Abstract

Purposes/Aims:

This project aims to reduce perceived noise in the ICU and promote a healing environment through a multi-interventional noise-reduction protocol and nursing staff education.

Rationale/Background:

The World Health Organization (WHO) recommends that hospital noise levels remain below 35 decibels during the day and 30 decibels at night. However, ICU noise often exceeds 50-70 decibels. Increased noise levels are primarily caused by conversations, monitoring alarms, and routine care activities, such as cleaning and procedures. These high noise levels directly affect patients’ sleep, which is essential to recovery. Insufficient rest can lead to immunosuppression, prolonged mechanical ventilation, and elevated stress hormone levels. The consequences of these effects can persist beyond hospitalization, with up to 80% of ICU survivors experiencing long-term physical, cognitive, or psychological impairments.

Methods:

A total of 24 ICU nurses and 20 patients/caregivers participated in this project. The Johns Hopkins Evidence-Based Practice Model was used to develop a multi-interventional approach for the ICU noise-reduction protocol. This protocol was implemented during Quiet Time hours, which were observed daily from midnight to 4 am and from 2 pm to 4 pm. During this time, nurses helped reduce noise, closed doors, distributed earplugs and eye masks, and clustered care. ICU noise champions were also available as a resource. Prior to implementation, nurses received education on noise reduction and completed the CDC’s Recommended Training Effectiveness Questions for Post-Course Evaluation survey. Nurses were then asked to identify current sources of noise in the ICU and their perception of ICU noise prior to implementation using the Primary Sources of Noise in the ICU and Noise in ICU Survey Tool. Seven weeks after the intervention, nurses completed the Primary Sources of Noise in the ICU and Noise in ICU Survey Tool again. Nurses also completed the CDC Recommended Questions for Delayed Evaluation survey. Patients and/or caregivers also participated by completing the Patient/Caregiver Survey on Noise During Hospital Stay, which assessed their perceptions of noise and the effectiveness of noise-reduction interventions.

Assessment of Findings:

Results demonstrated improved nurses' perceptions of ICU noise following implementation of the noise-reduction protocol. Alarms, ventilators, and IV pumps were identified as the primary sources of noise. The pre-survey showed that only 8.7% of ICU nurses received any advanced training on noise reduction. Fewer nurses also reported that noise negatively affected the healing environment (46% vs. 27%). Post-training evaluations showed that 100% of nurses found the education relevant and planned to apply it in practice, and that all nurses incorporated the training into practice to some degree. Patients and caregivers also responded positively, with most reporting that dimming lights, closing doors, and designated Quiet Time hours helped reduce noise and promote a quieter, more restful healing environment.

Conclusions and Future Implications:

In conclusion, this evidence-based practice project demonstrated that implementing a noise-reduction protocol fostered a quieter, more therapeutic ICU environment for both nursing staff and patients. Increased awareness of and integration of noise-reduction strategies into nursing practice were associated with improved perceptions of noise and patient rest. Patient and caregiver feedback further supported the effectiveness of Quiet Time interventions in promoting rest and healing. These findings reinforce the importance of incorporating standardized noise-reduction protocols, ongoing staff education, and environmental modifications into routine ICU practice to further improve patient outcomes and support a healing environment.

Keywords: noise, sound, noise reduction, quiet time, intensive care unit, nursing education.

LLU Discipline

Nursing

School

School of Nursing

First Advisor

Robin Pueschel

Second Advisor

Salem Dehom

Degree Name

Doctor of Nursing Practice (DNP)

Year Degree Awarded

2026

Date (Title Page)

Spring 2026

Language

English

Type

Doctoral Project

Page Count

100 p., 1 p.

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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