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... Staff conversations happen at levels that can be heard by the patients, and the patients affirmed these staff conversations to be the most annoying noise (Topf 1985a, Kahn et al. 1998, Russel 1999). The nurses' station is a spot where both personal and professional issues can be conversed by staff (Elliot andWright 1999, Russel 1999 Low frequency noise is more likely to stem from the mechanical equipment while high frequency energy corresponds more often to the high velocity airflow through the heating ventilation air conditioning (HVAC) systems ( Ryherd et al. 2008b). ...
... Another source of noise in hospitals is in-room medical equipment noise. High frequency energy often corresponds to alarms and mobile medical equipment ( Ryherd et al. 2008b). One aspect to keep in mind is the close proximity of these devices to the patient throughout their stay making these noise sources a particular concern that needs to be addressed. ...
... Administrative noise controls such as closing doors and asking staff to speak softly as recommended by Biley (1994) and Cmiel et al. (2004) have limited success in deterring noise ( Ryherd et al. 2008b). Walder et al. (2000) stated that the noise levels measured approximately 43.2 dBA even with the doors closed and with peaks at 70 dBA, which disturbed 50% of healthy subjects. ...
Article
Acoustic conditions in hospitals have been shown to influence a patient’s physical and psychological health. Noise levels in an Omaha, Nebraska, hospital were measured and compared between various times: before, during, and after renovations of a hospital wing. The renovations included cosmetic changes and the installation of new in-room patient audio-visual systems. Sound pressure levels were logged every 10-seconds over a four-day period in three different locations: at the nurses' station, in the hallway, and in a nearby patient’s room. The resulting data were analyzed in terms of the hourly A-weighted equivalent sound pressure levels (𝐿𝐴eq) as well as various exceedence levels (𝐿𝑛). Additionally, a subjective noise perception patient survey was conducted to record the impressions of patients in the ward regarding noise. The relationships between a patient’s gender, age and responses to noise were examined. Results show that current noise level guidelines were exceeded regularly; despite this the surveys showed most patients were not very annoyed with the noise. Additionally, no relationships were found between a patient’s gender or age to various noise responses. The survey also asked participants to rank the most bothersome noise sources in the hospital environment and showed that the number of people annoyed by TV noise doubled from the during renovation to after renovation time periods. Overall this study did not find very large changes in sound levels or overall patient noise perception between the various time periods.
... Studies reporting the sound sources and levels within the hospital soundscape have revealed a diversity of different sources. These sounds can disseminate from numerous sources such as lowfrequency sounds (10 Hz to 200 Hz) from heating, ventilating, and air-conditioning systems and audible alarms [33,138,207]. Lowfrequency sounds have been generally accepted to be a specific environmental noise hazard because of its impact on individuals and are more unbearable than other forms of auditory sensation, most especially for vulnerable or sensitive individuals [27,147]. Through nurses' questionnaire surveys, [123] found the major sources of hospital noise to be conversations between patients and An experimental design on perceived tranquillity of natural sounds and murals of natural landscape. ...
... Elevated sound levels trigger off physiological stress, increase work pressure, pain, fatigue and burnout among patients care teams [122]. Exposure to loud sound can activate the levels of urinary cortisol, cause irritability [169], altered memory, increased agitation, anxiety and deciphering speech difficulties [207,221]. Noisy environment of care can have a negative impression on patients and visitors physiological and psychological health outcomes [223], impairing perceptions, concentration, and judgment of medical care staff [168] including their efficiency and safety [123]. ...
Article
Purpose: Most prior hospital noise research usually deals with sound in its noise facet and is based merely on sound level abatement, rather than as an informative or orientational element. This paper stimulates scientific research into the effect of sound interventions on physical and mental health care in the clinical environment. Methods: Data sources comprised relevant World Health Organization guidelines and the results of a literature search of ISI Web of Science, ProQuest Central, MEDLINE, PubMed, Scopus, JSTOR and Google Scholar. Results: Noise induces stress and impedes the recovery process. Pleasant natural sound intervention which includes singing birds, gentle wind and ocean waves, revealed benefits that contribute to perceived restoration of attention and stress recovery in patients and staff. Conclusions: Clinicians should consider pleasant natural sounds perception as a low-risk non-pharmacological and unobtrusive intervention that should be implemented in their routine care for speedier recovery of patients undergoing medical procedures.
... Research studies demonstrate that unpleasant sound in the clinical environment has deleterious effects on health and the healing process. These effects include altered memory, increased agitation, aggressive behaviour, depression, anxiety, psychiatric disorders and deciphering speech difficulties [142,150]. ...
