Digital Repository Masters Projects Spring 2024 Reducing Non-Essential Noise in the Operating Room Natalie Harris Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Harris, N. 2024. Reducing Non-Essential Noise in the Operating Room Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. WSU REPOSITORY MSN/DNP Reducing Non-Essential Noise in the Operating Room Project Title by Natalie Harris, BSN, RN, MSN Student Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden, UT April 26, 2024 Date Natalie Harris BSN, RN, MSN Student April 26, 2024 Student Name, Credentials (electronic signature) Date JoAnn Tolman DNP, MSN-Ed, RN, CNE 4/26/2024 MSN Project Faculty Date (electronic signature) 4/26/2024 (electronic signature) DNP, N, CNE MSN Program Director Note: The program director must submit this form and paper. Date 1 Reducing Non-Essential Noise in the Operating Room Natalie Harris, BSN, RN, MSN Student Annie Taylor Dee School of Nursing Weber State University MSN Project 2 Abstract Purposes/Aims: This MSN project addresses noise in the operating room (OR). It aims to implement strategies to reduce non-essential noise in the OR, which will reduce the stress and distraction levels of OR staff. Rationale/Background: The OR is a busy, intense setting with numerous noise sources contributing to an excessively noisy environment. These conditions can increase the stress and distraction levels of OR staff. Some sources of noise are non-essential and modifiable. There are strategies to decrease noise that the OR staff may not realize could be beneficial. Methods: This project utilizes Lewin’s Theory of Planned Change framework for development and implementation. To address this practice gap and obtain feedback, OR staff and stakeholders will receive education on the effects of noise and reduction strategies through a PowerPoint presentation. OR noise level measurements are obtained pre-and post-implementation of noise reduction strategies to gauge the project's success. A pre-and post-survey will also assess the OR staff’s perception of noise. Ethical considerations include allowing anonymous participation, protecting patient privacy, and assessing personal bias. Results: This project aims to benefit the OR staff through education and implementation of research-based strategies to reduce non-essential OR noise. This reduction will be evident in the decreased noise levels and improvement in OR staff’s stress and distraction levels. Conclusions: Educating OR staff on the effects of OR noise and the strategies to reduce it empowers them to implement changes to reduce their stress and distraction levels. Reducing OR noise can also provide a calmer, safer, and more desirable workplace. Keywords: Operating room noise, noise reduction strategies, stress, distraction. 3 Reducing Non-Essential Noise in the Operating Room The operating room (OR) is a complex healthcare work environment with many modifiable factors contributing to noise. Typical noise in an OR environment consists of verbal communication, both relevant and non-relevant to the surgical case, staff coming in and out of the OR (traffic), music, loud equipment, and ventilation system air exchanges (Plaxton, 2017). One study found that the average noise levels of different surgical cases were as loud as that of a hairdryer, and peak noise levels were comparable to that of a bulldozer (Relias Media, 2020). Communication during peak noise time can be extremely difficult for OR staff and has the potential to lead to negative consequences such as surgical count errors, wrong site surgeries, patient harm, or possibly death (Grant et al., 2021). Additionally, OR staff working in these chronically noisy environments are at risk for noise-induced hearing loss, impaired memory and attention, and increased stress (Katz, 2014). Noise in the OR is inevitable; however, evidence shows there are methods for reducing non-essential noise (Katz, 2014). Non-essential noise includes case irrelevant conversations and noise from equipment, traffic, and music (Way et al., 2013) and can potentially affect staff and patients adversely (Plaxton, 2017). Recommended noise prevention strategies include strategically positioning noise-emitting equipment, investing in quieter technology, and reducing case-irrelevant conversations (Katz, 2014). However, these strategies may not be known or utilized during surgical cases due to insufficient education. Despite knowing the contributors and effects of nonessential noise, noise continues to plague ORs at decibel (dB) levels above set limits recommended by the World Health Organization (WHO) for hospitals (Arabaci & Onler, 2021). As a result, non-essential noise continues to put OR staff and their patients at risk for adverse effects and poor outcomes. 4 Statement of Problem Noise in the OR has been an issue since the 1970s (Bodin, 2022) due to little thought for designing a space, instruments, and tools conducive to the auditory senses (Shapiro & Berland, 1972). Noise is known to cause stress and hearing impairment and negatively affect overall health and well-being (Fu et al., 2021; Mcleod et al., 2021). Additionally, noise inhibits communication, distracts, disrupts, and can lead to potential adverse effects for patients and OR staff. For example, Arabaci and Onler (2021) found that noise levels above the recommended WHO set limit of 35 dB correlated positively with increased anxiety and workload scores among OR staff. Workload scores envelop the mental, physical, temporal, performance effort, and frustration of tasks that OR staff might not realize can fluctuate with increased noise (Arabaci & Onler, 2021). The OR staff may not understand the effects of noise or how to modify non-essential noise to decrease adverse effects on the OR staff (Ayas, 2022). Therefore, this MSN project aims to reduce non-essential noise in the OR to decrease stress and distraction levels to benefit the staff. This goal will be reached by surveying OR staff on their current stress and distraction levels, educating OR staff on the effects of noise, researching and implementing noise reduction strategies, and reevaluating their stress and distraction levels post-implementation. Significance of the Project With noise levels in the OR consistently reading above the WHO 35 dB recommended limit for background hospital noise, OR staff are at risk for distraction, communication impairment, increased rate of errors, poor performance, and increased stress (Mcleod et al., 2021). Staff and others in the healthcare field may need to realize the effect environmental stressors, such as noise, have on their health and well-being (Applebaum et al., 2010). 