Quiet please, for our health’s sake The rising noise levels on busy hospital wards can lead to stress and delay recovery, says Erin Dean
SUMMARY
With alarms beeping, people walking around, bin lids slamming and phones ringing, it is not surprising that patients in hospitals can find it difficult to sleep at night. Hospitals are busy places 24 hours a day, but the need to create a quieter, more restful environment at night is coming under scrutiny. At RCN congress in Liverpool in June, members backed a vote calling for staff in all health and social care settings to be educated about the impact of noise at night and to promote nurse-led measures to reduce noise when patients are sleeping. RCN Suffolk branch member Debbie Simmonds told congress that the increasing acuity of patients, requiring a greater intensity of care, is making hospitals busier – and therefore noisier. ‘This increased clinical activity is making the provision of an environment conducive to sleep more difficult to achieve,’ she said. It is not a new issue. Florence Nightingale wrote in Notes on Nursing: ‘Unnecessary noise, or noise that creates an expectation
Tips to reduce noise on wards at night Avoid having unnecessary conversations with colleagues. Ensure the nurse call system is on the nighttime setting. Set pagers to vibration mode. Change to soft-closing bins and drawers. Consider the noise potential of the ward design, equipment and furnishings. If immediate change is not possible, introduce low-noise options over the long term whenever equipment needs to be replaced. in the mind, is that which hurts a patient.’ But it is a problem that appears to be getting worse. A review of evidence on the effect of noise on health, published in The Lancet in October 2013, found that noise on hospital wards has increased since the 1960s and is now typically up to 20
NOISE IS ASSOCIATED WITH INCREASED RISK OF HYPERTENSION AND REDUCED PAIN CONTROL
As patients’ acuity has increased and hospitals have become busier, noise levels have increased. Excessive noise at night can have negative physiological and psychological effects on patients, delaying their recovery. It can also affect staff wellbeing and performance. Noise can be reduced by educating staff and making simple changes to the clinical environment. Author Erin Dean is a freelance journalist
from other patients, while 20 per cent said that they were bothered by noise at night from hospital staff. The RCN says that noise can lead to stress, which has physiological and psychological effects on patients. There is evidence, for example, that noise is associated with increased risk of hypertension and ischaemic heart disease, delayed wound healing, aggressive behaviour, and reduced pain control. Children, very low birthweight babies, pregnant women and the elderly are particularly vulnerable to sleep disturbance from noise. Annette Richardson, a nurse consultant in critical care at Newcastle upon Tyne Hospitals NHS Foundation Trust, has looked at the problem on wards and in intensive care units. She found that the causes of noise included alarms going off on monitors, nurses talking to and caring for other patients, opening drawers to access equipment, using noisy bins, and other patients getting up. The nurse
decibels above the recommended World Health Organization levels. Researchers carrying out a sleep laboratory study found that the most disturbing noises were intravenous pump alarms and ringing telephones. Noise is an important issue for patients. In the 2013 Inpatients survey of more than 62,000 people in England, carried out by the Care Quality Commission, almost 40 per cent said that they were bothered by noise at night
call system was rarely put on the nighttime setting, and the hard floor of the wards amplified the noise. In response to Ms Richardson’s findings, an education programme was introduced for hospital staff. They were urged to reduce noise by, for example, switching phones to the vibrate option and wearing soft soled shoes. Patients were encouraged to use earplugs and eyemasks at night. Thanks to this proactive approach, average peak noise
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ELLY WALTON
of patients waiting two minutes or more to get a response from a nurse has been reduced and it has reduced noise on the wards during the day and at night.’ The Lancet review that revealed the rise in noise on wards since the 1960s also found evidence that it is having increasing negative effects on hospital staff, particularly for nurses. Noise-induced stress is linked to burnout, diminished wellbeing, and reduced performance, as well as irritation, fatigue and tension headaches. Noise also affects the intelligibility of speech and can therefore lead to misunderstandings that result in medical errors. Adrian Davis, director of population health science at Public Health England, warns that intrusive noise at work can reduce the wellbeing and efficiency of staff, particularly those who have a hearing problem or for whom English is not a first language. ‘There is an added impact on them from communicating in the presence of background noise,’ he says. ‘Noise makes staff more tired at the end of the day and less able to participate in other elements of society, such as spending time with family and friends, exercising and volunteering.’
levels over 24 hours fell from 96 decibels to 77 decibels. ‘Noise is a big problem,’ says Ms Richardson. ‘In intensive care there is lots of activity and lots of sick patients, and the acuity of patients is increasing, so many more members of the team are needed to care for them. ‘But there are things that nurses and other staff can do to reduce noise. We asked the wards to purchase quietly closing bins, and we spent a lot of time explaining to staff the things that cause noise and the consequences for patients.’
