STIMULI IN THE OPERATING THEATRE ENVIRONMENT.
AUTHOR Arnav Mane is a first year Industrial design student at RMIT University, Melbourne with an interest in sketching and music.
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TABLE OF CONTENTS
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INTRODUCTION
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DESIGN RESEARCH
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SITE VISIT
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DESIGN INTERVENTION
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CONCLUSION
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REFERENCES
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INTRODUCTION The salutogenic approach is increasing in popularity due to advancements in research which links it to better outcomes for patients and h e a l t h ca re s t a ff . I t w a s a ll s t a r t e d b y o n e m a n , Aa r o n A nt o n o vs k y w h o raised a very important question : how is health created? Incorporating this approach into the healthcare system is a challenge as it involves investment, research and planning. One instance where this health-centric approach is currently practiced is in the waiting rooms of hospitals in the form of various design interventions in the pre-existing infrastructure such as updating graphics, technologies systems, etc.
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One term coined by Antonovsky during the course of his research was “Sense of Coherence” hereby referred to as SOC which was defined as:
“The extent to which one has a pervasive, enduring though dynamic, feeling of confidence that one’s environment is predictable and that things will work out as well as can reasonably be expected.”
Higher SOC scores mean that the person is less likely to experience stress. Arguably, the situation with the highest stress in a hospital environment is the operating theatre for both the patients and the h e a l t h ca re s t a ff .
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The first journal article talks about
DESIGN RESEARCH
t h e eff e ct t h a t v i s u a l a r t h a s o n the patients at the hospital. An evaluation suggests that there is a possibility of positive distraction caused by art as it can promote positive feelings, hold attention and reduces stress and in situations with no distractions, the patients are more likely to focus on their worry and pain.
The research included analysing various studies conducted and taking notes from precedents to come up with a project direction. W h i l e a ll of t h es e w e re d i ff e re nt i n terms of content and context, they all provided evidence that stimuli can h av e a p os it i v e o r a n e g a t i v e eff e ct humans.
Milestones on their Journey - Samantha Clark
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This study provides fur ther evidence for our research about the effects of visual stimuli and it also tells us about the difference that various kinds of ar t have on people
Memories - Dierdre Neilsen
Responses from patients as well as the healthcare staff have been positive with natural ar t or scenes depicting nature but abstract ar t may not be soothing for everybody
Sculpture Garden - Calum Sterling
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The Art Program at the Cleveland Clinic was started in 2005 and it displays donated museum-quality artwork in the hospital. Similar to the other initiatives, this aims to improve patient health and well being by creating a calming atmosphere in the clinic. The art includes paintings, drawings, prints, photography, video, digital imagery, computergenerated artworks etc.
Iñigo Manglano-Ovalle’s BlueBerg was commissioned for Glickman Tower in 2007.
Visitors can experience the artworks in many ways through exhibitions, audio tours and description labels.
Jennifer Steinkamps’s Mike Kelley 1 is a highlight of the collection.
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Jaume Plensa’s Cleveland Soul sits at the main entrance Art Ambassador tour for Art for the afternoon program at Cleaveland Clinic.
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Another research paper talks about using visual stimuli as a pain relief for the debridement of leg ulcers which is often painful and unpleasant and patients choose not to undergo treatment due to inadequate pain relief and adopt a sedentary lifestyle.
4 6 p a t i e nts u n d e r w e nt a ra n d o m i ze d t es t t o d e t e r m i n e t h e eff e ct t h a t visual stimuli has on the pain threshold by being subjected to visual content ranging from Chinese opera to cartoons and natural environments like mountains and Subject wearing the eyeglass display
waterfalls and some were shown blank static screens in an experiment spanning over 2 days.
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A tourniquet was used to measure the pain threshold and pain tolerance of patients over time. With visual stimuli, it was found that the mean tourniquet time for pain threshold increased from 109 seconds to 145 seconds and the pain tolerance increased from 310 to 393 seconds.
After data compilation, it was concluded that there was a significant p os it i v e eff e ct of a v i s u a l s t i m u l i .
However there was not enough
The Olympic Eyetreck eyeglass was connected to a VCD
evidence collected in this study to s u g g es t t h e eff e cts of v a r i o u s v i s u a l content.
