Car Rentals is a Must For Every Traveler

The Gold Coast is an ideal holiday destination for you and your family. It has everything that can make your holiday down under a memorable one. The Gold coast is arguably the best tourist destination in Australia with almost 10 million tourists enjoying its fabulous surf beaches, unparalleled theme parks and dense rainforests every year.

The most visited tourist spot in the Gold Coast is Surfers Paradise. The place offers you with many entertainment options to explore. You can indulge in various exciting activities like surfing, jet skiing, fishing and parasailing during your trip to Surfers Paradise. Apart from these, Surfers paradise is also well known for its active nightlife and unmatched facilities for beach volleyball, golf and bungee jumping.

Along with the surfers paradise, you will find many other tourist attractions. The American Style Theme Parks are few of them. These parks have in stored some of the most exciting options for you and your family. Dreamworld, Movieworld and Wet n’ Wild are the three most famous theme parks in Gold Coast. While planning a trip to these parks, make sure that you have ample time in your hand because these parks are too big and too wonderful to be done with in a single day.

Gold coast is also the home of some of the most incredible architectural masterpieces. The Q1 Building (world’s tallest residential building), Gold Coast Arts Centre, Ripley’s Believe It or Not Museum are the finest examples. You can’t even afford to miss out the attractions like Tropical Fruit Farm, Sea World and Currumbin Wildlife Sanctuary, during your trip to Gold Coast.

Car rentals gold coast is one of the ways to witness and admire the real beauty of all the tourist attractions. By renting a car, you can visit all these places at your own will. There are many car rentals options that are available for you in Gold Coast. You can go for one way car rental plan, which includes picking the car up from one place and dropping it to the other location. Generally, this plan is preferred by people, who hire cars between airport locations. Another one can be two way rental, which is normally taken up by tourists.

During peak seasons, you might also get some bonus or special offers on your car rental plan. In spite of the plan you choose, make sure that you negotiate with the car rental company.

After all, at the end of the day, it is your money!

Finding the Right Travel Nursing Placement Agency

Travel nursing is becoming one of our nation’s fastest growing professions, and it’s no surprise. If you love seeing new places and enjoy exciting new experiences that evoke the feeling of taking an extended vacation, then the career of a traveling nurse might be just what the doctor ordered! Travel nursing enables many people to stay on vacation for two to six months in free luxury accommodations while earning high hourly wages at the same time.

Yet despite all these advantages, many nurses describe to me that they’ve shied away from the traveling profession. Why? Because bad experiences with placement agencies have left them with nothing but a negative impression. They’ve been underpaid or lacked benefits, and I can’t tell you how many nurses have complained to me about inadequate housing or recruiters who were unkind, uncaring, and just plain unavailable. The sad result is that nurses end up jumping from one agency to the next, always in search of the perfect package that’s never there.

In this light, choosing the right staffing agency requires a nurse to consider everything that is offered. Some nurses emphasize pay as their top priority. Others require an excellent benefits package. Many travel RNs are location-specific and want to experience the lifestyle in the country’s hot spots. Career flexibility is often a pivotal factor, along with customer service. The bottom line is, your agency choice depends largely upon one of the four following criteria.


No question about it, there are some agencies that offer more money than others. So the first thing to remember is that agencies may base salaries upon things like location availability, need-to-fill assignments, and cost of living.

Some agencies must offer noticeably higher rates if they expect to fill certain assignments where nurse-to-patient ratios are very low, or where a facility has extreme patient needs. If you’re a nurse who is attracted by very high dollars, be alert for a potentially desperate situation you might be entering, and the workload it could bring. You may make more money, but you’ll earn every dollar and more.

Location also factors into salary. The California bay area and many larger east coast cities definitely offer more lucrative pay rates. It’s also much more expensive to live in those places, so recognize the relationship that exists between salary dollars and cost of living. I’ve seen nurses return from Hawaii saying they had a great vacation and made a lot of friends–but their purses were lighter, not heavier from the experience. You might get less money in an exotic location and come back with more money from a not-so-exotic location. My point is, your criteria will determine your priorities.


What some companies may lack in salary, they make up for with benefits. Many agencies offer benefits programs that revolve around monetary bonuses or discounted luxury housing; and I have even observed a trend with several newer companies that offer entirely free housing to all their nurses. Take note, however, that those agencies may not ante up the really high salaries. It’s a trade-off, so they compensate you with benefits to save you daily, monthly, and annual expenses. Every nurse should be aware of what benefits they need the most, and then ask their recruiters to assist in developing a package that is tailored to their individual needs.


