School of Nursing


Doctor of Nursing Practice (DNP)


Tonia Kennedy


Noise, Decibel Level, Sleep Promotion, Sleep Intervention, Intensive Care Unit, Critical Care Unit


Medicine and Health Sciences | Nursing


Excessive environmental noise in the ICU often negatively impacts patient sleep. The World Health Organization (WHO) and Environmental Protection Agency (EPA) have published recommendations for hospital decibel levels, but the literature indicates that noise levels in the ICU often exceed these values. Patients experience disturbed sleep and rarely enter into N3 and REM sleep. The integrative review examined both the patients’ and healthcare workers’ perception of noise in the ICU environment to identify contributors and suggested interventions to mitigate these occurrences. In addition, this study evaluated objective measurements of patient sleep to further determine how well patients were sleeping in this environment. Utilizing the PRISMA model, 1,124 articles were screened and narrowed down according to the problem statement, questions, and inclusion and exclusion criteria. A total of 43 articles were included in this review. The articles identified multi-component bundles and strategies to be effective in decreasing environmental noise, although there was no standard intervention used across multiple studies. Objective measurements of sleep including polysomnography, actigraphy, and circadian rhythm studies revealed that patients are not sleeping well in this environment. While multiple studies have investigated different means of decreasing noise in the ICU environment, this is a complicated and multi-factorial issue. Additional research studies with more patients should be conducted to formulate a best-practice nighttime bundle for the ICU environment.

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