How To Make A Membership Website And Make It Profitable

Learning how to make a membership website is the beginning of pursuing quite a productive venture. To learn to do so, you must begin by knowing what elements or factors contribute to a profitable membership website.

The Business

It is important to understand that the blog or the website itself is not the business. Instead, they are the tools that you need to use appropriate in implementing the business model or plan that you have created. Even before you put up a website, it is crucial that you carefully plan and map out the course you want to take in pursuing your business.

In making the membership site, you must first determine what it is that you want to achieve through the site. Identify what it is that people seek you or your website for. Settle on how you want to provide this particular need of your target audience. Identify, first and foremost, what the business is and from there, you have to decide on how you can provide your customers with their needs.

The Demand

While it is true that you would consider setting up a membership site in order to make money, it is sometimes not advised that you do it for this purpose alone. In line with this, you must also understand the importance of demand in building your website. Determine if there is a demand for in your market. This can be achieved by performing a survey with your clients and asking about what it is that they like to know more from you. This can also help in discovering other things that people like, which might have not yet crossed your mind. Listen to your clients in order to find out what their demands are.

The Relationship

The success of a website also relies on how good your established relationship with members is. Your members are the ones who are most likely going to be your buyers. Put yourself in a buyer’s position. You are most probable to buy products or avail services from someone that you know. Thus, you have to make yourself known to your clients and you must also know more about them as much as possible. In building a good relationship with your members, you have to have constant communication with them. Cultivate trust in your relationship with your members so they will think of you each time they need to purchase something.

The Beneficiaries

A membership website’s benefit is two-way. It benefits you by driving in more money to your account from your members’ fees and payments. On the same note, the website also benefits the members as they are able to obtain what they need from it. To ensure that both you and your members are benefitted, you must always ensure that your contents are of the best quality. Offer your clients with the best product and always provide them with what they actually need.

The Marketing

Your task does not end once the membership website is put up. Instead, you must think of ways on how to effectively market the website. Marketing involves reaching more people and letting them know about your business and what great things they can achieve from it.

No Fax No Teletrack Payday Loan – The Most Widely Searched Keywords In The Cyber World

No fax no teletrack payday loan are today the most widely searched for keywords on the internet. Availing a no teletrack or a telecheck advance is the most convenient way of organizing funds even with a bad credit history.

Gone are the days when no body was ready to finance a person with bad credit record. Now if you are willing to apply for a no fax, no teletrack pay day loan, numerous financiers will come forward to finance you. All you need to do is surf the internet to look out for options that are available then it is just a little paperwork. Just compare the finance quotes of different companies and shortlist the finance companies that suit your need of funds.

About Pay Day Loans

Payday loans are the most favored advance options now days which help a debtor to handle a financial urgency even with a record of bad credit history. No fax no teletrack payday loans assures peace of mind to a person even with a poor credit record that his need will not be turned down in his hour of need.

These loans are usually short term loans which handle an urgent need without teletracking. This is really beneficial for someone with a bad credit. You can file your application for this loan on the internet. The main advantageous point of these advances is that it is sanctioned to the person within 24 hrs, or even less, so, a debtor can start immediately using the funds towards fulfilling his requirements.

About The Teletrack System:

In general, Teletrack is the system that is used to examine the financial and credit record of the debtor’s account which can expose all the flaws of the debtor’s credit history. These drawbacks can deter him from being eligible for a loan. By applying for the no teletrack loans, one can be assured that there will be no need to fax any documents to the financier that are related to his credit details.

Pay day loan companies impart immediate cash for a short period as against normal loan companies’ long and lengthy procedures. These agencies charge a higher rate due to higher risk factor and no demand of collateral or security.

Benefits In Short

The main advantage of this loan is that the money will be transferred immediately to your savings account upon the approval of your application form and you can start using the funds as per your needs. Thus, these loans serve many purposes like peace of mind, no teletracking and immediate disbursal.

