E. Fasllija
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Hospital Soundscapes
Integrating Psychoacoustics and ISO 12913-based Perceptual Assessment for Departmental Profiling and Evidence-based Interventions
Every patient admitted to a hospital carries an invisible vulnerability. Pain, fatigue, and fear strip away the ordinary defences through which healthy people filter unwanted stimulation. In that condition, sound becomes something more than noise. It becomes part of the experience of being ill, and part of the experience of healing.
This thesis examines the acoustic environments of four clinical departments — Emergency, Intensive Care Unit, Oncology, and Haematology — across four Dutch hospitals. Its central argument is that hospital sound cannot be adequately understood through decibels alone. The study proposes and demonstrates an integrated approach that combines psychoacoustic metrics derived from the Zwicker model with ISO 12913-based perception surveys, to characterise not only how loud a department is, but how it is perceived.
Data were collected through 124 calibrated acoustic measurements and 86 in-situ perception surveys, administered simultaneously to staff and patients, enabling direct pairing of objective and subjective datasets. The findings show that hospital departments differ not only in volume but in acoustic profile. The Emergency department recorded the highest values across every dimension measured and was perceived as chaotic and acoustically inappropriate. Haematology achieved the quietest and most acoustically favourable profile, an outcome attributable to private room enclosure and soft-close hardware rather than reduced staffing or patient activity. The Intensive Care Unit and Oncology occupied intermediate positions with distinctly different acoustic characters: the ICU registered lower mean annoyance overall yet was perceived as persistently harsh, owing to the tonal character of monitoring alarms reflected in the highest tonality values of any department; Oncology carried a higher mean annoyance distributed more evenly across equipment and environmental sources, rendering it perceptually more tolerable in quality despite the comparable sound level.
The strongest statistical relationship identified is between equivalent sound level and perceived appropriateness, with a Spearman correlation of -0.94, p < 0.01. This finding reinforces the core argument: in clinical environments, how appropriate a soundscape feels is more strongly predicted by its acoustic character than by its level.
The ISO 12913 framework demonstrated diagnostic utility, separating departments on the soundscape circumplex and integrating objective with perceptual data. Method A proved feasible in active clinical settings. Three adaptations are identified as necessary for hospital research specifically: a proxy or observational pathway for patients unable to complete the perception questionnaire; longitudinal sampling in place of single-session surveys, since hospital acoustic exposure is sustained rather than momentary; and explicit treatment of clinical role as a perceptual moderator rather than untreated background context.
The thesis translates these findings into department-specific intervention priorities and a business case linking acoustic quality to patient experience, staff retention, alarm safety, and clinical recovery. The evidence points toward a model of soundscape-informed design in which psychoacoustic profiling, alongside conventional noise measurement, becomes a standard component of hospital acoustic assessment.
Hospitals will never be silent. Nor should they be. ...
This thesis examines the acoustic environments of four clinical departments — Emergency, Intensive Care Unit, Oncology, and Haematology — across four Dutch hospitals. Its central argument is that hospital sound cannot be adequately understood through decibels alone. The study proposes and demonstrates an integrated approach that combines psychoacoustic metrics derived from the Zwicker model with ISO 12913-based perception surveys, to characterise not only how loud a department is, but how it is perceived.
Data were collected through 124 calibrated acoustic measurements and 86 in-situ perception surveys, administered simultaneously to staff and patients, enabling direct pairing of objective and subjective datasets. The findings show that hospital departments differ not only in volume but in acoustic profile. The Emergency department recorded the highest values across every dimension measured and was perceived as chaotic and acoustically inappropriate. Haematology achieved the quietest and most acoustically favourable profile, an outcome attributable to private room enclosure and soft-close hardware rather than reduced staffing or patient activity. The Intensive Care Unit and Oncology occupied intermediate positions with distinctly different acoustic characters: the ICU registered lower mean annoyance overall yet was perceived as persistently harsh, owing to the tonal character of monitoring alarms reflected in the highest tonality values of any department; Oncology carried a higher mean annoyance distributed more evenly across equipment and environmental sources, rendering it perceptually more tolerable in quality despite the comparable sound level.
