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This project describes a multifaceted noise reduction program on 2 hospital units designed to ensure a quiet hospital environment, with the goal of improving the patient experience. The noise committee in an urban city hospital developed a plan to control noise including scripted leadership rounding, staff education, a nighttime sleep promotion cart, and visual aids to remind staff to be quiet. Postintervention improvement in patient satisfaction scores was noted.

Objectives: To study quality of patient rest before and after an intervention to reduce nighttime light and noise in the emergency department observation area of an urban hospital., Material and Methods: Quasi-experimental study in 2 groups before and after the intervention in the observation area of the Hospital Clínic de Barcelona. We administered a questionnaire about the quality of nighttime rest to assess the effect of light and noise on sleep. Light and noise were reduced by means of structural changes to the environment and through the introduction of protocols to modify how care plans were carried out at night., Results: Fifty nurses participated in the pre-intervention study and 371 in the post-intervention study. Seventy-two percent and 91.37% of the patients reported resting well before and after the intervention, respectively (P< .001). Factors like pain, nursing care, or daytime naps do not affect sleep quality., Conclusion: Nighttime rest in emergency department observation areas is affected by ambient light and noise more than by other variables. Reducing light and noise at night can measurably improve patients' rest.

Hospitalized elders frequently experience disturbed sleep related to environmental factors. To determine relationships between sleep and environmental noise and light, a descriptive exploratory study was conducted with 48 hospitalized older adults. Participants aged 70 years or older were monitored for sleep via wrist actigraphy, and noise and light levels were measured the first night of hospitalization. Sleep time was brief (mean, 3.75 hours) and fragmented (mean, 13 awakenings per night). The sleep environment was noisy with a median sound level of 49.65 dB(A). There was an average of 3 periods of elevated light levels (mean, 64 lux) lasting an average of 1.75 hours each night. No significant correlation was found among sleep and age, light, and sound. Recommendations include light and sound reduction measures and dedicated "do not disturb" times to allow for a full 90-minute sleep cycle., (Copyright 2010 Mosby, Inc. All rights reserved.)

Promoting an environment conductive to sleep in hospital is a challenge. Although patients may appear to sleep in hospital, it may not be refreshing or restorative. The reasons for this can be categorized into three groups: environmental, physiological and psychological. These factors can work concomitantly, making sleep virtually impossible for some patients. Nurses can help their patients by understanding what influences sleep patterns and acting on this knowledge. This may include a variety of interventions, from allowing patients to carry out their own bedtime routine, to explaining to elderly people how their sleeping patterns changes with age.

This study investigated the effects of non-disruptive nighttime care for residents in a personal care setting. The sample consisted of 18 personal care home residents in an urban, 388-bed, long-term care facility located in Winnipeg, Manitoba, Canada. The study used a quasi-experimental, single-arm design, exposing all residents to both intervention and control conditions. Independent variables were the current nighttime routine of regular rounds to turn and change residents, and a non-disruptive plan of care in which residents were checked hourly by staff and necessary care was provided when they were awake. Outcome variables included total sleep from evening bedtime to morning awakening, longest period of uninterrupted sleep at night, amount of time spent sleeping during the day, self-reported restfulness of cognitively intact residents, and skin condition. Findings suggested that the non-disruptive nighttime care routine increased total sleep by an average of 30 minutes a night for each resident. The amount of uninterrupted sleep increased by approximately 45 minutes with the new routine. No significant differences were noted in the amount of time spent sleeping during the day. There was no evidence of skin breakdown during any phase of the study. Clinical implications of this study demonstrate a need for gerontological nurses to re-evaluate nighttime care routines in personal care settings.

Objectives: The purpose of this study was to test whether an intervention combining increased daytime physical activity with improvement in the nighttime environment improves sleep and decreases agitation in nursing home residents., Design: A randomized trial., Setting: One community nursing home in the Los Angeles, California area., Participants: Twenty-nine incontinent residents (mean age 88.3 years, 90% female)., Intervention: Subjects were randomized to receive either (1) an intervention combining increased daytime physical activity (14 weeks in duration) plus a nighttime program (5 nights in duration) to decrease noise and sleep-disruptive nursing care practices (intervention group), or (2) the nighttime program alone (control group)., Measurements: Daytime physical activity monitors and structured physical function assessments; nighttime wrist activity monitors to estimate nighttime sleep; and timed daytime behavioral observations of sleep versus wakefulness, either in or out of bed, and agitation., Results: Physical function measures did not change significantly (MANOVA for repeated measures, group by time effect). Wrist actigraphy estimation of nighttime percent sleep (time asleep over time monitored in bed at night) increased in intervention subjects from 51.7% at baseline to 62.5% at follow-up compared with 67.0% at baseline to 66.3% at follow-up in controls (MANOVA, group by time, F = 4.42, P = .045, df = 27). At follow-up, intervention subjects averaged a 32% decrease in the percent of daytime observations in bed compared with baseline, with essentially no change in controls (MANOVA, group by time, F = 5.31, P = .029, df = 27). Seven of 15 intervention subjects had a decrease in observed agitation at follow-up, compared with baseline, versus only 1 of 14 controls with a decrease in observed agitation., Conclusions: This study provides preliminary evidence that an intervention combining increased physical activity with improvement in the nighttime nursing home environment improves sleep and decreases agitation in nursing home residents.