There Are Many Reasons Car Rentals Offer Cheap Rental Cars and You Should Be Aware of Such Reasons

The most obvious reason why you can get a cheap car rental is when the renting outfit is giving vacation discounts on certain months or seasons of the year. This is a matter of routine that they have to do to remain competitive in their market. Although vacation times are the times when people love to go on holiday trips, they will usually rent from companies with discounted rates.

Other companies apply discounts to their prices for certain special and tourist-attractive destinations. These discounts are seasonal such as if you were to attend the Mardi Gras in New Orleans. These types of discounts you have to avail of early on, perhaps a few weeks before the festivities start. The reason is that there will most often be a last-minute rush to the site just before the fun begins and at that time and usually all promos and packages are suspended. This is perhaps due to the fact that the rental companies may run out of their own vehicles to rent out and will have to borrow from those who have any available and leave off on giving discounts for the borrowed cars.

Alternatively, other discounts are given for the sake of boosting their rentals during the slower months of the year or for destinations that are not very popular.

What is obvious is that you shouldn’t have a difficult time getting a cheap rental car for your outing because car rentals are dying to give you discounts just to keep the money rolling in. They even furnish large companies with discount cards which can be distributed to the employees. So you better check with management, if you are working in a big establishment, about cheap rental car discounts from the better known rental companies.

Because the condition of the car you are renting is determined to a great degree by the age of the car itself, a regular renter should know how to determine the age of the car by looking at its plate number. The formula for doing this is available on the internet and it may be different from one country to another and even from one state to the next. So when you research for ‘how to tell the car’s age from the number’ you should select the rules for the locality you are in.

You should be aware that there are also cheap rental car scams. In this situation you may be getting a car which is poorly conditioned or just plain too old to be road-worthy. Besides the car’s age, a look at the mileage indicator of the car will tell you how much use the motor of that car has seen. Along the same line of good car condition, you should be aware that although you can get cheap rental cars at smaller rental outfits if you need to use it for a long time, there is a catch to this. Smaller outfits will not have that many personnel and if you were expecting them to provide back up for you during an emergency, you may get an unpleasant surprise when you find you have to dish out your own money to have the rented car repaired.

Cheap Car Insurance and Car Safety – Young Drivers

The term young drivers, in an insurance context, tends to refer to drivers normally between the ages of 17 and 25 years old. This can sometimes be seen as a slightly patronising term, but in fact is simply a reflection of an age group that the insurance industry deems to be most at risk and therefore the most expensive group of car owners to insure.

Whilst any generalisation is to some extent unfair, there is a lot of statistical evidence that supports the fact that the majority of claims and the majority of expensive claims that the insurance industry has to pay out comes from this age range of drivers.

There are two main areas of concern to this age group. Firstly is the fairly obvious fact that because of their age they have not been able to build up a sufficient level of driving experience that give them the benefit of being able to drive more safely and securely than people of an older generation might be able to do. There is also a belief that people of this age group tend to be slightly more irresponsible and erratic in their driving habits than people who are in their late 20s, 30s etc. This may or may not be true, but nevertheless is a factor in the amount that insurance companies will charge.

Young drivers will inevitably pay a much higher insurance cost for their car insurance than people of an older age group. Whilst they are gaining a level of experience that allows them to drive safely they will be developing a level also of what is known as road awareness. It is this sense of being able to “read the road” that will significantly affect their ability to drive safely, and subsequently their safety record and amount they pay for their car insurance.

Reading the road is a term applied to people who drive, and tends to be a sense that people pick up of what is happening around them they pay particular attention to. This normally involves paying attention to what other cars, cyclists, lorries, pedestrians and other road users are doing around them and anticipating what actions they might take, and what the consequences of those actions might be. Reading the road is also about applying the correct level of speed to any given situation at a conscious level. This normally refers to driving slowly rather than driving fast, but reflects more generally a sense of appropriateness to the speed of driving in any particular situation.

The other level of concern often raised concerning this age group in relation to car insurance, is that as an age group they are easily distracted, or more easily distracted than people of a different age group might be. Traditionally this has always been seen as distraction in the sense of having friends of theirs of a similar age in the car, possibly showing off to them by driving too fast or recklessly. It has also raised concerns about driving at night when visibility and road conditions are much more difficult to manage.