The strongest statistical relationship identified is between equivalent sound level and perceived appropriateness, with a Spearman correlation of -0.94, p < 0.01. This finding reinforces the core argument: in clinical environments, how appropriate a soundscape feels is more strongly predicted by its acoustic character than by its level.
The ISO 12913 framework demonstrated diagnostic utility, separating departments on the soundscape circumplex and integrating objective with perceptual data. Method A proved feasible in active clinical settings. Three adaptations are identified as necessary for hospital research specifically: a proxy or observational pathway for patients unable to complete the perception questionnaire; longitudinal sampling in place of single-session surveys, since hospital acoustic exposure is sustained rather than momentary; and explicit treatment of clinical role as a perceptual moderator rather than untreated background context.
The thesis translates these findings into department-specific intervention priorities and a business case linking acoustic quality to patient experience, staff retention, alarm safety, and clinical recovery. The evidence points toward a model of soundscape-informed design in which psychoacoustic profiling, alongside conventional noise measurement, becomes a standard component of hospital acoustic assessment.
Hospitals will never be silent. Nor should they be. ...
Every patient admitted to a hospital carries an invisible vulnerability. Pain, fatigue, and fear strip away the ordinary defences through which healthy people filter unwanted stimulation. In that condition, sound becomes something more than noise. It becomes part of the experience of being ill, and part of the experience of healing.
This thesis examines the acoustic environments of four clinical departments — Emergency, Intensive Care Unit, Oncology, and Haematology — across four Dutch hospitals. Its central argument is that hospital sound cannot be adequately understood through decibels alone. The study proposes and demonstrates an integrated approach that combines psychoacoustic metrics derived from the Zwicker model with ISO 12913-based perception surveys, to characterise not only how loud a department is, but how it is perceived.
Data were collected through 124 calibrated acoustic measurements and 86 in-situ perception surveys, administered simultaneously to staff and patients, enabling direct pairing of objective and subjective datasets. The findings show that hospital departments differ not only in volume but in acoustic profile. The Emergency department recorded the highest values across every dimension measured and was perceived as chaotic and acoustically inappropriate. Haematology achieved the quietest and most acoustically favourable profile, an outcome attributable to private room enclosure and soft-close hardware rather than reduced staffing or patient activity. The Intensive Care Unit and Oncology occupied intermediate positions with distinctly different acoustic characters: the ICU registered lower mean annoyance overall yet was perceived as persistently harsh, owing to the tonal character of monitoring alarms reflected in the highest tonality values of any department; Oncology carried a higher mean annoyance distributed more evenly across equipment and environmental sources, rendering it perceptually more tolerable in quality despite the comparable sound level.
The strongest statistical relationship identified is between equivalent sound level and perceived appropriateness, with a Spearman correlation of -0.94, p < 0.01. This finding reinforces the core argument: in clinical environments, how appropriate a soundscape feels is more strongly predicted by its acoustic character than by its level.
The ISO 12913 framework demonstrated diagnostic utility, separating departments on the soundscape circumplex and integrating objective with perceptual data. Method A proved feasible in active clinical settings. Three adaptations are identified as necessary for hospital research specifically: a proxy or observational pathway for patients unable to complete the perception questionnaire; longitudinal sampling in place of single-session surveys, since hospital acoustic exposure is sustained rather than momentary; and explicit treatment of clinical role as a perceptual moderator rather than untreated background context.
The thesis translates these findings into department-specific intervention priorities and a business case linking acoustic quality to patient experience, staff retention, alarm safety, and clinical recovery. The evidence points toward a model of soundscape-informed design in which psychoacoustic profiling, alongside conventional noise measurement, becomes a standard component of hospital acoustic assessment.
Hospitals will never be silent. Nor should they be.
This thesis examines the acoustic environments of four clinical departments — Emergency, Intensive Care Unit, Oncology, and Haematology — across four Dutch hospitals. Its central argument is that hospital sound cannot be adequately understood through decibels alone. The study proposes and demonstrates an integrated approach that combines psychoacoustic metrics derived from the Zwicker model with ISO 12913-based perception surveys, to characterise not only how loud a department is, but how it is perceived.
