Noise pollution in hospitals has become a major concern for patients and families. Research shows that there is a strong relationship between the environment and patient health (Alligood, 2014, p. 55). Disruptive noises has an effect on patient’s ability to rest and can impede the healing and recovery process. Nightingale noted that “unnecessary noise is the cruelest absence of care” (Nightingale, 1859). To reduce noise pollution and decrease the negative physiological and psychological impact on patient health, nurses and hospitals need to develop a program that increases staff awareness and behavior modifications, monitors and modifies equipment, and increases quiet time for patients to rest.
The World Health Organization (WHO) recommended that hospital noise should be 35 dBA during the day and 30 dBA at night (cite). However, research has shown that noise pollution in hospitals regularly exceed the recommendations (Montague, Blietz, & Kachur, 2009). There are different ways noises can occur in a hospital environment such as staff conversation, equipment alarms, overhead paging (Spence, Murray, Tang, Butley, & Albert, 2011), telephones and door banging. It can also include noises from distressed patients. A study based on postoperative cardiac surgery found that patients thought the noise level in the unit was in the same range as heavy traffic which is 80 dBA (Spence et al., 2011). The noises was due to “opening and closing doors, objects thrown in the garbage can, and intravenous device alarms” (Spence et al., 2011). Unexpected noises also increase both physiological and psychological stress level (Kam and Thompson, 1994). Psychological stress can cause irritability and feeling bothered (Kam and Thompson, 1994). Noise pollution can cause increase in heart rate, blood pressure, so patients are at a greater risk for heart disease (Choiniere, 2010).
Several studies have concluded the increasing staff awareness and behaviour modification has been effective in reducing noise pollution. It is essential to evaluate and observe the activities in the unit in order to know of which tasks or equipment need modifications to decrease noise pollution. During a study, guidelines were provided to the staff members in the Surgical Unit to instruct the staff to close doors carefully and quietly once they leave the patient’s room, or have conversations quietly (Cmiel, Karr, Gasser, Oliphant, Neveau, 2004). Nightingale noted that conversations happening outside the patient’s room or in the adjoining room is disrupting (Nightingale, 1859). It is important that staff members are mindful when choosing to have a discussion with other staff members in the hospital (Cmeil et al., 2004). Therefore, having a designated place such as a report room to have these discussion instead of unenclosed nursing station (Cmeil et al., 2004) is an effective way to reduce noise levels to help with patient recovery.
Research done by King’s College London found that noise levels due to technology and equipment in Intensive Care Unit were partially to blame for patients requesting to be discharged early before they were completely better (“noise pollution in hospitals”, 2018). Therefore, studies show that modifying equipment such as intravenous alarms is effective in decreasing unnecessary noise (Mazer, 2010) that cause startling responses. Nightingale stated that intermittent noises has more of an impact on patients compared to continuous noise (Nightingale, 1859). Northside Hospital in Atlanta was able to reduce equipment noise by 50 dBA in the ICU by using padding for certain equipment such as pneumatic tube system (Mazer, 2010). In another study, nurses were also suggested to adjust the volume of their communication systems such as a telephone and put pagers on vibrate mode (Konkani et al., 2014).
Based on Nightingale’s theory, lowering noise levels for an hour is an effective way to allow patients to fall asleep. Nightingale states that if a patient is waken up after a few hours of sleeping, it is likely that they will fall back asleep compared to if a patient is waken up after only a few minutes (Nightingale, 1859). Multiple studies implemented approximately two hours of quiet time one to twice a day in their intervention in the neurocritical care ( Maidl-Putz, McAndrew, Leske, 2014). During these quiet hours, nurses avoided taking vital signs and giving medication (Maidl-Putz et al., 2014).These studies concluded that patient complaint about noise levels declined by 38% and adding quiet time for patients was beneficial because it improved patient sleep (Maidl-Putz et al., 2014). “The nurses was required to assess the need for quiet and to intervene as need to maintain it” (Alligood, 2014, p.53). Therefore, allowing patients to have adequate rest will have a positive impact on their physiological and psychological health.
In conclusion, multiple research showed that hospital noises exceeding the recommended noise level had a negative effect on a patient’s overall health. Nurses need to be aware of their behaviours, modifying equipment alongside introducing quiet time to the patients can have a positive effect on their overall health. Although Florence Nightingale’s theory is over a century old, promoting these types of programs demonstrates how her theory and advocacy is still applicable for the twenty first century in the health care settings as it was in the nineteenth century.
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