Volume 93, April 2026, 104309Author links open overlay panelPyoung Jik Lee a, Ziwei Song bShow moreAccess through your organization

Check access to the full text by signing in through your organization.

Access through your organizationSection snippetsCoping strategies and resource conservation

Li and Yu suggest that describing avoidance strategies might misrepresent these behaviours as individual shortcomings and propose the Conservation of Resources Theory as an alternative lens. We agree that excessive noise in the ICU is a constant stressor. However, our study was grounded in the transactional model of stress and coping, a framework well-established in connecting noise perception with coping mechanisms [3]. Our observation that nurses utilised avoidance strategies was a

Voice fatigue and vocal load

We fully concur with the call for future studies that utilise objective vocal load measurements. As Li and Yu noted, the pandemic context necessitated the use of personal protective equipment, which exacerbates the vocal effort. Our prior work has objectively measured increased voice levels during ICU shifts [4] and the prevalence of voice handicap among nurses. However, the current qualitative study aimed to capture the subjective experience of these acoustic challenges. We agree that future

Sample demographics and generalisability

Li and Yu raised concerns regarding our all-female sample, suggesting that women may report greater noise sensitivity. We urge caution in generalising findings on noise sensitivity based on limited data. While some studies suggest gender differences, other literature remains inconclusive or statistically non-significant regarding gender-based noise sensitivity [5]. Furthermore, our sample composition reflected the reality of the nursing workforce in the participating hospitals in China, where

Funding

None.

CRediT authorship contribution statement

Pyoung Jik Lee: Writing – original draft, Writing – review & editing. Ziwei Song: Writing – review & editing.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References (5)

There are more references available in the full text version of this article.

View full text

© 2025 Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.