Breakfast Smoothie – Nursing Home Noise

(If you have never read “Breakfast Smoothies” you might want to read the short introductory page. Explanations about the most blatant lies usually follow the essay.)

Nursing Home“Her speech is impaired and she can only talk in a very quiet, low voice. I can barely hear her when it’s quiet – and it is never quiet there.”

Ben’s wife, Cindy, was talking. She almost never joins us for breakfast smoothies since her abortive attempt to fix me up with her mother (see previous post). But this morning, as she does every Sunday morning, Cindy is going to visit her mother and is expressing her frustration about the noise level at the nursing home.

“It’s like this whenever I visit, not just Sunday morning. On Sundays, though, you can hear three different preachers, on televisions in three different rooms, all with the sound turned up. They overlap in a sound stew of Jesus preaching.”

Many TelevisionsIn honor of Cindy’s Mom, this morning Alicia has made a ‘blind date smoothie’ I said to my neighbors sitting around the pool. Besides Ben and Cindy there was also Bob Johnson, a retired farmer from Massachusetts whose mom is also in a local nursing home.

“Add to that noise,” she continued after giving me a dirty look, “the sound of the call systems. When you press the button on a resident’s bed not only does the light in the hall outside the room start blinking but the alarm starts beeping. You can see the light down the end of the hall at the nursing station and you can also hear the alarm. So you get this alarm going off every few seconds and it continues until one of the aids has a chance to go to the room to see what the patient wants. And they take their time. Most of the patients are just calling for help to go to the bathroom.”

“Then you get the patient who starts yelling something – you can hear that in the entire wing.”

“And, there’s the TV that’s showing some movie in the community room.”

“And, the visitors talking to their loved ones in their rooms – they think that they need to speak in a loud voice so that Grandma can hear – in many cases it’s true – and everyone up and down the hall can hear their conversations.”

“Sunday mornings, though, are quiet compared to the activity that occurs most days; nights, too.” Cindy finally finished, worn out from her ranting.

Most studies that discuss noise in nursing homes focus on the noise at night that is disturbing the resident’s sleep, I said. But it’s the noise during that day that is driving them crazy.

I consider myself pretty normal, I started…

Ben, Cindy, and Bob just looked at each other, but out of politeness didn’t say anything.

…but even I get a headache from the noise after just visiting for 90 minutes.

“When are you in a nursing home?” Bob asked.

I volunteer three days a week with the local hospice. I visit hospice patients in the nursing homes around town. Just being in the place for a few house drives me a little crazy. I don’t know what I would do if I had to live there.

“Why the high level of noise?” Bob said.

Wheels - squeaky or just rollingLots of things, each of which somebody thinks is indispensable and unchangeable. There are the wheels on carts and lift machines making noise. Then there are the floor buffers and cleaning carts. There is nursing station noise like monitoring equipment and printers and the noise from the lounge areas like soda and vending machines and ice machines. Then there is the communal TV and the TVs in each room, overhead announcements, the beeping of call buttons, agitated patient’s shrieking their wants and needs and the normal talking of patients, visitors, care givers and floor personnel.

“Sounds like a lot,” said Ben.

It is noise pollution in a big way.

“You say you are there for only a few hours a day a few days a week,” said Bob. “This must have some effect on the people who work there – those that are trying to cope and care for the patients.”

Rolling ComputersOf course. I’m sure that it’s very stressful on them. And it’s got to lead to some loss of effectiveness. It causes them to make errors, like medication errors, and to eventually ignore alarm noises.

“It desensitizes them,” said Bob.

Exactly. I’m sure it has an effect on patient outcomes. Not to mention a lack of privacy for patients when the care givers are forced to speak up when talking to them.

If I were Nurse Ratched, I would…

“Who?” whispered Cindy to her husband.

“From ‘One Flew Over the Cuckoo’s Nest’. You know, Jack Nicholson,” he said.

I ignored them.

…everyone with a TV or computer or music device would have their own earphones so only they can hear. These days they make long cords or wireless earphones so that is not a problem. Or, for those patients who just cannot deal with earphones, I would have speakers installed in headboards at the heads of each bed or embedded in pillows.

“Noise, just for those who want it, huh?” said Ben.

Exactly. Why should you listen to Pink Floyd when I’m the only one in the room who likes them.

There are a lot of other, institutional steps that can be taken, too. Lots they could do to reduce the ambient noise.

Not having coverings on floors and walls make them easy to clean but echo the sound a lot more. Curtains and pictures on the walls would help mute the sound.

Wrap the ice machines and vending machines. Put them in closed rooms behind doors. With easy access for wheelchairs, of course.

room alarms, telephones, fire alarms, doorsThey could use call systems that don’t make any noise: calls directly to monitors carried by the aids, nurses, and other care givers – lights on panels and over doors.

“Which they already have, except they are accompanied by alarms,” said Cindy.

Right. And training for all the personnel. Quieter conversations. Quieter shoes.

And remember, I continued. Silence is not golden — some noise is necessary for comfort. Ambient noise is good. It masks other noise. They should use nature sounds like water bubblers, indoor water falls, ambient noise machines, or fans.

“Well, I’ll pass along your good words to my Mom’s friendly nurse,” said Cindy as she got up to go. “You sure you don’t want to go and see Mom with me?”

I’ll tell Alicia that you liked her smoothie, I said.

“Oh, right.”

Ben just rolled his eyes.

“Unnecessary noise is the most cruel abuse of care which can be inflicted on either the sick or the well,” Florence Nightingale in her 1859 book, “Notes on Nursing”.

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