Liz Johnson

Project Leader Elizabeth Johnson, Ph.D., RN
MSU Mark & Robyn Jones College of Nursing
elizabeth.johnson37@montana.edu 

The objective of this research is to leverage a transdisciplinary team of engineering, architecture, and nursing investigators to address a priority initiative identified by a Community Advisory Board composed of Malta, Montana, residents: namely, correcting minimal access to natural light sources when in Phillips County Hospital. Malta receives as low as 8.4 hours of sunlight in the winter and experiences frequent high cloud cover. The low amount of sunlight permeating interior areas of the hospital has required the use of artificial, fluorescent lighting, which has been shown to devastate the metabolic and circadian rhythm of both patients and providers during periods of  long-term exposure. This exposure, such as during long provider shifts or as an admitted patient, can result in altered cognition, delirium, and stress.

Virtual sunlight (imitation overhead sun) and virtual windows (naturescapes) have been integrated in healthcare facilities nationwide to address the ill effects of fluorescent lighting on patient outcomes and provider wellbeing. Based on preliminary infrastructure and community perception assessments collected by the engineering-nursing team in 2022-23, this pilot proposal will evaluate for changes in perceived and  biological indicators of stress among patients and providers when exposed to virtual lighting. During the 12-month project, the Community Advisory Board, providers, and patients will be engaged in local learning sessions about virtual sun and windows, with parallel project team activities surrounding provider-patient workflow and determination of best naturescapes through use of Sticky eye-tracking (Aim 1). Then we will measure providers’ and patients’ perceived and biological stress, as well as cognition before and after installation of the virtual sun and windows through survey questionnaires and salivary cortisol to determine any significant differences or relationships across repeated measurements (Aim 2).

The proposed work is important given that Phillips County is a designated healthcare provider shortage area, which necessitates wellness-minded integrations in the built environment to support recruitment and retention of skilled clinicians. With more than 50% of adults in Malta over the age of 56, the increased risk of delirium and stress among admitted patients requires cost-effective interventions such as the naturescapes provided by virtual windows in the clinical rooms. Virtual sun at the nurses’ station and virtual windows in the patient rooms have the potential for wellness transformation with minimal impact to overall facility burden, while maximizing the ability to deliver quality care and exceed provider satisfaction.

Co-investigators on the project include Julie Ruff, Ed.D., Mark & Robyn Jones College of Nursing, and Bernadette McCrory, Ph.D., Department of Mechanical and Industrial Engineering.

This project builds on a first-year CAIRHE pilot project in 2023-24.