Letter to the editors: a view from and on the window.

Abstract

One author, Diana Anderson, is a physician and an architect whose career is aimed at bridging the gap that exists between medicine, research, and architecture in order to improve design and operational efficiency of the clinical environment. She has worked in many hospitals and healthcare environments that are not supportive of staff well being nor sometimes even patient healing. Dr. Anderson often uses clinical anecdotes in her writing, linking them back to design in order to increase awareness of design's impact among her clinical colleagues. A recently published piece in the Journal of the American Geriatrics Society (Anderson & Hamilton, 2014) recounted her experience with critical care unit delirium and the potential impact of windows on a patient's physiologic response; a synopsis of this encounter is detailed below.The other author, Penelope Ann Shaw (Penny), is a nursing home resident who has been living in a facility in a bed by a window for 11 years. She is a survivor of critical care (having spent 4 months in an ICU on life support) from an acute phase of Guillain-Barre syndrome, a rare neuromuscular disorder in which a person's immune system damages the nerve cells, in her case causing almost total paralysis. That was followed by a year in a respiratory rehabilitation hospital. Of the 11 years in her current facility, she was mostly in bed for 3½ years with a tracheostomy and a feeding tube.Penny reached out to Diana after reading that piece in the Journal of the American Geriatrics Society in order to relate her story of how a window changed her experience dramatically while in long-term care. They teamed up to write a piece that builds on the topic of windows and exterior views. In the following sections, they provide insight into how these architectural elements can be life changing for patients and of vital importance for staff.Penny's Patient PerspectiveDuring these many years in my nursing home I've had the good luck to have a bed next to a large 5' by 6' window. The light streams through with daily and seasonal changes. I see light, bright warm sunshine, sunrise and sunset, lightning, overcast skies, and fog. The color of the sky alternately may be white, light or dark grey, blue, red, or leave my window completely black in the middle of the night. Sometimes the clouds in various formations may be visible.There is a beautiful maple tree directly outside my window with a building behind that I enjoy for its architectural details including rounded and circular windows. There is a wooden fire escape up and down which people walk. I follow the tree seasonally from the empty dark limbs of winter sometimes frosted in snow, to the early yellowish-green buds of spring, to the mature dark green of summer, to the autumn changes of red, orange, yellow, and brown, after which the cycle begins again. The motion and force of the wind brushes snow off the tree in flurries and leaves off the tree in great abundance.Staff members use my window to check the weather, see how much snow is falling and whether they'll have to scrape their cars after the storm. It's a conversation opener for them to stop for a moment in their busy schedule and chat.The sounds I hear through the window are another source of pleasure. The wind may be soft and mild or harsh and howling. When it rains there are the sounds of thunder, and other times the delicate pings and spatterings of rain and snow against the pane. Sometimes the droplets fall in many straight lines side by side, appearing like a beaded curtain that makes the window opaque, letting little light in between. The windowpane is a canvas for the elements to draw abstract geometric patterns that can absorb and distract me, creating a form of entertainment for several minutes. Another sound I hear through the window is that of the whistle of an Amtrak train going by, reminding me of people traveling from place to place, living their lives, enjoyably I hope, connecting me with the larger world. …