title: The impact of windows and daylight on acute-care nurses' physiological, psychological, and behavioral health.
abstract: OBJECTIVE
  To investigate the physiological and psychological effects of windows and daylight on registered nurses.
  
  
  BACKGROUND
  To date, evidence has indicated that appropriate environmental lighting with characteristics similar to natural light can improve mood, alertness, and performance. The restorative effects of windows also have been documented. Hospital workspaces generally lack windows and daylight, and the impact of the lack of windows and daylight on healthcare employees' well being has not been thoroughly investigated.
  
  
  METHODS
  Data were collected using multiple methods with a quasi-experimental approach (i.e., biological measurements, behavioral mapping, and analysis of archival data) in an acute-care nursing unit with two wards that have similar environmental and organizational conditions, and similar patient populations and acuity, but different availability of windows in the nursing stations.
  
  
  RESULTS
  Findings indicated that blood pressure (p < 0.0001) decreased and body temperature increased (p = 0.03). Blood oxygen saturation increased (p = 0.02), but the difference was clinically insignificant. Communication (p < 0.0001) and laughter (p = 0.03) both increased, and the subsidiary behavior indicators of sleepiness and deteriorated mood (p = 0.02) decreased. Heart rate (p = 0.07), caffeine intake (p = 0.3), self-reported sleepiness (p = 0.09), and the frequency of medication errors (p = 0.14) also decreased, but insignificantly.
  
  
  CONCLUSIONS
  The findings support evidence from laboratory and field settings of the benefits of windows and daylight. A possible micro-restorative effect of windows and daylight may result in lowered blood pressure and increased oxygen saturation and a positive effect on circadian rhythms (as suggested by body temperature) and morning sleepiness.
  
  
  BACKGROUND
  Critical care/intensive care, lighting, nursing, quality care, work environment.
authors.affiliation: CORRESPONDING AUTHOR: Rana Sagha Zadeh, Department of Design & Environmental Analysis, Cornell University, 2425 Martha Van Rensselaer Hall, Ithaca, NY, 14853, USA; rzadeh@cornell.edu; (607) 255-1946.
authors.forename: Rana Sagha
authors.initials: RS
authors.lastname: Zadeh
authors.forename: Mardelle McCuskey
authors.initials: MM
authors.lastname: Shepley
authors.forename: Gary
authors.initials: G
authors.lastname: Williams
authors.forename: Susan Sung Eun
authors.initials: SS
authors.lastname: Chung
mesh_terms: D000328:Adult; D000339:Affect / Q000502:physiology; D001291:Attitude of Health Personnel; D001794:Blood Pressure; D001831:Body Temperature / Q000502:physiology; D003142:Communication; D005260:Female; D006272:Health Facility Environment; D006304:Health Status; D006339:Heart Rate / Q000502:physiology; D006749:Hospital Design and Construction / Q000379:methods*; D006801:Humans; D008029:Lighting; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology*; D010100:Oxygen / Q000097:blood; D013472:Sunlight; D014851:Wakefulness / Q000502:physiology
chemical_list: D010100:Oxygen