architectural framework for the design of psychologically

InternationalResearchJournalofEngineeringandTechnology(IRJET)e-ISSN:2395-0056Volume:08Issue:02|Feb2021www.irjet.netp-ISSN:2395-0072

ArchitecturalFramework

ForTheDesignofPsychologicallySupportivePatientRoomsEmanM.O.Mokhtar

AssistantProfessor,ArchitectureEngineeringDept.,FacultyofEngineeringModernUniversityforTechnologyandInformation,Cairo,Egypt

Email:emomokhtar@gmail.com

------------------------------------------------------------------------------------------------------------------------------------------------------------ABSTRACTNowadays,thedesignofhospitalshasencounteredabigshifttowardswhatiscalledpsychologicallysupportivedesignsorhealingenvironmentsthatcanaffecthealthandwellbeing.Theenvironmentisanimportantdeterminantofhowpeoplefeel.Thereareevidencesofthelinkbetweentheenvironment,patient stress andhealth outcomes.Gettingwell is not limited to physical curebut it has also spiritual, emotional andenvironmentaldimensionsthatmustnotbeignored.Inthiscontextthearchitecthasaparamountroleintheprocessofhealingforpatients.Thispaperisanendeavortopointouttherequirementofimplementingrationalconceptsinhospitalsdesign.Thenarrowfunctionalistviewinhospitalsdesignmustchange.Hence,enhancementsareneededinarchitecturaldesignstoactasanarrativemadeupofpatientspsychologyandbehavioralprocesses.This researchpaperencompassesanewapproach in thedesignofpatient rooms' interior that considerall influencingfactors satisfyinghealing environment simultaneously.Proposed interiordesigns and treatments forpatient roomsarehereinintroducedfromanarchitecturalpointofviewtoleaveechoesofpositivefeelingsonpatientsandthusevokehealing.KEYWORDS:Supportivearchitecturaldesign,Healinghospitals,Patientroomdesign,Psychoneuroimmunology,Evidence-baseddesign,Sickbuildings,Alternativemedicine.OBJECTIVETheaimofthisresearchpapercanbebrokendownintotwoobjectives.Thefirstistocarryoutareviewofthescientificfactsthatemphasistheideaofsupportivedesign.Supportivedesignisapsychological,qualitativeaspectthatneedsarigidbasetodependupon.Thesecondistointroduceaholisticframeworkforthedesignofpatientroomsaspatientsexpendmostoftheircuringandhealingtimeinthem.Theframeworkrepresentsanarchitecturalinterpretationforallcollectedfactorsaffectingpatient'spsychologyandhencethehealingprocess.Itdealswitharchitecturaltreatmentsinpatientroomseitherexternally in the formofwalls,openings, floororceilingand internallyas theambientenvironment, the formoffurnitureandotherinteriordesignelements.RESEARCHMETHODOLOGYThemethodologyapplied in this researchpaperbeginswithabackgroundofhealingandsupportiveenvironments.Anintroductiontothephilosophyofpsychoneuroimmunology,sickbuildingsyndrome,andalternativetherapiesaredisplayedtogivetheconceptofsupportivedesignitsscientificbase.Ultimately,aholisticarchitecturalframeworkforthedesignofpatientroomsbasedonevidencebaseddesignandpatientneedswillbeintroducedwithsomerationallyproposeddesigns.Thefullschemeofresearchmethodologyisshowndiagrammaticallyinfigure(1).

