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The Effects of Noise Pollution in the Hospital Environment
- 1. Running head: NOISE POLLUTION 1 The Effects of Noise Pollution in the Hospital Environment Sara Masciarelli NUR 102- DD Professor Anne Moorhouse November 3, 2014
- 2. Noise Pollution 2 The Effects of Noise Pollution in the Hospital Environment Florence Nightingale was the first person to explore physical environment as a determi- nant of health. She focused on aspects such as ventilation, cleanliness, light, and, as will be dis- cussed in this essay, noise. As defined by Maid-Putz, McAndrew, and Leske, (2014) noise is “unwanted sound” (p.57), which, according to Florence Nightingale, is harmful to patients (Nightingale, 1859). Therefore, the focus of this essay is to illustrate how Florence Nightingale’s theory is still relevant in today’s health care settings by outlining the types of noise that affect patients, how this noise affects the recovery of patients, and how nurses can become more active in preventing unnecessary noise in the hospital setting. First, sound levels are measured in decibels (dB), 0dB is considered the threshold for hearing of humans (Maid- Putz et al., 2014). The World Health Organization (WHO) recom- mends that sound levels should not surpass 35 dBA during the day, and 30dBA at night, with a maximum of 40dBA (Montague, Blietz, & Kachur, 2009). However, it was discovered that sound levels in hospitals often reach 85dBA (Montague et al., 2009). This creates a significantly noisier environment than the recommended noise levels. Results published on the Department of Health and Human Services Hospital Care Website reveal only 56% of patients reported their rooms be- ing quiet all the time which suggests that there is a mandatory need for improvement in this field (Montague et al., 2009). There are certain noises created in a hospital environment that create more of a distur- bance to patients than others (Spence, Murray, Tang, Butley, & Albert, 2011). Noise created in hospitals may range from overhead paging to conversations between staff (Spence et al., 2011). A study concerned with noises that interrupt sleep in a postoperative cardiac surgery unit
- 3. Noise Pollution 3 found that common noises created in the unit were in the same noise range as heavy traffic (80d- BA) (Spence et al., 2011). These noises were often the “opening and closing of doors, objects thrown into garbage cans, and intravenous device alarms” (Spence et al., 2011). According to the study, sleep disturbances were created by different factors such as noise type (both continu- ous and intermittent). In accordance with Nightingale’s theory, intermittent noises are more dis- ruptive than continuous noises because they create a sense of anticipation, and increase stress levels (Nightingale, 1859). This suggests that sudden noises such as intravenous alarms are more disruptive than continuous sounds such as those that come from televisions. Furthermore, follow- ing the completion of a questionnaire of patients, it was discovered that telemetry alarms and talking are the most disruptive sounds (Spence et al., 2011). All of these factors create intermit- tent noises which supports Nightingale’s theory. Next, consider how these noise disruptions negatively affect the health and recovery of patients. First, it it may disrupt the sleep of patients. Referring back to the study on postoperative cardiac patients, 148 patients were chosen to answer questions about fifteen noise factors that either prevented or interrupted their sleep. 92% of participants stated that at least one noise af- fected their nighttime sleep, and 8% of participants identified all fifteen factors as effecters (Spence et al., 2011). According to Nightingale, patients should never be intentionally or accidentally waken (Nightingale, 1859), because lack of sleep weakens one’s immune system and negatively affects the speed of recovery (Morgenthaler, 2012). Therefore, if patients are being disturbed by noises throughout the day and night which interrupt or prevent them from sleeping, this could ultimate- ly inhibit their recovery.
- 4. Noise Pollution 4 In addition to sleep, there are other effects noise pollution has on patients. The body’s re- sponse to noise is very similar to it’s response to stress, and overtime this can dramatically effect one’s health (Choiniere, 2010). Noise can stimulate the pituitary glands, which in turn produce changes in the endocrine and sympathetic nervous systems which are common in one’s response to a stressful situation. Therefore, patients can become increasingly more stressed if they are ex- posed to high noise levels (Choiniere, 2010). This hinders patients recovery because stress increases patients susceptibility to certain diseases, and causes physiological changes such as changes in temperature and oxygen levels which help maintain homeostasis (Choiniere, 2010). Although a certain amount of stress is healthy for an individual, constant exposure to stressful situations can be harmful (Choiniere, 2010). Since noise triggers a stress response, an individuals heart rate increases, blood pressure is elevated, individuals are placed at greater risk for developing heart disease, and wound healing is delayed (Choiniere, 2010). Noise pollution not only negatively affects patients, but also, to a lesser degree, hospital staff. Various noises like call alarms, and pagers affect the overall well being of health care pro- fessionals by increasing stress levels, increasing heart rates, and increasing annoyance rating (Choiniere, 2010). In turn, noise pollution may also affect the performance of hospital staff by increasing miscommunication, impairing concentration, and delaying response to alarms (Choiniere, 2010). All of these factors affect the safety of patients (Choiniere, 2010). Given these points, there is obvious need for improvement within hospitals to make the environment more desirable for the well being of both patients and staff. There are many small changes that can be enforced by hospital staff. As Nightingale states “the nurse is required to
