Исцеляющая среда в здравоохранении: от Флоренс Найтингейл к современным исследованиям.

Healing environment, for healthcare buildings describes a physical setting and organizational culture that supports patients and families through the stresses imposed by illness, hospitalization, medical visits, the process of healing, and sometimes, bereavement. The concept implies that the physical healthcare environment can make a difference in how quickly the patient recovers from or adapts to specific acute and chronic conditions.

The original concept of the healing environment was developed by Florence Nightingale whose theory of nursing called for nurses to manipulate the environment to be therapeutic (Nightingale, F. 1859). Nightingale outlined in detail the requirements of the "sick room" to minimize suffering and optimize the capacity of a patient to recover, including quiet, warmth, clean air, light, and good diet. Early healthcare design followed her theories outlined in her treatise, "Notes on Hospitals". Following the discoveries by Louis Pasteur and others which lead to the Germ Theory, plus other technologies, the role of the environment was dominated by infection control and technological advances. Starting in the 1960s, healing environments have been linked with evidence based design (EBD), giving the concept a strong scientific base. While in some respects it can be said that the concept of healing environments has evolved into EBD, it's mainly in the area of reduction of stress that this overlap occurs; as EBD goes beyond the healing environments dimension to consider the effect of the built environment on patient clinical outcomes in the areas of staff stress and fatigue, patient stress, and facility operational efficiency and productivity to improve quality and patient safety. A 1984 study by Roger Ulrich found that surgical patients with a view of nature suffered fewer complications, used less pain medication and were discharged sooner than those who looked out on a brick wall. Since then, many studies have followed, showing impact of several environmental factors on several health outcomes. Today, the philosophy that guides the concept of the healing environment is rooted in research in the neurosciences, environmental psychology, psychoneuroimmunology, and evolutionary biology. The common thread linking these bodies of research is the physiological effects of stress on the individual and the ability to heal. Psychologically supportive environments enable patients and families to cope with and transcend illness.

Eighty percent of what we interpret of our surroundings comes to us from what we see of our environment and that is greatly affected by the light available in that environment. Lighting design in healthcare environments is a major factor in creating healing situations. Since the design of healthcare environments is said to influence patient's outcomes, yet high costs prevent most hospitals from renovating or rebuilding, changes in lighting becomes a cost effective way to improve existing environments. It is proven that people who are surrounded by natural light are more productive and live healthier lives. When patients are sick, and surrounded by medical equipment and white walls, the last thing they need is a dark, stuffy room. This is why it is important for every room to have a window for natural light to come into and help create a healing environment for the patient.

While so much of the patient's experience is based on visual cues, the majority of meaning of their experience is auditory. The many sounds of a hospital are foreign to their experience and their line of sight is limited. Nightingale claimed that sounds that create "anticipation, expectation, waiting, and fear of surprise damage the patient. "( The current pressure to reduce noise at night has been mistakenly understood to mean undue quiet at night when patients most need cues that people are around them and available if they need help. Just s lighting must be designed to serve both day and night, so much the auditory environment be designed to support activity, cognition, rest, and sleep. Adding to the above, patients need positive visual and auditory stimulation. Nightingale called for variety, color, and form as a means of arousing creativity and health in patients. Currently, using appropriate art, nature imagery and music are found to improve the experience of the patient. Technologies have afforded patients infinite options to use media as the choose. The addition of beauty must also be accompanied by an attention to orderliness: removal of clutter, trash, and other distractions.