The Role of Positive Distraction in the Patient’s Experience in Healthcare Setting: A Literature Review of the Impacts of Representation of Nature, Sound, Visual Art, and Light

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Dabrowska, Maria Anna
Zimring, Craig
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Background One of the key strategies to help patients reduce stress and anxiety in healthcare settings is positive distraction defined as “an environmental feature that elicits positive feelings and holds attention without taxing or stressing the individual, thereby blocking worrisome thoughts” (Ulrich, 1991, p. 102). While several studies found the impact of positive distraction on health-related outcomes, few studies have categorized the distractors and collected the evidence from experiments. Despite the common use in design and broadly accepted assumption that positive distraction brings psychophysiological benefits, there has not been a comprehensive evaluation of research on positive distraction. Methods The present literature review examined 40 peer-reviewed articles from the last 20 years on nature, artwork, music, and light to describe the phenomenon of positive distraction, review the evidence on the impact of interventions on outcomes, and investigate the quality of the research. This paper explored historic background, definitions, and organized the key information from articles into a table. Based on the similarities of themes, I categorized and described the interventions. This paper presents a framework that links the categories to healthcare settings, outcomes, and measures which were used to assess each outcome. Finally, I marked the number of studies in each category that indicated the beneficial influence of interventions for each outcome. The significance of this study lies in collecting and analyzing the studies, describing the crucial aspects that need to be considered when designing positive distractions, and pointing out the directions for future research. Results I organized interventions into the following seven categories: Real and artificial nature, Visual representation of nature, Music and Sound, Light, Illuminated projection, Audiovisual, and Audiovisual with light. The most common interventions were plants placed in a patient room as well as Illuminated projection and Audiovisual interventions with light in diagnostic imaging rooms. Pain and anxiety were the most studied outcomes. While 16 out of 22 studies found a statistically significant improvement in perceived pain, only 10 out of 24 articles found this effect for anxiety. More than 60% of studies that measured the impact of interventions on pain, satisfaction, environmental satisfaction, reduction in restlessness and calm behavior, and perceived attractiveness found statistically significant positive results. Although the positive distraction was initially recognized for its potential to reduce stress, only eight articles investigated stress and distress, but more than half of those studies found a beneficial effect. Interventions in Real and Artificial Nature, and Music and Sound, and Audiovisual with Light showed a beneficial impact on more than six outcomes and emerged as the most promising. Conclusions Despite the 40-years tradition, the field of positive distraction is still in an exploratory phase. This analysis confirmed that there is a positive correlation between positive distraction and outcomes and strong evidence that positive distraction helps reduce perceived pain. Future work should consider the division of the term positive distraction into more precise sub-terms to account for different characteristics of interventions categorized as a positive distraction as well as focus on defining the beneficial features of the distractors, explaining the underlying mechanisms, determining the effect size of interventions, and improving both aesthetics of interventions and the methodological quality of studies.
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