Healing environments

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Healing environment, for healthcare buildings describes a physical setting and organizational culture that supports patients and families through the stresses imposed by illness, hospitalization, medical visits, the process of healing, and sometimes, bereavement. The concept implies that the physical healthcare environment can make a difference in how quickly the patient recovers from or adapts to specific acute and chronic conditions. [1]

Contents

Background

The original concept of the healing environment was developed by Florence Nightingale whose theory of nursing called for nurses to manipulate the environment to be therapeutic (Nightingale, F. 1859). [2] Nightingale outlined in detail the requirements of the "sick room" to minimize suffering and optimize the capacity of a patient to recover, including quiet, warmth, clean air, light, and good diet. Early healthcare design followed her theories outlined in her treatise, "Notes on Hospitals". [3] Following the discoveries by Louis Pasteur and others which lead to the Germ Theory, plus other technologies, the role of the environment was dominated by infection control and technological advances.

Starting in the 1960s, healing environments have been linked with evidence-based design (EBD), giving the concept a strong scientific base. While in some respects it can be said that the concept of healing environments has evolved into EBD, it's mainly in the area of reduction of stress that this overlap occurs; as EBD goes beyond the healing environments dimension to consider the effect of the built environment on patient clinical outcomes in the areas of staff stress and fatigue, patient stress, and facility operational efficiency and productivity to improve quality and patient safety. A 1984 study by Roger Ulrich found that surgical patients with a view of nature suffered fewer complications, used less pain medication and were discharged sooner than those who looked out on a brick wall. [4] Since then, many studies have followed, showing impact of several environmental factors on several health outcomes. [5]

Today, the philosophy that guides the concept of the healing environment is rooted in research in the neurosciences, environmental psychology, psychoneuroimmunology, and evolutionary biology. The common thread linking these bodies of research is the physiological effects of stress on the individual and the ability to heal. Psychologically supportive environments enable patients and families to cope with and transcend illness.

Goal

The goal of creating a healing environment is to reduce stress, and thereby reduce associated problems such as medical error, inability to concentrate, and physical symptoms of stress that can affect logical thought process. While use of EBD techniques would not necessarily make an environment a healing one, through EBD we can define environmental factors that can help to ease stress and thereby result in a healing environment. Malkin [6] emphasizes the contribution of research to concepts that can create a healing environment, but just the inclusion do not make setting a 'healing environment'. The design team needs to translate the EBD into design solutions unique to the individual hospital.

According to "The Business Case for Creating a Healing Environment" written by Jain Malkin, the physical setting has the potential to be therapeutic if it achieves the following:

Importance of lighting and sound

Lighting

Eighty percent of what we interpret of our surroundings comes to us from what we see of our environment and that is greatly affected by the light available in that environment. Lighting design in healthcare environments is a major factor in creating healing situations. Since the design of healthcare environments is said to influence patient's outcomes, yet high costs prevent most hospitals from renovating or rebuilding, changes in lighting becomes a cost-effective way to improve existing environments. It is proven that people who are surrounded by natural light are more productive and live healthier lives. When patients are sick, and surrounded by medical equipment and white walls, the last thing they need is a dark, stuffy room. This is why it is important for every room to have a window for natural light to come into and help create a healing environment for the patient.

The auditory environment

While so much of the patient's experience is based on visual cues, the majority of meaning of their experience is auditory. The many sounds of a hospital are foreign to their experience and their line of sight is limited. Nightingale claimed that sounds that create "anticipation, expectation, waiting, and fear of surprise ... damage the patient."( [2] ). Add to the perception and meaning attribute to any sound the factors of age-related hearing impairment common to older patients, heavy medication, pain, and other conditions, cognition is impacted as is the ability to understand language. Hospital noise, at any volume level, is credited with being the primary cause of sleep deprivation, a contributing factor in delirium, and a risk factor for errors. [7] The current pressure to reduce noise at night has been mistakenly understood to mean undue quiet at night when patients most need cues that people are around them and available if they need help. Just s lighting must be designed to serve both day and night, so much the auditory environment be designed to support activity, cognition, rest, and sleep.

Adding to the above, patients need positive visual and auditory stimulation. Nightingale called for variety, color, and form as a means of arousing creativity and health in patients. Currently, using appropriate art, nature imagery and music are found to improve the experience of the patient. [8] Technologies have afforded patients infinite options to use media as the choose. The addition of beauty must also be accompanied by an attention to orderliness: removal of clutter, trash, and other distractions.

