Evaluating Environmental Ward Performance: Insights From Acoustic,Lighting,and Temperature Monitoring in a Palliative Care Unit

Abstract

The physical environment of inpatient wards plays a critical role in supporting rest and care delivery. In palliative care, environmental conditions such as sound, lighting, and temperature directly influence patient comfort, circadian rhythms, and staff performance. However, few studies have quantitatively assessed these factors in functioning palliative care units (PCUs).

Objectives

To evaluate the spatial and environmental performance of an acute PCU through sensor-based monitoring of acoustic exposure, light levels, and temperature.

Method

A postoccupancy evaluation approach was employed to assess conditions within inpatient rooms. Environmental loggers recorded data continuously at 1-min intervals across two 1-month periods. Parameters included sound levels (Lmax, Leq, Lmin in A-weighted decibels) to reflect perceived loudness, lighting (lux), and temperature (°C). Measurements were benchmarked against World Health Organization and Australian guidelines for sleep-supportive healthcare environments. Data were collected from both single- and multibed rooms in a metropolitan tertiary hospital PCU.

Results

Sound levels frequently exceeded recommended thresholds. Nighttime averages reached 54 dB(A), while daytime LAeq exceeded 60 dB(A), with minimal day–night variation (<6 dB), indicating sustained exposure. Lighting data showed repeated nighttime spikes above 20 lux and insufficient daytime illumination for circadian regulation. Temperature exhibited minimal diurnal variation (<2°C), falling short of conditions known to support sleep.

Conclusion

Environmental monitoring revealed persistent deviations from sleep-supportive conditions. These stressors likely impact both patient well-being and staff performance. Findings underscore the need for evidence-based design strategies and translational research that position the built environment as an active contributor to holistic care. In palliative contexts, architectural design should enable rather than simply contain clinical practice.

Keywords

environmental monitoring palliative care PCU healthcare spatial performance light noise sound temperature postoccupancy evaluation

Get full access to this article

View all access options for this article.

References

Andrade

C. C.

Devlin

A. S.

Pereira

C. R.

Lima

M. L.

(2017). Do the hospital rooms make a difference for patients’ stress? A multilevel analysis of the role of perceived control, positive distraction, and social support. Journal of Environmental Psychology, 53, 63–72. https://doi.org/10.1016/j.jenvp.2017.06.008

Australian Commission on Safety and Quality in Health Care. (2021). Delirium clinical care standard | Australian Commission on Safety and Quality in Health Care. In Safetyandquality.gov.au. ACSQHC. https://www.safetyandquality.gov.au/standards/clinical-care-standards/delirium-clinical-care-standard.

Australasian Health Facility Guidelines (AusHFG) (2016). AusHFG |. [online] healthfacilityguidelines.com.au. Australasian Health Infrastructure Alliance. http://www.healthfacilityguidelines.com.au/.

Berglund

Lindvall

Schwela

D. H.

(2010). Guidelines for community noise. World Health Organization. Occupational and Environmental Health Team. https://apps.who.int/iris/handle/10665/66217.

Blume

Garbazza

Spitschan

(2019). Effects of light on human circadian rhythms, sleep and mood. Somnology: Sleep Research and Sleep Medicine, 23(3), 147–156. https://doi.org/10.1007/s11818-019-00215-x

Brown

T. M.

Brainard

G. C.

Cajochen

Czeisler

C. A.

Hanifin

J. P.

Lockley

S. W.

Lucas

R. J.

Münch

O’Hagan

J. B.

Peirson

S. N.

Price

L. L. A.

Roenneberg

Schlangen

L. J. M.

Skene

D. J.

Spitschan

Vetter

Zee

P. C.

Wright

K. P.

(2022). Recommendations for daytime, evening, and nighttime indoor light exposure to best support physiology, sleep, and wakefulness in healthy adults. PLOS Biology, 20(3), Article e3001571. https://doi.org/10.1371/journal.pbio.3001571

Busch-Vishniac

Ryherd

(2023). Hospital soundscapes. In Schulte-Fortkamp

Fiebig

Sisneros

J. A.

Popper

A. N.

Fay

R. R.

(Eds.), Soundscapes: Humans and their acoustic environment (pp. 277–311). Springer Handbook of Auditory Research. https://doi.org/10.1007/978-3-031-22779-0

Çelik

Usta Yeşilbalkan

(2022). The effect of the bright white light application to cancer patients receiving palliative care on their fatigue level and sleep quality: A randomized control trial. OMEGA - Journal of Death and Dying, 88(1), Article 302228221093462. https://doi.org/10.1177/00302228221093462

Chen

H.-I.

Tang

Y.-R.

(1989). Sleep loss impairs inspiratory muscle endurance. American Review of Respiratory Disease, 140(4), 907–909. https://doi.org/10.1164/ajrccm/140.4.907

10.

