NOISE REDUCTION: ENVIRONMENTS THAT FOSTER PEACE AND COMFORT

In the silence of a resident’s room, I could not believe how noisy it was all around me. Introduction:

The noise level in a traditional nursing home is very high and can contribute to many negative outcomes for both staff and residents. This noise level can sometimes contribute to a sense of chaos, confusion and even provide the backdrop for combative events. For some residents the ensuing agitation and constant upheaval can lead to the need for medication, a lack of sleep or rest, or worse, a constant grating on one’s nerves that prevents one from living their best life on a daily basis. Imagine being in a setting that never allowed for a sense of peace or solace. Noises from food trucks, carts, staff calling to one another from hallways, overhead paging all contribute to an industrial atmosphere that resembles a warehouse more than someone’s home-a resident’s home. Home is not without its sounds- creaking floors, laughing, TVs, radios playing, water through pipes but the level is usually within one’s control and usually at a level agreed upon by those who dwell together. Noise in nursing homes is yet, another area that is outside of a resident’s control. The aim of these lessons is, as much as possible, to restore control to the residents. In this particular lesson providing an opportunity to become aware of the sound and to create some modest changes can perhaps lead to a far more inviting and less stressful environment for all who dwell within. Based on research from many homes that have been awakened to this particular environmental issue, a home could see changes in the number of combative events, decreases in psychotropic drug use and a noticeable decrease in complaints related to stress.

We have to recognize that a nursing home is both a home for residents and a work environment for staff. When homes are very noisy it is quiet often because the work place environment is the setting that dominates. This is evidenced by staff calling to each other or to residents down the hallway, or gathered at the nursing station talking. This can contribute to the nursing home feeling very institutional for the resident. Staff also benefit from the quieter environment. First, workers in homes that have made the change to a quieter environment report that the work is easier when residents are calmer, but second, they report that they find that the interactions that they have with both other staff members and with residents has a different quality when there is a deliberate attempt to reduce noise.

Many homes have reduces noise levels by eliminating overhead paging. Homes that have done this have developed different ways of getting information to each other and that the many of the new ways increase face to face connection with each other. They recognize that most information that is relayed on a loudspeaker is information that can be given in a different way. The new way is often increases effective communication and feels better for all involved.

Once we become aware and actively try to promote a quieter environment we start to see how the tasks we are doing can be done differently or at different times of the day for a better result. For example, buffing the floors is easier to do at six o’clock in the morning, but it makes it hard to sleep for the resident. Can this be done at another time? Reducing noise actually helps to create a gentler environment. Goal: This goal is to help create an awareness of the noise level in your setting and then to begin to rethink how we can go about our work in such a way that we are getting the work done but getting it done in a way that respects the sanctity of the residents home.

Begin to consider: 1. Ways to help staff and others consider the actual noise level in your home

2. What are some of the many thing s that are contributing to the noise

3. A way to start thinking about how we each contribute to the noise level

4. A way to identify organizational contributions to the noise level and suggestions about ways to cut down on noise

5. How would you measure this?

6. What systems would be impacted upon?

Barriers: There are no barriers that prevent us from becoming mindful of our own contribution to a noisy hectic environment. Changing the times when certain jobs and tasks are scheduled especially when it involves noisy equipment requires thinking through with every department what needs to be done and exploring new timing. Eliminating overhead paging will greatly reduce noise, but it requires thinking through with everyone how information will spread and a commitment to doing something different from everyone. Chair alarms, food trucks, sun-downing residents are all examples of noise issues. These are all contributing factors and would need a considerable amount of thinking. Many organizations have found a way.

Going forward: These are just a few examples of the many ways that the environment can be changed to create a less institutional environment. You may discover areas that are very specific to your own nursing home. Take the time to explore with staff from all departments ways that you can improve and make small adjustments that will have a big impact. You might also want to try tracking some of the changes you make and begin to document some of these changes. You might find that as a result of this change some wonderful outcomes can be realized making life far better for residents and staff. Example:

A gentleman who was the charge nurse on a special care unit reported this story. The unit was predominantly the home to many men. The charge nurse found himself often breaking up fights and mitigating incidences of combative behavior. Staff often called out because of the high stress and the unit also had a reputation for a high rate of injuries to both staff and residents. In one month they logged eighty-one combative incidences. On one particular morning after several incidences the charge nurse called the staff together. They agreed that things could be better but where to start. They talked together about contributing factors to the chaos, hostility and general unhappiness that characterized the unit. Stressed out staff poured out their hearts describing the noise, the disruptions of staff members coming and going to the unit to perform tasks such as delivering food or cleaning floors. Noise seemed to be a big contributing factor to the problem. The charge nurse stopped at Radio Shack on his way home and picked a few handheld monitors that measure noise. For one month staff carried the monitors recording the noise level. They began to realize that combative events and noise were synonymous with each other. After one month they came to realize that once the noise rose to a level of about 90 decibels, it was not a matter of “if” but a matter of “when” a combative event would occur. Using the handheld monitors staff began to redesign the way they went about tasks. Staffs from other disciplines were offered a simple training and were encouraged to think about new ways to bring food trucks onto the unit, buff floors, communicate the need for help. It led to conversations that explored whether some of these things were even necessary. As a result they began to realign and redesign the systems on the unit to accommodate the residents sensitivity to noise. Within a short period of time they went from 81 episodes of combative behavior to three in one month. They decreased their use of psychotropic drugs and created an activity program that was extraordinary in keeping residents active and engaged.