Improved environment
She suggests that organisations, not just individual staff, need to commit to noise reduction. ‘Hospitals should have a replacement policy when it comes to buying equipment such as bins and drawers, so that quiet closing versions are used.’ At NHS Borders in Scotland, a pilot to reduce noise was introduced on two wards in 2012. It involved moving to a call system where patients alert nurses through pagers set to vibration. Diane Keddie, interim associate director of nursing for acute services, says: ‘The number
The good news, says Professor Davis, is that it is possible to turn down the volume overall in busy hospitals. ‘Within the modern working environment there is a lot of scope for designers, human resources, decision makers and staff to sit back and think about innovative ways in which they can improve their working environment,’ he says. ‘There might be a need for some initial investment, but if staff feel that they are having a much better working environment then the savings will be quite substantial. It could lead to much greater staff efficiency, staff retention and a greater sense of wellbeing’ NS
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SUMMARY
With alarms beeping, people walking around, bin lids slamming and phones ringing, it is not surprising that patients in hospitals can find it difficult to sleep at night. Hospitals are busy places 24 hours a day, but the need to create a quieter, more restful environment at night is coming under scrutiny. At RCN congress in Liverpool in June, members backed a vote calling for staff in all health and social care settings to be educated about the impact of noise at night and to promote nurse-led measures to reduce noise when patients are sleeping. RCN Suffolk branch member Debbie Simmonds told congress that the increasing acuity of patients, requiring a greater intensity of care, is making hospitals busier – and therefore noisier. ‘This increased clinical activity is making the provision of an environment conducive to sleep more difficult to achieve,’ she said. It is not a new issue. Florence Nightingale wrote in Notes on Nursing: ‘Unnecessary noise, or noise that creates an expectation
Tips to reduce noise on wards at night Avoid having unnecessary conversations with colleagues. Ensure the nurse call system is on the nighttime setting. Set pagers to vibration mode. Change to soft-closing bins and drawers. Consider the noise potential of the ward design, equipment and furnishings. If immediate change is not possible, introduce low-noise options over the long term whenever equipment needs to be replaced. in the mind, is that which hurts a patient.’ But it is a problem that appears to be getting worse. A review of evidence on the effect of noise on health, published in The Lancet in October 2013, found that noise on hospital wards has increased since the 1960s and is now typically up to 20
NOISE IS ASSOCIATED WITH INCREASED RISK OF HYPERTENSION AND REDUCED PAIN CONTROL
As patients’ acuity has increased and hospitals have become busier, noise levels have increased. Excessive noise at night can have negative physiological and psychological effects on patients, delaying their recovery. It can also affect staff wellbeing and performance. Noise can be reduced by educating staff and making simple changes to the clinical environment. Author Erin Dean is a freelance journalist
from other patients, while 20 per cent said that they were bothered by noise at night from hospital staff. The RCN says that noise can lead to stress, which has physiological and psychological effects on patients. There is evidence, for example, that noise is associated with increased risk of hypertension and ischaemic heart disease, delayed wound healing, aggressive behaviour, and reduced pain control. Children, very low birthweight babies, pregnant women and the elderly are particularly vulnerable to sleep disturbance from noise. Annette Richardson, a nurse consultant in critical care at Newcastle upon Tyne Hospitals NHS Foundation Trust, has looked at the problem on wards and in intensive care units. She found that the causes of noise included alarms going off on monitors, nurses talking to and caring for other patients, opening drawers to access equipment, using noisy bins, and other patients getting up. The nurse
decibels above the recommended World Health Organization levels. Researchers carrying out a sleep laboratory study found that the most disturbing noises were intravenous pump alarms and ringing telephones. Noise is an important issue for patients. In the 2013 Inpatients survey of more than 62,000 people in England, carried out by the Care Quality Commission, almost 40 per cent said that they were bothered by noise at night
call system was rarely put on the nighttime setting, and the hard floor of the wards amplified the noise. In response to Ms Richardson’s findings, an education programme was introduced for hospital staff. They were urged to reduce noise by, for example, switching phones to the vibrate option and wearing soft soled shoes. Patients were encouraged to use earplugs and eyemasks at night. Thanks to this proactive approach, average peak noise
20 september 3 :: vol 29 no 1 :: 2014 NURSING STANDARD Downloaded from RCNi.com by ${individualUser.displayName} on Nov 13, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
ELLY WALTON
of patients waiting two minutes or more to get a response from a nurse has been reduced and it has reduced noise on the wards during the day and at night.’ The Lancet review that revealed the rise in noise on wards since the 1960s also found evidence that it is having increasing negative effects on hospital staff, particularly for nurses. Noise-induced stress is linked to burnout, diminished wellbeing, and reduced performance, as well as irritation, fatigue and tension headaches. Noise also affects the intelligibility of speech and can therefore lead to misunderstandings that result in medical errors. Adrian Davis, director of population health science at Public Health England, warns that intrusive noise at work can reduce the wellbeing and efficiency of staff, particularly those who have a hearing problem or for whom English is not a first language. ‘There is an added impact on them from communicating in the presence of background noise,’ he says. ‘Noise makes staff more tired at the end of the day and less able to participate in other elements of society, such as spending time with family and friends, exercising and volunteering.’
levels over 24 hours fell from 96 decibels to 77 decibels. ‘Noise is a big problem,’ says Ms Richardson. ‘In intensive care there is lots of activity and lots of sick patients, and the acuity of patients is increasing, so many more members of the team are needed to care for them. ‘But there are things that nurses and other staff can do to reduce noise. We asked the wards to purchase quietly closing bins, and we spent a lot of time explaining to staff the things that cause noise and the consequences for patients.’
Improved environment
She suggests that organisations, not just individual staff, need to commit to noise reduction. ‘Hospitals should have a replacement policy when it comes to buying equipment such as bins and drawers, so that quiet closing versions are used.’ At NHS Borders in Scotland, a pilot to reduce noise was introduced on two wards in 2012. It involved moving to a call system where patients alert nurses through pagers set to vibration. Diane Keddie, interim associate director of nursing for acute services, says: ‘The number
The good news, says Professor Davis, is that it is possible to turn down the volume overall in busy hospitals. ‘Within the modern working environment there is a lot of scope for designers, human resources, decision makers and staff to sit back and think about innovative ways in which they can improve their working environment,’ he says. ‘There might be a need for some initial investment, but if staff feel that they are having a much better working environment then the savings will be quite substantial. It could lead to much greater staff efficiency, staff retention and a greater sense of wellbeing’ NS
NURSING STANDARD september 3 :: vol 29 no 1 :: 2014 21 Downloaded from RCNi.com by ${individualUser.displayName} on Nov 13, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
