HOW CAN YOU REDUCE PATIENT ANXIETY?
A hospital stay can be a frightening experience. It’s often sudden and unexpected, taking someone out of the comfort of his or her home and into an unfamiliar environment.
Worries can abound, along with questions such as: Will I get better? How will my family be without me? And, above all: When can I go home?
The negative consequences of a hospital stay can include not only anxiety but also:
• Depression and anger
• Increased blood pressure, elevated levels of stress hormones and reduced immune function
• Sleeplessness, aggressive outbursts and noncompliance with physician instructions1
These issues are even more pronounced in children, who may not fully understand the reasons for hospitalization. Anxiety is the most commonly reported of these negative responses and high levels of anxiety can be harmful to children’s physiological and psychological health, according to a research study published in BMC Pediatrics.2
The design of the hospital environment contributes to these problems. Excessive noise from paging systems, alarms and machines. Inadequate lighting, which has been linked to patient depression as well as to staff medication errors. Double-occupancy rooms that impinge on patient privacy and rest and can impede recovery.3
“Stress results from any situation that requires behavioral adjustment such as invasions of privacy, no control over noise, acute or chronic pain, separation from family and things familiar, feelings of helplessness, and loss of control over events and the immediate environment,” according to an article in HealthDesign.org.4
In order to create a model healthcare environment that will enhance the patient experience and reduce some of the stresses associated with a hospital stay, hospitals need to improve their physical design and construction, the ways in which staff members do their work, and their institutional cultures.5
What Are Some of the Solutions?
One approach that has been shown to help reduce patient anxiety is the delivery of patient-centered care, also known as “patient centeredness.”
Patient centeredness is defined as encompassing “qualities of compassion, empathy and responsiveness to the needs, values and expressed preferences of the individual patient.” 6
Patient-centered approaches to care have been shown to improve patients’ health, lessen patients’ symptom burdens, increase compliance with treatment regimens, and reduce the chance of misdiagnosis due to poor communication.7 They have also been shown to reduce both underuse and overuse of medical care, reduce the strain on system resources and save money by reducing the number of diagnostic tests and referrals.8
In short, patient centeredness enhances patient well-being while benefitting a hospital’s bottom line. Some believe that a patient-centered approach could positively impact HCAHPS scores, a leading key performance indicator (KPI).9 It also provides hospitals with an opportunity to differentiate themselves from other facilities by enhancing the overall patient experience. In addition, as patients exercise their rights as consumers to choose hospitals based on reputation and as hospitals shift from volume to value, the need for strong patient satisfaction only increases.
Familiarity and Comfort
What exactly is the patient experience? “The sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care,” according to the Beryl Institute, a thought leader in this area.10
Many hospitals are looking to improve the patient experience through patient-centered design and by providing hospital staff, such as Environmental Service Professionals, with more time to interact and care for patients, according to the Beryl Institute.11
Designing a hospital environment that is more welcoming can help reduce the anxiety and vulnerability that patients feel when they are hospitalized. One potential way to do this is to bring in familiar brands that patients are accustomed to using at home, such as personal care products like facial tissue, bathroom tissue and towels.
This can help bring a touch of comfort and familiarity to the hospital environment. When patients see products and brands that they use in their own homes perhaps it will, in some small way, help to offset those feelings.
Because the physical and the emotional are inextricably linked, it is certainly possible that these well-known, familiar products can help to deliver emotional comfort to patients and demonstrate another level of compassionate care. Given that 64 percent of patients say they feel more cared for and more at home when they see familiar brands, the answer may be “yes.”