Czeisler

Buxton

Khalsa

(2005). The human circadian timing system and sleep-wake regulation. In Kryger

Roth

Dement

(Eds.), Principles and practice of sleep medicine. Elsevier.

11.

Czeisler

C. A.

Buxton

O. M.

(2005). [Chap. 35] The human circadian timing system and sleep–wake regulation. In Kryger

Roth

Dement

W. C.

(Eds.), Principles and practice of sleep medicine (pp. 402–419). Elsevier Saunders. https://doi.org/10.1016/b978-1-4160-6645-3.00035-9

12.

de Dear

R. J.

Akimoto

Arens

E. A.

Brager

Candido

Cheong

K. W. D.

Nishihara

Sekhar

S. C.

Tanabe

Toftum

Zhang

Zhu

(2013). Progress in thermal comfort research over the last twenty years. Indoor Air, 23(6), 442–461. https://doi.org/10.1111/ina.12046

13.

Delaney

L. J.

Currie

M. J.

Huang

H.-C. C.

Lopez

Litton

Van Haren

(2017). The nocturnal acoustical intensity of the intensive care environment: An observational study. Journal of Intensive Care, 5(1). https://doi.org/10.1186/s40560-017-0237-9

14.

Delaney

L. J.

Van Haren

Lopez

(2015). Sleeping on a problem: The impact of sleep disturbance on intensive care patients - A clinical review. Annals of Intensive Care, 5(1). https://doi.org/10.1186/s13613-015-0043-2

15.

Deodhar

Salins

Muckaden

M. A.

(2016). Intensive care unit death and factors influencing family satisfaction of intensive care unit care. Indian Journal of Critical Care Medicine, 20(2), 97–103. https://doi.org/10.4103/0972-5229.175942

16.

Dewan

Benloucif

Reid

Wolfe

L. F.

Zee

P. C.

(2011). Light-induced changes of the circadian clock of humans: Increasing duration is more effective than increasing light intensity. Sleep, 34(5), 593–599. https://doi.org/10.1093/sleep/34.5.593

17.

Duffy

J. F.

Czeisler

C. A.

(2009). Effect of light on human circadian physiology. Sleep Medicine Clinics, [Online], 4(2), 165–177. https://doi.org/10.1016/j.jsmc.2009.01.004

18.

Figueiro

M. G.

Rea

M. S.

(2014). Office lighting and personal light exposures in two seasons: Impact on sleep and mood. Lighting Research & Technology, 48(3), 352–364. https://doi.org/10.1177/1477153514564098

19.

Figueiro

M. G.

Steverson

Heerwagen

Kampschroer

Hunter

C. M.

Gonzales

Plitnick

Rea

M. S.

(2017). The impact of daytime light exposures on sleep and mood in office workers. Sleep Health, 3(3), 204–215. https://doi.org/10.1016/j.sleh.2017.03.005

20.

Fridh

Forsberg

Bergbom

(2009). Close relatives’ experiences of caring and of the physical environment when a loved one dies in an ICU. Intensive and Critical Care Nursing, 25(3), 111–119. https://doi.org/10.1016/j.iccn.2008.11.002

21.

Jonescu

E. E.

Farrel

Ramanayaka

White

Costanzo

Delaney

Hahn

Ferrier

Litton

(2024). Mitigating intensive care unit noise: Design-led modeling solutions, calculated acoustic outcomes, and cost implications. HERD: Health Environments Research & Design Journal, 17(3), Article 0. https://doi.org/10.1177/19375867241237501

22.

Jonescu

E. E.

Farrell

Ramanayaka

C. E.

Delaney

Litton

Uylaki

T. J.

Watts

Brigham

Bel Lemore

Seah

(2025a). A collaborative communities-of-practice methodology for environmental design research: A case study application in palliative care. HERD: Health Environments Research and Design Journal. https://doi.org/10.1177/19375867251365876

23.

Jonescu

E. E.

Litton

Farrell

(2025b). Investigating the interplay of thermal, lighting, and acoustics in intensive care for enhanced patient well-being and clinical outcomes. HERD: Health Environments Research & Design Journal, 18(2), 158–173. https://doi.org/10.1177/19375867251317235

24.

Jung

E. H.

Lee

S. W.

Kim

Y. J.

Kang

Suh

K. J.

Lee

J. H.

Jeon

Kim

Hur

S. S.

Lee

J. Y.

Kim

J.-W.

Kim

S. H.

Kim

J. W.

Lee

J.-O.

Lee

K.-W.

Kim

J. H.

Bang

S.-M.

Lee

J. S.

Bruera

(2022). Clinical outcomes of operating an acute palliative care unit at a comprehensive cancer center. JCO Oncology Practice, 18(10), e1661–e1671. https://doi.org/10.1200/op.22.00163

25.