5 Fortunately, studies indicate numerous noise reduction strategies that have benefited OR staff members' communication ability and stress and distraction levels (Grant et al., 2021; Arabaci & Onler, 2021). However, the OR staff may not know the strategies or how to implement them. Educating OR staff on the effects of OR noise and ways non-essential noise can be modified is paramount to mitigating its adverse effects on their stress and distraction levels (Bodin, 2022). This MSN project is significant because it will fill a practice gap and combine interventions from multiple studies explicitly focusing on improving the OR staff's stress and distraction levels related to non-essential noise. Review of the Literature This literature review aims to explore the literature on noise levels in the operating room setting, how this noise affects the OR staff, and noise reduction strategies. Specifically, this MSN project will focus on the question: Does reducing non-essential ambient noise levels in the OR, compared to no reduction of non-essential noise, decrease distractions and stress levels for OR staff over three months? Lewin’s Theory of Planned Change framework was selected to design, implement, and evaluate this MSN project. Framework The framework utilized to implement this MSN project is Lewin’s Theory of Planned Change because excessive non-essential ambient noise exists in the OR, and a change needs to occur to decrease the effects of noise on OR staff. This theory will assist in mitigating the detrimental effects of noise in a phased approach by identifying the issue of OR noise, educating OR staff, implementing noise reduction strategies, and instituting a quieter OR for the betterment of the OR staff. 6 Lewin’s Theory of Planned Change consists of three phases: unfreezing, movement, and refreezing (Marquis & Huston, 2021). The unfreezing phase is when there is an understanding or problem awareness that change is needed (Wojciechowski et al., 2016). Unfreezing requires motivated forces and a sense of urgency to drive the problem to the forefront for change to occur (Shirey, 2013). Next is the movement phase, when the change undergoes extensive planning, implementation, and evaluation. This phase takes time and patience because stress can detract from progress (Marquis & Huston, 2021). Finally, the refreezing phase establishes the change and considers it the new status quo (Marquis & Huston, 2021). Training and monitoring continue through this refreezing phase to stabilize and solidify the change (Wojciechowski et al., 2016). This MSN project will align with Lewin’s Theory of Planned Change, beginning with the unfreezing phase. During this phase, the OR staff will receive education on the problem of excessive noise. Transitioning into the movement phase is where non-essential noise reduction strategies will be planned and implemented. Locking in the change during the refreezing phase will require support and reinforcement (Marquis & Huston, 2021) to attain a new environment of reduced noise, making the OR a safer, quieter care environment for all. Strengths and Limitations Using Lewin’s Theory of Planned change in the operating room setting has several strengths and limitations. Identified strengths include ease and simplicity of use (Shirey, 2013). The three-phase process is practical and versatile and has been widely used since its inception in the early 20th century (Marquis & Huston, 2021; Shirey, 2013). This theory is highly successful when driven from a senior leadership or managerial standpoint with champions to support the program throughout its duration (Shirey, 2013). While ease and simplicity of use are strengths, some may view them as limitations. With the fast-paced, ever-evolving healthcare system 7 requiring timely results, some theorize Lewin's Theory of Planned Change needs to adapt more quickly and entail more complexity to fit the needs of today's healthcare issues. Furthermore, the top-down approach of this theory may hinder desirable change (Shirey, 2013). When applied to this MSN project, the ease, simplicity, and versatility of Lewin’s Theory of Planned Change (Shirey, 2013) will assist in making this project understood and accepted by the OR staff. Additionally, the three-month project timeline allows OR staff sufficient time to adjust to changes and reflect on their overall effectiveness. While this change may be considered top-down driven, champions at any level can steer this project toward success with decreased stress and distraction levels for OR staff. Analysis of Literature A review of the literature was conducted and analyzed on operating room noise, effects of excessive noise, stress and distraction levels related to noise, and other similar topics related to the project’s PICOT question regarding non-essential ambient noise levels in the OR. Search methods specifically focused on OR noise and its effects to ensure the most applicable information guides this MSN project. These search methods uncovered three common themes, which will be discussed further. Search Strategies A search of the literature found current, relevant evidence