improve sleep in nursing homes

[Chellyse]

I came across this article and thought I would post and get comments. I work the night shift and am constantly aware of the noise and keeping it down.Sometimes it is difficult with the level of staffing we have in LTC to complete all treatments assessments ect, on the dayshift, so nights become responsible, inevitably we have to wake up residents to complete these tasks. Of course this article does not address this factor. I believe research into the area of improving sleep is important, but this seems unrealistic to expect the industry to shell out monies for sound proof equipment when some claim to have too little funds to provide basic care. And where does the money for research come from? Could it be better spent? Ergonomic med carts perhaps? Just my opinion.

http://www.eurekalert.org/pub_releases/2002-10/giot-rdw100102.php

Public release date: 1-Oct-2002

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Contact: Jane Sanders

[email protected]

404-894-2214

Georgia Institute of Technology Research News

Researchers devise ways to reduce noise, improve sleep in nursing homes

Even modest increases in noise above the background level disturb the sleep of seniors in nursing homes, an ongoing study shows. Now, researchers will test the effectiveness of several noise-reducing environmental interventions they developed to reduce sleep disturbances among nursing home residents. Their ultimate goal is to improve residents' health and quality of life.

Noise increases measured at six or more decibels were a factor in 18 percent of almost 4,000 nighttime awakenings, according to researchers at the Georgia Institute of Technology, Emory University and the Atlanta Veterans Administration Medical Center. Researchers collected the data from 92 metro Atlanta nursing home residents studied for about 500 person-nights. The National Institute of Aging is funding the five-year study.

"The nursing home population has a great deal of sleep disturbance," said Bettye Rose Connell, a health research scientist at the Atlanta V.A. Medical Center and an assistant professor of medicine at Emory. ".... Not all awakenings are related to noise. But sleep disruption related to noise is enough of a problem that we want to find ways to relieve it."

Researchers have determined that nursing home noises usually fall into one of three broad categories: people talking; mechanical noises, such as cleaning equipment; and people doing things, such as pushing carts.

So acoustical engineers at the Georgia Tech Research Institute (GTRI) have created several low-cost, noise-reducing environmental interventions and tested them in five nursing homes. The results are promising, researchers said. One of the interventions - sound-absorbing panels hung on hallway walls - has reduced noise by a factor of 16. That is equivalent to the difference in noise between music booming from 16 speakers versus just one speaker.

"These interventions reduce echoes and reverberations in hallways and rooms," said Krishan Ahuja, a Regents researcher at GTRI and a professor of aerospace engineering at Georgia Tech. "We have the noise-absorbing panels, ways to reduce the noise of banging doors, special hooks for curtains, and we even wrap the ice machines with a sound-deadening blanket to reduce noise."

Researchers are also reducing television noise by moving the speakers from the TV set to the headboards of nursing home beds, eliminating the need for residents to turn up the volume too high. And they are experimenting with tiny speakers embedded in bed pillows. "These environmental interventions are appealing because they create no additional burden on the staff, which is already stretched thin because of the nursing shortage," Connell says.

Nursing home residents and staff participating in the study report positive effects from the interventions.

At Ross Memorial Healthcare Center in Kennesaw, Ga., assistant administrator Jimmy Ross noted "a tremendous reduction" in noise after researchers temporarily installed sound-absorbing panels on his facility's hallways. "You don't even hear yourself walking down the hall," he said.

Nursing home resident Alice Cook, added: "It's much quieter here, especially in the evening.... There really has been quite a bit of difference. When I'm watching TV in the evening, it's definitely quieter. I don't hear all the interference from the hall." Having studied the extent to which noise level is associated with wakes in nursing home residents, researchers are eager to determine how much the noise-reducing strategies can reduce awakenings among residents, Ahuja said.

"In the next phase, we will apply these interventions in facilities for a longer period of time and actually compare the noise at bedside with data from volunteer residents who are wearing equipment to detect whether they are sleeping and how many times they wake up during the night," explained Robert Funk, a GTRI research engineer, who is leading the field study.

Researchers are studying sleep using wrist actigraphy, in which residents wear a device that looks like a large sports watch. The device records the normal arm movements a person makes when he or she awakes. To gather noise data, researchers use standard sound level meters. After researchers quantify the effects of environmental interventions on nursing home residents' sleep, they plan to study the combination of these environmental interventions with behavioral interventions being investigated in a parallel study led by physician Joseph Ouslander, a professor of medicine and nursing and director of the Emory Center for Health in Aging. Ouslander's study is testing the effects of such things as increased daytime activity, light exposure and consistent bedtime routine.

"The implications of our data so far are that it will probably take a combination of behavioral and environmental interventions to improve sleep in nursing home residents," Ouslander said.

Ross is hopeful the studies will provide some practical insight for nursing homes. "We're looking forward to the data from the study so we can make better decisions about dealing with noise," he said.

For nursing homes, which operate under tight budgets, the cost of the interventions will have to be weighed against the benefits, Ross added. The cost of implementing noise-reducing interventions is unknown for now. But Ahuja estimates the cost of sound-absorbing panels at $1.50 to $2 per square foot.

