Environmental Stressors

There is mounting evidence that the physical work environment affects job performance, job satisfaction, employee injuries, worker behaviors, communication patterns, employee fatigue, employee error rates, and physical and psychological stress.


The perception of odor is dominated by pleasant or unpleasant dimensions. Odor can affect mood because of the overlap of the olfactory and emotional systems in the brain.6 Just as pleasant odors contribute to a sense of well-being and health, malodors have the ability to produce an organismic response that can be most unpleasant and even possibly harmful.6 Odors are on a continuum and can be viewed as a range or levels, such as “no odor” to “highly odiferous,” but these are not clearly defined.


Many researchers have examined the effects of noise on patients, but comparatively few studies are available for healthcare staff.7 There is evidence that nurses are adversely affected by high noise levels. Such levels have been associated with increased stress and annoyance, fatigue, emotional exhaustion, and burnout.8Increased feelings of noise-related stress and burnout can lead to an increase in turnover intention. A recent study by Blomkvist and colleagues9 examined the effects of higher versus lower noise levels on a group of coronary intensive-care nurses over a period of months. Lower noise levels were linked with a number of positive effects on staff, including reduced perceived work demands, increased workplace social support, improved quality of care for patients, and better speech intelligibility.7 These positive outcomes for the staff have the potential to decrease nurses’ intention to turnover.


Most healthcare settings are lit by a combination of daylight entering through windows (natural light) and electric light sources (artificial light). There are few empirical studies that have examined the impact of light, artificial or natural, on mood or task performance in healthcare settings. Constant exposure to artificial light, in particular, fluorescent tube light, is commonly mentioned by nurses as one of the most draining aspects of work on a nursing unit.10 One study of 141 nurses in Turkey found that nurses exposed to natural daylight for at least 3 hours a day experienced less stress and were more satisfied at work.11 Furthermore, looking out at natural light can improve health outcomes, including agitation, sleep, and circadian rest-activity rhythms.12This can apply to both patients and nurses.

Researchers from the Center for Health Design confirm from previous research that the most obvious effect of light on humans is that of enabling vision and performance of visual tasks. According to Boyce and colleagues,12 the nature of the task, as well as the amount, spectrum, and distribution of the light, determines the level of performance that is achieved. Performance on visual tasks improves as light levels increase.

Another factor that affects performance on visual tasks is age. The need for light increases as a function of age because of reduced transmittance of aging eye lenses.13 This is significant in that the nursing work-force is aging, and there is a need to critically assess the lighting provisions for different types of tasks performed by nurses. Individuals may feel stressed if they are unable to perform tasks because of inadequate levels of lighting.


Color is an essential element of visual stimulation with well-documented psychological and physiological effects. Reds, yellows, and oranges have longer wavelengths and are considered warm, stimulating colors. Blues, greens, and purples have shorter wavelengths and are considered cool, soft, soothing colors. Warm colors, especially when accompanied by high illumination levels, have been found to encourage activity or movement, whereas cool colors promote more passive behavior.10 Because greens and blues are calming, these may be highly appropriate in the adult workplace as green has also been found to stimulate growth and balance emotions and is highly preferred by adults.14

These characteristics can be applied to specific clinical areas. For example, a postoperative unit can promote a feeling of calmness with cool, soft colors such as greens and blues. A more stimulating environment can be created with vibrant warm colors and may be appropriate for a geriatric unit.10

In summary, odors affect mood, noise affects stress, the type and amount of light affect stress, and certain colors are preferred by adults and affect behavior.


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