on OR noise using CINAHL Complete, Google Scholar, Ovid, MEDLINE, Cochrane Library, and PubMed databases. Articles spanning from 1972 to 2022 were included in this literature review to reflect the broad scope of the issue, including the history, data, and evidence. The keywords in the search included operating room noise, effects of noise, excessive OR noise, stress and distraction, noise in the OR, OR staff, operating room, quantitative, qualitative, and Association of periOperative 8 Registered Nurses (AORN) standards. Combinations of the keywords enhanced search results. A broad range of materials, including research and non-research-based articles, emerged. Numerous Boolean combinations were utilized with the keywords mentioned above to create a comprehensive search, such as “operating room” OR “OR” AND “noise” OR “effects of noise” AND “stress” AND “distraction.” Synthesis of the Literature Through a synthesis of the literature, three common themes evolved. First, OR communication is vitally important (Plaxton, 2017). Second, there are identifiable sources of OR noise and effects on staff (Mcleod et al., 2021). Finally, OR noise reduction strategies are effective (Arabaci & Onler, 2021). Further details on these common themes will be given. OR Communication is Vitally Important Clear, effective communication in the OR is paramount to patient safety and optimal surgical outcomes (Arabaci & Onler, 2021; Crockett et al., 2019; Fu et al., 2021; Grant et al., 2021; Gui et al., 2021; Katz, 2014; Mcleod et al., 2021; Nasri et al., 2023; Plaxton, 2017; Srivastava et al., 2021; Way et al., 2013). Unfortunately, noise in the OR can hinder the ability of the OR staff to communicate successfully with each other (Arabaci & Onler, 2021; Way et al., 2013). Case-relevant conversations amongst the OR staff include sharing vital information regarding the patient’s status, medication orders, possible or actual adverse events, outcomes, or other pertinent information (Plaxton, 2017). However, this transfer of information, when combined with other sources of OR noise such as equipment, traffic, or music, can lead to misinterpretation of the information, medical and technical errors, patient harm, and even patient death (Ayas et al., 2022; Grant et al., 2021; Katz, 2014; Mcleod et al., 2021). 9 The WHO has set the recommended threshold for continuous background noise in hospitals at 35 dB (Arabaci & Onler, 2021). The evidence shows OR noise frequently above this threshold. One prospective investigational study, which included 15 surgeons (n=15), found that when surgeons were in a task state, there was a statistically significant decrease in auditory comprehension when words they heard were unpredictable (Way et al., 2013). The levels of noise to which these surgeons operated were in the average range (55 to 80 dB), which does not consider the spikes in noise associated with the use of specific equipment ranging between 131 to 140 dB during the case, further decreasing auditory comprehension (Way et al., 2013). Documented noise levels this high lead OR staff to intensify the volume of their voices, thus increasing overall noise levels. According to an article by Mcleod et al. (2021), auditory signals need to be 10 to 15 dB louder than the background noise to be understood with an accuracy of 90%. Padmakumar et al. (2017) surveyed medical staff members (n=519) of nearly 50 hospitals and learned that 80% of respondents indicated that noise adversely affects communication in the OR. This constant battle between noise and being able to communicate hampers effective case-relevant conversations and can negatively impact OR staff and their patients (Grant et al., 2021). Sources of OR Noise and Effects on Staff Contributors to OR noise comes from equipment, instruments, conversations, air exchanges/ventilation, traffic, alarms, music, and highly acoustic surfaces (Arabaci & Onler, 2021; Ayas et al., 2022; Fu et al., 2021; Grant et al., 2021; Gui et al., 2021; Katz, 2014; Mcleod et al., 2021; Nasri et al., 2023; Plaxton, 2017; Relias Media, 2020; Shapiro & Berland, 1972; Srivastava et al., 2021; Way et al., 2013). OR noise can be classified as essential or non-essential to the surgical case. Essential noise includes environmental factors. For ORs to maintain a clean, 10 safe environment, surgical instruments and surfaces, including floors, walls, and ceilings, must be easily cleaned and maintained. The ventilation system must provide frequent air exchanges to keep air quality controlled. These factors increase OR noise levels when highly acoustic instruments and surfaces combine with frequent air movements through ventilation systems (Gui et al., 2021; Kane, 1968; Relias Media, 2020; Shapiro & Berland, 1972). Furthermore, essential equipment can produce loud noises and subsequent alarms, increasing the overall noise level. Additionally, essential noise comes from case-relevant conversations. Verbal communication is essential during the surgical case, such as during timeout, surgical counts, and the end-of-case debrief. Other relevant communication involves relaying important information between providers and staff regarding medications, treatments, interventions, supply requests, and other urgent needs (Arabaci & Onler, 2021; Katz, 2014; Plaxton, 2017). Non-essential noise contributors are from the OR staff through irrelevant conversations, music playing, and traffic in and out of the OR. Irrelevant conversations, or ‘small talk’ amongst the OR staff, can occur throughout the case. While these conversations can boost morale and build team unity, they can impair coordination and communication among the OR staff (Plaxton, 2017). Furthermore, traffic in and out of the OR is a known distraction that can be modified (Gui et al., 2021; Srivastava et al., 2021). Finally, while music may be considered non-essential noise, studies suggest that music, if used