The aim of the poster presentation is to report an analysis of the concept of noise following Walker and Avant’s (2011) framework with an overarching goal of constructing an operational definition. Examining the concept of noise is important in furthering the theoretical development of nursing practice, nursing education, and nursing research.
Background
In the clinical setting, noise has been documented to have a negative impact on both the staff and patients, resulting in poor patient outcomes and slow recovery (Lim, 2014). In order to improve patient outcomes and promote a healing environment numerous studies have been conducted on the level of noise within intensive care units (Halm, 2016). Although, as noted by Stafford, Haverland, and Bridges (2014), few studies have been conducted on the meaning and perception of noise.
Nightingale (1860) once stated “unnecessary noise, then, is the most cruel absence of care which can be inflicted either on sick or well.” Most often the term noise immediately evokes feelings of chaos and apprehension, and within the clinical setting those feelings may further exacerbate illness. Although Nightingale (1860) warned against “unnecessary noise” related to health and healing, she articulated noise as unnecessary, therefore distinguishing unnecessary from necessary noise. As a result of this distinction, could necessary noise be used to facilitate healing and promote health? Stafford et al. (2014) noted “what is noise to one person may not be to another” (p. 57), further distinguishing the perceptions of noise. Herein lies the intriguing nature of noise and the overarching purpose of this concept analysis.
Meaning of Noise
Noise originated from the Latin word “nausea,” which means stomach illness or seasickness (“Noise,” 2018a). The term “nausea” evolved from the 13th century term to the modern day “noise.” The pronunciation and spelling of the word may have changed, but in many ways the underlying meaning has remained the same. According to the research conducted by Beach, Williams, and Gilliver (2012), noise can be evaluated both as a subjective concept and an objective concept. Although noise can be arguably quantified as a dual concept, most literature reported noise as a subjective concept.
Attributes of Noise
Several defining attributes emerged from the literature after an extensive search of noise was conducted. The following are considered to be the defining attributes that were found to be repetitive throughout the literature, an influential invisible phenomenon that either impairs or repairs, an adaptive perception, and a healing environment. These three attributes epitomize the complexity and multidimensional aspect of the concept.
The first attribute recognizes noise as an influential invisible phenomenon that either impairs or repairs. This attribute depicts noise as an audible or silent phenomenon affecting cognition, ultimately leaving the individual vulnerable to the stimulus. Noise can manifest itself in a physical form as noted by Jobs (2005) or an invisible state as documented by Ridder et al. (2014). Although the projection of noise in Jobs’ (2005) speech was in the physical form of a person, the implication of noise was an invisible phenomenon that could potentially suffocate ambitions and aspirations. Whereas in the research conducted by Ridder et al. (2014), noise was referred to as a phantom that caused emotional suffering among some individuals. Furthermore, whether noise is a physical distraction or a mental disturbance, both may trigger errors in cognition (Tainter et al., 2016). The second characterization of noise is an adaptive perception. This characteristic further validates Nightingale’s (1860) distinction of unnecessary and necessary noise, as well as the implication of noise as a perception identified by Stafford et al. (2014). Noise impacts everyone differently and is often based on the situation surrounding the individual. What is considered noise today may not be considered noise tomorrow. Wright’s (personal communication, February 22, 2018) perception of noise adapted to her needs after a life altering event. Recognizing noise based on individual perception can assist in facilitating an environment that will encourage healing and promote health.
The salient principles of the aforementioned attributes accentuate the importance of the third defining attribute, a healing environment. Throughout the literature noise is depicted as an unwanted noxious stimulus that disrupts the physiological and psychological wellbeing of an individual (Christensen, 2007; Halm, 2016; Stafford et al., 2014). Nightingale’s (1860) recognition of the nurse’s responsibility to create an environment to promote healing further exemplifies this attribute. Therefore, the best condition may necessitate the manipulation of noise, by altering the perception of the stimulus.
Model Case
Constructing a model case is “useful to test the defining attributes and to refine them using comparative reflection” (Firth et al., 2015, p. 47). The model case incorporates each defined attribute, therefore creating a “pure exemplar” (p. 163) of the concept (Walker & Avant, 2011). The defining attributes to be included within the model case are: an influential invisible phenomenon that either impairs or repairs; an adaptive perception; and a healing environment.
The following is a real-life example of a model case with the use of pseudonyms. Marie Wright and her daughter Hannah Smith enjoyed listening to the blaring music from the speakers inside the boat. On the other hand, everyone else on the boat, including the author, would urge the two of them to turn down the music. The noise was deafening and having a conversation was virtually impossible. While out on the lake the music from the speakers did not bother Wright, but once inside a controlled, less entertaining environment she would complain about the noise from patient monitors, which she likened the noise to her ex-husband’s voice, Smith’s father. The memory of her marriage to him was not pleasant, and hearing his voice made her sick to her stomach. One night her ex-husband called and as usual she ignored him. After some time had passed she listened to the message he left for her. She was told via voicemail her 16 year old daughter had committed suicide and the coroner was taking her body to the morgue. Wright went to a counselor for several months after Smith’s death and continues to do things she and her daughter enjoyed together. Throughout the grieving process she has discovered ways that work for her as she continues to cope with the loss of her daughter. One thing Wright appreciates now is constant background noise.
Antecedents
One of the fundamental antecedents for the concept of noise is sound. While sound production is important, another antecedent of high importance is the ability to hear. After sound has been produced and heard, the individual must be exposed to a variation of sounds in order to distinguish pleasant sounds from unpleasant sounds. Lastly, a provoking stimulus is the final antecedent that must occur before there can be noise. This final antecedent portrays the momentous impact noise can have on an individual necessitating a healing environment.
Consequences
While there are several instrumental consequences documented for the term noise, identifying a consequence related to the concept of noise was more challenging. After careful reflection of the defined attributes for noise the author identified the consequence of noise to be a positive change. Furthermore, positive change is also the aspired consequence for nursing practice, nursing research, and nursing education.
Empirical Referents
Identification of the empirical referents is the final step in the eight-step process developed by Walker and Avant (2011). As stated by Walker and Avant (2011) empirical referents are the “means by which you can recognize or measure the defining characteristics or attributes” (p. 168). Additionally, the concept’s validity is further supported through the process of identifying the empirical referents (Firth et al., 2015). Instruments to measure the duration and levels of sound were utilized in many of the aforementioned studies. An empirical referent in this instance is level of noise heard in decibels. Another empirical referent would be from a qualitative approach of analyzing the individual’s perception of noise. As noted by Stafford et al. (2014), noise is based on the individual’s perception, “what is noise to one person may not be to another” (p. 57).
Conclusion
Recognizing noise as an essential component of nursing practice, nursing education, and nursing research can not only improve present patient care, but it has the potential to be the catalyst in furthering research to improve patient care. While most associated noise as being a potential harmful stimulus, one must also ponder if all noise is negative? Creating an environment that produces positive change, whether in the patient care area, classroom setting, or research arena, should be the focus of noise. Noise is what the individual perceives it to be. Therein lies the potential for theory development regarding an environment that produces positive change utilizing the concept of noise.
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