To investigate the physiological and psychological effects of windows and daylight on registered nurses.
BACKGROUND:
To date, evidence has indicated that appropriate environmental lighting with characteristics similar to natural light can improve mood, alertness, and performance. The restorative effects of windows also have been documented. Hospital workspaces generally lack windows and daylight, and the impact of the lack of windows and daylight on healthcare employees' well being has not been thoroughly investigated.
METHODS:
Data were collected using multiple methods with a quasi-experimental approach (i.e., biological measurements, behavioral mapping, and analysis of archival data) in an acute-care nursing unit with two wards that have similar environmental and organizational conditions, and similar patient populations and acuity, but different availability of windows in the nursing stations.
RESULTS:
Findings indicated that blood pressure (p < 0.0001) decreased and body temperature increased (p = 0.03). Blood oxygen saturation increased (p = 0.02), but the difference was clinically insignificant. Communication (p < 0.0001) and laughter (p = 0.03) both increased, and the subsidiary behavior indicators of sleepiness and deteriorated mood (p = 0.02) decreased. Heart rate (p = 0.07), caffeine intake (p = 0.3), self-reported sleepiness (p = 0.09), and the frequency of medication errors (p = 0.14) also decreased, but insignificantly.
CONCLUSIONS:
The findings support evidence from laboratory and field settings of the benefits of windows and daylight. A possible micro-restorative effect of windows and daylight may result in lowered blood pressure and increased oxygen saturation and a positive effect on circadian rhythms (as suggested by body temperature) and morning sleepiness.
Aan het RotM.MoskowitzD. S., & YoungS. N. (2008). Exposure to bright light is associated with positive social interaction and good mood over short time periods: A naturalistic study in mildly seasonal people. Journal of Psychiatric Research, 42, 311–319.
2.
AlimogluM. K., & DonmezL. (2005). Daylight exposure and the other predictors of burnout among nurses in a university hospital. International Journal of Nursing Studies, 42, 549–555.
3.
AriesM. B. C.VeitchJ. A., & NewshamG. R. (2010). Windows, view, and office characteristics predict physical and psychological discomfort. Journal of Environmental Psychology, 30(4), 533–541.
4.
BadiaP.MyersB.BoeckerM.CulpepperJ., & HarshJ. R. (1991). Bright light effects on body temperature, alertness, EEG and behavior. Physiology & Behavior, 50, 583–588.
5.
BealeD.LawrenceC.LeatherP., & PyrgasM. (1998). Windows in the workplace: Sunlight, view, and occupational stress. Environment and Behavior, 30(6), 739–762.
6.
BegemannS. H. A.van den BeldG. J., & TennerA. D. (1997). Daylight, artificial light and people in an office environment, overview of visual and biological responses. International Journal of Industrial Ergonomics, 20, 231–239.
7.
BernardiL.SpadaciniG.BellwonJ.HajricR.RoskammH., & FreyA. W. (1998). Effect of breathing rate on oxygen saturation and exercise performance in chronic heart failure. Lancet, 351, 1308–1311.
8.
BenedettiF.ColomboC.BarbiniB.CamporiE., & SmeraldiE. (2001). Morning sunlight reduces length of hospitalization in bipolar depression. Journal of Affective Disorders, 62(3), 221–223.
9.
BenedettiF.ColomboC.PontiggiaA.BernasconiA.FloritaM., & SmeraldiE. (2003). Morning light treatment hastens the antidepressant effect of citalopram: A placebo-controlled trial. Journal of Clinical Psychiatry, 64(6), 648–653.
10.
BlegenM. A.VaughnT.PepperG.VojirC.StrattonK.BoydM., & ArmstrongG. (2004). Patient and staff safety: Voluntary reporting. American Journal of Medical Quality, 19(2), 67–74. doi:10.1177/106286060401900204
BuchananT.BarkerK.GibsonJ.JiangB., & PearsonR. (1991). Illumination and errors in dispensing. American Journal of Health-System Pharmacy, 48(10), 2137–2145.
13.
CajochenC. (2007). Alerting effects of light. Sleep Medicine Reviews, 11, 453–464.
14.
ChaudhuryH.MahmoodA., & ValenteM. (2009). The effect of environmental design on reducing nursing errors and increasing efficiency in acute care settings: A review and analysis of the literature. Environment and Behavior, 41(6), 755–786.
15.
