Comparison Car Rental Websites

The World Wide Web, or internet, is by far the most revolutionary invention mankind has come up with. There is an unlimited amount of information available to us with just a few key strokes. Car hire is included in this. We can now compare rates from the major car hire companies instantly. The good thing about this is that the companies are aware that clients can check. This keeps them more competitive and we reap the benefits with cheaper car hire.

With the internet however it does reduce our power to bargain with the companies as they already have the cheaper rates on the website. So the bargaining is already done and it doesn’t matter if you have a provider you prefer. You can still use the internet to get the best price from that branch, if it is more convenient. Whatever the reason, this extra information is good for us.

You can now find the best deals on car hire where ever you are in the world by using a comparison site. No need to spend your valuable time looking for local car operators numbers and spending hours on the phone talking sometimes to someone who may not speak your language. A comparison site will use software that taps into the National Companies live systems and will display the available cars and prices for you to choose from. Bottom line is that you will save money and time.

These comparison sites are ever evolving, working to make the process of booking car hire as streamlined as possible. The site will be easy to navigate providing all the information you need to complete the booking as well as offer you the ability to select any optional extras that may be required during your car rental. These may include Satellite Navigation (GPS), baby seats, additional driver and excess reduction, reducing your liability in the event of any accident. All the information is available at your fingertips, so be sure to read the Terms and Conditions applicable to the car you are planning to hire.

The global economic climate has not stopped travelers from taking their scheduled holidays. Some travelers are shortening the holiday, but overall with the airlines competing with cheap airfares people are still moving around and enjoying travel. You may find car hire rates a little cheaper due to competition and by far the best place to shop is on line for the best deals. Book early for car hire. Don’t expect to show up at a popular airport and get a bargain. You’re there, you need a car, they have the car and you will need to have the money and drivers license. So it will not be cheap. Book well before leaving home and have your confirmation with you on arrival. Remember if you are traveling during peak seasons, you will pay more for car hire, and everything else for that matter. See you somewhere in the great outdoors. Save travels everyone!

Fixing Solutions for Automotive Industry

Automotive industry demands high strength fasteners and precision components such as nuts, bolts, studs, screws, rivets, tie rods, shims etc. that are applied to various parts and components to hold and connect two or more surfaces or objects together in a structure.

Automotive industry uses fixing components coming in a huge variety of materials ranging from common steel to aluminum, brass, copper, titanium and plastic to other exotic materials. Choosing the material to manufacture these fixing components is essential due to difference between each material’s strength, corrosion resistance, brittleness, galvanic corrosion properties, and of course cost. Materials are basically selected on considerations of environment, corrosive or thermal extremes, magnetic properties, weight, re usability, stresses, and expected life time.

Depending on these specifications materials are classified into grades & quality standards to produce specific quality alloy mixtures that are then used to produce the fixing components. In addition to this, materials are further processed through a variety of coating, plating and hardening processes to form different specified grades of the alloy mixtures.

The various stages to enhance the metal corrosion resistance and appearance increase the cost of production that leads to expensive parts and fixing components. To keep costs within control, it is always advisable to use standardized materials. As specifying the material with specific chemical analysis adds time & cost to the whole process of manufacturing of fixing components. In a common practice, using standard materials only needs heat treating, cold working and coating to manufacture ready to use fixing components.

Quality is the primary concern for every manufacturing process and hence in order to manufacture high quality fixing tools and apply best industry practices that ensure timely deliverables, companies apply quality control methods such as computerized statistical process control archival documentation and various other approaches.

Inspection process involves utilizing tri-roll gages, hardness testers and optical comparators to ensure optimum performance. Automated sorting technologies are applied for assurance of contaminant free product for use in automated feeding equipment. Other than this, third party inspection, verification and certifications testify quality process on the go.

Used in a variety of application areas, replacing fasteners is quite tedious. It is generally best to match them while replacing. Replacing a bolt or screw with a stronger one is always now a good practice as harder bolts tends to be more brittle and may not work for specific applications. In some environments, applying galvanic corrosion methodology may result better.

