Lighting plays an important role in healthcare, improving both the patient experience and the staff’s ability to provide the required level of care. Not only a sustainable choice, LED lighting can enhance the care environment and reduce costs by saving energy and improving operational efficiency.
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Light influences our health and well-being more than we know. In clinics and hospitals, many areas exist with insufficient daylight or even none at all. This is why, especially for patients needing to spend a lot of time in hospitals, their ‘inner clock’ may lose its sense of balance, in turn causing restlessness. Back in 2006, Anjali Joseph, Ph.D. published a paper, “The Impact of Light on Outcomes in Healthcare Settings” for The Center for Health Design. Her objective was to identify the mechanisms by which light impacts human health and performance and review the literature linking light (daylight and artificial light) with health outcomes in healthcare settings. Her key findings, with which we are these days all au fait, were that light impacts human health and performance by enabling performance of visual tasks, controlling the body’s circadian system, affecting mood and perception, and by enabling critical chemical reactions in the body.
Studies show that higher light levels are linked with better performance of complex visual tasks and light requirements increase with age. By controlling the body’s circadian system, light impacts outcomes in healthcare settings by reducing depression among patients, decreasing length of stay in hospitals, improving sleep and circadian rhythm, lessening agitation among dementia patients, easing pain, and improving adjustment to night-shift work among staff. The presence of windows in the workplace and access to daylight have been linked with increased satisfaction with the work environment. Further, exposure to light is critical for vitamin D metabolism in the human body. Light exposure is also used as a treatment for neonatal hyperbilirubinaemia.
She concluded that the adequate and appropriate exposure to light is critical for health and wellbeing of patients and staff in healthcare settings. A combination of daylight and electric light can meet these needs. Natural light should be incorporated into lighting design in healthcare settings, not only because it is beneficial to patients and staff, but also because it is light delivered at no cost and in a form that most people prefer. More recently, studies of 90 stroke patients in a Danish hospital indicated that LED lighting tuned to mimic the patterns of daylight can have a positive effect on depression, fatigue, anxiety, and wellbeing, although there was some amount of inconclusiveness, and lighting made no difference in cognition improvement.
The results of the observations at the Stroke Rehabilitation Unit in Copenhagen's Righospitalet from May 2014 through June 2015 were only recently published. The studies were conducted by the University of Copenhagen's departments of neurology and neurophysiology and by the hospital's department of ophthalmology, using specialty lighting from Chromaviso, based in Aarhus, Denmark. The scientists generally tuned lighting in patient rooms to deliver the brighter and more blue-rich makeup associated with natural daylight during the mornings and afternoons. They toned down the brightness and delivered warmer spectral content in the evenings. At the same time they delivered ordinary hospital lighting to control groups. The team worked on the hypothesis that the tuned lighting would support human circadian rhythms associated with the 24-hour cycle of day and night, whereas ordinary hospital lighting and indoor confinement deprives patients of circadian normalities and can thus cause physiological disturbances.
All patients were hospitalised for over two weeks. In one study, focused on fatigue, they concluded that “fatigue was significantly reduced in rehabilitation patients exposed to naturalistic lighting during admission”. They based their conclusion on a couple of questionnaires, one called the Multidimensional Fatigue Inventory questionnaire, and the other the Rested Statement, noting that the experimental groups reported less fatigue compared to the control group. However, by another measurement, the Pittsburgh Sleep Quality Index, “no differences were detected between groups in sleepiness or subjective sleep quality,” wrote the authors, led by Anders West from the neurology department. If those results were encouraging but mixed, the same could be said of a separate set of observations looking at a combination of depression, anxiety, wellbeing, and cognition.
“Depressive mood and anxiety was reduced, and wellbeing was increased in the (experimental) group at discharge compared to the (control group),” the authors reported. However, “no difference was found in cognition,” the authors stated. The team applied the Hamilton Depression Scale, the Major Depression Inventory, the WHO-Five Well-being Index, the Hospital Anxiety and Depression Scale, and the Montreal Cognitive Assessment to determine the results. “This study is the first to demonstrate that exposure to naturalistic light during admission may significantly improve mental health in rehabilitation patients,” they concluded, adding that “further studies are needed to confirm these findings”.
A move towards lighting that helps heal
Major lighting companies around the world are looking to create a more effective healing environment using the natural power of light. HealWell, for instance, from Philips, aligns patient room lighting automatically with our human circadian rhythm to help hospital patients sleep better, feel happier and heal faster.
