Healing Environment: A Map Towards Patient Safety

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Most people working in hospital understand the impact of the hospital environment on the patient experience. There is evidence that good environments can have a therapeutic effect on patients. But what constitutes a good environment? The mind, body, and spirit are always striving to maintain resonance with the environment. If that environment is unbalanced or superficial it will use up its energy in maintaining its life force. This is why many people are sick and/or tired most of the time. On the other hand, where the environment is balanced and in harmony with nature, little energy is needed to maintain the body in health.

People have different needs in different spaces. Studies clearly show that a whole range of environmental factors including lighting, color, aroma, views, art, scale, proportion, sound, texture and materials - have a powerful healing and therapeutic effect on patients.

We perceive our environment through our five senses: sight, smell, touch, taste, and hearing. The information we pick up from our senses is relayed to the brain which, in turn, will affect our physiological, emotional, psychological and, ultimately, physical condition. Healing environment leads to faster patient recoveries, reduced pain, fewer cases of infection, greater patient satisfaction and reduced stress level among staff.

Upcoming paragraphs would reveal the role of each sense in leading towards better healing.

Light: Some things that are easy on the eye can relax and reassure us. Other things may be more stimulating. Interesting views, natural light, works of art, and the use of particular colors can all make us feel better. Light and color are the two aspects of sight that have the greatest impact on a patients overall wellbeing. Our overall environment has a tremendous effect on the way we feel. Natural light, pleasant views, work of art and particular colors can all enhance our sense of wellbeing. The therapeutic value of light has been recognized for thousands of years. If you spend less than three hours outside every day it will help to revitalize your energy and the effect of light on health is really very critical.

Second, only to fresh air should be inclined to rank light in importance for the sick. Direct sunlight, not only daylight, is necessary for a speedy recovery Florence Nightingale, 1860.

In the more recent past, hospitals had large windows to allow light to penetrate, beds were pushed out onto balconies and terraces and solariums were used as healing environments. With little or no natural light, melatonin, a hormone that depresses mental function tells the body to log off and even causes illness such as seasonal affective disorder (SAD). The diurnal cycle of night and day and the spectral properties of light are essential to the regulation of stress and fatigue, as well as a range of physiological functions.

Light is the most important environmental input, after food, in controlling bodily functions. Richard Wurtman, Neuroscientist.

The quality and quantity of natural or artificial light have a major impact on the body's healing processes. Careful attention to this factor alone may help to reduce the length of stay for inpatients. Other benefits of full spectrum lighting include; better visual acuity, improved motor skills, less physiological fatigue, overall improved tasks performance, and vitamin D synthesis.

Artificial light is often deficient in certain wavelengths compared to natural light. This can cause depression, moodiness, and cravings for carbohydrates and even raise systolic blood pressure. Artificial lighting must mimic natural light as closely as possible inpatient areas. It must enable changes to the patient's skin tone and color to be clearly defined and easily identified underdiagnosis. Particular attention should be paid to the lighting at the bed head and inpatient examination, treatment, and recovery areas. Designers should develop high-quality lighting schemes in public and ward areas that create a non-threatening and relaxing environment. Indirect lighting should be used extensively. Designers should avoid equally spaced light fittings along corridors and hospital streets, as this may have a stroboscopic effect on patients moving along a corridor on a trolley or in a bed. A reflected, diffused light is a better option. Lights should not be mounted on ceilings immediately above patients in incubators, cots, beds, trolleys or couches. Lights should be designed to reflect off walls and ceilings. Where appropriate lighting should be dimmer controlled.

Color: color is an extremely powerful, and potentially inexpensive, medium. Appropriate use of color within healthcare settings can make a significant contribution to patients' well being. Certain colors can trigger certain reactions and influence people's moods: Certain colors slow our perception of time and others accelerate it. For example:

Specific reds can induce epileptic fits. Other reds can reduce pain caused by rheumatism and arthritis.

Blues can subdue aggressive patients in accident and emergency departments.