Distraction amongst young drivers, as well as most other drivers, has become a major issue much more in recent times because of the advent of cellphones and ability of drivers to make calls and send and receive SMS messages at the same time. Research by the United States government shows that this is as dangerous potentially as that of drink-driving. Distraction is a major concern because it is in the split-second where people need to be aware of and focused of what is going on around them that decisions are made which profoundly affect the safety of the driver, the passengers and other road users who may be involved in any potential incident.

Bad Credit Cash Advance Loans – Get Instant Cash With Flexible Terms

If you are looking forward to instant credit, then cash advance loans can be your ultimate destination. These are the fastest ways of arranging desired cash, as these loans do not bother the borrower for arranging unnecessary details. These can provide you with smart cash within the least possible time; in fact, with these loans, you can enjoy fastest approval and instantaneous processing of your loan request. These cover credit requirements of every borrower section; therefore, people who are facing rejection due to their bad credit history can also manage suitable cash with cash advance loans. Bad credit cash advance loans are specially tailored for people, who have troubled credit history, so that they may also avail finest credit facilities to meet their requirements.

If your credit statement includes bankruptcy or foreclosure, then also you can get the desired loan amount with bad credit cash advance loans. The biggest benefit of these loans is that you get the cash instantly without wasting time on unnecessary documentation. Since these are for bad credit borrowers, lenders do not check your credit statement to approve the loan. Usually, these loans are based on the repayment capability of the borrower therefore, you need to have statement regarding steady source of monthly income. For getting an idea about the repayment capability of the borrower, lenders verify income details by contacting his or her employer. Income verification is the only term that a borrower need to fulfill for getting approval, as income statement of a borrower helps the lender in determining whether the borrower is eligible or not. Therefore, if you are employed and in need of urgent cash then bad credit cash advance loans can settle your emergency expenses without making any further delay.

People, who use credit card to meet emergency financial requirements, may find these loans expensive, as these loans charge higher interest than credit cards. However, bad credit borrowers hardly get the privilege to cash their credit card benefits but with bad credit cash advance loans they can also obtain desired cash. In fact, these can provide bad credit borrowers with excellent financial benefits. Since there is not any provision regarding usage of loan amount, you can use these loans in paying off your due bills and short term debts.

Basically, these loans are paid back by making a lump sum payment, as there is not any provision for installment. The repayment amount includes interest and is automatically deducted from the salary account of the borrower on due date. If you are going to take bad credit cash advance loans for the very first time, then carefully compare all available loan deals in the marketplace. Comparing rates will definitely help you in getting a more reasonable loan with lower interest rate thus compare schemes to make sure that you are getting a rational loan deal. Therefore, if you are struggling to arrange for desired cash for settling your emergency financial requirements, then apply for bad credit cash advance loans to get smart credit within minutes.

Smart Shopping For Evening Dresses

How do you know if a dress is really worth buying no matter how expensive it is? Aside from the quality, you need to determine what kind of dress it is. Even if a dress is affordable, you won’t buy it either if you don’t think it’s worth wearing.

Shopping for evening dresses requires careful selection. You would want to make sure that you are making a good investment for your wardrobe. You may want to determine first whether it is really a functional dress or not. Do you think you can wear this on almost every special occasion that you’re about to attend? The price is the vital factor that will determine its worth. Aside from the quality of the fabric, it is the nature of dress itself. Not all of night dresses are versatile, because some women are choosy with their style.

Go for evening dresses that are still classic, elegant, and stylish. Don’t go for trendy clothing for they will just run out of fashion. Consider the design and the color of the dress. Classic styles are worthy of wearing for almost all occasions for it fits anywhere. Unlike the trendy ones, they will be a part of wardrobe’s collection. Petite dresses are trendy nowadays yet you can find its style in a classic version. Find a cheap dress that you don’t need to alter just to fit on occasion or suit on the new demands of trends.