Figure1:Methodologyappliedintheresearch

1.INTRODUCTION

Thepowerofarchitectureinthehealingprocessisnowadaysoverlooked.Unlikecuring,healingisconcernedwithaspectsofhealth that are psychological. There is a big connection between the mind and body. Themind affects the autonomic,endocrineandimmunesystems[1]whichinturnprovidethemachineryofhealing[2].Anexampleofmind-bodyconnectionishowthebodyrespondstostress.Itisthecentralpointofpsychologicallysupportivedesignwhichisassociatedwiththesurroundingenvironment.Mostpatientsexperienceconsiderablestressinhospitals.Itisconsideredanunseenfactormakingthedifferencebetweenrecoveryandrelapse[3].Itisthebody'sobstacleinhealing.Theimpactofthephysicalenvironmentisofagreaterimportanceinhospitalsthaninanyotherspaceasthelesscompetentthepersonisthegreatertheimpactofenvironmentalfactorsonhim[4].Thus,patientsundercircumstancesofillnessandpainwillbeeasilyaffectedbyenvironmentalstimuli.Recently stress reducing factors associated with the architecture and interior designs of hospitals are taken intoconsiderationduringhospitaldesign.Factorslikenaturallight,pleasantviews,artworkandevencolorcanhavethepotentialtotransformastressfulenvironmenttoatherapeuticone[5].Ulrich[6]introducedthetheoryofsupportivedesignwhichemphasizedtheimportanceofthesefactorsandothersincreatingindoorenvironmentthatencouragehealing.Newconceptsofinteractionbetweentheenvironmentandhealinghadbeenthoughtforandhadbeenconsideredindesign.Promotinghealingcanbeachievedbyeitherreducingnegativeenvironmentalfactorsorbyaddingpositivefactors.Itisalsonecessarytodesignthephysicalenvironmentbasedonthebehavioralcharacteristicsandneedsofpeopletoachievehealing[7].For decades, the design of hospitals concentrated on creating spaces that are functional and that supportmedical andtechnologicalneeds.Nowadaysthisapproachhasbeenshiftedtowardspsychologicallysupportivehospitalsthatact,moreovertheirtraditionalfunction,asacatalystforthepatientshealingprocess.Morethan2000yearsagotheancientRomanphysicianGalenrecognizedthehealingaspectthatcanbeprovidedbytheenvironment[8].Inthe19thcenturyFlorenceNightingale[8]addressedtheprovisionoffactorslikecolor,naturallightandeliminationofexcessivenoiseastheyplayacentralroleinpatient'shealing.Apaviliontypehospitalwithpenetrationofsunlight,greatcirculationoffreshairandappropriatetemperaturewasproposed[9].2.SCIENTIFICBASEFORTHEDESIGNOFSUPPORTIVEPATIENTROOMS

Thedesignofsupportivepatientroomscontainsmanyqualitativefactorsthatissaidtoaffectpatient'srecovery.Inthisresearchpaperthescientificbasefortheseassumedfactorsarehereindiscussedwhichverifiesthese

Figure2:Effectofsurroundingenvironmentalstimulionhealingassumptions.Abriefdiscussionofpsychoneuroimmunology,sickbuildingsyndrome,alternativetherapiesandevidencebased design; all indicate the effect of the surrounding environment on patient's psychology and identify the role thearchitectcanhelpinpatient'shealingandrecovery.2.1.PsychoneuroimmunologyPsychoneuroimmunologyreferstothestudyoftherelationshipbetweenthemindandtheimmunesystem[10].Itaddressestheimportanceofstimulatingtheimmunesystembypositivestimulicomingfromtheenvironment[11].Inhospitals,patientsexperienceconsiderablestress fromillnessand fromphysical-socialenvironment.Stresscanhavesuppressiveeffectsonimmunesystem[12].Ourbrainandournervous,endocrineandimmunesystemsareinteractingasinfigure(2).Whatweareseeingarounduscanchangeourbiochemistry.Hormonesarereleasedinresponsetostresswhichcancontrolthepatient'simmunesystem.Afullyfunctioningimmunesystemisintegraltotimelyandeffectivehealing[13].Highstressmaycauseslowhealingprocess[14].Architecture,interiordesignandlandscapeinhospitalswouldeventuallyimposewhatweseeandthinkaboutandcanaffectourmoodandbehavior.Designscanbestressfulorrestfulforpatientsandthusaffectshealthoutcomes.2.2.SickBuildingSyndrome(SBS)Sickbuildingsyndromeisanindoorairqualityrelateddisease,whichstimulatesthenervesystem,skinandrespiratorysystemandcancausemanysymptoms[15].Itaffectsnegativelyphysicalhealthwhichisrelatedtopsychologicalwell-beingbecausethehumanbodyisoneinteractivebiologicalsystem[16].ThecauseofSBSisusuallyrelatedtoseveralfactors,physicalandchemical.Poorarchitecturaldesignmaybeacontributiontophysicalfactorsincludinginadequateventilation,poorindoorairquality,temperatureandhumidity,noiseandpoororinadequatelighting[17].Becauseofthenatureofhospitals,theirarchitecturaldesignpresentsanextraordinarychallengeinSBSprevention.2.3.AlternativeTherapiesAlternativetherapies,otherthanmedicalones,mayhealandcomfort,ifnotcure.Theyincludemanytypes;oneofthemismind-bodytherapiesthatcanbeincorporatedintheambientenvironmentofanyhospital.Theyincludemusictherapy,lighttherapy,arttherapy,naturopathictherapy,aromatherapy,distractiontherapyandcolortherapy.Followsareabbreviatedviewofthesetherapies.2.3.1.MusictherapyMusictherapyorpsychoacoustictherapyusesmusictoheal.Suitablemusiccausesthebraintoreleasedopamine,thefeel-goodhormonewhichpreventsdepression.The soundsof rain, birds andwaves for example are integratedwith loweranxiety[18].2.3.2.LighttherapyProvidingnaturallightingisgoodforhealing.Itincreasesserotoninlevelswhichisaneurotransmitterlinkedtopositivefeelingsandhappiness[18]

