Characteristics of the Nighttime Hospital Bedside Care Environment (Sound, Light, and Temperature) for Children with Cancer

Lauri A. Linder, PhD, APRN, CPON; Becky J. Christian, PhD, RN

Disclosures

Cancer Nurs. 2011;34(3):176-184. 

In This Article

Abstract and Introduction

Abstract

Background: Children with cancer must cope not only with their disease and its treatment but also with the environment in which treatment is given. The intensities of sound and light levels required to perform necessary patient care may result in a disruptive nighttime care environment.
Objective: The purpose of this study was to describe nighttime patterns of environmental factors, sound, light, and temperature levels, at the bedside of children with cancer receiving inpatient chemotherapy.
Methods: Participants were 15 school-aged children receiving chemotherapy on an inpatient pediatric oncology unit. Sound, light, and temperature in the child's room were measured continuously using a digital-sound pressure-level meter and an external channel data logger.
Results: Mean nighttime sound levels were 49.5 (SD, 3.1) dB (range, 34.6-84.8 dB). Sound and light intensities were greatest early in the shift and decreased through the night. A basic mixed linear model identified significant main effects of time of night for both sound (F = 50.42, P < .01) and light (F = 12.43, P < .01).
Conclusions: Study findings identified a bedside care environment with persistently elevated sound levels and abrupt increases in sound intensity throughout the night. Such a disruptive nighttime environment is not conducive to restful nighttime sleep and may serve as an additional source of physiological and psychological stress for hospitalized children with cancer.
Implications for Practice: Efforts are needed to identify modifiable sources of nighttime sound and develop interventions to reduce nighttime sound. Collaborative efforts to organize clinical care to minimize nighttime disruptions may lead to reduced bedside sound levels.

Introduction

Children with cancer must cope not only with their disease and its treatment, but also with the environment in which treatment is given. Children with cancer often have greater acuity levels than other pediatric medical-surgical patients, in part because of the intensity of nursing care activities, including number of medication doses, and the symptoms that the child is actively experiencing. These increased patient care needs often lead to increased interactions with members of the health care team, which can persist into the nighttime hours. As a result, the intensities of sound and light levels required to perform necessary patient care may result in a nighttime bedside care environment that may disrupt sleep and may not be conducive for hospitalized children with cancer to obtain adequate levels of nighttime sleep.

Studies investigating nighttime sound and light intensities in pediatric and adult critical-care settings have identified levels in excess of World Health Organization (WHO) standards for health care settings.[1–7] These studies also have identified increased sound and light levels, as well as interactions with health care providers, as significant predictors of fewer nighttime sleep minutes and greater fragmentation of sleep.[1,4,8] To date, no studies have investigated sound and light levels in either pediatric or adult inpatient oncology units. Furthermore, changes in these environmental characteristics across the course of a night shift have not been investigated in previous pediatric or adult studies. Moreover, this is the first study to examine direct measures of sound, light, and temperature at the bedside of children hospitalized in an inpatient pediatric oncology setting.

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