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

Study Methods

Design

An exploratory, descriptive multiple-case study design was used to describe characteristics of the nighttime hospital bedside care environment (sound, light, and temperature) for children with cancer and to describe patterns of sound, light, and temperature across the interval of a 12-hour night shift over 3 consecutive nights. This design emphasizes the context in which the phenomenon is occurring and does not require investigator control of behavioral or contextual events.[17] Because environmental factors in the hospital setting that may contribute to disturbed sleep children with cancer are not well established, the case study design, with its emphasis on the individual, was well suited to this study because of its relatively small sample size. Reported findings were part of a larger study exploring environmental and biobehavioral influences on nighttime sleep of school-aged children receiving inpatient chemotherapy.

Measurement of Environmental Variables

Sound Sound was measured using an Extech Instruments model number 407736 digital sound pressure level meter.[18] Sound measurements were obtained at 30-second intervals throughout each 12-hour night shift for 3 consecutive nights and stored in the internal memory of a HOBO U12-012 data logger. The sound pressure level meter measures sound pressure level ranges of 35 to 100 dB, with 0.1-dB resolution and an accuracy of ±1.5 dB. This device is a type 2 sound level meter, designed for measurement of environmental noise in residential, industrial, and commercial settings. The dimensions of the sound pressure level meter are 9.54 × 2.68 × 1 in.

Light and Temperature Light and temperature levels in the child's hospital room were measured continuously using the HOBO U12-012 Temp/RH/Light/External Channel data logger.[19] Light and temperature measurements were recorded at 30-second intervals throughout each 12-hour night shift and stored in the data logger's internal memory.

The data logger's light sensor measures light intensity with a range of 1 to 3000 lumen/ft2, and the temperature sensor measures from 0°C to 50°C, with a resolution of 0.03°C and accuracy of ±0.35°C. The data logger features 12-bit resolution measurements to support detection of greater variability in recorded data and is capable of storing up to 43 000 individual measurements.[20] The data logger's dimensions are 2.3 × 2.9 × 0.85 in.

Procedures

Study Setting The study setting was a 24-bed inpatient pediatric oncology unit in a tertiary-level children's hospital located in the Intermountain West of the United States. The unit serves children with immune-compromised conditions, including cancer, hematologic disorders, and hematopoietic stem cell and solid organ transplant. Each room is private with a private bathroom.

Institutional review board approval was granted for this study. Participant eligibility was reviewed with hospital staff prior to the child's scheduled admission for inpatient chemotherapy. Families who had expressed an interest in the study were contacted by the investigator at the time of the child's admission, and the study procedures were explained. Parental consent was obtained for all participants, and child assent was obtained from children 7 years or older.

Study Sample Participants were 15 children (10 boys and 5 girls) with cancer ranging from 5.4 to 12.3 years of age (mean, 8.8 [SD, 2.3] years; median, 8.3 years) who were receiving inpatient chemotherapy. Fourteen children were white/non-Hispanic, and 1 child was African American. Ten participants were receiving treatment for leukemia or lymphoma, and the remaining 5 were receiving treatment for solid tumors. Although this sample was heterogenous with regard to cancer diagnosis, the nursing care procedures for children receiving chemotherapy in the inpatient setting were similar across diagnoses. As such, the patterns of nighttime environmental characteristics and clinical-care activities were likely to be similar.

Eligibility criteria included children between 5 and 12 years of age receiving inpatient chemotherapy for 3 or more days as treatment for a primary diagnosis of cancer or for recurrent disease. Exclusion criteria included surgery during the admission or active treatment for a secondary health condition requiring additional nursing care interventions.

Because of the exploratory nature of this study and the relatively small sample size, variables were examined with the individual serving as the unit of analysis. Analyses emphasized individual variation through within-subjects analyses, which are more sensitive in detecting individual differences.[21] An a priori power analysis supported the proposed sample size of 15 to yield at least 80% power using a fixed-effects-model analysis of variance, with α set at .05.

Data Collection Procedures Data were collected continuously for 12-hour intervals (7:00 PM to 7:00 AM) over a 3-night period beginning with the first night of the child's hospitalization during a scheduled admission for chemotherapy. This period was selected based on the oncology unit data and represents the average length of stay for children receiving inpatient chemotherapy.

The investigator was responsible for calibration and maintenance of study equipment. At the onset of data collection, data loggers were initialized using HOBOware Pro version 2.4.2 software.[20] The sound pressure level meter and data logger were placed on the bedside supply cart in each child's room. The bedside supply cart was maintained in a consistent location in each child's room and was approximately 48 in from the child's bedside. This location also did not interfere with participants' daily activities or nursing care activities. The 2 devices were attached to a frame made of polyvinyl chloride pipe to ensure that they remained in place during the data collection period. The combined dimensions of the devices and frame were 10.5 × 4.75 × 3.5 in. Parents, child participants, and staff nurses did not have additional responsibilities related to the data collection procedures.

Data Analysis

Stored environmental data were downloaded from the data logger into a laptop computer for analysis using HOBOware Pro software. Numeric data were downloaded directly into Excel and then transferred into SPSS version 16.0 for Macintosh for data analysis.[22]

Characteristics of sound, light, and temperature environmental variables at the children's bedside during each 2-hour time interval were calculated using descriptive statistics (mean, SD, and ranges). Basic linear mixed models were undertaken for each of the environmental variables to identify patterns based on night and time intervals, as well as to test for a night × time interval effect. The linear mixed model has an advantage over the general linear model in that it does not assume independence of observations and therefore is able to manage data when serial dependency may be present.[23] Each variable was measured over six 2-hour intervals over 3 nights, with 45 observations for each 2-hour interval, for a total of 270 observations per night, with 18 observations per participant for each of the 3 environmental variables over 3 consecutive nights.

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