Trouble Sleeping in the Hospital? Maybe It's That Jackhammer

ROCHESTER, Minn. - Newswise -- A Mayo Clinic nursing team looking into reasons why patients have difficulty sleeping in the hospital after surgery found surprisingly high peak noise levels, rivaling those produced by a jackhammer. The findings, and the steps the team has taken to counteract the problem, are published in the February 2004 issue of American Journal of Nursing.

"Adequate sleep is important to the healing process, and sleeping in the hospital is notoriously difficult," says Cheryl Cmiel, the lead author of the paper. "Our continuous improvement team wanted to find specific causes for the problem, and see what concrete steps we could take to help solve it."

In response to patient reports of poor sleep and noise while trying to sleep, the nursing team started its study by placing noise dosimeters in three empty patient rooms during a night shift, without the night staff's knowledge, to continuously measure decibel levels from 10 p.m. to 7 a.m. A second set of readings was taken when two nurses volunteered to sleep overnight in a semiprivate room, with equipment and monitors typically used during a thoracic surgery patient's stay. They logged their experiences, noting bothersome noises that were then matched against the decibel readings. Patients in the thoracic surgery unit typically have had operations involving the lungs or esophagus, and the average length of their hospital stay is five to 10 days.

"We wanted to experience the patient's perspective, so we became patients for one night," says Cmiel. "We got an earful."

Peak dosimeter readings as high as 113 decibels -- roughly equivalent to the noise of a chainsaw or a jackhammer -- came at the time of morning shift change, around 7 a.m., although the 11 p.m. shift change also was noisy. Sleep-promoting changes made after the problems were identified included:

- Moving staff reports at shift change to an enclosed room, instead of at the nurses' desk

- Placing foam rubber padding in the chart holders outside patient rooms and in the pneumatic tube document-delivery system

- Replacing noisy roll-type paper towel dispensers with silent folded-towel dispensers

- Routinely closing doors to patients' rooms

- Modifying cardiac monitor settings to allow for lower volumes in the patient rooms, but with additional alarms sounding at the nurses' station

- Changing nightly chest X-ray times to 10 p.m. instead of 3 a.m.

- Using flashlights instead of overhead lights when entering patients' rooms

- Staff education to help draw attention to the issue and to share noise control measures

Noise levels were recorded again after the interventions, and the peak at shift change was reduced to 86 decibels, a reduction of more than 80 percent. (A 10-decibel reduction is equal to a 50 percent drop in sound intensity.) The average overnight noise level was reduced from 45 decibels originally to 42 decibels after the changes. Nearly two-thirds of the patients commenting in a satisfaction survey about noise and sleep issues gave positive feedback on the closed doors, general unit quietness and the willingness of staff to ensure a quiet night of sleep.

Cmiel hopes the results from her group's study will encourage nursing teams elsewhere to investigate barriers to sleep in their units, and take action. "The first step is to survey patients and ask what noises are interfering with their sleep," Cmiel says. "Problems in a given environment may be different from our experience, and noises patients find disturbing are not always apparent to nursing staff. But it's worth the effort; reductions of even a few decibels can improve sleep and help patients get the rest they need to heal."

Co-authors of the paper include Dana Karr, Dawn Gasser, Loretta Oliphant and Amy Neveau. The original leader of the sleep promotion team was Jean Henderson, now at Innovis Health in Fargo, N.D.

Source: Mayo Clinic