Friday, 18 October 2013

‘Hospitalogenesis’ - you heard it here first

Roger Watson, Editor-in-Chief

Sleeping in hospital is always problematic but we usually assume that it is due to noise and bright lights from early hours until late with little control or choice over the lighting to which we are exposed.  When a paper by Bernhofer et al. (2013) from the USA entitled ‘Hospital lighting and its association withsleep, mood and pain in medical inpatients’ arrived in my inbox I assumed that this is what the authors would report.  I am always interested in potential papers on the effect of the hospital environment on patients but this one especially interested me because the results were not what I expected. 

It transpires that hospitals tend to have low light intensity and that prolonged exposure to this lowers our mood and upsets our normal sleep-wake cycles.  The effect is possibly twofold: our mood becomes suppressed in low light - like living in a dull environment for a long time - and our sleep pattern becomes disturbed.  The outcome is that patients become fatigued and also experience greater pain.

These are serious findings.  Hospitals are distressing and dangerous enough places already.  To a list that includes sensory deprivation, isolation, loneliness, malnutrition, pressure sores and cross-infection we can now add the adverse effects of poor lighting.

It was always Nightingale’s maxim that we ought to do the patient no harm.  We also know about iatrogenesis - the unintended adverse consequences of medical treatment - and I recall someone even coining the term ‘nursogenesis’ to mean the adverse effects of nursing care.  However, it is clear that, while iatrogenesis is used generally to describe the adverse effects of medical encounters, that there may well be a place for a science of ‘hospitalogenesis’ or something along those lines to describe, specifically, the adverse effects of simply being in a hospital environment, before the medical and nursing staff line up to inflict more damage.

Naturally, this will encourage the ‘something must be done’ brigade to swing into action: ‘what do we want? Bright lights’.  But this is not going to be an easy issue to solve.  The green lobby have been active in encouraging the widespread adoption of low energy light bulbs.  In Europe it is virtually impossible to purchase any other kind.  So much so, that in the UK where I live, streets and houses are markedly duller than before and entering any room in my house requires planning. First: turn on the light; second: wait for the low energy bulb to reach an acceptable level of illumination - one that prevents you walking into the furniture.

I digress, but there is a serious message here.  Hospitals tend to be huge buildings with hundreds of rooms requiring illumination; the expense of attending to the effects of poor illumination could take a significant slice of the gross national product of any country.

I will watch this line of research with interest.


Reference

Bernhofer I, Higgins PA, Daly B J, Burant CJ & Hornick TR (2013) Hospital lighting and its association with sleep, mood and pain in medical inpatients. Journal of Advanced Nursing doi: 10.1111/jan.12282

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