The Physiological Effects of Window Decals on Pediatric Patients

Presented by: Michelle Pinson, MS; Kristi Gaines, PhD; Debajyoti Pati, PhD; Malinda Colwell, PhD; Nicole Adams, PhD; and Lesley Motheral, MD

Because the built environment has been shown to impact its' users, both positively and negatively, a greater emphasis has been placed on understanding the consequences relating to the design choices for the built environment (Dijkstra, Pieterse, & Pruyn, 2006; Ulrich & Zimring, 2004)  When hospitals are well designed, it can have a positive impact on patient outcome and has the potential to promote healing (Varni et al, 2004).  

Research relating to pediatric patients has shown that the built environment of the hospital can directly impact healing processes by either preventing or facilitating stress.  When a pediatric patient perceives the hospital environment negatively, he or she may experience a number of  negative physiological and psychological effects. Alternatively, when a patient perceives the hospital environment as supportive, the potential for healing is heightened. 

This study built on Ulrich's Theory of Supportive Design (1991), which focuses on the relationship between stress and ways that the built environment can influence general wellness through access to positive distractions and their relationship to stress reduction.  Research has shown that views of nature from the patient room and access to positive distractions have been linked to a number of positive health-related impacts, including lowered blood pressures and heart rate.  

Hospitals, however, cannot guarantee that every patient room will come equipped with a window view filled with nature.  The lack of view may be due to geographic location, the architecture of the building, etc.  With the understanding that nature filled views have been linked to a reduction in stress, oversized window decals were designed based on preferences for art of pediatric patients. The decals featured two scenes: an aquatic scene and a tree scene.  

The objective of this study was to understand the impact of the view from the window on pediatric patients, and whether the installation of the window decals affected the individuals within a pediatric patient room during their stay at the hospital in a physiological manner.  In addition, the researcher sought to determine if developmental stages of the patient was correlated to the physiological outcomes.  The medical data of individuals (n=90) who stayed in the rooms with the window decals was compared with medical data of individuals who stayed in rooms without the decals.

Findings supported the idea that patient stress is heightened at the time of admission.  Patients in the rooms with decals were found to have slight improvements in blood pressure, systolic heart rate and diastolic blood pressure in comparison to patients in control rooms.  Overall, there were not any significant physiological differences between patients in regards to the subject matter of the decals. Finally, age and cognitive understanding appeared to play a small role in health-related outcomes.

This study should increase understanding in the design of pediatric hospitals and ways that designers can provide nature-filled window views when they do not naturally occur.  In turn, findings may be used to expand future research on ways that windows can be enhanced in alternative settings (i.e. classrooms, offices, etc.).  The value in impacting the physiological processes in a positive manner holds tremendous value for future patients, designers, and healthcare administrators alike.


  • Ulrich, R. S. (1991). Effects of interior design on wellness: Theory and recent scientific research. Journal of Healthcare Interior Design , 97-109.
  • Varni, J., Burwinkle, T., Dickinson, P., Sherman, S., Dixon, P., Ervice, J., et al. (2004). Evaluation of the built environment at a children's convalescent hospital. Varni, J., Burwinkle, T., Dickinson, P., Sherman, S., Dixon, P., Ervice, J., et al. (2004). Evaluation of the built environ
  • Dijkstra, K., Pieterse, M., & Pruyn, A. (2006). Physical environmental stimuli that turn healthcare facilities into healing environments through psychologically mediated effects: systematic review. Journal of Advanced Nursing , 56, 166-181.
  • Ulrich, R. S., & Zimring, C. (2004). The role of the physical environment in the hospital of the 21st century: A once in a lifetime opportunity. Center for Health Design, 69.

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