effectively, can contribute positively to the OR environment (Fu et al., 2021; Padmakumar et al., 2017; Srivastava et al., 2021). Despite the type of noise the OR staff is subjected to, essential or non-essential, noise is a known stressor that can impact staff well-being (Arabaci & Onler, 2021; Fu et al., 2021). Constant noise adversely affects people by impairing concentration and memory, increasing stress and distraction levels, and causing anxiety, fatigue, and burnout (Applebaum et 11 al., 2010; Arabaci & Onler, 2021; Bodin, 2022; Crockett et al., 2019; Fu et al., 2021; Gui et al., 2021; Kane, 1968; Mcleod et al., 2021; Nasri et al., 2023; Padmakumar et al., 2017; Plaxton, 2017; Srivastava et al., 2021; Way et al., 2013). Historically, the exploration of noise conditions in the OR suggests that the overall design of an OR did little to combat noise pollution and its detrimental effects on a person’s health and well-being (Kane, 1968). An early article described the OR noise as the third pollution, behind air and water pollution. The article continues by stating that while the other forms of pollution are tightly regulated in the OR, noise is not (Shapiro & Berland, 1972). Several more recent studies agreed with historical findings in that ORs are continuing to produce high noise levels, well above the WHO recommended limits, and OR staff are being affected (Arabaci & Onler, 2021; Fu et al., 2021; Mcleod et al., 2021; Way et al., 2013). One survey of surgeons and anesthesiologists (n=290) found that over 85% of respondents felt noise increased their stress levels and decreased their concentration levels (Srivastava et al., 2021). A literature review by Mcleod et al. (2021) agreed that verbal communication and noise affect staff's cognitive and emotional functions and are highly distracting. However, despite noise negatively affecting the health and well-being of those subjected to it, interventions and modifications are available to minimize its effects. OR Noise Reduction Strategies Multiple studies suggest strategies to decrease OR noise to improve communication and overall staff well-being (Arabaci & Onler, 2021; Bodin, 2022; Crockett et al., 2019; Fu et al., 2021; Grant et al., 2021; Gui et al., 2021; Kane, 1968; Katz, 2014; Plaxton, 2017; Srivastava et al., 2021). A Plan-Do-Study-Act quality improvement initiative reduced auditory distractions from 61% to 10% by educating staff on the importance of minimizing distractions, pausing 12 music on patient arrival to the OR, and having the anesthesia provider initiate a quiet time during induction (Crockett et al., 2019). Furthermore, Bodin (2022) agrees that regular education and training regarding noise in the OR and its effects on OR staff is essential to ensuring a safe environment for patients and staff. Numerous other articles also stress the importance of OR noise education, explicitly focusing on staff behavior modification efforts during daily morning huddle discussions. Staff can help decrease noise levels by minimizing irrelevant conversations, reducing OR traffic, and keeping music at a reasonable volume (Arabaci & Onler, 2021; Gui et al., 2021; Katz, 2014; Plaxton, 2017). While these behavior modifications are essential, other strategies successfully decrease OR noise. Additional effective noise reduction strategies include strategic positioning of noiseemitting equipment, upgrading to quieter equipment, instruments, and surfaces, and using headphones and microphones (Bodin, 2022; Fu et al., 2021; Grant et al., 2021; Katz, 2014; Srivastava et al., 2021). Grant (2021) interviewed 26 OR healthcare professionals regarding noise and discovered that the position and location of equipment can adversely affect the ability of the OR staff to communicate effectively. With time, staff could identify these equipment barriers and strategically place them to facilitate communication among the staff (Grant, 2021). While a noise-free OR is not attainable, noise can and should be modified to benefit the OR staff and, subsequently, the patients they serve. Summary of Literature Review Findings and Application to the Project A detailed review of current literature on OR noise and its effect on OR staff reveals that high noise levels plague the OR from multiple sources, some of which can be modified. Excessive noise increases stress and distraction levels, decreases communication abilities, and causes other physical and emotional symptoms. The literature also suggests that one solution to 13 this problem is educating all OR staff on OR noise and its effect on their well-being, including ways to help decrease noise levels. The noise reduction strategies include strategically placing noise-emitting equipment and instruments, minimizing irrelevant conversations, reducing OR traffic, and keeping music at an acceptable volume during the surgical case. These findings assist in substantiating this MSN project's potential to decrease non-essential noise in the OR. The evidence identifies the knowledge gap area this project will use to create evidence-based education. This education will focus on educating OR staff on noise sources and strategies to reduce noise to decrease stress and distraction levels in the OR staff. Project Plan and Implementation This MSN project aims to educate OR staff on the effects of OR noise and ways to modify non-essential noise to mitigate the adverse effects on their stress and distraction levels based on themes found throughout the literature review. The project provides a PowerPoint educational presentation, a pre-and post-survey for the OR staff, and data on current OR noise levels. The OR staff includes registered nurses (RNs), orderlies, surgical technologists, anesthesiologists, surgeons, physician assistants (PAs), and nurse practitioners (NPs), in addition to the OR manager, surgical services nurse educator and the safety coordinator, who serves