Age Appropriate and Attractive Ideas For Aging Gracefully

Maturity is a badge of honor to be respected with good taste. There simply comes a time when all the extra bling and fabulousness of fashion, hair and makeup is best toned down. When you were a younger Alluring, Innovative or Dramatic woman, those items of “look at me, I’m au currant” stood for something. Status, hipness, a woman in the moment who’s up on the trend. But wisdom carries with it a confidence and sophistication that allows you to do less and achieve more. A maturing face and figure carries a patina of wisdom. A statement in and of itself, it doesn’t require bright lips, over the top earrings or a crazy hip belt to bring it forward. It stands there, gently making its own beautiful statement. Less is simply more as we age. To accentuate your second act best:

o    Avoid drawing attention to your mouth with bright or dark lips.
o    Avoid drawing attention to aging eyelids with frosted shadow.
o    Avoid drawing attention to aging hands with bright nail polish and/or a multitude of attention-grabbing rings.
o    Draw the eye to your face with neckline interest and earrings.
o    When in doubt leave it out.

The Importance of Being Current 

Keeping current is undoubtedly a constant and not inexpensive challenge. With all the technology with which we are bombarded, however, we still have the old standby; the monthly magazine. Magazine subscriptions are one of the most effective ways of getting information you can absorb on your downtime. The whole experience of sitting down with and perusing a magazine that inspires is a ritual that endures. Magazines are the great equalizer. No matter where you live in the country you have the same access to fashion, fitness and beauty that the most upscale, in-the-know New York socialite has, because she gets her “W” magazine the same time you do. When “O” comes out, you’re right there with all of Oprah’s associates on the hottest, latest and most suitable fashion, food, fun and inspiration you need that month. You just go to your mailbox, Oprah is waiting for you, and it’s your turn to dream. 

What Were We Thinking?

We’ve all done it. Looked back at those embarrassing fashion photos and wondered, “What was I thinking?” I look back at my pinstriped jeans, permed hair and parachute pants and think “Hmmmm.” The more extreme trend, the more risk of later embarrassment. We may forgive the young. But it’s not so easy to forgive a second actor in a leather mini.

A woman in Act Two need never wear:

1.     A micro mini
2.     Combat boots with formal wear
3.     White hose
4.     Frosted eye shadow
5.     Chunky platforms
6.     Dark brown lipstick
7.     Butterfly barrettes
8.     Extreme low-rise jeans
9.     Visible underwear
10.   A spiral perm

What’s Age Appropriate Now?

In our Second Act it becomes difficult to find the balance between matronly and modern. Looking current and youthful should not translate into “mutton dressed as lamb.” I met a woman recently whose long, blonde, permed hair was pulled up on one side and suspended with a comb. For height she created gravity defying bangs with a curling iron and “Spritz Forte.” She wore a fitted navy knit tank, tight tapered pale denim jeans and a crocheted sparkly baby blue shawl tied around her hips. She was 48. 

I liked her and enjoyed hearing her tales of woe in raising teenagers. But as I listened I was continually distracted by her image. It just wasn’t working in her favor. The reason it didn’t work was because it was expressing only a part of this woman. I obviously knew who she had been, but as she talked, the more interesting experienced and attractive parts were hidden behind a façade of fear of aging. Yes, she was attractive and sexy but she was also a 48-year-old single mother of teenagers who had quite a bit of sun damage, an advancing derriere, tan lines across her back and thinning hair. The look did not make her look younger; it made her look vulnerable and insecure. Our image must reflect who we’ve become, not who we were. That is age appropriate. 

Medical Equipment Marketplace

The medical equipment marketplace is replete with broad selections of equipment and supplies for medical, dental, and beauty salon equipment. There are several websites devoted to supplying such items. Trade networks exist within social commerce climates that constantly move products in this category every hour of every day. It is a highly competitive market and the information provided regarding the products is sometimes reliable and in other situations it is unreliable.