To many traveling nurses, customer service and aid are the most important attributes a placement agency possesses. If you called ten agencies and only talked with one live recruiter, it’s probably best to narrow it down to the agency where individual placement specialists were easily available. After all, if you’re ready to proceed with a new assignment you’ll want an agency that can make it happen fast and has recruiters available who already understand your criteria. In fact, your criteria may change from one assignment to another, so customer service is paramount. Determine what you want and then find out which agencies can make it happen.


While for some nurses, salary, benefits, and career flexibility might be the number-one interest, many others just want the obvious–to travel and see the world. If you’re an adventurer who cares more about the travel experience than the money, then you’ll need an agency that can offer you the locations you want.

Not every agency can send you just anywhere. Figure out where you want to go, and then call around to discover who can send you there.

A travel nursing career is absolutely one of the best, most rewarding choices any nurse can make, but it’s important to select a company who will partner with you every step of the way. Before you jump in, do your homework and research all the best placement agencies. Finding the agency that fits your unique wants and needs will drastically increase your chances of success and happiness in your career.

Managing a Family With a Travel Nursing Career

A career as a travel nurse can be an exciting and rewarding opportunity to see the country. Travel nurses have the opportunity to see many places and people while earning a substantial income. Most travel nurse placements run for about 13 weeks which means relocating quite frequently. Fortunately, travel nurse agencies take into account that many nurses have families so they make arrangements to accommodate a nurse with a family.

A travel nursing career will give you more control over your work and life. Most travel nurse companies allow nurses to choose their assignments based on their personal needs. They tend to select assignments based on location, pay, benefits, professional opportunities, and accommodating their family. No matter where you choose to go in your travel nursing career, most agencies will provide you with nursing positions customized to your fit your lifestyle requirements. Most agencies will allow nurses to choose locations that are not too far from their home. The agencies will also assist nurses with finding accommodations with additional rooms for family members. Some may charge a small fee for the additional rooms. An agency may also help workers find a location in their local area with flexible shifts that will allow them to spend quality time with their family.

Some families will choose to accept a housing stipend instead of housing facilities and travel in a RV. They can then maintain a comfortable lifestyle with all of the necessities and supplies contained in the vehicle. Some families choose to home school their children. Most communities have a wealth of resources to assist in your home schooling needs. This often includes activities that will encourage active socialization activities for children. Married couples who are both travel nurses have the flexibility to arrange their work schedules so that someone is always at home with their children while the other one is on their travel nurse assignment. They will often alternate work placements. This will allow a couple to maintain a family unit as well as have work breaks. If home schooling is not an option, there are some work assignments that can last up to nine months so a child can attend a full school year. Others may choose to accept work assignments that are a few hours drive from their permanent home. With a little time management scheduling, one can earn a great living while raising a family.

Having children does not mean you cannot enjoy a successful career as a travel nurse. There are many advantages that can benefit you as well as your children. Many recruiting agencies will provide you with free housing. Another benefit of bringing your children on assignment is that they have the chance to see other parts of the country and people while you earn a great salary with great benefits. Most travel nursing pay scales are anywhere from ten to fifteen percent higher than the pay of a regular staff nurse. It is much like a working vacation.

The nursing shortage has health care facilities across the country seeking skilled professionals. Travel nurses are in great demand and travel nursing agencies are eager to recruit qualified workers to ease the workload. Finding the best and safest housing for you and your family is not a problem for most agencies. They will accommodate your extra needs, whether you require an extra room for the children or even extra needs for a pet. . As well, you will receive great compensation, great health care coverage, and other appealing incentives. If you are a travel nurse or are interested in a travel nurse career, it is a great time to acquire a position in a fast growing and popular health field.

Is an electronic cigarette the best way to quit smoking?

For more than fifty years now, physicians have tried to raise people’s awareness regarding tobacco related illness and death, but even with all the anti-smoking ads and the increased excises, a lot of people continue their nicotine addiction. Trying to quit is not an easy process and there have been many ways suggested and praised, from nicotine patches to the newest electronic cigarette. However, giving up smoking is just about strength of character and will, as it is about finding the right method for you. Determination is certainly a factor here, but one should also keep in mind that every body is different and what worked just fine for your friend or relative, may not work for you. The recent invention of the electronic cigarette, however, seems to be enjoying a lot of popularity, although lately, the e-cigarette industry was hit by an FDA report, calling them dangerous.

