Hi, and welcome to my blog! I'm Susan E. Mazer -- a knowledge expert and thought leader on how the environment of care impacts the patient experience. Topics I write about include safety, satisfaction, hospital noise, nursing, care at the bedside, and much more. Subscribe below to get email notices so you won't miss any great content.
September 5, 2014
Yes, noise can be loud. But, loud is not necessarily noisy. The sound of a 100-piece symphony orchestra played at fortissimo can be breathtaking and passionate, and hardly considered noise by those who love classical music.
And, the sound of a distorted talk radio coming from another room can be very annoying, although the measured sound level is soft. So, what do we mean by noise control and what do we mean by sound control?
Every room has its own sound, the characteristics generated when a sound is made and literally bounces off the walls. The reverberation of a sound in a given space determines how many times it hits the walls and bounces back.
Think of an indoor pool and how it sounds when lots of kids are swimming in it. Happy screaming and yelling, and not a word to understand.
Then, think of the Taj Mahal with its 28-second echo. Or how music reverberates in a grand cathedral.
In the hospital, hard surfaces down a long hallway make a conversation at one end travel down to the other end. Even if the volume diminishes with distance, if the patient is distracted and disturbed by the overheard banter, telling him or her that the volume level was “not that loud” is irrelevant.
So, the first truism: Noise has an “annoyance” factor.
Second, The “annoyance factor” is not determined solely by volume of decibel levels.
Third, a “soft noise” is still noise.
Now, let’s consider environmental acoustics, the study of how a sound acts in a given space. It is not about noise; rather, it is about any sound.
Fourth: A sound that “bounces off the walls” can be both noise and not noise, depending on who is listening.
Fifth: Controlling reverberation is necessary but not sufficient to control noise.
To get inside the patient experience we need to only go to Florence Nightingale’s Notes on Nursing. She wrote:
Unnecessary noise, or noise that creates an expectation in the mind, is that which hurts a patient. It is rarely the loudness of the noise, the effect upon the organ of the ear itself, which appears to affect the sick. How well a patient will generally bear, e.g., the putting up of a scaffolding close to the house, when he cannot bear the talking, still less the whispering, especially if it be of a familiar voice, outside his door.
Specifically, Nightingale points to the suffering of a patient yearning to participate in a discussion just beyond his listening, but not beyond his or her hearing.
I have often been surprised at the thoughtlessness, (resulting in cruelty, quite unintentionally) of friends or of doctors who will hold a long conversation just in the room or passage adjoining to the room of the patient, who is either every moment expecting them to come in, or who has just seen them, and knows they are talking about him. If he is an amiable patient, he will try to occupy his attention elsewhere and not to listen–and this makes matters worse–for the strain upon his attention and the effort he makes are so great that it is well if he is not worse for hours after. If it is a whispered conversation in the same room, then it is absolutely cruel; for it is impossible that the patient’s attention should not be involuntarily strained to hear.
“Soft” does not eliminate a disturbing sound. Rather, the disturbance grows and grows as patients try to hear what is beyond them.
Taking care of your patients’ experience means listening for them, assuming they hear everything you hear, and being mindful of not creating “expectation, anticipation, and fear of surprise.” The sense of hearing is not only the last sense to go, but is the first sense to awaken, be aroused, and be in want of understanding.
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