- 5. Noise Pollution 5 assess the need for quiet and to intervene as needed to maintain it” (Alligood & Tomey, 2014, p. 64). Therefore, nurses (and other hospital employees) should take on the responsibility of mak- ing changes that lower the noise levels in hospitals. The University of Maryland Medical Centre took action by creating “quiet hour” (Choiniere, 2010). During this time, visitors are asked to leave, patients doors are closed, lights are dimmed and announcements over intercom are not al- lowed (Choiniere, 2010). According to Nightingale’s theory, lowering noise levels for an hour is effective in allow- ing patients to fall asleep. Nightingale states that if a patient is waken up after a few hours of sleeping, it is likely he/she will fall back asleep, although if a patient is waken up after only a few minutes of sleeping, it is unlikely they will fall back asleep (Nightingale, 1859). Further, I think nurses should perform all necessary procedures (eg. taking vitals and linen changing) be- fore the hour begins to ensure the patient is not disturbed while trying to initially fall asleep. Even though noise levels may rise after the hour is over, if the patient was able to fall asleep within it is less likely if the patient is waken up that he/she will not be able to fall back asleep. Ensuring patients receive adequate rest is essential in restoring their health. In addition to ensuring patients are able to rest, the hospital staff should also take into consideration unnecessary noise created by equipment such as intravenous alarms. As stated be- fore, Nightingale explains that intermittent, or unexpected sounds are the most disruptive (Nightingale, 1859). With that said, in order to prevent stress caused by these unexpected alarms, nurses should refill or reset the equipment before the alarm goes off. This will cause less distrac- tion, and lower the stress levels of patients. Lastly, another practice hospital staff can take on in order to lower the noise levels of
- 6. Noise Pollution 6 hospitals is being more mindful of their actions. For example, Nightingale states that doing things in a patients room that are slow and gentle is more disruptive than “firm light steps” (Nightingale, 1859). For this reason hospital staff should not try to be overly careful or gentle while entering a patients room. Additionally, Nightingale also states that conversations taking place just outside of the patient’s room or in the adjoining room disrupts them (Nightingale, 1859). Therefore, staff should be mindful when choosing a location to discuss a patient with fellow staff or family of the patient. More appropriate locations would be in conference rooms or any other private location. All of the above suggestions are small changes hospital staff can adopt in order to lower noise levels in the hospital, and create a more desirable environment for healing patients. In conclusion, the types of disruptive noise, the effects of noise and a plan has been pro- vided in order to illustrate how Florence Nightingale’s theory is still relevant in today’s health care settings. Florence Nightingale was the first to illustrate the effects of environment on the health and recovery of patients, and although her teachings are over a century old, it is clear that her theory is still very relevant in today’s health care system and is essential in restoring the health and well being of patients.
- 7. Noise Pollution 7 Works Cited: Alligood, M. R. (2014). Nursing Theorists and Their Work (8th ed). St. Louis, Missouri: Elsevier. Choiniere, D. B. (2010). The Effects of Hospital Noise. Nursing Administration Quarterly, 34(4): 327-333. doi: 10.1097/NAQ.0bo13e3181f563db Maidl-Putz, C., & McAndrew, N.S., & Leske, J.S. (2014).Noise in the ICU: sound levels can be harmful. Nursing Critical Care. 9(5): 29-35. doi: 10.1097/01.CCN. 0000453470.88327.2F Montague, K. N., & Blietz, C. M., & Kachur, M. (2009). Ensuring Quieter Hospital Environments. American Journal of Nursing. 109(9): 65-67. doi: 10.1097/01.NAJ. 0000360316.54373.0d Morgenthaler, T. (2012, July 10). Mayo Clinic. Retrieved October 18, 2014, from http://www.mayoclinic.org/diseases-conditions/insomnia/expert-answers/lack-of- sleep/faq-20057757 Nightingale, F. (1859). Notes on Nursing: What it is, What it is not [Google Books version]. Retrieved from: http://gutenberg.org/files/17366/17366-h/17366-h.htm Spence, J., & Murray., T, & Tang, A., & Butler, R. S., & Albert, N. (2011). Nighttime Noise Issues That Interrupt Sleep After Cardiac Surgery. Journal of Nursing Care Quality. 26(1): 88-95. doi: 10. 1097/ NCQ.0b013e3181ed939a
- 8. Noise Pollution 8 Research Process Evaluation: PRSA Cita- tion Database Search Words Suggested Terms Limits used Use of Source Article 1: Noise in the ICU Ovid “noise in hos- pitals” N/A Ovid full text, limit to last five years provided in- formation on how sound is measured, and compared the noise level of hospital nois- es to noises we hear in the community (eg. motorcy- cles) Article 2: Nighttime Noise… Surgery Ovid “noise in hos- pitals” N/A Ovid full text, limit to last five years provided in- formation on which sounds are disruptive to recovering patients (eg. overhead pag- ing) Article 3: En- suring…Envi- ronments Ovid “noise in hos- pitals” N/A Ovid full text, limit to last five years provided sta- tistics on how many patients are disturbed by noise pol- lutions, guide- lines set by the WHO, and the evolution of noise pol- lution in hos- pitals
- 9. Noise Pollution 8 Article 4: The Effects… Noise Ovid “noise in hos- pitals” N/A Ovid full text, limit to last five years provided in- formation on how noise pollution di- rectly effects recovering patients (eg. higher blood pressure)