Chronobiology is the science of biological rhythms as daily light cycles, seasonal changes and their effect on people'spsychology[19].Workingwiththenaturalcyclesoflightanddarkpositivelyimpactsleepcycles[20]aspoorsleepleadstoincreasedstress.Architectscansurelycontrol luminance intensitynaturallyandartificiallybyrational indoordesignofpatient’srooms.2.3.3.ArttherapyTheartsvalidateemotionsandcontributetothehealingprocess[20].Artworks,asworkscontainingnaturalimages,canhavepositiveeffects.Theycandecreaseanxietyinpatientsandincreasetolerancetopain[21].Architectsroleis,therefore,toselectproperindoorartwork.2.3.4.NaturopathictherapyOneofthemainprinciplesofnaturopathictherapyisthehealingpowerofnature.Architecturedesignsdistancepeoplefromnatureinartificialbuildings.Bringingnatureindoorsisknowninarchitectureasbiophilia.Ulrichcomparedthepositiveeffectsofviewingnaturalsceneryonpatients'recoveryfromsurgerytopatientsexposedtoaviewofabrickwall[22].Thereare extensive evidences showing that patientswhohave access to nature healmore rapidly [18]. Architecture designsbringingnatureindoorareamust.2.3.5.AromatherapyAromatherapypromotesphysicalandpsychologicalhealthbymakinguseofselectedoutdoorplantsspreadingvaporofessentialoilsfoundintheflowersandleavesofvariousnaturalplants[23].Itisusedtorelievepain,improvemood,promoterelaxationandalleviatesstress[24].Thus,itincreasessleepqualityandpromotehealing.2.3.6.DistractiontherapyEngrossingenvironmentaldistractionscauseagreatpainreduction[25].Visualandacousticalstimulationcanserveasadiversiontomakepainfulproceduresmorebearable[26].2.3.7.ColortherapyColor is fundamental factor inthedesignofhospitalsas itaffectshumanpsychologicallyandphysiologically[27].Manyresearchestalkedabouttheeffectofcoloronrecovery[28].Whencoloristransmittedthroughtheeye,thebrainreleaseshypothalamushormonewhichaffectsmood[29].Ulrichetal[30]recommendedtheconsiderationofcolor inthedesignofpatientrooms.Specialcolorscanarousepeople,whereasotherscangivepeopleasenseofcalmnessandthusreducingstresswhichaffectspatients'sleep[31].Hospitalsnowtendtoborrowcolorsfromnature.Greenandblueforexampleproducerelaxingandcalmingeffects[18].Theselectionofappropriatecolorsandtheirmixoutisoneofarchitect’sjobs.2.3.8.GeometrytherapyInarecentstudybytheauthor[32],ithasbeenshownthatthegeometricalfeaturesofhospitalsarchitecturaldesignandevenroomsdesignwouldhaveapositiveeffectonpatientshealing.Theuseofpyramidsshapesinthedesignisexpectedtohelplargelyinhealing.3.EVIDENCE-BASEDDESIGN(EBD)

Afullanalysisofhospitalsdesigncomprisesatremendousnumberofitemstobeunderinvestigationandneedsfurtherresearchwork.Inthepresentwork,investigationonoptimumdesignofhospitalswillbeconfinedtothedesignofpatients'rooms.Itisimportanttouseevidencebaseddesignasthetheoreticalconcepttodesignpsychologicallysupportivepatientrooms.Evidencebaseddesignreferstoguidingdesigndecisionsbyscientificevidenceinordertopromotehealthandwellbeing[33].EBDcanbebrieflydefinedas:“basingdecisionsaboutthebuiltenvironmentoncredibleresearchtoachievethebestpossibleoutcomes”[34].

