Nursing Research Utilization Project Proposal: Hospital Noise

Nursing Research Utilization Project Proposal: Hospital Noise The level of noise in a hospital is a serious issue for the nurses and the patients. Surveys have been created in an effort to determine if the noise is bothersome, what kinds of problems it causes, and whether there is anything that can be done about the noise levels. It is important not only to identify the problem, but to determine what can be done so that the problem is mitigated as much as possible.

Here, the problem of noise in the hospital is discussed, and from that point the issue of how to address and correct it is brought into play. There are many ways in which noise in a hospital can be reduced, including better and heavier screens for patient privacy, signs and warnings for people to keep quiet, machines that alert in other ways as opposed to noise, and equipment adjustments that allow for less noise when being moved from place to place.

Because there are so many suggestions for noise reduction in the hospital, nurses have plenty of options they can consider when they want to make changes or work with doctors, administration, and staff in order to have a quieter environment. Additional information to be considered relates to cost. Some options for noise reduction cost much less than others, of course, and when a hospital wants to make changes and keep things quieter it may not have much money to spend in order to get the desired results.

Because that is the case, hospitals must carefully consider all the options made available to them and determine if they can get grants or other help in order to take care of noise issues. When hospitals focus on the patients instead of other issues such as the bottom line, they are much more likely to provide those patients with a higher level of care and focus on how to help patients get through their hospital stay and lead better lives once they are discharged.

Nursing Research Utilization Project Proposal: Noise in Hospitals Introduction The Department of Health and Human Services Center for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ) partnered together in developing a comprehensive survey for "Hospital Consumer Assessment of Healthcare Providers" known as "HCAHPS." The purpose of the survey is to collect patients' reports and perspectives that were developed while they were in the hospital.

The public is encouraged to express their feelings and concerns about hospitals and to rate their hospital experience in this way. One of the specific questions that was asked on the survey was about noise. National healthcare quality surveys have found that noise in hospitals is an urgent concern. Noise level is among the physical environment factors that influence the "healing environment" of any healthcare setting (Reiling, Huges, & Murphy, 2008).

Not all patients have trouble with the level of noise that is involved with their hospital stay, but enough patients struggle with it to indicate that there is an issue for a significant percentage of patients. Because more than one survey has shown a correlation between quieter hospital stays and a better chance of faster healing. That is worth looking into, since it is much better for a patient to have a good hospital stay that is as short as possible.

If the level of noise in the hospital can affect that and the patient who has a quieter environment heals faster and is able to leave sooner, it would stand to reason that hospitals, patients, and even insurance companies would be very interested in finding ways to provide quieter environments in any and all types of hospital settings. Each and every hospital has a different way to handle things when it comes to patient complaints about noise or anything else.

For the hospital that wants to do something about the issue of noise and really wants to make sure that their patients are treated properly and are comfortable during their stay, there are plenty of options. The idea of taking a survey of patients and how they feel about their stay is one of the best ways for any hospital to get true and accurate answers about areas in which they need to improve.

That can help the patients, of course, but it also helps the hospital to make sure it is handling things as well as possible. Even if a hospital is focused on making money, as is the case with many hospitals because they have to have funds in order to remain open, a hospital should also care about the patients who come through its doors. When a hospital focuses on the people and not on the money, everything else will fall into place for it.

That is good news for all involved, but it can only be done if the hospital takes the time to make sure that it hears the needs of its patients. To that end, this paper is designed to explore the problem of excessive noise in a hospital setting, most specifically in the cardiac care unit.

By determining the noise level and whether that noise level is detrimental to patients, the hospital can decide how it wants to make changes and what it needs to do in order to improve patient outcomes. Not all patients are bothered by noise, but it is an issue for many people in the hospital. Problem Identification The problem is focused on only one hospital as a study example.

The Coronary Care Unit of North Shore University Hospital, Manhasset, New York is a 12-bed unit that has seen a 20% increase in hospital complaints about the noise level over the last three quarters of the year. This is, clearly, an issue for that hospital and something that has become more of a problem than it was in the past.

From the baseline number of complaints that are generally received in that unit, the rise in complaints - and a subsequent drop in complaints once measures are taken to reduce noise - can be measured. In order to keep patients comfortable and perhaps actually improve their health and outcomes, lowering the number of complaints will be necessary and will be focus of the hospital.

