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.
Delirium in the Intensive Care Unit (ICU) has become a genuine phenomenon and can be problematic for the patient and the staff caring for them. Delirium occurs when a patient is placed in an unfamiliar environment and has to endure the stress of not just the hospitalization but the stimuli of the environment, which can cause disturbances in consciousness. Patients can become confused, anxious, and agitated; making this difficult for the staff to correctly diagnosis and care for them. Sleep deprivation and environmental factors along with neurotransmitters are strongly related to the occurrence of ICU delirium. ICU staff needs to become more educated on prevention, detection, and proper treatment for the patient experiencing this condition.
Today, most hospitals have strict ICU visiting hours despite increasing awareness that family and friends play an active role in a patient’s care. Typically, patients in ICU are critically ill and are often at the end stages of their lives. The presence of family and friends in these circumstances is vital in creating the most comfortable and therapeutic environment for the patient. Studies have shown the benefit for the patients when the support and positive reinforcement of family and friends is present. Furthermore, a randomized controlled trial revealed that an unrestricted ICU visiting policy is associated with reduced cardio-circulatory complications, possibly because visits reduce patient anxiety and promote a more favorable hormonal profile (Berti, Ferdinande, Moons, 2007).
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.
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,
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,
As we are well aware, being a patient at a hospital can prove beneficial or problematic. As it is with the most critical of patients, they require a closer level of surveillance and monitoring than those on other med-surg associated units. As the care of an ICU patient can escalate quickly, it’s critical to assess the needs of your patient in a timely manner. Looking at a ventilated patient who requires many different modalities, assessing the need for such ther...
Bartlett, G., Blais, R., Tamblyn, R., Clermont, R.J., & MacGibbon, B. (2008, June 3). Impact of patient communication problems on the risk of preventable adverse events in acute care settings. CMAJ, 178(12), 1555-1562. Retrieved November 12, 2013 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2396356/
Nurses play an important role in the recovery and assurance of a patient’s health. They need to make sure patients are safe and advocate for their rights. This idea is stated under Provision number 3 in the Code of Ethics for nurses. To better explain it, the following section will explain two main points that belong to this provision. The first aspects this paper will cover are privacy and confidentiality. Privacy is essential to every human being; it is a right that every person is born with. Nurses advocate for an environment that provides for sufficient physical privacy, including auditory privacy for discussion of personal nature and policies and practices that protect the confidentiality of information (Code of Ethics for nurses, 2011, p. 6). In some cases, a person can be sick, unconscious, alone in a hospital room with no
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...
Healthcare Professionals in Intensive Care Units: A Systematic Review.” PLOS Medicine, Public Library of Science, journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0136955.
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 cacophonous, resounding clang of the alarm can be the gatekeeper between life and death for a patient. Alarms bring providers to the rescue and allow for an array of immediate interventions, from preventing a disoriented patient from falling to signaling impending medical crisis or malfunction of vital assistive equipment. Much of the time, however, these alarms are either clinically insignificant or inappropriately triggered and thus deemed “nuisance alarms.”
In the Intensive Care Unit (ICU), patients are being monitored very closely while their vital signs, their neurological status, and their physical status are being managed with strong medications, lifesaving machines, and the clinical knowledge and skills of trained ICU nurses. Outside of the ICU, it is essential for staff nurses to identify the patient that is clinically deteriorating and in need of urgent intervention.
What this journal article talks about is different models of communication and how the role of “noise” comes into play because of different cultures. Within this article there is a model that describes the sources of noise in patient communication pathway. Through the providers mind to the patients mind, there are nonverbal actions and words heard that affect the message like assumptions, stereotypes, language, anxiety and other interruptions that affect the outcome of the message being
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.