Noise is unwanted sound. Over the past 50 years, sound levels in hospitals have increased,1-3 with all studies exceeding the recommendations from World Health Organization (WHO) Guidelines for Community Noise.4 In 2006 the Hospital Consumer Assessment of Healthcare Providers and Systems began surveying patients regarding their perspectives on hospital care. This survey specifically asks about noise: “During this hospital stay, how often was the area around your room quiet at night?” In 2013, the responses to this question were included in the calculation of a Value Based Purchasing score, which is linked to payments from the Centers for Medicare & Medicaid Services. To effectively carry out noise reducing interventions it is important to understand what we know about noise in the hospital. This article, which focuses on noise in the Intensive Care Unit (ICU), describes basic sound level measurement terminology, the effect of noise on critically ill patients and evidence-based strategies to which nurses can actively contribute to decrease or protect patients from noise.
Noise in the ICU
Despite the increased emphasis on the need for noise reduction, studies published in the past five years found that sound levels in the ICU continue to exceed the WHO noise recommendations.3, 5-10 To interpret research on noise in the hospital, it is important to have an understanding of the terminology used (Table 1.) Noise is simply unwanted sound. What is noise to one individual may not be to another. Sound levels are reported in decibels (dB), with 0 dB being the threshold for human hearing. A 3 dB change in sound level is just discernible, a 5 dB change is discernible and a 10 dB change is perceived as a doubling or halving of the sound level....
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...o generalize the results to broader ICU populations.
Conclusions
Despite interventions aimed at decreasing noise, sound levels continue to exceed WHO recommendations and the ICU sounds (e.g., alarms and conversations) may interfere with sleep. The psychological impact of noise in the ICU varies. For some patients, the sounds in the ICU are comforting and for others they cause distress. To create a therapeutic environment, continued efforts are needed to decrease background noise, and to modify behaviors and factors that cause peak noise events. Interventions to protect patients from noise in the ICU, such as earplugs, may be beneficial in optimizing outcomes; however, further research is needed in a broader ICU population. Finally, to evaluate the effects of these interventions, valid and reliable methods for outcomes, such as sleep and sound levels, must be used.
Respiratory assessment is a significant aspect of nursing practice. According to the National Institute for Health and Care Excellence, respiratory rate is the best indicator of an ill patient and it is the first observation that will demonstrate a problem or deterioration in condition (Philip, Richardson, & Cohen, 2013). When a respiratory assessment performed effectively on a patient, it can result in upholding patient’s comfort and independence in progress of symptom management. Studies have acknowledged that in spite of the importance of the respiratory rate (RR) it is documented rarely than the other vital signs in the hospital settings (Parkes, 2011). This essay will highlight the importance of respiratory assessment and discuss why nurses
...s, physicians, and family members on the importance of prevention, detection, and treatment of ICU delirium. When successful, the ICU staff can promote a healthy environment to support physical and physiological well-being.
An audit of patient records completed in 2005, revealed a low incidence of respiratory rate recording. An initial audit completed revealed that only 7% of 341 patients had a respiratory rate recording (Butler-Williams 2005). Due to this worrying outcome, the priority was to implement appropriate training to raise respiratory rate significance. Due to the audit being completed hospital wide and with no prior warning, it is an accurate indicator of an overall attitude of practice towards the recording of respiratory rate. Various studies have been conducted in order to gain an understanding as to why this precious sign is so often ignored. Jacqueline Hogan explored the paucity of patient monitoring on acute wards, completing qualitative research using focus groups in 2004. Four major themes were identified, firstly the issue of the nursing workload. Many participants acknowledged the expansion of the nurse’s role and with this added responsibility, the need for delegation of activities such as patient observations. Observations are often delegated to junior staff members such as healthcare assistants and student nurses. Although many nurses admitted to delegating this vital activity, 73% of nurses did not consider healthcare assistants possessed the required knowledge to interpret observational results. With this lack of knowledge comes the absence of appreciation for the completion of such vital signs, and
The unit used to measure the intensity of sound is called the decibel(dB). Sounds that measure up to 75dB are considered to be in the "safe zone". Constant exposure to to sound at these levels are very unlikely to cause any lasting damage to long term hearing. The sound of regular volume conversation measures at around 60dB and the sound of a running dishwasher measures at roughly 75dB. Sounds around the 85dB level are considered a moderate risk to hearing. Exposure at these levels for extened periods of time may lead to some form of damage causing NIHL. Sounds at these levels include heavy traffic and crowded areas at 85dB, active subway stations at 95dB and listening to an mp3 player with ear buds at maximum volume at 105dB in which listening for just 15 minutes can cause permanent damage. Sound at 120dB and above are in the "danger zone". This level of sound is to be avoided at all cost as exposure even for a short pulse will lead to immediate permanent damage. This level includes the sound of ambulance sirens at 120dB, a jet taking off at 140dB and gunshots at 165 dB and above. (Rabinowitz,
The nurse to patient ratio is unrealistic in many hospitals. In most cases it is almost impossible to give each patient the true amount of detailed care they really need. This is seen in most cases where there is one nurse assigned to 16 patients and each patient requires a different level of attention. Nurses are pressed for time, forcing them to cut corners, resulting in an increase in nosocomial infections and patient deaths. “The past decade has been a unsettled time for many US hospitals and practicing nu...