You don’t need to get confused when choosing a worthy evening dress, in spite of an overwhelming number of selections. Once you determine its style, function, and versatility, you can stick on these criteria and choose the best dress that you can ever buy aside from its price and design. And don’t forget that it is capable of enhancing your looks and give you a good boost of self-confidence.

Car Rental Deals – Why People Like Car Rental Deals

I know that you can relate when I say that I love to get a good deal on something. It shouldn’t take a lot of explaining why car rental deals are some of the most important things that you can partake in when shopping for a rental car. Some people will go to great lengths to find the best car rental deals that they can while others will be more willing to pay the advertised normal price. But did you know that you can just type in the name of the company you are looking for followed by the word coupon and you can find a better price. That is just one of the ways that you can get easy and cheap car rental deals.

There are many other techniques that one can use to get good car rental deals, one little known fact is just ask the company what deals they are offering at the time. A lot of agencies will have a special if you are willing to rent the car for a week, or if you are only going to have it for the weekend. Prices can vary and change depending upon the holiday season or during peak times in the summer, one can really never know how much it is going to cost to rent a car but you can also try to get the best car rental deals.

Don’t get discouraged when one company offers you a high price for a car, there are always more options than you could believe when you look for that perfect rental car for you. You also have to make a choice between two different options, let’s say for example you are on a very tight budget and you just want get the cheapest car possible than you may want to rent an economy style car and try to get the best possible deal on it, but on the other hand you also have the option of getting car rental deals in another way. You could go to an agency and request for a luxury vehicle at the price of a budget or hybrid style vehicle. You would be surprised at how many companies or agencies would be willing to make this switch simply if you ask. They may be having a special and would never have told you about it if you didn’t ask, who would have guessed?

Regardless of what deals or techniques you go after everyone and their moms love good deals so don’t let yourself charge full price for anything that you can get at a discount! I know you would rather have a luxury car instead of a budget car and drive in style, or maybe you just want to get a budget style car even cheaper than they say it is. The most important thing to learn is don’t be afraid to ask, there are many options out there when dealing with rental car deals!

E-Cigarette – A Safer Substitute to Smoking?

I am not a smoker, so I sat comfortably on a chair resting my arms on the arm rest and try to analyze how chain smokers can ever get out from the dilemma of smoking cigarette. I take a mild drag as I watch people exhale white wafts round their face, wondering how many nicotine they save from years of smoking.

I wonder how celebrities made through like Audrey Hepburn when she smoke, yet she isn’t. Many times I have been wondering what an e-cigarette is and wonder if it really a solution to safer smoking. E-cigarette is not a smoke at all, but they resemble like smoke. This is a perfect solution if you want to quit smoking but cannot.

E-cigarette is battery powered device or I would say an electronic device to help you get free from nicotine yet doesn’t have the stamina to quit smoking. Its physical appearance looks like a real cigarette. The tip of e-cigarette glows red just like when you lit one real cigarette. It even emits smoke or produces puffs but it is not burning and so you can use it anywhere you are even in those places where smoking cigarette is banned.

Smokers definitely enjoy smoking but the nicotine it gives is another story. E-cigarette allows anyone to enjoy the pleasure of smoking less the guilt of bad effect it does to our body. The actual effect of smoking simply puts it to physical act, like when you want to have a cigarette in your hand always.

Regardless of the pleasure it gives, smoking is still and will always be harmful to health, but e-cigarette is free from this side effect and definitely harmless. The world is full of bad elements, for this reason the public in general has covered a propaganda regarding the effect of smoking cigarette to the body, particularly our lungs.

Because of these information, a lot of smokers wanted to quit their bad habit but the question is, how will they do that when addiction have almost gotten into their nerves. E-cigarette is a break through to this kind of problem most cigarette smokers are facing and this breakthrough has begun to increase popularity on e-cigarette.

What makes it appealing to smokers is the fact that it does not contain harmful ingredients than an ordinary cigarette. It does not produce nicotine and most importantly it is free from carcinogens. It is also free from second hand smoke, which means you can use it even in front of your co-workers or even in front of a baby.

