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Healing Environments
By Barbara Dellinger
The concept of healing has broadened dramatically in the last century; this
has resulted in striking changes in the design of healthcare environments and
a positive effect on the healing process of individuals. In the past, the design of
healthcare environments was targeted mainly for the benefit of physicians and
nurses; however, the central focus of environmental design today is directed
toward patients and their families. Subsequently, staff have reaped the benefits
of working in these improved surroundings. To ensure the designs remain
effective, those who plan and design healthcare spaces must remain attentive to
any evidence that verifies the effect of healing environments on patients, their
families, and healthcare personnel.
place where life, death, illness, and healing define the moment and
A
the building supports those events or situations.
46 Evidence-Based Design for Healthcare Facilities
Some still argue that just using EBD techniques does not
necessarily make the environment a healing one. Malkin (2008)
emphasizes that research contributes to the concepts that can be used
3 Healing Environments 47
Thermal comfort
Noise control
Privacy
Light
Views of natures
Over the last decade, those working with healing environments have
expanded this list to include:
Access to nature
Positive diversion
Patient and staff safety and elimination of stress remain at the top
of any definition of a healing environment, but a healing environment is
more than a safe building. It is one that embraces patients, visitors, and
staff while supporting them during the time they are in the building.
48 Evidence-Based Design for Healthcare Facilities
Think about everything patients see, from the minute they walk
into the facility until the minute they leave. Create an experience for
them.
52 Evidence-Based Design for Healthcare Facilities
Advanced air filtration systems can keep the air cleaner; however,
many smells reach the patient before they can be removed. Many
hospitals are instituting green cleaning methods, meaning they no
longer use products that contain toxins or can be harmful. Wax, heavy-
duty cleaners, disinfectants, and other chemicals often give people
headaches and interfere with the healing process.
the problems that arise from it, such as medical error, the inability to
concentrate, and the physical symptoms noted earlier in this chapter.
Through EBD, you can accurately define which environmental factors
help ease stress and make each situation more healing.
windows), offices to the rear, and interchangeable offices and exam rooms
in the center. This concept is repeated dozens of times throughout the
buildings, allowing future programs to expand or contract as needed.
Positive Distractions
Positive distraction can be anything that helps divert attention, even
for a short time, and causes a positive emotional response. Because
hospitals are not typically places people go to because they want to,
most people feel some level of anxiety. Integrating wow features
to help distract people from their negative feelings can change a dull
or even negative experience into one that is tolerable and possibly
relaxing and enjoyable (see photo 3.12 in color insert).
Water Features
Water features of various sizes are being designed in hospital lobbies
as a welcoming landmark and wayfinding element. Joseph (2006)
found that water features have a calming effect and help reduce stress.
Unfortunately, many administrators fear that water features will foster
and spread disease, even though little proof has emerged concerning
actual problems that have occurred (Huelat, 2007, p. 23).
Artwork
Patients and their families judge a healthcare facility by many factors.
The appearance of the facility ranks high on that list. Few environments
seem complete without art on the walls, and a hospital is no exception.
In EBD discussions art generally falls in the positive distractions
category and, as such, helps bring calm to an otherwise stressful
environment.
Katcher, Segal & Beck (1984) note that restoration from the
stressed state is manifested within 3 minutes, and sometimes as fast
as several seconds, when a nature-based element is introduced into
the space. They cite one scientific study that measured recovery from
anxiety in patients waiting to undergo dental surgery. On some days,
an active aquarium was placed in the waiting room, and on other days,
it was removed. The results showed that anxiety was lower on days
when the aquarium was present. Additionally, the clinicians noted that
patients compliance during surgery was higher as a result.
The Culture
Demographics and culture play a significant role in defining what a
healing environment might be for a given population. For example, for
a project in Puerto Rico, key users requested very bright, tropical colors.
Therefore, planners used bright pink, lime green, and tealcolors the
users live with day to dayin the interior design scheme.
The Theme
A theme or story can help define the hospital and make it unique and
memorable. For example, the New Hanover Regional Medical Center,
in Wilmington, North Carolina, is only 8 miles from the beach. For the
new Betty H. Cameron Womens and Childrens Hospital, they selected
the theme of a cozy beach house. They noted in the visioning session
that the general population of Wilmington had chosen to live there
because they love the ocean and all things beachy; therefore, adopting
this theme in a soft, feminine way made perfect sense.
