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

Implications for Clinical Practice and Policy

Implications for clinical practice and policy include evaluation of existing care delivery practices that may lead to increased nighttime disruptions and, as a result, increased bedside sound levels for children receiving chemotherapy. This includes attention to admission processes and facilitating daytime delivery of chemotherapy medications to prevent disruption of sleep during the night. Many pediatric chemotherapy protocols require prehydration fluids to meet specified urinary output parameters. When admissions occur later in the day, actual initiation of chemotherapy may not occur until nighttime hours when adequate hydration is achieved. Scheduling admissions earlier in the day may facilitate earlier administration of chemotherapy medications and potentially reduce the number of nighttime disruptions that may be associated with increased nighttime sound levels.

Examination of unit-based nursing care routines and how these routines are organized within the course of a night shift may reduce nighttime sound levels. Strategies to decrease sound levels and abrupt increases in sound intensity may include collaboration with the multidisciplinary team to coordinate scheduling clinical-care activities, such as medication doses, in a manner that minimizes nighttime disruptions. Attention to quiet hours or "lights out" for the unit may serve as an intervention that could lead to decreased sound levels within the patient's room. In the present study, the perceived sound intensity between 9:00 and 10:59 PM was nearly twice the level between 5:00 and 6:59 AM. Additionally, light levels were not at their lowest levels until after 11:00 PM. For many school-aged children, routine bedtime hours occur around 9:00 PM. Maintaining home sleep routines would facilitate sleep in hospitalized children with cancer. However, persistently elevated sound levels do not create an environment that is conducive to maintaining home sleep routines.


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