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Noise in Nightingale’s Environmental Theory


Nurse researchers utilize concept analysis in order to understand various concepts of medical care from the perspective of different theories and frameworks (Christie, 2017). It is a necessary procedure that enables to ground the abstract theoretical concepts and attach them to reality by interpreting various factors and situation. The purpose of this paper is to analyze the concept of noise and audial disturbances through the prism of Nightingale’s environmental theory. The paper is comprised of eight sections, each of which addresses a particular purpose within the scope of the research, such as:

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  • Definition of Noise in Nursing – provides a description of the concept accepted within the nursing community.
  • Literature Analysis – provides an academic background for the chosen concept as well as the most popular views on it found in peer-reviewed literature.
  • Defining Attributes of Noise – describes the three defining qualities of noise in nursing.
  • Antecedents and Consequences – analyzes factors that lead to noise in a hospital setting as well as potential consequences for the patients and the nursing specialists.
  • Empirical referents – provide ways of measuring the effects of noise in a healthcare setting.
  • Case scenarios – this section offers three hypothetical situations, in which the concept has serious, limited, and marginal effects on the effectiveness of care.
  • Theoretical Applications of the Concept – in this section, we will discuss the possibility of utilizing the chosen nursing theory to research and analyze the concept as well as the importance of concept research in general.
  • Conclusions – a brief summary of the paper and a closing statement.

Definition of Noise in Nursing

In nursing, noise is defined as the presence of unwanted irritating sounds that bring discord to patients and physicians alike (Park et al., 2014). The majority of hospital settings are made to contain any noises in order to prevent any disturbances. However, it is a prominent factor in the event of overcrowding, emergencies, and field medicine. Exposure to noise causes distractions, loss of attention spans, temporary or permanent deafness, as well as sleeping pattern disturbances. All of these factors increase the difficulty of patient care. By analyzing noise through the prism of Nightingale’s environmental theory, it should be possible to develop simple and effective countermeasures to noise.

Literature Analysis

The first source analyzed in the scope of this literature review defines what Nightingale’s environmental theory is. According to Alligood (2017), Nightingale’s nursing theory was the first theoretical framework to shape nursing practice into what it is today. Her theory established many of the standard practices that are considered common sense in the 21st century. Her theory emphasizes the role of the environment in the patient’s recuperation process. Some of the main components of a healthy environment, according to Nightingale, are ventilation, sanitary conditions, light, and quiet. Thus, her framework identifies the absence of noise as one of the critical components necessary to facilitate health.

Although Nightingale’s theory is considered to be relatively basic compared to other theories that have emerged in the past centuries, its simplicity and effectiveness have contributed to the longevity of the framework in nursing research. Karim (2015) argues for continued practical application of Nightingale’s seven philosophical assumptions in a clinical setting, with a particular focus on noise control. The researcher finds that the utilitarian and simplistic approach of Nightingale’s framework makes it useful in medical settings run by untrained personnel, such as students, volunteers, and other groups of people not familiar with the application of complicated nursing theories.

Noise is a permanent problem for patients hospitalized in medical wardrooms. According to the study performed by Park et al. (2014), the amount of noise exposure for patients in medical wards is at 63.5 decibels during the 24-hour period, which is two times higher than the standard norms for medical wards approved by WHO. Continuous exposure to noise has a negative effect on patient sleeping patterns. The research concluded that heightened levels of noise resulted in sleep deprivation for 86% of the patients.

Noise can affect health in numerous ways, both auditory and non-auditory. The majority of cases related to temporary or permanent hearing loss are associated with exposure to occupational and social noises. According to Basner et al. (2014), noise can facilitate not only hearing damage but also cellular damage to nerves and hair. The researchers state that in a hospital setting, exposure to noise leads to annoyance, causes daytime sleepiness, and affects staff performance, increasing the probability of accidents and medical errors.

Subsequent nursing studies find the connection between noise and nursing to go beyond immediate and long-term physical effects. Noise can serve as a facilitator for various social and psychological issues associated with nursing as well. Alidosti, Heydarabadi, Baboli, Nazarbigi, and Mobasheri (2016) have discovered the association between nurse burnout and noise pollution at the workplace. Nurse burnout is one of the major factors affecting the entire healthcare industry. According to the research, exposure to noise at the workplace lead to increased levels of depersonalization (63.6%) and emotional exhaustion (64.2%) (Alidosti et al., 2016).

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One of the nursing departments associated with high levels of noise is the ICU unit. According to Luetz et al. (2016), noise is the primary cause of wakefulness and disturbed sleeping patterns in critically ill patients. The researchers have modified the layout to reduce the amount of noise affecting the patients. As a result of their modifications, the amount of noise was decreased by 50 decibels, with a roughly 30% decrease from the door side and a 50% decrease from the window side. The researchers advocate the use of sound-dampening doors, windows, and the construction of a vestibule in order to reduce noise.

