| Summary: | <p>Introduction </p>
<p>Sound levels in the intensive care unit (ICU) are persistently higher than World Health Organisation recommendations. This can lead to poor patient experiences including limited sleep, increased risk of delirium during admission, and prolonged recovery. Staff too can be affected. High noise levels are a distractor, can reduce concentration, and impair effective delivery of care. </p>
<p>This thesis explores the working environment of the ICU and proposes practical interventions for reducing sound levels.</p>
<p>Methods</p>
<p>The mixed methods approach incorporates an exploratory sequential design with an embedded convergent parallel design. Findings from secondary analysis of interviews with ICU patients and relatives, staff focus group discussion, ethnography, and sound levels were amalgamated to build a rich sonic picture of the ICU. </p>
<p>These findings generated materials for the accelerated experience-based co-design (AEBCD) trigger film and subsequent discussion with staff and patients. </p>
<p>The AEBCD process facilitated a complex noise reduction intervention focussed on quantitative measures of sound, which were explained by qualitative analyses of ethnography and interviews. </p>
<p>Teaching materials were developed in line with adult education theory. The electronic interface (visual display of sound) was designed using agile methodology with a focus on user-centred experience. </p>
<p>Results</p>
<p>Staff were motivated to reduce sound levels but were unaware how to do this, or how to assess change. This DPhil has identified opportunities for noise reduction strategies. Experiential learning in combination with online modules increased staff knowledge of how high sound levels can affect patients in their care. </p>
<p>High-fidelity sound level monitoring identified elevated levels occurring at handover, and throughout the day are generated mostly close to patients’ heads. </p>
<p>Conclusions</p>
<p>It is feasible to reduce sound levels in the ICU. Maintaining long-term support for change in the clinical environment requires an understanding of the social and cultural influences that will facilitate or hinder sustained improvement, and multi-disciplinary involvement at all stages.
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