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Revisiting the operating theatre
There were 78 procedures
scenario, it is important to minimise
performed and the distractions
distractions, which was proven by
included pagers, telephones, door
this study that was conducted to find
movement, irrelevant communication,
the relation between distractions
equipment-based distractions, etc.
of d i ff e re nt fre q u e n c i es a n d t h e outcome of the procedure.
An interview was conducted and it was agreed by all that distractions h av e a n e g a t i v e eff e ct o n t h e
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Seven subjects were observed during
quality. This means that during a
their procedures spanning 6 months
surgery it is necessary to reduce the
and data was collected. A scale from
distractions and hence any solution
1-7 was adopted to measure the
devised henceforth must have this in
intensity of a distraction.
consideration.
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When it comes to making changes inside an operating theatre, it is worthwhile to note that a lot of research has already gone into minimizing distractions.
Fo r e x a m p l e , t h e co l o u r s c h e m e of t h e opeating theatre is Blue-Green as the colour lies on the opposite end of the colour wheel to red and looking at it is said to reset the colour perception and colour sensitivity. Green also m i n i m i s es t h e “ a f t e r eff e ct � i llu s i o n that people experience after looking at something for too long.
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SITE VISIT The Royal Children’s Hospital Melbourne was chosen to be the location for a site visit due to it’s relative newness. It was evident that a salutogenic approach was used in designing the building.
Inside the waiting rooms, there are a lot of things to keep children occupied such as painting stations, multiple televisions playing children’s movies, small games, a garden, a terrarium and other interactive things.
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Space management and Colour theory
Easy to read symbols and boards, hand
play an important role in the entire
sanitizing stations, colour coded zones etc, make
hospital.
it a better experience for patients.
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DESIGN INTERVENTION The research provides evidence in favour of stimulus centered approach. in the medical setting.
However, a case study would be required in order to verify the benefits of the same. The most eff e ct i v e p l a n of a ct i o n f o r s u c h a research experiment would be to minimise distraction experienced by t h e h e a l t h ca re s t a ff w h i l e p ro m o t i n g positive distractions for patients.
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One of the ways that this can be achieved is by the assistance of Virtual Reality (VR) or Augmented Reality (AR) equipment that is similar to the headsets used by the Hong Kong study on patients with leg ulcers 2003.
Originally designed as a gaming accessory, VR is rapidly gaining popularity in the healthcare sector.
Due to advancements in technology, the current generation of VR headsets have better capabilities and there is a plethora of content available and development for the same will continue into the future.
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When it comes to using AR/VR technologies, there should be certain considerations based on the protocols inside the operating theatres such as maintaining the integrity of the microbe-free environment inside an operating theatre by possibly using sterile and changeable foam for the eye-piece and ear-piece of the headset.
This tecnology can benefit patients who are undergoing treatments under local anaesthesia or no anaesthesia such as suture removals, nail extractions, dressing changes, etc.
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Having a choice is proven to be eff e ct i v e i n i n c re a s i n g re l a x a t i o n responses. The patients may be given a catalogue to choose from various genres of content that are known to have a positive impact.
While video may be the forefront of this design intervention, Audio plays an equally impor tant role in stimulating and immersing the mind.
Audio content should accompany the visual content however, the subject may choose to select only one of the two.
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Nature landscapes such as mountains, seas, etc are found to have a positive impact on the human mind due to the blue/green colour palette in most situations.
An upcoming concept of Virtual Art Galleries, in which Ar t is displayed in a digitally created environment, could be used to curate art pieces for the patients.
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Cartoons or Child-friendly content may be shown to younger subjects. This is popular in children’s hospitals as was observed during the site visit. Children flocked around a television screen while waiting for their appointments.
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Breathing exercises, meditation, prayers or sleep therapy videos/ audio could help relax and de-stress as meditation programs result in an improvement in anxiety and stress among various clinical populations
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Medical advice related to the procedure can be displayed to the willing subjects such as advice on diet, follow-up appointments, p oss i b l e s i d e eff e cts e t c.
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Another possible avenue to explore
CONCLUSION
would be the recovery room where patients are waiting post operation for upto 6 hours. Screens could be placed in the field of vision of the patient with similar content as above, to aid with recovery and reduce the focus on pain and anxiety by providing positive distraction.