Prevention of ICU psychosis should occur as soon as the patient has been in the ICU for a few hours. Review visiting policies for the facilities, provide great periods of sleep, by reducing the disturbing and noise levels in the patient room, also try to minimize shift change in nursing staff caring for the patient, assess the patient alertness for the place, date and time on every shift(Welker, M. MSN, 2016). ICU psychosis can be increase by health care professional awareness of early clinical signs of delirium during patients assessment(Arend, E., Christensen, M. 2009). ICU psychosis is affecting the majority of the patient admitted to the ICU. Evidence base shows that the ICU environment is contributed to it’s development. Delirium is increased with morbidity and mortality as well as increased with length of stay in the intensive care unit(Arend, E., Christensen,
...managing the environment for the benefit of the patient to help reduce risk factors. Supportive measures by the nurse such as attention to noise reduction and lighting should be implemented to all patient care settings. The nurse should be proficient in their assessment method. The bedside nurse is in a front-line position to manage and prevent delirium.
Patient safety is a large concern for practices, nurses and doctors. There are many tasks and precautions that can be taken to prevent accidents in the work place, whether it involves patients or not. Florence Nightingale once said “The very first canon of nursing, the first and last thing on which a nurse’s attention must be fixed is to keep the air within as pure as the air without”. This quote is argued to be an analogy for keeping the patient safe and to return them to the same condition as before they fell ill. Patient safety is one of many top priorities in a nurse’s creed, right next to caring for the patient and returning them to proper health. It is the nurse’s responsibility to keep the patient as comfortable as possible. This has
Sayar S.,Turgut, S., Dogan, H., Ekici, A., Yurtsever, S., Dermirkan, F., Doruk, N., Tsdelen, B. (2009) Incidence of pressure ulcers in intensive care unit patients at risk according to the Waterlow scale and factors influencing the development of pressure ulcers. Journal of Clinical Nursing 18, 765-774.
Physiotherapy in the ICU is a separate specialty. The clinical decision in this area is based on three main principals: a) knowledge of underlying pathophysiology and base for general care, b) normal and scientific evidence for therapeutic interventions, c) clinical experience.
There are still many barriers interfering with sleep in the hospital, as the disruption of sleep is common through frequent monitoring and procedures, noise, lighting, and anxiety about being in the hospital (Robinson et al., 2005). Another barrier is the critical care environment, which has more invasive monitoring and tests and noise from monitors and ventilators (Eliassen & Hopstock, 2011).
Using numerous studies, the article reviews nurse under-staffing in hospitals and how it not only impacts the care the patient receives, but also the nurse’s well-being. This article supports that staffing has a direct impact on patient care and safety, and that improved staffing improves patient outcomes. Curtain (2016) discusses the ethics of safe staffing. If management can apply a caring approach to administration, they will see the benefits of nurses spending more time with patients.
Nurses form an important role in influencing patient safety from everyday tasks and gradually obtaining the patient vital signs have increasingly been seen as a chore instead of collecting clinical evidence. This then creates an extreme danger to patient’s as irregular monitoring of vital signs prevented early detection of deterioration in a patient’s condition, which postpones transfer to intensive care unit ( Kyriacos U et al 2011; Boulanger, 2009). Due to this, a...
Along with vision, hearing is one of the most important senses that humans have. We use it to communicate, learn, and stay aware of our environment. In fact, hearing is the only sense that never stops receiving sensory input. While all of our other senses become drastically less sensitive when we are sleeping, our brain still processes auditory information to awaken us the second something is wrong. Although this may have been more practically used before people slept safely in homes, it’s still useful for hearing a fire alarm or our alarm clock in the morning. We are able to hear by processing sound waves. This energy travels through the delicate structures in our ears to be transformed into neural activity so that we can perceive the sensory information we receive (Myers, 2010).
Although students were not allowed in the recovery unit, I was able to talk to one of the recovery nurses. I learned that a nurse’s duty of care includes monitoring the patient’s vital signs and level of consciousness, and maintaining airway patency. Assessing pain and the effectiveness of pain management is also necessary. Once patients are transferred to the surgical ward, the goal is to assist in the recovery process, as well as providing referral details and education on care required when the patient returns home (Hamlin, 2010).