In addition, because it does not produce ash, e-cigarette is considered to be environmental friendly. What e-cigarette does is it provides smokers with a taste that is similar to real cigarette and so cigarette smokers still feel the act of smoking real cigarette when in fact they are not smoking cigarette at all. For this reason you can use it anywhere, even in private places like air conditioned room and states were cigarette is prohibited.

Planning and Design of Behavioral Healthcare Facilities

Behavioral Healthcare Facilities: The Current State of Design

In keeping with most districts of healthcare, the marketplace has seen a boom in the construction of Behavioral Healthcare facilities. Contributing to this increase is the paradigm shift in the way society views mental illness. Society is placing a heavier value on the need to treat people with serious addictions such as alcohol, prescription and elicit drugs. A large percentage of people suffering from behavioral disorders are afflicted with both mental and addictive behaviors, and most will re-enter communities and either become contributors or violators.

These very specialized facilities do not typically yield the attention from today’s top healthcare designers and their quantity accounts for a small fraction of healthcare construction. However, Behavioral Healthcare projects are increasing in number and are being designed by some very prominent architectural firms such as Cannon Design and Architecture Plus. Many are creating state-of-the-art, award-winning contemporary facilities that defy what most of us believe Behavioral Healthcare design to be.

Changing the Way We Design Behavioral Healthcare Facilities

As with all good planners and designers, A+D (along with facility experts) are reviewing the direct needs of patient and staff while reflecting on how new medicine and modern design can foster patient healing rates, reduce environmental stress, and increase safety. This is changing the face of treatment and outcome by giving the practitioner more time to treat because they require less time and resources to “manage” disruptive patient populations.

The face of Behavioral Healthcare is quickly changing. No longer are these facilities designed to warehouse patients indefinitely. And society’s expectations have changed. Patients are often treated with the belief that they can return to their community and be a contributor to society. According to the National Association of Psychiatric Health Systems (NAPHS), depending on the severity of illness, the average length of stay in a Behavioral Healthcare facility is only 9.6 days.

What has changed?

Jaques Laurence Black, AIA, president and principal of New York City-based daSILVA Architects, states that there are two primary reasons for the shortened admission period:

1. Introduction of modern psychotropic drugs that greatly speed recovery

2. Pressures from insurance companies to get patients out of expensive modes of care

To meet these challenges, healthcare professionals are finding it very difficult to effectively treat patients within the walls of antiquated, rapidly deteriorating mental facilities. A great percentage of these facilities were built between 1908 and 1928 and were designed for psychiatric needs that were principled in the belief to “store” not to “rehabilitate.”

Also impacting the need for Behavioral Healthcare construction is the reluctance of acute-care facilities to provide mental health level services for psychiatric or addiction patients. They recognize that patient groups suffering from behavioral disorders have unique health needs, all of which need to be handled and treated only by very experienced healthcare professionals. This patient population also requires a heightened level of security. Self-harm and injuring staff and other patients are major concerns.

The Report of the Surgeon General: “Epidemiology of Mental Illness” also reports that within a given year about 20% of Americans suffer from a diagnosable mental disorder and 5.4% suffer from a serious mental illness (SMI ) – defined as bipolar, panic, obsessive-compulsive, personality, and depression disorders and schizophrenia. It is also believed 6% of Americans suffer from addiction disorders, a statistic that is separate from individuals who suffer from both mental and addiction disorders. Within a given year it is believed that over one-quarter of America’s population warrants levels of mental clinical care. Even if these statistics were cut in half, it cannot be denied as a serious societal issue.

With a growing population, effectively designing in accordance with such measures is at the heart of public health.

Understanding the Complexity of Behavioral Healthcare Design

Therefore, like Corrections, leading planners and designers specializing in Behavioral Healthcare are delving deeper to better understand the complexity of issues and to be the activist to design facilities that promote treatment and healing – and a safer community.

The following is a list of key design variables that are being studied and implemented:

1. Right Sizing

2. Humanizing Materials and Color

3. Staff-Focused Amneties and Happiness

4. Security and Safety

5. Therapeutic Design Tenants


Today’s Behavioral Healthcare facilities are often one-story single buildings within a campus size. Often debated by Clients due to costs, this design preference is driven by the demand for Uncategorized light, window views to nature for all patient areas, and outdoor open-air gardens “wrapped” within. All of this provides soothing qualities to the patient, reduces their anxieties, counteracts disruptive conduct and helps to reduce staff stress.