All the examples have ideas linking better health to advancements in technology and investing in the such technology that can improve health and increase SOC in people and this technology could be the driving factor
Changes to the lighting systems can also bring about a positive mood and
that pushes salutogenesis forward into the future.
better perception as various colours and schemes of lights have been known to alter the chemical response in the brain
As healthcare improves the salutogenic practices will be widely adopted and it would be difficult to imagine a scenario without salutogenesis.
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REFERENCES Antonovsky, A. (1996). The Salutogenic Model as a Theory to Guide Health Promotion. Health Promotion International, 11, 1118. doi: 10.1093/heapro/11.1.11 Antonovsky A. (1979). Health, stress and coping. San Francisco: JosseyBass. Antonovsky, A. (1987). Unraveling the mystery of health: How people manage stress and stay well. San Francisco: Jossey Bass. Belkin N. L. (1998). Surgical scrubs-where we were, where we are going, Today’s Surg Nurse, 1998 Mar-Apr; 20(2):28-34. Bigliassi M., Karageorghis C.I., Wright M. J., Orgs G., Nowicky A. V. (2017). Effects of auditory stimuli on electrical activity in the brain during cycle ergometry. Physiol Behav. Aug 1;177:135-147. doi: 10.1016/j. physbeh.2017.04.023. Epub 2017 Apr 23 Bruestle E. R. (2015). Effects of Participant-Selected Preferred versus Relaxing Music on GSR and Perceived Relaxation, Retrieved from https://pdfs.semanticscholar.org/0ec5/ e8de46435dcabce9f1a58ab9cbc61e08605d.pdf Collingwood J. (2018). Your Sense of Coherence. Psych Central: Retrieved on September 24, 2019, from https://psychcentral.com/lib/your-senseof-coherence/ Goyal M., Singh S., Sibinga E.M.S., et al. (2014). Meditation Programs for Psychological Stress and Well-Being [Internet]. Agency for Healthcare Research and Quality ; 2014 Jan. (Comparative Effectiveness Reviews, No.124.) Results available from https://www.ncbi.nlm.nih.gov/books/ NBK180107/
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How Stuff Works. (2017) Why Do We Get So Much Pleasure From Symmetry? Retrieved from: https://science.howstuffworks.com/why-doget-so-much-pleasure-from-symmetry.htm Jones M. (2009). Music in the waiting room; British Journal of General Practice. 2009 Aug 1; 59(565): 613-614. Doi: 10.3399/bjgp09x453864 Joseph A. (2006), Impact of Light on Outcomes in Healthcare Settings, The Center for Health Design, Retrieved from https://www.healthdesign. org/chd/research/impact-light-outcomes-healthcare-settings Kickbusch, I. (1996). Tribute to Aaron Antonovsky—‘what creates health’. Health Promotion International, 11, 5–6. Lankston L., Cusack P., Fremantle C., Isles C.(2010). Visual art in hospitals : Case studies and review of the evidence. J R Soc Med. 2010 Dec 1; 203(12):490-499. doi: 10.1258/jrsm.2010.100256 Maurice B. M., Shifra S., Monica E., Georg F. B., Jürgen M. P., Bengt L., and Geir A. E.(2017). The Handbook of Salutogenesis. Cham (CH): Springer; 2017. Available from: https://www.ncbi.nlm.nih.gov/books/NBK435831/ doi: 10.1007/978-3-319-04600-6 Sevdalis N., Hull L., Birnbach D. J. (2012).Improving patient safety in the operating theatre and perioperative care: obstacles, interventions, and priorities for accelerating progress. British Journal of Anaesthesia, Volume 109, Issue suppl_1, December 2012, Pages i3–i16, https://doi. org/10.1093/bja/aes391 Shiralkar U. (2017). Surgeon, Heal Thyself: Optimising Surgical Performance by Managing Stress, CRC Press. Retrieved from ttps://books. google.com.au Tse, MMY; Ng, JKF; Chung, JWY. (2003). ‘Visual stimulation as pain relief for Hong Kong Chinese patients with leg ulcers’, Cyberpsychology and Behavior, 2003, v. 6 n. 3, p. 315-320 doi: 10.1089/109493103322011623
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