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The soundscape dimensions of third-class hospital ward in Indonesia

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Anugrah Sabdono Sudarsono at Bandung Institute of Technology
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Joko Sarwono at Bandung Institute of Technology
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Aisyah Shabrina
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Abstract and Figures

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.
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PROCEEDINGS of the
23rd International Congress on Acoustics
9 to 13 September 2019 in Aachen, Germany
The soundscape dimensions of third-class hospital ward in
Indonesia
Anugrah Sabdono SUDARSONO1; Sugeng Joko SARWONO1; Aisyah SHABRINA1, Laudita Natasha
TAMRIN1
1 Institut Teknologi Bandung, INDONESIA
ABSTRACT
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.
Keywords: soundscape dimensions, third-class hospital ward
1. INTRODUCTION
The hospital environment is vital in speeding up the patient’s recovery (1). The optimal healing
environment must be designed carefully based on several aspects in both in the indoor and outdoor
area(2). One of the critical environmental aspects which need to consider is the sound environment.
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 (3–5). The
improvement for the sound quality is focused on reducing the noise level using several methods(6).
Other studies focus more on the perception aspects using soundscape approach (7–10). This
approach focuses more on what people feel and perceive in the environment, not only based on sound
level measurement. Previous studies have been conducted in several areas in a hospital such as the
Intensive Care Unit (9,11) of hospital ward (7,12). Most of the previous study tries to enhance the
acoustic comfort without determined the other important perception in the hospital area. Specifically,
in the hospital ward, the soundscape study focusses on the hospital wards which have limited beds.
This study tries to understand the soundscape dimensions of a third-class hospital ward which
consist of more than four beds inside. This type of ward is typical in a developing country and might
have different problems compared to the normal hospital ward. This type of ward also the cheapest
ward and always full of patients. The focus of this study is to develop semantic scales for third-class
hospital ward and to determine the soundscape dimensions of the third-class hospital ward.
2. Method
The surveys for this study were conducted in five third-class hospital wards. Third-class ward has
a larger room size with a f ew more beds than the other types. The number of beds is within the range of
1 anugrah@tf.itb.ac.id
4208
6 – 8 beds wi th 7 .2m2 for each bed [8] as shown in Figure 1. This type of room is usually full of patients
due to the cheapest rate than the other types of room. The beds in this room usually located near to each
other and only separated by a curtain. In this room class, the beds are separated by thin curtain to
visually closed the view among the patients. The room usually used by patients with the government’s
insurance or poor people who do not have to pay for the cure. Most of the patients in this room are in
the recovery stage of their illness.
Figure 1 –Third-class hospital ward room Layout
The experiments were conducted at an Islamic Hospital in Bandung, Indonesia. Fifty-nine
respondents (28 males and 31 females) voluntarily join the experiment. 36 patients joint the
experiment and 23 patient’s guard who also stayed in the ward. The average age of the patients was
42.5 with a standard deviation of 15.4. In the first experiment, the patients of third-class hospital
ward were asked about what they feel in the ward. The perception appeared in this step then
implemented to develop a set of semantic scales. In the second steps, the patients of the ward were
requested to filled a questionnaire of semantic scales. The data from semantic scales were analy sed
using principal component analysis to determine the soundscape dimensions of the third-class hospital
ward.
4209
3. Analysis
The first experiment was conducted to developed semantic scales. Several perceptions were
gathered in this experiment as shown in Table 1.
Table 1 – Term used to explain the situation in the third-class hospital ward
Indonesian
English Translation
Indonesian
Mengganggu
Disturbing
Tidak nyaman
Membosankan
Boring
Dinamis
Dynamic
Menakutkan
Scary
Sempit
Tertekan
Depressed
Lambat
Puas
Satisfied
Penuh
Full
Ribut
Noisy
Kesal
Annoyed
Tidak privat
Not Private
Table 1 shows that most of the term used to described the third-class hospital ward are negative
terms. This description might indicate the soundscape of the ward which needs to be improved.
