## 4 Results
### Nurse-Related Health Outcomes  
In addition to patient outcomes, the effects of dynamic circadian lighting design on healthcare staff performance, retention, and well-being are also critically relevant.  
\begin{table}
\begin{tabular}{l l l l l l l l} \hline \hline
**Category** & **Ref.** & **Setting** & **Participants** & **Study Design** & **Intervention** & \
\begin{tabular}{l} **Mediating** \\ **Factor** \\ \end{tabular} & **Level** \\ \hline
\begin{tabular}{l} **Physical** \\ **Activity** \\ **Length of** \\ **Hospitalization** \\ \end{tabular} & [27] & CCU & Patients (n = 748) & Retrospective & Dynamic & CCT & 3 \\  & & & cohort study & lighting system & & & \\  & & & & Field survey & Blue-enriched & CCT & 3 \\  & & & & lighting system & & & \\  & & & & & & & \\  & & & & Patient (n = 748) & Retrospective & Dynamic & CCT & 2 \\  & & & cohort study & lighting system & & & \\  & & & & & Pilot study, & Dynamic & CCT, light & 3 \\  & & room & patients (n = 30) & observations & lighting system & intensity & \\
**Delirium** \\ \end{tabular} & [27] & CCU & Patient (n = 748) & Retrospective & Dynamic & CCT & 3 \\  & & & & & cohort study & lighting system & & \\
**Psychotropic** & [32] & Nursing & Nursing home & Randomized & Dynamic & Light intensity, & 2 \\  & & home & residents (58 & controlled trial & lighting system & timing & \\  & & & women, 19 men) & & & & \\  & & & Patients (n = 183) & Retrospective & Dynamic & CCT & 2 \\  & & care unit & & cohort study & lighting system & & \\  & & & Patient’s & Depressed & Pilot study, & Dynamic & CCT, light & 2 \\  & & room & patients (n = 30) & observations & lighting system & intensity & \\
**Alertness** & [32] & Nursing & Nursing home & Randomized & Dynamic & Light intensity, & 2 \\  & & home & residents (58 & controlled trial & lighting system & timing & \\  & & & women, 19 men) & & & & \\
**Pain** & [60] & Patients’ & Medical & Correlational & Dynamic & Light intensity & 2 \\  & & room & inpa-tients & study or non- & lighting system & & \\  & & & (women = 23; & experimental & & \\  & & & men = 17) & study & & & \\ \hline \hline \end{tabular}
\end{table}
Table 6: Thematic analysis of reviewed papers: patient-related health outcomes.  
Several studies investigated the perceptions and satisfaction of nurses and staff members (Table 7), specifically concerning the physical environment and lighting conditions in the institutional setting.  
It has been suggested that errors caused by fatigue during patient care have significant negative impacts on the healthcare system [69]. Previous research has reported that blue-enriched light can enhance alertness and attention [70]. In one study, however, interventional blue-enriched lighting had little effect on reducing medical error rates in an adult ICU within a university hospital [6].  
Nurses' perception of the healthcare environment has a direct impact on their work experience and patient care as well as the well-being of the staff. Dynamic lighting systems implemented in healthcare settings have the potential to influence how nurses perceive their environment, which in turn can impact their job satisfaction, performance, and overall experience [23; 65]. Nurses in medical-surgical hospital units have found that standard lighting at decentralized stations and at bedsides were the least favorable for job performance, and that more control over that would improve satisfaction [24]. Another study found that institutional care staff considered a dynamic circadian lighting system more satisfactory and more suitable for work compared to the existing lighting system [28]. Although some of these studies should be replicated due to their small sample sizes, taken together, these studies indeed suggest that implementation of dynamic lighting can improve healthcare worker job satisfaction, in turn potentially leading to improved patient care and well-being for both the patients and staff.