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

Results

Description of Environmental Variables

Because measurements were obtained at 30-second intervals, each 12-hour night shift included 1440 individual measurements for sound, light, and temperature environmental variables. Means of each variable were calculated for each 2-hour time interval (eg, 7:00 to 8:59 PM, 9:00 to 10:59 PM) within each 12-hour night shift. A descriptive summary of sound, light, and temperature within each 2-hour time interval for each of the 3 study nights is presented in Table 1.

Sound Sound levels within the child's hospital room were consistently greater than WHO's recommended 35 dB or less for a healthy sleep environment.[13] Although sound levels did decrease during each night, the mean lowest levels were 46.4 dB—a measurement that was more than 10 dB above the recommended level. Because measurement in decibels represents logarithmic units, an increase in 10 dB translates to a 10× increase in sound intensity level. To the human ear, a gain of 10 dB is perceived as being twice as loud, meaning that 45 dB would be perceived as twice as loud as 35 dB. In comparison, mean sound levels in this study were approximately 5 dB less than that reported in a pediatric critical-care setting. The range, however, was similar with values as low as 40 dB with abrupt increases in excess of 80 dB.[1–4] All children experienced spikes in nighttime sound levels comparable to those generated by moderate traffic or loud conversation. Average nighttime sound levels at the bedside for this sample of children were similar to those generated by moderate conversation or rainfall.

Light Overall light intensity was low, with a maximum recorded value of 20.1 lumen/ft2. Light intensity was greatest during the first nighttime interval, consistent with the time when children were least likely to be sleeping. Light intensity was lower at minimal levels during the second through sixth time intervals, with minimal variation. These values are consistent with light intensity that is conducive to sleep.[16] The values also suggest that nighttime nursing care activities were able to be completed without generating increased light intensity at the children's bedside.

Temperature The average nighttime temperature within participants' rooms was less than 75°F, which is regarded as the upper threshold for recommended room temperature for healthy sleep.[16] Minimal variation in temperature was present across each nighttime interval, suggesting that significant fluctuations in temperature, a potential source of disturbed sleep patterns, were not occurring.

Patterns of Environmental Variables within Study Nights

Sound A significant main effect for time of night was observed (F = 50.42, P < .01), indicating that sound levels were significantly different based on 2-hour time interval during the 12-hour night shift. Mean sound levels during each 12-hour night shift did not vary based on study night (F = 0.45, P = .64). A significant study night by time interval effect was not observed (F = 0.57, P = .84), suggesting that the interaction of the given study night and time of night did not influence sound levels.

A comparison of differences between the six 2-hour nighttime intervals was conducted for sound, light, and temperature (Table 2). Sound levels were significantly greater during the first 2 time intervals (7:00 to 8:59 PM [P < .01] and 9:00 to 10:59 PM [P < .01]) compared with the sixth time interval (5:00 to 6:59 AM). Significant differences were not identified between the third (P = .34), fourth (P = .78), and fifth (P = .92) time intervals as compared with the sixth. These findings indicate that sound levels were significantly greater during the first 4 hours of the 12-hour night shift compared with the remaining 8 hours and that sound levels between 11:00 PM and 6:59 AM were similar.

It is important to note that these statistical differences also represent clinically significant differences between time intervals during the night. The difference of 7.25 dB between the first and sixth time intervals indicates a sound level that is more than 4× more powerful between 7:00 and 8:59 PM than at 5:00 and 6:59 AM. The difference of nearly 4 dB between the second and sixth time intervals indicates a sound intensity level between 9:00 and 10:59 PM that was more than twice as powerful as that between 5:00 and 6:59 AM. Although sound levels did decrease through the night shift, mean sound levels between 5:00 and 6:59 AM (47.4 dB) were more than 10 dB above the recommended level for healthy sleep.

Light A significant main effect for time of night was observed (F = 12.43, P < .01), indicating that light levels were significantly different across 2-hour time intervals. Mean light levels during each 12-hour night shift did not vary based on study night (F = 1.21, P = .31). However, a significant study night by 2-hour time interval effect was observed (F = 4.18, P < .01), suggesting that the interaction of the given study night and time of night influenced light levels.

Differences in light levels between the six 2-hour time intervals were analyzed (Table 3). Comparisons identified significant differences between the second time interval (9:00 to 10:59 PM) (P = .03) compared with the sixth (5:00 to 6:59 AM). These findings indicate that light levels were significantly greater between 9:00 and 10:59 PM compared with the remaining hours of the night shift. Significant differences in light intensity were not identified between other 2-hour time intervals compared with the sixth.

Although mean light levels were greatest during the initial two 2-hour time intervals of the night, overall levels were low relative to light levels that are necessary for reading or close work. Light levels were at their lowest between 11:00 PM and 6:59 AM, providing an appropriate sleep environment. Low variability in light levels through the night also suggests that nursing staff were able to complete required patient care activities without causing disruptive increases in light levels.

Temperature A significant main effect for time of night was not observed (F = 1.61, P = .16), indicating that temperature was not significantly different across the six 2-hour time intervals during the night. Mean temperature during each 12-hour night shift did not vary based on study night (F = 0.03, P = .97).

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