Designing a Better Experience
One effective way to create a healing and stress-reducing environment is to practice “evidence-based design.” Evidence-based design is defined by the Center for Health Design (CHD) as “the deliberate attempt to base building decisions on the best available research evidence with the goal of improving outcomes and of continuing to monitor the success or failure for subsequent decision-making.”12
In a report published by the CHD, Roger Ulrich, Ph.D., of Texas A&M University, et al. (2004) identified more than 650 studies (more than 1,000 in the current compilation) in peer-reviewed journals that establish how hospital design can impact clinical outcomes.13
The research behind the concept of a healing, psychologically supportive environment is drawn from the neurosciences, environmental psychology and other fields.14 However, evidence-based design goes beyond the healing environments dimension to consider the effect of the built environment on patient clinical outcomes in such areas as staff stress and fatigue, patient stress, and facility operational efficiency and productivity to improve quality and patient safety.15 A scorecard published by HealthDesign.org lists many studies linking environmental factors with improvements in quality, patient safety, patient stress and staff stress.16
And a guide by the American Hospital Association (AHA) entitled Improving the Patient Experience Through the Health Care Physical Environment provides further evidence of the benefits to both patients and hospitals: “By working across multiple factors influencing the patient experience and by using evidence-based design, hospital and health system leaders can assert greater control over their organization’s HCAHPS scores.”17
Among the ways that evidence-based design seeks to reduce stress are by:
• Enhancing the connection to nature, by bringing the outside in as much as possible
• Giving patients more control, through the ability to regulate room temperature and lighting or to order favorite foods or better television programming
• Providing space for loved ones, to rest or sleep overnight in a patient’s room
• Eliminating environmental stressors, such as noise, poor air quality and glare
• Providing complementary therapies, such as guided imagery, meditation and acupuncture 18
Ulrich and Craig Zimring, Ph.D., of Georgia Institute of Technology, in their review of this topic have made the following recommendations:
• Eliminate double-occupancy rooms to reduce stress for patients and their families by enhancing patient privacy.
• Install sound-absorbing ceiling tiles and carpeting to reduce noise and lower stress for patients.
• Provide better lighting and access to natural light to improve health outcomes, including depression, agitation, sleep and circadian rest-activity rhythms.
• Create pleasant, comfortable and informative environments to relieve stress and promote satisfaction among patients, their families and staff.
• Make hospitals easier to navigate to reduce stress on patients and their families.19
These improvements can have a beneficial effect on stress during a patient’s stay, which may even lead to a speedier recovery at home20 as well as increased patient satisfaction.21
As the AHA states in its guide:16 “Every aspect of a patient’s experience of care is influenced by valuable and often underused resources: the health care physical environment and the people who manage it,” adding that “by working with people, processes and place, hospital and health system leaders can take a more holistic approach to improving the patient experience.”
Choosing to make the hospital experience less daunting by creating a more familiar “healing home” is one way to accomplish this. Oftentimes it’s the little things that can make a very big difference.
1 Evidence-Based Hospital Design Improves Healthcare Outcomes for Patients, Families and Staff. June 2004.
2 Play interventions to reduce anxiety and negative emotions in hospitalized children. BMC Pediatrics. March 2016.
3 Evidence-Based Hospital Design Improves Healthcare Outcomes for Patients, Families and Staff. June 2004.
4 Evidence-Based Design. Healthdesign.org. https://www.healthdesign.org/sites/default/files/Malkin_CH1.pdf
5 Evidence-Based Hospital Design Improves Healthcare Outcomes for Patients, Families and Staff. June 2004.
6 National Healthcare Disparities Report. 2010. Chapter 5. “Patient Centeredness.” https://archive.ahrq.gov/research/findings/nhqrdr/nhdr10/Chap5.html
9 The Beryl Institute, http://www.theberylinstitute.org
11 Health Catalyst. “How to Improve Patient Satisfaction Scores By Using Data.” https://www.healthcatalyst.com/how-cleveland-clinic-improve-patient-satisfaction-scores-data-analytics
12 Evidence-Based Design. Healthdesign.org. https://www.healthdesign.org/sites/default/files/Malkin_CH1.pdf
17 Health Research & Educational Trust. (2016, March). Improving the Patient Experience Through the Health Care Physical Environment. Chicago, IL: Health
Research & Educational Trust. Accessed at www.hpoe.org/resources/hpoehretaha-guides/2823
18 Evidence-Based Design. https://www.healthdesign.org/sites/default/files/Malkin_CH1.pdf
19 Evidence-Based Hospital Design Improves Healthcare Outcomes for Patients, Families and Staff. June 2004.
20 Kiecolt-Glaser, J.K., G.G. Page, P.T. Marucha, R.C. MacCallum, and R. Glaser. 1998. Psychological influences on surgical recovery: Perspectives from psychoneuroimmunology,
American Psychologist 53 (11): 1209-1218.