Data were collected through 124 calibrated acoustic measurements and 86 in-situ perception surveys, administered simultaneously to staff and patients, enabling direct pairing of objective and subjective datasets. The findings show that hospital departments differ not only in volume but in acoustic profile. The Emergency department recorded the highest values across every dimension measured and was perceived as chaotic and acoustically inappropriate. Haematology achieved the quietest and most acoustically favourable profile, an outcome attributable to private room enclosure and soft-close hardware rather than reduced staffing or patient activity. The Intensive Care Unit and Oncology occupied intermediate positions with distinctly different acoustic characters: the ICU registered lower mean annoyance overall yet was perceived as persistently harsh, owing to the tonal character of monitoring alarms reflected in the highest tonality values of any department; Oncology carried a higher mean annoyance distributed more evenly across equipment and environmental sources, rendering it perceptually more tolerable in quality despite the comparable sound level.
The strongest statistical relationship identified is between equivalent sound level and perceived appropriateness, with a Spearman correlation of -0.94, p < 0.01. This finding reinforces the core argument: in clinical environments, how appropriate a soundscape feels is more strongly predicted by its acoustic character than by its level.
The ISO 12913 framework demonstrated diagnostic utility, separating departments on the soundscape circumplex and integrating objective with perceptual data. Method A proved feasible in active clinical settings. Three adaptations are identified as necessary for hospital research specifically: a proxy or observational pathway for patients unable to complete the perception questionnaire; longitudinal sampling in place of single-session surveys, since hospital acoustic exposure is sustained rather than momentary; and explicit treatment of clinical role as a perceptual moderator rather than untreated background context.
The thesis translates these findings into department-specific intervention priorities and a business case linking acoustic quality to patient experience, staff retention, alarm safety, and clinical recovery. The evidence points toward a model of soundscape-informed design in which psychoacoustic profiling, alongside conventional noise measurement, becomes a standard component of hospital acoustic assessment.
Hospitals will never be silent. Nor should they be.
The Intensive Care Unit (ICU) is a high-stress environment that often disrupts patients’ circadian rhythms and emotional well-being due to artificial lighting, unfamiliar routines, and the absence of natural day-night cues. This project explores how lighting interventions can improve the ICU experience from the perspective of critically ill patients. Conducted in collaboration with Critical Alarms Lab (TU Delft) and Leiden University Medical Center (LUMC), the study followed a human-centered design process to understand and address patient challenges related to light exposure.
Through observations, interviews with healthcare professionals, and environmental light assessments, key vulnerable moments in the patient journey particularly during waking and sleep preparation were identified. This led to the development of LumoGlaze, a wearable smart goggle, and LumoSync, a mobile app that uses physiological data (Heart rate and sleep phase from Fitbit) to adapt lighting. The system provides calming evening light and a morning bright light therapy to support circadian alignment.
Prototypes were refined through iterative testing and evaluated in a simulated ICU setting. Participants reported the system as comfortable, intuitive, and non-intrusive. While physiological data showed no significant variations across lighting modes, the intervention was perceived as supportive in creating a calmer environment.
This work highlights the potential of patient-centered, non-pharmacological lighting solutions in critical care. LumoGlaze serves as a blueprint for integrating adaptive, human-focused lighting technology into healthcare environments. Future recommendations include in-site ICU testing, extended physiological monitoring, and exploring more personalized lighting strategies. ...
Through observations, interviews with healthcare professionals, and environmental light assessments, key vulnerable moments in the patient journey particularly during waking and sleep preparation were identified. This led to the development of LumoGlaze, a wearable smart goggle, and LumoSync, a mobile app that uses physiological data (Heart rate and sleep phase from Fitbit) to adapt lighting. The system provides calming evening light and a morning bright light therapy to support circadian alignment.
Prototypes were refined through iterative testing and evaluated in a simulated ICU setting. Participants reported the system as comfortable, intuitive, and non-intrusive. While physiological data showed no significant variations across lighting modes, the intervention was perceived as supportive in creating a calmer environment.
