Picture the scene: It’s been a long day, you’ve been violently ill and feel like every ounce of strength has been drained from your body. Finally, after being poked and prodded, interrogated and tested, you find yourself in a warm bed with a soft pillow behind your head. Drained and slightly disoriented, you manage to overcome the nagging nausea and discomfort and eventually your eyelids grow heavy and the days trials begin to wash away as you drift into a gentle sleep… AAARRGGHH, you’re suddenly jolted awake as a distressed cry pierces the air. Confused and groggy you turn to see an elderly woman moaning and sobbing in a bed to your left, alarm bells ring and soon a young nurse is by her side cooing gently and diffusing her confused rage. Flustered, you turn your head away and close your eyes, trying to blank out the unfolding scene. You must have fallen asleep again, since the next time you awake the drama is over, but now you notice a small frail woman standing at the foot of you bed tugging your sheet. “Excuse me” she mutters politely, “I don’t know where I am and I need to get home, can you help?”. After trying in earnest to console her, you drag yourself out of bed and fetch a nurse to help settle her back into bed. Soon after this you are awoken a third time, now by a pair of nurses loudly chatting a few meters from your bed. Exasperated, you notice that their conversation isn’t even about their patients and instead centres around some dodgy sounding shenanigans that occurred on a staff ‘night out’.
Unfortunately this story is not fictional, this is an actual account of a night I recently spent in hospital whilst receiving treatment for a kidney infection. Further to this, I don’t believe my experience was isolated. Over the past two years I have been unfortunate enough to experience both first and second hand the nocturnal practices of four separate NHS hospitals. One, as described above, was my own personal experience, while the remaining three have been accounted to me by both my late grandma and my fiancé’s nan. Each account has shared a common thread specifically, sleep deprivation blamed on excessive night time noise – usually from both fellow patients and staff.
The World Health Organisation recommends that hospital patients are not exposed to noise over 35-40 decibels, the equivalent of a loud whisper. However, a range of studies have found that noise levels in hospital wards often significantly exceed 60 decibels, even during the night (60 decibels being equivalent to a regular conversation). Noise levels in this range are expected to cause sleep disturbances and have been highlighted in patient surveys as being responsible for increased stress and lack of sleep.
Sleep is an essential biological function and lack of it has been associated with a range of adverse outcomes including; altered immune function, metabolic dysfunctions and psychological disturbances including depression, stress and anxiety. Although most studies of sleep disruption are performed on healthy volunteers, it makes sense that those recovering from illness will also benefit from a good night’s sleep; a fact which was recognised over 100 years ago by Florence Nightingale in her ‘Notes on Nursing’, where she writes: “Unnecessary noise then is the most cruel absence of care, which can be inflicted either on sick or well…. A nurse who rustles (I am speaking of nurses professional and unprofessional) is the horror of a patient, though perhaps he does not know why. The fidget of silk and of crinoline, the rattling of keys and of shoes, will do a patient more harm than all the medicines in the world will do him good.”
Noise levels undoubtedly affects some patents to a greater extent than others and studies are yet to conclusively link hospital noise levels with sleep disturbances or negative patient outcomes. However, it has been suggested that disrupted sleep can cause additional stress to acutely ill or injured patients and may potentially impede successful recovery. Anecdotally, I often wonder whether the hospital environment played a significant role in my grandma’s passing. She was a kind, quiet woman who loved her own home comforts. I still remember the distress in her voice when she explained to me how she couldn’t sleep because her fellow patients and the nursing staff were always so loud, even at night. She was a sensitive soul and it was painfully obvious that the hospital environment caused her distress. The cause of her passing was officially registered as ‘frailty of age’. However, I wonder whether the degeneration of her condition and her ultimate decision to refuse food was linked to distress caused by her surroundings, and whether things would have been different had she been cared for at home?
I have no doubt that nurses and doctors perform the best job they are capable of, given the structures in which they are expected to work. However, I also think it’s time that hospitals dedicate more time and resources to optimising patient comfort and ensuring that they achieve adequate recovery sleep while under hospital care. Ironically, much of the noise present in the hospital environment is created by measures put in place to improve patient health and safety. This includes: loud machinery, a high density of staff working to care for patients and uncarpeted floors, which reduce the risk of infection but can be loud underfoot or under the wheels of rolling equipment. Noise sources such as these must be assessed and noise reduction measures brought into place. Indeed, some hospitals are already addressing these issues by training staff about noise reduction and by providing patients with ear plugs and eye masks (to reduce the effect of continuous light in hospital wards). It is promising to note that such interventions, alongside structural alterations designed to reduce noise, appear to have a positive effect on reported patient satisfaction and recorded levels of noise on hospital wards. Therefore, I believe that practical noise reduction measures are a must for the future of all public hospitals. A good review of hospital noise and practical solution to these problems can be found here.
Note: I have no intention of revealing the names of hospitals mentioned in this report since, I believe this is a wide-spread problem involving hospital structure and not specifically the fault of any individual establishment.
Post by: Sarah Fox