as the content expert for this MSN project. Three deliverables will be available for the implementation of this MSN project both in paper and electronic formats. The deliverables include (a) a pre-survey for the OR staff on their perceptions of noise and their distraction and stress levels related to noise in the OR, (b) a PowerPoint educational presentation on the cause and effects of excessive noise, sources of non-essential ambient noise in the OR and strategies to reduce non-essential ambient OR noise, (c) a post- survey that will be sent to participants three months after the deliverables are disseminated and will include all elements from the pre-survey 14 to check for a change in stress and distraction levels to measure the effectiveness of this MSN project. Results from the pre-survey, post-survey, and noise level measurements will also be available for OR staff to review. Plan and Implementation Process Lewin's Theory of Planned Change is the selected framework for planning, implementing, and evaluating this MSN project. This theory comprises three phases: unfreezing, movement, and refreezing (Marquis & Huston, 2021). The unfreezing phase began with the knowledge that a change was needed to decrease noise in the OR. The movement phase begins with this project's planning and implementation stages and will require assistance from the OR manager and safety coordinator. A meeting with the OR manager, project team lead, and safety coordinator will occur in the OR manager's office in the operating room. This meeting will present the importance of the project and plan for noise level measurement testing during random daily cases to see if the OR is experiencing noise levels at or above the 35dB set limit recommended by the WHO for hospitals (Arabaci & Onler, 2021), as well as the introduction to project deliverables used to bolster buy-in from these essential interdisciplinary team members. Once the OR manager approves, the project team lead holds an informational and educational meeting for the OR staff to present the PowerPoint educational presentation and an explanation of the deliverables. All meeting information will also be sent via email to the OR staff, and the deliverables will be attached. The explanation of the deliverables includes the timeline for completion of the presurvey, which will be set at two weeks from the meeting date to allow the OR staff sufficient time to complete the pre-survey. 15 After the meeting, and over the next two weeks, reminders of the email's content will be shared in daily unit huddles to ensure that OR staff can complete the pre-survey by the given due date. During these two weeks, the safety coordinator and project team lead will measure noise levels during random OR cases to obtain data on the current noise levels. Once the OR staff have viewed the PowerPoint educational presentation and taken the pre-survey, results of the presurvey and noise level measurements will be accessible to the OR staff via email and daily unit huddles. Based on these results, discussions at subsequent daily unit huddles with OR staff will decide which strategies to prioritize and implement temporarily as part of the movement phase for this MSN project. The OR staff will be able to act on what they have learned by identifying sources of non-essential noise and assist in implementing appropriate noise reduction techniques to effectively decrease their stress and distraction levels. During this phase, the project team lead will randomly monitor these changes and rely on self-reports from OR staff for adherence. Follow-up noise measurements will be taken during random OR cases by the project team lead and safety coordinator as part of the movement phase to compare to earlier measurements and gauge potential improvement in OR noise levels once temporary strategies have been prioritized and implemented. Three months after the temporary implementation of noise reduction strategies has commenced, a post-survey will be sent to the OR staff via email to gain project feedback and evaluate its effectiveness in decreasing noise-related stress and distraction. Based on the comparison of pre-survey and post-survey data, including noise level measurements, the interdisciplinary team will modify the project as the results dictate. Then, the refreezing phase of 16 Lewin's Theory of Planned Change can begin by implementing a new status quo for reducing OR noise (Marquis & Huston, 2021). Interdisciplinary Team Higher quality patient care and better outcomes are the results of high-functioning interdisciplinary teams. Teams are essential to successful organizational change in healthcare today (Melnyk & Fineout-Overholt, 2019). This MSN project proposes an interdisciplinary team approach to discover the best practices for reducing non-essential noise in the OR to decrease the stress and distraction levels of OR staff effectively. This project will be successfully implemented through the collaboration between OR staff, the OR manager, and the safety coordinator, led by the project team lead. The diverse characteristics of each team member will bring unique perspectives and solutions with the common goal of decreasing non-essential OR noise. OR Manager. The OR Manager has nearly forty years of experience in the operating room in various roles such as surgical technologist, circulating RN, charge nurse, nurse educator, and, for the last eight years, OR manager. With a wealth of knowledge and expertise, the OR manager is vital to the interdisciplinary team to gain buy-in from OR staff by setting aside time in OR staff meetings and encouraging participation amongst the staff on all levels of this MSN project. As a long-time employee of the OR, the manager’s insights, suggestions, and support will be vital to the project's success. OR Staff. The OR staff comprises numerous employees in various roles, such as RNs, orderlies, surgical