Yellows in patients bedrooms can be detrimental to REM sleep.

Orange creates a feeling of wellbeing in social and dining areas.

Patients recover faster when they have pleasant and interesting views of the outside world. It is desirable that all patients' bedrooms, wards, and patient areas have outside views. Internal areas can also be enhanced with murals and artwork. Internal plant scapes can be used to create an outside-inside experience.

I have seen in fevers, the most acute suffering produced from the patient (in a hut), not being able to see out of the window and the knots in the wood being the only view. I shall never forget the rapture of fever-patients over a bunch of bright-colored flowers. Florence Nightingale, 1860.

Prolonged exposure to natural views not only helps to calm patients but can also have positive effects on other health outcomes and shorten recovery periods. Ulrich, Lunon & Eldridge, 1993.

Gardens in healthcare facilities tend to alleviate stress effectively if they contain green or relatively verdant foliage, flowers, non-turbulent water, park-like qualities (grassy spaces with scattered trees). Barnes & Ulrich, 1999.

The arts can enrich the healthcare environment. They help to reduce patients' stress levels by offering visual stimulation and distracting them from their health problems. One form of healing art is visual art that may be expressed in many forms such as painting, murals, prints, photographs, sculptures, decorative tile, ceramic, textile hanging, and furniture. Art can celebrate life, allay patients' fears and anxieties, amuse, encourage, educate and indeed distract for long periods of time. Artwork images should impart and evoke messages of hope, joy, love, dignity, peace, tranquility, energy, comfort, security, safety, growth and life. Works of art can be used as landmarks for wayfinding in hospitals in the form of icons, sculptures, and water features.

Another form of the art is the performing arts have a better effect on patients than visual arts (P. Scher and P. Senior, The Exeter Evaluation, 1999). This form of art includes puppetry, musicians, clowns, opera, dancing, storytelling, poetry reading, and singing.

In addition to that, participatory play a key role in the healing process of long-term inpatients in many healthcare departments, from pediatrics to mental illness. Patients take part in interactive activities, which may involve relatives, friends, artists in residence and staff.

Smell: Hospitals are remembered with their medicinal smell that increases our anxiety. What if it changes to pleasant smell, which is known to lower our blood pressure and heart rate. Our sense of smell reaches more directly into our memory and emotions than the other senses. The days before hi-tech medicine, physicians and nurses depended on all their senses, including their sense of smell, to diagnose illness. We are told typhoid smelled like baking bread and yellow fever like a butchers shop. A surgeon on his rounds would smell a patients bandage for infection by Pseudomonas bacteria. Apparently, it has the musty odor of a wine cellar. Some research has shown that olfactory message reaches the brain faster than auditory or visual ones. Research has demonstrated that floral and fruit fragrances slow respiration, lower blood pressure and heart rate, and relax muscles. Fragrances may also reduce pain by encouraging the release of endorphins, one of the body's most powerful painkilling hormones; if they are able to relax people, then they can enable them to focus on other matters. Research indicates that this aroma is de-stressing in its own right.

In hospitals, medicinal smells can produce anxiety. Unpleasant odors increase heart rate and respiration. It is widely believed that sensitivity to smell increases during pregnancy. Most pregnant women experience an increased sensitivity to all odors, usually with unpleasant consequences. Sprays and aerosols should be avoided to ensure that susceptible patients do not suffer allergic, asthmatic responses. Bacteria metabolizing secretions from various skin glands produce body odors.

Touch: Touch is the basic mechanism of exploring world during infancy. Touch confirms what they see, smell, taste and hear. Touch is known as the confirmatory sense. By touching, we confirm what we pick up from our other senses that are what we see, hear, smell or taste. The skin is the largest sensory organ. In nursing, we use therapeutic touch as a method in which the hands are used to "direct human energies to help or heal someone who is ill. Touch is particularly important with visual impairments. Tactile floor and wall surfaces can be used to convey important information about their environment. Changes in texture can also warn of potential hazards or provide directional information. Children need tactile experience to develop their sensory receptors. Where possible designers should introduce textured surfaces, which can form an integral part of a child's play and learning process. This is a useful tool for a child's developing sensory receptors.

