However, there was an insignificant difference in the meal frequency and physical activity status between the ASDN and IASDN group." (Shaikh, Patel and Singh, 2009, p
Examples of Commonplace Noise Levels Source: Based on tabular data in Wenham & Pittard, 2009, p. 180 These are particularly important issues in intensive care units (ICU) where the need for recuperative periods of rest is crucial and the need has been long known (Baker, 1984)
284). Although more research is needed to identify the precise effects of sleep deprivation on patient recovery in the ICU, there are some steps that staff members can take to help mediate these environmental factors, including noise reduction, light reduction, patient comfort improvement and clustering of patient care activities that promote more uninterrupted time for adequate sleep in the ICU (Eliassen & Hopstock, 2011)
So why can we not provide the quiet and healing environment that we so desire for our patients? More often than not it is the human factor. Studies have shown that ICU sound levels have a negative impact on sleep (Fontana & Pittiglio, 2010)
3). Despite the need for more research in this area, the etiologies of sleep disturbances in the ICU are increasingly recognized to be multifactorial, but there is a gap in the body of knowledge concerning the precise mechanisms that are responsible for disturbances in the sleep -- wake cycle in ICU settings (Freedman, Gazendam & Levan, 2001)
3). Despite the need for more research in this area, the etiologies of sleep disturbances in the ICU are increasingly recognized to be multifactorial, but there is a gap in the body of knowledge concerning the precise mechanisms that are responsible for disturbances in the sleep -- wake cycle in ICU settings (Freedman, Gazendam & Levan, 2001)
Source: Friese, 2008, p. 698 Despite the growing body of research into the effects of sleep disturbance and disruption in the ICU, there remains a lack of timely and relevant research concerning the wide range of factors that may contribute to the levels of noise in these intensive care wards (Friese, 2008)
It is reasonable to suggest that many, if not most, of these patients will recall their ICU experience in these terms rather than the caring and compassionate care that allowed them to remember them in the first place, but the fact remains these perceptions of quality of care frequently translate into suboptimal clinical outcomes. In truth, these levels and patterns of sleep disruption are not that difficult to understand given the inherently noisy environment of most ICUs (Hardin, 2009)
3). Some studies suggest that sleep deprivation affects the immune system in detrimental ways (Hultman et al
1). Some sleep scientists sleep as "a period of behavioral quiescence and non-responsiveness to the environment that is electroencephalographically, physiologically, and behaviorally distinct from the waking state" (Kushida, 2005, p
264). There are some theoretical frameworks that have been advanced in recent years to help explain why people sleep, with behavioral adaptation sleep theory maintaining that humans sleep in an effort to remain static when there was insufficient light for hunting (Lavie, Pillar & Malhortra, 2002)
Likewise, it is difficult to quantify the effects of noise on sleep because human hears things in different ways and intensities. In sum, sound is measured in terms of its pressure as a sound level, or sound pressure level termed "SPL" which is noise measured in decibels using a sound level meter, or "SLM" (Lawson, Thompson, Saunders, Saiz, Richard, Brown, et al
94). Normal sleep architecture divides sleep into 2 main types: (a) REM sleep and (b) NREM sleep, with NREM sleep being further subdivided; Stages 1 and 2 are light stages of sleep (termed N1 and N2) and Stages 3 and 4 of sleep are deeper stages (termed N3) which are collectively referred to as SWS (Lee & Douglass, 2010)
It's a cause for concern because studies have shown that a lack of sleep can cause patients to experience delirium - an altered mental state that may delay their recovery and lead to short- and long-term confusion and memory problems. (para 2) More troubling still, these researchers found that many ICU patients were unable to recall all of the arousing events that disturbed their sleep, but the telemetry provided by monitors indicated that just a very small fraction of these arousing events were recalled, suggesting the problem may be far more severe than many researchers currently believe (Levitt, 2013)
For example, the patient's underlying chronic illness, acute pain, the pharmacological preparations used in treatment of the primary illness, as well as the ICU environment have all been shown to contribute to the process of sleep deprivation (Stanzak, 2006). For example, drugs such as benzodiazepines, opioids, inhalation agents, anticholinergics, antibiotics, and muscle relaxants can interact and result in agitation and restlessness in ICU patients (Ozdemir & Karabulut, 2009)
Studies have correlated sleep disturbance in patients with decreased immune function, changes in mental status and increased stress levels. These effects may interfere with the healing process in adults who require acute care in a hospital setting (Patel, Chipman, Carlin, & Shade, 2008)
Irrespective of its precise etiology, the adverse clinical implications of sleep disruption and altered sleep patterns on ICU patients are well documented, and these issues are discussed further below. Clinical Implications of Sleep Disruption and Altered Sleep Healthcare providers from Galen's Regimen sanitatis Salernitanum to Florence Nightingale's advice to "tailor interventions that take into account the unique characteristics of the person receiving care, including affective state, biological state, cognition, ethnicity, beliefs, goals, needs, preferences, and resources" have all stressed the need for ensure people receive sufficient rest and sleep (Richards & Enderlin, 2007)
The first step taken by the change team was to install posters at nursing stations and patient doors encouraging everyone to keep things quiet using a finger-on -- the lip cartoon (see Figure 3 above). An interesting step taken by the Stanford team was the purchase of two LED displays known as "SoundEars" that are shaped like a human ear and provide a visual display in green, yellow and red that alert users when noise thresholds are crossed (Rogers, 2009)
The adverse clinical outcomes that can result from these problems include longer periods of ventilation, lengthened stays on the ICU and more complicated periods following extubation (Tembo & Parker, 2012). These findings highlight the importance of the built environment as well as the presence of various medical equipment in contributing to noise and lighting levels that can have an adverse effect on the physical and psychosocial well-being of patients, their families, and hospital staff (Sherman-Bien, Malcarne & Roesch, 2011)
(1999) were congruent with the findings reached by Simpson, Lee, and Cameron (1996) that also requested patients to rate the environmental factors that most adversely affected their sleep, with the results of both studies shown that patients' sleep was disrupted when they felt uncomfortable, when they were awakened for procedures, and when the ICU environment was noisy. Further exacerbating the problem of sleep disruption and deprivation on the ICU is the fact that sleep may be elusive for many patients because of fears, anxiety and worries concerning their medical condition (Soh & Soh, 2008)