Literature Review - HSC Home - University of the West of England

outcomes including depression, elevated blood pressure and reducedimmune functioning (Ulrich et al., 1991).Environmental features that affect patient outcomes include noise, lighting,colour, windows, views and art. Research suggests a number of negativeeffects of excessive or unwanted sound, including sleep deprivation (Simpsonet al., 1996), are associated with a number of negative physiologicaloutcomes (Topf and Davis, 1993). The review highlights earlier research thathas demonstrated that patients’ experiences in hospital are affected by thepresence or absence of a window (see for example Ulrich, 1984). Work byUlrich (1992) on the role of art in hospital is also discussed. Artworks thatfeature images that hold the attention and create a positive distraction fromworries and invasive thoughts are seen as of most benefit. These include: Nature elements, such as trees, plants and water. Happy, laughing or caring human faces. Benign animals, such as pets.The 2000 review by Day et al., (2000) focuses on design and dementia,including facility planning, environmental attributes, building organisation, allof which are increasingly recognised as an important aid in caring for peoplewith dementia. The review includes 71 empirical studies published from 1980onwards.The review identifies a number of characteristics of the environment that canhave an impact on this group. For example, residents’ orientation can beaffected by factors such as noise and lighting, while orientation can beimproved by design features such as colour. While there is relatively littleemphasis on arts, the review does consider other planning principles relevantto our research including relocation to new environments. A number ofstudies cited in the review suggest that when people are moved together asan intact group, to residents and staff there are few negative effects ofrelocation (Anthony et al., 1987; McAuslane and Sperlinger, 1994). However,residents with dementia who are moved individually appear to suffer higherrates of depression and mortality (Anthony et al., 1987; Robertson et al.,1993). The extent to which these studies considered the quality of theenvironment in relation to the effects of relocation is unclear, although onestudy suggests that the more pleasant environment of a new facility maypartially explain the lack of negative impact for relocated residents(McAuslane and Sperlinger, 1994).The review notes that the majority of studies were based on small samplesizes. These are included as they reflect the limited populations of residentsat single facilities in which most of the research took place. Nevertheless, theauthors conclude that further research is needed to build on these exploratorystudies in order to investigate the therapeutic use of design in dementia care.The final review discussed in this section focuses specifically on the evidenceregarding the effects of improvements in hospital design and construction onthe occurrence of nosocomial infections (Dettenkofer et al., 2004). Although it22