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Purpose: Exposure to noise has been related to aggressive behavior. As hospital noise may affect nursing students’ psycho-physiological health due to their inexperience, it ;1;is important to investigate possible violent tendencies among them. Since no similar research has been found in the literature, a study has been conducted to investigate the relationship between noise sensitivity and violence tendencies among nursing students. Methods: The design of this study was cross-sectional. There were 260 nursing students (61% female) aged 18 to 24 years who filled out the Personal Information Form, Weinstein’s Noise Sensitivity scale, and Violence Tendency scale. We investigated the distribution of students’ noise sensitivity and violence tendencies scores in relation to age, gender, grade, and place of residence. Multiple regression analysis was performed with the noise sensitivity score and possible confounders as independent variables and the severity tendency score as a dependent variable. Results: We found smoking to be significantly and positively associated with both noise sensitivity and violent tendencies (P < 0.001). Multiple regression analysis with smoking as a possible confounder revealed that a raise of 0.203 units on the violence tendencies scale may be expected per unit increase on the noise sensitivity scale (P < 0.001). Conclusion: Due to the limitations of our study, a possible relationship between nursing students’ noise sensitivity and violent tendencies is tentatively pointed out. More detailed studies are needed to test this assumption.
Keywords: Hospital, noise, nursing student, violence
How to cite this article:
Chronic noise is related to psychological stress, while intense stress is associated with violence.[1] Violence, which comes from the Latin word “Violentia” (hard or cruel personality, power) has been defined by the World Health Organization (WHO) as “the intentional use of physical strength or force against oneself, another person, a group or community with physical harm or physical harm.” It is defined as the threat or actual use of physical force or power that causes psychological harm, death, developmental problems, or deprivation.[2] Aggression is a very important factor in the lives of individuals, which negatively affects people’s lives in their work and social environment.[3] Prolonged exposure to high levels of noise can cause tension and aggression in individuals, causing deterioration in cognitive functions, increasing human errors, causing negative consequences, and most importantly, increasing psychological responses in the social and family environment.[4] These issues are of great importance in terms of health and safety in working environments. De Araújo Vieira et al. in their study to determine the effect of workplace indoor environment quality on the incidence of psychological and physical symptoms in intensive care units, found that acoustic characteristics contributed to the 3.4% risk of symptomatological complaints.[5]
Nursing is one of the professions that deals with humans as bio-psycho-social beings and human problems holistically.[6] For this reason, nurses have important duties in preventing the phenomenon of violence, determining the extent of existing violence, and eliminating the health problems caused by its consequences.[7] Nursing students are thought to be relatively more affected by hospital noise as they are inexperienced and new to professionalization. When the literature is searched, no study has been found that deals with noise sensitivity and violent tendencies of nursing students. It is thought that measures can be taken to determine the presence of sensitivity to hospital noise and the extent to which this situation affects the violent tendencies of students.
In this context, the aim of our study is to determine the relationship between noise sensitivity and violence tendencies among nursing students.
MethodsParticipants and setting
The research was carried out among 260 nursing students (61% female) at a university in Turkey in January to May 2022. Nursing students were from all four grades. The purpose and nature of this study were explained to the participants, and they signed an informed consent. It took 15 minutes for data collection.
Data collection
In collecting the research data, three forms were used: “Individual Information Form” created by the authors, “Weinstein’s Noise Sensitivity Scale,” and the “Violence Tendency Scale.”
Individual information form
In this form, there are five closed-ended questions: age, gender, grade, smoking status (yes/no), and place of residence (dormitory, with family, and single).
Weinstein’s noise sensitivity scale (WNSS)
The scale was developed by Weintein[8] and its Turkish validity and reliability study was conducted by Yıldız.[9] The scale consists of 21 items and Likert type scaling is made from 1 (agree/very much) to 6 (disagree/never) for each item. The lowest score that can be obtained from the scale is 21 and the highest score is 126. The increase in the scale scores indicates an increase in the person’s noise sensitivity.
Violence tendency scale (VTS)
VTS is used in the Turkish language. VTS was developed for a project prepared for the Ministry of National Education.[10] VTS consists of questions related to the fact that students immediately get angry when they encounter an unpleasant incident, get angry when they are criticized, lack of self-control when they are angry, the desire to be physically violent, the desire to break something when they are angry, the situation of arguing with people too often, the situation of fighting often, and the desire to harm others. The scale consists of 20 questions. Scale scoring is accomplished through the use of a four-point Likert type scoring system ranging from (1) “not at all appropriate” to (4) “very appropriate.” Since all items are one-sided, there is no reverse scored item. The highest score to be obtained from the scale is 80, and the lowest score is 20. A high score indicates that students have a higher tendency towards aggression and violence. Scores between 1 and 20 are considered “too little,” scores between 21 and 40 “less,” scores between 41 and 60 “high,” and scores between 61 and 80 “too much” violence, according to the scale.[20]
Data analysis
The data were analyzed with the IBM SPSS V25 program. Frequency and percentage were used in the analysis of socio-demographic data. The conformity of the distribution of the data to the normal distribution was tested by examining the skewness and kurtosis values (+1, −1) with the Kolmogorov–Smirnov test. Student t test and a one way ANOVA test were used to compare normally distributed data. Multiple regression analysis was performed to determine the relationship between noise sensitivity and violent tendencies, taking into account possible confounders.