“When you look at the program mix in these buildings, there’s a high demand for perimeter because there are a lot of rooms that need Uncategorized light. Offices, classrooms, dining areas, community rooms, and patient rooms all demand Uncategorized light, so you end up with a tremendous amount of exterior wall, and it forces the building to have a very large footprint.” – James Kent Muirhead, AIA, associate principal at Cannon Design in Baltimore

These design principles are also believed to improve staff work conditions. Unlike a multi-story complex, at any moment staff can walk outdoors and access nature, free from visual barriers, and within a building that more accurately reflects building types that both patients and staff would encounter in their communities.

In addition to right-sizing for the overall building footprint, is right-sizing for internal patient and staff support area. Similar to the move we have seen in Corrections to de-centralize support spaces, Behavioral Healthcare is moving to decentralized nursing/patient units called “neighborhoods.” With mental health facilities there is a large concern with distances and space adjacencies in relation to the patient room and patient support areas such as treatment and social spaces. Frank Pitts, AIA, FACHA, OAA president of Architecture Plus, Troy, NY, advocates neighborhoods that average 24-30 beds arranged in sub-clusters, called “houses”, of 8-10 beds. Thus, each neighborhood consists of three houses. Often these layouts will include a common area where patients congregate and socialize, with a separate quiet room so patients can elect to avoid active, crowded areas. In addition Pitts states, “There’s a move away from central dining facilities. So, while facilities will still have a central kitchen, it’s a whole lot easier moving food than it is patients.” However, it is important for the facility to mimic normal outside daily life routines, so patients are encouraged to frequently leave their neighborhoods to attend treatment sessions, and outdoor courtyards.

Humanizing Materials & Color

In all facilities that play a role in rehabilitation, design strives to create spaces that humanize, calm, and relax. Behavioral Healthcare patients need to feel that they are in familiar surroundings; therefore, the architectural vocabulary should feel comfortable and normal. Since these facilities are about rehabilitation (when possible) and encouraging patients to merge back into society, the facility should feel like an extension of the community. Their spaces should reflect the nature and architecture of the surrounding region and thus so, no two facilities should look too much alike.

“Our a
pproach to designing these facilities is to view the facility as an extension of the community where patients will end up when they’re released. Interior finishes also depend on geography because you want to replicate the environment patients are used to. You want to de-stigmatize the facility as much as possible.” – Tim Rommel, AIA, ACHA, OAA, principal with Cannon Design in Buffalo, NY.

Therefore, materials and colors within these spaces want to feel familiar to one’s region and everyday life. To soothe the psyche and rehabilitate, they want to feel soft and comfortable, yet visually stimulating. An interior that is overly neutral or hard in appearance is not appropriate. Materials should reduce noise, and colors should lift the spirit. This can help to create an environment in which the patient can learn, socialize, and be productive while easing anxieties, delivering dignity, and modifying behavior. As stated previously, behavioral studies advise the use of softer interior materials-like carpeting, wood doors and tile. Doing so translates directly to both patient and staff well-being, particularly staff safety, and makes for a nicer place to work. In addition, staff have more resources to “treat” instead of manage heated situations. When staff experiences are eased and satisfied, morale is boosted and life-saving rules and policies are more likely to be enforced.

Staff-Focused Amenities & Happiness

While reducing staff stress and fatigue through a healing supportive environment seems like an obvious goal, there are relatively few studies that have dealt with this issue in any detail. More attention has been given to patient outcomes. However, many leading hospitals that have adopted therapeutic tenants into their newly built environments have seen vast improvement through their “business matrixes” and financial reporting.

In one example, the Mayo Clinic, a national leader in implementing healing design in its facilities, has reported a reduction of nursing turnover from a national annual average of 20% to an annual 3%-4%. In another example, when Bronson Methodist Hospital incorporated evidence-based design into its new 343-bed hospital, they cited their 19%-20% nurse turnover rate dramatically dropped to 5%.