Taking first things first, supporters of the elektronisk cigaret are claiming that it is the best tool in one’s efforts of giving up smoking. It has the feel and look of the real thing, but without any of the harmful substances. The e cigaret does contain nicotine, but none of the other chemicals, such as tar or carcinogens. So basically, it has three main components: the cartridge, which is the part you put in your mouth, an atomizer, being the heating element, through which the liquid is being vaporized and a battery, which works as a power supply. The elektronisk cigaret also makes use of a flavouring component, which, believe it or not, was one of the aspects for which it has been criticized. The FDA report stated that young people, who are not yet smokers, can be attracted by the different flavours of the e cigaret and thus tempted to try the real thing.

However, the electronic cigarettes industry has a lot to bet on, considering the benefits that opting for an e cigaret brings. Apart from the fact that it has none of the dangerous and extremely harmful substances of real tobacco, such as carcinogens or cancer causing agents, tar and second-hand smoke, the innovative product also eliminates other disturbing elements like smell, the bad breath or the discolouration of teeth. Furthermore, they had such a good start-off and were so well received by people, as a healthy alternative to smoking, that a couple of airlines even allowed their use during flights.

Health campaigners on the other side have argued that going from a tobacco cigarette to an elektronisk cigaret is not a solution. The only solution is giving up smoking in all of its forms, otherwise, sooner or later, people will go back to tobacco or just alternate between the two. Others stated their concerns with propylene glycol, which is a main ingredient in an electronic cigarette as it helps create the illusion of smoke, and how it had not been tested thorough enough.

All things considered, one can try many ways to quit smoking, such as a nicotine patch or gum or even the application of medication, but if the invention of such a device as an electronic cigarette was needed and it works, then it may as well be regarded as a very good, if not best, method.

Travel Nursing Benefits

Travel nursing gives you the right opportunity to satisfy your medical aspirations. With travel nursing jobs, you can choose the most stressful and fulfilling process of serving people, located in various states of the United States. All you have to identify a good placement agency where your dreams can be turned into a reality.

There are many traveling agencies who recruit travel nurses to place them in different hospitals and medical facilities in order to fulfill the shortages of medical personnel in different parts of the US. However, the compensation package, accommodation and utilities of each placement agency vary from each other. Being a new phenomenon in the healthcare sector, travel nursing is seen as the bright future for women going for full time nursing career. Normally, traveling nursing jobs are set up for a short term basis but it can be extended after the mutual agreement from both the employer and nurses part.

This can be chosen for many reasons. One of the main reason is this job can fulfill your traveling desires. You gotta see different geographies and feel their difference and exclusive beauty. Secondly, you can experience the working of nurses in different cities or states of the United States. Besides these, you will be awarded with a good and well furnished home, attractive salary package, other allowances and benefits to enjoy a great and high standard of living. Above more, it is the duty of travel agency to help nurses to get their passports, work licenses and other documents in order to work comfortably.

These jobs also offer other advantages including above market payment rates to live and work in a new place or area. It also includes provision of certain utility services, health, dental and workers compensation as well as payroll benefits. Many times a traveling nurse agency also offers 401K and other retirement plans. A travel nurse is paid by the agency it contracts with and the mode of payments is generally by direct bank deposit checks.

So if you are a nurse, trying to make a good career, opting for travel nursing can give you some of the added advantage.

Vacation Rentals and Holiday Home Rentals – "Tips For Renting"

So you’re planning the holidays, you fancy something in the sun, but where to go? Who is coming? How many?
Will we rent a luxury condo or house instead of staying in a hotel? Well you can make big savings by taking a Villa. Plus, you’ll have more space and privacy to relax and enjoy your home away from home. Renting a vacation home is an especially smart choice if you’re traveling with a group of friend or with kids.

Here are some tips to help you get the biggest bang for your buck.

1. Once you choose a destination.
If you’re looking for sensational savings your best bet is to choose a destination where there are a lot of holiday rentals on the market, keeping prices competitive. You can find some of the best bargains on vacation home rentals online if you know what to ask about and how to protect yourself as a renter. Don’t be shy contact the owner and ask for a deal.

2. Comparison sites- way to go!
Now it’s easier than ever to comparison shop when you’re looking to save on a vacation home rental. You can find some of the best rental home listings the net has to offer on sites like holiday121 and other consolidator sites like these. These are referral sites not booking site and you can check out many homes at the same time to get the best prices and most suitable dates and keep a record of sites visited.

3. Don’t send money.
When renting a vacation home, never send anyone money it’s a bad idea. Pay by credit card or PayPal where you have some come back.
Ask for references, and check out their Web site and their track record. Read their reviews! Read the fine print. Is there a cancellation policy? What if you have to leave early? Does it stipulate when you will get your breakage deposit back? Spend the time up front checking things out so you won’t have any hassles later.

