Screen reader users, click here to load entire articleThis page uses JavaScript to progressively load the article content as a user scrolls. Screen reader users, click the load entire article button to bypass dynamically loaded article content. Volume 58, December 2012, Pages 70–80 Healing environment: A review of the impact of physical environmental factors on usersa b c Received 21 November 2011, Revised 11 May 2012, Accepted 22 June 2012, Available online 11 July 2012In recent years, the effects of the physical environment on the healing process and well-being have proved to be increasingly relevant for patients and their families (PF) as well as for healthcare staff. The discussions focus on traditional and institutionally designed healthcare facilities (HCF) relative to the actual well-being of patients as an indicator of their health and recovery. This review investigates and structures the scientific research on an evidence-based healthcare design for PF and staff outcomes.
Evidence-based design has become the theoretical concept for what are called healing environments. The results show the effects on PF and staff from the perspective of various aspects and dimensions of the physical environmental factors of HFC. A total of 798 papers were identified that fitted the inclusion criteria for this study. Of these, 65 articles were selected for review: fewer than 50% of these papers were classified with a high level of evidence, and 86% were included in the group of PF outcomes. This study demonstrates that evidence of staff outcomes is scarce and insufficiently substantiated. With the development of a more customer-oriented management approach to HCF, the implications of this review are relevant to the design and construction of HCF. Some design features to consider in future design and construction of HCF are single-patient rooms, identical rooms, and lighting. For future research, the main challenge will be to explore and specify staff needs and to integrate those needs into the built environment of HCF.
Highlights► The built environment can contribute to reducing errors, falls, and infections. ► The built environment can enhance the privacy, comfort, and control. ► Examples of design features are: single-bed rooms and identical rooms. ► Most of the evidence is found in the topic of view and acoustic comfort. ► Most staff outcomes are empirical based and not scientifically proven.Keywords; ; ; ; ; 1. IntroductionHealth is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity [1]. Healthcare facilities (HCF) are places where patients with health conditions go for treatment, which is provided by specialists and other care professionals. In recent years, we see a growing interest in the role of technology and the built environment as part of the holistic treatment of patients. Discussions about the importance of the built environment for the patient's health and well-being and the provision and support of healthcare extend at least as far back as 400 BC [2] with Hippocrates and the 19th century with Florence Nightingale [3].
Burge described the relationship between symptoms of the “Sick Building Syndrome” (SBS) and the indoor environment of buildings [4]. The term SBS comprises a group of symptoms of unclear aetiology consisting of dry skin and symptoms related to mucous membranes, as in the eyes, nose, and throat, together with what are often called general symptoms of headache and lethargy [4]. In an office setting, the symptoms of SBS can reduce productivity and increase absenteeism from work. Similar problems occur in other buildings, for instance, in HCF. These effects of the physical environment on the patient's healing process, recovery, and well-being have consequences for the design and construction of HCF. In the 1990s, design solutions in healthcare, based on published research, were defined as “evidence-based design” (EBD). Healing environments can be considered as “smart investments” because they save money, increase staff efficiency, and reduce the hospital stay of the patient by making the stay less stressful [5].
Based on the definitions of several academic researchers [6], [7], [8] and [9], a healing environment can be defined as a place where the interaction between patient and staff produces positive health outcomes within the physical environment.The movement towards EBD in healthcare started with Ulrich [10], who compared the positive effect of views of natural scenery on the recovery of patients from surgery to patients in similar conditions who were exposed to a view of a brick wall. Ulrich showed that in comparison with the wall-view group, the patients with the tree view had shorter postoperative hospital stays, had fewer negative evaluative comments from nurses, took fewer moderately strong and strong medication, and had slightly lower scores for minor postsurgical complications. Since then, the impact of the physical environment of the hospital on the well-being and health of the patient has received extensive academic attention. Consequently, this resulted in a creation of spaces considered to be healing environments.
An increasing body of knowledge on evidence-based healthcare design has become available, and the amount of information has grown rapidly in recent years.This study surveys and structures the scientific research on evidence-based healthcare design from the perspective of the needs of end-users. The group of end-users is defined as patient, family (PF) and staff in this review. The perspectives of the designer or project developer are omitted from consideration in this review. Furthermore, this review distinguishes between empirical data and evidence-based data concerning the patient and staff health outcomes in hospital settings.2. AimThe aim of the review is to provide an overview of the evidence in the literature on healing environments. The hypothesis is that healing environments, through EBD, make hospitals less stressful and promote faster healing for patients and improve well-being for their families, as well as creating a pleasant, comfortable and safe work environment for staff [7] and [8].
Therefore, the following questions are explored in this review:(1)Which findings of research related to PF outcomes and staff outcomes of healthcare design are evidence based or scientifically proven or are not (sufficiently) proven?Which findings of research related to PF outcomes and staff outcomes of healthcare design are under discussion?2.2. Search methods for identification studiesThe Cochrane Methodology [11] was used to search the data. Potentially relevant literature was identified through computerised searches. Pubmed [Medline], Jstor, and Scopus were the databases used to find relevant articles (Fig. 1). The search was performed using the keywords evidence-based design, hospital design, healthcare design, healthcare quality, outcomes, patient safety, staff safety, infection, hand washing, medical errors, falls, pain, sleep, stress, depression, confidentiality, social support, satisfaction, single rooms, noise, nature and daylight. The search criteria were based on characteristics of the several groups in this study.