Healing environment, for healthcare buildings describes a physical setting and organizational culture that supports patients and families through the stresses imposed by illness, hospitalization, medical visits, the process of healing, and sometimes, bereavement. The concept implies that the physical healthcare environment can make a difference in how quickly the patient recovers from or adapts to specific acute and chronic conditions.
Background
The original concept of the healing environment was developed by Florence Nightingale whose theory of nursing called for nurses to manipulate the environment to be therapeutic (Nightingale, F. 1859). Nightingale outlined in detail the requirements of the "sick room" to minimize suffering and optimize the capacity of a patient to recover, including quiet, warmth, clean air, light, and good diet. Early healthcare design followed her theories outlined in her treatise, "Notes on Hospitals". Following the discoveries by Louis Pasteur and others which lead to the Germ Theory, plus other technologies, the role of the environment was dominated by infection control and technological advances.
Starting in the 1960s, healing environments have been linked with evidence-based design (EBD), giving the concept a strong scientific base. While in some respects it can be said that the concept of healing environments has evolved into EBD, it's mainly in the area of reduction of stress that this overlap occurs; as EBD goes beyond the healing environments dimension to consider the effect of the built environment on patient clinical outcomes in the areas of staff stress and fatigue, patient stress, and facility operational efficiency and productivity to improve quality and patient safety. A 1984 study by Roger Ulrich found that surgical patients with a view of nature suffered fewer complications, used less pain medication and were discharged sooner than those who looked out on a brick wall. Since then, many studies have followed, showing impact of several environmental factors on several health outcomes.
Today, the philosophy that guides the concept of the healing environment is rooted in research in the neurosciences, environmental psychology, psychoneuroimmunology, and evolutionary biology. The common thread linking these bodies of research is the physiological effects of stress on the individual and the ability to heal. Psychologically supportive environments enable patients and families to cope with and transcend illness.
Goal
The goal of creating a healing environment is to reduce stress, and thereby reduce associated problems such as medical error, inability to concentrate, and physical symptoms of stress that can affect logical thought process. While use of EBD techniques would not necessarily make an environment a healing one, through EBD we can define environmental factors that can help to ease stress and thereby result in a healing environment. Malkin emphasizes the contribution of research to concepts that can create a healing environment, but just the inclusion do not make setting a 'healing environment'. The design team needs to translate the EBD into design solutions unique to the individual hospital.
According to "The Business Case for Creating a Healing Environment" written by Jain Malkin, the physical setting has the potential to be therapeutic if it achieves the following: eliminates environmental stressors such as noise, glare, lack of privacy and poor air quality; connects patients to nature with views to the outdoors, interior gardens, aquariums, water elements, etc.; offers options and choices to enhance feelings of being in control - these may include privacy versus socialization, lighting levels, type of music, seating options, quiet versus 'active' waiting areas; provides opportunities for social support - seating arrangements that provide privacy for family groupings, accommodation for family members or friends in treatment setting; sleep-over accommodation in patient rooms; provides positive distractions such as interactive art, fireplaces, aquariums, Internet connection, music, access to special video programmes with soothing images of nature accompanied by music developed specifically for the healthcare setting; and engenders feelings of peace, hope, reflection and spiritual connection and provides opportunities for relaxation, education, humour and whimsy.