Ethical considerations
Ethics committee approval and institutional permission were obtained before the study was conducted (Decision no: 04.12-2022). Nursing students who agreed to participate in the study were informed about the purpose and process of the study, and their verbal consent was obtained. The study was conducted according to the principles of the Declaration of Helsinki.
Research questions
How is the students’ noise sensitivity related to gender, age, smoking status, grade, and the place of residence?How are the students’ violence tendencies related to gender, age, smoking status, grade, and the place of residence?What is the relationship between noise sensitivity levels and violence tendencies of nursing students, taking into account possible confounders?Working hypothesis
H1: There is a significant relationship between noise sensitivity levels and violence tendencies of nursing students.
ResultsThe investigated students were aged 18 to 24 years, with a 61% majority of female students. The students were mainly smokers (62%), and their prevalent residence was a dormitory (43.5%). [Table 1]
No statistically significant relationship was found between students’ gender, grade, and place of residence. However, the average noise sensitivity score was significantly higher among smokers compared to non-smokers and among older students compared to younger ones [Table 2].
Table 2 Noise sensitivity scale and violence tendency scale mean scores according to nursing students’ sociodemographic characteristicsThe students’ violence tendencies were not significantly related to gender or age. However, violence tendencies scores were significantly higher among smokers compared to non-smokers and among those who lived in a dormitory or with family compared to students living alone or with a friend.
Smoking was included in the multiple regression model as a possible confounder as it was significantly and positively associated with both noise sensitivity and violence tendencies [Table 3]. A significant relationship remained between noise sensitivity and violent tendencies. For the investigated students, a raise of 0.203 units on the violence tendency scale may be expected for each unit increase on the noise sensitivity scale.
Table 3 Multiple regression analysis of noise sensitivity and smoking as independent variables and violence tendency as a dependent variable Discussion A significant and positive relationship was found between nursing students’ noise sensitivity and violent tendencies when adjusted for smoking as a possible confounding factor. The possible explanation for this relationship has been sought in literature.
The sympathetic nervous system releases catecholamines and glucocorticoids (adrenaline, noradrenaline, and cortisol) to put the organism in a state of alarm stress, accelerate the heart rate, increase blood pressure, and constrict blood vessels.[11],[12] Organisms show stress responses not only to life-threatening events, but also to much less dangerous but disturbing environmental changes.[13] Dhifallah and Lu[14] reported that noise was associated with stronger neural activity and higher psychometric functions at the individual level.[14] Terzi et al.[15] found in their study that the noise levels in intensive care units are well above the recommended levels, and this affects the job satisfaction and anxiety levels of nurses. Park et al.,[16] found that there is a significant relationship between the level of noise sensitivity and psychophysiological responses. Hener[17] found in his studies on noise pollution and violent crime that a 1 dB increase in average noise levels increases the violent crime rate by 1.6%. Alimohammadi et al.[18] report that exposure to noise in the work environment increases the frequency of aggression-related tension and inappropriate behaviors. Eyi and Eyi[19] reported that nursing students, exposed to physical, psychological, and chemical risks are affected by anxiety and nervousness as well as physiological problems and show symptoms similar to burnout syndrome. Lim et al.,[20] found that students’ noise sensitivity is significantly related to internalization, externalization, and total behavior problems. Nordin et al.[21] reported that the relationship between noise sensitivity, stress, and odor sensitivity in university students was significant. However, no study has been found in the literature that deals with the relationship between nursing students’ noise sensitivity and their violence tendencies.
In this study, it was determined that as the age of the students increased, their noise sensitivity levels also increased. When the literature is searched, Shepherd et al.,[22] also reported that there was a statistically significant relationship between noise sensitivity and age in their study with adults to explain the relationship between noise sensitivity and personality. However, Heinonen-Guzejev[23] found a negative relationship between age and noise sensitivity in her study to examine the medical, psychological, and genetic aspects of noise sensitivity. Belojevic and Jakovljevic[24] found that age did not affect noise sensitivity in their study to examine the factors affecting subjective noise sensitivity in an urban population. Moreira and Bryan[25] also reported that noise sensitivity is not age dependent. According to Stansfeld et al.,[26] noise sensitivity was found to be highest among women aged 30 to 44 and lower in older age groups.
We found that noise sensitivity levels and violence tendencies of the students who smoked were higher (P = 0.001) [Table 2] and [Table 3]. In a study conducted by Suzuki et al.,[27] to determine stressful events and coping strategies associated with depression symptoms, it was reported that individuals exhibit smoking as a coping behavior to escape from stressful life events. Siegel et al.,[28] reported that smoking behavior is associated with avoidance-focused coping.
There are several limitations of our study. Firstly, the cross-sectional design does not allow causal reasoning, but only a relationship. Secondly, other possible factors (personality traits, socioeconomic status, family problems, stressful life events, alcoholism, and drug addiction) that might have affected students’ violence tendencies were not investigated.
Conclusion and recommendationsIn this study, it was found that there is a positive and highly significant relationship between the noise sensitivity levels of nursing students and their violent tendencies when adjusted for smoking as a possible confounding factor. As such, it is important to pay attention, and reduce noise levels in hospital environments, and take into account noise-sensitive individuals. As this is pioneering research on this topic, further and more detailed studies are needed to test our findings.
Financial support and sponsorship
None.
Conflicts of interest
There are no conflicts of interest.
References
Correspondence Address:
Tuba Karabey
Tokat Gaziosmanpasa University Faculty of Health Science, Tokat 60100
Turkey
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/nah.nah_75_22
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