Within this market it is important to know certain facts. In order to learn these facts, you might have to critically shop around and ask many questions. When you do this, you will find contradictory information as well as useful information. You will see that some businesses selling these products are reliable and others are not. Ultimately it is confusing. One of the best companies that I have seen is Crystal Medical http://www.crystalmedical.co.uk.

Crystal Medical has a special niche in the medical equipment marketplace. They offer an exceptional variety of products in many categories including dental, medical, surgical, opthamalic, nursing, homecare, veterinary, pharmaceutical, and software categories. All of the products they offer are of high quality. Their dental equipment line is comprehensive and takes quality seriously.

Perhaps one of their best features is the flexible payment plans. With Crystal Medical, you may purchase medical equipment, dental equipment, and beauty salon equipment outright or you may rent the products on agreement for nominal fees. They have their payment plans set up in such a way that the equipment you purchase can pay for itself with added profit. Often these upgrades in equipment yield better business profits, easily offsetting the cost of the equipment itself.

Uncategorizedly, there are other organizations that offer similar equipment. You should research those as well. I believe you will discover that Crystal Medical offers the best products and the most practical payment plans. Considering the fact that they offer a 5 year warranty on all of the products they sell, it is a deal worth considering. Advance the technology of your healthcare practice with a reliable company and you will be assured better quality and cost.

Ways To Stop Smoking Permanently by sigarette elettroniche

A lot of smokers want to stop and you might be looking for information on how to stop smoking having made previous unsuccessful attempts sigaretta elettronica.

It is not uncommon to be in this position as stopping smoking cigarettes electroniques is not easy and you need to really make a very firm decision to do so. It may help to write down why you to want to quit to remind you when the going gets tough.

The difficulty with stopping smoking cigarette electronique is there are both physical and mental addictions to beat and beating the physical addition is the easy part (relatively).

People smoke because:

• It is a pleasurable experience and relaxes the smoker.

• Smokers have developed an unconscious link between certain activities and environments and smoking elektronisk cigaret.

• They have an addiction to nicotine.

As an alternative to quitting smoking you might think about using electronic cigarettes(elektroniske cigaretter). People have used these to stop smoking although they are not marketed for this purpose but they do make smoking cheaper, cleaner and harmless to others. You can also choose how much, if any, nicotine they supply.

Some of the possible approaches to stopping smoking are:

Cold Turkey

This is the simplest and cheapest method but not the most successful. You pick a date and from that point you no longer smoke. The initial period is very difficult so you need to be very strong minded to be successful. The success rate is estimated to be between 5% and 10%.

Alternative Sources Of Nicotine

Products such as nicotine patches or gum are used to replace that previously received from cigarettes. They deliver a controlled dose into the body to relieve some of the withdrawal symptoms. There is a lot of variation in the claimed success rates but for nicotine replacement used on its own they vary from 7% to 35%.

Stop Smoking Medication

Medications (such as Zyban) help relieve withdrawal symptoms without the use of nicotine but are intended for short-term use only. There are also homeopathic remedies (such as Smoke Deter) which do the same thing.

Various Therapies

You can learn how to modify your behavior to break habits that lead to smoking and how to stay motivated to quit smoking. In fact it is very difficult to stop smoking without help and support and any sort of counseling or organized program will help considerably.

Quit Smoking Hypnosis

When considering how to stop smoking, hypnosis should be taken seriously as it has success rates of up to 50%. Quit smoking hypnosis is based on reprogramming the subconscious mind to stop associating smoking with pleasure and relaxation and to substitute some other behavior. It can also be used to remove conditioned responses so the smoker loses the urge to smoke when in the environments that used to trigger it.

Hypnosis will not work for everyone, but it is well worth trying.

Best Option

Trying to stop smoking on your own is very difficult and likely to fail. Support of some sort will increase your chance of success considerably and it may be that taking something to help with the nicotine withdrawal, combined with hypnosis or behavioral therapy to address the psychological addiction, is likely to give you the best chance to stop smoking for good.

