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The implementation of a noise reduction bundle in the intensive care unit: A qualitative process evaluation
Jeanette Vreman1, Mark van den Boogaard1, Johannes G van der Hoeven1
1Radboud University Medical Center, Department of Intensive Care, Nijmegen, the Netherlands.
Objective:
To explore factors that influenced the application of a noise reduction bundle in daily practice as experienced by healthcare professionals.
Methods:
Between April and June 2024, seven semi-structured focus group interviews were conducted. Recorded interviews were transcribed and coded. Using Flottorp's checklist for identifying determinants of practice, data were categorized to identify factors influencing the bundle's application. The analysis was carried out collaboratively by multiple researchers.
Results:
The focus group interviews were conducted with 31 participants: nursing staff and physicians. A total of 37 factors were identified. Facilitating factors were: phased implementation, clear communication and work instructions, addressing the theme regularly, routine-building, supportive materials, reminders, training, technical assistance, engaged leadership, key nurses, feedback. Hindering factors were: limited urgency, lack of outcome expectancy, limited adherence of the interventions, limited raising of issues, absence of noise norms, unsuitable environment.
Conclusions:
This process evaluation of the randomized clinical trial investigating a bundle of noise-reducing interventions, demonstrates that successful ICU noise reduction requires a structured implementation and attention to contextual and cultural factors. While engaged leadership and feedback facilitated adoption, a limited sense of urgency and the absence of shared noise norms impeded sustainability. An integrated approach-combining technical solutions with behavioral strategies, and promoting team ownership and open communication-is essential.
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