Are noise reduction interventions effective in adult ward settings? A systematic review and meta analysis.

OBJECTIVE: High levels of environmental noise in hospitals disturbs sleep. We aimed to identify, critically appraise and summarise primary research that reports studies that tested interventions to reduce night-time noise levels in ward-settings. DESIGN: Systematic review and meta-analysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. DATA SOURCES: Key health-related and specialist acoustic databases (CINAHL, EMBASE, MEDLINE, The Cochrane Library, PsycINFO, NHS Evidence, Knovel, Journal of the Audio Engineering Society, Journal of the Acoustical Society of America, IEEE Xplore Digital Library, Acta Acustica and Acoustics in Practice) were searched from their inception to April 2017, with no language restrictions. REVIEW METHODS: Experimental, quasi-experimental and observational study designs assessing the effect of noise reduction interventions on patient outcomes and/or environmental noise levels were included. Two reviewers independently conducted a quality appraisal using a published framework. RESULTS: In total, 834 records were identified with nine studies meeting inclusion criteria. Quality appraisal showed that the level of evidence was generally weak. A range of noise reduction interventions were identified: one study implemented a single intervention, whilst the remainder were complex, multi-faceted interventions. Findings from individual studies showed mixed results but preliminary evidence suggests that noise reduction interventions can reduce environmental noise levels in ward settings and improve patients' sleep ratings. Quantitative data from 6 studies were pooled. A random effects meta-analysis determined that a synthesised estimate for the standardised mean difference in total hours sleep (no intervention - intervention) was -0.11 h (95% CI -0.46 to 0.25 h; p = 0.556), with moderate statistical heterogeneity. A random effects meta-analysis determined that a synthesised estimate for the standardised mean difference in awakenings per night (no intervention - intervention) was 0.05 (95% CI -0.20 to 0.29; p = 0.715), with negligible statistical heterogeneity. A random effects meta-analysis determined that a synthesised estimate for the odds ratio for disturbed nights (no intervention: intervention) was 0.75 (95% CI 0.55 to 1.01; p = 0.059), with low statistical heterogeneity. CONCLUSIONS: Individual studies show that noise reduction interventions are feasible in ward settings and suggest they have potential to improve patients' in-hospital sleep experiences. However meta-analyses show insufficient evidence to support the use of such interventions at present. There is a lack of appropriately designed studies to test intervention effectiveness. Robust studies are required to identify the most effective interventions to address this significant and ubiquitous problem. WHAT IS KNOWN ABOUT THE TOPIC: WHAT THIS PAPER ADDS.

Twelve tips for the use of mobile technologies for work based assessment.

There is increasing interest in the use of mobile technologies (including personal digital assistants (PDAs) and mobile phones) for work based assessment. These devices can offer data collection anytime and any place but they can also enhance the assessment process by collecting a variety of multimedia. The experience of using mobile technologies for work based assessment in a range of professions has highlighted several important aspects that need to be considered. It is essential that the choice of technology is determined by the overall assessment strategy. Important technology aspects include the choice of device and the method of data collection and transfer. An initial pilot scheme is recommended before widespread adoption so that institutional cultural and information technology (IT) barriers can be identified and overcome.

Student self-assessment and its impact on learning - a pilot study.

Student self-assessment is widely reported to offer numerous advantages to the learner. It is a popular practice for empowering students and the advantages are claimed to incorporate increased dialogue between students and teachers and the development of skills that encompass critical awareness and reflectivity. It is, potentially, a process that may enable health care practitioners to be lifelong learners, equipped with the skills for autonomy in learning and professional practice. As such it might be viewed as an essential element of the curriculum. This paper reports on a study designed to evaluate the implementation of self-assessment among student health care practitioners. The pilot study examined the impact of self-assessment on learning and how the process was perceived by students and staff. Findings indicated that a varied approach had been taken to its implementation, which had significant repercussions in the way in which it was perceived by students. Similarly, there was a varied approach taken by students to the process of self-assessment and this had significant repercussions for its overall value as a learning tool. The outcomes of this study provide a sound rational for maintaining and expanding the practice of student self-assessment and important lessons for the process of doing so.

Knowing nursing and finding the professional voice: a study of enrolled nurses converting to first level registration.

This study explored the experiences of a group of second level registered nurses converting to first level registration in a two-year, part-time open learning programme. It aimed to examine the relationship between the mode of course delivery and the personal and professional development experienced by the learners. Data were collected by semi-structured interviews, conducted at five points over the two-year period and analyzed by constant comparative analysis. A theoretical model was developed to demonstrate the stages of knowing nursing, experienced by the students as they made the transition from passive to autonomous professional practice. In their 'Women's Ways of Knowing' [Belenky M.F., Clinchy B.A., Goldberger N.R., Tarule J.M., 1986. Women's Ways of Knowing. Basic Books, New York] identified a progression through different stages of thinking about the nature of knowledge and evidence. This progression was evident in the nurses in this study. It was applied and developed to reflect the progression through ways of knowing nursing. This process consisted of three positions of development, each underpinned by their associated ways of knowing [Belenky M.F., Clinchy B.A., Goldberger N.R., Tarule J.M., 1986. Women's Ways of Knowing. Basic Books, New York] and characterized by a specific approach to professional nursing practice. The changing ways of knowing nursing, described in this paper, are likely to be observed in registered nurses and health care assistants who are now entering Higher Education (HE) to undertake higher awards for the first time. A clearer understanding of this process of personal and professional change, and factors that impact upon it, will be a useful guide for those supporting learners both in the clinical and academic arenas.

A reflection on the use of semi-structured interviews.

Based on the her experiences of completing a doctoral study in which semi-structured interviews featured as the primary data collection method, Christine Dearnley offers a reflective insight into using semi-structured interviews as a method of data collection. The processes of reflection in, and on, the interview process are explored, and some of the ethical dilemmas that emerged during the study are reflected on. The practicalities of conducting semi-structured interviews are considered with a view to sharing new understandings of the process and its management.