9 juni 2011 - Vision Dinner Chronische Zorg - Cor Datema Philips Heathcare


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9 juni 2011 - Vision Dinner Chronische Zorg - Cor Datema Philips Heathcare

  1. 1. Healing EnvironmentsCor DatemaC D t
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  4. 4. Healing g 100%Health 5% Time 4
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  8. 8. •Spatial layout Architecture •Nature views Physical Interior •Coloring •Furniture Environment Design •Flooring •Lighting Ambient •Sound / Music features •Scent Healing Environment g Healing Environment ea g o e Organizational Clinical / Admin Culture Processes P •Social support •People centric Human Efficiency y •Facilitate understanding Facilitate •Fast but accurate F tb t tinteractioni t ti •Identifying needsCommuni •Openness / Clear •Hygiene Safety cation •Respectful •Medication distribution Human •Privacy, Dignity, Respect, •Staff – Patient touch Information •Trust, Compassion •Staff – staff exchange 8
  9. 9. What senses link environment and healing? sight hearing smell touch 9
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  11. 11. Vision: healing effects of daylight g y g• Known impact areas: Pain, Sleep, Emotional state, Length of stay, Staff p , p, , g y, performance• 28% more pain medication in dull rooms vs bright rooms ( p g (Walch, 2005) , )• Ill patients need sufficient sleep for recovery (Bahamman, 2006)• Depressed patients stay 3 days shorter in sunny rooms (Beauchemin, 1996), or 3.7 days shorter in east facing rooms vs west facing ) y g g (Benedetti, 2001). Warm/dry versus colder climate (Golden 2005)• Light therapy works for seasonal disorders (Joseph, 2006)• Shorter stay and lower morbidity in ICU with sunny rooms (Beauchemin, 1998).• Medication dispensing errors reduced through high surface lighting (Buchanan, 1991) 11
  12. 12. • Picture color light g 12
  13. 13. Vision: Healing effects of visible colored light g g• Know impact areas: Pain, Sleep, Emotional state, Staff performance, p , p, , p , Appetite, Other medical conditions• No conclusive effects of moderate colors/light on mental state ( j g (Rajae 2010).• High levels of blue light show effects for SAD treatment (Glickman 2006 & Strong 2009) g )• Melatonin levels suppressed by blue, enhanced by red (Thapan 2001)• Blue light can treat neonatal hyperbilirubinemia (Lucey 1968)• Blue light can suppress appetite (Tofle 2004)• Various clinical requirements for interior colors• Red light for treatment of acne (Yeh 2010) 13
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  15. 15. Vision: Effects of nature views, plants and art ,p• Know impact areas: Pain, Emotional state, Length of stay p , , g y• Patients spent less time in hospital in rooms with nature view (Ullrich 1984))• Nature videos reduced pain levels (Miller 1992; Tse 2002, Malenbaum 2008)• Nature videos reduced stress (Ulrich & Simons 1986; Frederickson & ( Levenson 1998; Parsons 1998; Laumann 2003; Ulrich 1991, 2003; Sponselee 2004; de Kort et al. 2006)• Nature art on the wall reduced anxiety or stress among patients (Heerwagen 1990; Ulrich et al. 1993) 15
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  17. 17. Hearing: Healing effects of sound g g• Know impact areas: Pain, Sleep, Emotional state, Rehabilitation p , p, ,• Pain medication reduced by 15% post-surgery (Cepeda 2006)• Distress of pain of women in labor reduced ( p (Phumdoung 2003) g )• Sound masking: 42% improvement in sleep in ICU (Xie 2009)• Music assisted relaxation improve sleep quality (De Niet 2009)• Music reduces anxiety and stress during normal care and y g invasive/unpleasant procedures (Evans 2002)• Music improves recovery from stroke (Sarkamo 2008) 17
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  19. 19. Hearing: Noise reduction g• Known impact areas: Sleep, Emotional state, Staff p p p, , performance, , Communication• 20% of arousals caused by noise ; 26% of awakenings occur after 10 y g dB increase (Gabor 2003)• Noise induced stress leads to higher cortisol & increased HR (Falk ) 1973);• Acoustic isolation minimize distress sounds (Ryherd 2008)• 1.4% of telephone orders leads wrong prescription (Camp 2003) 19
