Environmental Noise in Intensive Care Units: Occupational Exposure, Nurse Well‐Being and Care Quality—A Mixed‐Methods Study

BACKGROUND: Noise pollution in intensive care units (ICUs) is a pervasive occupational exposure that may affect nurses' well-being, patient safety and quality of care. AIM: To examine ICU nurses' perceptions and experiences of noise pollution and explore associations between perceived noise exposure, well-being, work performance and patient safety. STUDY DESIGN: A convergent mixed-methods design was used. Quantitative and qualitative data were collected using structured questionnaires and semi-structured interviews. Qualitative data were analysed using inductive thematic analysis in accordance with GRAMMS guidelines. RESULTS/FINDINGS: A total of 60 nurses participated in the quantitative phase, and 13 nurses participated in the qualitative interviews. A substantial proportion of nurses reported that noise often or always increased stress (56.6%, n = 34), restlessness or discomfort (48.3%, n = 29), sleep disturbance (53.3%, n = 32), fatigue or frustration (45.0%, n = 27) and headaches (41.7%, n = 25); 33.3% (n = 20) reported frequent or constant effects on decision-making. Integrated analysis of quantitative and qualitative data identified three overarching themes: (1) the dual role of alarms in patient safety and workflow; (2) alarm burden as a systemic and technical challenge; and (3) strategies for managing alarm-related stress. CONCLUSION: ICU noise is functionally essential for monitoring and safety yet burdensome for nurses and patients. Individualising alarms for responding staff and using wrist-vibrating bands may reduce noise burden and improve staff well-being and perceived patient outcomes. RELEVANCE TO CLINICAL PRACTICE: ICU noise is a modifiable risk to provider health and clinical performance. Practice should move from unit-wide audible alerts to targeted, non-auditory systems (e.g., wrist-vibrating bands) to reduce cognitive load. Clinical leaders must implement 'quiet zones' for high-stakes tasks like medication titration and provide protected rest periods in low-decibel environments to mitigate documented nurse fatigue and sleep disturbance.