To appreciate Florence Nightingale’s thoughts about hospitals, nursing, and patient care in the 21st century, let’s imagine what she would observe in a hospital today. Florence would walk through the hospital to scrutinize each unit and department and observe patients' and nurses' behaviours. Satisfied that the inspection has shown her what healthcare is like in the modern-day hospital, Florence Nightingale would conclude this–hospitals are noisy, and the noise prevents the patient from achieving health and well-being. The science supports Florence’s (hypothetical) conclusion.
Hospitals are Polluted with Noise
Noise is any unwanted, unpleasurable, or disturbing sound. Sound, measured in decibels (dB), varies widely. Sound levels range from rustling leaves (20 to 30 dB), to conversational speech (60 dB), to a vacuum cleaner (70 dBs), to a jet aircraft (120 dBs).[1,2] Noise above 65 dB is considered noise pollution.
In hospitals, noises are emitted from many things like monitoring devices, alarms, HVAC systems, telephones, overhead pagers, ventilators, suction machines, drains, and people talking. The World Health Organization recommends an average noise level of no more than 35 dB in patient treatment or observation rooms and no more than 30 dB in patient unit rooms. No hospital since 1960 has met this guideline.
Noise pollution has many negative impacts on patient health and well-being including:
high blood pressure,
the need for more pain medication, and
diminished ability to focus. [1,5]
In addition, excessive noise can increase a patient’s hospital length of stay for up to a day.
Build ‘Quiet’ Into Hospitals
What would Florence advise that nurses do about noise pollution in hospitals? Perhaps she would first praise us for our innovations because they prevent diseases, cure illnesses, and prolong life. Then she would point out that our innovations create noise which is a “cruel absence of care”. She would press us to redirect our penchant for building machines and technology to creating noise-reduction solutions to support patient healing and recovery. She would want us to build ‘quiet’ into hospitals.
Florence would insist that we begin our journey to develop solutions with an observation exercise. She would ask us to lay down on a patient bed, close our eyes, and pay attention to the noises all around. These noises, Florence would say, are absorbed into the body and mind of the patient. These noises, she would continue, interfere with the calm disposition that the patient needs for a restful sleep, a steady breath, and a relaxed mind.
The point of Florence’s observation exercise would be for nurses to understand, through observation, how the patient ‘hears’ the hospital. By understanding the patient, we can begin to develop the right solutions. Our solutions might be technology-focused such as installing soundproofing systems, purchasing equipment with ‘silent’ settings, or eliminating overhead paging by providing nurses with personal devices. Or processed-focused solutions such as restocking supplies in the evening rather than at night when patients are trying to sleep, designating routine ‘quiet times’, or posting signs to remind people to talk quietly. We might devise simpler solutions like planting trees outside of the hospital to absorb sound or transform unused rooms into ‘quiet rooms’ with calming wall colours and large windows to let in sunlight.
Reduce Hospital Pollution Through Science and Art
According to Florence, nursing “is achieved through environmental alteration”. Because hospital noise pollution is a tremendous problem, it is tempting to believe that the solutions are beyond nursing. But nurses are in the perfect position to fix the problem as we are both scientists and artists. It’s easy to fixate on the science to solve problems because science is groundbreaking and praised. But to focus solely on the science is to overshadow the art. And when the art is forgotten, so too is the patient.
Some 200 years after her birth, nurses still look to Florence Nightingale, the mother of modern nursing, for guidance. To make hospitals quieter and thus healthier, I believe that she would encourage us to become reacquainted with the art of nursing– being intuitive, showing compassion, and observing the environment through the eyes of the patient.
Hsu, T., Ryherd, E., Persson, K., & Ackerman, J. (2012). Noise pollution in hospitals: Impact on patients. Journal of Clinical Outcomes Management, 19(7), 301-309.
National Geographic. (2019, July 16). Noise pollution. https://www.nationalgeographic.org/encyclopedia/noise-pollution/
Berglund, B., Lindvall, T., Schwela, D. H, World Health Organization, & Occupational and Environmental Health Team. (1999). Guidelines for community noise. World Health Organization. https://apps.who.int/iris/handle/10665/66217
Busch-Vishniac, I. J., West, J. E., Barnhill, C., Hunter, T., Orellana, D., & Chivukula, R. (2006). Noise levels in Johns Hopkins Hospital. The Journal of the Acoustical Society of America, 118, 3629-3645. https://doi.org/10.1121/1.2118327
Iberdrola. (n.d.). Noise pollution: How to reduce the impact of an invisible threat? https://www.iberdrola.com/environment/what-is-noise-pollution-causes-effects-solutions
Fife, D., & Rappaport, E. (1976). Noise and hospital stay. American Journal of Public Health, 66(7), 680-681. https://doi.org/10.2105/AJPH.66.7.680