Accordingtoevidencebaseddesigntheintegrationofallsenseshelpstocompletethehighestpotentialofanenvironmentto heal [35, 36]. The main principles that can positively impact patient outcomes are views of nature, fresh air withventilation,increasedlight,theuseofcolorsandapplyingpropergeometry.4.PATIENT'SNEEDSANDBEHAVIORALPROCESSESAsupportivepatientroomisonethatevokesfeelingsofcalmandrelaxation.Thereisavastarrayofcomponentsthatmakeupapatientroom.Inordertodesignasupportiveroom,patients'needsandbehavioralprocesseshavetobefullystudiedasillustratedinfigure(3).Ifhospitalsdesignischangedinaccordancewithpatients'ergonomicsandpsychologicalneeds,itwillimprovehealing.4.1.Privacy,personalsafetyandsecurityPeoplefeeldiscomfort,angerandanxietywhentheirprivacyisexposedbeyondtheirdesires.Abalancebetweenprivacyandsocialinteractionisrequired.Auditoryandvisualisolationaremainfactorsofprivacy.Meanwhile,patientsalsoneedasenseofpersonalsafetyandsecurity;knowingwho’senteringtheroom,reducingfallsandreducinginfections.4.2.PersonalspaceandaccessibilityPatientsareinroomswithassociatedequipment.Adequatespacearoundthebedshouldbeavailableforphysicians,nursesandportablemachines tobemaneuvered [37].Thedesignofpatient roomsshouldbeeasily reachablebynursingandmedicalstaff.Alsotheroomitsselfmustbedesignedtohaveeasymeansbywhichthepatientcanaccesstohispersonalneedwheneverrequired.

Figure3:Patient'sneedsandbehavioralprocesses

4.3.ComfortThreeitemsareessentialtoproduceacalmandcomfortableplaceforpatientstoaidthemtosleepandrelax.Theseitemsincludevisualcomfort,acousticalcomfortandindoorairquality.Visualcomfortconsidersdaylightfactors,luminanceintensityandtheireffectonpeople.Choietal.[38]showedthatthereisasignificantrelationshipbetweenindoordaylightenvironmentsandpatients'lengthofstay.Moreover,materialswithqualityasglarecancausevisualimpairmentandtheymustbeusedcarefullyinpatientrooms.

Asregardsacousticcomfort,highnoiselevelshaveseriousimpactonpatients.Thenegativeeffectsofnoiseareassociatedwithpatients'recovery[39],increasedstress[40]anditseffectonqualityandquantityofsleep[41].Thecontrolofairqualityinsideroomsisofparamountimportance.Theairmustbefreshtoensuresufficientcleanoxygen,topreventpossibleinfectionthroughrespiration,andtopreventanypollutingparticles,includingdustanddirtparticles,frompollutingsterilizedequipmentormedications4.4.ControlPersonalcontrolmeanstheabilitytoadjustenvironmentalconditionstopreventfeelingsofpowerlessnessthatcanratchetstress levels. Control devices should be located for ease of patient construability [18]. Proximity to nursing, excludingsunlight, controlling lighting, adjusting temperature, minimizing noise and accessing phones and personal computingdevicesareallimportant.4.5.ConnectionThetraditionalapproachinwhichfriendsandfamilyhadtoabidebystrictvisitinghoursisnowadayschanging.Astrongsenseofconnectiontovisitorsisneeded.Familysupportislinkedtohigherpatientsatisfactionscoreswhichurgesusasarchitectstocreatefamilyzonesinpatientroomsencouragesvisitorstobepartofthehealingprocess.5.FRAMEWORKFORTHEDESIGNOFPATIENTROOMSInordertogiveaframeworkforthedesignofpatientrooms,wehavetoknowalotofinformationabouttheseroomsasinfigure(4).Thisinformationmustincludethetypesofpatientrooms,peopleusingtheroomsaspatients,doctors,nurses,familyandfriends,andfurnitureandmedicalequipments.Theframeworkmustincludethecomponentsofthearchitecturespacefromwalls,openings,floorandceilingtoproduceacalm, relaxing and safe space togetherwith the surrounding ambient conditions. Themain aimof the framework is tooptimizemanyissuesrelatedtopatients'needsandtocorrectlydesigntheambientenvironmentinordertoreducestressinpatientrooms.Theproposedframeworkintheformofarchitecturaldesigntactics is illustrated intable1dependingholisticallyonallpreviouslydiscussedparameters