Implementing the researchers' noise-reducing interventions is problematic for now, though. "Some of the interventions are not commercially available yet, but they are made from commercially available materials," Funk explained.

Bringing the materials together to create a product available on the market may take some time. The researchers' immediate focus is on creating design rules for retrofitting existing nursing homes and designing new ones to mitigate noise.

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For more information, you may contact: 1. Krishan Ahuja, Georgia Tech Research Institute, 770-528-7054 or [email protected]

2. Bettye Rose Connell, Atlanta V.A. Medical Center, 404-321-6111, ext. 6798 or [email protected]

Georgia Tech Research News and Research Horizons magazine, along with high-resolution JPEG images, can be found on the Web at http://www.gtresearchnews.gatech.edu

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[cargal]

I have been giving much thought to our environment at work. I have often wondered if they use the overhead paging system at night, and after reading the article, I realized that they probably use the pill crusher that makes the pounding sound. I have been trying to bring some of these issues to the attention of administrator and DON, but my efforts are falling on deaf ears. She actually interrupted me to tell me the administrator didn't like the way the beds were made. I told her frankly that I didn't care. Today at work, the ALPHA watch alert that sounds when a wanderer who is wearing a bracelet tries to elope went off; I was standing next to it, it is near the phone and it was sooo loud, my ear hurt and my brain was going to explode. Aren't there laws in place that protect an employee from unsafe environments? Not to mention the constant noise and overhead paging that affect our residents. We have a lot of dementia and I am trying to address the chaos and noise on the unit. Might as well Pizz in the wind.

Today I pulled two agency nurses from the all purpose room where the feeders were: they were pounding the meds. They moved on to the diningroom and did the same thing, where another nurse pulled them out! Bad day to say the least.

Blessings,

[VivaLasViejas, ASN, RN]

And don't you just love the sound of those freaking laundry barrels rolling down the halls in the middle of the night?!

Seriously, I believe we LTC nurses would see a lot fewer behaviors and less depression in our residents if they weren't so sleep-deprived. Think about it: how would WE behave if we were being awakened every 2 hours, night after night, to be turned and/or changed, bright lights shining in our eyes, and a "silver bullet" at 0500 to get our bowels moving before breakfast? (I know how I am after even a night or two of broken sleep: I'm a b**** on wheels, and I'm only in my 40s.) Then we label these folks as "combative" or "resistive to care" when they take exception to our midnight ministrations. Ya THINK??!

There is an alternative, however, and that is the Best Friends approach. This is a resident-centered program that teaches nursing home staff to plan care that conforms to the needs of the resident, not the facility. Imagine working in a place where the residents are allowed to sleep all day and be up all night if they choose, wake up when they're ready, eat what and when they want, nap in front of the TV in the family room if they feel like it, and generally spend their time the way they choose. No more screaming and crying in the shower (residents who are frightened of showers get a tub or bed bath when they really need one, a PTA bath when time is tight). No more "rounds" or wee-hours med passes (all meds are given when residents are awake, and skin issues are prevented with good nutrition and continence products). No more laundry barrels scraping across floors at 0530 waking up the chickens half a mile away (the hallways are carpeted). These are just a few of the ways Best Friends works to improve the lives of residents, but think how much better their quality of life can be if we would only let them SLEEP!!

[adrienurse, LPN]

How about reducing noise at the nursing station, so that I can concentrate while I chart? How about banning the ^*&%** floor polishers.

Okay, my opinion. It is well known that as we age, the amount of sleep that we are able to get is reduced. In the few years that I have been a nurse, I have definately seen a trend in efforts to reduce the amount of interruptions while they do sleep. We do not wake people up to change them. This is not done in order to save money on briefs, but because of data that sees a correlation between sleep and wellbeing. We use "Night Plus" attends that can be worn for 8 hours. Of course, we do pay attention to skin integrety, and people who are frail and at risk are changed and turned on a regular basis. It's an individual intervention, not the rule.

[eddy]

I have been in several LTC's that sound like a 24/7 house party. I have witnessed nurses and aides yelling down halls just to save the few steps at 0200. It's a respect thing to me. If this place was MY home how would I want my neighbors (in this case other residents AND employees) to conduct themselves when I was trying to saw logs? I wouldn't stand for this stuff! Ever think this is why we have so many people literally "lose it" after only being in an LTC for a month or two? The facility makes them crazy!!! It's a shame.

I have worked in a facility that was quite similar to this "Best Friends" thing. The place actually looked like a home and not a "facility". It was dare I even say COZY. The residents seemed a LOT happier and there were very few screamers like there are in many LTC's. We did nite meds, but many if not most of the people were already awake. They had special sleep schedules that allowed them to get plenty of rest. They ORDERED meals when they wanted to eat, and they had a menu to choose from if they liked or could go with the "daily special". Employees were encouraged to "sit and chat" with the residents, and it was not uncommon for someone to "hang out" with someone for over an hour. Yet, everything always got done. It was a glimpse at how things SHOULD be.

[cargal]

Pleez tell me where this facility is! Are you still there? What happened?

[night owl]

Originally posted by mjlrn97

and a "silver bullet" at 0500 to get our bowels moving before breakfast?

I know that if anyone came near me at 0500 with a silver bullet at that hour would wind up getting it themselves!