Planning care spaces for daylight and views

Prior to Roger Ulrich’s seminal work on window views and patient healing, Florence Nightingale promoted the use of large windows offering ventilation and natural light. While it may be intuitive to some or a code requirement for others, the topics of windows, daylight and views have been an ongoing exploration for researchers.

A few recent papers, summarized here, advance what we understand about view types, the orientation of patient room beds and blinds, and window decor.

A team led by Elnaklah used a mixed-method design to see how different window views (i.e., nature, urban or no window) influenced indoor environmental variables, patient and staff perceptions of comfort, and the relationship between comfort and how our brains work. Researchers recruited patients and staff from eight different buildings in a hot, arid region. The team found that rooms without windows had lower temperatures, carbon dioxide levels and noise levels, with no differences in relative humidity. However, study participants exposed to views of nature perceived higher levels of indoor environmental quality and greater cognitive function scores than those with urban views or no windows at all. The study helps us understand that window views of nature not only improve comfort but also cognitive function. Like many design decisions, such improvements come with a tradeoff, since windowless rooms typically have lower cooling costs.

Jafarifiroozabadi and colleagues investigated how different bed/window orientations and window blind positioning influenced patient anxiety, depression and pain medication use in a cardiac intensive care unit. The cardiac intensive care unit where the study took place included rooms where patient beds were parallel to a window and rooms where patient beds were perpendicular to a window (where the patient’s head was facing away from the view). Interestingly, researchers found no difference in patient anxiety, depression or pain medication use between the two room layouts but did note significant differences in rooms where blinds were open or semi-open compared to closed.

Finally, a team led by Pearson studied the influence of nature-themed, semi-permanent, opaque, vinyl window murals on the heart rate and blood pressure of pediatric patients. Patients were assigned to one of three room conditions: a room with an unaltered window (neither the sky nor the minimal landscaping was visible from the bed), a room with a tree-themed window mural or a room with an aquatic-themed window mural. After the murals had been in place for two years, the team conducted retrospective chart reviews of 90 patients to examine heart rate and blood pressure trends. Overall, researchers found that the window murals were associated with a reduction in heart rate between 24 and 48 hours of admission, and there was a greater improvement in blood pressure in rooms with tree murals versus those with the aquatic murals. Findings suggest that window murals may positively influence these physiological metrics, especially in rooms where views of sky and greenspace are limited.

Each of these studies addresses windows from a different perspective, yet all are relevant to the design of health care spaces. If you are interested in more research on how windows may influence outcomes, you can find articles on this and other health care design topics in The Center for Health Design’s Knowledge Repository. 

Research used for this column

The following research citations from The Center for Health Design’s Knowledge Repository of health care design resources were used by the author when writing this column:

• Roger S. Ulrich, “View through a Window May Influence Recovery from Surgery,” Science, vol. 224, no. 4647 (1984).
• R. Elnaklah and H. AlWaer, “Impact of Window Views on Cognitive Functions and Perceived Comfort in Healthcare Environments,” Building and Environment, vol. 270 (2025).
• R. Jafarifiroozabadi, “Investigating the Impact of Window Features and Room Layout on Anxiety, Depression, and Analgesic Medication Intake among Patients: A Pilot Study in a Cardiac Intensive Care Unit,” HERD: Health Environments Research & Design Journal, vol. 18, no. 2 (2025).
• M. Pearson et al., “The Physiological Impact of Window Murals on Pediatric Patients,” HERD: Health Environments Research & Design Journal, vol. 12, no. 2 (2019).

About this column

“Design Discoveries” highlights research from The Center for Health Design’s Knowledge Repository, a user-friendly library of health care design resources. This research effort is supported by the American Society for Health Care Engineering, the American Institute of Architects, the Academy of Architecture for Health Foundation and the Facility Guidelines Institute.

Yolanda Keys, Ph.D., R.N., EDAC, research associate, The Center for Health Design.