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
5. The Design Case Kidkit
5.1 Context & Problemnext section
A daughter of a patient with head injury explains how her mother told her that she thought she died several times while slowly waking up from an unconscious state in the hospital. She later explained that this experience was triggered by the alarm sound from another bed in the shared ward. She associated this sound with that of a heart monitor stopping as she remembered it from movies. (Højlund and Kinch, field notes)
Building upon field work and interviews with patients, anthropologist Tom Rice describes the hospital as a holistic entity with an “unusual atmosphere of sensory absences” (Rice 2003: 5) – caused by the lack of tactile, visual and olfactory, among other, stimuli – leading to a sense of alienation and detachment from the surroundings. These sensory absences often cause the soundscape of the hospital to shift to the foreground of attention, making hearing one of the most important senses for understanding and making sense of the environment. This resonates with statements from the nurses at NIA, in which noise is said to be the main stressor. In initial stages of the research, one of the nurses stated that her biggest wish was that someone would design a noise deflector that could create a private atmosphere for the patients and relatives in the shared wards.
The soundscape of this unit, as is often experienced in modern functionalistic hospitals in general (Frandsen et al. 2009: 71), is dominated by a cacophony of alarms and other functional sounds relevant for specific members of the staff. As they are not relevant or functional for the patients, they become unwanted noise for them. Because the alarming sounds are designed to arouse and attract attention, they are difficult to ignore and resist being shifted to background awareness, and thus interfere with patients’ attempts to sleep, interact, or relax. Combined with other sounds from, for example, equipment and conversations, they form a complex soundscape with many intrusive sounds, intensified by long reverberation times related to the acoustic properties of hard tiled walls and floors. This soundscape induces unnecessary anxiety and aroused body states, counteracts healing and sleeping, and augments the feeling of seclusion and alienation from the environment.
After being prepared through a verbal explanation in the waiting room, two brothers, seven and five years old, enter the ward to meet their hospitalised mother for the first time following her accident. The nurse explains that the two kids feel ill at ease when entering the ward and that “both of them are standing at a remarkable distance from the bed. Neither of the boys moves closer when the mother extends her hand”. The nurse believes that they are frightened and that this is why they approach their mother as a stranger. Afterwards the nurse says that she believes “that this visit was not, by any means, successful for anyone”. (Højlund and Kinch, field notes)
Nurses stress that children brought to the unit must be meticulously prepared in the waiting room for what they are about to experience, in particular concerning the many alarming sounds in the ward. The sudden shift in atmosphere from waiting room to ward often becomes an obstacle for an engaged meeting with the relative. The actual change in atmosphere itself becomes the foreground of attention, even though all parties would prefer this to remain in the background. In such a situation, the rhythms of the alarming atmosphere in the ward affect the bodily rhythms of the child, which leads to a feeling of stress in response to aroused bodily rhythms. Our main design challenge has been to find an adequate response to this invisible obstacle between child and environment.
5.2 Form & interaction
Kidkit is flexible interactive furniture, which accompanies the children and nurse throughout a visit: from the waiting room, to the ward, and back again. Its flexibility allows for change in form, and its interaction corresponds to the specific functions it serves during the different stages of the visit. Kidkit is designed with the overall rhythm and structure of the visit in mind: First, Kidkit assists children through the entire visit, becoming a secure anchor that can detract focus from the sudden shifts in atmospheres, thus helping the children become more sensitive to time than to spaces. Second, the temporal design allows for adaption to specific rhythmical functions, appropriate to the different environmental settings. Taking these aspects into account, the bodily rhythms of the children adapt in relation to their habituation process, as described below. We thus present different design tactics relating to specific stages of the visit:
VideoObject2: Kidkit in use
a) When Kidkit is introduced to the user in the waiting room for the first time, it is in the form of five upholstered blocks, stacked into two piles, the upper block of each of the two piles being flexible. Kidkit is designed to afford two occupants (child and adult) a surface to sit on, at eye-level with each other, accommodating an intimate atmosphere. A touch interface with eight sound triggers (explained in detail in the next section) is sewn onto the surface of the upper, green, block of Kidkit.
VideoObject3: Kidkit sound triggers
b) When the users are ready to go into the ward, the wheels of Kidkit are revealed by means of a handle, thus making it possible to lift and lower the furniture and wheel it from one space to another. The mobility of Kidkit allows the child to bring something to which she is habituated into the ward, encouraging her to take ownership of Kidkit before, during, and after the visit as a familiar anchor in a confusing and unknown environment.
VideoObject4: Kidkit wheeling
c) The flexibility of the form allows the child to alter the form from that of a seat to a stairway configuration when placed by the bedside in the ward, assisting her to stand, at eye-level, beside the hospitalised relative. The physical, bodily, way of interacting with Kidkit, through rhythmic folding and unfolding manoeuvres, invites the child to create meaning through embodied interaction.