4. Know exactly what’s included.
When you book a rental home for your holidays it’s a short term rental and everything should be included, if there are extras like pool heat, these will be stipulated on the invoice.
Most rental homes will say “everything’s included,” but you want to double-check to be sure that there are no hidden surcharges there should not be any.
If utilities, Internet and cable are included, does this mean the property has Wi-Fi and high-speed Internet? Is it basic cable or premium? If electricity is paid is there a cap? Many properties will say they include utilities, electricity and gas and then the fine print says it’s included, up to the first $200.
Recommendation; don’t touch a short term rental that is not all inclusive.

5. Who is the local management company?
Ask who has the local management of the property these are a very important part of the service and backup. Your rental contract should include who to call if your dishwasher breaks or there’s some other problem with the property. It should also state a time frame for fixing any major problems. You don’t want to rent a home and have the hot water heater conk out and end up with cold showers for two week. The information should also be posted in a contact book inside the property. Make sure you have a phone number and email address of the contact and if possible get a second person as a backup.

6. Is the home family friendly?
If you’re traveling with kids, make sure the property you rental is family friendly. Check the bed configurations. If you have three kids and the guest room only has a king-sized bed you could be in trouble. Does the pool have an alarm? (Toddler safety)
Also make sure you see lots pictures of the home. Do you really want to rent a place with a white couch and fancy d├ęcor if your 3-year-old still thinks it is fun to color on everything in sight? Make sure the home you’re renting fits your family’s needs so you’re all comfortable. What about the location? Where is the house what are the local amenities? Is it close to the attractions?

7. Can you bring a pet?
Some vacation rentals accept pets, but they may have a size limit. Some folks would not like to rent a property for their family that had the possibility of a pet staying in with previous guests in the home, unhygienic, so if that may be a problem eliminate pet friendly from your search.

8. Is a refund available if you leave early?
If you think you may want or need to leave early, check your contract to see if you’re eligible for a partial refund. Most vacation rentals are for a specific time period and don’t offer refunds because that leaves the homeowner in a lurch with no time to rent to someone else. Know going in what the rules are so there are no unpleasant surprises.

9. Pick a house that most suits your needs.
Keep in mind when you’re renting a vacation home you’re renting a property that’s individually owned. This isn’t a hotel where if you don’t like what you have you can get something else. Once you book and pay your deposit for a specific property, that’s the property you’re getting, so make sure it’s exactly what you want. Ask if reviews from other renters are available; also remember you get what you pay for so contact the owner. While scoring a good deal is the goal, if it’s too cheap there’s probably a reason check it out. Sometimes the cheapest price is not the best value.

10. Book early.
Avoid disappointment; there are certain times of the year when the villa rentals are on fire, so book early. Also you might look at the availability on the owners web site and pick a slightly out of season time, which brings me back to point one, don’t be shy contact the owner and ask for a deal. A last point to help is a lot of vacation rental owners have links to car rental and cheap flights sites or attraction ticket sites. Try and do a package deal for all three or four services. Good luck!!

Go on a Shopping Expedition With Gold Coast Car Rentals

It would be practically impossible to think of a holiday, without indulging in a little retail therapy, and if you have to come a shopper’s paradise like Gold Coast, there is no way you can leave without at least a few bags. With cars for rental, Gold Coast becomes easy enough to traverse.

Now, when you come to the Gold Coast, you really need to think about and plan your shopping trips, because there is simply too much for you to choose from. Perhaps, the first thing you should do when you get into town is get yourself Gold Coast car rentals. This way, not only will you be able to get to all the places you want to visit, but also get your purchases back to your hotel.

As mentioned before, the choices on the Gold Coast are extensive and these range from high-end shopping to local markets. It is up to you where you want to shop and what you want to shop for. The local markets include those held at Surfers Paradise, Burleigh Heads, Broadbeach and Coolangatta. Other popular markets include Tamborine Mountain, Robina Town Centre, Canungra Country Market, Paradise Point Art and Craft Market.

With cars for hire, Gold Coast shopping can be much more fun, because you can shuttle from branded shopping to street side, with ease. Perhaps one of the first places you should head to is the Pacific Fair Shopping Centre, which is home to some of the best retailers in the country. You can find almost anything and everything you need, under this roof and at reasonable rates as well. If at any point of time, you feel hungry or thirsty, there are several restaurants, bars and cafes.

The Oasis Shopping Centre is another place, worth visiting, because here you will find over 100 stores, which deal in specialty products. You will be able to find gifts to take back home, latest trends and fashion, including clothes and accessories as well as a supermarket. The best thing about this place is that you will also find a range of services, such as a bank, a post office and salon.