Figure4:Frameworkforthedesignofpatientrooms

Table1:ArchitectureDesignTactics

DESIGNTACTICSPARAMETER§ Selectionofcolorsshouldemphasisthepaletteofthenaturalenvironmentwithsofttones

§ Directaccesstonaturalviewsthroughwindowsorterraces.§ Usingnaturalelementsaswater,trees,bushes..etc..§ Usingnaturalmaterialsasstoneandwood.§ Naturalsimulationusingnaturalisticartworkonwallsandceiling.

NATURE

§ Usesuitablewindowstoadmitnaturallighting.§ Workwithinnaturalcyclesoflightanddark.§ Useskylightsandlightwellswhererequired.§ Provideshadingdevicestocontrolnaturallightingandglare.

NATURALLIGHT

§ Provideuserswithpointsoffocus.§ Useartwork,aquariumsandwaterfallstoevokefeelingsofcalm.

POSITIVEATTRACTIONS

§ Singlebedaccommodationispreferred.§ Patientprivatezoneshouldbeprovided.§ Inwardsvisualbarrierscanbeusedtoensureprivacy.

PRIVACY

§ Sufficientspacearoundthebedtoaccommodatemostactivitiesatthebedside,includingtheuseofequipmentandthemaneuveringofwheelchair.

PERSONALSPACE

§ Easyaccessbetweenpatientsandvisitorswithavailablespaceforhostingthem.§ Multipleseatingarrangementsfromsinglechairstoclustersofseating.§ Provideovernightaccommodationforpatients.

SOCIALCONNECTION

§ Wheelchairsshouldbeintegratedinseatingarrangements.§ Accessibleentrydoors.§ Enoughturningspaceforwheelchair.§ Forportablepatientliftorstretcherenoughadditionalspaceisneeded.§ Accessibleroutetobathroommustbeprovided.

ACCESS-ABILITY

§ Handrailstofacilitatemovingandpreventfalling.§ Usingnonslippingfloors.§ Preventinginfection.§ Providingaconeofvisionwherepatientcanseeenteringpeopleforsecurity

reasons.

PERSONAL SAFETY ANDSECURITY

§ Provideblindstoadjustnaturallightintensity.§ Controlglare.§ Providegenerallighting,examinationandtreatmentlighting,nightlightandbathroomlighting.

VISUALCOMFORT

§ Workingwithroomenclosures,finishesandsystemstoprovideappropriateacoustics.§ Useacousticalceilingtiles,acousticalwallpanels,reflectingpanelsandceilingclouds.

ACOUSTICALCOMFORT

§ Theorientationofwindowsanddoorsisimportanttoensurenaturallightingandnaturalventilation.

INDOORAIRQUALITY

§ LocalizelightingcontrolsothatpatientcanadjustthedesiredLight.§ Installadjustableinternalwindowshadingdevicestocontrollightandglare.§ LocalizeheatingandcoolingtemperaturecontrolstoadjustTemperature.

PERSONALCONTROL

6.PROPOSEDDESIGNSOFPATIENTROOMSFrompreviousoverviewofpatientshealingfactorsandthemainfunctionalmedicalandclinicalrequirements,itisevidentthattheroleofarchitect,inpatientroomdesign,issubstantial.Theroomdesignhastobedealtwithfrommanydirections.Bywayofexample,threeplansofpatientroomscomplyingwiththepreviouslydiscussedparametersaredesignedandputforwardasshowninfigure(5).Despitetheyallattainthemainconceptsyetdifferentdesignsareintroducedshowingthatthereisafreedomandflexibilityforthearchitecturedesignertoproducecreativedesignsandatthesametimeachievinghealingspaces