This work highlights the potential of patient-centered, non-pharmacological lighting solutions in critical care. LumoGlaze serves as a blueprint for integrating adaptive, human-focused lighting technology into healthcare environments. Future recommendations include in-site ICU testing, extended physiological monitoring, and exploring more personalized lighting strategies. ...
The Intensive Care Unit (ICU) is a high-stress environment that often disrupts patients’ circadian rhythms and emotional well-being due to artificial lighting, unfamiliar routines, and the absence of natural day-night cues. This project explores how lighting interventions can improve the ICU experience from the perspective of critically ill patients. Conducted in collaboration with Critical Alarms Lab (TU Delft) and Leiden University Medical Center (LUMC), the study followed a human-centered design process to understand and address patient challenges related to light exposure.
Through observations, interviews with healthcare professionals, and environmental light assessments, key vulnerable moments in the patient journey particularly during waking and sleep preparation were identified. This led to the development of LumoGlaze, a wearable smart goggle, and LumoSync, a mobile app that uses physiological data (Heart rate and sleep phase from Fitbit) to adapt lighting. The system provides calming evening light and a morning bright light therapy to support circadian alignment.
Prototypes were refined through iterative testing and evaluated in a simulated ICU setting. Participants reported the system as comfortable, intuitive, and non-intrusive. While physiological data showed no significant variations across lighting modes, the intervention was perceived as supportive in creating a calmer environment.
This work highlights the potential of patient-centered, non-pharmacological lighting solutions in critical care. LumoGlaze serves as a blueprint for integrating adaptive, human-focused lighting technology into healthcare environments. Future recommendations include in-site ICU testing, extended physiological monitoring, and exploring more personalized lighting strategies.
Through observations, interviews with healthcare professionals, and environmental light assessments, key vulnerable moments in the patient journey particularly during waking and sleep preparation were identified. This led to the development of LumoGlaze, a wearable smart goggle, and LumoSync, a mobile app that uses physiological data (Heart rate and sleep phase from Fitbit) to adapt lighting. The system provides calming evening light and a morning bright light therapy to support circadian alignment.
Prototypes were refined through iterative testing and evaluated in a simulated ICU setting. Participants reported the system as comfortable, intuitive, and non-intrusive. While physiological data showed no significant variations across lighting modes, the intervention was perceived as supportive in creating a calmer environment.
This work highlights the potential of patient-centered, non-pharmacological lighting solutions in critical care. LumoGlaze serves as a blueprint for integrating adaptive, human-focused lighting technology into healthcare environments. Future recommendations include in-site ICU testing, extended physiological monitoring, and exploring more personalized lighting strategies.
In critical care environments like the Intensive Care Unit (ICU) , patients are surrounded by an abundance of unwanted sounds from the medical alarms and equipment that often lead to heightened stress, confusion and psychological discomfort. This graduation project explores how the acoustic environment of the Adult Intensive Care Unit can be reimagined to support the critically ill patients using a soundscape system. The context of this project is the Leiden University Medical Centre (LUMC) and the stakeholders considered in this project along with the patients are the healthcare providers and loved ones.
Existing literature and field studies reveal that while sound is a vital component for healthcare professionals (HCP) to monitor patient status, it is often a source of disruption and emotional strain for patients and their loved ones. The project identifies a gap in current interventions, which largely focus on reducing noise rather than enhancing the patient’s experience. A soundscape is defined as the acoustic environment as perceived or experienced and/or understood by a person or people, in context (ISO 12913, 2014). The current acoustic environment has been outlined through a context study, along with its impact on key stakeholders. This provided a clear understanding how the current ICU soundscape hinders the emotional well - being of the patients. A multi-method research approach was conducted, including contextual observations at LUMC, interviews with healthcare providers, and a review of ICU patient experiences to identify the affected psychological needs of patients.