Aesthetics
It is critical to determine how the project owner wants its facility to be
perceived by the public. During the planning process, a list of adjectives
should be gathered that describes the desired image. Should the facility
be sleek and contemporary? Or cozy and friendly? An effective way to
clearly define this image is to tour existing, similar facilities and noting
66 Evidence-Based Design for Healthcare Facilities
which design features the clients like and, just as importantly, which
elements they dislike.
Technology
No matter how thorough the planning process, project planning teams
will always encounter elements that need to be included at the tail end
of a project. For example, when the clients at a surgery center made a
last-minute decision to add a large, flat-screen patient tracking device in
the waiting area, interior designers had to rethink the art for this wall.
Another example might be wayfinding kiosks that were intentionally not
part of the project at the beginning but might get added when funding
becomes available. The space and power supply needed for them might
not be available. Thus, the design team must be prepared to adapt the
latest technology into their plan at any given moment.
Evidence-Based Design
The degree to which EBD will impact design decisions also needs to
be identified early in the process. There are a number of questions
designers need to ask and answer. Are the findings of the latest research
being incorporated into the project? Will actual research be done using
before and after criteria? Is funding for research planned into the
project from the beginning?
Hours of Operation
Will the facility be operational 24/7, typical of most hospitals? Or does
it function as a clinic, closing in the evenings? This decision drives
many other decisions, including the type of chairs and fabric selected for
workstations. Chairs that are to be used in a 24/7 environment are often
3 Healing Environments 67
sturdier than typical office chairs. Also, chairs used in a busy emergency
department must withstand much more use and abuse than chairs in a
surgeons waiting room that is open only a few mornings per week.
Having a vision for the new building or space helps put a unifying
envelope around the desires expressed by the architectural team. Often,
conducting a visioning session produces helpful information that
might not have been considered previously. The concept of the vision,
after defined and refined, then begins to shape and guide many other
decisions. For example, a hospital in an urban setting would most likely
have a very different theme than one in a rural locale.
and aligns the team members, creating champions of the vision who
carry it forward to others involved in the project. As the project
progresses, the vision guides the team, particularly the architectural
team, in their decisions and recommendations.
The design of the hospital was based on the latest research, EBD
recommendations, and patient and user interviews. Safety, patient- and
family-centered care, and inclusion of the latest technologies were
major goals. All patient rooms, including the NICU/NTCU rooms,
are private.
Each of the zones in the pre-op and post-op areas have their own
identification based upon flowers native to the local area, including
magnolia, oleander, dogwood, azalea, and rose (used in the PACU).
Patient focus is the first priority. To the extent possible, all critical
elements of EBD, such as access to nature and natural light, private
patient rooms, healing environments, air quality, and family areas, are
planned into the buildings.
Caring for our own became the overarching theme. Other ideas
with a majority of votes included the following:
Symbolically include the bald eagle.
Thus, the five major buildings and their components will have the
following themes.
Building ARiverside
Recognition of the many bodies of water in and around the campus
will be included in this scheme. Colors include various shades of teal,
earth tones, and neutrals.
3 Healing Environments 75
Building BFeatherstone
Elements in this building will recognize the hundreds of species of
birds, including the bald eagle, which has become the overall symbol
for the project through art and educational displays. The color scheme
will incorporate rich clay (earthy) colors, spice and shrimp tones, and
warm grays and golds.
Building DSunrise
This building was themed to recognize the importance of natural
light in a healthcare setting. All the Fort Belvoir buildings will have an
abundance of floor-to-ceiling windows in all public spaces, allowing
the sunlight to filter into waiting areas, the galleries connecting the
buildings, inpatient rooms, and corridors. Specifically, the color
scheme of this building will contain various shades of soft golds, warm
beiges, and accents of spice and warm brown. Art and signage will
contain images of the rising sun, bringing hope and inspiration.
Final Thoughts
Ultimately, the definition of a healing environment must be
developed by the healthcare facilitys multidisciplinary team. They
must first understand the mission, goals, and objectives for the project
and understand and translate the EBD research into a meaningful and
financially sound design and construction plan.
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