HealWell takes an evidence-based approach to lighting with ceiling modules simulating daylight rhythms with dynamic light levels and tones while providing excellent visibility for medical examinations. Patients can easily personalise lighting from their beds while subtle LED orientation lighting helps health workers navigate quietly. Studies show HealWell helps patients sleep more quickly and deeply, improving mood.
Benefits at a glance of specialised hospital lighting:
International case studies
The ambition of Montefiore Private Hospital in Hove, England, was to transform an old Victorian building into a private hospital. Originally built as a furniture depository for Hannington’s Department Store in the 1890s, the building was extended in the 1930s and converted to an office in the 1970s. With its staggered floor plates (lined with asbestos), steep internal ramps, fixed service cores and dreary decor, this was going to be a complex task to achieve and presented a fascinating architectural problem.
Zumtobel, in conjunction with Hamson JPA and Nightingale Associates, had the challenging task of creating a unique lighting design that fully met the client’s brief, to create the look and feel of a sophisticated modern hotel, rather than a hospital. Zumtobel’s luminaires have fully achieved this brief throughout the entire building. In the reception area, tunable Arcos luminaires allow for full colour change according to the artwork on display from local artists.
In the patient rooms, Belia’s discreet appearance blends into wooden panels, whilst also still being fully functional. Throughout the offices Mellow Light IV glare free, energy efficient luminaires have modernised the entire look of the administration offices. Slotlight II lightlines and Panos downlights using white reflectors blend inconspicuously and uniquely into the hospital’s corridors. Functionality was also made possible thanks to the Zumtobel Emotion lighting control touch panel which allows the user to change scenes according to the function required and the time of the day At the German Heart Institute in Berlin, Germany, each year around 3 000 open-heart operations are undertaken along with more than 1 500 additional surgical procedures. With patients often in critical condition, the Institute sought a new way to improve care on the wards. “It is extremely important to us that the patients in our intensive care unit feel secure, comfortable and well looked after – both medically and emotionally.
The all-encompassing HealWell lighting concept from Philips creates the optimum framework for this,” said Doctor Roland Hetzer, Medical Director at the German Heart Institute. Doctors at the German Heart Institute understand the importance of light. When extensive renovation was carried out at the facility, they were looking for a modern, controllable lighting concept that could assist patient recovery. Not only would this make it easier for staff to give treatment but, as mentioned, innovative lighting has been shown to have a positive effect on stress, sleep patterns and hormone release. Philips HealWell was specified.
This patient room lighting system has been designed to support natural sleep rhythms by mimicking the natural light patterns outside. When patients enter hospital, they often have trouble sleeping, which can have a negative effect on their health and mood. Not only does HealWell help to keep their sleep patterns normal, but light hues can be changed at the patient’s desire, and the system complies with all hygiene regulations. In the patient recreation room, additional comfort comes from luminous textiles. They deliver ever-changing ambience that soothes and relaxes, while also softening sound. The new lighting systems are helping the Institute to provide better care for patients, and a better working atmosphere for staff. Just what the doctor ordered. Patients are able to control the light in their rooms via remote control, using preferred coloured settings. This gives them a greater sense of control, and an increased sense of wellbeing.
Other considerations
Further reading:Economical light for health: The range of applications in medical practices and hospitals is diverse and challenging – patient rooms, corridors and glare-free computer workstations meet the need for safety and orientation. Energy efficiency adopts a decisive role due to the continuous use of artificial light. Mature LED technology together with an intelligent light management system is able to cut energy overheads by up to 85 percent compared to conventional, obsolete lighting systems.
Colour rendering: During minor medical procedures an accurate colour rendering and a glare-free light field are crucial for staff to administer care. In emergency situations the light fixture must also be easy to manoeuvre, have a wide range of movement and the ability to stay where it is positioned. Lighting in a patient’s room must be multifunctional to assist physicians and staff who are busy keeping close watch on patients, while also creating atmosphere in a hospital environment that is comforting and contributes towards the healing process. In public areas such as hospital corridors, stairways and lounges lighting should be bright enough for people to see clearly while maintaining comfortable light levels.
The work environment for nurses and physicians in hospitals is stressful. They are required to perform a range of complex tasks – charting, filling prescriptions, administering medication, and performing other critical patient-care tasks. Inadequate lighting and a chaotic environment are likely to compound the burden of stress and lead to errors. However, very few studies have focused specifically on the impact of different types of lighting conditions on staff work performance in hospitals.
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