Florence Nightingale would be horrified that we deny people natural light

Spending all day in artificial light is not good for patients' physical or psychological health

A close relative, Richard, was recently admitted to hospital via A&E suffering from pneumonia and pleural effusion.

It was a bank holiday, beds were in short supply, so although he was a respiratory medical emergency – being over 70 – he was admitted to an acute assessment ward for the elderly.

Like most modern wards it was made up of multi-bedded bays and single rooms. Admission went smoothly and the nursing care was pretty good. But there was one thing I found shocking, something that in 50 years in nursing I had never seen before.

His seven-bed bay had almost no windows, just two narrow frosted-glass slits high up on the end wall. Patients received no direct natural light, and had no view.

‘The absence of daylight is depressing,’ reported Richard. ‘Artificial lighting is essential night and day. Only a few windows in the complex open; none in my ward.’

Florence Nightingale would have been horrified. She believed the first two essentials for patients were fresh air and natural light, and she stressed the importance of a view to the outside.

‘Who has not observed the purifying effect of light, and especially of direct sunlight, on the air of a room?’ she asked. ‘[The sick] should be able, without raising themselves or turning in bed, to see out of windows, to see sky and sunlight.’

Nightingale had an immense influence on hospital design. The large open ‘Nightingale’ ward, with windows down both sides, was commonplace in my early days as a nurse.

Official Department of Health guidance on buildings still states that daylight ‘has beneficial effects on patients, visitors and staff’. However this is merely guidance.

One reason for a reduction in daylight and ventilation was because of conflicting requirements for privacy, changes in medical and nursing practice and the need for increased efficiency.

Open Nightingale wards were superseded by wards of smaller units, and single rooms. A consequence of this change, made for the best of motives, make it almost impossible for modern wards to meet Nightingale’s aims.

Elderly confusion is exacerbated by lack of daylight. Light is essential to maintaining our day/night rhythms, and this is even more the case for the elderly and those who are confused.

Not surprisingly, many patients in Richard’s bay were restless at night, trying to get out of bed and setting off the alarms on the pressure pads.

‘By night the atmosphere becomes oppressive; the patients’ demons come out,’ reported Richard. ‘Elderly patients, some already disorientated, are inclined to argue, fail to understand the night staff, strip or try to wander.’

Staff had become used to the conditions. No doubt concerns had been raised, but what was the alternative? These patients needed to be assessed, investigated and referred onwards. There was acceptance of what had become an unsuitable environment.

Yet just as Nightingale wards were seen as no longer reflecting what society considered appropriate, we need to see that what might have been acceptable for a patient who was only going to spend a few hours is totally unsuitable when their stay becomes longer.

‘I was fortunate,’ said Richard. ‘Every evening I could leave. That week the weather was lovely. Once outside I took deep breaths of fresh air and experienced a tremendous sense of relief. When, after eight days, I was discharged, I spent the rest of the day sitting at the open patio door looking at the sunshine and grass.’

There is immense pressure on beds, so we can’t afford to lose any. But natural light and a view to the outside are as important to patients’ physical and psychological outcomes and wellbeing as other aspects of care and treatment.

If we insist that evidence-based practice is the norm for clinical interventions, surely the same standard should apply to the physical environment in which care is provided?

About the author

Jennifer Hunt is a retired nurse.



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