Inthethreeplansthefourmainzonesareconsidered;thepatient,family,clinicandbathzones.Thepatientisabletoviewanypersonentering the roomand thevisitorswaitingoutsidewhendesiredas thedoors are glass andhavedimmerscontrolledbyswitchesontheheadwall.ThepatientshavesmartT.V. forentertainmentandconnectionwithinternettofollowuptheirdailyactivitiesandtheycancommunicateeasilywiththeirfamily.Atthesametime,thevisitorsoutsidecanwatch thepatient inside according tohisdesire.A viewof colorfulplants iswithin thepatient's vision.The roomsareorientedsothattheprevailingwindcarriesoutthescentoftheplantstotheroomtakinginmindnottoputirritatingplants.Thereisflexibilityintheroomasthesofascanopentoformcomfortablesleepingareasforaccommodation.Theproposedplansgivealltherequirementsgivenintable1.Theplansactasalivingsystemchangingthestaticconceptofapatientroom.Theyprovideagoodbiophilicdesignwhichinteractsandaffectstheemotionsandmoodofpatient.Interiorshotsforonetheseplansareintroducedintable2toshowtheambientfactorscoupledwiththearchitecturalfactorstomakethepatientroomasatisfactoryhealingspace.

Figure5:Threedifferentpatientroomplans

Table2:DescriptiveShotsofthepatientroomfromdifferentdirections

patient. Interior shots for one these plans are introduced in table 2 to show the ambient factors coupled with the architectural factors to make the patient room a satisfactory healing space.

Figure 5: Three different patient room plans

Table 2: Descriptive Shots of the patient room from different directions

1. Window There is a large window facing the north. It can affect healing through the natural lighting and ventilation. Iit provides, the colors one sees, the sound one hears and the odors one smells through the presence of different natural colorful scented plants. Widows can have any geometrical shape to coupe with façade design and allow for best orientation as regards air and sun.

2. Nature simulation Ceilings can be helpful in patient’s relaxation. By way of example, the ceiling is painted with a picture of clouds as a simulation for clouds from nature; this can cause relaxation for patients.

3. Patient ceiling lift

There is a lift hanged in the ceiling in order to help patient to move and avoid falling. It transfers a patient in an up and down motion using a motor but the caregiver must manually move the person along the track.

4. Aquarium An aquarium in front of the patient acts as a distraction which can lessen pain.

104000000000

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1.Window Thereisalargewindowfacingthenorth.Itcanaffecthealingthroughthenaturallightingandventilation.Iitprovides,thecolorsonesees,thesound one hears and the odors one smells through the presence ofdifferent natural colorful scented plants. Widows can have anygeometrical shape to coupe with façade design and allow for bestorientationasregardsairandsun.

2.Naturesimulation Ceilingscanbehelpful inpatient’s relaxation.Bywayofexample, theceilingispaintedwithapictureofcloudsasasimulationforcloudsfromnature;thiscancauserelaxationforpatients.

3.Patientceilinglift

Thereisalifthangedintheceilinginordertohelppatienttomoveandavoid falling. It transfersapatient inanupanddownmotionusingamotorbutthecaregivermustmanuallymovethepersonalongthetrack.

4.Aquarium Anaquariuminfrontofthepatientactsasadistractionwhichcanlessenpain.

5.Acousticaltiles Itisimportantintheroomtocontrolnoiseasitaffectssleepandstress.Thereisauseofacousticaltilesintheceilingandwalls.

6.Waterfall Anoutsidesmallwaterfallcreatesasoundofwaterforrelaxation.

7.SmartT.V. AsmartT.V.forentertainmentandconnectiontointernet

8.Familyzone The family zone is beside the patient consisting of adequate area forsittingforsocialconnection.

9.Foldablebed Aclosetanddrawerswithafoldablebedforsleeping

10.Headwall Theheadwallconsistsofalltheswitchesthepatientneedtohavecontrolon lighting,viewingoutsidevisitors throughdimmers inglass, callingnursesoranyotherneeds.

11.Wheelchair Awheelchairisbesidethepatientwithadequatespaceformaneuvering.

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114000000000

12.Bathroom Abathroomisavailablewithadequatefurnishingsuitabletopatient.

13.visitorsarea Extraseatingforvisitorsisavailableoutsidefromwhichvisitorscanseethepatientthroughglasseddoor.

14.Indirectlighting Afalseceilingwithindirectlightingissuitabletohospitalsenvironment.

15.Doctorsarea Doctorscancheckthepatientstatusoutsidebeforeenteringtheroomandthereisanursingunitbesidethedoorforhandwashingandneededequipment.

