PROCEEDINGS of the23rd International Congress on Acoustics
9 to 13 September 2019 in Aachen, Germany

The soundscape dimensions of third-class hospital ward inIndonesia

Anugrah Sabdono SUDARSONO1; Sugeng Joko SARWONO1; Aisyah SHABRINA1, Laudita Natasha
TAMRIN1
1

Institut Teknologi Bandung, INDONESIA

ABSTRACTIn Indonesia, the categorisation of the hospital ward is determined based on the number of beds. Third classhospital ward (the lowest class) is the ward which consists of more than four beds inside the room. This typeof ward is typical in a developing country and might have different acoustic problems compared to thestandard ward. This study aims to understand the soundscape dimension in a third-class hospital ward. Twoexperiments were conducted: the development of semantic scales and the identification of soundscapedimensions. The semantic scales were developed by asking the patient about the feeling in the ward. Most ofthe terms used to describe the environment are negative terms such as annoying, boring, scary, upset, anduncomfortable.
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 theimportant 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 outdoorarea(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 noiseof 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). Thisapproach focuses more on what people feel and perceive in the environment, not only based on soundlevel measurement. Previous studies have been conducted in several areas in a hospital such as theIntensive Care Unit (9,11) of hospital ward (7,12). Most of the previous study tries to enhance theacoustic 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 -classhospital 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 few more beds than the other types. The number of beds is within the range of14194

anugrah@tf.itb.ac.id6 – 8 beds with 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 eachother and only separated by a curtain. In this room class, the beds are separated by thin curtain tovisually 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-ninerespondents (28 males and 31 females) voluntarily join the experiment. 36 patients joint theexperiment 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 hospitalward were asked about what they feel in the ward. The perception appeared in this step thenimplemented to develop a set of semantic scales. In the second steps, the patients of the ward wererequested 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.

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3. Analysis
The first experiment was conducted to developed semantic scales. Several perceptions weregathered in this experiment as shown in Table 1.
Table 1 – Term used to explain the situation in the third-class hospital ward
IndonesianEnglish Translation

IndonesianEnglish Translation

MenggangguDisturbing

Tidak nyaman

Uncomfortable

Membosankan

BoringDinamisDynamicMenakutkan

ScarySempit

CrampedTertekan

Depressed

LambatSlowPuas

Satisfied

Penuh

Full

Ribut

Noisy

Kesal

AnnoyedTidak 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
IndonesianEnglish 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-nyamanUncomfortable-comfortable

Dinamis-monoton

Dynamic-monotonous

Sempit-luas

Cramped-spacious

Lambat-Cepat

Slow-fastPenuh-kosong

Full-empty

Kesal-Senang

Annoyed-pleased

Further analysis is conducted by analysing the score of perception rating. The median value of thescore is shown in figure 2. Contrary to the term found in the first experiment, the rating shows that ingeneral, 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 feelthat 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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Disturbing
2

Annoying

Boring1

Scary

Full0-1

Slow

Depressing-2

CrampedSatisfiedDynamicNoisy

Uncomfortable

Not private

Figure 2 – Median score of perception rating in third-ward hospital
Further analysis is conducted using principal component analysis to determine the soundscapedimensions of the third-class hospital ward. The PCA result is shown in Table 3. The soundscapedimensions 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

00.88

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

00.22Uncomfortable

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

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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 isrepresented by the semantic scale of disturbing, and uncomfortab le
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 thesemantic scales of boring and scary.
5. The dimension related to the perception of satisfaction (11%). This dimension isrepresented by the semantic scales of satisfied and annoyed.
The dimension of privacy become the most dominant soundscape dimension. This privacy of theward 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 tothe 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 (pleasantnessand 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 ashort 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 whoworks in the Intensive Care Unit (ICU)(11) and a student in a class (17). In this environment, the mostdominant 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 theperception 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, overallrating, and soundscape dimensions. The verbal response from the patients indicates a negative acousticenvironment. 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 , andthis 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 .

REFERENCES
1.

Monti F, Agostini F, Dellabartola S, Neri E, Bozicevic L, Pocecco M. Pictorial intervention in a pediatrichospital environment: Effects on parental affective perception of the unit. J Environ Psychol [Internet].
2012;32(3):216–24. Available from: http://dx.doi.org/10.1016/j.jenvp.2012.03.001

2.