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  21. 21. Smell: Healing effects of scent g• Know impact areas: Pain, Emotional state, Wound healing p , , g• Scents (Jasmine tea, Lavender) can provide a sedative effect (Kuroda 2005, Moss 2003) , )• Presence of odors can intensify pain perception (Martin 2006)• Scent can reduce anxiety levels of dental patients (Lehmer 2005) and mental patients ( Angelo 2002) p (‘d g )• HR drops significantly after inhaling lavender scent (Kuroda 2005)• Scents have seasonal and time of day influence (Goel 2004)• Hypersensitivity: negative effect can lead to health condition: Multiple Chemical Sensitivity (Miller 1994) 21
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  23. 23. Smell: Healing effects of fresh air g• Know impact areas: Infection reduction, Sick building syndrome p , g y• HEPA filters significantly reduce infection rates (Schulster 2003) but does this outweigh the benefits of fresh air? g• Recirculation of air increases influenza infections (much higher) in elderly homes (Drinka 2007)• In non-clinical settings supply of fresh air via ventilation results in g pp y decreased Sick Building Syndrom (SBS).• Air conditioning systems increase risk of SBS compared with naturally or mechanically ventilated buildings. 23
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  25. 25. Touch: Healing effects of touch g• Known impact areas: Pain, Emotional state, Communication p , ,• Massage therapy positive effect on advanced cancer patients (Kutner 2008))• Tactile therapy positive on: distress (Hayes 1999), latent phase of labor (Andren 2005), Anorexia nervosa (Axelsson 2007), lower blood p pressure and HR ( (Bilhult 2007), diabetes ( ) (decreased gglucose, Andersson 2004), reduced incontinence (Olsson 2004)• Negative effects: Feeling of abandonment and return to discomfort (Henricson 2009) 25
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  27. 27. Touch: Healing effects of infra-red radiation g• Known impact areas: Pain, Sleep, Emotional state, Wound healing p , p, , g• Inconclusive evidence for pain relieve through infrared radiation p g• 0.4C skin temperature (through IRB/IRC) increase leads to decrease early morning awakening from 58% to 4% in elderly (Raymann 2008)• Chronic infrared radiation decrease indicators of depression and anxiety in animals (Tanaka 2010)• IR works similarly well for SAD (Meesters 1999)• IR helps in wound healing (Yeh 2010) 27
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  29. 29. Multisensory stimuli: architectural features y• Single and multi p g patient rooms – little evidence of reduction in hospital acquired infections (Cooper 2005) – No conclusive evidence on improved sleep ( p p (Glind 2007); important ); p factors are: pain, noise, footsteps, nurses doing rounds. – Positive impact on patient privacy (Chaudbury 2006) and patient satisfaction (Glind 2007) ( ) – Single patient room: doctor spends more time, more empathy, (Glind 2008) – Cancer patients want to have choice; social support is appreciated (McGurk 2007)• Family zone: Family spends more time with patient (Ullrich 2008)• Corridors: Orientation, no glare, reduce boredom (Kopec 2006) 29
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  31. 31. Multisensory stimuli: interior design features y g• Number of stimuli in the room: provide orientation, no glare, reduce p , g , boredom. Depends on illness (Kopec 2006)• Two types of stimuli (Rice 1980): – Stimuli objects and interactional objects – unknown what effect j j which has• Movable furniture provides flexibility arrangements and improves social interactions (Berry) and eating behavior ( ( y) g (Ullrich 2008))• Flooring: – Trend to use carpet: improved appearance, more efficient walking of elderly, longer visits for rehab patients, better outcome after patient falls, new cleaning methods, indications that carpet is also more hygienic. – Disadvantage: more difficult to move wheeled equipment 31
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  33. 33. Healing thoughts g g• Nuns that pray in MR have shown activity in the brain in areas of vision p y y and hearing (Beauregard, 2006)• During meditation part of brain of vision is active• There is indication that altruistic people ( g nuns) are more healthier p p (e.g. ) than people that do not do meditation, gentle walking, praying (Sternberg 2008)• Emotional responses can lead to positive brain stimulation (e.g. Asclepius and Lourdes)• Placebo effect and the brain: – Associated with the release of dopamine (Parkinson disease) – Reduction of depression in many of the same areas that are activated by antidepressants 33
  34. 34. Healing SpacesEster M. Sternberg, M.D. 34