Journal of Sonic Studies, volume 6, nr. 1 (January 2014)Marie Højlund; Sofie Kinch: ALARMING ATMOSPHERES - EMBODIED SOUND HABITUATION AS DESIGN STRATEGY IN A NEURO-INTENSIVE CARE UNIT
Many parents are, certainly, fearful of bringing their children here, and they are not pleased to do it, and that is, of course, understandable. They want to protect their children. (Nurse at the Neuro-Intensive Care Unit at Aarhus University Hospital)
Through a design project, we seek to explore how introducing sounds from the hospital ward into the waiting room at a Neuro-Intensive Care Unit can be a helpful tool in facilitating a less stressful visit situation between a child and the hospitalised relative. The project is a response to a growing wish amongst staff at NIA, the Neuro-Intensive Care Unit at Aarhus University Hospital, to motivate parents to bring children to visit relatives, with the understanding that it is important to involve children in the hospital stay of a relative, as they need to demystify the situation – fantasies are replaced by an experience of the actual situation – and they can benefit from being included in the process instead of feeling left out (Heslet 2010). Today, nurses spend much time informing relatives about the importance of this involvement, but more often than not, relatives maintain the belief that the hospital is an environment not suitable for their youngest children. Not only the meeting with a sick relative, but also the context of the hospital keep parents from bringing their children. To understand how we might meet the worries of relatives facing the visit situation, this research investigates what sets the grounds for such scepticism and how we, in a respectful manner, can prepare the visit in order to make it more inviting to bring children. The video below gives an impression of the design context:
VideoObject1: Impression of NIA
NIA represents a typical Neuro-Intensive Care Unit in Denmark where patients are hovering between life and death due to severe head and spine injuries. On the left-hand side of the main corridor is a small waiting room. Visitors often spend hours here, waiting for the right time to visit their relatives in one of the two wards, each holding six beds. The wards are located on the right-hand side of the corridor, each one separated by a glass monitoring room, where 6-8 nurses and doctors constantly monitor the patients. In addition to the ambient noise of conversations, equipment, computers and phones coming from the monitoring room, the soundscape of the wards also includes the constant beeping from up to fifteen alarms per bed, mixed with sounds from equipment that, when handled, can be quite loud. The sounds are not easily differentiated and emerge as a cacophony, difficult to understand for others than the experienced staff. Therefore, the staff emphasises that the soundscape of NIA represents the primary stressor to patients and visitors, as they perceive it as both intrusive and alarming. This experience is supported and documented in several studies made in similar hospital environments, showing how unwanted sound, or noise, is a general problem in the modern hospital (Falk and Woods 1973; Baker 1984; Meredith and Edworthy 1995; Berg 2001; Rice 2003; Busch-Vishniac et al. 2005; Edworthy and Hellier 2005; Ugras and Öztekin 2007; Wainwright and Wynne 2007).
The nurses insist that children who are visiting NIA for the first time should be meticulously prepared for what they are about to experience before entering the ward. Otherwise they might become anxious, or even panic, which inevitably obstructs the aim of the visit. The nurses typically try to demystify the situation in the waiting room by drawing and talking about the hospital apparatus. However, relevant tools are lacking to prepare the children in an appropriate way for the soundscape, as it is difficult to mimic its effect using only words or drawings. This often leaves the children standing, frozen, in the ward, as the unfamiliar sensorial impression inhabits the foreground of their attention, leaving no perceptual room for the meeting. Therefore, in response to this concrete challenge, we initiated the development of the design artefact Kidkit, which invites children to familiarise themselves with the alarming sounds they will face in the ward, through the process of controlling and repeating them in an embodied and socially engaging way, with interactive furniture in the waiting room.
With specific attention for how the multiple sensory inputs of an environment affects the way we feel, behave and interact with others, the notion of atmosphere is presented as the overall theoretical approach when designing a tool to help children prepare for engaging with environments in which the soundscape forms an obstacle for social relations and/or a relaxing bodily state (Thibaud 2011). A focus on atmospheres underlines the impact of these impressions on the people involved, relevant to the view of a hospital setting as a place filled with unfamiliar sense impressions. From a design point of view, the concept of atmosphere is to be understood as a dynamic shift between those factors that might inhabit the foreground of the subject’s attention and which might later inhabit her background awareness. The relations between different states of awareness are essential to the way we habituate ourselves to a place. Habituation is an often-overlooked phenomenon when investigating how humans sense, and cope with, their surroundings (Horowitz 2013: 44). Building upon habituation to atmospheres, ascribing to a dynamic perspective inspired by Henri Lefebvre’s (Lefebvre 2004) concept of rhythm, we introduce embodied sound habituation as design strategy. Exploring how to smooth the way for a faster habituation process within alarming atmospheres, a strategy has been developed through implementing different tactics in the concrete design project, Kidkit.
In a broader perspective, embodied sound habituation represents a design strategy that challenges the growing field of solutions aimed at improving the quality of hospital environments through positive distractions (Hamilton and Shepley 2012: 165). Instead of offering a momentary distraction from the environment, embodied sound habituation aims at imposing a change in the attitude of the user towards an existing situation. Guiding the user to become an integrated and meaningful part of the existing environment is relevant in situations where it is not desirable to be distracted from the social and spatial surroundings, e.g. when interacting with others.