Car Rental Coupons

Rental cars have become quite popular during the current economic slowdown. People who plan to buy a used car or even a brand new car is getting attracted to different car rental agencies because of the tough competition, cheap prices and unbelievable options car rental companies offer. Several car rental agencies offer car rentals coupons throughout the year for various reasons. Some of the agencies want to promote their business during off season while some other agencies offer car rentals coupons so that their service will be cheaper than that of their competitor who offers similar services.

Once you finalize a rental company suiting well to your needs, you can check on their official website for ongoing discounts and rental coupons. These coupons come with different offers. Some of the coupons offer a discount on rate from 10-50% while some others add 1-5 extra days to your booking period without extra cost. It is up to you to choose the right type of discount. If you plan to rent for long term, a discount on the rental price will be the right choice for you. If you plan a trip for 7 days and find a coupon offering ‘book for 5 days and get 3 extra days free’ will be the right choice for you.

There are several websites that compare different car rental services and their rates. These websites also highlight the ongoing discounts and coupons available. Such comparison websites are a good choice to know what is going on in the neighborhood but always watch out for scam. Try to rent your car from a reputed car rental agency but also check for any hidden costs. Then check for car rental coupons offered by such reputed agencies.

Some coupons also provide free insurance coverage for a selected number of days and some additional accessories like GPS or child seat for free of cost. Such promotional offers may or may not be useful for you. For example, if you are planning to travel somewhere you are not very familiar, a coupon offering free GPS navigation system can be a great choice for you because you hardly will ‘get lost’ somewhere. Similarly a free child seat is good for you only if you are travelling with a child. Car rental companies design their coupons targeting different customers and their various tastes.

If you are planning to rent a car for your vacation trip or for your everyday requirements, check with different agencies for their specialized coupons. Don’t assume that you will not get a discount coupon because its holiday season. There are several service providers and several offers throughout the year and you will not find the best for yourself without constantly checking for them. Websites such as carrentalmomma.com and rentalcarscode.com have coupons throughout the year with a wide array of offers. Even Google is a great place to find information on best deals available.

Effective Bird Control For Healthcare Centers & Hospitals

It’s no secret that people who are already sick are more vulnerable to contracting diseases.And one potentially unhealthful source of disease is bird waste. As a hospital administrator, you are no doubt aware of the problems pest birds can cause. Many species of birds, including pigeons, starlings and sparrows, often gather to roost on a hospital’s roof, under parking structures, in receiving bays and loading docks, and around exterior employee lunch and snack areas. Without bird control, you soon have a noisy, smelly and potentially dangerous problem on your hands.

Keep in mind that a single pigeon can excrete up to 25 pounds of droppings per year. The bacteria, fungal agents and ectoparasites in bird droppings and nesting materials have been known to carry any of 60 diseases–including histoplasmosis, encephalitis, salmonella, meningitis, and toxoplasmosis, even the West Nile virus.

No less harmful is bird fecal dust carried into hospitals through rooftop heating, ventilation and air-conditioning ducts. Birds often build nests around air handling equipment, ducts, compressors and other vented pathways. Dried by wind and sun, this disease-infested dust gets sucked into HVAC systems. The fine particles can quickly spread diseases throughout a hospital or medical center.

Hospital administrators should also be aware of the negative visual impact bird droppings, nests and other debris can have on a hospital’s image. Finally, bird droppings can cause dangerous slip-and-fall hazards–a huge legal liability for any institution.

Today’s Bird Control Measures

Hospitals and healthcare centers are somewhat restricted in their use of pest bird control measures. They certainly can’t use firearms, noise cannons or fireworks. And poisons present too much of a liability. Besides, federal, state and local wildlife protection ordinances forbid the use of lethal or harmful bird control measures. Fortunately, there are several highly effective bird proofing solutions currently available that are safe, sane and humane.