Now, both the Mayo Clinic and Bronson Methodist Hospital have had to initiate a waiting list for nursing staff seeking positions. This converts to better-trained and qualified staff, and a reduced error rate. Therefore, more health facilities are investing in staff support areas such as lounges, changing rooms, and temporary sleep rooms. Within these staff spaces and in the hospital throughout, facilities are also recognizing the need for upgrade materials, better day lighting, and an interesting use of color: One soon realizes that the need of patients and staff are interwoven, each impacting positively or negatively the other.

Security & Safety

Without debate, self harm and harm to staff is one of the biggest concerns mental health facilities manage. Often the biggest safety and security concern is the damage patients can do to themselves. “There are three rules I had drummed in me,” says Mark Hanchar; Director of Preconstruction Services for Gilbane Building Company, Providence, R.I. “First, there can’t be any way for people to hang themselves. Second, there can be no way for them to create weapons. Third, you must eliminate things that can be thrown.” Hanchar says that the typical facility is, “a hospital with medium-security prison construction.” This means shatter proof glass, solid surface countertops (laminate can be peeled apart), stainless steel toilets and sinks (porcelain can shatter), push pull door latches and furniture that cannot be pulled apart and used as a weapon. These are just to name a few.

Additionally, removing barriers between patients and nursing staff is a safety consideration. Frank Pitts, AIA, FACHA, OAA president of Architecture Plus, says what may be counter-intuitive for safety precautions, “Glass walls around nursing stations just aggravate the patients.” Removing glass or lowering it at nursing stations so patients can feel a more human connection to nurses often calms patients. There is also discussion of removing nursing stations altogether; decentralizing and placing these care needs directly into the clinical neighborhoods and community spaces. Pitt says, “The view is that [nursing staff] need to be out there treating their patients.”

Therapeutic Design Tenants

As medicine is increasingly moving towards “evidence-based” medicine, where clinical choices are informed by research, healthcare design is increasingly guided by research linking the physical environment directly to patient and staff outcomes. Research teams from Texas A&M and Georgia Tech sifted through thousands of scientific articles and identified more than 600 – most from top peer-reviewed journals – to quantify how hospital design can play a direct role in clinical outcomes.

The research teams uncovered a large body of evidence that demonstrates design features such as increased day-lighting, access to nature, reduced noise and increased patient control helped reduce stress, improve sleep, and increase staff effectiveness – all of which promote healing rates and save facilities cost. Therefore, improving physical settings can be a critical tool in making hospitals more safe, more healing, and better places to work.

Today’s therapeutic spaces have been defined to excel in 3 categories:

1. Provide clinical excellence in the treatment of the body

2. Meet the psycho-social needs of patients, families, and staff

3. Produce measurable positive patient outcomes and staff effectiveness

Considering the cost of treating mental illness, which is exceedingly high, and wanting facilities to have effective outcomes, a further practice of incorporating therapeutic design is increasing. The National Institute of Mental Health (NIM H) approximated in 2008 that serious mental illnesses (SMI ), costs the nation $193 billion annually in lost wages. The indirect costs are impossible to estimate.

The estimated direct cost to clinically treat is approximately $70 billion annually and another $12 billion spent towards substance abuse disorders. In addition to the increased need of care and the boom in Behavioral Healthcare construction, it becomes an obligation to make certain that we as facility managers, architects, designers and manufacturers therapeutically plan and design these facilities.

Notably, in 2004, “The Role of the Physical Environment in the Hospital for the 21st Century: A Once-in-a-Lifetime Opportunity,” published by Roger Ulrich P.H.D., of Texas A&M University, was released. In a culmination of evidence-based research, research teams found five design principles that contributed significantly to achieving therapeutic design goals.

