内科病区护士站噪声暴露现状及干预研究
摘要
目的：
测量浙江省1家三级乙等综合医院内科病区护士站噪声,分析内科病区护士站的噪声暴露现状及主要影响因素,提出合理的干预措施,评价其对环境噪声的干预成效,以期在护理工作环境管理上为护理管理者和研究者提供一定的理论依据和应用参考。
方法：
本研究是以三级乙等综合医院内科病区护士站为研究对象,于2010年7月在浙江省1家三级乙等医院随机抽取1个内科病区,使用杭州电子工业学院机电总厂生产的HE5624A噪声统计分析仪,测量护士站的各种噪声,并连续72h监测护士站环境噪声及护士工作状况和引起噪声突然改变的事件,分析噪声暴露现状及其主要影响因素,并据此确立干预措施；实施干预措施四周后,在2010年9月按相同方式进行再次测量和记录,纵向比较干预前后的差异。数据采用SPSS 11.5统计学软件进行录入和统计分析,具体统计方法为描述性统计分析方法和成组设计样本均数t检验,以P<0.05认为有统计学意义上的差异。
结果：
1、干预前护士站病人呼叫系统、针式打印机、电话铃声均超过70 dB(A),最高达86.5 dB(A),在干预后有明显降低；交谈声、附近病房的关门声在干预后较干预前降低；走路声、车辆的车轮声相对较低,在干预前后降低不明显。
2、干预前护士站环境噪声指标(昼间和夜间的等效声级(Leq)分别为64.39±5.66 dB(A)和52.64±7.67 dB(A),夜间的最大声级(Lmax)为81.53±7.83 dB(A))均远远超过WHO和我国制定的医院内环境噪声标准。
3、干预前后护士站昼间各项噪声指标(Leq、Lmax、Lmin、L10、L50、L90)均高于夜间,差异有统计学意义(P<0.05)。
4、干预后护士站各项噪声指标,除昼间最大声级(Lmax)略有升高外,其余指标均有不同程度的降低。干预后昼间和夜间的等效声级(Leq)、夜间的最小声级(Lmin)、昼间和夜间的累积百分声级(L10)这5项指标较干预前均有明显降低,差异有统计学意义(P<0.05)。
结论：
内科病区护士站环境噪声均远远超过WHO和我国制定的医院内环境噪声标准。通过对医护人员的教育培训和行为干预、设备设施管理和环境改善,能有效地降低护理工作环境中的噪声水平,有利于提高护理服务质量和护士生活品质。研究还存在一定不足和局限性,比如研究对象的地域、医院等级和专科限制,与环境噪声相关的其他影响因素的干预研究,噪声干预成效的长时间追踪。因此,可以进一步研究噪声干预在护理环境噪声管理中的作用。
Objective:
Our study aims to analyze the noise exposure status and its main influential factors in the internal medicine ward nurse station of middle three-grade comprehensive hospital in Zhejiang Province. Then we set the reasonable intervention strategies. The effective of interventions were also studied in order to reduce hospital noise and optimize nursing work environment. Then it will provide the theroretical and applicable basic for the nursing managers and nursing researchers.
Method:
Our study was carried out in an internal medicine ward nurse station of middle three-grade comprehensive hospital in Zhejiang Province. Noise statistics analyzer was used to measure kinds of noise in the internal medical ward nurses station, and continuous monitore the noise over 72h in July 2010. The working conditions of nurses and the events causing a sudden change of noise were also recorded. Then analyze the noise exposure status and its main influential factors. Based on the investigated, we established the reasonable intervention strategies. After appling the interventions for 4 weeks in the internal medicine ward nurse station, the same measure and monitore were investigated in September 2010. Compare the effect on hospital noise pre and post intervention to find differences. Descriptive statistics and t test were used in the data analysis of SPSS 11.5 software. The P<0.05 was considered statistically significant in all tests.
