NEONATAL INTENSIVE CARE UNIT SOUND LEVELS BEFORE AND AFTER STRUCTURAL RECONSTRUCTION
Krueger C, Schue S, Parker L. MCN. 2007;32(6):358-362.
Researchers employed a descriptive, pretest-posttest design to measure differences in sound levels in a neonatal intensive care unit (NICU) in response to structural reconstruction.
Sound levels outside the normal range (Leq < 50 dB; L10, 55 dB; and Lmax < 70 dB) can be detrimental to neonatal development. Specifically, 1997 recommendations by the American Academy of Pediatrics specify that sound levels for NICUs should be maintained at an hourly Leq of 50 dB and hourly L10 of 55 dB, and a 1-second duration Lmax should not exceed 70dB (Leq is the average sound, L10 is the sound level that is exceeded for 10% of the time, and Lmax is the momentary maximum of sound).
The authors delineate that there are 2 types of sound. The first type of sound is operational sound, which refers to that generated by staff or equipment. The second type is structural sound, which is that generated by the building.
Reconstruction of a level III NICU included changes to decrease structural sound level, including lowering ceilings, installing ceiling tiles with high sound absorption, and placing monitor alarms away from walls to reduce sound transmission.
Investigators measured sound continuously for 8 hours before and after reconstruction. Although there was about 4 dB decrease in Leq sound (it was not stated whether it was a statistically significant change), a decrease in L10 and Lmax did not occur, and sound levels in the NICU still exceeded recommended levels.
The authors conclude that structural changes can decrease sound levels, but such changes are not in themselves enough to result in safe sound levels for neonates. Specific types of structural changes, as well as operational sound factors, need to be examined to further reduce sound levels.
COMPASSION FATIGUE AND SECONDARY TRAUMATIZATION: PROVIDER SELF CARE ON INTENSIVE CARE UNITS FOR CHILDREN
Meadors P, Lamson A. J Ped Health Care. 2008;22(1):24-34.
Investigators used a quantitative, pretest-posttest design to examine compassion fatigue of providers working on critical care units with children.
Compassion fatigue is described as "a result of prolonged exposure to trauma resulting in a variety of problematic symptoms that manifest in the workplace and at home"(p24). Providers for critically ill children are susceptible to compassion fatigue, particularly if events are perceived as traumatic to the provider and/or the provider has unhealthy coping strategies.
A total of 185 healthcare providers and staff were given a modified version of the Social Readjustment Rating Scale, Index of Clinical Stress, and a compassion fatigue measure developed by the researchers. They completed these questionnaires before and after an educational seminar on compassion fatigue.
Participants who indicated high levels of stress were more likely to show signs of clinical stress such as feeling tense or jittery. They also exhibited more negative behaviors than did those with low levels of stress and had more difficulty separating work and personal life.
There were statistically significant differences in the 10 predetermined items from compassion fatigue and the Index of Clinical Stress after the educational seminar. For instance, participants reported increase knowledge of warning signs of compassion fatigue (mean, 2.97 vs 4.22; P = .001), having enough resources to manage stressors at work (mean, 3.31 vs 7.51; P = .001), and having decreased feelings of being overwhelmed (mean, 3.60 vs 1.29; P = .001).
The authors recommend that providers should be offered seminars on compassion fatigue and that the work culture should support the physical and emotional health of providers. In this way, compassion fatigue can be minimized.