Investigation of environmental stimuli in the neonatal intensive care unit of Ghaem Hospital in Mashhad

Introduction[N1] :One of these annoying stimuli and a major source of stress in the NICU is sound. In neonatal intensive care units, sounds with different intensities and frequencies are produced from different sources such as fan devices, intermittent alarms, ventilators, telephones, door opening and closing, and staff conversations; Studies have reported that the average noise level in the NICU is 55-67 decibels, with periods of up to 120 decibels. The American Academy of Pediatrics recommends that the average volume in the ward be around 45 decibels during the day and about 35 decibels at night. Physical and behavioral responses to sudden, loud noises have been observed in the NICU ward among older and fuller infants. Physiological changes include apnea, bradycardia, palpitations, respiration, blood pressure, oxygen saturation, and changes in the sleep-wake cycle. This information indicates that infants in the NICU environment are able to respond to sounds around them. Another stressor in the ward is early and long-term exposure to high light or continuous exposure to low light, which can be harmful to premature infants. In recent years, most neonatal wards have been on continuously during the day and night, with light intensities of 600-600 lux recommended for these wards. The results of Glutzij study showed that the average light intensity in neonatal intensive care units is about 300 lux and the maximum light intensity reaches 2251 lux. The standard values for the intensive care unit are as follows: general lighting 100 lux, simple examinations 300 lux, specialized examinations 1000 lux, lighting for night visits 20 lux. It is suggested that the best light mode in the NICU environment is adjustable light for each board; The range of this light should be 645-7 / 10 lux. According to the American Academy of Pediatrics, this light should not exceed 1615-1075 lux. In neonatal wards, premature infants receive essential medical and nursing care; They are frequently manipulated and touched. They often find this type of touch anxious and disturbing. In order to reduce the effects of environmental stress on continuous cardiorespiratory control, nursing examinations and daily care should be coordinated so that the infant is less manipulated. In the intensive care unit, infants' rest is often disrupted due to repeated manipulations. This manipulation is associated with physiological adverse effects such as hypoxia, apnea, hyperventilation, increased intracranial pressure, and behavioral disorders. Research has shown that 56% of such disorders are moderately to severely caused by intrusive nursing care. This manipulation, in addition to light and noise, can have devastating effects on the developing baby. Methods: This descriptive cross-sectional study was performed in 2014 in the neonatal intensive care unit of Ghaem Teaching Hospital in Mashhad. In this study, to measure the sound level, the sound level meter TES1358, the amount of light was used using a Hagner brand luxmeter model EC1. The validity of sound meter and luxmeter was determined by referring to reputable brands and used under the supervision of an expert. Also, to evaluate the reliability of sound level meter and luxury meter, the equivalent reliability method was used; In this way, each time before the intervention, its accuracy was compared with another device. Sound pressure level and light level by regular network stationing method using sound meter and luxury meter in 100 stations in 24 hours at random hours (7am - 11pm) in two normal days and holidays (Saturday and Friday) and in three Morning, evening, night, as well as noise-causing factors were measured in the section and based on the measured values using noise level measurement formulas, total sound pressure level (LPT), average sound pressure level (LP―) and equivalent noise exposure level ( Leq) was calculated. Noise level measurement time was performed without building repairs, installation or commissioning of new equipment and without implementing noise reduction protocol. During the data collection period, the sources of sound production include background noise and noise from personnel activities and noise from the operation of all devices in the ward, which were recorded by the person measuring the sound and analyzing the sound. The number of manipulations of mothers and nurses was evaluated by the researcher. This study was performed after obtaining permission from the ethics committee of Mashhad University of Medical Sciences and submitting a referral letter from the School of Nursing and Midwifery to the Ghaem Research and Treatment Center. The collected data were analyzed using SPSS16 editing software and analysis of variance with repeated measures (Reapeated measurement). Results: The results showed that the average sound pressure level (LP―) in the neonatal intensive care unit of Ghaem Hospital on a normal day (Saturday) in the morning, evening and night was 66.35, respectively. 65.90, 61.70 decibels and on holidays (Friday) were measured as 65.30, 63.90, 59.94 decibels, respectively. The highest average sound pressure level was related to the NICU section on Saturday morning (66.35 dB) and the lowest value was related to the section on Friday night (59.94 dB). Alarms Monitors, ventilators, and the noise of doctors and nurses are important components of noise in the NICU. According to the results of test, there was no significant difference in the average sound pressure level between Friday and Saturday in the NICU. Also, the repeated measures test showed that there was a significant difference in the mean sound pressure level between the measurement times (morning, evening and night) (P <0.05). There was no significant difference between NICU in terms of light and manipulation between Friday and Saturday, but there was a significant difference between the measurement times (morning, evening, night) in the two variables. (P<0/04) (P<0/01) Conclusion: According to the findings of the present study, there is no significant difference between the average level of sound pressure, light and manipulation in the neonatal intensive care unit of Ghaem Hospital between Friday and Saturday; While between morning, evening and night shifts, it was significant according to the factors causing environmental stimuli. Most environmental stimuli were in the morning shift; Which corresponds to the peak of nurses' work, the presence of medical students, nursing and mothers, and the head of the visit. Also, the highest noise level in the NICU was due to the presence of ventilators, infusion pumps and monitors.Based on the findings of this study, the level of noise and light and the number of manipulations in the neonatal intensive care unit of Ghaem Hospital is higher than the standard. Alarm monitors, ventilators, and the noise of physicians and nurses are important components of noise in the NICU. In addition, nurses can reduce noise, light, and manipulation by implementing new policies. Noise and light control at the NICU helps promote sleep, stabilize physiological parameters, and reduce potential side effects on premature infant hearing development. The results of this study can be used to develop a protocol for reducing environmental stimuli. The results of studies showed that the noise level can be significantly reduced by increasing staff awareness. Changing manipulation methods also requires the cooperation and awareness of staff that many observations of the baby can be made without manipulation. When the baby is connected to the monitor in the ward; The need for manipulation is reduced. All manipulation methods should be reviewed and unnecessary methods should be combined and performed at the same time if possible. Many departments use hands off; In all unnecessary methods, nursing care is postponed to provide infants with sleep-wake periods without manipulation. According to Dr. Lucy's studies, any over-sensory stimulation should be stopped for a certain period of time, and nurses should write down vital signs on the device screen without touching the baby. Finally, interventions such as dimming are recommended. , Noise reduction and infant manipulation should be used as evolutionary care to improve the growth and development of premature infants. These interventions are also recommended as the main dimensions for caring for premature infants admitted to the NICU to improve their health.