Results:
1、The noise levels of patient call system, stylus printer and telephone ring exceeded 70 dB (A), up to 86.5 dB (A) in pre intervention, and reduced significantly in post intervention. In post intervention, sound of conversation and nearby door closing were lower than that in pre intervention.
2、In pre intervention, The equivalent continuous A-weighted sound pressure level (Leq)of each hour during day-time and night-time of day-time and night-time was 64.39±5.66 dB (A) and 52.64±7.67 dB (A) respectively in the nurses station. The maximum sound level(Lmax) of night-time was 81.53±7.83dB (A)
3、The noise levels (hourly Leq, Lmax, Lmin, L10, L50, L90)of the day-time were all higher than that of night-time in pre and post intervention. The difference was statistically significant (P<0.05).
4、Compared to pre intervention, Leq and L10 of day-time and night-time, Lmin of night-time were all lower in post intervention. The difference was statistically significant (P<0.05).
Conclutions:
The noise levels of the medical ward nurses station is much higher than standards setted by WHO and China. The noise level in the nursing work environment can be reduced effectively by education, training and behavioral intervention on staff,equipment and facilities management and environmental improvement. Then it will improve the quality of nursing service and life quality of nurses. There were some shortcomings and limitations in this study, such as the restrictions of region, hospital grade and specialist, the impact of other influential factors and lasting tracking of effectiveness of interventions. Therefore, we can further study the effect of noise interference in noise management of the nursing environment.
测量浙江省1家三级乙等综合医院内科病区护士站噪声,分析内科病区护士站的噪声暴露现状及主要影响因素,提出合理的干预措施,评价其对环境噪声的干预成效,以期在护理工作环境管理上为护理管理者和研究者提供一定的理论依据和应用参考。
方法：
本研究是以三级乙等综合医院内科病区护士站为研究对象,于2010年7月在浙江省1家三级乙等医院随机抽取1个内科病区,使用杭州电子工业学院机电总厂生产的HE5624A噪声统计分析仪,测量护士站的各种噪声,并连续72h监测护士站环境噪声及护士工作状况和引起噪声突然改变的事件,分析噪声暴露现状及其主要影响因素,并据此确立干预措施；实施干预措施四周后,在2010年9月按相同方式进行再次测量和记录,纵向比较干预前后的差异。数据采用SPSS 11.5统计学软件进行录入和统计分析,具体统计方法为描述性统计分析方法和成组设计样本均数t检验,以P<0.05认为有统计学意义上的差异。
结果：
1、干预前护士站病人呼叫系统、针式打印机、电话铃声均超过70 dB(A),最高达86.5 dB(A),在干预后有明显降低；交谈声、附近病房的关门声在干预后较干预前降低；走路声、车辆的车轮声相对较低,在干预前后降低不明显。
2、干预前护士站环境噪声指标(昼间和夜间的等效声级(Leq)分别为64.39±5.66 dB(A)和52.64±7.67 dB(A),夜间的最大声级(Lmax)为81.53±7.83 dB(A))均远远超过WHO和我国制定的医院内环境噪声标准。
3、干预前后护士站昼间各项噪声指标(Leq、Lmax、Lmin、L10、L50、L90)均高于夜间,差异有统计学意义(P<0.05)。
4、干预后护士站各项噪声指标,除昼间最大声级(Lmax)略有升高外,其余指标均有不同程度的降低。干预后昼间和夜间的等效声级(Leq)、夜间的最小声级(Lmin)、昼间和夜间的累积百分声级(L10)这5项指标较干预前均有明显降低,差异有统计学意义(P<0.05)。
结论：
内科病区护士站环境噪声均远远超过WHO和我国制定的医院内环境噪声标准。通过对医护人员的教育培训和行为干预、设备设施管理和环境改善,能有效地降低护理工作环境中的噪声水平,有利于提高护理服务质量和护士生活品质。研究还存在一定不足和局限性,比如研究对象的地域、医院等级和专科限制,与环境噪声相关的其他影响因素的干预研究,噪声干预成效的长时间追踪。因此,可以进一步研究噪声干预在护理环境噪声管理中的作用。
Objective:
Our study aims to analyze the noise exposure status and its main influential factors in the internal medicine ward nurse station of middle three-grade comprehensive hospital in Zhejiang Province. Then we set the reasonable intervention strategies. The effective of interventions were also studied in order to reduce hospital noise and optimize nursing work environment. Then it will provide the theroretical and applicable basic for the nursing managers and nursing researchers.