Bird Spikes

The good thing about Bird Spikes is that they prevent many species of large birds from landing in the first place. Suddenly, rooftops, ledges, signs, light fixtures and other elevated areas are off-limits to birds. Bird Spikes come in rows of spiked strips. And you can get them in either rigid U.V.-resistant unbreakable polycarbonate or high strength, durable stainless steel. The stainless steel spikes come in 3-, 5- and 8-inch widths; the plastic spikes (which cost slightly less) come in 3-, 5- and 7-inch widths. Plastic spikes are ideal for use near antenna arrays since they won’t interfere with radiated RF energy. You can get bird spikes in a non-reflective metal finish or a variety of colors–like white, tan, gray, black, brown, brick red and crystal clear. There’s also a no-gap spike that’s easy to affix to curved surfaces.

If your hospital or healthcare center is being invaded by large birds like gulls, try the Mega Spike. Its 7-inch spikes made of marine grade stainless steel will make sure these birds get the point and leave. There’s also the Gutter Spike, ideal for keeping large pest birds out of gutters or drains. Look for gutter spikes that have adjustable clamps at the base; these allow the spikes to be easily attached to the lip of a gutter.

Lastly, Birds Spikes look dangerous, but they are harmless to birds or people. They have even been approved by a number of humane groups worldwide–including the U.S. Humane Society and PICAS (Pigeon Control Advisory Service).

Sonic Bird Deterrents

Ideal for use in certain areas of a hospital or healthcare center, Typically, Sonic Bird Deterrents emit predator and distress calls that frighten pest birds but are basically just Uncategorized sounds that are not unpleasant to humans. Some highly versatile sonic systems emit distress and predator calls for as many as 22 types of birds. The sounds are cycled every few minutes to convince pest birds that they best leave or risk being attacked. Sonic Bird Deterrents are an ideal bird control solution for deterring pigeons, crows, starlings, swallows, gulls, woodpeckers, sparrows, grackles, cormorants and many other birds.

Bird Netting

To keep pest birds out of certain specific areas–like eaves, overhangs, patios, and parking structure recesses–there’s Bird Netting. This barrier bird control measure is available in various cuts and mesh sizes. For large birds like pigeons or seagulls, use a 1-1/8-inch to 2-inch mesh size. Sparrows or starlings, on the other hand are best excluded using a 3/4-inch mesh net. The best bird repellent netting will meet ISO 1806 protocols, is U.V. stabilized, flame resistant and rot- and water-proof. In areas where electrical conductivity or radio frequency interference is a problem, non-conductive netting is often used. Also note that netting now comes in various colors– including white, stone and black–to match a structure’s color scheme.

Electric-Tracks
A great spot deterrent for ledges, rooflines, eaves, signs and most flat or curved surfaces, Electric Tracks impart a mild electrical shock when birds land on their surface. This is an ideal bird control device for use against a wide variety of pest birds–including pigeons, sparrows, gulls, starlings and crows. The best electric tracks feature a low-profile design that makes them almost invisible. The strips of electrified track are usually powered by an AC charger or solar charger. One manufacturer uses copper knitted wire mesh in a continuous tube-in-tube stocking design. This gives the track greater conductivity, strength and reliability. The copper mesh is resists corrosion and will stand up to alkali and acidic environments.
Bird Slope
These angled, slippery PVC panels known simply as Bird Slope, won’t allow pest birds enough of a grip to land. After a few unsuccessful attempts, they just slide off like water off a goose. Bird slopes are easily installed, tucking unnoticeably into ledges, eaves, beams and other 90-degree areas pest birds often nest. The best panels are U.V. protected and sun and weather resistant. They deter a wide range of birds, including swallows, starlings, pigeons and seagulls. Some panels have a “snap-on” extender, which allows them to adapt more easily to wider ledges and coverage areas.
Bird Scare Deterrents

These inexpensive bird control devices make pest birds too nervous to nest. There’s Flash tape, an iridescent material that shimmers and crackles in the sunlight and breeze to scare pest birds. And Bird Scare Balloons, which, emblazoned with lifelike reflective predator eyes, bob and weave menacingly in the breeze to make birds really uncomfortable.