CrepeauL. J.BulloughJ. D.FigueiroM. G.PorterS., & ReaM. S. (2006). Lighting as a circadian rhythm-entraining and alertness-enhancing stimulus in the submarine environment. (Unpublished conference paper). Undersea HSI Symposium: Research, Acquisition, and the Warrior. Mystic, CT. Retrieved from http://cogprints.org/6574/.
16.
CzeislerC.AllanJ.StrogatzS.RondaJ.SanchezR.RiosC.KronauerR. (1986). Bright light resets the human circadian pacemaker independent of the timing of the sleep wake cycle. Science, 233, 667–671.
17.
FeagaiH. E. (2011). Let humor lead your nursing practice. Nurse Leader, 9(4), 44–46. doi:10.1016/j.mnl.2010.10.005
18.
GenesN.ChandraD.EllisS., & BaumlinK. (2013). Validating emergency department vital signs using a data quality engine for data warehouse. TOMINFOJ The Open Medical Informatics Journal, 7(1), 34–39.
19.
GiffordR. (1988). Light, decor, arousal, comfort and communication. Journal of Environmental Psychology, 8, 177–189.
KamaliN. J., & AbbasM. Y. (2012). Healing environment: Enhancing nurses' performance through proper lighting design. Procedia - Social and Behavioral Sciences, 35, 205–212.
22.
KaplanR. (1993). The role of nature in the context of the workplace. Landscape and Urban Planning, 26(1-4), 193–201.
23.
KentS. T.McClureL. A.CrossonW. L.ArnettD. K.WadleyV. G., & SathiakumarN. (2009). Effect of sunlight exposure on cognitive function among depressed and non-depressed participants: A REGARDS cross-sectional study. Environmental Health, 8, 34–48.
24.
KimS.CranorB. D., & RyuY. S. (2009). Fatigue: Working under the influence. Proceedings of the XXIst Annual International Occupational Ergonomics and Safety Conference, Dallas, Texas, USA, June 11–12 (pp. 317–322).
25.
KoohestaniH., & BaghcheghiN. (2009). Barriers to the reporting of medication administration errors among nursing students. Australian Journal of Advanced Nursing, 27(1), 66–74.
26.
KräuchiK.Wirz-JusticeA., & GrawP. (1990). The relationship of affective state to dietary preference: Winter depression and light therapy as a model. Journal of Affective Disorders, 20(1), 43–53. doi:10.1016/0165-0327(90)90048-D
27.
MayoA. M., & DuncanD. (2004). Nurse perceptions of medication errors—What we need to know for patient safety. Journal of Nursing Care Quality, 19(3), 209–217.
28.
MroczekJ.MikitarianG.VieiraE. K., & RotariusT. (2005). Hospital design and staff perceptions: An exploratory analysis. The Health Care Manager, 24(3), 233–244.
29.
MoraesW.PiovezanR.PoyaresD.BittencourtL. R.Santos-SilvaR., & TufikS. (2014). Effects of aging on sleep structure throughout adulthood: A population-based study. Sleep Medicine, 15(4), 401–409. doi:http://dx.doi.org/10.1016/j.sleep.2013.11.791
30.
MünchM.LinhartF.BorisuitA.JaeggiS. M., & ScartezziniJ. (2012). Effects of prior light exposure on early evening performance, subjective sleepiness, and hormonal secretion. Behavioral Neuroscience, 126(1), 196–203.
31.
MyersB. L., & BadiaP. (1993). Immediate effects of different light intensities on body temperature and alertness. Physiology and Behavior, 54, 199–202.
Noell-WaggonerE. (2006). Lighting in nursing homes—The unmet need. Proceedings of the 2nd International Commission on Illumination Expert Symposium on Lighting and Human Health, Ottawa, Ontario, Canada, September 7–8 (pp. 77–81). Retrieved from http://www.centerofdesign.org/pdf/LightingNursingHomeUnmetNeed.pdf
34.
OlsenR. V.HutchingB. L., & EhrenkrantzE. (2000). Media memory lane: Interventions in an Alzheimer's day care center. American Journal of Alzheimer's Disease, 15(3), 163–175.
35.
OttR. L., & LongneckerM. (2008). An introduction to statistical methods and data analysis (6th ed.). Pacific Grove, CA: Duxbury Press.
36.
PalmerG. K. (2005). Laughter: The perfect family medicine. Marriage & Families, 15(1), 23–25.
37.
PatiD.HarveyT. E., & BarachP. (2008). Relationships between exterior views and nurse stress: An exploratory examination. Health Environments Research & Design Journal, 1(2), 27–38.
38.