Method:
Our study was carried out in an internal medicine ward nurse station of middle three-grade comprehensive hospital in Zhejiang Province. Noise statistics analyzer was used to measure kinds of noise in the internal medical ward nurses station, and continuous monitore the noise over 72h in July 2010. The working conditions of nurses and the events causing a sudden change of noise were also recorded. Then analyze the noise exposure status and its main influential factors. Based on the investigated, we established the reasonable intervention strategies. After appling the interventions for 4 weeks in the internal medicine ward nurse station, the same measure and monitore were investigated in September 2010. Compare the effect on hospital noise pre and post intervention to find differences. Descriptive statistics and t test were used in the data analysis of SPSS 11.5 software. The P<0.05 was considered statistically significant in all tests.
Results:
1、The noise levels of patient call system, stylus printer and telephone ring exceeded 70 dB (A), up to 86.5 dB (A) in pre intervention, and reduced significantly in post intervention. In post intervention, sound of conversation and nearby door closing were lower than that in pre intervention.
2、In pre intervention, The equivalent continuous A-weighted sound pressure level (Leq)of each hour during day-time and night-time of day-time and night-time was 64.39±5.66 dB (A) and 52.64±7.67 dB (A) respectively in the nurses station. The maximum sound level(Lmax) of night-time was 81.53±7.83dB (A)
3、The noise levels (hourly Leq, Lmax, Lmin, L10, L50, L90)of the day-time were all higher than that of night-time in pre and post intervention. The difference was statistically significant (P<0.05).
4、Compared to pre intervention, Leq and L10 of day-time and night-time, Lmin of night-time were all lower in post intervention. The difference was statistically significant (P<0.05).
Conclutions:
The noise levels of the medical ward nurses station is much higher than standards setted by WHO and China. The noise level in the nursing work environment can be reduced effectively by education, training and behavioral intervention on staff,equipment and facilities management and environmental improvement. Then it will improve the quality of nursing service and life quality of nurses. There were some shortcomings and limitations in this study, such as the restrictions of region, hospital grade and specialist, the impact of other influential factors and lasting tracking of effectiveness of interventions. Therefore, we can further study the effect of noise interference in noise management of the nursing environment.
引文
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[1]殷磊.护理学基础.第3版.北京：人民卫生出版社,2005,123-124.
[2]MacKenzie DJ,Galbrun L. Noise levels and noise sources in acute care hospital wards. Building Serv Eng Res Technol,2007,28(2):117-131.
[3]Walder B, Francioli D, Meyer JJ, et al. Effects of guidelines implementation in a surgical intensive care unit to control nighttime light and noise levels. Crit Care Med,2003,28(7):2242-2247.
[4]Freedman NS,Gazendam J,Levan L, et al. Abnormal sleep/wake cycles and the effect of environmental noise on sleep disruption in the intensive care unit. Am J Respir Crit Care Med,2001,163(2):451-457.
[5]Richardson A,Thompson A,Coghill E, et al. Development and implementation of a noise reduction intervention progamme:a pre- and postaudit of three hospital wards. J Clin Nurs,2009,18(23):3316-3324.
[6]Elander G, Hellstrom G. Reduction of noise levels in intensive care units for infants:Evaluation of an intervention progamme. Heart Lung,1995,24(7):376-379.