Placing controls for nurse call, lighting, telephone, television, and radio within easy reach of a patient enhances self-reliance and increases patient safety. In multi-bed rooms, each patient should have equal access to controls for items such as windows, blinds, curtains, and television. An environment scaled for young children and elderly or disabled people will enhance their sense of independence. Very careful attention should be paid to the detailing of furniture and fittings. The design should minimize the risk of users trapping their fingers and toes etc. Where possible sharp corners should be avoided and redesigned to prevent predictable injury. All domestic hot water should be delivered to sanitary fittings at safe temperatures. Furniture that cant be moved may cause patients to feel stressed or anxious and may contribute to a patients sense of helplessness and dependence. It also creates an extra burden for staff. Fixed tables and chairs should be avoided where possible.

Taste: both illness and medication can alter our sense of taste, and our ability to identify flavors becomes less acute as we grow older. Taste and smell are closely linked: two-thirds of the capacity to taste depends on the ability to smell. Research has shown that children are born with a desire for sweet tastes. Children will generally explore their environments using all senses including the sense of taste. Offering high-quality food and drink in hospitals will not only help to ensure an adequate nutritional intake among patients but will enhance their overall sense of wellbeing. The Better Hospital Food program aims to improve the quality of food services in hospitals

Since we know teething infants sometimes find relief in licking the glass on windows and mirrors, and biting stainless steel handles and other cold surfaces. Designers must check the toxic nature of materials during specification and avoid products containing formaldehyde, wood preservatives, orificenic, white spirit, benzene, and other toxic substances.

Hearing: Wounds take longer to heal when patients are exposed to noise for long periods. Noise can also affect our weight and our hormonal balances. Agreeable sounds, such as music, can reduce our blood pressure and heart rate. The sound has a fundamental effect on us, both psychologically and physiologically.

Sounds of such as rain, a breeze, the sea, moving water, and songbirds can calm and create a sense of wellbeing. Such sounds create sensations of pleasure affecting the limbic system. They improve the function of the autonomic nervous system and help release endorphins, the body's natural opiates. Biological sounds, such as a mothers heartbeat, have been used to de-stress infants. Courtyards and landscaped gardens close to patient areas should include plants that encourage songbirds

Music can have an analgesic painkilling effect, and can also reduce blood pressure, heart and respiration rates. Patients should have the opportunity to listen to music via headphones and live performances. The former should be offered as part of bedside communication. At the same time, it is important to remember that some people will view music as noise. Therefore, people should have a choice as to whether they have to listen to music. Music therapy is used to treat depression, to reach autistic children and to calm and relax agitated psychiatric patients. Relaxing music has been known to lower the level of catecholamines, such as adrenaline, and free fatty acids in the blood.

Sounds can be relaxing or agitating both, any unwanted sound is a noise, i.e. what one person views as a sound another may view as a noise this may include music for some people. Noise can increase heart rate, blood pressure, respiration rate, and even blood cholesterol levels. It can reduce weight gain, disturb sleep patterns and negatively affect hormonal balances. As long ago as 1859, Florence Nightingale recognized the vital importance of a quiet and restful environment as an essential aid to recovery. As she stated in her Notes on Nursing: Unnecessary noise is the most critical absence of care which can be inflicted on the sick or well.

Noise should be controlled at the source. Sources can include telephones, trolleys, and interactive toys, alarm panels and monitors. These should be monitored and policies should be in place to turn down tones on phones and nurse call systems at night. Designers should ensure that patient areas are located away from external sources of noise, such as road traffic. Noisy spaces, such as restaurants and day rooms, should not be located next to quiet spaces, such as bed areas.

To conclude, healing environment provides with an atmosphere that relaxes the mind, body and soul and helps in jiffy physical and psychological recovery.

Healing Environment: A Map Towards Patient Safety

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