Old News: Noise in Hospitals Disturbs Patients

If you've ever been a patient in a hospital, you know that hospitals are not where you go to rest. And if you happen to have a room next to a nursing station or the entry to the unit or floor,  you're even worse off because of all the noise.

Even as a young nurse, I was aware that noise was an issue, particularly during the night shifts. I tried to speak at a lower level and not move around the rooms as much if I could avoid it. But, patient care still needed to be done and I found myself often waking patients so I could do certain procedures or give medications. I would feel so bad for the patients who had just finally fallen asleep, only to have me wake them up.

I had my three children at the same hospital, and the first two times, I was placed in a room right across from the nursing station. That experience opened my eyes. I got no rest. People were constantly walking past my room, rolling noisy carts and chatting with others. Some people would be calling up the hallway to colleagues as they asked or answered questions. The phone would ring all day long and staff members of all stripes would gather at the station, particularly at the change of shift. It was N.O.I.S.Y. Even with the door closed, I was disturbed. Night time was quieter, but there was still chatter and the noise of all the call bells that would go off all night long. It was anything but restful. I lucked out with my third child though - I was given the last room at the end of the hall. It was so quiet, it was like I was in a different place altogether.

The thing is, we already know that hospitals aren't restful places and that they're noisy. Researchers have been studying this - although they really just needed to speak to some patients to find out. But at least now, they're taking the noise seriously. There was a study presented at a conference earlier this month, showing how loud an intensive care unit can be, Quiet please in the intensive care unit! As a former ICU nurse, I could relate.

What does this all mean? It's hard to say. Patients are limited in power. They could ask to have doors closed, but they can't do anything about the alarms and the need for healthcare staff to communicate with each other in the halls. They also can't do anything about room placements or if they are near a hub of activity.

Hopefully continued research like this ICU one may change some policies - changing how alarms are used and instituting quiet times, when noisy activities stop and patients are encouraged to rest are a good start. Some facilities are already doing this. We know we need sleep to heal, to get better. The thing is figuring out how to provide it in the hospital environment.

Surgeons Perform Penis Transplant, Story Comments Go Wild

It's the nature of the Internet beast. Write "penis" in a headline and you're almost sure get more clicks than usual. Add "transplant," and curiosity will likely get the best of many people.

Last week, surgeons at Massachusetts General Hospital in Boston announced that they had performed the world's third penis transplant, the first done in the U.S. According to the news reports I read, there had been two previous attempts elsewhere - one successful and one not. I have to admit, I admire the bravery of the patient, Thomas Manning, who allowed his team to go public with the news of the surgery, although I suspect that it was part of the deal when they offered to do it, picking up the costs at the same time.

Sure, it's easy to giggle or snicker when one thinks of a penis transplant, and people of a certain age may think of the Bobbitt case, where the angry wife decided to amputate her husband's penis. But in all seriousness, this could be a major breakthrough to men who are injured or who are affected by cancer that requires amputations.

Sure, a penis is not a required part of the body, like the heart, the liver, kidneys, lungs and so on. It's used to transport urine and semen - and urine can be directed from the bladder through other methods. But that doesn't mean it doesn't have a vital role in life and in quality of life. Just as many women who have mastectomies go on to have reconstructive surgery, men may want/need that as well for their own psychological well-being. The difference is transplantation of a penis, with all that's involved, is a trickier and more intensive procedure - and probably considerably more expensive. In addition to the issue of obtaining the cadaver donations to be able to perform the surgery at all, another difference is a man who has a transplant will have to take antirejection drugs, while a woman who had breast reconstruction doesn't face that particular drug regimen, with its associated risks.

What is interesting about this whole thing though is the reaction of people to the news. Some feel it is a waste of time, while others applaud the research and learning that goes into it - after all, medicine and research don't live in a vacuum. Information gleaned from research in one area is often transferable to another. Some commenters make sick jokes, while others say that while this is all good, they don't want to read about a man's penis in the news. I wonder if they feel the same way about articles that discuss better ways for breast reconstruction (just wondering).

Finally, I have to admit, my eyebrows did raise a touch when I first heard the story. But the man had cancer. He survived it. Why would he not want to be as whole as possible again? Plans are for future transplants for men who have been injured in combat or who had traumatic car accidents.

For those who are saying that the surgeons and researchers should be looking at "more important" things, who decides what is more important? And, who is to say what they learn here can't be somehow used to help you one day for another health or medical problem?

There shouldn't be, in my opinion, a "it's either this or that" in research. There is room for so much of it. I wish Mr. Manning well, with smooth recovery and a happy, cancer-free life.

New York Times: Man Receives First Penis Transplant
CBS: Penis transplant glad to be a "complete" man

Nurses Helping Nurses

Being part of the nursing blog community can be fun and interesting. Although my blog is usually geared towards the general public, I do get many student nurses and new nurses who visit to see what I'm writing about.

A couple of weeks ago, I was approached by an online nursing site and asked if I would share some tips for new nurses for a round up post. Sure - I like doing things like that so I gave her four tips that I thought were particularly important. They ended up being in this post, 101 Nursing Tips From the Experts. I wish I'd known or taken heed of some of those suggestions all those years ago, that's for sure.

The list of contributors is impressive. Some names are familiar, while others are new to me, so I'm off to check them out. After all, I'm still learning too, even after all these years.

Light Therapy or Talk Therapy for SAD

It's that time of year again in the northern hemisphere - talk about seasonal affective disorder, or SAD.

What is SAD? Much of how we feel comes from the amount of daylight we experience, experts believe. So in the fall, as daylight hours shorten and night hours are longer, we see less sunlight. Some people go to work in the dark and come home in the dark. There may be days when they only see sunlight through their office window - if they have one. It's believed that in some people, this lack of sunlight causes SAD. And one remedy for this is to use light therapy - exposure to special lights of specific wavelengths to combat the lack of natural light.

SAD lights are commercially available in various shapes and forms, from large standing ones to portable folding ones, usually promoted as great for travel or to bring to your office. But do they work? A new (small) study published today in the American Journal of Psychiatry shows that while the lights may be helpful, they may not be as effective over the long-term in battling SAD as "talk therapy," or cognitive behavioral therapy (CBT).

The light therapy works, the researchers agree, but the problem behind using light therapy is the need for continuous use for it to be effective. Users need to use the light every day for a set number of minutes per day, and if they stop, their SAD symptoms reappear or worsen. The researchers also point out that there can be problems with ensuring that the light therapy is always available. People may not be able to purchase portable units or be in environments where they can use lights. Talk therapy, on the other hand, doesn't require special equipment or adaptation.

The study looked at 177 people with SAD over the course of two winters. The group was  divided into light therapy and CBT subgroups. By the end of the second winter, more people who used light therapy experienced a return of their SAD symptoms than did those who used CBT. But, only 30% of the light therapy group were still using their lights that second winter.

"Light therapy is a palliative treatment, like blood pressure medication, that requires you to keep using the treatment for it to be effective," lead author Kelly Rohan said in a news release. "Adhering to the light therapy prescription upon waking for 30 minutes to an hour every day for up to five months in dark states can be burdensome," she said. 

Light therapy does work for many people, but it must be used consistently. If that isn't possible, perhaps CBT is the better option.