From these insights, a detailed patient journey map was created, highlighting critical moments where the auditory environment could support or hinder well-being. Through a thorough understanding of the journey map , four unfulfilled psychological needs were identified - Lack of autonomy , relatedness, security and comfort. Following literature, these unfulfilled psychological human needs can be fulfilled by providing the right sonic ambience at the right moment. A need for connectedness with the outside world through these sonic ambiences was investigated to be fulfilled to meet the identified fundamental needs. Literature explores how need based sonic ambiences should be tested for their functional role i.e. to comfort, to distract during long stretches of time without visitation or spontaneous breathing trails etc. Connectedness to environment became a facet to explore as a design direction which was further explored in the event based journey map of the patient through different times of the day and modes for sonic ambiences which could fulfil the desired functions. These findings underlined the importance of a personalized approach to creating meaningful soundscapes within the ICU. By mapping out key moments of interaction, the framework for the system was outlined detailing when and how each stakeholder would be engaged. Implementation touchpoints were identified as: patients pre-admission, loved ones at the beginning of the ICU stay, and healthcare providers throughout the admission, who would be responsible for tailoring and adjusting the sonic experience. This multi-stakeholder approach became essential for integrating the system into the complex ICU environment.
Several mobile and tablet based prototypes were created to conduct usability tests with fellow students to test the engagement on the app and how easily sounds are selected based on contextual cues like related to specific given environments (like forest, beach ,Café )leading to the most intuitive methods to be implemented in the real world setting.
The resulting design, SoulSound, is a soundscape system integrated into the ICU room to deliver personalized auditory experiences that help patients feel a sense of connectedness to positive environments in an otherwise sterile and unsettling atmosphere. The system includes an interface for input collection by patients, family members, or HCPs and dynamically adjusts sound based on changing needs throughout the day. Four key sonic functions were defined: calming, distracting, activating, and reassuring. These roles help support patients during moments of loneliness, discomfort, or procedural stress, waking up or sleeping times of the day. Usability testing with design students validated the concept’s interaction model and the emotional outcomes of the sound experience , while expert evaluation highlighted practical challenges and ethical considerations. Positive responses from participants indicated that personalized sound could serve as a subtle yet powerful tool to support mental well-being during ICU admission by reducing stress and meaningfully involving loved ones and HCPs in the care journey. However, concerns were raised regarding the appropriateness of certain sounds and aspects of integration into clinical workflows, leading to a set of recommendations for future research. The feedback and insights gathered from these tests resulted in recommendations for future research. Finally an overall reflection on the study concluded the research. ...
Existing literature and field studies reveal that while sound is a vital component for healthcare professionals (HCP) to monitor patient status, it is often a source of disruption and emotional strain for patients and their loved ones. The project identifies a gap in current interventions, which largely focus on reducing noise rather than enhancing the patient’s experience. A soundscape is defined as the acoustic environment as perceived or experienced and/or understood by a person or people, in context (ISO 12913, 2014). The current acoustic environment has been outlined through a context study, along with its impact on key stakeholders. This provided a clear understanding how the current ICU soundscape hinders the emotional well - being of the patients. A multi-method research approach was conducted, including contextual observations at LUMC, interviews with healthcare providers, and a review of ICU patient experiences to identify the affected psychological needs of patients.
From these insights, a detailed patient journey map was created, highlighting critical moments where the auditory environment could support or hinder well-being. Through a thorough understanding of the journey map , four unfulfilled psychological needs were identified - Lack of autonomy , relatedness, security and comfort. Following literature, these unfulfilled psychological human needs can be fulfilled by providing the right sonic ambience at the right moment. A need for connectedness with the outside world through these sonic ambiences was investigated to be fulfilled to meet the identified fundamental needs. Literature explores how need based sonic ambiences should be tested for their functional role i.e. to comfort, to distract during long stretches of time without visitation or spontaneous breathing trails etc. Connectedness to environment became a facet to explore as a design direction which was further explored in the event based journey map of the patient through different times of the day and modes for sonic ambiences which could fulfil the desired functions. These findings underlined the importance of a personalized approach to creating meaningful soundscapes within the ICU. By mapping out key moments of interaction, the framework for the system was outlined detailing when and how each stakeholder would be engaged. Implementation touchpoints were identified as: patients pre-admission, loved ones at the beginning of the ICU stay, and healthcare providers throughout the admission, who would be responsible for tailoring and adjusting the sonic experience. This multi-stakeholder approach became essential for integrating the system into the complex ICU environment.