Interestingly, there are term satisfied (puas) which indicates that the patients satisfied with the ward.
The second experiment was conducted by requesting the participants to rate the acoustic
environment based on five-point semantic scales. The scales were developed based on the perception
term found on the first experiment. The scale is shown in Table 2.
Table 3 – Semantic scale used for the experiment
Indonesian
English Translation
Mengganggu - Tidak Menganggu
Disturbing-not disturbing
Membosankan – Menarik
Boring-interesting
Menakutkan-Tidak menakutkan
Scary-reassuring
Tertekan – Menenangkan
Depressing-calming
Puas-Tidak Puas
Satisfied-unsatisfied
Ribut-hening
Noisy-silence
Tidak privat-privat
Not private-private
Tidak nyaman-nyaman
Uncomfortable-comfortable
Dinamis-monoton
Dynamic-monotonous
Sempit-luas
Cramped-spacious
Lambat-Cepat
Slow-fast
Penuh-kosong
Full-empty
Kesal-Senang
Annoyed-pleased
Further analysis is conducted by analysing the score of perception rating. The median value of the
score is shown in figure 2. Contrary to the term found in the first experiment, the rating shows that in
general, the patients feel positive about the environment. They feel not scary, comfortable,
monotonous, and full. This finding might indicate the acceptance of the environment. The patients feel
that this type of ward is the best option for them and they accept the environment. Most of the patient
get free cure there, and it is the better option rather than does not get the cure.
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Figure 2 – Median score of perception rating in third-ward hospital
Further analysis is conducted using principal component analysis to determine the soundscape
dimensions of the third-class hospital ward. The PCA result is shown in Table 3. The soundscape
dimensions are the components which have eigenvalue bigger than one.
Table 3 – Principal Component Analysis Result
Kaiser-Meyer-Olkin Measure of Sampling Adequacy =0.710, sig. 0.000
Component 1
Component 2
Component 3
Component 4
Component 5
18%
13%
13%
12%
11%
Disturbing
0.1
0.74
0.21
0.32
0.14
Boring
0.55
0.19
0.19
0.51
-0.19
Scary
-0.04
0.17
0
0.88
0.07
Depressing
0.68
0.11
-0.21
0.4
-0.16
Satisfied
0.13
0.05
0.18
0.13
0.81
Noisy
0.27
0.41
0.5
0.1
-0.07
Not private
0.67
0.07
0.39
0
0.22
Uncomfortable
0.39
0.75
0.03
0.07
0.04
Dynamic
0.06
-0.12
0.68
-0.07
0.25
Cramped
0.04
0.22
0.69
0.09
-0.14
Slow
0.39
-0.48
0.18
0.39
0.33
Full
0.78
0.3
0.14
-0.2
0.03
Annoyed
0.31
-0.07
0.39
0.22
-0.63
-2
-1
0
1
2
Disturbing
Boring
Scary
Depressing
Satisfied
Noisy
Not privateUncomfortable
Dynamic
Cramped
Slow
Full
Annoying
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There are five soundscape dimensions appear in this experiment:
1. The dimension related to the perception of privacy (18%). The dimension is represented by
the semantic scales of boring, depressing, not private, and full.
2. The dimension related to the perception of disturbance (13%). The dimension is
represented by the semantic scale of disturbing, and uncomfortable
3. The dimension related to the perception dynamic (13%). The dimension is represented by
the semantic scales of dynamic and cramped.
4. The dimension related to the perception of fear (12%). The dimension is represented by the
semantic scales of boring and scary.
5. The dimension related to the perception of satisfaction (11%). This dimension is
represented by the semantic scales of satisfied and annoyed.
The dimension of privacy become the most dominant soundscape dimension. This privacy of the
ward is related to the scale of depressing which mean the privacy can make the patients depressed. This
result is interesting since the soundscape dimensions usually dominated by the perception related to
the preference of the space. In an urban area, the first dimension is called Pleasantness (13),
Calmness(14), or Relaxation (15). In an academic library, two soundscape dimensions (pleasantness
and dynamic)(16) indicates similar soundscape dimensions with the urban soundscape.
