Archive: Reports: The Effect of Healthcare Architecture and Art on Medical Outcomes

Abstract

Persons who came to visit the patients with the glossy hard flooring stayed an average of eleven minutes in the room. By comparison, visitors to patients in carpeted rooms spent an average of 24 minutes. This raises the possibility that carpet in patient rooms might improve outcomes by heightening social support from visitors.The following lists a few examples of the many reasons why hospital patients and their families experience stress.�\tAnxiety about the treatment, illness �\tPain �\tNot knowing where to go or how to get there, in a large hospital �\tLack of information from staff �\tLoss of privacy �\tHaving a room that is noisy, and prevents you from controlling the lights or temperature �\tLoss of control �\tImpersonal attitude of staff, physicians; non-person treatment It is worth mentioning that the World Health Organisation issued guidelines several years ago recommending that continuous sound levels in patient rooms and treatment spaces should not exceed 35 dB. Even low decibel levels - 38 to 40dB - were enough to consistently worsen sleep quality. An important finding in Berg's work was that persons were almost never consciously aware that they had been aroused from sleep. Nearly every time a low decibel noise occurred, and especially when poor acoustic conditions caused the sound to linger or reverberate in the air, the patient was aroused from deep sleep levels to shallow levels as indicated by changes in their brain electrical activity.The study findings indicated that the good acoustics condition (sound-absorbing ceiling), compared to poor acoustics, had a number of positive effects on the nurses. (Two journal articles about the study are in press.) When the sound-absorbing tiles were installed, staff experienced lessened work demands and increased social support from fellow workers. This is good news because lessened work demands and higher workplace social support are known to be important for reducing turnover in nursing staff. Further, the staff reported that the quality of care they gave to patients was significantly better during the good acoustics condition compared to when the sound-reflecting ceiling was installed. Also, the nurses reported that they slept better at home when they experienced the good acoustics condition during their working hours. The improved staff sleep quality may be a carryover effect of less stress in the workplace. Lastly, the sound-absorbing ceiling condition substantially improved speech intelligibility. This is also noteworthy because of its implications for the possibility of reducing staff errors and thereby enhancing patient safety.Concerning the patients in the CCU, when acoustic conditions were good they reported that nurses gave them better overall care. This was quite in agreement with what the staff reported. Also, blood pressure recordings were consistent with the interpretation that sympathetic nervous system activity in patients was lower when the sound-absorbing ceiling was in place. Reduced sympathetic activity indicates lower stress responding. Patients reported fewer sleep awakenings during the good acoustics condition. Also, there were indications that the incidence of re-hospitalization (within three months of discharge) was lower if patients had experienced the sound-absorbing rather than sound-reflecting ceiling during their stay in the CCU.Research indicates that patients who receive higher social support from their families or friends experience less stress and often have better outcomes.Single versus multi-bed rooms: It should be mentioned that the quality of staff communication accounts for about 20% of everything in patients' overall satisfaction with quality of care. Kaldenburg (1999) has proposed that when doctors and nurses are talking with patients in multi-bed rooms with roommates present, they automatically or unconsciously censor what they are saying out of respect for the person's privacy. It seems that when a patient is in a single room staff comments are more candid, informative and probably more emotionally supportive than when roommates are present. Good staff communication helps reduce patient anxiety, promotes better care at home after discharge and in other ways can improve outcomes. Another very important advantage of single-bed rooms, reduced medication errors by staff, stems from the fact that single rooms lessen patient transfers. Because family members were there more often in single rooms to help patients, fall rates were lower than for similar patients assigned to two-bed rooms. A recent U.S. study found that changing from two-bed rooms and centralized nursing stations to single-bed family-centred rooms and decentralized staff workstations reduced falls on a patient care floor by 75%. Single-bed rooms may cost more initially to construct, but due to the substantial savings resulting from reduced infection rates, fewer falls, fewer medical errors and other advantages, single-bed rooms save money after year one of operation.Traditionally healthcare architecture has aggravated the loss-of-control problem by depriving patients of visual privacy, control over lighting, forcing bedridden patients to stare at glaring ceiling lights, and creating wayfinding difficulties for patients and visitors. Dimmers enable patients to control room lighting; privacy in imaging areas; comfortable break rooms that give staff a sense they can escape briefly from workplace demands and stressors;Effects of view: Figure 8 displays findings from the same study (effects of looking at nature) for skin conductance, a measure that indicates sympathetic nervous system activity and can be said to reflect 3flight or fight� stress mobilization. Half of the patients had a window overlooking trees whereas the other half looked out on a brick wall (Ulrich, 1984). The groups of patients were similar in terms of factors that could affect recovery such as age, weight, and previous medical history. Those patients with the nature window view had better emotional well-being, suffered fewer minor postsurgical complications such as persistent headache or nausea, had shorter hospital stays and needed fewer doses of costly strong pain drugs. Another study at a Swedish hospital examined whether displaying nature pictures improved outcomes for patients following heart surgery (Ulrich, Lund�n, and Eltinge, 1993).