Healing environments

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.

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). 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.". 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.

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.

There is considerable confusion about what constitutes a healing environment. Some refer to what we have come to know as "hospitality healthcare design" of the 1980s as healing environments. While some hotels have a high level of design and drama which may be aesthetically appealing, they generally lack those qualities that one would consider to be restorative or conducive to physical, emotional, and spiritual healing.

Goal
The goal of all healing environments is to engage patients in the conscious process of self-healing and spiritual growth. Spaces are designed to be nurturing and therapeutic and, most important, to reduce stress. This is a research-based approach to design (also known as Evidence-based design), aimed at eliminating environmental stressors and putting patients in contact with nature in the treatment setting.

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:


 * eliminates environmental stressors such as noise, glare, lack of privacy and poor air quality;
 * connects patients to nature with views to the outdoors, interior gardens, aquariums, water elements, etc.;
 * offers options and choices to enhance feelings of being in control - these may include privacy versus socialization, lighting levels, type of music, seating options, quiet versus 'active' waiting areas;
 * provides opportunities for social support - seating arrangements that provide privacy for family groupings, accommodation for family members or friends in treatment setting; sleep-over accommodation in patient rooms;
 * provides positive distractions such as interactive art, fireplaces, aquariums, Internet connection, music, access to special video programmes with soothing images of nature accompanied by music developed specifically for the healthcare setting; and
 * engenders feelings of peace, hope, reflection and spiritual connection and provides opportunities for relaxation, education, humour and whimsy.

Bringing Home to the Hospital
The most important thing for inpatients at hospitals is the comfort and normalcy of having family members and friends that visit and spend time with them. With advances in healthcare most patients are treated in an outpatient setting, where they come in have a procedure or test run and then go back to their homes. Today’s inpatients are more likely to have a serious condition and be there for a period of at least several days and sometimes even months. This explains the growing trend of creating healthcare environments that make not only the patient, but also their loved ones feel like they can relax and maybe even forget that they’re at the hospital. It is proven that if someone feels comfortable and relaxed, they can rest easier and heal faster.

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.". 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. 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. 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.