See also

Related Research Articles

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The biophilia hypothesis suggests that humans possess an innate tendency to seek connections with nature and other forms of life. Edward O. Wilson introduced and popularized the hypothesis in his book, Biophilia (1984). He defines biophilia as "the urge to affiliate with other forms of life".

<span class="mw-page-title-main">Applied psychology</span> Application of psychological theories or findings

Applied psychology is the use of psychological methods and findings of scientific psychology to solve practical problems of human and animal behavior and experience. Educational and organizational psychology, business management, law, health, product design, ergonomics, behavioural psychology, psychology of motivation, psychoanalysis, neuropsychology, psychiatry and mental health are just a few of the areas that have been influenced by the application of psychological principles and scientific findings. Some of the areas of applied psychology include counseling psychology, industrial and organizational psychology, engineering psychology, occupational health psychology, legal psychology, school psychology, sports psychology, community psychology, neuropsychology, medical psychology and clinical psychology, evolutionary psychology, human factors, forensic psychology and traffic psychology. In addition, a number of specialized areas in the general area of psychology have applied branches. However, the lines between sub-branch specializations and major applied psychology categories are often mixed or in some cases blurred. For example, a human factors psychologist might use a cognitive psychology theory. This could be described as human factor psychology or as applied cognitive psychology. When applied psychology is used in the treatment of behavioral disorders there are many experimental approaches to try and treat an individual. This type of psychology can be found in many of the subbranches in other fields of psychology.

<span class="mw-page-title-main">Social environment</span> Setting in which people live or something happens, from a social perspective

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<span class="mw-page-title-main">Health psychology</span> Study of psychological and behavioral processes in health, illness, and healthcare

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<span class="mw-page-title-main">Environmental psychology</span> Academic study of the minds relationship to ones immediate surroundings

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<span class="mw-page-title-main">Social determinants of health</span> Economic and social conditions that influence differences in health status

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<span class="mw-page-title-main">Nursing</span> Health care profession

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<span class="mw-page-title-main">Therapeutic garden</span>

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<span class="mw-page-title-main">Biophilic design</span> Building industry concept

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References

  1. Stichler, J.F. (2001). "Creating healing environments in critical care units". Critical Care Nursing Quarterly. 24 (3): 1–20. doi:10.1097/00002727-200111000-00002. PMID   11858554. S2CID   31080389.
  2. 1 2 Nightingale, Florence (1859). Notes on Nursing. Gutenberg Project: public domain.
  3. Nightingale, Florence (1860). Notes on Hospitals. Google Books: Public Domain.
  4. Ulrich, R.S. (1984). "View through a window may influence recovery from surgery". Science. 224 (4647): 420–421. Bibcode:1984Sci...224..420U. CiteSeerX   10.1.1.669.8732 . doi:10.1126/science.6143402. PMID   6143402.
  5. Dijkstra, K. (2009). Understanding healing environments: Effects of physical environmental stimuli on patients' health and well-being (PDF) (Thesis).
  6. Malkin J (2008). "A visual reference for evidence-based design". Center for Health Design.
  7. BI&T (Mazer, SE, Increase Patient Safety by Creating a Quieter Hospital Environment Biomedical Instrumentation & Technology Journal, September/October 2010 - See more at: http://www.healinghealth.com/resources/increase-patient-safety/#sthash.VwFmiKBu.dpuf
  8. Mazer, Susan E [1]; Music and Nature at the Bedside, Part I, published by Research Design Connections, 2009 Mazer, Susan E [2]; Music and Nature at the Bedside, Part II, published by Research Design Connections, 2010 /

Sources

Malkin, Jain; Healing Environments at the Century Mark: the Quest for Optimal Patient Experiences; unpublished article by summarizing a presentation given at a mini-course sponsored by the Institute for Healthcare Improvement and The Center for Health Design, October 2003.

Malkin, Jain; The Business Case for Creating a Healing Environment; published article written by Jain Malkin and published by The Center for Health Design, 2003

Simeonova, M. (2002) Healthy lighting. Evidence Based Building Design for Healthcare. Retrieved 3 Apr. 2010. <https://web.archive.org/web/20080706165845/http://www.healthdesign.org/resources/pubs/articles/essays/healthy_lighting.php>.