... Noise [58,73,82,91,94,117,142,150,185,192]. ...
Article
Purpose: The aim of this review is to document the role of physical environmental factors in clinical environments and their impact on patients and staff wellness with a particular focus on physical and mental healthcare. Methods: Data sources comprised relevant English language articles and the results of literature search of ISI Web of Knowledge, PubMed, Scopus, ProQuest Central, MEDLINE, and Google. Results: Incorporating physical environmental factors into hospital design can facilitate better user satisfaction, efficiency and organisational outcomes. Many of the design interventions convey positive distractions for patients and staff, in terms of views of pleasant outside vistas, soothing sound, artwork and music. Conclusions: Well-designed physical settings play an important role in the healing process of patients in health care facilities. The challenge then is to fully understand that role in the ecological context of health care. Other contributors are possible and should be explored in further research.
... The measurement of noise in ICU indicates that the noise is exceeding the standard (6,7). The similar condition also happened in the operating room (8) and hospital ward (9) Most of the previous study regarding the sonic environment of the hospital focused more on the overall sound level without further analysis of the perception in the hospital ward. The study conducted by Mackrill et al. has analysed the soundscape of the hospital, although without considering the temporal aspect (10). ...
... The surveys for this study were conducted in five third-class hospital wards. Third-class ward is a lowest class of hospital ward in Indonesia, which consists of more than six beds [8]. This type of room is usually crowded due to the cheap rate. ...
Conference Paper
Full-text available
In Indonesia, the hospital ward is classified according to the number of beds inside the ward. Third class ward is the lowest class, which consist of six or eight beds inside the ward. In this study, the soundscape of a third-class hospital ward is analysed on different time of the day. The analysis is conducted based on noise level measurement, sound source identification, annoying sound source identification, and semantic scales. The noise level in the ward fluctuates between 51.5-62.1 dBA with the highest noise level measured during the afternoon. The dominant sound sources in the third-class ward, which are similar in the morning and the afternoon, are the sound of fan and visitor of the patients. The three most annoying sound sources in the morning are the sound of patients, visitors, and doors. This result is slightly different from the afternoon survey, which shows that the three most annoying sound sources are the sound of the door, food cart, and visitors. The semantic scales show different score in the morning and the afternoon. This study shows that the soundscape in the third-class ward is changing from time to time, and the soundscape intervention must consider the difference.
... At the Stockholm meeting we have seen interest from city planners and administrators to adopt the soundscape approach [63] -but here the implementation and not the evaluation is the first concern. "Health care acoustics" is emerging as a new topic that applies also psychoacoustic techniques within a soundscape approach [64], [65]. Soundscape approaches have recently been applied also on larger scales (ecological level approach) and explored the relation between urban structures and soundscape masking taking aggregate information on socio-economic factors, perception and cultural factors into account [66] [67]. ...
... Other sources of sound that contribute to hospital noise include paging systems, suction apparatus, heart monitor alarms, nebulizers, pulse oximeter tones, telephones, televisions and radios, banging of objects, rubbish bin and trolley sounds, intercoms, staff bleeps, and conversation (MacKenzie and Galbrun, 2007;Xie et al., 2009). Therefore, bothersome sound can alter memory, increase agitation, aggressive behavior, and depression or anxiety (Ryherd et al., 2008;Short et al., 2011). (2010); Zentner et al. (2008) Listening to music elicits real emotional responses in the listener. ...
... There is increasing concern about the level of noise in hospitals and its impact upon staff and patients. 17 Most of the previous research on the noise climate in hospitals has focused on particular areas within hospitals, notably those that are perceived as "noisy" such as emergency departments 18,19 and ICUs 2-15 with a particular focus on the latter. There is comparatively little published data on general noise levels within inpatient care accommodation. ...
Article
Many hospital noise surveys have shown that patients are subject to high levels of noise, in excess of current World Health Organization guidelines. Much of the previous research has focused on areas perceived to be noisy, such as intensive care units and operating theatres. This paper presents the results of a comprehensive noise survey of five general inpatient hospital wards in the UK. The survey involved continuous noise monitoring over several days, including identification of noise sources, in 31 locations representing a range of typical patient accommodations including single rooms and multi-bed bays, and nurse stations. The results were consistent with those of previous studies with daytime levels ranging from 50 to 61 dB L Aeq and nighttime levels from 41 to 51 dB L Aeq. Noise levels were not correlated with room/bay size, with single rooms having some of the highest levels. Overall levels were related to reverberation times and to the numbers of high level noise events. Analysis of noise sources showed that much of the noise could be eliminated or reduced through improved design of equipment and ward layouts. In general, noise levels in wards built since the year 2000 were lower than those in the older buildings.
