Pediatric Nursing Research by MacKay et al.

Purpose of the Study

The researchers aimed to discuss how a quiet environment might improve relief among patients who feel pain. The quantitative study explored the influence of a mute environment on post-operative patients’ well-being, particularly in children of ages birth to 6 years old. Scientists also wanted to prove that the intensification of noise in hospital settings is apparent, and nurses should discover the techniques to reduce this stress factor. They also suggested resetting existing noise guidelines for clinic environments.

Research & Design

To conduct the study, scientists applied the Comfort Theory developed by Kolcaba and DiMarco (2005) since it presents a framework for measuring the influence of a quiet environment on patients’ comfort. Researchers also applied an innovative design to match FLACC scores and noise levels quantitatively.


Scholars used a convenience sample of 33 participants, including infants and children of ages birth to 6 years old who have gone through a surgical procedure from November 2012 to November 2014. Scientists chose post-operative subjects since they presumably needed pain relief. Another reason was that the nursing procedure included checking these patients every four hours, providing an opportunity for research measurements.

Data Collection

Nurses collected data in the first 24 hours after transfer from the Post-Anesthesia Care Unit, performed and registered FLACC estimations. They also recorded noise levels in patients’ rooms; sound measurements were indicated as fast or slow, depending on their length. A fast measure continued for 1/125 of a second, and a slow measure lasted 1 second. There were also indicators The Low Threshold Level or the lowest level measured during 1 second and The Slow Max or the highest level measured during 1 second. Nurses performed estimations every 4 hours and made up to 7 records during the 24 hours.

Data Analysis

Scientists expected a statistically significant difference (a < 0.05) in FLACC rates among the patients from the Quite Room and other subjects. They collected data from 100 participants and determined this sample size as appropriate; scholars mentioned patients’ age, gender, race, and diagnosis. The variables’ interdependence was studied using the Pearson Chi-square, ANOVA, and the corresponding p-value. The researchers applied a mixed-model logistic regression to analyze noise influence on pain rates of patients from Quite Room.


After the study was completed, the scholars discovered that a bigger sample could be more appropriate since only 33 subjects gave their consent for participation. Researchers hoped to find participants in one year, but they could not manage to do it due to recruitment challenges. They had to revise two study criteria to include 33 subjects.

Findings/Discussion: The study results showed that the average sound level for both groups was 57.98 dB, and the highest point of maximum noise was 97.9 dB in the control group. Two environments almost did not differ in average sound level. Researchers did not find that children in the Quiet Room felt better than those in the control group. Scholars suggested that the Quiet Room patients did not feel more comfortable because these rooms were not sufficiently quiet.

Reading Research Literature

Scientists cited numerous authors who assert that nowadays clinics show general failure to set the required noise levels (Basner et al., 2014; Cranmer & Davenport, 2013; do Carmo da Silveira Neves de Oliveira et al., 2013; Konkani & Oakley, 2012; Linder & Christian, 2011, 2012). They also presented the opinion according to which noise decrease in clinics can be reached using architectural design, facilities design, and personnel education (Milette & Carnevale, 2003). The scholars also pointed out nurses’ responsibility to create a tranquil environment (Ljusegren, Johansson, Berglund, & Enskar, 2012). Finally, they stated that bare nursing judgment is insufficient to change the acoustic environment (Pope, 2010).


MacKay, P., Ruhlen, T., Crow, P., Hughes, J., Pfeiffer, K., & Hagler, K. (2019). The effect of a quiet environment on the comfort of post-operative infants and young children. Pediatric Nursing, 45(5), 244-257.