Ghazali R, Abbas MY. Assessment of Healing Environment in Paediatric Wards. Procedia - Soc Behav
Sci[Internet].

2012;38(December2010):149–59.

Availablefrom:

http://dx.doi.org/10.1016/j.sbspro.2012.03.3353.

Hsu, T.

et al. Noise Pollution in Hospitals: Impact on Patients. www.jcomjournal.com [Internet]. 2012

[cited 2017 Jun 8];19(7). Available from: http://ww.w.turner-white.com/pdf/jcom_jul12_noise.pdf

4198

4.

Konkani A, Oakley B. Noise in hospital intensive care units—a critical review of a critical topic. 2012.

5.

Rhiana F, Sarwono J, Soelami FN. Acoustic analysis of High Care Unit (HCU) at hospital “X” inBandung, Indonesia. In: 2011 2nd International Conference on Instrumentation, Communications,Information Technology, and Biomedical Engineering [Internet]. IEEE; 2011 [cited 2017 Jun 8]. p. 58–
63. Available from: http://ieeexplore.ieee.org/document/6108594/

6.

Ryherd EE, West JE, Busch-Vishniac IJ, Waye KP. Evaluating the Hospital Soundscape. Acoust Today.
2008;4(4):22.

7.

Mackrill J, Jennings P, Cain R. Exploring positive hospital ward soundscape interventions. Appl Ergon[Internet]. 2014;45(6):1454–60. Available from: http://dx.doi.org/10.1016/j.apergo.2014.04.005

8.

Rofiatun I, Azzahra N, Sarwono J, Sudarsono AS, Frans R. Hospital Soundscapes : Perception Analysisof Acoustics Environment in Intensive Care Unit. Inter Noise 2017. 2017;1811–6.

9.

Park M, Kohlrausch A, de Bruijn W, de Jager P, Simons K. Analysis of the soundscape in an intensive
care unit based on the annotation of an audio recordinga). J Acoust Soc Am [Internet].
2014;135(4):1875–86.

Availablefrom:

http://scitation.aip.org/content/asa/journal/jasa/135/4/10.1121/1.4868367
10.

Okcu S, Ryherd EE, Zimring C, Samuels O. Soundscape evaluations in two critical healthcare settings
with different designs. J Acoust Soc Am [Internet]. 2011 Sep [cited 2013 Nov 11];130(3):1348–58.
Available from: http://www.ncbi.nlm.nih.gov/pubmed/21895076

11.

Azzahra IRN, Sarwono J, Sudarsono AS, Fela RF, Utami SS, Hardjoprawito TJA, et al. Hospitalsoundscapes: Perception analysis of acoustics environment in intensive care unit. In: INTER-NOISE
2017 - 46th International Congress and Exposition on Noise Control Engineering: Taming Noise andMoving Quiet. 2017.

12.

Mackrill J, Cain R, Jennings P. Experiencing the hospital ward soundscape: Towards a model. J Environ
Psychol [Internet]. 2013;36:1–8. Available from: http://dx.doi.org/10.1016/j.jenvp.2013.06.004

13.

Axelsson Ö, Nilsson ME, Berglund B. A principal components model of soundscape perception. JAcoust Soc Am [Internet]. 2010 Nov [cited 2013 Nov 11];128(5):2836–46. Available from:http://www.ncbi.nlm.nih.gov/pubmed/21110579

14.

Kang J, Zhang M. Semantic differential analysis of the soundscape in urban open public spaces. Build
Environ[Internet].

2010Jan[cited2013Nov6];45(1):150–7.

Availablefrom:http://linkinghub.elsevier.com/retrieve/pii/S0360132309001309
15.

Sudarsono AS, Lam YW, Davies WJ. The effect of sound level on perception of reproduced soundscapes.
ApplAcoust[Internet].

2016

Sep;110:53–60.

Availablefrom:

http://linkinghub.elsevier.com/retrieve/pii/S0003682X16300482
16.

Ikhwanuddin R, Sarwono J, Sudarsono AS, Utami SS. Library soundscape: Higher education students’
perception. In: INTER-NOISE 2017 - 46th International Congress and Exposition on Noise Control
Engineering: Taming Noise and Moving Quiet. 2017.

17.

Djimantoro MI. Multisensory experience for mental health in higher education classroom design. IOP
Conf Ser Earth Environ Sci. 2018;195(1).

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