technologists, anesthesiologists, surgeons, PAs, and NPs, including the surgical services nurse educator, all of whom can be adversely affected by OR noise. This MSN project is designed with the OR staff in mind. Their participation, support, and dedication are 17 essential in enacting real change during the project timeline and for years to come. Garnering their buy-in and collaboration with all project elements, including the education, pre-, and postsurvey, will be of utmost importance to the success of this project. Project Team Lead. The project team lead has been an RN in the OR for nearly twenty years, currently serving as a charge nurse and shared leader in the department, and is a current MSN student. The role includes researching, designing, planning, and implementing this MSN project. With permission and support from the OR manager and assistance from the safety coordinator, the project team lead will meet, plan, and coordinate all aspects of the project. Disseminating deliverables and data, evaluating the effectiveness of the project, and modifying the final project as needed will fall within the scope of the project team lead with outreach to the interdisciplinary team as needed. The project team lead will be a resource and support throughout the project timeline for any questions, comments, or concerns. Safety Coordinator. The safety coordinator is a member of the industrial hygiene team and the content expert for this MSN project. The safety coordinator's duties include anticipating, recognizing, evaluating, and controlling recognized hazards, such as noise, that arise within and from the workplace. The safety coordinators' experience will be integral in coordinating noise level measurement testing, identifying noise hazards, and providing the team with noise level recommendations from regulatory agencies and non-government organizations such as the WHO. Description and Development of Project Deliverables Three deliverables are available to support this MSN project. This section describes each deliverable in detail and the purpose each has in the overall scope of this project. 18 OR Staff Pre-Survey. The first deliverable available for this project is a pre-survey for the OR staff (see Appendix A). The pre-survey incorporates seven questions with two different question types, including a four-point Likert scale and multiple choice. There is a place for OR staff to write their name, if they choose, and their role in the OR, which is required. A comment area at the bottom of the survey is available for suggestions regarding OR noise. This deliverable is essential to gather the perceptions of the OR staff on OR noise before delivering the PowerPoint educational presentation. Reducing Non-Essential Noise in the Operating Room PowerPoint Educational Presentation. The second deliverable available for this project is a PowerPoint educational presentation (see Appendix B). This PowerPoint presentation is designed to be shown during the informational and educational meeting for the OR staff. This presentation is the first step in establishing the buy-in and support crucial to the potential improvements this project may garner. The PowerPoint presentation introduces the project's aim, which is to reduce non-essential noise in the OR to decrease stress and distraction levels of OR staff, and the four steps the project will take to find potential success. Research shows that the detrimental effects of excessive noise exposure include increased stress and distraction levels on OR staff (Applebaum et al., 2010; Arabaci & Onler, 2021; Fu et al., 2021). This PowerPoint educates the OR staff on the sources and effects of OR noise, strategies to decrease non-essential noise, and the project timeline. This deliverable aims to fill a knowledge gap by educating OR staff on the detrimental effects of noise. It provides an avenue for change by enticing OR staff to join this crucial interdisciplinary team. OR Staff Post-Survey. The last deliverable for this project is a post-survey for OR staff (see Appendix C). The post-survey incorporates the same questions as the pre-survey, with the 19 last question asking whether the OR has made progress in decreasing noise levels. Again, there is a comment area at the end of the survey for suggestions the OR staff may have following the completion of the project. The post-survey is essential in garnering feedback from the OR staff on their perceptions of OR noise, stress, and distraction levels post-implementation. This deliverable helps to measure the project's potential success and identify areas for improvement. Timeline A comprehensive timeline is vital to implementing this MSN project (see Appendix D). The established timeline will cover approximately three months from initial approval through post-implementation reassessment. First, a meeting occurs with the OR manager, safety coordinator, and the project team lead to emphasize the importance of this project, disseminate deliverables, garner buy-in, and receive approval from the OR manager to proceed as outlined with the project. Following approval, the project continues with the informational and educational meeting with OR staff led by the project team lead to discuss the project, present the PowerPoint educational presentation, and explain the deliverables. The project team lead presents the pre-survey deliverable during this meeting, and the two-week completion window begins. For those absent, the project team lead will email a summary of the meeting, the PowerPoint presentation, and the pre-survey. As the two-week window for pre-survey completion continues, the project team lead conveys reminders to OR staff about the deadline date during daily unit huddles and email correspondence. This two-week window allows the project team lead and safety coordinator time to obtain noise level measurements during random OR cases. As the