Objectives: The sleep of nursing home residents is fragmented by frequent awakening episodes associated, at least in part, with environmental variables, including noise and light changes. The purpose of this study was to improve sleep by reducing the frequency of nighttime noise and light changes., Participants and Setting: Two hundred sixty-seven incontinent nursing home residents in eight nursing homes., Design: A randomized control group design with a delayed intervention for the control group., Measurements: Bedside noise and light monitors recorded the number of 2-minute intervals at night with peak sounds recorded above 50 dBs and the number of light changes of at least 10 lux between adjacent 2-minute intervals. Daytime behavioral observations measured sleep and in-bed time during the day, and wrist activity was used to estimate sleep at night. Awakening events associated with the environmental variables were derived from the wrist activity data., Intervention: A behavioral intervention implemented between 7:00 p.m. and 6:00 a.m. that involved feedback to nursing home staff about noise levels and implementation by research staff of procedures to both abate noise (e.g., turn off unwatched television sets) and to individualize nighttime incontinence care routines to be less disruptive to sleep., Results: Noise was reduced significantly, from an average of 83 intervals per night with peak noises recorded above 50 dBs to an average of 58 intervals per night in the group that received the initial intervention, whereas noise in the control group showed no change (MANOVA group x time P < .001). All 10-dB categories of noise from 50 to 90+ dBs were reduced, and light changes were reduced from an average of four per night per resident to two per night (P < .001). Despite these significant changes in the environmental variables, there was a significant differential improvement in the intervention group on only two night sleep measures: awakening associated with a combination of noise plus light (P < .001) and awakening associated with light (P < .001). However, there was a significant correlation between change in noise and change in percent sleep from baseline to intervention (r = -.29, P < .05), suggesting that the intervention did not reduce noise to low enough levels to produce a significant improvement in sleep. The intervention effects on all environmental variables were replicated in the delayed intervention group, who again showed significant improvement on the same sleep measures. Observations of day sleep and in-bed time did not change over the phases of the trial for either group., Conclusion: The significant reductions in noise and light events resulting from the intervention did not lead to significant improvements in the day sleep and most night sleep measures. An intervention that combines both behavioral and environmental strategies and that addresses daytime behavioral factors associated with poor sleep (e.g., excessive time in bed) would potentially be more effective in improving the night sleep and quality of life of nursing home residents.

Objective: To evaluate the association between noise, light, nursing care practices, and nighttime awakenings in incontinent nursing home residents., Design: Cross-sectional survey., Setting: Four long-term care nursing facilities., Participants: One hundred eighteen incontinent nursing home residents., Measurements: Over two nights, bedside monitoring equipment recorded wrist activity, resident bed movements, and environmental noise and light changes in consecutive 2-minute intervals. Changes in sleep and bed movement were compared with changes in noise and light that occurred within the same or proximal 2-minute intervals. Noise and light changes in combination with large resident movement at the hip and shoulder were interpreted as related to incontinence care based on observational measures. Specific outcome measures were: (1) the number of noise and light changes as well as staff care practices that did not wake the resident during periods of consecutive sleep, ie, sleep lasting a minimum of 10 minutes; (2) the number of noise and light changes as well as staff care practices that occurred immediately before or during the 2-minute intervals during which a resident woke from a period of consecutive sleep; and (3) the number of such staff care practices that were related to incontinence care., Results: Noise and light changes associated with both general environmental events and more specific nurse care practices were associated with 50% of all waking episodes of 4 minutes or longer and 35% of all waking episodes of 2 minutes or shorter. The major sources of all noise were traced to nursing staff. Eighty-seven percent of all incontinence care practices were associated with episodes of waking., Conclusion: The data reported in this paper document that general environmental noise and incidents of nursing care practices, particularly those related to incontinence care, are responsible for a substantial amount of the sleep fragmentation that is common among nursing home residents.