasty, improve their quality of life and social function, and obtain higher satisfaction.

Association Between Perceived Noise Pollution and Sleep Quality: Findings from the 2018 Community Health Survey

OBJECTIVES

This study aimed to investigate the potential relationship between sleep quality and perceived noise.

METHODS

A cross-sectional study involving 185,246 adults (81,854 men and 103,392 women) participating in the 2018 Korea Community Health Survey (KCHS) was conducted. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while perceived noise pollutants were categorized into two groups: perceived noise pollution (n = 43,638) and perceived non-noise pollution (n = 141,608). We used chi-square tests and independent sample t tests to compare differences between the perceived noise group and the non-perceived noise group, as well as multivariate logistic regression analysis to calculate adjusted odds ratios (OR) for sleep quality variables.

RESULTS

The perceived noise pollution group had significantly poor psychosocial variables (stress, depression assessed by Patient health questionnaire-9 (PHQ-9)) than the perceived non-noise pollution group. Poor sleep quality (PSQI > 5) was associated with perceived noise pollution (OR 1.33, 95% confidence interval (CI) 1.30-1.36, P < 0.001). In addition, sleep quality (OR 1.09; 95% CI 1.06-1.13, P < 0.001); sleep latency (OR 1.11; 95% CI 1.09-1.14, P < 0.001); sleep duration (OR 1.10; 95% CI 1.07-1.13, P < 0.001); sleep efficiency (OR 1.20; 95% CI 1.16-1.25, P < 0.001); sleep disturbance (OR 1.46; 95% CI 1.42-1.51, P < 0.001); sleep medication use (OR 1.13; 95% CI 1.07-1.20, P = 0.002); and daytime dysfunction (OR 1.23; 95% CI 1.20-1.26, P < 0.001) were associated with perceived noise pollution after confounding variables.

CONCLUSION

Perceived noise pollution was significantly associated with poor sleep quality. Perceived noise annoyance could be used as a signal of health effects in the public community.

Actual versus perceived noise levels among critical care nurses and their related adverse effects: A cross-sectional study

BACKGROUND

Critical care nurses should help in reducing noise to improve the well-being of patients and health care providers.

AIM/S

To measure actual noise levels in intensive care units, identify nurses' perceived irritation levels of noise sources and examine the impact of noise on nurses' work performance and well-being.

STUDY DESIGN

This cross-sectional study was conducted from January to April 2023 at a teaching hospital's six intensive care units. It involved three phases: mapping locations for noise measurement, actual noise measurements in decibels and a cross-sectional survey to identify nurses' perceptions and the adverse effects of noise. Actual noise was measured between patients' beds, nursing stations and beside 16 noise sources for 7 days 24 h a day. For nurse perceptions, the mean of perceived irritation levels by a Likert scale for each noise source was calculated to present perceived noise levels. Ranking of noise sources according to the actual measured and perceived irritation by nurses was done based on mean values. Curve estimation regression test was used to predict the relationship between actual and perceived noise and stepwise multiple linear regression identified factors associated with noise adverse effects.

RESULTS

The mean noise level in the intensive care units was 65.55 dB. Nurses perceived mechanical ventilator alarms as the most irritating noise. However, the mean noise measurements showed that conversations among colleagues were the primary source of noise. There was no significant predictive relationship between the actual and perceived noise. Nurses reported feeling distressed, irritable, fatigued and less productive due to noise.

CONCLUSIONS

There was a discrepancy between actual and perceived noise levels by nurses. Perceived noise levels had more impact on nurses than actual noise.

RELEVANCE TO CLINICAL PRACTICE

By incorporating both objective measurements and subjective perceptions into efforts aimed at reducing noise, health care providers can create quieter intensive care units.

Effect of Noise in the Emergency Department on Occupational Burnout and Resignation Intention of Medical Staff

OBJECTIVE

This study aims to explore the effect of noise in the emergency department on the occupational burnout and the resignation intentions of medical staff.

METHODS

This retrospective study selected 42 medical staff (group A) in the emergency department of our hospital from March 2020 to March 2021 and 39 medical staff (group B) in the rehabilitation department during the same period as research subjects. Noise levels in the daily working environment of medical staff were collected. The Maslach Burnout Inventory General Survey and Intent to Leave Scale was used to evaluate occupational burnout and resignation intention. A multivariate linear regression analysis was adopted to explore the effects of noise exposure level in the emergency department on occupational burnout and resignation intention.