If you want a slightly more stylish shopping experience, then Harbour Town is the place for you. This is where you will find all the big brands, including, end of season lines of renowned designers. The shopping center also boasts of the country’s premier purpose built outlet shopping experience.

Power Inverter Uses and Variations – Auto, Car, Boat, Laptops

Power Inverters, also known as power supply units or power converters, are a great way to power electronic devices when there is not a ready electrical outlet present but there is DC power available. When it comes to choosing a power inverter, there are a number of available options out on the market, each with a variety of different features. The basic concept of a power inverter is that it can convert a car’s 12 volt direct current power into the same type of alternating current power available from a wall socket, enabling electronics to charge while traveling. They work in cars, boats, or anywhere else equipped with a cigarette lighter adapter (DC Adapter).

Why run the risks of losing power to your essential electronics, when you can always have a backup power source ready for use almost anywhere an electrical current is generated? Power inverters work especially well for charging laptops, DVD players, digital cameras, radar detectors, cell phones, PDA’s, printers, digital cameras, external hard drives, personal media players, flash drives, scanners, iPods, MP3 players, video games, and much more.

On the market you can find an ever-increasing number of different power inverters. They all perform the basic function of charging your electronic devices, but each has its own particular features that may suit one person’s needs better than another’s. There are power inverters that can provide power for one, two, three, or four plugs simultaneously. There are also power inverters that contain USB ports that can charge USB-enabled devices; this can add to the functionality of your power inverter if you carry around devices like the popular iPhone.

Power inverters also differ in the amount of power they supply. Some emit more wattage to charge larger items, while others emit smaller amounts of wattage for electronics with smaller energy demands. This is an important feature to keep in mind, which can help prevent battery drainage and preserve your car battery’s life. When buying a new power inverter it’s best to look if it has an automatic kill switch or switching regulator (available in switched-mode power supplies) so that your car’s battery never reaches a critical point. It can be quite frustrating to see your car battery die, but your laptop fully charged.

A nice feature to look for is a long, extendable cord to reach far away electronics. You may also want a swivel head if your cigarette lighter adapter is placed in a difficult-to-access location. This will help adjust the positioning and make sure it will not slip out of place for maximum convenience. Some power inverters also come with replaceable fuses–one of the most likely parts to fail–and the ability to replace the fuse is more convenient and efficient than having to replace the whole inverter.

Remember, when choosing a new DC-to-AC inverter examine the features, the power output level, number of available receptacles, and pricing to ensure that you purchase the right inverter for your needs. Every year new and more efficient inverters hit the market, so happy hunting and read the reviews before purchasing and you’ll be sure to find just the right inverter you need.

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.

The Commercial Real Estate Outlook for Agents and Realtors in 2012

The commercial property year has well and truly started, and in most locations formed some common trends and patterns. If you are a commercial agent it pays for you to read the patterns in the marketplace and use them for the opportunity they provide. Property change and churn factors are active in most markets. They are an opportunity in waiting.

These are some of the common trends that most agents are seeing:

  1. Sellers are now adjusting their prices to suit the real property market and the existing levels of enquiry
  2. Buyers are fewer and taking longer to make a decision. Some buyers are looking for bargains.
  3. Finance is still tougher to get and the banks remain selective and diligent in the provision of a mortgage to buyers.
  4. Tenants are out looking for better premises at more favourable rents
  5. Developers are not doing much unless they can see a significant demand for a certain property type
  6. Developers are finding in many cases that the set up and construction costs for the new developments is out of balance with the achievable sale prices

Taking these things on-board, it is the agent that works both the leasing and the selling market that catches more opportunity. You have to be versatile.

As this article is being written it is the start of the second quarter of the 2012 calendar year; it is commonly the time where more listings and deals occur leading up to the change of financial year.

Right now is the right time to push your marketing and networking to the fullest. Sellers and Landlords that need help with property this year are typically planning that process right now.

So the best ways forward if you are an agent is to build a solid prospecting and cold calling model that is relentless in its process and drive. You have 8 months of the year to make the commissions that you need. Now is the time to get moving on this as it takes about 3 months of real effort before the conversions and listings start to appear.

Should you list everything that comes your way? Probably not, given that the market and buyers or tenants are so selective currently. It is better to choose the properties to list that are realistically priced or rented. You only have a certain amount of time to apply to your listed properties, and on that basis they should be the properties that offer the most realistic chance of selling or renting.

On one final note, it is appropriate to look at your listing strategy and decide if you should be taking open listings or just exclusive listings. In the case of exclusive listings, you have control of the property for a definite period of time and you can do more in marketing. In simple terms and in most cases exclusive listings sell faster and at a better price than openly listed properties. Make the right choices here.