Several mobile and tablet based prototypes were created to conduct usability tests with fellow students to test the engagement on the app and how easily sounds are selected based on contextual cues like related to specific given environments (like forest, beach ,Café )leading to the most intuitive methods to be implemented in the real world setting.
The resulting design, SoulSound, is a soundscape system integrated into the ICU room to deliver personalized auditory experiences that help patients feel a sense of connectedness to positive environments in an otherwise sterile and unsettling atmosphere. The system includes an interface for input collection by patients, family members, or HCPs and dynamically adjusts sound based on changing needs throughout the day. Four key sonic functions were defined: calming, distracting, activating, and reassuring. These roles help support patients during moments of loneliness, discomfort, or procedural stress, waking up or sleeping times of the day. Usability testing with design students validated the concept’s interaction model and the emotional outcomes of the sound experience , while expert evaluation highlighted practical challenges and ethical considerations. Positive responses from participants indicated that personalized sound could serve as a subtle yet powerful tool to support mental well-being during ICU admission by reducing stress and meaningfully involving loved ones and HCPs in the care journey. However, concerns were raised regarding the appropriateness of certain sounds and aspects of integration into clinical workflows, leading to a set of recommendations for future research. The feedback and insights gathered from these tests resulted in recommendations for future research. Finally an overall reflection on the study concluded the research. ...
In critical care environments like the Intensive Care Unit (ICU) , patients are surrounded by an abundance of unwanted sounds from the medical alarms and equipment that often lead to heightened stress, confusion and psychological discomfort. This graduation project explores how the acoustic environment of the Adult Intensive Care Unit can be reimagined to support the critically ill patients using a soundscape system. The context of this project is the Leiden University Medical Centre (LUMC) and the stakeholders considered in this project along with the patients are the healthcare providers and loved ones.
Existing literature and field studies reveal that while sound is a vital component for healthcare professionals (HCP) to monitor patient status, it is often a source of disruption and emotional strain for patients and their loved ones. The project identifies a gap in current interventions, which largely focus on reducing noise rather than enhancing the patient’s experience. A soundscape is defined as the acoustic environment as perceived or experienced and/or understood by a person or people, in context (ISO 12913, 2014). The current acoustic environment has been outlined through a context study, along with its impact on key stakeholders. This provided a clear understanding how the current ICU soundscape hinders the emotional well - being of the patients. A multi-method research approach was conducted, including contextual observations at LUMC, interviews with healthcare providers, and a review of ICU patient experiences to identify the affected psychological needs of patients.
From these insights, a detailed patient journey map was created, highlighting critical moments where the auditory environment could support or hinder well-being. Through a thorough understanding of the journey map , four unfulfilled psychological needs were identified - Lack of autonomy , relatedness, security and comfort. Following literature, these unfulfilled psychological human needs can be fulfilled by providing the right sonic ambience at the right moment. A need for connectedness with the outside world through these sonic ambiences was investigated to be fulfilled to meet the identified fundamental needs. Literature explores how need based sonic ambiences should be tested for their functional role i.e. to comfort, to distract during long stretches of time without visitation or spontaneous breathing trails etc. Connectedness to environment became a facet to explore as a design direction which was further explored in the event based journey map of the patient through different times of the day and modes for sonic ambiences which could fulfil the desired functions. These findings underlined the importance of a personalized approach to creating meaningful soundscapes within the ICU. By mapping out key moments of interaction, the framework for the system was outlined detailing when and how each stakeholder would be engaged. Implementation touchpoints were identified as: patients pre-admission, loved ones at the beginning of the ICU stay, and healthcare providers throughout the admission, who would be responsible for tailoring and adjusting the sonic experience. This multi-stakeholder approach became essential for integrating the system into the complex ICU environment.
Several mobile and tablet based prototypes were created to conduct usability tests with fellow students to test the engagement on the app and how easily sounds are selected based on contextual cues like related to specific given environments (like forest, beach ,Café )leading to the most intuitive methods to be implemented in the real world setting.
