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


Cancer Nurs. 2011;34(3):176-184. 

In This Article


Study findings identified a bedside care environment for children with cancer with persistently elevated sound levels throughout the night shift. Sound levels in children's rooms were consistently in excess of the 35 dB recommended by WHO for a healthy sleep environment during each 2-hour time interval of the night shift.[13] Sound levels were similar to those identified in pediatric critical-care settings and represented sfa sound intensity of greater than 10× that of a healthy sleep environment even during the later hours of the night shift.[1–4] These elevated sound levels are those recognized as being associated with disrupted sleep.[13] Each 2-hour time interval also included abrupt increases in sound intensity of greater than 70 dB. All children experienced spikes in nighttime sound levels comparable to those generated by moderate traffic or loud conversation.

Findings reported in this study also complement those reported by Hinds and colleagues.[14] Their study identifed a range of 3 to 22 self-reported room entries and exits by staff and parents/visitors during the course of an 8-hour night shift (11:00 PM to 7:00 AM). Together, findings from these studies suggest that individual clinical-care-related activities occur throughout the course of the night shift and contribute to a disruptive nighttime care environment for hospitalized children with cancer.

In contrast to previously reported findings in PICU settings, light intensity levels were minimal in the private rooms during the nighttime hours when sleep was most likely to be established.[4] These findings suggest that nighttime light levels are maintained at those which are conducive to sleeping. The light levels reported in this study also suggest that nursing staff are able to complete care activities without increasing light intensity in the child's room. Temperature within children's rooms was stable and at acceptable levels for nighttime sleep.

Study findings warrant closer examination of sources of excessive nighttime sound such as identifying sound levels associated with commonly performed care activities. Study findings also may guide the development of individual- and system-based interventions to create a healthier care environment for children with cancer. These may include organizing nighttime nursing care, when possible, based on patient/family preferences to minimize nighttime disruptions so that children may receive the restorative benefits of uninterrupted sleep. System-based interventions may include restructuring unit-based practices to facilitate daytime administration of chemotherapy medications and to minimize the frequency of cares that are necessary during nighttime hours.

In summary, the nighttime hospital care environment for children receiving inpatient chemotherapy is marked by excessive sound levels and abrupt increases in sound intensity that persist throughout the night shift. Such a disruptive nighttime environment is not conducive to restful nighttime sleep. This type of environment also may serve as an additional source of physiological and psychological stress that may adversely influence the health, response to chemotherapy, and recovery of children with cancer.


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