results of the pre-survey and initial noise measurements become available after the two-week window closes, the project team lead will make them available to staff via email and 20 daily unit huddles. During these huddles, OR staff will decide which strategies and modifications to implement to decrease OR noise temporarily. The project team lead will monitor these identified strategies and modifications through self-report to assess change compliance over three months. As the three-month timeline nears the end, the project team lead and safety coordinator will obtain follow-up noise measurements for comparison with prior measurements to indicate if OR noise levels decreased. Following these measurements, the project team lead will make the post-survey deliverable available at daily unit huddles and email it to those not in attendance. This survey will assist in gauging the effectiveness of the project according to the OR staff. All data compiled during this time will be made available to OR staff to review in daily unit huddles where discussion on potential modifications to the project can occur. Once the OR staff reaches a consensus on continually implementing noise reduction strategies, the project will be complete. This MSN project requires time and dedication from all interdisciplinary team members to decrease non-essential ambient noise in the OR to avoid the detrimental effects of excessive noise (Srivastava et al., 2021). This project plan assesses noise perception, educates staff, and implements noise reduction strategies in the OR. Additionally, this plan reassesses the effects of reduced noise on the OR staff’s stress and distraction levels. Project Evaluation There will be two overall evaluation measures for the effectiveness of this MSN project. The first project evaluation compares the pre- and post-survey results. Post-survey results that indicate less stress, less distraction, and decreased OR noise, compared to the pre-survey results, will show that the PowerPoint educational presentation effectively prompted the OR staff to apply strategies to decrease OR noise. A four-point Likert-scale rating of three or four will 21 establish that the project is effective in this area. The project team lead reviews the comment section on both surveys and identifies common emerging themes that may require follow-up during this evaluation. The second project evaluation method compares the noise level measurements pre- and post-implementation. A decrease in the noise levels post-implementation of noise reduction strategies validates their effectiveness, especially if levels measure at or near the WHO recommended limit of 35 dB. The project team lead evaluates this data for any continued high OR noise measurements that may need further addressing by the interdisciplinary team. Based on the evaluation of the data from the surveys and noise level measurements, the project team lead, OR manager, and safety coordinator will meet to establish if the project is ready for permanent implementation or if modifications are necessary to enhance the overall success of the project. If evaluation provides inconclusive results, the project team lead involves the entire interdisciplinary team for input on adjusting the current project to acquire more desirable results. However, if the survey and noise level measurements are favorable, as defined above, the project's success is evident, and steps for permanent implementation occur. Ethical Considerations Addressing ethical considerations is vital for this MSN project. First, while participation amongst OR staff is highly encouraged, those who avoid participating will not be criticized. Those participating are encouraged to respond openly and honestly without fear of retaliation. Both the pre- and post-survey deliverables can be anonymous if desired. The only demographic to collect in the pre-and post-survey is the role the OR staff member currently holds. This information helps to identify potential trends in OR noise perceptions among the different groups 22 within the OR staff. Dissemination of the pre-and post-survey results will not include OR staff names if they opt to write one. Second, patient confidentiality is of utmost importance to this MSN project. There is no need for the project team lead or safety coordinator to attain protected health information (PHI) during the noise measurement periods. Primary data such as the date, time, and case specialty are all needed to record each noise measurement entry. The project team lead and safety coordinator, employed by the organization of the OR under study, have permission from the OR manager to enter random ORs to procure each measurement briefly. Instituting measures to protect patients’ privacy is paramount. Lastly, there is the risk of personal bias from the project team lead as a long-term staff member at the OR under study for this MSN project. As the project is designed, developed, and implemented, it is crucial to remain neutral to avoid any unwelcome effects bias could generate. It is vital that the stakeholders critically evaluate each aspect of the project before implementation to address any preferences the project team lead may have. Stakeholders must have the opportunity to include their viewpoints in this MSN project. Anticipating these considerations will ensure that the project is ethically sound. Discussion Noise is a known stressor that, at high levels, negatively affects the surgical team (Fu et al., 2021). Reducing non-essential OR noise is crucial to decreasing these adverse effects. However, OR staff may need to learn the numerous noise reduction strategies available for their benefit. This MSN project aims to fill a practice gap to reduce non-essential noise in the OR to decrease stress and distraction levels to benefit the OR staff. This project implementation occurs at the OR site under study, and the information