Solution Statement The Coronary Care Unit of North Shore University Hospital will implement a noise reduction protocol that will include the following evidence based (EB) elements: a. A reduction of equipment and machinery noise level, b. A reduction in the volume of staff conversations, c. A reduction of construction, trash pickup, traffic, and other exterior noises, and d. A reduction of overall hospital sounds such as food carts, other patients, and any extraneous noise not covered by a, b, and c.

It is necessary to measure the noise levels of these specific areas and then to measure the noise levels once plans to reduce the noise have been implemented. That will help to provide solid feedback as to whether the noise reduction plans have been appropriate or whether other changes still need to be made. Evidence from past studies shows that there are several areas of noise that can be reduced in a hospital (Xie, Kang, and Mills, 2009).

This is important, because it gives a hospital many areas on which to focus. Not all hospitals have noise issues in all of the areas mentioned, but a hospital with even one area of noise has an area on which it can work. When these noises are reduced or eliminated as much as possible, patients heal faster, feel better, complain less, and generally get released earlier than patients who must deal with constant noise and aggravation (Xie, Kang, and Mills, 2009).

In order to make sure patients have the best chance at recovery, the hospital noise level should be kept to a minimum to allow for peace and healing - and that is especially true in cardiac patients who are often recovering from surgery or any serious medical event (Xie, Kang, and Mills, 2009). Too much noise can slow healing and raise heart rate and blood pressure.

Those are all issues that should be avoided in cardiac patients, and if noise is a contributing factor to those issues the hospital must work to reduce that noise. Project Objective and Goal The Critical Coronary Care Unit of North Shore Hospital has launched a project to reduce the noise level in the unit, which will be measured by at least a 20% reduction in complaints marked on patients' surveys by July 1, 2013.

This will compensate for the 20% increase that was seen on past surveys and will return the hospital to its baseline. From that point, the hospital can work on getting complaints lowered even further. Any changes implemented will be tracked by surveys given to patients so the value of the changes that are made can be better determined. Without success in these plans, the hospital will have to change the plans and determine what to try as an alternate plan.

Solution Description Staff education and new employee orientation will mandate staff awareness of managing noise, including use of personal phones, overall noise levels, and IV pumps, as sound control needs to be regarded with accountability in maintaining an appropriate sound environment (Mazer, 2006). Reducing staff conversation and overhead voice paging by introducing electronic documentation and collaboration via emails, electronic messaging, and electronic orders will improve the quality of noise levels in the unit and improve the comfort of patients (Solet, Buxton, Ellenbogen, Wang, & Carballiera, 2010).

Exterior noises coming from outside the hospital building (road traffic, etc.) will be counteracted by the installation of window treatments that will provide soundproofing and insulation around the window frames. The exterior noises were found to be the least annoying stimuli, as opposed to other stimuli (towel dispenser, door close, toilet flush, ice machine) that tended to be more annoying to patients who are recovering (Solet, Buxton, Ellenbogen, Wang, & Carballiera, 2010). These sources of noise have been addressed, and being aware of them gives the staff the power of control.

Installation of sound-wave-blocking generators near the nursing station, and in the patients' rooms will also keep things quieter for those who are recovering from serious surgery or a cardiac event. Sound masking appears to be the most effective technique to improve sleep, decrease the noise level, and promote healing (Xie, Kang, and Mills, 2009). Creating small stations at both ends of the corridors will decongest the main nursing station.

The doctors' station was created on a side out of the way, so they can sit quietly and be able to concentrate on the patients' charts. The proposed solution is also consistent with current research knowledge, making it a logical choice for the unit. Research Support "Unnecessary noise is the most cruel abuse of care which can be inflicted on either the sick or the well," Florence Nightingale wrote in her 1859 book, Notes on Nursing (Miller, 2006).

Sleep disturbance is a factor in the development of delirium, as well as producing specific effects on the respiratory, cardiovascular, and immunological systems. Critical care patients are especially prone to delirium, better known as "sundown syndrome" as their normal circadian pattern of adrenocorticotropic hormone and melatonin levels is changed markedly by sepsis, and the change in white blood count due to heart attacks and other serious cardiac events (Xie, Kang, and Mills, 2009).

