Design works hand in hand with the technology of healing.
by Beth Frankowski Jones (ISdesigNET Magazine)
As the world population ages, health concern issues will only continue to become more vitally important with time. Researchers in new medical fields like psychoneuroimmunology are studying the links between mind, body and health, while others gather information on the human body’s daily rhythms. It is becoming increasingly obvious to both scientists and caregivers that state of mind is a determining factor in who gets sick, who gets well — and why. It also is becoming more and more evident that patients’ surroundings have significant effects on their mental and thus physical well-being.
Much of today’s health care design theory is based on recent research by Roger S. Ulrich of Texas A & M University. His work, first presented in 1990 at The National Symposium on Health Care Design, decries traditional design principles which, through their overwhelming emphasis on function and efficiency, produce facilities he describes as “psychologically hard.”
This type of facility is often a failure from a business standpoint, Ulrich says, for two reasons. First, it is completely unattractive to potential patients and therefore has difficulty holding its own in today’s competitive health care market. Second, a “hard” facility is stressful — not only for patients, but for visitors and staff as well.
Hospital stays are inherently stressful, and poor decisions can increase that stress in ways that have specific, measurable effects on patient health. Psychological results of stress on patients include feelings of helplessness, anxiety and depression. Physiological symptoms such as muscle tension, increased blood pressure and higher levels of stress hormones are common. In addition, patients may exhibit behavioral problems: emotional outbursts, sleeplessness, withdrawal, substance abuse. Any one of these can be a serious hindrance to the healing process.
These same stress factors affect members of the health care staff. Studies have shown that high stress levels often result in high rates of burn-out, low job satisfaction and excessive absenteeism.
Ulrich has outlined three primary factors which he says will reduce patient stress in the health care environment: first, a sense of control over surroundings; second, access to support from family and friends; and third, positive distractions.
- A Sense of Control
Humans have a basic need for some control of themselves and their environment. A health care facility that is noisy, confusing, lacks privacy and allows individuals no control over their immediate environment reduces a patient’s sense of autonomy and can lead to depression, passivity, elevated blood pressure levels and reduced immune system functioning. Illness carries its own inherent stress, and studies show that a patient’s physical and social environment can exacerbate those anxiety levels to a point where they interfere with recovery.
- Create visual privacy in imaging areas for gown-wearing patients.
- Allow channel and volume control of television, both in patient rooms and in visitor areas.
- Include gardens or grounds in facility.
- Allow patients control over temperature and light levels in their rooms.
- Create comfortable, private break areas for staff members.
- Design staff work stations so as to keep interruptions to a minimum.
- Give patients a means of controlling contact with visitors and other patients.
- Provide areas in nursing homes that allow patients to pursue hobbies and personal interests.
- Opportunities for Social Support
Many studies have shown that healthy individuals experience less stress and illness when they feel part of a supportive social system. Intuitive evidence supports the belief that a patients’ health also benefits from supportive contact with family, friends and caregivers. Ulrich cautions, however, that the designer avoid encouraging interaction at the expense of personal privacy.
- Provide convenient overnight accommodation for family and friends.
- Specify comfortable, movable seating in waiting areas, allowing friends and family to create their own support environment.
- Design outdoor gardens or sitting areas for interaction between patients and visitors.
- Set aside special areas for nursing home residents to allow for pets.
- Positive Distractions
Ulrich believes that a lack of personal stimulation may lead patients to focus on their illnesses and lead to additional stress. In various studies of ICUs, dating from as early as 1967, lack of windows has been shown to lead to anxiety, depression, delirium and even psychosis. Other common conditions such as uniformly high levels and continual noise from various machines and medical equipment only serve to aggravate the situation.
Nature is one of the most successful sources of positive distraction. Simply viewing a mural of a water scene has been shown to alter electrical activity in the brain, reduce levels of stress hormones and ease muscle tension. Ulrich’s own study in 1984 found that patients with a window view of trees had shorter post-operative stays, fewer complications and required less pain-killing medication.
Designers must take care, however, that the distractions they provide are positive and do not overstimulate patients, says Ulrich. For instance, while intuitive reasoning might indicate that artwork of any kind would be a pleasant diversion, studies have shown that abstract pictures and nature scenes depicting high levels of activity actually tend to raise anxiety levels in patients, higher even than those with no source of distraction at all.
- Design facilities to include atriums, indoor gardens and/or greenhouses.
- Use water and fire elements, including fountains, fireplaces and fish tanks, whenever possible.