RESULTS

The scores of emotional fatigue, work apathy and sense of achievement in group A were higher than those in group B (P < 0.05), among which reverse scoring was adopted for sense of accomplishment. Group A had significantly higher scores of resignation intention I, resignation intention II and resignation intention III than group B (P < 0.001). The department of group A had significantly higher noise level than that of group B (P < 0.001). The Multivariate linear regression analysis showed that noise level in the emergency department was correlated with the occupational burnout and resignation intention of medical staff (all P < 0.05).

CONCLUSIONS

The emergency department is exposed to a high noise level, which is correlated with the occupational burnout and resignation intentions of medical staff. Therefore, hospitals should give importance to noise exposure in the emergency departments and adopt positive coping strategies to reduce the effect of noise on medical staff and the resignation rate.

Effects of personal noise exposure, sleep quality, and burnout on quality of life: An online participation cohort study in Taiwan

Chronic noise exposure in daily life not only causes physical and mental illness but also reduces quality of life. However, collecting objective data on sound exposure and subjective acoustic comfort through a traditional one-shot survey is difficult. This study applied online chatbots in social media to explore the effects of daily sound exposure, personal characteristics, noise sensitivity, burnout status, and sleep quality on quality of life using a short-term participatory cohort design. During the two-month survey in 2022, 207 participants completed at least 15 days of collection of data on sound exposure and perception, as well as periodic structural questionnaires during the follow-ups. Linear regression and generalized linear models were applied to explore the factors influencing personal burnout, the Pittsburgh Sleep Quality Index, and quality of life. A chain mediation model was applied to explore the direct and indirect effects of noise exposure on quality of life. The results showed a better quality of life among respondents who rated their home environment better, were in good health, had better daily acoustic comfort, and were less exposed to noise during the week. In contrast, respondents with lower daily acoustic comfort and a higher frequency of noise-induced sleep disturbances and mood disorders were more likely to have poorer sleep quality. A higher personal burnout was associated with poorer health, longer exposure to noise during the week, a higher frequency of noise-induced illnesses, and neurotic traits. In the mediation analyses, noise-induced sleep disturbance and better daily acoustic comfort also had important direct influences on quality of life compared to the indirect pathway through sleep quality and personal burnout. In conclusion, noise exposure in daily life not only exacerbated poor sleep quality and personal burnout but also reduced quality of life.

Evaluation of Multisensory Interactions Between the Healing Built Environment and Nurses in Healthcare Nursing Stations: Case Study of Tehran Hospitals

BACKGROUND

Nursing stations are important features of medical centers that are constantly in use. As nursing is an inherently stressful occupation, nursing stations should be designed to minimize stress on those who must spend time there.

AIM

This study evaluated the effect of environmental design factors on mitigating the stress levels on nurses in nursing stations by determining the environmental factors that most influence the perceptual senses that affect physical and psychological comfort.

METHODS

A quantitative approach was used to evaluate the parameters that affect the sensory perceptions of nurses in nursing stations at four hospitals in Tehran. A survey was conducted to identify environmental design parameters that affect the visual, auditory, tactile, kinesthetic, and olfactory senses.

RESULTS

The results revealed that the olfactory category scored highest, followed by the auditory, visual and tactile categories, which had similar scores, and kinesthetic was ranked last.

CONCLUSION

A connection was revealed between the educational level of the nurses and environmental factors affecting their sensory perception in terms of materials, aesthetics and the appropriate number of windows as a visual sense, and ergonomics as a kinesthetic sense. Significantly, the gender variable differed in the Furniture variable based on comfort of seating with respect structure. Based on the results of this study, a combination of olfactory, visual, and auditory factors should be required at the nursing stations to decrease the stress level of nurses.

Exploring the Association Between the Healthcare Design Elements and Physician Well-Being: A Scoping Review

PURPOSE

To evaluate the association between elements of the built environment and physician well-being using a scoping review.

BACKGROUND

Physicians currently report low work satisfaction, high burnout and depression. The built environment has been shown to affect well-being in the general population, but its relationship to physician well-being is not well understood. Gaining a better understanding of this relationship will allow for better evidence-based design for physician well-being.

