Light Impact

Health Care Environment of the FutureGroup 7

Geetanjali Ningappa, Jeff Jopling, Adriana Fuentes, Luxmi Saha, Lars Christensen

Light is very critical in Health Care settings

VisuallyEmotionallyBiologically

Importance of Light in Hospitals

• Affects Patients well-being•  Increases visual performance of the staff

resulting in enhanced work performance•  Healing Property; Light therapy is used as

treatment to cure many diseases• Induces alertness in staff• Errors by staff is reduced•  Reduces number of falls by patients

Visual Impacts of light

Enabling Performance of Visual tasks• Light enables us to see things ahead of us• Higher levels of light helps reduce staff error• Age related performance errors are reduced• Day lighting is preferred for fine color

discrimination

Visual Impacts of Light

Sleep quality of residents and number of fall incidents during night time• Patient falls reported inspite of wall

mounted luminaire over the bedo can not reach the switch or can not see the

switch in the dark• Light near the head disrupted the sleep of the

patient at night

Emotional Impacts of Light

Affecting Moods and perceptions• affects behavior and performance at work• Daylight has better impact in a work

environment than the artificial lighting• Patients exposed to bright daylight experienced

lesser perception of light

Emotional Impacts of Light

Exposure to Colored light• long exposure to a particular color is not

advisedo Causes over saturation

• creates an emotional state of mind

Biological Impacts of Light

Controlling body's Circadian System• Higher levels of light suppress Melatonin causing

alertness• Daylight is a better source as it provides higher

levels of light at eye level• Very important to staffs as they work in night shifts• Controlling the Circadian system helps combat

o depressiono sleepo circadian rest activity rhythmso length of stay

Biological Impacts of Light

Facilitating direct absorption for critical chemical reactions within the body

• Light radiation is directly absorbed by body stimulating chemical reactions in the blood and other tissueo Vitamin D metabolismo Jaundice prevention

Right selection of light critical

• Factors important in selection of light:o Technical needso Soft lighting for relaxingo Night lightingo Location, Intensity and Controllability of light

• Natural light is the best preference due to its natural healing properties and economy.

Family and Communication

Family and CommunicationFamily• 'a group of persons with close familial, social or emotional

relationship to the patient.'  • religious, cultural and social factors influence who is

considered family, and how those family members understand illness.

 • family members are more than just visitors - they, too,

experience the processes of care... • ...and can suffer from anxiety, PTSD and/or depression as a

result  

Effective Communication

• Communicationo 'As a result of treatment and the seriousness of the

illness, the ICU patient's body sends signals that the next of kin neither recognize or understand.' (Eriksson 2010)

• Aspects of good communicationo appropriate timing, style, and wordingo message effectively received and understoodo allow family to stay during times of crisiso support and appreciate family's contributions in caring for

the patient.

Role of Communication in Family Satisfaction

• Satisfaction - influenced by gap between needs and expectations and perceived fulfillment of those expectations.

• Need to make health professionals aware of the needs and expectations of patients and their families.

End of Life CommunicationWhy is needed?

• One out of five or 22% of Americans die in an ICU   • Need for clinicians and families to make decisions about

withdrawing or withholding life supporting therapies has become standard

 • 54% of family/patients may misunderstood patients

diagnosis or treatment if meetings last less than 10 minutes • Perceived to lack hospitality towards dying patients and their

family members • Doctor communication is not taught in an ICU

Good CommunicationAdvantages

Good communication makes a difference.• improved clinical outcomes:

o  Reducing psychological trauma symptomso  Reducing depression and anxietyo  Decreased length of stayo More frequent referral to hospice o earlier orders for DNR and withdrawal of life support

 Improving quality of death and dying• Critical care training may also change significantly if there is

some data that demonstrates improvement of patient/family outcome as a result of communication skill training

Assessing Communication in the ICU

• Validated tools primarily based on questionnaires can assess communication and satisfaction:o critical care family needs inventory (CC-FNI)o critical care family satisfaction survey (CC-FSS)o family satisfaction in the ICU (FS-ICU)

 • Results from individual ICU used to drive improvements in

that same ICU • Next steps: 

o develop means of tracking effective communication over time.

o further develop tools for NICU and PICU settings

Electronic CommunicationWhat is the need?

• Advances in information technology have led to an increase in the options for mode of communication

 • Increasing need for patients to read doctors' notes which

can help on:o Understanding their healtho Foster communicationo Ease and promote shared decision making processo Lead to better health patients' outcomes

Electronic Communication Results

Positive:•  Communication improvement through:

o internet portals with secure electronic messageso display medications, tests results, problems lists and facilitate

communication refillso ease on appointment scheduling 

• Efficiency in relating laboratory findings and doctors notes • Helps remind patients what happened during visits

Negative:• More questions raised about doctors' writing• Doctor's concerned about patients reactions from notes

Conclusion:• Current literature suggests positive results may be greater

than negative

Things to Consider

• Role that the built environment plays in facilitating or hindering communicationo Make patient rooms less obviously dominated by loud,

mechanical medical deviceso Allow for 'open access' to the unit

 • Effective discussion of prognosis and goals of care

o Family members use various types of information from a wide array of sources for prognostication

 • Shared decision making based on patient's and family's

values and preferences o  Develop patient-specific triggers for palliative care

consults