What is Involved With a Career in Travel Nursing

Becoming a registered nurse has many advantages as well as the gratitude felt from helping others. Working as a nurse has changed over the years and it is no longer simply finding a job in a hospital or nursing home. The careers in nursing are virtually limitless. Travel nursing is an exciting option; however, there are many things to consider before taking the position.

If you are outgoing and thrive on meeting lots of new people, this is a perfect position for you. With a career in travel nursing you can meet people from all walks of life as well as experience how other countries operate in the medical field.

Another excellent benefit with traveling is the option of choosing your preferred climate. If you currently live in a state with horrible winters and are desperate to find warmth in the winter, you have a choice to choose sunny places to work.

The traveling can feel brutal at times so you have to really enjoy traveling. The assignment lengths vary for each job but overall you will be changing locations that could include other countries, approximately every three months or less. To some the extensive traveling can be exhausting so it is important to enjoy it but take care of you in the process.

While you are on an assignment you must be on time to work. It will be tempting to visit the area where you have been assigned and you do have the opportunity, but it must be done on your on time and not when you should be at work. The location you have been assigned to needs your full focus and time.

Though you may come across a lot of new faces, there will be times when you feel alone. You are in a new place with family and friends still at home. This can be overwhelming for some so be prepared to spend a vast amount of time alone.

Also take into consideration your spouse or children. They should be okay with you being gone for long periods of time. This type of work can be hard on relationships so you should make your family aware of the requirement needed for the position.

The rewards will outweigh the sacrifices for many choosing this career. This position takes extreme concentration and focus as well as the desire to do extensive traveling. The money is amazing but you will have to most definitely give up some of the family time.

If this is a career you think might interest you, go online and search for agencies specializing in travel nursing. There are many agencies that hire for this type of position but make sure the company is a reliable agency before agreeing to a position. The agency is responsible for the travel expenses and should be clarified as to amount prior to accepting a location. This form of work can be extremely exciting and rewarding so if you are just completing your degree or have been at it a while, consider the options available.

Enjoy your Devon holiday in a luxury cottage

The charming county of Devon is the ideal place to spend a vacation, whether it is a weekend getaway for a couple, family or friends. The wealth of diversity offered in Devon is unrivalled in England – there is so much to do here whether you wish to ramble through nature’s creations or indulge in more active sport. The list of attractions in Devon is endless, which is why visitors can never get enough of the place, and return to Devon time after time.

If you are a beach and water sports fanatic, Devon is ideal for you. There are so many beaches to list, but here are a few. Blackpool Sands has a Blue Flag award for cleanliness and provides breathtaking views; Slapton Sands has a great car park and is dog friendly; Bantham Beach is one of the best sandy beaches in Devon and is perfect for sandcastle making.

Devon also has several famous Rivers – River Dart is one of the most popular and is referred to as the ‘most beautiful river in England’. Here you can enjoy fishing and the scenery while going on a boat ride. There are numerous sporting activities for enthusiasts in Devon – the most popular include fishing, horse riding and golf.

If you prefer visiting historic towns and sites, then Devon has so much in store for you. Historic towns include Totnes, Ashburton, Dartmouth, Salcombe, Exeter and Plymouth to name a few. These towns have fascinating old buildings, houses, castles and gardens. Some of the most visited properties in Devon include Dartington Hall, Buckland Abbey, Castle Drogo, RHS Rosemoor Gardens and Saltram House.

There are several types of accommodation available in Devon.

From hotels to cottages, bed and breakfast establishments to apartments, camping to caravans, the options are numerous. A stay in a luxury cottage in Devon is one of the many ways that one can enjoy Devon, and guarantees that your holiday will be perfect.

Self catering luxury cottages in Devon are ideally located either close to the coast or else in the beautiful countryside. Either way, you can enjoy Devon in style. Cottages come with bedrooms and bathrooms which are comfortable and well equipped and come complete with kitchen, living room and dining room furniture. Typical luxury cottages in Devon come with several facilities such as TV/DVD players, washer/dryer, full cooker, fridge, freezer, dishwasher, garden furniture and sun umbrellas.

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

Right-sizing

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.