Litton

Carnegie

Elliott

Webb

S. A. R.

(2016). The efficacy of earplugs as a sleep hygiene strategy for reducing delirium in the ICU: A systematic review and meta-analysis. Critical Care Medicine, 44(5), 992–999. https://doi.org/10.1097/CCM.0000000000001557

26.

Lusczek

E. R.

Knauert

M. P.

(2021). Light levels in ICU patient rooms: Dimming of daytime light in occupied rooms. Journal of Patient Experience, [Online], 8, Article 237437352110331. https://doi.org/10.1177/23743735211033104

27.

McKinley

Fien

Elliott

(2013). Sleep and psychological health during early recovery from critical illness: An observational study. Journal of Psychosomatic Research, 75(6), 539–545. https://doi.org/10.1016/j.jpsychores.2013.09.007

28.

McLaughlan

Richards

(2023). Realizing homeliness in palliative care: Inpatient and family perspectives on designing the built environment. Design for Health, 7(2), 138–157. https://doi.org/10.1080/24735132.2023.2228599

29.

Mercadante

Bruera

(2023). Acute palliative care units: Characteristics, activities and outcomes – Scoping review. BMJ Supportive & Palliative Care, 13(4), 386–392. https://doi.org/10.1136/spcare-2022-004088

30.

Naef

A. C.

Knobel

S. E. J.

Ruettgers

Jeitziner

M.-M.

Holtforth

M. g.

Zante

Schefold

J. C.

Nef

Gerber

S. M.

(2022). Methods for measuring and identifying sounds in the intensive care unit. Frontiers in Medicine, 9(836203). https://doi.org/10.3389/fmed.2022.836203

31.

Okamoto-Mizuno

Mizuno

(2012). Effects of thermal environment on sleep and circadian rhythm. Journal of Physiological Anthropology, 31(1). https://doi.org/10.1186/1880-6805-31-14

32.

Ormandy

Ezratty

(2012). Health and thermal comfort: From WHO guidance to housing strategies. Energy Policy, 49, 116–121. https://doi.org/10.1016/j.enpol.2011.09.003

33.

Ormandy

Ezratty

(2016). Thermal discomfort and health: Protecting the susceptible from excess cold and excess heat in housing. Advances in Building Energy Research, 10(1), 84–98. https://doi.org/10.1080/17512549.2015.1014845

34.

Palliative Care Australia. (2018). Palliative care service development guidelines. In Palliativecare.org.au. Palliative Care Australia. https://palliativecare.org.au/resource/palliative-care-service-development-guidelines-january-2018.

35.

Sagha Zadeh

Eshelman

Setla

Kennedy

Hon

Basara

(2018). Environmental design for end-of-life care: An integrative review on improving the quality of life and managing symptoms for patients in institutional settings. Journal of Pain and Symptom Management, 55(3), 1018–1034. https://doi.org/10.1016/j.jpainsymman.2017.09.011

36.

Simsek

H. U.

Canturk

N. Z.

(2014). Response to trauma and metabolic changes: Posttraumatic metabolism. Turkish Journal of Surgery, 30(3), 153–159. https://doi.org/10.5152/ucd.2014.2653

37.

Ulrich

Quan

Zimring

Joseph

Choudhary

(2004). The role of the physical environment in the hospital of the 21 st century: A once-in-a-lifetime opportunity. The Center for Health Design. https://www.healthdesign.org/sites/default/files/Role%20Physical%20Environ%20in%20the%2021st%20Century%20Hospital_0.pdf.

38.

Ulrich

R. S.

(1991). Effects of interior design on wellness: Theory and recent scientific research. Journal of Health Care Interior Design: Proceedings from the … Symposium on Health Care Interior Design. Symposium on Health Care Interior Design, 3(10123973), 97–109. https://pubmed.ncbi.nlm.nih.gov/10123973/ .

39.

Ulrich

R. S.

Zimring

Zhu

DuBose

Seo

H.-B.

Choi

Y.-S.

Quan

Joseph

(2008). A review of the research literature on evidence-based healthcare design. HERD, 1(3), 61–125. https://doi.org/10.1177/193758670800100306

40.

Watt

C. L.

Momoli

Ansari

M. T.

Sikora

Bush

S. H.

Hosie

Kabir

Rosenberg

Kanji

Lawlor

P. G.

(2019). The incidence and prevalence of delirium across palliative care settings: A systematic review. Palliative Medicine, 33(8), 865–877. https://doi.org/10.1177/0269216319854944

41.

World Health Organization. (1999). Guidelines for community noise. Www.who.int; World Health Organization. https://www.who.int/publications/i/item/a68672.

42.

Xie

Kang

Mills

G. H.

(2009). Clinical review: The impact of noise on patients’ sleep and the effectiveness of noise reduction strategies in intensive care units. Critical Care, 13(2), Article 208. https://doi.org/10.1186/cc7154

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.06 MB