Review Of The Issue Of Noise Pollution In Hospitals
Noise pollution in hospitals has become a major concern for patients and families. Research has shown that there is a strong relationship between a patient’s environment and their health (Alligood, 2014, p. 55). Disruptive noises have 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, 1860, p. 27). To reduce noise pollution and decrease the negative physiological and psychological impact on patient health, nurses need to develop a program that increases staff awareness and behavior modification, monitors and reduces noise levels of equipment, and increases quiet time for patients to rest.
The World Health Organization (WHO) recommends that noise levels in hospitals should not exceed an average of 30 dBA over the course of the day and should not exceed a maximum of 40 dBA during the night (WHO, 1999). However, research has shown that noise pollution in hospitals regularly exceed the recommended values (Montague, Blietz, & Kachur, 2009). There are a number of ways noises can occur in a hospital environment such as staff conversation, equipment alarms, and overhead paging (Spence, Murray, Tang, Butley, & Albert, 2011). A study on postoperative cardiac surgery patients estimated the noise level in the unit was in the same range as heavy traffic which measures 80 dBA (Spence et al., 2011). The noises were due to “opening and closing doors, objects thrown in the garbage can, and intravenous device alarms” (Spence et al., 2011). Unexpected noises not only increase psychological stress levels which can cause irritability, but also physiological stress levels (Kam and Thompson, 1994).
Staff Awareness and Behavior Modification
Several studies have concluded that increasing staff awareness of noisy behavior and making modifications is an integral component of any program to reduce noise pollution. It is essential to observe and evaluate the activities in the unit, in order to know which tasks or equipment need modifications to decrease noise pollution. During a study, guidelines were provided to the staff members in the surgical unit, instructing them to close doors carefully and quietly when leaving patients’ rooms, and to have conversations quietly (Cmiel, Karr, Gasser, Oliphant, Neveau, 2004). Nightingale noted that conversations occurring outside the patient’s room or in the adjoining room are disruptive (Nightingale, 1860). It is important that staff members are mindful when choosing to have discussions with other staff members in the hospital (Cmeil et al., 2004). Therefore, having a designated place such as a report room to have these discussions, rather than in an open nursing station, is an effective way to reduce noise levels to help with patient recovery (Cmeil et al., 2004).
Monitor and Modify Equipment
There have been a number of strategies proposed to modify equipment to reduce noise pollution in hospitals. Research done by King’s College London found that noise levels due to technology and equipment in its intensive care unit were partially to blame for patients requesting to be discharged early, before being sufficiently recovered (Xyrichis, 2018). In particular, studies show that modifying equipment such as intravenous alarms is effective in decreasing unnecessary noise (Mazer, 2017). Nightingale stated that intermittent noise has more of an impact on patients compared to continuous noise (Nightingale, 1860). Northside Hospital in Atlanta was able to reduce equipment noise by 50 dBA in the intensive care unit by using padding for certain equipment such as pneumatic tube systems (Mazer, 2010). In another study, nurses were advised to adjust the volume of their communication systems, such as a telephone and put pagers on vibrate mode (Konkani, Oakley, Penprase, 2014).
Increasing Quiet Time
Several studies have found a positive correlation between quiet time and improved sleep among patients. Nightingale states that if a patient is woken up after a few hours of sleeping, as opposed to being woken up after only a few minutes, it is more likely that they will fall back asleep (Nightingale, 1860). Multiple studies implemented approximately two hours of quiet time once to twice a day in their intervention in the Neurocritical Care Unit (Maidl-Putz, McAndrew, Leske, 2014). According to Nightingale, reducing noise levels for an hour is an effective way to allow patients to fall asleep (Nightingale, 1860). In another study, nurses avoided taking vital signs and giving medication during quiet time (Maidl-Putz et al., 2014). Patient complaints about noise levels declined by 38% during the study and adding quiet time for patients was beneficial because it improved patients’ sleep (Maidl-Putz et al., 2014). “The nurses were required to assess the need for quiet and to intervene as needed to maintain it” (Alligood, 2014, p.53). Quiet time has been repeatedly demonstrated to be an effective means of allowing patients to get adequate rest, and to have a positive impact on their physiological and psychological health.
The literature is clear on the negative effect of hospital noises exceeding recommended levels on a patient’s overall health. A multifaceted approach to tackling the problem of noise pollution which considers the impact of behaviour, equipment, and quiet time on patients can have a positive effect on their overall health. Although Florence Nightingale’s work is over a century old, it remains as relevant in the twenty first century as in the nineteenth century; noise will always be a problem to contend with in health care settings.
