Sound Cultures of Critical Care

Abstract

The intensive care unit (ICU) is a special department of the hospital that admits critically ill patients who need intensive monitoring, supporting, and/or take-over of one or more of their vital functions. The patients are monitored and supported by medical equipment as well as a team of intensivists, nurses and other medical staff members 24/7. Due to the audible alarms of the devices, but also because of conversing people and other machinery and incidental sounds, the ICU transformed into an acoustically hostile environment. Ironically, the ICU’s excessive amount of sounds threatens both patient safety and clinicians’ wellbeing and work efficiency (Redert, 2018). In light of these sound issues in the ICU, this graduation assignment aimed to capture the ICU nurses’ sound-related values and practices and to develop an understanding of the phenomenon of sound in a sociocultural context – the so-called ‘ICU sound culture’. By understanding the ICU sound culture, the second aim of the assignment was to look for opportunities for silencing down the ICU whilst considering the sound cultures. The first aim, capturing and typifying different ICU sound cultures, was addressed in a field research study with a procedure based on contextmapping. The research findings showed that nurses working in the same Dutch ICU and nurses working in different ICUs share three (sound-related) core values: autonomously working (together), being situationally aware and giving and receiving social support. It seems that the accompanying practices are transmitted through learning and typical for the Dutch ICU (sound) culture. However, nurses from different ICUs but also nurses of one and the same team could differ in their value orientations and practicing these. As a result, the nurses can be divided into three types based on shared customs, beliefs and needs, called ‘personas’. The field research showed that similarities and differences exist due to ICU specific sound cultures and ICU specific group cultures within one and the same team. Though different sound cultures and coping strategies with the sounds exist, there is a commonality regarding the ‘sound problem’ (i.e. the excessive amount of sounds in an ICU): in all ICUs, the sounds, or even issues with them, are sort of accepted to a greater or lesser extent due to nurses not knowing why (by being ignorant or indifferent) or not knowing how to reduce sounds. Additionally, the current sound-reducing efforts that do exist are often taken individually, ad-hoc and they have a short-term impact. When ICUs want to reduce the sounds with a bigger impact in the longer term, ICUs need to create ‘sound-issue awareness’ and motivate every individual nurse to act upon the sound issues. This opportunity for silencing down the ICU whilst considering the sound cultures, which was the second aim of the project, was further translated into a campaign for sound cultural change. The campaign challenges the ICU management team and nurses to establish a ‘collectivistic sound culture’, in which every individual nurse commits to the group effort and goal to create a more peaceful sound environment in the ICU.