The impact of noise on patients' sleep and the effectiveness of noise reduction strategies is part of the safety program implemented by hospitals to decrease the effects of sundown syndrome. Higher blood pressure leads to a higher risk of cardiac problems. Berlin hospitals found that chronic noise in a hospital environment, where people are already ill and psychologically stressed, can be very harmful and can lead to heart attacks (Miller, 2006). The sources of noise are of both interior and exterior causes.

The phones, the beepers, the cardiac monitors, and the IV pumps were found to alter the noise level in critical care units. Other stimuli, such as towel dispensers, closing doors, toilets flushing, and ice machines tended to be even more annoying and upsetting to patients who are already ill (Solet, Buxton, Ellenbogen, Wang, & Carballiera, 2010). The impact of noise on patients' sleep and the effectiveness of noise reduction strategies in ICUs have shown that staff conversation and alarms are generally the most disturbing noises for patients' sleep in ICUs.

Literature explains that working with the staff on reducing the level of noise generated by these sources will become part of the personnel training (Mazer, 2006). The build of the hospital itself, with hard, long-lasting materials, in addition to the human and machinery sound emanating in a working environment will contribute to monitor and promote patient health. The reason that hospital interiors and furnishings are made of reflective materials is to avoid pathogens adhering to surfaces. They are easily cleaned and cannot harbor any infections.

Housekeeping caddies, X ray machines, electrocardiograms and echo machines rolling on a hard surface are causing sounds enhancement, overlapping and lingering longer than normal. Adding to them are the pneumatic tube system, automatic doors, and the rolling ventilators and IABP (Miller, 2006). Controlling noise involves actually adding sound to the environment with a series of speakers installed in the ceiling that electronically distributes a background sound, unperceived by humans, that serves to cover or reduce the impact of noise spikes.

It is a specially engineered sound creating an ambient environment that is quieter and that enhances speech privacy in healthcare facilities (Xie, Kang, and Mills, 2009). Dispersing the main nursing station by adding small cells of nursing station at the ends of the corridors is also beneficial in dispersing the activity horizontally on the floor. Evaluation Plan In order to evaluate the situation, it is important to find out what is wrong, specifically (Miller, 2006; Xie, Kang, and Mills, 2009).

If there are noise issues, what is causing those issues? It is easy to say that there are machines that make too much noise, or that there are people who talk too loudly, but those could also be symptoms of bigger problems that also have to be addressed. Some of the issues with noise are also hard to avoid because they are not related to something the hospital can easily control.

Traffic noise, for example, would be hard to address from the standpoint of the hospital without spending a lot of money to soundproof windows, doors, and other entrances. To evaluate the solution properly, the hospital needs to know whether the patients in its care are happy with the noise level they are experiencing or whether it is too noisy for them.

Some people are much more sensitive to noise than others, but the survey should focus on whether the patients are happy with the noise level overall, and it is expected that one or two patients will not be satisfied even if other patients are comfortable with the level of noise around them. Because noise can be a subjective issue, the survey conducted has to be subjective as well.

Then the project objective (reduced noise) can be determined based on what patients actually think and feel about the experience in the hospital. The survey (See Appendix) is designed to ensure that every patient has a say and that the opportunity is available for these patients to express themselves and let the hospital know about the noise levels.

In the unit in question, noise levels are particular important because individuals recovering from cardiac events or surgery need to be able to relax and be comfortable so they have time to heal (Xie, Kang, and Mills, 2009). Without proper healing time, these patients could be risking another cardiac event and may end up more seriously injured or in poorer health than they were originally.

The outcome measure that will be used (the survey) is valid and reliable for the study at hand and the information that will be collected, because it is specifically designed to ask patients about their experiences with noise during their stay in the hospital. That is the issue at hand and the area that needs to be measured. There is no better way to get information about a specific issue than to ask the people who are directly involved with that specific issue about their feelings.

When they are asked for their feelings, they need to be able to give those feelings honestly and be clear on whether they feel they have been exposed to too much noise during their hospital stay (Miller, 2006). The survey being used is also sensitive to change, because it can be adjusted in order to ask about the overall level or noise or to ask about more specific noise issues.

No matter what aspect of noise the researcher wants to study, the survey will be available and can be modified to suit the needs of the researcher at that particular time and with that group of individuals. This will allow the researcher to use the survey for the current Cardiac Unit, but also for other units in the hospital. The data from the survey will be collected using qualitative methods. In other words, statistical analyses will not be conducted on the information that is collected from the surveys.

