The right environment can restore the body, mind and spirit of the patients and the people who care for them.
By Lara Macklin
It’s the simple things in life that bring us feelings of comfort and happiness: the sight of the sun rising above the horizon, the smell of cookies baking in the oven, the sound of rain pattering on the roof. These sensory experiences soothe and calm us—they heal. As facilities that provide care and comfort to kids, children’s hospitals often include the latest medical technology, as well as environmental attributes that support the mental and spiritual needs of patients, family members and the health care team. Here are some key strategies for creating positive and healing spaces.
Use light strategically
Psychosomatic research, including data compiled by Daylight and Architecture magazine, shows that light has a direct impact on healing. For example, access to natural light can speed up a patient’s recovery time, reduce anxiety and tiredness, improve alertness, and increase patient satisfaction. At the Seattle Children’s Hospital Bellevue Clinic in Bellevue, Wash., the corridor outside the surgery suites and induction rooms has floor-to-ceiling windows. Staff members and patients report having nature as a backdrop in this area of the facility provides a calming, relaxing atmosphere to interact with physicians before surgery. In addition, LED ceiling lights in the induction rooms twinkle like stars and help reduce anxiety as a child prepares for surgery. This simple feature is routinely used as one of the tools of distraction before surgery as clinicians ask the child, “How many stars do you see?” While there are benefits to light exposure, there are situations when limited exposure to light is ideal. This is true for babies in the neonatal intensive care unit (NICU). The University of Washington Medical Center in Seattle has a new NICU that features 47 beds—39 are in private rooms with low light exposure. Prior to this project, the Washington State Department of Health (WSDOH) required private NICU rooms to have direct access to natural light. While this was a wonderful amenity for the care team, it was not the best scenario for fragile infants.
Because NICU babies have thin eyelids, light reaches their retinas much easier than full-term babies, according to research collected by Carole Kenner, Ph.D., RNC-NIC, author of the book, Comprehensive Neonatal Nursing Care. Many medical conditions can decrease an infant’s ability to constrict and control light exposure, which has a direct effect on sleep patterns and development. By presenting this research to the WSDOH, the hospital design team was granted approval to place additional rooms across a corridor accessible by borrowed natural light. This greatly reduced the overall light level in these spaces, creating a more appropriate space for the NICU babies.
Connect with nature
Outdoor play areas are essential in health care environments for children. When children interact with nature, it can help with a variety of conditions, including physical and mental illness. To mitigate infection control concerns connected to soil, hospitals can install planters without dirt. This allows kids to participate in growing their own plants but reduces exposure to toxins in the dirt that could compromise their health. For kids who are on long-term stays in an inpatient unit, this is a great group activity. The idea of integrating nature into health care facilities was also the precept of a recent design competition for the new Hong Kong Center of Excellence in Pediatrics (HKCEP). The design included outdoor spaces complete with a tree house guarded by a dragon, visual access to the ocean and mountains, and naturally ventilated courtyards with sand castle building activities. The design also included a large landscaped central garden situated between two towers that integrated major circulation arteries, dining activities and rest areas in a seamless garden environment.
Provide normalcy and personalization
For many sick children, there is healing power in normalcy. Events that healthy teenagers take for granted, like going to prom, watching a movie in a theater, or playing video games with friends, can be easily be organized and implemented into the hospital environment. Another way to create feelings of normalcy is by helping the family gather around the dinner table. According to research conducted by the University of Leeds in England and the American Dietetic Association, when families eat meals together they tend to eat healthier, reducing risk for obesity, and adding normalcy to unbalanced life. Designing family kitchens on the patient floor or common areas not only benefits the child, but undoubtedly helps the family and care team come together in a familiar, yet nonclinical setting. Although not necessarily appropriate for some patients who are coping with eating restrictions or nausea, writing recipes of favorite dishes, playing food bingo games, and making food collages can help with discussions about dietary changes in patients’ lives. It also allows the kids to participate in meal time even if they eat only a little or nothing at all.
Patients also want to personalize health care spaces to suit their own interests and preferences. There are several ways to make this possible. Hospitals can include design elements in patient rooms that allow a reasonable sense of control and fun, such as light fixtures that change color at the touch of button. Window paint and decals create simple, yet personalized works of art and are similar to an activity a child might engage in at home.
Find therapy spaces
Having the right space and plenty of it can be key to effective patient therapies. For example, animal therapy is a popular tool among hospitals. Research compiled by the Early Childhood Education Journal shows that being with a pet can lower blood pressure, release endorphins and diminish pain. Even the act of petting a dog produces an automatic relaxation response that may reduce the need for prescribed medication. (For more on therapy dogs and pets in children’s hospitals, read “The Healing Power of Pets” from the fall issue of Children’s Hospitals Today.)
