Recent Research About Nursing, January 2014
This is part of the January 2014 issue of Sharing Nursing’s Knowledge.
Hush!!! Testing nurse-designed noise-reduction strategies for hospital wards
A common complaint of hospital patients is that just when their bodies need it the most, they can't get a good night's sleep because of noise and interruptions. A new initiative of three nurses at Beth Israel Deaconess Medical Center in Boston takes direct aim at the problem.
In response to patient satisfaction surveys that highlighted the problem of nighttime noise, Gina Murphy, BSN, RN, Anissa Bernardo, LCSW, and Joanne Dalton, PhD, RN, studied existing literature on the topic, developed a program they call Quiet at Night, and tested it on a 44-bed medical-surgical unit. The program includes a number of strategies for reducing noise, including closing doors at night when medically appropriate, supplying earplugs to patients, keeping patients by themselves in semi-private rooms when the census permits, using mini-flashlights when performing overnight checks to avoid turning on the lights, performing change-of-shift conversations in the break room rather than in hallways or at the nurses' station, providing headphones to patients who need the television on at night, and using beep-free keypads on doors. In addition, after 9 p.m., they implemented a number of “quiet hours” practices, including dimming lights, turning pagers to vibrate, avoiding overhead pages and hallway conversations, and more.
After implementing the strategies, the trio compared before and after surveys. In the three survey periods before the program, 43 to 47 percent of patients reported that their rooms were “always” quiet at night. After the program was in place, that jumped to 60 percent, which is the goal the nurses had set.
“Not only is sleep critical to the physical functioning and emotional well-being of patients, but brief or fragmented sleep has negative effects on the immune system, the healing process and general health,” the team wrote in an article in the December issue of the American Journal of Nursing. “This is something that nursing can totally own and make the environment better for their patients,” Murphy told nursezone.com. “This is something that should be part of our practice and something that’s important. We are making sure our patients have as quiet an environment as physically possible.”
Guarding Against Back Problems for Nurses
Nurses frequently suffer from back problems, the result of their physically demanding work. Much of the research on the causes of nurses' back pain, and the safeguards implemented to guard against it, have focused on manual patient transfers. But many other tasks in nurses' daily work can put stress on their backs. A new study by a group of European researchers explores the effect of interventions aimed at minimizing the time nurses spend performing such tasks while bending over from the waist—a position that can amplify such stress.
In the study, published December 26, 2013, in The Annals of Occupational Hygiene, 12 nurses in a geriatric nursing home donned electronic sensors that measured their body posture and then performed a series of tasks, three at the bedside and three in the bathroom. During the bedside portion of the study, the nurses performed each task with the patient's bed set at different heights—first at the nurse's knee level, then thigh level, and finally, hip level. Data from the sensors allowed researchers to determine the percentage of time the nurses spent in bending positions, as well as the angle at which they bent. In addition, nurses were asked to evaluate how stressful they found the activities at each bed height.
In the bathroom, nurses performed three more common tasks, standing, kneeling and sitting, again wearing sensors and again providing feedback on stress levels.
In the bedside tests, nurses reported that the activities were least stressful the higher the bed level. That assessment jibed with the data from the sensors, which found that the higher bed levels prompted less bending at the waist.
The bathroom tests, during which patients were seated, followed suit. The less time nurses spent bending over, the less stress they experienced. Accordingly, sitting on a stool was judged the most comfortable.
The authors write, "[The] study shows that there is a significant connection between the work method, the proportion of time in an upright posture and perceived exertion, when performing selected basic care activities at the bedside or in the bathroom. Raising the bed to hip height and using a stool in the bathroom significantly increases the proportion of time that nursing personnel work in an upright position. These work methods are perceived as requiring the least exertion. Around five minutes invested in raising beds to hip height will allow nurses to work in an ergonomic posture for most of their shift. Reduction in these risks for back injury requires both institutional provision of enabling furniture and the effective use of these devices by nursing staff."