Each member of the health care team plays an important role in providing quality care to patients and families. Whether it be the doctor who has identified the cause of the patient’s illness, the housekeeper who has cleaned the patient room, the nurse who has attended to the patient’s daily needs, or the child life specialist who has provided normalization for the patient during a hospital stay, each role is vital to the delivery of high quality care. In some hospitals, the child life assistant is the person who checks in with families to fulfill patients’ developmental play needs and carries out activity sessions with patients. As a child life assistant in the Pediatric Intensive Care Unit (PICU) at Dell Children’s Medical Center, this role also enabled me to see opportunities for comfort to be enhanced. One such measure that I identified as a needed resource was the use of sound machines to offer timed music and white noise options to calm patients’ fears, allay anxiety, or to just provide stimulation in a room where no one else was present, if appropriate. Since the rooms did not have a music or sound machine, I carried out a quality improvement project that would provide parents with regular music or sound options.

I began by investigating what pediatric research had to say about the benefits of sound or music machines, for PICU patients in particular. According to Hugh et al. (2014) “too much noise can lead to disturbances in sleep and arousal in infants, and acoustic disturbance can have direct physiologic effects on infants that can negatively influence the quality and quantity of their sleep” (p. 2), as well as affect healthy speech intelligibility (Saint Louis, 2014). Because hearing loss has been known to be induced at high levels, conservative noise limits are advised for infants (Hugh et al., 2014). The resonance properties of the infant’s smaller ear canal amplify higher-frequency sounds in the ear canal, and with continued exposure, these higher-frequency sounds can damage the developing ear canal (Hugh et al., 2014). In fact, when Hugh and colleagues tested 14 commercially available sleep machines at maximum volume and close distance, three exceeded workplace safety limit for adults, one significantly (Hugh et al., 2014).

Given the physiological and auditory effects that too much noise can have on the hospitalized infant, the study by Hugh and colleagues attempted to better understand the risks associated with infant sound machines and develop recommendations for caregivers on the maximum output levels of these machines for the ear canals of a 6-month-old infant. 

Discussing the Hugh et al., study, Dr. Blake Papsin, chief otolarynologist at the Hospital for Sick Children in Toronto and one of the authors, summarizes, “Farther away is less dangerous, a lower volume is better and shorter durations of time, all things that deliver less sound pressure to the baby” (Saint Louis, 2014, para 8).

With this information as guidance, a pilot test was undertaken with a single patient: a critical care, cardiac 6-month-old infant in the PICU at Dell Children’s Hospital. The Munchkin Nursery Projector and Sound System, identified as being the most economical and usable machine with the highest consumer ratings, was installed on a countertop 200 cm from the patient’s head. In addition to providing music/ sounds (heartbeat, ocean, rain, lullabies, Mozart, and white noise), the machine also had the option to project images (fish in the sea, a tropical bird in the rainforest, and a sheep in the sky at night) onto the ceiling above the patient’s bed.

For nine days, each assigned day shift nurse used the sound machine when they identified that the infant required calming, playing a selected choice of one of the 10 sound options for no longer than 60 minutes at one time (based on the machine’s timer). At the end of their shift the patient’s assigned nurse completed a short questionnaire that asked for feedback on the ease of use of the machine and its perceived usefulness as a sound tool. When nurses worked more than one day during the nine days, they completed a questionnaire at the end of each shift. A total of seven different nurses completed the questionnaire over the nine days.