The information provided by the patients through the survey will be analyzed carefully, and answers will be compared to previous levels of complaints that were provided by patients in the past. This will allow the researchers to use the original baseline as a comparison to the survey conducted.

By doing this, the researchers will have data points to which they can compare other data points - thus providing them with not only how patients feel about current noise levels but how they have felt in the past and whether this has changed. Being aware of changes in hospital noise levels is highly important when it comes to hospitals that want to make changes to those levels (Miller, 2006; Xie, Kang, and Mills, 2009).

For evaluation, the only thing needed is the survey and a spreadsheet that the researcher can use to include all of the information that was provided in the survey. There are no complex mathematical formulas that are needed and there is no statistical analysis that has to be conducted, so no software or programming are needed by the researcher.

This allows for a much simpler, easy to handle study that is still valid and that will still provide enough information to make a determination about the noise level in the unit. Whether the noise level is a problem and how it compares to the noise level in the past are both significant, and both of those areas can be addressed by this survey. One of the ways in which the hospital can get noise-reducing measures incorporated into what they are already doing is through grant funding.

Several sources of grant funding are available, but the most likely ones for the researcher to contact would be the state in which the hospital is located and the American Medical Association. If no help can be provided by contacting them, they may have suggestions for who the researcher could contact - and that would provide much needed grant money that could be used to make noise-reducing improvements at the hospital and improve the lives of patients.

The problem with noise is not just about it "bothering" people, but about the fact that it can create real upset and anguish in people who are sensitive to it and who are trying to get well again. Because that is the case, it is vital that hospitals focus on lowering the level of noise in cardiac units in order to help patients have a better outcome and heal as quickly as possible from their surgery or illness.

Decision In order to decide the future of the solution for the hospital, it is necessary to come up with a method that will actually work to provide that solution and to indicate that it is the most viable of the options that are available (Xie, Kang, and Mills, 2009). It can be hard for a hospital to make that determination because there are many ways to create a solution to a problem.

However, some of the solution options are better than others and some are also much more costly than others. There is no need to automatically assume that the highest priced solution is the best one, but there is also no reason to choose the least expensive option and assume that it will be the best choice. Cost, within reasonable considerations, should not come into play for a hospital focused on reducing noise for patients.

The solution and how it will evolve and be handled in the future should only involve taking the best care of the patients that the hospital is able to handle. There is always the chance that there will be some noise at different times during the person's hospital stay, but the overall level of noise is what is at issue. If the level of noise continues unabated and bothers the patients without letting up, it is possible these patients could suffer in their recovery and even relapse.

The future of the solution can be a strong one by making sure plans to make things quieter are actually carried out and that individuals who break the rules about too much noise are reminded, then reprimanded, then disciplined. There is no reason for an excessive amount of noise in a hospital setting, and it is the job of the hospital to take care of its patients and make sure they are treated properly and cared for in the right way.

Not all hospitals do this, but those that are conscientious about their patients will be mindful of issues that could bother those patients, like too much noise. The project solution must be maintained by ensuring that the rules continue to be followed. It is easy for people to get lax and go back to old habits, but that could be to the severe detriment of the patients (Miller, 2006; Xie, Kang, and Mills, 2009).

Instead of simply allowing that to happen, hospital personnel must be aware of the issue and must make sure that the old habits really stay in the past. If all the suggestions for making things quieter that have been presented in the above-referenced material are implemented, there is no reason why the hospital should have any trouble with noise or any patient complaints for noise. However, keeping that level of quiet is what matters at that point.

If the plans for the project are not successful, changes will have to be made to the plans in order to ensure that they provide a successful resolution in the end (Xie, Kang, and Mills, 2009). Any successful plans should be implemented and continued, and any unsuccessful plans should be adjusted so that they are successful when they are re-implemented. It is possible that a plan will actually have to be completely "scrapped" at some point, but this generally shows a lack of good initial planning in the first place.

It is much better to plan something appropriately in the first place, but even the best laid plans are not always successful. If the hospital creates a plan for lowering the noise level for patients but the plan is not successful, another plan must be attempted. Careful planning, design, and implementation are all necessary, and when the hospital focuses on issues such as providing the best possible care for patients, that hospital will spend more time focused.