The resulting design, SoulSound, is a soundscape system integrated into the ICU room to deliver personalized auditory experiences that help patients feel a sense of connectedness to positive environments in an otherwise sterile and unsettling atmosphere. The system includes an interface for input collection by patients, family members, or HCPs and dynamically adjusts sound based on changing needs throughout the day. Four key sonic functions were defined: calming, distracting, activating, and reassuring. These roles help support patients during moments of loneliness, discomfort, or procedural stress, waking up or sleeping times of the day. Usability testing with design students validated the concept’s interaction model and the emotional outcomes of the sound experience , while expert evaluation highlighted practical challenges and ethical considerations. Positive responses from participants indicated that personalized sound could serve as a subtle yet powerful tool to support mental well-being during ICU admission by reducing stress and meaningfully involving loved ones and HCPs in the care journey. However, concerns were raised regarding the appropriateness of certain sounds and aspects of integration into clinical workflows, leading to a set of recommendations for future research. The feedback and insights gathered from these tests resulted in recommendations for future research. Finally an overall reflection on the study concluded the research.
Existing literature and field studies reveal that while sound is a vital component for healthcare professionals (HCP) to monitor patient status, it is often a source of disruption and emotional strain for patients and their loved ones. The project identifies a gap in current interventions, which largely focus on reducing noise rather than enhancing the patient’s experience. A soundscape is defined as the acoustic environment as perceived or experienced and/or understood by a person or people, in context (ISO 12913, 2014). The current acoustic environment has been outlined through a context study, along with its impact on key stakeholders. This provided a clear understanding how the current ICU soundscape hinders the emotional well - being of the patients. A multi-method research approach was conducted, including contextual observations at LUMC, interviews with healthcare providers, and a review of ICU patient experiences to identify the affected psychological needs of patients.
From these insights, a detailed patient journey map was created, highlighting critical moments where the auditory environment could support or hinder well-being. Through a thorough understanding of the journey map , four unfulfilled psychological needs were identified - Lack of autonomy , relatedness, security and comfort. Following literature, these unfulfilled psychological human needs can be fulfilled by providing the right sonic ambience at the right moment. A need for connectedness with the outside world through these sonic ambiences was investigated to be fulfilled to meet the identified fundamental needs. Literature explores how need based sonic ambiences should be tested for their functional role i.e. to comfort, to distract during long stretches of time without visitation or spontaneous breathing trails etc. Connectedness to environment became a facet to explore as a design direction which was further explored in the event based journey map of the patient through different times of the day and modes for sonic ambiences which could fulfil the desired functions. These findings underlined the importance of a personalized approach to creating meaningful soundscapes within the ICU. By mapping out key moments of interaction, the framework for the system was outlined detailing when and how each stakeholder would be engaged. Implementation touchpoints were identified as: patients pre-admission, loved ones at the beginning of the ICU stay, and healthcare providers throughout the admission, who would be responsible for tailoring and adjusting the sonic experience. This multi-stakeholder approach became essential for integrating the system into the complex ICU environment.
Several mobile and tablet based prototypes were created to conduct usability tests with fellow students to test the engagement on the app and how easily sounds are selected based on contextual cues like related to specific given environments (like forest, beach ,Café )leading to the most intuitive methods to be implemented in the real world setting.
The resulting design, SoulSound, is a soundscape system integrated into the ICU room to deliver personalized auditory experiences that help patients feel a sense of connectedness to positive environments in an otherwise sterile and unsettling atmosphere. The system includes an interface for input collection by patients, family members, or HCPs and dynamically adjusts sound based on changing needs throughout the day. Four key sonic functions were defined: calming, distracting, activating, and reassuring. These roles help support patients during moments of loneliness, discomfort, or procedural stress, waking up or sleeping times of the day. Usability testing with design students validated the concept’s interaction model and the emotional outcomes of the sound experience , while expert evaluation highlighted practical challenges and ethical considerations. Positive responses from participants indicated that personalized sound could serve as a subtle yet powerful tool to support mental well-being during ICU admission by reducing stress and meaningfully involving loved ones and HCPs in the care journey. However, concerns were raised regarding the appropriateness of certain sounds and aspects of integration into clinical workflows, leading to a set of recommendations for future research. The feedback and insights gathered from these tests resulted in recommendations for future research. Finally an overall reflection on the study concluded the research.