PauleyS. M. (2004). Lighting for the human circadian clock: Recent research indicates that lighting has become a public health issue. Medical Hypotheses, 63(4), 588–596.
39.
PostolacheT. T., & OrenD. A. (2005). Circadian phase shifting, alerting, and antidepressant effects of bright light treatment. Clinical Sports Medicine, 24(2), 381–413.
40.
ReaM.FigueiroM., & BulloughJ. (2002). Circadian photobiology: An emerging framework for lighting practice and research. Lighting Research and Technology, 34(3), 177–187. doi:10.1191/1365782802lt057
41.
ReaM. S.FigueiroM. G.BulloughJ. D., & BiermanA. (2005). A model of phototransduction by the human circadian system. Brain Research Reviews, 50(2), 213–228.
RogersM. A.SmallD.BuchanD. A.ButchC. A.StewartC. M.KrenzerB. E., & HusovskyH. L. (2001). Home monitoring service improves mean arterial pressure in patients with essential hypertension. A randomized, controlled trial. Annals of Internal Medicine, 134(11), 1024–1032.
44.
RossbergJ. I.MelleI.OpjordsmoenS., & FriisS. (2008). The relationship between staff members' working conditions and patients' perceptions of the treatment environment. International Journal of Social Psychiatry, 54(5), 437–446. doi:10.1177/0020764008090689
45.
ScottA. J. (2000). Shift work and health. Primary Care, 27(4), 1057–1079.
46.
SharmaV. K.ChandrashekaranM. K., & NongkynrihP. (1997). Daylight and artificial light phase response curves for the circadian rhythm in locomotor activity of the field mouse Mus booduga. Biological Rhythm Research, 28(S1), 39–49.
47.
ShermanS. A.VarniJ. W.UlrichR. S., & MalcarneV. L. (2005). Post-occupancy evaluation of healing gardens in a pediatric cancer center. Landscape and Urban Planning, 73(2), 167–183.
48.
SmoldersK. C. H. J.de KortY. A. W., & CluitmansP. J. M. (2012). A higher illuminance induces alertness even during office hours: Findings on subjective measures, task performance and heart rate measures. Physiology & Behavior, 107, 7–16.
49.
StandleyJ. M., & MooreR. S. (1995). Therapeutic effects of music and mother's voice on premature infants. Pediatric Nursing, 21(6), 509.
50.
StevensR. G., & ReaM. S. (2001). Light in the built environment: Potential role of circadian disruption in endocrine disruption and breast cancer. Cancer Causes & Control, 12(3), 279–287.
51.
StoneA. A., & ShiffmanS. (1994). Ecological momentary assessment (EMA) in behavioral medicine. Annals of Behavioral Medicine, 16, 199–202.
52.
TakanishiT.EbaraT.MurasakiG. I.KuboT.TachiN.ItaniT., & KamijimaM. (2010). Interactive model of subsidiary behaviors, work performance and autonomic nerve activity during visual display terminal work. Journal of Occupational Health, 52(1), 39–47.
53.
TurnerP. L.Van SomerenE. J. W., & MainsterM. A. (2010). The role of environmental light in sleep and health: Effects of ocular aging and cataract surgery. Sleep Medicine Reviews, 14(4), 269–280.
54.
UlrichR. S. (1984). View through a window may influence recovery from surgery. Science, 224, 420–421.
55.
van BommelW. J. M., & van den BeldJ. G. (2004). Lighting for work: A review of visual and biological effects. Lighting Research and Technology, 36, 255–269.
56.
VarniJ. W.SeidM., & RodeC. A. (1999). The PedsQL™: Measurement Model for the Pediatric Quality of Life Inventory. Medical Care, 37(2), 126–139.
57.
WalchJ. M.RabinB. S.DayR.WilliamsJ. N.ChoiK., & KangJ. D. (2005). The effect of sunlight on postoperative analgesic medication usage: A prospective study of spinal surgery patients. Psychosomatic Medicine, 67(1), 156–163.
58.
WrightK. P.HullJ. T., & CzeislerC. A. (2002). Relationship between alertness, performance, and body temperature in humans. American Journal of Physiology—Regulatory, Integrative and Comparative Physiology, 283(6), R1370–R1377. doi:10.1152/ajpregu.00205.2002
59.
ZadehR. S.ShepleyM. M.WilliamsG. & ChungS. S. E. (2014). The impact of windows and daylight on acute-care nurses' physiological, psychological, and behavioral health. Health Environments Research & Design Journal, 7(4), 35–61.
