Abstract
<title>Abstract</title> <p>Background 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. Aim To examine ICU nurses' perceptions of noise sources and their perceived effects on health, occupational functioning, and burnout, and to explore their lived experiences of noise exposure, coping strategies, and perceptions of organizational responses to noise. Methods A convergent mixed-methods design was used. A cross-sectional survey of 228 ICU nurses across Lebanon assessed perceived noise sources, burnout, and the perceived impact of noise across four domains (subjective perception, emotion, physiology, performance). Semi-structured interviews with 20 ICU nurses were thematically analyzed. Qualitative and quantitative components were integrated during interpretation to compare, contrast, and explain findings. Results Most noise sources were rated "moderate" by the majority of nurses, with monitor alarms, the most frequently cited high-level source (50%). Impact scores exceeded the domain midpoint for subjective perception (11.0 ± 3.4/20), emotion (13.8 ± 4.4/25), and physiology (14.2 ± 4.3/25), and fell below it for performance (10.6 ± 4.2/25); impact varied significantly by region across all domains (p ≤ 0.017), highest in Bekaa and lowest in North Lebanon. Burnout was at the onset threshold (mean 3.5 ± 1.2/7). Perceived impact increased with longer hospital (r = 0.17, p = 0.009) and ICU experience (r = 0.13, p = 0.046), even as nurses reported the least effect on performance. Qualitative accounts helped explain this pattern: nurses described "getting used to" noise while continuing to report impaired concentration, repeated tasks, tinnitus, and headaches that persisted after their shifts, alongside informal, individually driven coping and inconsistent institutional responses. Conclusion Getting used to" ICU noise is compensatory endurance that preserves task performance while cognitive and emotional costs accumulate as early burnout. Because systems lean on individual adaptation, the burden is silently displaced onto staff, a dynamic intensified in an unstable LMIC context. These findings support the need for system-level mitigation rather than individual habituation.</p>