Noise pollution in the intensive care unit: a mixed − methods exploration of Lebanese nurses’ perceptions

Noise in intensive care units (ICUs) is a recognized environmental hazard, yet most evidence documents its prevalence and sources rather than how nurses experience, interpret, and absorb sustained exposure, particularly in low − and middle − income country (LMIC) settings, where systemic strain may reshape that experience. To examine ICU nurses’ perceptions of noise sources and their perceived effects on health, occupational functioning, and burnout, and to explore their experiences of noise exposure, coping strategies, and organizational responses. An explanatory sequential mixed − methods design was used. A cross − sectional survey of 228 ICU nurses across Lebanon (March–June 2025) assessed perceived noise sources, burnout, and the perceived impact of noise across four domains (subjective perception, emotion, physiology, performance). Semi − structured interviews were then conducted with 20 nurses purposively selected from survey respondents (September–October 2025) to explain and elaborate the survey findings, and were thematically analyzed. The two strands were integrated at the interpretation stage using a joint display. Most noise sources were rated moderate, with monitor alarms and ventilators the leading high − level source (50%). Impact scores fell below the midpoint for all domains: subjective perception (11.0 ± 3.4), emotion (13.8 ± 4.4), physiology (14.2 ± 4.3), and performance (10.6 ± 4.2). In bivariate analysis, impact varied significantly by region across all domains (p ≤ 0.017), highest in the Beqaa and lowest in North Lebanon. The mean burnout score (3.5 ± 1.2) fell at the lower boundary of the band indicating the presence of burnout. Perceived impact in the subjective perception domain increased with longer hospital ( r = 0.17, p = 0.009) and ICU experience ( r = 0.13, p = 0.046). Qualitative accounts helped explain this pattern: nurses described "getting used to" noise while continuing to report impaired concentration, repeated tasks, tinnitus, and headaches persisting after their shifts, alongside informal, individually driven coping and inconsistent institutional responses. Nurses’ adaptation to ICU noise reflected endurance rather than relief, with continued task performance alongside persistent cognitive and emotional strain. Where institutional responses were inconsistent, nurses managed noise individually, a pattern they linked to the strained LMIC context in which they work. These findings support system − level mitigation rather than reliance on individual habituation.