Dog therapy is by far the most common of animal therapies, but some hospitals are getting creative with the use of miniature horses and even birds depending on a hospital’s infection control guidelines. Other popular therapies include specially trained therapeutic clowns and laughter yoga, which is gentle yoga breathing, stretching and simulated, self-induced laughter. Medical studies conducted in Italy demonstrate the healing power of humor and the positive emotions it elicits. Humor boosts the immune system, stabilizes blood pressure, reduces stress, massages the inner organs, stimulates circulation, and increases the flow of oxygen to muscles.
Often it’s not necessary for hospitals to dedicate spaces to therapy alone, but it’s important to create spaces that are easy to adapt so they can be used for a variety of purposes. A multipurpose room is a common solution. Another solution would be to allow these activities to take place in multiple areas of the hospital, like the corner of the main lobby, a courtyard or an inpatient floor, which gives more exposure to a variety of people who would benefit. In the emergency room, designers could create a space for a therapeutic clown to provide a distraction in what can be a scary and stressful environment.
Comfort the family
In addition to patients, families need places for support as well. Obvious needs include a dedicated area in the patient room for sitting and sleeping, as well as storage and work space. One facility that dedicates healing space for the family, even when the patient may not become healthy again, is the Bayt Abdullah Children’s Hospice (BACH) near Kuwait City, Kuwait. The building design of BACH and its programs support a family’s spiritual needs. The program provides opportunities for medical assistance, psychological counseling, play and social opportunities, as well as meditative retreats. Families can also gather in the Rainbow Room—a private area of the facility—to pray, reminisce and say goodbye to their loved one in a peaceful environment. Video or photo rooms allow families to create legacy projects, such as audio and video recordings or professional-quality family photos. This can be an important part of the grieving and healing process for many families.
Siblings also play an integral part of the healing process for a sick child. Therefore, it’s important to incorporate spaces for kids to not only play and escape from the reality of being ill, but also to feel welcome and ask questions about what is happening. Some health care settings accomplish this by incorporating the use of museumquality interactive displays. This not only engages but informs kids about health issues and intrigues their curious minds. Incorporating familiar sights into the hospital environment is also a useful technique. It could be a simple poster about a local sports team or a performing arts program in that city. When designing these spaces, it’s important to ask, what’s the first thing a child sees when he or she walks into the hospital? The answer might have the greatest effect on his or her overall emotional health.
Make space for the team
Just as flight attendants remind us upon takeoff to “place the mask over our own mouths and then assist others,” it is important to ensure clinician and staff member well-being. The hospital team’s role is vitally important to the care of children, yet it can be stressful or lead to compassion fatigue. To keep spirits high and facilitate team work, the exam rooms at Seattle Children’s Bellevue Clinic are positioned so that the care team has private access via the work zone, and the patients and families have access from a public zone. This creates an optimal work space and the most efficient workflow. With the addition of skylights in the staff-only work space in the surgery recovery area, clinicians have constant visual and auditory contact with nature throughout the day. Originally these skylights were about bringing in as much natural light as possible to the space. But in an area like Bellevue, Wash., just across the lake from Seattle, even hearing the sound of the rain overhead is a welcome feeling and allows staff members to connect with the outdoors. Another plus of this arrangement is that the work zone helps aid collaboration. It allows the clinicians and other medical staff to hear conversations, support each other in their everyday workflow, and it helps to bring a sense of camaraderie to the job—something less likely to occur in traditional decentralized work areas or private offices.
In some hospitals, child life specialists support fellow care team members by providing activities like mini retreats, supplies for quick 10-minute art projects, and sensory machines with music or aromatherapy to help team members relax. Some hospitals are reducing the number of physician-only lounges in favor of a central lounge area for all staff members to enjoy. These facilities provide spaces for everyone to eat together at large family-style tables; living room-like settings for casual conversation; outdoor areas for fresh air and daylight; and computer stations for people to catch up with the outside world. Regardless of the number or size of the lounges, don’t underestimate the importance of these spaces.
While healing is complex and multifaceted, the physical space that surrounds us plays an integral role in how we heal. Children’s hospitals can ensure that all spaces—from simple waiting rooms to complex surgery suites—are designed to do what’s important: assist in the overall healing of a child and get him or her back into the normal routine of life.
Lara Macklin, NCIDQ, LEED AP, is a health care planner, programmer and interior designer at NBBJ, a design and consulting firm. She is also an associate member of the Child Life Council.