[7]Christensen M. Noise levels in a general surgical ward:a descriptive study. J Clin Nurs,2005,14(2):156-164.
[8]王莹,张巍,李兴启,等.北京地区三级新生儿重症监护病房噪音的暴露现状及干预措施.中华儿科杂志,2008,46(2)：120-123.
[9]Allaouchiche B,Duflo F,Debon A, et al. Noise in the postanaesthesia care unit. B J A,2002,88(3):369-373.
[10]McLaren E, Maxwell-Armstrong C. Noise pollution on an acute surgical ward. Ann R Coll Surg Engl,2008,90(2):136-139.
[11]Akansel N, Kaymakci S. Effect of intensive care unit noise on patients:a study on coronary artery bypass graft surgery patients. J Clin Nurs,2008,17: 1581-1590.
[12]Berglund B,Lindvall T, Schwela DH. Guidelines for Community Noise. World Health Organization,Geneva.1999
[13]环境保护部,国家质量监督检验检疫总局.中华人民共和国国家标准声环境质量标准.2008,GB 3096-2008.
[14]Tijunelis MA,Fitzsullivan E,Henderson SO. Noise in the ED. Am J Emerg Med,2005,23(3):332-335.
[15]Macedo IS, Mateus DC,Costal Ede M, et al. Noise Assessment in Intensive Care Units. Braz J Otorhinolaryngol,2009,75(6):844-846.
[16]Busch-Vishniac IJ,West JE, Barnhill C, et al. Noise levels in Johns Hopkins Hospital. J Acoust Soc Am,2005,118(6):3629-3645.
[17]Carvalho WB, Pedreira ML,de Aguiar MA. Noise levels in a pediatric intensive care unit. J Pedia,2005,81(6):495-498.
[18]Marques Sanchez del P, Calle Pardo AP, Sanchez DC, et al. Nurses'perception of noise levels in hospitals in Spain. J Nurs Adm,2008,38 (5):220-222.
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[28]Donchin Y,Seagull FJ. The hostile environment of the intensive care unit. Curr Opin Crit Care,2002,8(4):316-320.
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[2]MacKenzie DJ,Galbrun L. Noise levels and noise sources in acute care hospital wards. Building Serv Eng Res Technol,2007,28(2):117-131.
[3]Walder B, Francioli D, Meyer JJ, et al. Effects of guidelines implementation in a surgical intensive care unit to control nighttime light and noise levels. Crit Care Med,2003,28(7):2242-2247.
[4]Freedman NS,Gazendam J,Levan L, et al. Abnormal sleep/wake cycles and the effect of environmental noise on sleep disruption in the intensive care unit. Am J Respir Crit Care Med,2001,163(2):451-457.
[5]Richardson A,Thompson A,Coghill E, et al. Development and implementation of a noise reduction intervention progamme:a pre- and postaudit of three hospital wards. J Clin Nurs,2009,18(23):3316-3324.
[6]Elander G, Hellstrom G. Reduction of noise levels in intensive care units for infants:Evaluation of an intervention progamme. Heart Lung,1995,24(7):376-379.
[7]Christensen M. Noise levels in a general surgical ward:a descriptive study. J Clin Nurs,2005,14(2):156-164.
[8]王莹,张巍,李兴启,等.北京地区三级新生儿重症监护病房噪音的暴露现状及干预措施.中华儿科杂志,2008,46(2)：120-123.
[9]Allaouchiche B,Duflo F,Debon A, et al. Noise in the postanaesthesia care unit. B J A,2002,88(3):369-373.
[10]McLaren E, Maxwell-Armstrong C. Noise pollution on an acute surgical ward. Ann R Coll Surg Engl,2008,90(2):136-139.
[11]Akansel N, Kaymakci S. Effect of intensive care unit noise on patients:a study on coronary artery bypass graft surgery patients. J Clin Nurs,2008,17: 1581-1590.
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