Defining Attributes of Noise

Park et al. (2014) identify several attributes of noise and their effect on patients and nurses alike. These attributes are as follows:

  • Disturbed sleeping patterns. Mounting evidence suggests that exposure to noise, especially during nighttime negatively influences health and the ability to sleep.
  • Lack of attention. Exposure to loud and irritating sounds affects a person’s ability to focus on the task and remain alert and attentive to other factors. In many cases, noise is associated with medical errors and decreased patient outcomes.
  • Physical exhaustion. Lack of sleep and constant wakefulness often leads to physical exhaustion. As a result, nurses and patients have reduced physical and cognitive capabilities. Exhaustion also leads to increased levels of burnout.

Antecedents and Consequences

One of the main antecedents of noise in a hospital setting is the number of patients going through the doors of the healthcare facility in question. The majority of hospitals are designed to keep the noise out of individual wards and maintain a quiet and healthy environment, as the positive effect of a quiet environment was acknowledged ever since the creation of Nightingale’s nursing framework. However, many hospitals are currently overworked and do not have the capacity to expand. As a result, wards are rearranged to hold more patients than they should, and corridors full of people produce enough noise to affect the working environment (Luetz et al., 2016).

As a major consequence of such an approach, many wards suffer from increased levels of noise, which leads to exhaustion and reduced capability for restoration and healing. Alligood (2017) highlights the need for sleep and rest to be one of the most prominent concepts found in virtually every nursing theory presented in her book. Without an adequate sleeping schedule, a person’s natural patterns remain disturbed, which reduces the chances for a successful recovery.

Empirical References

The presence of noise in a clinical setting is typically indicated by two empirical references, which are the overall decibel range and the presence of noise-generating activities. In the study performed by Luetz et al. (2016), the average decibel range for a wardroom was around 60-65 decibels, which is associated with numerous health issues. In all research articles presented in this paper, the high volumes of noise were associated with the vigorous activity performed in the vicinity of the facility, which makes the presence of such an empirical reference to be used in studies.

Case Scenarios

Model Case

Alexander is a patient stationed in a hospital facility with a leg injury. Outside of the wardroom where he is staying, there is the ICU unit, which operates numerous vehicles. As a result, the sounds of medical vans and sirens are present on a nearly 24-hour basis. After staying in the hospital for a week, Alex began suffering from sleep deprivation.

Borderline Case

Elizabeth is a patient suffering from extreme pain after surviving a car accident. In order to keep her pain levels at tolerable levels, she is administered with painkillers on a regular basis. Her ward is located next to a large corridor, which is used for transporting medical equipment from one ward to another. Her lack of sleep is caused not only by the presence of noise but also by pain.

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Contrary Case

Napoleon is a patient in long-term care, after having received a trauma at the construction site. His ward has a noisy ventilation system that produces howls whenever the wind is directly blowing into it. It does not affect Napoleon’s sleep, as he is used to the noise back at work, and adapted to be able to sleep in any situation.

Theoretical Applications of the Concept

As evidenced by Karim (2015), Nightingale’s nursing theory is very useful in addressing issues related to the environment. Mounting evidence suggests that the presence of noise in a hospital setting presents a much greater threat to patients and nurses alike than initially anticipated. Nightingale’s theory puts an emphasis on controlling the environment in order to deliver the best healing experience to the patient. In the majority of cases, the volume of noise can be reduced through adequate planning and management of wards. The purpose of this concept analysis is to demonstrate the issue through the lens of Nightingale’s theory and utilize the framework in order to determine potential solutions.


Noise is a major issue in the majority of busy hospital settings. It affects patients and nurses on a physical and psychological level, resulting in a temporary loss of hearing, disrupted sleeping patterns, and burnout. Nightingale’s theoretical framework identifies noise as one of the major environmental factors that affect a patient’s health. The theory suggests altering the environment in a way to reduce the volume of noise affecting the patients and the personnel.


Alidosti, M., Heydarabadi, A. B., Baboli, Z., Nazarbigi, H., & Mobasheri, M. (2016).

Association between job burnout and noise pollution among nurses in Behbahan city, Iran. Journal of Fundamentals of Mental Health, 18(2), 103-108.

Alligood, M. R. (2017). Nursing theorists and their work (9th ed.). New York, NY: Elsevier.

Basner, M., Babisch, W., Davis, A., Brink, M., Clark, C., Janssen, S., & Stansfeld, S. (2014). Auditory and non-auditory effects of noise on health. The Lancet, 383(9925), 1325-1332.

Christie, E. (2017). Calling to nursing: Concept analysis. Advances in Nursing Science, 40(4), 384-394.

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Karim, H. N. (2015). Clinical application of Nightingale theory. International Journal of Innovative Research and Development, 4(11), 225-227.

Luetz, A., Weiss, B., Penzel, T., Fietze, I., Glos, M., Wernecke, K. D., … Spies, C. (2016). Feasibility of noise reduction by a modification in ICU environment. Psychological Measurement, 37(7), 1041-1055.

Park, M. J., Yoo, J. H., Cho, B. W., Kim, K. T., Jeong, W. C., & Ha, M. (2014). Noise in hospital rooms and sleep disturbance in hospitalized medical patients. Environmental Health and Toxicology, 2014(29), 1-6.

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