... [11][12] Improving the soundscape can relieve stress for patients, increase patience and work enthusiasm for medical staff, and enhance the comfort of the hospital environment. [13] Some studies have proved that soundscape as a non-pharmacological intervention can positively affect people suffering from diseases in recent years. Providing a natural soundscape can reduce pain for patients, and music therapy has also been proven to improve the mental state of patients. ...
... The average subject affect reported in prior testing was 33.3 (SD ± 7.2). Conversely, negative affect scores were calculated using PANAS items 2, 4, 6,7,8,11,13,15,18, and 20, with lower scores representing lower levels of negative affect. The average subject affect reported in prior testing was 17.4 (SD ± 6.2). [91] For each perceptual test subject, a positive and negative affect score was generated for both pre and post-test time periods. ...
Article
Patients routinely perceive hospital soundscapes to be poor when rating their experience on HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) surveys administered after discharge. In this study, sound levels within five hospital units were correlated with HCAHPS noise perception survey data. Acoustic metrics including A-weighted equivalent, minimum, and maximum (LAEQ, LAMIN, & LAMAX) and C-weighted peak (LCPEAK) sound pressure levels, occurrence rate, and speech intelligibility index were evaluated in 15 patient rooms and 5 nursing stations. Average patient room LAEQ values within the five units ranged between 52 dBA and 61 dBA with speech intelligibility ranging from poor (<0.45) to marginal (0.45 to 0.75). The absolute minimum values measured within the patient rooms (LAMIN, LCMIN, & LZMIN) were found to be correlated with HCAHPS data and other metrics revealed trends consistent with patient perception. For example, the lowest rated unit also had higher occurrence rates, indicating this unit was louder more often. Ceiling type was also found to impact sound levels with LAEQ 5 dBA quieter on average for rooms utilizing acoustic tile ceilings. Taken as a whole, these results provide insight into acoustic metrics and design strategies which can ultimately be utilized to improve patient experience.
... 5 There is increasing concern about the impact of ICU noise levels on both patients and staff. 6,7 Although there is some discrepancy in the literature regarding the importance of noise in sleep, high noise levels can affect sleep quality even if the individual does not actually wake up. Instead, sleep may enter a more superficial stage, often stage 1. 8,9 Environmental noise is responsible for 11.5 and 17% of overall arousals and awakenings from sleep, respectively. ...
Article
Full-text available
BACKGROUND The effects of noise are harmful to patients in the ICU environment, and the latter are particularly noisy places. High noise levels seem to be a factor in sleep disturbance, which can, in turn, result in increased morbidity. LOCAL PROBLEM High noise levels are a recognised problem in ICUs worldwide. OBJECTIVE(S) The goal was to estimate the effect of a visual noise-warning system on noise levels in a surgical ICU before and after its implementation. DESIGN A quality improvement initiative. SETTING A 12-bedded surgical ICU in a tertiary care university hospital. PATIENTS A total of 148 adult nonintubated and nonsedated patients completed the study, during a 6-week period. INTERVENTION Noise levels were continuously recorded using a Type II sound level meter for 6 weeks. The study was divided into three phases. The first 2 weeks, baseline noise levels were measured (phase I). In week 3 of the study, a visual noise warning system (SoundEar II) that changed colour depending on noise levels within the ICU was installed and implemented (phase II). The alarm system was set to light up green at levels below 55 dBA, orange at levels between 55 and 60 dBA and red at levels above 60 dBA. The device was switched off at the beginning of week 5 and the sound level meter continued recording noise levels for another 2 weeks (phase III). RESULTS Mean night-time noise level was 55.98 dBA in the preintervention phase, 54.14 dB during the intervention, and 54.98 dBA in the postintervention phase. Mean noise level was reduced statistically significantly by 1.35 dBA, and there was a sustained reduction of 0.86 dBA from the baseline noise level 2 weeks after SoundEar II was switched off. CONCLUSION Visual noise warning systemscan be effective in achieving a reduction in noise levels in critical care units
... This suggests that unpleasant or distressing sounds impact negatively on the rate of recovery of patients in the hospital and in some extreme cases worsen the health condition of the patients. This includes psychological and physiological effects such as altered memory, increased agitation, aggressive behaviour, depression, anxiety, psychiatric disorders and deciphering speech difficulties (Elmenhorst et al., 2012;Helton et al., 2009;Joseph and Ulrich, 2007;Ryherdet al., 2008;Short et al., 2011). According to Frumkin and Louv (2007), it could be argued that people are closely attached to the natural world, which suggests that contact with nature is beneficial to health and wellbeing. ...