7.CONCLUSION

Thispaperemphasizesthattherationaluseofthesurroundingphysicalenvironmentisapowerfulwaytopositivelyengageallsensesofpatientsasanantecedenttohealing.Therearemanyaspectsofspacethathaveameasurableimpactonhealing.Itisimportanttoadoptaholisticapproachduringdesignofanyhospitaltoproducethedesiredpsychologicallysupportivedesign.Architectsshouldseekdesignswithenvironmentsthataremorecomfortableforpatients.Thisislinkedwithfasterpatient recovery and improved emotional wellness. Special attention should be given to patients’ room design as itrepresentsthepatients’worldtoliveinandreactwith.8.RECOMMENDATIONS

When talking about humanhealth, an involvement of different fields related tomedicine, psychology, architecture andenvironmentalengineeringareneededinhospitaldesigntoparticipateinthehealingprocess.Therecommendationsinthiscontextare,thus,twofolds.First,thearchitectsshoulddesignhospitalsbringingnatureindoors,i.e.applyingtheconceptsof biophilia. Second, furtherwork andmore research should be carried on the psychological effect of the surroundingenvironmentonpatients.Theremustbearevolutioninarchitecturetowardswhatwecancallneuro-architectureandtheremustbeaconnectionbetweenneuro-scientistsandarchitectsduringallthephasesofdesign.REFERENCES

[1] Ader, R., “Psychoneuroimmunology”, Int. Encyclopedia of the Social &Behavioral Sciences,2001,https://www.sciencedirect.com/topics/medicine-and-dentistry/psychoneuroimmunology[2]Sternberg,E.,”HealingSpaces:TheScienceofPlaceandWell-Being”,TheBelknapPressOfHarvordUniversityPress,London,2009[3] Murray, C., “Can Design Thinking Reduce Stress in Healthcare Environments?” September 13, 2017,www.bresslergroup.com[4]Lawton,M.P.,Simon,B.,“TheEcologyofSocialRelationshipsinHousingfortheElderly.Gerontologist”,1968,8,108-15.[5] Myra Fauts, Diane Gabay, “Healing Through Evidence Based Design”, Oncology Issues, 2008,www.accc_cancer.org/docs/documents/oncology_issues/articles/mj08/mj08_healing_through_evidence_based_design.pdf[6]Ulrich,R.,”EffectsofInteriorDesignonWellness:TheoryandRecentScientificResearch.”JHealthCareInterDes1991;3:97–109.[7]Einifar,A.,&Tabaeian,S.”AStudyofthePerspectivesofArchitecturalandEnvironmentalPsychology”.InternationalJournalofArchitectureandUrbanDevelopment,2011,1(1),pp.28-31.[8]https://pdfs.semanticscholar.org[9]Nagasawa,Y.,“GlobalHospitalsin2050:AReviewoftheHistoricalDevelopmentofHospitalBuildingStudiesfromaGlobalPerspective”,JapanArchitecturalReview,ArchitecturalInstituteofJapan,2019[10]Marberry,S.,”InnovationsinHealthcareDesign”,JohnWiley&Sons,INC,Toronto,1995[11]DelNord,R.,“TheCulturefortheFutureofHealthCareArchitecture”,Proceedingsof28thInternationalPublicHealthSeminar,AlineaEditrice,Firenze,2009[12]Roger,S.,”ATheoryofSupportiveacilities,JournalofHealthcareDesign”,ProceedingfromtheSymposiumofHealthcareDesign,February1997

