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

8. Findings from Research on Health Care Design andEnvironmentsOur review included ten studies of the impact of the design and environmentof health care facilities on patients and staff (see Appendix 8). This was themost extensively researched area, and also the area that included thegreatest number of experimental studies (see section 5 for a methodologicaldiscussion of the studies). A wide range of outcomes were examinedincluding: physiological effects, clinical outcomes, behavioural responses tothe environment and psychosocial items. The impact of the environment wasalso examined in qualitative research (Francis et al., 2003).8.1 Physiological effects of health care environmentsThe largest study was an investigation of the effects of environmentalconditions on 872 blood donors drawn from 942 would be blood donatorsarriving at a US clinic (Ulrich et al., 2003). The study used physiologicalmeasures, including blood pressure and pulse rate, as well as self-reportmeasures of psychosocial items. The study found that stress was higherduring periods of exposure to certain environments, including television andurban settings. In contrast, nature images and sounds were associated withlower levels of stress as measured by physiological indicators. The authorsconclude that the common practice of playing uncontrollable daytimetelevision in health care waiting areas may increase stress for patients.Support for the healing effects of nature is also found in an earlier controlstudy of the effects of natural versus urban settings on recovery following astressful experience (Ulrich et al., 1991). This study involved 60 male and 60female undergraduates at a university in the US, who were randomised intogroups exposed to stress through viewing a film about the prevention of workaccidents followed by exposure to one of six different everyday outdoorsettings (two natural, two urban). Physiological measures, includingcardiovascular activity and pulse rates, were taken continuously throughoutthe stressor and recovery periods and the study also measured psychosocialitems three points (pre-stressor, post-stressor and post-recovery). Significantdifferences as a function of environment were found for all three physiologicalstress measures in the recovery period. Recovery from stress was faster andmore complete when subjects were exposed to natural settings as opposed tothe other environments. Self-report data also indicated that the differentexposures had markedly different effects on psychosocial states.8.2 The impact of the environment on clinical indicatorsThree studies examined the impact of the environment on clinical indicators.For example, a study in a maximum-security hospital in the UK measuredchanges in medication rates, seclusion rates and casualty incidents, as wellas perceptions of the ward following rearrangement of the physicalenvironment of the ward dayrooms from non-social to group arrangements(Baldwin, 1985). The study population included residents from seven male41