- Lower window sills to allow access to views for bed-bound patients.
- Use representational art featuring calm, serene subject matter.
Some of the most basic elements of the human relationship with the environment — color, light, sound and smell — have long been the basis for creating surroundings that are comfortable, satisfying and aesthetically pleasing. Researchers are now discovering the scientific facts behind these emotions, using them to help designers create more effective healing environments.
Color is an essential element of visual stimulation with well-documented psychological and physiological effects. Warm colors, especially when accompanied by high illumination levels, have been found to encourage activity, while cool colors promote more passive behavior. These effects are so significant that, in Sweden, patients are assigned to hospital rooms in certain colors based on the nature of their illness; as the healing process progresses, they are moved to rooms with gradually higher levels of color stimulation.
Color also is vital in setting objects apart from their backgrounds. Contrasts in hue, brightness and saturation help the human eye define objects by distinguishing shapes and edges. This is an important scientific concept to bear in mind, especially when designing for those with impaired vision.
Nursing homes and other facilities for the aging may require special consideration. Many of the elderly have color-related visual problems, among them reduced sensitivity to colors at the blue end of the spectrum and less ability to distinguish between closely related colors.
- Begin with an appropriate field color and highlight with a variety of schemes.
- Avoid excessively monochromatic or high-contrast color schemes to maintain the appropriate level of visual stimulation.
- Use warm or cool color schemes to reinforce and encourage the desired activity level for an area.
- Implement color cueing to aid in wayfinding and color coding for identification purposes.
- Make use of contrasting colors to reinforce figure-ground definition.
Light is likewise essential to good vision, and also has proven physiological effects. In addition to its influence on the synthesis of certain vitamins, biochemical and hormonal body rhythms can be influenced by the amount of light exposure.
Light and color are inherently linked, in that light temperature significantly affects color rendering. As a result, a designer’s choices can have a psychological influence, making a well person look sick or an ill person look healthier.
The elderly often have special needs, requiring up to three times the light needed by young adults for identical activities and tasks. Improperly directed light can cause glare, however, intensifying existing vision problems and resulting in eye fatigue and loss of concentration, especially within this age group.
- Keep artificial lighting in the 3500?K temperature range.
- Use indirect sources for general illumination, preferably adjustable to a wide range of human needs and activity levels.
- Provide ample sources of task lighting.
- Adjust lighting levels to natural daylight rhythms.
- Ensure access to unfiltered, non-glare daylight whenever possible, especially for long-term patients.
- Provide patients with control of light levels within their individual environments.
- Use spotlighting and other specialty lights to enhance object rendering and create variety.
Noise, whether positive or negative, is defined as environmentally-generated sound with no specific human purpose. High noise levels have been shown to enhance patients’ perception of pain, resulting in increased need for medication, and certain antibiotics can add to a patient’s vulnerability. Among the elderly, broad swings in noise levels are a significant source of sleep deprivation and can cause confusion and disorientation.
Natural sounds, especially water, have a calming, relaxing effect and effectively mask other undesirable noise. Music, which stimulates the body’s release of endorphins and lowers heart rates, can have similar positive results. Classical music played in operating suites has been shown to lower patient anxiety and even reduce the need for anesthesia, while certain types of New Age music, tuned to natural body rhythms, also have significant relaxing effects.
- Use space planning to eliminate negative noise whenever possible.
- Alleviate unavoidable noise through the use of masking sounds.
- Provide for patient control of sound levels, even those that are positive.
Smells, like sounds, also can be positive (aromas) or negative (odors). Smells have a strong link to the limbic system, the brain’s emotional center, and thus are often more memorable than either sights or sounds. Medicinal smells stimulate anxiety, fear and stress, while pleasant aromas can reduce blood pressure, slow respiration and lower pain perception levels.
Aromatherapy is widely accepted in Europe and Asia as part of the healing process; the scent of vanilla has proven to be particularly beneficial. The essential oils of certain fruits and flowers are shown to have similar effects.
- Site patient and visitor areas away from potential sources of medicinal odors whenever possible.
- Recommend the use of light, pleasant aromas to mask unwelcome odors, especially in patient areas.
The technology of healing is moving in new directions as researchers, scientists and health care leaders explore the intricate links between mind and body. In the final analysis, today’s interior designers, hospital administrators and caregivers have come to realize that each has a part in advancing and promoting the recuperation process. All must work in partnership toward a common goal: truly effective health care environments that work hand in hand with medical technology to support patients in their fight for health.