The impact of daylight and window views on length of stay among patients with heart disease: A retrospective study in a cardiac intensive care unit.

Background: Heart disease is the leading cause of death in the United States. The length of stay (LOS) is a well-established parameter used to evaluate health outcomes among critically ill patients with heart disease in cardiac intensive care units (CICUs). While evidence suggests that the presence of daylight and window views can positively influence patients' LOS, no studies to date have differentiated the impact of daylight from window views on heart disease patients. Also, existing research studies on the impact of daylight and window views have failed to account for key clinical and demographic variables that can impact the benefit of such interventions in CICUs. Methods: This retrospective study investigated the impact of access to daylight vs. window views on CICU patients' LOS. The study CICU is located in a hospital in the southeast United States and has rooms of the same size with different types of access to daylight and window views, including rooms with daylight and window views (with the patient bed located parallel to full-height, south-facing windows), rooms with daylight and no window views (with the patient bed located perpendicular to the windows), and windowless rooms. Data from electronic health records (EHRs) for the time-period September 2015 to September 2019 (n=2936) were analyzed to investigate the impact of room type on patients' CICU LOS. Linear regression models were developed for the outcome of interest, controlling for potential confounding variables. Results: Ultimately, 2319 patients were finally included in the study analysis. Findings indicated that patients receiving mechanical ventilation in rooms with access to daylight and window views had shorter LOS durations (16.8 h) than those in windowless rooms. Sensitivity analysis for a subset of patients with LOS ≤3 days revealed that parallel bed placement to the windows and providing access to both daylight and window views significantly reduced their LOS compared to windowless rooms in the unit (P=0.007). Also, parallel bed placement to the window significantly reduced LOS in this patient subset for those with an experience of delirium (P=0.019), dementia (P=0.008), anxiety history (P=0.009), obesity (P=0.003), and those receiving palliative care (P=0.006) or mechanical ventilation (P=0.033). Conclusions: Findings from this study could help architects make design decisions and determine optimal CICU room layouts. Identifying the patients who benefit most from direct access to daylight and window views may also help CICU stakeholders with patient assignments and hospital training programs.

Exploring the Relationship between Window View Quantity, Quality, and Ratings of Care in the Hospital.

Hospital ratings reflect patient satisfaction, consumer perception of care, and create the context for quality improvement in healthcare settings. Despite an abundance of studies on the health benefits of the presence and content of window views, there is a gap in research examining how these features may impact patient satisfaction and consumer perceptions of the quality of care received. A quantitative exploratory study collected data from 652 participants regarding their previous stay in the hospital, their perception of windows in their room, and their perception of their room, the hospital, and the quality of care received. On a scale of 0-10, participants with access to windows gave a 1-unit higher rating for the hospital. Access to window views from their bed provided a 1-unit increase, and having a view to green spaces resulted in a 2-unit increase in hospital ratings. Statistically significant results were also found for room ratings and care ratings. Windows in the patient rooms impact the key patient satisfaction measures and patient experience during the hospital stay. Patient room design, bed set up, and quantity and quality of window views may play an important role in shaping the patient's experience.

Exploring the Relationship Between Perceived Visual Access to Nature and Nurse Burnout.

OBJECTIVE: This study aims to investigate the relationship between perceived visual access to nature views in nurse work and break environments and scores for subscales of Maslach Burnout Inventory among nurses. BACKGROUND: Burnout is a severe problem among nurses. Literature shows a relationship between stress and burnout and between nature exposure and stress. However, the possible consequent relationship between connection to nature and nurse burnout needs further study. METHODS: This cross-sectional study explored the relationship between the subscales (Emotional Exhaustion, Depersonalization, and Personal Accomplishment [EE, DP, and PA]) of the Maslach Burnout Inventory as "outcome variables" and perception of view duration, frequency of exposure to views, view content and artwork content as "explanatory variables" in a subset regression model. The study model also included organizational stressors, environmental design factors, unit type, workload, and personal factors as control variables. Fifty-one nurses working in six units in a large tertiary care hospital participated in the study. RESULTS: Percentage of perceived nature views and organizational stressors were the top two best predictors correlating with EE (37% of the EE variance; p < .05). Percentage of perceived nature views, organizational stressors, and environmental design were the top three predictors correlating with DP (43% of variance for DP; p < .05). No significant relationship was found between study variables and PA. CONCLUSIONS: The results of this study recommend perceiving nature views as an independent or integrated intervention to meditation and relaxation techniques. From a design standpoint, this study suggests that a unit and breakroom design with access to nature views could work as a consistent preventive intervention for burnout.

Impact of window views on recovery-an example of post-cesarean section women.

OBJECTIVE: The objective of this study was to examine the impact of urban landscape from window views on quality of care for women who underwent Cesarean Section (C-section) in Taiwan. DESIGN: The participants were randomly assigned into 46 different hospital rooms to see the effects of various window views and daylight exposure on women's recovery from post C-section care. SETTING: We carried out this study in the obstetrics departments of three tertiary hospitals located in two major cities of Taiwan: Taipei City and New Taipei City. PARTICIPANTS: A total of 296 women who underwent C-sections and used patient-controlled analgesic (PCA) for pain control after their surgery during the 10-month data collection period were recruited for this study. INTERVENTION: The 46 different patient rooms provided diverse window views and different daylight exposure for the participants. MAIN OUTCOME MEASURES: Recovery for the women who underwent C-sections in this study was defined as PCA usage and perceived pain measured by Brief Pain Inventory (BFI). RESULTS: Higher satisfaction of window view significantly decreased analgesic usage (P = 0.057), reduced the scores of overall perceived pain (P = 0.046), pain severity (P = 0.004), and 'pain's interference with relations with others, enjoyment of life, and mood (REM).' (P = 0.095). CONCLUSIONS: To maximize benefit and well-being of patients recovering from surgery, health care architects should design patient rooms to create maximum satisfaction with visual impacts and optimize window views. By doing so, it may decrease the use of pain medication and substantially reduce healthcare costs.