METHODS

A scoping review of the literature was conducted of Scopus and PubMed databases using key words for (1) environmental variables such as "environmental design"; (2) physician terms, such as "doctor"; and (3) outcome measures of well-being, such as "burnout." Studies were included if they had at least one measure of the built environment and one measure of physician well-being. Of 1,723 abstracts screened, 146 full-text articles were reviewed, leaving 16 articles to be included for data extraction.

RESULTS

Included studies were from all around the world, except for, notably, the United States. Robust interpretation of the data was challenging because of the lack of standardization in the assessment of environmental factors and physician well-being. Excessive noise was the variable most linked to well-being. Suitable surroundings, including lighting, furniture, and art, were also linked with satisfaction, but it was unclear whether there was an association with well-being.

CONCLUSION

Understanding how environmental factors affect physician well-being is paramount but considerably understudied. Standardization of research approach should be developed in order to produce more robust research to create evidence-based designs for physician well-being.

Noise exposure in pediatric otolaryngology clinic: A sound survey of a single-institution tertiary care facility

BACKGROUND

The Occupational Safety and Health Administration (OSHA) considers acoustic exposure of 90 decibels (dB) an occupational risk for noise-induced hearing loss. Pediatric healthcare clinicians are exposed to considerable noise especially during invasive procedures, predisposing them to noise-induced hearing loss, increased work-related stress, and increased complications associated with intense noise exposure. While there has been extensive research in noise exposure in dentistry, to date there has been no research on noise exposure in the pediatric otolaryngology clinic setting. The objective of this study is to quantify the degree of noise exposure that pediatric otolaryngologists encounter in the clinical setting.

METHODS

A sound survey was performed of 420 pediatric otolaryngology clinic visits within a single-institution tertiary care facility from January 2022 to March 2022, with a total of 409 visits included. At each visit, noise was measured using a calibrated National Institute for Occupational Safety and Health (NIOSH) Sound Meter application, an iPad, and a microphone. The Equivalent Continuous Sound Pressure Level (LAeq), peak sound pressure level (SPL), C-weighted peak noise level (LCpeak), and the 8-hour time-weighted average (TWA) sound level were recorded.

RESULTS

The average LAeq was 61.1 dB, the median LAeq was 60.3 dB, and the average peak SPL was 80.5 dB. Only 0.5 % of visits reached an LAeq above 80 dB, however, 51 % were above 60 dB and 99 % were above 45 dB. No clinicians were exposed to noise exceeding established limits of safety. Patients younger than ten years old (p < 0.001) and those who underwent procedures such as cerumen removal (p < 0.001) elicited higher ranges of elevated noise. Multivariate analysis confirmed that increased age decreased acoustic exposure while procedures increased acoustic exposure.

CONCLUSIONS

The results of this study suggest that pediatric otolaryngology clinicians do not exceed hazardous noise limit exposure. However, they are exposed to levels above those which have been linked to stress, poor productivity, and stress-related disorders. This analysis also reports that patients who are younger and those that undergo procedures, specifically cerumen removal, tend to expose their providers to the highest levels of noise. This is the first study examining noise exposure in pediatric otolaryngology, and further research should evaluate the risks of noise exposure in this environment.

Medical staff's sentiments on the establishment of quiet time in the NICU

AIM

To explore the sentiments of medical staff in setting quiet time in a tertiary neonatal intensive care unit.

BACKGROUND

Quiet time, which can help create a healing neonatal intensive care unit environment, is increasingly being valued by hospital administrators.

METHODS

Semi-structured interviews were used to interview twelve neonatal intensive care unit staff members, with data analyzed using the content analysis method.

RESULTS

This study extracted four themes: support, concern, education, and teamwork.

CONCLUSIONS

If quiet time needs to be set up, implemented, and maintained in the neonatal intensive care unit, it is necessary to establish a quiet time culture throughout the whole ward, to carry out detailed management of quiet time, and to cooperate and communicate with multidisciplinary departments.

IMPLICATIONS FOR NURSING MANAGEMENT

To keep the ward quiet and minimize handling during quiet time, it is necessary to take adequate steps from a management level. Targeted staff training and education allow staff to appreciate the necessity and urgency of setting quiet time for themselves and babies. It is also necessary to refine the educational content of noise reduction and minimal handling, and provide clear guidance on the best means to carry out clinical work during quiet time. Nursing managers need to establish a monitoring system for NICU noise and manage various noise sources made from equipment and people.