VOL: 96, ISSUE: 41, PAGE NO: 38
Gillian Arblaster, RGN, DPSN, MSc, BSc, is head of clinical practice, Walsgrave Hospitals NHS Trust, Coventry
Sarah Carr, MSc, BA, is quality manager, Walsgrave Hospitals NHS Trust, CoventryGillian Arblaster, RGN, DPSN, MSc, BSc, is head of clinical practice, Walsgrave Hospitals NHS Trust, Coventry
Noise in hospitals at night is well known for disrupting patients' sleep (Haddock, 1994; Ersser et al, 1999). Not only are patients trying to sleep in an unfamiliar environment, they are also exposed to noises that they are probably unaccustomed to, such as telephones ringing, staff talking and equipment alarms going off. In addition to this, general hospital activity - drug administration rounds, lights being switched on and off and so on - cause further disturbance. Bearing in mind that sleep deprivation in hospital is thought to slow recovery rates (Biley, 1994; Green, 1992), staff at Walsgrave Hospitals NHS Trust in Coventry decided to find out the level and nature of disruption caused by noise on the wards with the aim of taking action to reduce it.
Assessing the problem
These comments supported prior feedback from patients that had been identified via comments, complaints and discussions with various groups representing patients, including the community health council.
Creating a standard
It was decided that to effectively assess the effect that noise was having on patients' sleep, a standard needed to be created. This was done using the Dynamic Standard Setting System (DySSSy) devised by the RCN (1990).
The DySSSy is a programme for setting, monitoring and evaluating standards of nursing practice at ward level that uses a problem-solving, patient-focused approach to continuous quality improvement. The underlying philosophy of this system is that the judgements and actions of staff working in a clinical setting should determine the quality of care provided. DySSSy is based on six key principles (Box 2).
A draft of the proposed standard was created by the standard-setting group in conjunction with one of the senior night sisters and circulated among the following members of the trust: executive and non-executive directors; senior nurse managers; senior night sisters; practice development nurses; and community health council ward staff. Upon receipt of comments from these parties, amendments were made and a final draft created (Table 1).
An audit tool was developed which had two main themes: a staff observational audit that the senior night sisters completed; and a patient audit that focused on patients' perception of noise levels. There was also a section simply for 'comments', allowing staff and patients to make a qualitative input (which provided further evidence to support the quantitative data).
A pilot study was then implemented for a four-month period, with one ward in each of the five directorates (medical, surgical and oncology, specialist services, trauma, and women and children) chosen to participate. On completion of the pilot study an audit was carried out. The results can be seen in Box 3.
The majority of wards demonstrated an improvement in the timing of the lights going on and off. In general, the lights were turned on later in the morning, that is, after 7am as opposed to ritualistically turning them all on at 6am, which enabled patients to wake up naturally.
At night the lights were turned off by 11pm and where lighting was required, bedside lights were used rather than the main lights. In support of these improvements (Box 3) patients on the wards felt that they were generally disturbed less by noise, particularly by telephones, call bells, other patients and admissions.
However, a number of patients felt that they were slightly more disturbed by outside noise, for example, car engines, ambulances arriving and people leaving the social club.
This study has highlighted a number of causes of noise on the wards and has shown that noise can be reduced when specific measures are undertaken. Many of the noise-reduction measures were based on common sense and involved no resource implications. Such actions have already led to a more restful atmosphere for patients on the pilot wards within Walsgrave Hospitals NHS Trust and it is hoped that this will have a positive impact on patient recovery.
The trust recognises that there are still areas that require improvement and aims to continue raising awareness of noise issues, particularly at night. It is now the intention of the standard-setting group to expand the night noise standard to the trust and to involve staff in mandatory audits of practice on an annual basis.