Article
Full-text available
Alfa-Öztürk: Perceived indoor environmental quality of hospital wards and patients' outcomes: a study of a general hospital, Minna, Nigeria-8235-APPLIED ECOLOGY AND ENVIRONMENTAL RESEARCH 17(4):8235-8259. Abstract. The objective of this study was to assess patients' perceptions of the indoor environment of wards in a hospital in terms of architectural design, thermal comfort, indoor air quality (IAQ), lighting and acoustical parameters. The study attempted to determine the factors influencing the perceived indoor environmental quality (PIEQ) and explored the relationships between the perceived importance of indoor environmental quality (PI-IEQ) and health recovery, health satisfaction and therapeutic ambience of the hospital. A field study of the indoor environmental quality (IEQ) of 4 wards in the General hospital at Minna, Niger state, Nigeria was conducted, and responses from 271 patients were obtained. Structural equation modelling was employed for data analysis. The research identified the six IEQ factors that influenced PIEQ as architectural design features, thermal comfort, adaptive opportunities, lighting, IAQ and acoustics aspects. PIEQ had a positive influence on a ward being perceived as conducive for wellbeing. It was observed that health satisfaction had the most significant and positive influence on PI-IEQ. The second most positive influence was health recovery. Therapeutic ambience also had a positive influence on PI-IEQ but this was not significant.
... Many approaches have been made to improve the sonic environment but mainly focus on the noise of the environment since the effect has been determined for both patients and staff (3)(4)(5). The improvement for the sound quality is focused on reducing the noise level using several methods (6). ...
Conference Paper
Full-text available
In Indonesia, the categorisation of the hospital ward is determined based on the number of beds. Third class hospital ward (the lowest class) is the ward which consists of more than four beds inside the room. This type of ward is typical in a developing country and might have different acoustic problems compared to the standard ward. This study aims to understand the soundscape dimension in a third-class hospital ward. Two experiments were conducted: the development of semantic scales and the identification of soundscape dimensions. The semantic scales were developed by asking the patient about the feeling in the ward. Most of the terms used to describe the environment are negative terms such as annoying, boring, scary, upset, and uncomfortable. Interestingly, the perception ratings indicate that the patients feel positive about the sound environment. Principal component analysis is used to analyse the rating resulting in five soundscape dimensions. The dimensions are Privacy, Disturbance, Dynamic, Fear, and Satisfaction. These dimensions indicate the important aspect which needs to be understood in increasing the quality of third-class hospital ward.
... [19][20][21][22] Some previous studies tried to make possible interpretations of the observed differences of the acoustical data based on the architectural/physical characteristic differences where the acoustical data were obtained. 8,11,23,24 These explanations often resulted in comparisons that included the SPL magnitude differences across multiple locations, but perhaps missed discovering particular differences in terms of how deterministic those parameters are in each location. The units included in this study were certainly different in terms of their sonic characteristics, architectural features (volume, door types), acuity level, numbers of occupants, and so on. ...
Article
The previous hospital acoustic literature has highlighted some important considerations and various complexities regarding objective noise measurements. However, extensive use of conventional acoustical metrics such as logarithmically averaged equivalent sound pressure levels (Leq) do not sufficiently describe hospital acoustical environments and often lack considerations of the room-based activity status that can significantly influence the soundscape. The goal of this study was to explore utilizing statistical clustering techniques in healthcare settings with a particular aim of identifying room-activity conditions. The acoustic measurements were conducted in the patient rooms of two pediatric hospital units and subsequently classified based on two room-activity conditions—active and non-active conditions—by applying statistical clustering analyses with standard k-means and fuzzy c-means algorithms. The results of this study demonstrate the most probable noise levels and degree of associations of the measured noise levels for the two room-activity conditions. The results were further validated in terms of the clustered levels, the number of conditions, and parameter dependency. The clustering approach allows for a more thorough soundscape characterization than single-number level descriptors alone by providing a method of identifying and describing the noise levels associated with typical, intrinsic activity conditions experienced by occupants.