The report indicates five key factors that are essential for the psychological well-being of patients, families and staff, including:

1. Access to Nature

2. Provide Positive Distractions

3. Provide Social Support Spaces

4. Give a Sense of Control

5. Reduce or eliminate environmental stress

Access to Nature

Studies indicate that nature might have the most powerful impact to help patient outcomes and staff effectiveness. Nature can be literal or figurative – Uncategorized light, water walls, views to nature, large prints of botanicals and geography, materials that indicate nature and most importantly, stimulating color that evokes nature. Several studies strongly support that access to nature such as day-lighting and appropriate colorations can improve health outcomes such as depression, agitation, sleep, circadian rest-activity rhythms, as well as length of stay in demented patients and persons with seasonal affective disorders (SAD).

These and related studies continue to affirm the powerful impact of Uncategorized elements on patient recovery and stress reduction. Thus, it is clea
r that interior designs which integrate Uncategorized elements can create a more relaxing, therapeutic environment that benefits both patients and staff.

Positive Distractions

These are a small set of environmental features that provide the patient and family a positive diversion from “the difficult” and, in doing so, also negate an institutional feel. These can be views to nature, water walls, artwork, super imposed graphics, sculpture, music – and ideally all of these want to be focused on nature and, when applicable, an interesting use of color. Therapeutic environments that provide such patient-centered features can empower patients and families, but also increase their confidence in the facility and staff. This helps with open lines of communication between patient and caregiver.

Social Support Spaces

These are spaces designed partially for the patient but mainly for the comfort and socialization of family members and friends of the patient; therefore, family lounges, resource libraries, chapels, sleep rooms and consult rooms all play a role. When family and friends play a key role in a patient’s healing, these spaces encourage families to play an active role in the rehabilitation process.

Sense of Control

In times when patients and family feel out of control, it is very healing for the facility design and staff to provide it back when appropriate. Although, this cannot always be done suitably in mental healthcare facilities. However, when applicable, these design features include optional lighting choices, architectural way-finding, resource libraries, enhanced food menus, private patient rooms and

optional areas to reside in. A few well-appointed studies in psychiatric wards and nursing homes have found that optional choices of moveable seating in dining areas enhanced social interaction and improved eating disorders. When patients feel partially in control of their healing program and that the building features are focused to them, an increased confidence of the quality of care enters and tensions lower.

As with all therapeutic design, this allows the caregiver to use their resources healing in lieu of “managing” patient populations.

Reduce or Eliminate Environmental Stress

Noise level measurements show that hospital wards can be excessively noisy places resulting in negative effects on patient outcomes. The continuous background noise produced by medical equipment and staff voices often exceeds the level of a busy restaurant. Peak noise periods (shift changes, equipment alarms, paging systems, telephones, bedrails, trolleys, and certain medical equipment like portable xray machines are comparable to walking next to a busy highway when a motorcycle or large truck passes.

Several studies have focused on infants in NIC Us, finding that higher noise levels, for example, decrease oxygen saturation (increasing need for oxygen support therapy), elevate blood pressure, increase heart and respiration rate, and worsen sleep. Research on adults and children show that noise is a major cause of awakening and sleep loss.

In addition to worsening sleep, there is strong evidence that noise increases stress in adult patients, for example, heightening blood pressure and heart rate. Environmental surfaces in hospitals are usually hard and sound-reflecting, not sound-absorbing causing noise to travel down corridors and into patient rooms. Sounds tend to echo, overlap and linger longer.

Interventions that reduce noise have been found to improve sleep and reduce patient stress. Of these, the environmental or design interventions such as changing to sound-absorbing ceiling tiles, are more successful than organizational interventions like establishing “quiet hours.”

Conclusion and Additional Information

The information contained in this excerpted report is intended as a guide for architects, specifiers, designers, facility planners, medical directors, procurers, psychologists and social workers which have a stake in providing improved facilities for behavioral healthcare patients. It is a portion of a report entitled “The Contributions of Color” authored by Tara Hill, of Little Fish Think Tank. Ms. Hill was commissioned by Norix Group Inc., in 2010 to research the role color plays in the safe operation of correctional facilities and behavioral health centers. More in-depth information specifically about the psychological influence of color and behavioral healthcare facility design can be found by reading the full report.

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