New knowledge about nurses’ perception of the traditional lighting system in a newly built hospital
How do nurses perceive the lighting system in a new hospital? This is examined in an article which has just been published by Kathrine M. Schledermann, Business PhD student, MSc., a part of the Industrial PhD. study a collaboration between Kathrine, Chromaviso and Aalborg University and partly financed by the Innovation Fund. The PhD study investigates the implementation of circadian lighting in nursing homes and hospitals focusing on the staff’s working environment. This article covers the time leading up to the implementation of circadian lighting.
Previous research from Rigshospitalet has shown that a Danish-developed circadian light reduces depression, anxiety, circadian rhythm disturbances and fatigue for hospitalized patients (Anders West – PhD: The effects of Naturalistic Lighting in stroke patients, Copenhagen University 2018). These results mean that hospitals and nursing homes today use circadian light as an integral part of care and treatment. This has created a need to investigate and systematize the way in which the circadian light is used and experienced.
This article examines how the traditional light, that was installed prior to the refurbishment of the lighting, was perceived by nurses who work in the Neuro Intensive Care Unit (neuro-ICU) and a Postanesthesia Care Unit (PACU), Neuroscience Centre, which treats patients with acute brain and nerve injuries and illnesses. Advantages and challenges of the traditional lighting are examined in connection with their daily work and routines.
How the traditional lighting was used and other key observations
In the study, a number of observations have been made regarding the use of light in the hospital in the nurses’ daily work:
- The patients’ needs and health play a part in how nurses use the lighting, e.g. the evening and night shifts often work in nearly complete darkness to spare the patients and minimize disturbances in their circadian rhythm. This was, among other things, seen by their use of a pencil light (flashlight), which frequently was used at night when checking medicine and other medical instruments to which the patients were attached.
- The nurses were frequently placed in a quandary, where they must choose between adjusting the light to accommodates their work task and the patient’s well-being.
- In PACU with capacity of up to five beds in one room, several patients are disturbed when one patient is examined, as the nurses must turn on the lighting in the entire room for examination, lacking the possibility to divide the room into multiple light zones.
- The nurses greatly appreciated being able to adjust the brightness of the ceiling light manually and determine the height and angle of a desk lamp. In order to avoid turning on the ceiling luminaries, the nurses also found creative means of using a desk lamp. In this way they could still perform their job without disturbing the patients.
- Not everyone found the lighting easy to operate and often experimented with the lighting until they found a suitable setting. The nurses also asked critical questions about the purpose of the current lighting and when it is optimal to use the different light settings.
- The nurses often used the nursing tables as a workstation to store medicines, medical equipment, gloves etc., however, they had no light for the nursing tables. Instead, the nurses employed the desk lamp, turning it 180 degrees away from the desk to illuminate the nursing table wherever possible. In general, they were quite happy with the desk lamp, as it has a warmer correlated color temperatures and can be adjusted in height and angled. Some nurses highlighted that they lack such a lamp by the patient bed
- The nurses lacked the opportunity to offer warm color temperatures to create cozy atmospheres for the patients and their relatives – or e.g., when parting with a family member. They also missed changes in the lighting during the day, which some of the nurses had in their previous ward before they moved to the North Wing.
- They have many light sensitive patients, thus, with their current lighting they lack having warmer, dimmed light for this patient group. Especially on recovery, where patients must wake up after a surgery.
Results and conclusions
The study finds several important factors for helping both patients’ well-being and supporting the nurses’ tasks and work routines.
Overall, it is concluded that it is essential to involve the staff during the design phase, as they can contribute with knowledge about specific needs and use of the light, which would otherwise not necessarily be taken into account in the design. In addition, this study indicates that even new buildings do not live up to the activities and users who are in a complex environment such as a neuro intensive care unit and recovery.
Based on the study findings, a number of recommendations have been presented. Here are some of them:
- Introduce and educate the staff in the use of light, the different settings and the effect light has on people’s circadian rhythm.
- Design the lighting systems for each department’s specific needs
- Include zone divided lighting in e.g., multi-bedrooms so that other patients are not disturbed at night when one needs to be examined.
- Create flexible lighting solutions that can be adjusted after installation, as new needs arise
- Install lights for specific tasks and work surfaces in a room, e.g., handling of medicines and medical equipment.
- Design a dynamic light profile that supports people’s natural circadian rhythm, with night lighting that allows work to be carried out without affecting sleep.