Article
This study examines the impact of the sound environment on spatial knowledge acquisition in a virtual outpatient polyclinic. Outpatient polyclinics have a salient role in determining early outpatient treatments of COVID-19 to prevent hospitalization or death and reduce the burden on hospitals. However, they have not been widely investigated in the literature. The studies on spatial knowledge have identified environmental elements mainly related to vision with no focus on sound. Currently, there is limited research on the effect of sound environment on spatial knowledge acquisition in virtual outpatient polyclinics. In this study, a virtual simulated outpatient polyclinic has been created with varying levels of visual and audio cues. Eighty participants were assigned to one of the four groups: a control (no visual signage), a visual (visual signage), an only audio (no landmarks and no visual signage), and an audio-visual group. The virtual environment was presented as a video walkthrough with passive exploration to test spatial knowledge acquisition with tasks based on the landmark-route-survey model. The results showed that a combination of visual signage and sound environment resulted in higher spatial knowledge acquisition. No significant difference was found between the performance of the visual group and the control group that shows that signage alone cannot aid spatial knowledge in virtual outpatient polyclinics. Data from the only audio group suggests that landmarks associated with sound can compensate for the lack of visual landmarks that may help design a wayfinding system for users with visual disabilities.
Article
Full-text available
Most research on the acoustic environment in the modern Western hospital identifi es raised noise levels as the main causal explanation for ranking noise as a critical stressor for patients, relatives and staff. Therefore, the most widely used strategies to tackle the problem in practice are insulation and isolation strategies to reduce measurable and perceptual noise levels. However , these strategies do not actively support the need to feel like an integral part of the shared hospital environment, which is a key element in creating healing environments, according to the paradigm of Evidence-Based Design and Healing Architecture. This article suggests that the gap in contemporary research is intimately linked to a reductionist framework underlying the fi eld, which is incapable of accommodating the multisensory and atmospheric conditions amplifying the experience of noise. This article argues that an attuning approach should be included in the fi eld to help bridge the gap by offering active ways of attuning to the shared environment.
Article
Hospitals should be conducive to patient recovery and safety as well as employee health and productivity. A variety of diverse noise sources populate hospitals such as HVAC systems, occupant sounds, alarms, and medical equipment. There is strong and growing evidence of the negative impacts of a poor hospital acoustic environment. For example, patient sleep disruption, cardiovascular arousal, increased incidence of rehospitalization, and extended hospital stay have been linked to hospital acoustics. There is also evidence that staff mental efficiency, short-term memory, stress, burn-out, and hearing loss are related to the acoustic environment. The Hospital Acoustics Research Team (HART) is a unique collaboration of specialists in engineering, architecture, psychology, medicine, and nursing that is working to evaluate the modern hospital acoustic environment and the associated psycho-physiological responses of occupants. Case studies and findings from this body of work will be discussed. The results are advancing the understanding how various aspects of the acoustic environment impact occupants, how to best measure and quantify these aspects, and how to improve the hospital acoustic environment to make hospitals healthier for occupants.
Article
Alarm safety is one of healthcare's most high-profile and intractable problems. A phenomenon known as “alarm fatigue”, including limited capacity to identify and prioritize alarm signals, has led to delayed or failed alarm responses and deliberate alarm de-activations. Alarm fatigue has been implicated according to federal agency reports as well as in the lay press, in patient deaths, some highly publicized. It has been reported that between 200 and 566 patient deaths have resulted between 2005 and 2008; these numbers are likely to be underestimates.
Chapter
Alarms contribute significantly to noise pollution in healthcare and “alarm fatigue” limits a care provider’s capacity to identify and prioritize these signals. The exceedingly high rates of clinically irrelevant alarms and high background noise levels in clinical environments contribute to staff desensitization resulting in response failures. Monitoring devices that process complex data should produce clinically relevant alarm signals. This chapter identifies multiple levels of influence and opportunities for system intervention and innovation to facilitate timely and reliable alarm responses. These include addressing the broader acoustic context, clinician responsibility, deployment and teamwork training, threshold-setting guidelines, improved user interfaces, and algorithms balancing alarm specificity and sensitivity. Monitoring devices that process complex data streams should produce clinically relevant alarm signals, in environments optimized for discernment and attribution, with user interfaces designed for timely interpretation, prioritization, and prompt action. Hospitals need a system-wide alarm management policy and protocols that define the alarm management strategy for alarmed medical equipment, and delineate how caregivers/nurses should respond to alarm conditions and signals. It is imperative that a human factors approach based around the hospital’s culture is used that actively engages architects, designers, acoustical engineers, facility engineering, staff, and clinicians to address alarm fatigue and the implications of the physical built environment. Involving patients in the redesign of hospital acoustic environments may improve patient experiences and satisfaction with their care.
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