Dr Helle Wijk, Associate professor at Gothenburg University, Sweden, recently visited South Africa to take part in the series of seminars on the healing properties of colour in healthcare environments organised by FloorworX. The following is a résumé of her presentation.
Current research establishes the firm relation between the physical environment in healthcare architecture and caring and medical outcomes. New design principles have been developed, aimed at promoting healing environments that can contribute to the recovery of patients and their well-being, as well as helping staff to cope better with stress and increasing the involvement of relatives in the caring process.
The demographic situation around the world stresses the need for innovative thinking and research in healthcare environments as well as in housing for the elderly, where there is a strong need to enable better architectural programming as well as design in different kinds of healthcare building projects including assisted-living services.
In addition, residential healthcare is a new research area within the field of evidence-based design, concerned with a situation where more of healthcare activities take place in private homes. This is an increasing tendency connected to the demographic development in many countries around the world.
The impact of colour and light in healthcare environments
The experiences of colour and light are interdependent and cannot be analysed separately. The colours of the surrounding room influence our experiences of light and the need for lighting, and the intensity, quality and distribution of light are essential for our perception and experience of colour. The aesthetics of colour and light play an important role in the fields of healthcare.
The interaction between colour and light demands an interdisciplinary approach as well as requiring a deep understanding of colour and light applications in architectural spaces.
In our research we have found significant evidence of a preserved colour perception in old age considering discrimination, naming, preferences and colour coding.
The colour samples are selected from the Natural Colour System, the Swedish standard system for colour notation. Despite significant differences in age and visual and cognitive function between the participants, their results follow the same pattern.
All show a better detection of colour differences in the red and yellow areas than in the blue and green, with the dimension of lightness difference being a determining factor. Elementary colours are assigned a name more correctly than mixed colours. The colour preference ranking order put blue, red and green as the most preferred.
A colour code gives significant support for immediate recognition compared to the situation after 20 minutes retention time where shape gives the strongest support for recognition instead. The results are implemented in healthcare environments in order to promote orientation and well-being for the patients.
When the whole team is aware of the impact of the environment upon the quality of care they may be instrumental in reducing some of the harmful effects of a negative design of the environment.
Collaboration between architecture, medicine and caring could be expanded when planning for new institutions in order to promote a better understanding of the special needs of the patients.
Meeting and listening to research facts
Architecture, design and healthcare needs should have a priority of taking cognisance of environmental design. Studies have shown that every tenth visit to hospital contributes an adverse event such as patients tripping and falling, which results in patients experiencing healthcare establishments as being frightening environments. Thus there is a need to improve the quality of these environments.
So how does one increase the interest in healthcare design? Initially by meeting and listening to research facts.
Sweden has four distinct seasons; winter is very dark, and has an adverse impact on staff and patients. Sweden also has one of the oldest populations in the world – almost half of all patients are over 65 years of age, many with common diagnoses that go with age, which means that each hospital has to take its target group into account, and be able to accommodate geriatric patients.
A poor environment adds to the confusion and ill-being of older patients, and here colour plays an important role, helping them to pay attention. For example, the elderly often ignore signs, but colour coding of departments can solve the problems of orientation. In other words, person-centred care must be created to ensure that the physical environment is increasingly recognised.
The centrepoint of any research on colour perception must be on safety and well-being, but what is evidence-based design, and are designers aware of what new evidence is available?
Non-institutional design features such as personalised rooms, colour schemes and lighting all improve well-being, and a higher degree of exposure to daylight is important to reduce depression and length of stay; to reduce pain; and to increase quality of sleep – all essential requirements needed for recovery.
Colour and lighting also increase well-being and satisfaction amongst staff by decreasing stress, increasing awareness and attention which in turn prevents errors in medication and ensures better patient care.
However, the general communication between designers, architects, staff and patients is poor, and must be constructed to create zones for adequate behaviour and well-being.
Person-centred environments need to support a feeling of control for patients as well as providing orientation and nice meeting places that are attractive and stimulating.
The importance of the attractiveness of healthcare environments should not be underestimated, and some ‘greeting environments’ in healthcare facilities are just not welcoming and do not promote well-being.
It is generally accepted that colour is important for children, but in fact it is equally important for everyone. Desk heights must be able to accommodate all patients, and they must be able to move around and be independent in order to increase their well-being. Painting techniques can also influence space perceptions.
The reception desk is the heart of the ward, and it should be open and welcoming. Another aspect is the transparency of the ward. Too much glass could create glare. Also, lots of meeting places are important, and the function of each room should be adequately displayed.
Another important aspect is that patients should not feel like they are forgotten, and the waiting room should support the feeling of relaxation. The attractiveness of the waiting room weighs heavily on patient’s feedback of the whole hospital experience.
Consulting and investigation rooms are not only for taking blood and so forth, but should exhibit art and perhaps even a view of the outside scenery because Nature is very important. It is well known that patients in surgery who have a room with a view have significantly shorter stays.
However, it is a slow process to transfer this knowledge into everyday practice. Not much research has gone into colour coding, and the attention to colour, recognition of its benefits in healthcare facilities, and its aesthetic properties are key.
Designers would find the NCS Colour Atlas very helpful in determining the use of colours. For example, the floor plays an important role as one of the walls when it comes to colour. A contrasting floor colour could create a different level perception and older patients may be apprehensive about crossing over the colour shades.
A hospital or nursing home is often a patient’s last home. The environment has a great impact on both the patients and their families who have to leave their loved ones in care.
Ongoing studies include Patient Related Outcome (POM) in oncology for pain relief; QoL in forensic psychiatric care is pharmacological use, often leading to violence in the ward and a need for return to care. How does colour affect this?
Intensive care study is also being carried out on Feng shui in intensive care units, with single rooms, soft colour schemes, sound absorbents, and natural views from windows.
Dr Helle Wijk, RN/T, PhD, (b. 1958) is a senior lecturer and associate professor at The Sahlgrenska Academy at Gothenburg University’s Institute of Health & Care Sciences in Sweden.