In healthcare facilities, lighting design and the technology behind it can be a matter of life and death. A well-designed system can lead to reductions in medical errors, pain, stress, depression, and length of stay, as well as aid in a good night’s sleep. By anticipating the lighting needs of the patient and the medical staff, it’s possible to reach a healthy, cost-effective, and sustainable system.
The nurses’ station is the central hub of the in-patient floor. Although there’s a trend toward decentralization, you often find main nursing stations operating 24/7 on each floor. At the nursing station, lighting systems and the technology behind them must be flexible to allow the night shift to be exposed to intermittent bright light and to have sufficient illumination to perform their work. Several studies have demonstrated that exposure to intermittent bright light during the course of the night helps staff members adjust to the night shift.
Additional studies show that professionals with at least 3 hours of daylight exposure during their shift have higher job satisfaction than those who have less exposure to daylight. Where daylight is not available, it can be simulated with electric lighting systems. Cove lighting at nurses’ stations can create bright ceilings or walls, and can be coupled with downlights and under-cabinet lights for specific tasks. Multi-level switching is the key for flexibility, and may be tied into a centralized lighting-control system for automated time-of-day control.
Patient corridors often incorporate decentralized nursing stations that are small desks outside patient rooms for closer observation. In patient corridors, you want to be sensitive to a non-institutional feeling, and carry the hospitality theme from the main lobby through the corridors and into the patient rooms.
The preferred lighting system is indirect or partially indirect to avoid glare and facilitate patient comfort. Integrate daylighting whenever possible – borrowed light from interior partition glazing and views from windows at the ends of corridors are ways to bring daylight into the corridor.
The presence of daylight aids in regulating patient and staff circadian rhythms, but the electric lighting system should also include controls for daytime/nighttime awareness. Lighting zones should be tied to the overall lighting-control system such that, in the evening, lighting levels are automatically decreased until morning, saving energy and aiding in a better patient sleeping environment.
Lighting for patient rooms creates a design challenge because lighting requirements vary for patient, family, nurse, doctor, and housekeeping needs. Because of the variety of lighting levels required, flexibility is the key. Create multiple zones of light with simple switching.
Daylight via a window is required in all patient rooms by the AIA Guidelines for Design and Construction of Hospitals and Health Care Facilities so the patient is oriented to the outside world – a critical element in stress reduction. The AIA guidelines also suggest lighting controls for patients so they can have some control over their environment.
Coves make the room bright and provide soft illumination; slim asymmetric exam lighting on either side of the bed – not over the bed – is desirable. A reading light/observation light may be incorporated in the headwall millwork or at the ceiling plane. Dimming may be considered if the examination lighting doubles as a reading light.
Nightlights should be provided in the patient rooms and associated toilet rooms. LED-type nightlights of the red/warm wavelengths are preferred for low energy consumption, long life, and appropriate low light levels.
For energy savings, occupancy sensors with integrated time-of-day controls can trigger on and off general lighting in toilet rooms during the day. In the evening hours, a lower light level that comes on automatically won’t shock a patient who makes a trip to the bathroom in the middle of the night.
Critical Care Areas
Intensive care units, emergency departments, and post-operative recovery rooms require more complex lighting systems. Multiple levels of lighting are required for general lighting levels and exam lighting levels, but in these areas, the staff controls the lighting. Daylight and views are again required in intensive care rooms because it makes a profound difference in patient orientation.
Lighting systems in cancer centers are designed with one primary goal: patient comfort. Patients undergoing chemotherapy need control over their environment, and this includes lighting. Controls should be easy to use and vary the lighting levels. Natural light, views of the outdoors, and interior gardens are extremely important in reducing anxiety.
In imaging and radiation oncology suites, lighting can aid in distracting the patient from the intimidating equipment in the room. Coves and backlighting panels can create visual interest in the space. Dimming is required, and LED sources are very well suited to these spaces because they have long life and use low energy, and are easily dimmed.
Typical lighting recommendations for patient comfort don’t apply when the patient is a premature infant. Daylight and direct light aren’t desired in neonatal intensive care units (NICUs) because the eyes of premature infants are still developing; a dark environment is best. General lighting in the NICU should be an all-indirect system, dimmable and zoned for individual bassinet areas. Any observation lighting should be kept to very short time periods.
The general lighting principles for children’s hospitals are similar to adult hospitals, but there should be a sense of playfulness and usually an overarching design theme. Some examples of successful lighting in a themed environment are fiber-optic star lighting in a ceiling, or a rainbow road with LED color-changing floor tiles that are triggered by foot movement. Any chance to brighten the moods of the families and children in care is really lighting the way.
Mary Alcaraz is an electrical engineer/lighting designer with EwingCole. Based in Philadelphia, the firm has offices in Irvine, CA, and Washington, D.C.