VideoObject5: Kidkit unfolding
The colours support the various transformations of Kidkit. In the waiting room, where it serves as a tool for playful exploration, Kidkit exhibits strong colours. In the ward, in the stairway configuration, the sound triggers are hidden, and its most visible colours are in the grey scale, so as to attract less visual attention. The simplicity of the quadrangular shapes of the five poufs is similar to building blocks, and the shape of Kidkit, corresponding to the scale of a child’s body, allows for flexible play practices. We emphasize that Kidkit is not a handheld device, but furniture that physically relates equally to body and space, affording collective use. In this manner, Kidkit initiates a shared transitional space, for the child, the other relatives, and also for the nurse, assisting them with coordinating the visit (Kinch and Højlund 2013). Furthermore, the size and materiality of Kidkit challenges the child to be physically engaged, moving focus away from the sudden shifts in atmospheres.
5.3 Sound Design
Magnus, a seven-year-old boy is going to visit his hospitalised sister who has a brain tumour. In the waiting room he meets Kidkit and pushes one button at a time, triggering the sounds. When he asks, ”Can these sounds be heard by Julia right now?” the nurse answers, ”No, the sounds around Julia are coming from the equipment and the two other patients. The equipment is noisy because it wants the nurse to look at it. It does not make noise because the patients are in pain”. This conversation gives the boy insight into the sounds of the apparatus, and after this conversation, he and the nurse decide to go and see Julia. Upon entering the ward and during the meeting, Magnus is focused on his sister. He appears relaxed and tells stories. Afterwards, when we are in the waiting room, we ask him about the alarming sounds in the ward, but he says that he did not notice them at the time. We then asked him if he thinks he heard any of the sounds from Kidkit introduced earlier in the ward. He answers, “Yes, I heard the funny dododododo sound”, and he repeats it in a rhythmic pattern similar to the sound from the Kidkit, which was sampled from one of the alarm sounds in the ward. (Højlund and Kinch, field notes)
Following the specific sound design focus presented in this article, Époché is implemented as a tactic to design for embodied sound habituation in the waiting room. Époché refers to a practice presented by Pierre Schaeffer (reworked by Michel Chion). Adapted from a phenomenological understanding of how the bracketing of a phenomenon can open up a method to examine it aside from one’s associated assumptions and beliefs, the concept refers to the process of putting specific sounds in parentheses in order to actively create reduced listening circumstances (Chion 2009: 28). Reduced listening can change listening from serving as a vehicle of meaning concerning the source, asking us, instead, to listen to the sound itself. By isolating or moving the sound from its source and out of the audio-visual complex to which it initially belonged (what Schaeffer calls acousmatic listening) and listening to it repeatedly, one can actively recondition one’s habitual listening patterns and references. This will allow “us to clarify many phenomena implicit in our perception” (Chion 2009: 31). Although the most natural mode of listening is to try and understand the sound by identifying its source, this repeated reduced listening can “perhaps ‘exhaust’ this curiosity and little by little impose ‘the sound object as a perception worthy of being listened to for itself’” (Chion 2009: 12).
Époché, through repeated reduced listening, can set the ground for habituating sounds quickly, thus changing the attitude towards them, e.g. through developing a more musical perception in the waiting room. This tactic is unfolded by presenting the eight sounds separately from each other. One button triggers one sound file as feedback, made with touch sensors and a phidgets board. Hidden beneath the upholstery, a computer and loudspeaker play the sounds that have been sampled directly from the ward. These sounds are based on a one-hour recording made in the ward - where the nurses presented all sounds they found dominating, not only alarm sounds, but also noises made while handling equipment - that were thought to be suitable for sampling. The duration of the different sound files is two seconds, maximum, and the sounds are categorised into three groups: yellow areas play three different alarm sounds, red areas play two suction sounds from a respirator, and the blue areas play three dominating equipment sounds, e.g. the lid of a bin being shut. The characters of the eight sounds are quite different in pitch, timbre, rhythm, and expression. The feedback is immediate and can be triggered again and again when pushed, and the system can play several sounds on top of each other if more than one trigger is activated. In this way the child is able to create a rhythmic pattern corresponding to well-known beat structure, resembling a drum loop with various drums, and thus conditioning a musical interpretation of the sounds.
The embodied experience of controlling the concrete rhythms of the environment repeatedly in one’s own tempo can help children to synchronise the sounds with their own bodily rhythms. In this way, the alarming sounds can be shifted to background awareness upon entering the ward, as they are now habituated as familiar, expected, and predictable in the context rather than frightening and uncontrollable.
Magnus’ interaction with Kidkit indicates that he habituated the “dododododo” alarm sound anew and could separate it from the rest of the sounds in the ward.
The way he repeated the sound, rhythmically and melodically as in the sound sample, and referred to it as funny indicates that the strategy of embodied sound habituation through Époché in the waiting room helped him transform his perception of the sound into something primarily musical and not frightening. Furthermore, his statement that during the visit in the ward he did not really notice the sounds indicates that he was able to put the alarming atmosphere in his background awareness, leaving room for the visit to take the foreground of attention.