The difference might happen because, in the urban and library area, people stay in that area for a
short period, so the most important aspect is to enjoy the environment. Another similarity between
those two studies is that people have the choice to leave the environment if they want to.
There is another case similar to the hospital ward where people need to be in the area for a long
period and does not have the opportunity to leave the place. The case happened for the nurse who
works in the Intensive Care Unit (ICU)(11) and a student in a class (17). In this environment, the most
dominant soundscape dimension is the dimension which not representing the preference of the space.
The perception of information is the most important perception for nurses who work in ICU while the
perception of space is the most important perception for student in a classroom. The perception related
to space preference (Calmness) become the second soundscape dimension.
4. Conclusion
Third-class hospital ward soundscape has been analysed according to the verbal response, overall
rating, and soundscape dimensions. The verbal response from the patients indicates a negative acoustic
environment. Interestingly, the rating of semantic scales indicates positive perception. This result
might indicate the acceptance of the acoustic environment among the patients.
There are five soundscape dimensions gathered from third-class hospital ward: privacy, disturbance,
dynamic, fear, and satisfaction. The first dimension is not related to the preference of the space, and
this result is consistent with the place where people do not have the opportunity to move.
ACKNOWLEDGEMENTS
The funding of this project is from KLN This research is funded by Kementerian Riset, Teknologi,
Dan Pendidikan Tinggi Republik Indonesia under the scheme of Kerjasama Luar Negeri.
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... This study focused solely on ICUs, whereas Mackrill et al. (2013) presented sound clips from various areas of the hospitals, such as ward corridors and patient bays. Similarly, Sudarsono et al. (2019) identified five perceptual components of hospital wards, including privacy, disturbance, and dynamics. Azzahra et al. (2017) described the soundscape of ICUs using attributes such as calmness, dynamics, and information, which are notably different from those used in this study. ...
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Article
  • Apr 2014
Sound is often considered as a negative aspect of an environment that needs mitigating, particularly in hospitals. It is worthwhile however, to consider how subjective responses to hospital sounds can be made more positive. The authors identified natural sound, steady state sound and written sound source information as having the potential to do this. Listening evaluations were conducted with 24 participants who rated their emotional (Relaxation) and cognitive (Interest and Understanding) response to a variety of hospital ward soundscape clips across these three interventions. A repeated measures ANOVA revealed that the 'Relaxation' response was significantly affected (n(2) = 0.05, p = 0.001) by the interventions with natural sound producing a 10.1% more positive response. Most interestingly, written sound source information produced a 4.7% positive change in response. The authors conclude that exploring different ways to improve the sounds of a hospital offers subjective benefits that move beyond sound level reduction. This is an area for future work to focus upon in an effort to achieve more positively experienced hospital soundscapes and environments.
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Experiencing the hospital ward soundscape: Towards a model
Article
  • Dec 2013
  • J ENVIRON PSYCHOL
Within healthcare design the soundscape or auditory landscape is often overlooked in favour of a focus on sound level. However, sound level is only one aspect of the soundscape. In order to improve healthcare environments it is important to understand the role of sound and to determine what may be positive, negative, and the feelings that different soundscapes can evoke. This paper reports on a semi-structured interview study which aimed to understand individuals' subjective responses to the soundscape of a cardiothoracic ward within a public University Hospital in the UK. A total of 27 in-situ interviews were conducted with patients and nurses and thematic coding was used to develop a conceptual model describing perception. This revealed that the soundscape is a diverse mix of sound sources with perception dependent not only on specific sounds, but also the physical, temporal and social context in which they are heard. Subjectively, the soundscape held both positive and negative aspects. It was found that coping methods were adopted by individuals by accepting and habituating to aspects of the soundscape. The conceptual model highlights potential physical and cognitive interventions that could be explored which may make the soundscape more positively perceived regardless of sound level.
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