New Research on Hospital Staff's Satisfaction with Circadian Lighting

Can you improve hospital staff's visual comfort and satisfaction with the lit environment by implementing circadian lighting? A recent study conducted at the Neuroscience Centre Rigshospitalet has provided the answer.

The referenced article was published by Kathrine M. Schledermann as part of her professional PhD, along with co-authors Thomas Bjørner, Anders Sode West, and Torben Skov Hansen.

Recent research has revealed a significant correlation between the lighting environment in the workplace and overall job satisfaction. As a result, researchers have emphasized the need for a specialized lighting design for individuals who do shift work and sleep at atypical hours. A customized lighting design can help regulate productivity and circadian rhythm, while also ensuring job satisfaction and well-being.

Currently, there is a lack of data on healthcare professionals' perceptions of circadian lighting in relation to visual comfort and satisfaction. The scarcity of research in this area may be due to the challenges of studying a lighting solution that changes throughout the day. However, it is still recommended to use an automated lighting system in the healthcare sector because it supports the body's biological need for light and darkness, but it also reduces the number of systems that employees need to adjust on a daily basis, thus alleviating their workload.

Background of the study

The recently published research article delves into healthcare professionals' perceptions of automatic circadian lighting, including their perceived satisfaction, ease of use, usefulness, and visual comfort. Specifically, the study investigates the research question: Can hospital staff members' satisfaction with the lit environment and their visual comfort be improved by implementing a circadian lighting system?

Implementation of circadian lighting

Before installing the circadian lighting system, data was collected on the pre-existing lighting, which revealed the flexibility and adjustability of the light sources in terms of height, angle, and brightness as the main advantages. However, it was also found that nurses in the departments often struggled to select the appropriate lighting setting. This was due to their desire to shield patients from unwanted light exposure while still needing sufficient light for their tasks. Additionally, the nurses mentioned a need to personalize the lighting for individual patients by their beds, which was not possible with the pre-existing lighting. As a result, they would use either a bedside lamp or a penlight when attending to patients in the evening and at night. All this data was taken into consideration when designing and implementing the circadian lighting system. 

The participants in the study on healthcare professionals' satisfaction with a circadian lighting system were exclusively employed in the neurointensive care or recovery units. They primarily fell within the age range of 30-29, were predominantly female nurses, and had been working in the department for 1-5 years.

Practice

The article highlights that the study utilizes elements from the Technology Acceptance Model (TAM2), which incorporates the concept of "perceived ease of use" to describe the technological implementation of lighting systems. The study is based on two different surveys. The first survey, which had 63 participants, examined the employees' experience with the pre-existing lighting and their expectations for the new lighting system. The second survey, with 48 participants, focused on the employees' experience with the new circadian lighting. Due to the COVID-19 pandemic and the fact that the study took place in a physical setting, the number of respondents varied between the two surveys. It is worth mentioning that Chromaviso, the supplier of circadian lighting for the project, provided a 15-minute presentation on circadian lighting to the employees in late September 2022. However, the employees received no training or information about the pre-existing lighting when it was installed back in 2020.

Key findings

Perceived satisfaction and visual comfort

The results of the study reveal a significant difference in satisfaction between the pre-existing lighting and the circadian lighting system. The article highlights the increased satisfaction with the circadian lighting system compared to the pre-existing lighting. The employees particularly appreciated the visual expression of the circadian lighting, finding it more naturalistic, especially at night. They also perceived the circadian lighting to have a warmer colour temperature compared to the existing lighting, especially at night. According to the interviewed nurses, the atmosphere in the department became calmer as the lighting became warmer in the evening. The zone-based control systems and the warmer lighting settings were considered an improvement compared to the pre-existing lighting. Previously, nurses often used penlights when attending to patients for short periods at night.

The nightlight setting of the circadian lighting system was considered useful in the neurointensive care unit for reading screens and monitors. The employees further explained that they preferred working in dark environments at night, especially the recovery unit, which turned off all lights at workstations and in the hallways, leaving only the computer screens on. While the employees were generally satisfied with the circadian lighting, some interviews revealed criticisms regarding the brightness level at noon and the lack of manual control over brightness. Other nurses criticized the nightlight for lacking an option between "night work" and "emergency light" because the "night work"-setting was not powerful enough for certain tasks, while the emergency light was too intense. Finally, the nightlight was criticized for being too dim for detail-oriented tasks such as blood sampling. All feedback was continuously recorded, and the lighting was adjusted to ensure that the nurses had the best possible lighting conditions.

Perceived ease of use and usefulness

The circadian lighting system was generally rated as easier to control than the pre-existing lighting. Ease of use was measured based on the employees' understanding of the icons on the circadian lighting system's control panel, and no significance was found regarding:

• Whether the employees found the lighting intuitive or easy to instruct a colleague.
• Whether the employees found the lighting useful.
• Whether the employees saw potential in the circadian lighting system or if they wanted it to be installed in the department.

The employees also ranked the circadian lighting system as more satisfying than the pre-existing lighting when it came to instrumental care and tasks such as blood sampling and blood pressure measurement. Additionally, the staff stated that the circadian lighting system provided the necessary lighting settings for patient care.

Continual modification leads to increased satisfaction

One significant advantage of the study discussed in the article is that the implementation of circadian lighting took place on-site and was evaluated by actual users in a hospital building. The circadian lighting system was adjusted during the evaluation period, making the study more of a "before and during" study rather than a "before and after" study. One modification made based on feedback from the staff was a faster sunset in the afternoon. The lighting gradually became warmer and dimmer earlier in the afternoon than initially programmed. This adjustment was made to accommodate light-sensitive patients who had just undergone neurological procedures and often had an increased need for rest and tranquillity in the afternoon and evening. Another ongoing modification was to dim the circadian lighting's nightlight one hour later in the evening to accommodate routine tasks such as hygiene tasks, which typically occur around 9 pm. Additionally, the colour temperature for the "night work" lighting setting was increased to improve visibility for the staff at night.

Conclusion: Circadian lighting can enhance the work environment

The study demonstrates statistically significant satisfaction with the circadian lighting system compared to the pre-existing lighting. The staff found it easier to use and adjust according to their needs compared to the pre-existing lighting. Furthermore, the article concludes that circadian lighting can support the complex work environments in hospitals, but it requires close collaboration with users and continuous adjustment of lighting settings for successful implementation and long-lasting solutions. The study also emphasizes the importance of fostering more knowledge on designing lighting systems for complex healthcare environments. Additionally, it is crucial to focus on the users' experience and interaction with automated lighting systems in practice. The study concludes that circadian lighting can improve the work environment for healthcare professionals working in neurointensive care or recovery. The staff's satisfaction and reported familiarity with circadian lighting at the Neuroscience Centre may be attributed to the fact that they received training on circadian lighting immediately after installation, whereas they received no training when the pre-existing lighting was installed. However, these presented results may be case-specific, necessitating further research in the field to determine if the findings can be extrapolated to other departments and hospitals.

Source: Schledermann KM, Bjørner T, West AS, Hansen TS, Evaluation of staff's perception of a circadian lighting system implemented in a hospital, Building and Environment (2023).