gained will be available to share within the 23 hospital organization. Furthermore, the presentation of the project to peers and professors, as part of the Weber State University Master of Nursing program, will occur. This section discusses the dissemination of project results, their significance to nursing practice, implications, and recommendations. Evidence-based Solutions for Dissemination Dissemination of the project results occurs in multiple ways following implementation. First, the data from the pre-survey and initial noise level measurements is circulated via email to all interdisciplinary team members and stakeholders. In addition, discussions regarding the data results will occur in daily unit huddles for one week to reach as many team members as possible in person. Next, dissemination of the project results from the post-survey and final noise level measurements are emailed and discussed similarly and will include all project results for easy comparison. Sharing all the results with the hospital organization's surgical services service line in their monthly meeting will also occur. Finally, developing a poster presentation conveying the significance of this MSN project findings will occur with student peers and faculty in attendance at Weber State University. Significance to Advanced Nursing Practice This MSN project can benefit OR staff by providing education to fill a practice gap regarding the hazard noise poses in the OR environment on staff's stress and distraction levels. Despite the knowledge that the OR is too noisy, further research is needed to apply noise reduction strategies to combat this issue (Bodin, 2022). This project aims to provide the necessary education and training to institute noise reduction strategies that the staff identify as beneficial in reducing stress and distraction. By providing the opportunity for both a pre- and post-surveys OR staff can see how they feel both before and after the implementation of noise 24 reduction strategies. Furthermore, if noise level measurements drop post-implementation, OR staff will see that their strategies have successfully decreased OR noise levels for their health and benefit. Effective teamwork is essential to achieve significant results such as these (Arabaci & Onler, 2021). Implications This MSN project contains several strengths and weaknesses. Strengths include fulfilling a practice gap for OR staff, including various OR roles in the interdisciplinary team, and a direct focus on improving OR working conditions for the health and benefit of OR staff. The strengths are evident by providing the necessary education and training to empower OR staff to apply noise reduction strategies. Including all OR staff roles and allowing them to voice their perceptions of OR noise before and after implementation enhances the project by allowing for a wide range of viewpoints and customizations. Finally, the implementation of this project provides not only the benefit of a quieter work environment for OR staff, where they can experience less stress and distraction, but also an environment where effective communication occurs for the safety and well-being of OR patients (Ayas et al., 2022; Grant et al., 2021; Katz, 2014; Mcleod et al., 2021). Prospective limitations to this project include implementation barriers, OR staff buy-in, and limited sample size. At the time of the PowerPoint educational presentation, the project team lead must convey the significance of this MSN project to entice as many staff members as possible to participate. Garnering sufficient buy-in during implementation will ensure that the reach of this project is maintained. Additionally, the site of this project is a hospital that runs six to seven ORs Monday through Friday. Numerous surgical specialties operate at this location, except heart and neurological services. The random noise level measurements may exclude 25 certain specialties, thus failing to represent this location fully. This MSN project is mindful of the posed limitations and the potential they have to affect the outcomes. Recommendations While this MSN project employs numerous resources to achieve successful outcomes, indications for further improvements will address any lingering gaps. While this project utilizes paper copy surveys, adding a QR code or electronic method, such as an online survey platform, may attract prospective participants who seek the ease of the electronic format. Eliminating paper surveys may make data compiling easier for the project team lead. Additionally, formatting this project to another OR location may glean new insights and outcomes worth exploring. Expanding to locations that operate a different number of ORs each day and a more extensive variety of surgical specialties will be valuable to assess. Finally, while noise is known to plague the OR, other hospital units are experiencing similar issues (Applebaum et al., 2010; Katz, 2014; Mcleod et al., 2021). Adapting portions of this project for use outside the OR setting may be beneficial and worth examining. Conclusions High noise levels are a known issue in ORs, causing distraction, stress, poor performance, impaired concentration, and increased errors (Ayas et al., 2022; Fu et al., 2021; Mcleod et al., 2021). Despite the vast research and development of strategies to reduce OR noise, data has established that noise levels continue to be above WHO-recommended limits (Arabcai & Onler, 2021; Fu et al., 2021; Mcleod et al., 2021; Way et al., 2013). 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The Online Journal of Issues in Nursing, 21(2). https://doi.org/10.3912/OJIN.Vol21No02Man04 31 Appendix A OR Staff Pre-Survey 32 Appendix B Reducing Non-Essential Noise in the Operating Room PowerPoint Educational Presentation NRSG6802HarrisNFinalPowerPointEducationalDeliverable3_31_24.pptx 33 Appendix C OR Staff Post-Survey 34 Appendix D Timeline