[13]Lucas,V.,“PsychologicalStressandWoundHealinginHumans:WhatWeKnow”,Wounds,Volume23,Issue4,April2011[14]Article,“WhatImpactdoestheEnvironmentHaveOnUs:takingChargeofYourHealthandWellbeing”,UniversityofMinnesota,Takingcharge.csh.umn.edu/explore-healing-practices/healing-environment[15] Hodgeson, MJ., Adorisio, MR., “Exposures in Indoor Environments”, Rosenstock Linda Clinical Occupational andEnvironmentalMedicine,SecondEdition,Elsevier,Saunders,2005;2:1133-142[16]Ghaffarianhoseini,A.,AlWaer,H.,etel,“Sickbuildingsyndrome:arewedoingenough”,ArchitecturalSciencereviewJournl,p.99-121,2018[17]Passarelli,G.,”Sickbuildingsyndrome:Anoverviewtoraiseawareness”,JournalofBuildingAppraisal,volume5,p.55–66,2009[18]Davies,N.,“EmpathyinArchitecture”,Interiorssources,2014[19]Wirz-Justice,A., Fournier,C.,“LightHealthandWellbeing:Implicationsfromchronobiologyforarchitecturaldesign,WorldHeaithDesign,January2010,pp.44-49[20]Article, “HealingEnvironment: Design Guidelines”, U.S.Department of Veterans Affairs, Office of Construction andFacilitiesManagement,2016,www.wbdg.org/FFC/VA/VADEMAN/healing_envir.pdf[21]Staricoff,R.,Loppert,S.“Integratingtheartsintohealthcare:canweeffectclinicaloutcomes?”In:KirklinD,RichardsonR,(Eds,)TheHealingEnvironment:WithoutandWithin.London:RCP;2003,pp63-79[22]Ulrich,R.S., “ViewThroughaWindowMayInfluenceRecovery fromSurgery”,Science,224(4647),420-421,1984[23]JangS.B.,ChuS.H.,KimY.I.,YunS.H.,”TheEffectsofAromaInhalationOnSleepandFatigueinNightShiftNurses.”,TheJournalofKoreanAcademicSocietyofAdultNursing.2008;20(6):941–949.[24] Cunha AP, Nogueira MT, Roque OR, “Aromatic plants and essential oils-composition and applications.”, CalousteGulbenkianFoundation.Lisboa,Portugal,2012[25]McCaul,K.D.,&Malott,J.M.“Distractionandcopingwithpain”,PsychologicalBulletin,1984.95(3),516–533.[26]MillerAC,HickmanLC,LemastersGK.,”Adistractiontechniqueforcontrolofburnpain”,JBurnCareRehabil1992;13(5):576-80.[27] Ghamari, H, Amor, C.”The Role of Color in Healthcare Environments, emergent Bodies of Evidence-based DesignApproach”,SociologyandAnthropology4[11]:1020-1029,2016[28]Edge, K.J.,”Wall Color of Patient’s Room: Effects on Recovery”, Thesis for the Degree of Master of Interior Design,UniversityofFlorida,2003[29]Engelbrecht,K.,”TheImpactofColoronLearning”,PerkinsandWill,Chicago,Illinois,2003[30] Ulrich, R.S. et al., “A Review of the Research Literature on Evidence-Based Healthcare Design”, HERD: HealthEnvironmentsResearchandDesignJournal,vol.1,no.3,pp.61-125,2008[31]Stone,N.J.,andEnglish,A.J.,”TaskType,Posters,andWorkSpaceColoronMood,Satisfaction,andPerformance”,JournalofEnvironmentalPsychology18,175-85,1988[32]Mokhtar, E., Amin, A., " Pyramids In Meditation: Healing Hospitals Architecture ", Journal of Egyptian Society ofEngineers,Vol.57,No.2,2018,pp.2-7[33]Mchale,J.,Cordell,M.,”HumanNeeds:aFrameworkforAction”,TransactionBooks,1977[34] Bellieni, C., Bellieni, A., “Evidence- based Health Architecture”, www.oatext.com/Evidence-based-health-architecture.php.,2018[35] Naughton, C.,”Applying Evidence-Based Design to Healthcare facilities”, HMC Architects, 2018,hmcarchitects.com/new/[36]Brian,S.,“ArchitectureHealingenvironments”,SyracuseUniversity,Surface,SchoolofArchitectureDissertationsandTheses,Spring,2012,http://surface.syr.edu/architecture-theses[37]Leitch,M.,”StudyShowsWhatPatientNeedtoFeelcomfortableDuringHospitalStay”,TheOhioUniversity,wexnerMedicalCenter.2017.https://wexnermedical.osu.edu/mediaroom/pressreleaselisting/patient-room-comfort[38]ChoiJ-H,BeltranLO,KimH-S.,”Impactsofindoordaylightenvironmentsonpatientaveragelengthofstay[ALOS]inahealthcarefacility”.BuildEnviron.,2012;50:65-75[39]BayoMV,GarciaAM,GarciaA.,”Noiselevelsinanurbanhospitalandworkers’subjectiveresponses”.ArchEnviron.Health1995;50[3]:247-51.[40]Toph,M.,”Hospitalnoisepollution:anenvironmentalstressmodeltoguideresearchandclinicalinterventions.“,JAdvNurs2000;31[3]:520-8.[41]HiltonBA.,”Quantityandqualityofpatients’sleepandsleep-disturbingfactorsinarespiratoryintensivecareunit.”, JAdvNurs1976;1[6]:453-68.

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