Moving Toward Person-Centered Care: Valuing Emotions in Hospital Design and Architecture

The intangible value of emotions is often neglected in healthcare evaluations; however, it forms an important part of the hospital experience that needs to be taken into consideration to move toward person-centered care. This article conceptualizes how space and architecture may influence patient, family, and healthcare provider emotions. Building upon Gaston Bachelard’s Poetics of Space, theories on emotional design and architecture, as well as research in environmental design, we suggest several ways to value emotions in hospital design and architecture. The first theme explores several hospital spaces (the waiting room, the hospital room, the treatment room) using Bachelard’s phenomenology in order to show how to facilitate emotional security by catering to the individual needs of the user. The second discusses the overall hospital room environment, notably the influence of light, color, and sound on the patient’s emotional experience. The third explores architectural theorist Giuliana Bruno’s theory of e(motion) to explore the hospital space as vissuto, a space of lived experiences, that invites us to rethink the design and architecture of hospital spaces to allow for patient participation. The article also gives suggestions of qualitative, person-centered methodologies that can be used to move forward this debate.

One dose of Architecture, taken daily: Building for Mental Health in New Zealand

<p>Thousands of New Zealanders were treated in the nation’s mental hospitals in the late nineteenth and twentieth centuries. Existing research has examined this history of institutionalisation from the perspectives of policy, psychiatric medicine and nursing culture, but to date little has been written about the built fabric of this type of institutional care. This dissertation asks what does the architectural approach taken to Seacliff Asylum (1878-84), Kingseat Hospital (1927-40) and Cherry Farm Hospital (1943-71) indicate about official attitudes to mental illness in New Zealand. Architecture was thought to be capable of performing a curative role in the treatment of mental illness; the administrators of New Zealand’s mental hospitals stated this belief publically in various press releases and reports to the government between 1878 and 1957. This dissertation examines Seacliff, Kingseat and Cherry Farm against current thought regarding the treatment of mental illness and against best architectural practice in mental hospital design. While these three institutions were the jewels in the crown of New Zealand’s mental hospital network, only Kingseat could be considered an exemplary hospital of its time. The compromises that occurred in the construction of Seacliff, Kingseat and Cherry Farm hospitals indicate that meeting the needs of the mentally ill was only one of a number of agendas that were addressed by the officials involved in the design of these institutions. Many of these agendas were peripheral to the delivery of mental health care, such as the political desire for colonial propaganda and professional concerns of marginalisation, and conflicted with the attainment of ideal environments for the treatment of mental illness. The needs of the mentally ill were a low priority for successive New Zealand governments who exhibited a reluctance to spend taxpayer funds on patients who were not considered curable. The architects and medical advisors involved in the design of these facilities did attempt to meet the needs of these patients; however, they were limited by a design and procurement process that elevated political and operational concerns over the curative potential of these hospitals. This dissertation also examines the role of individuals in the design of these institutions. Architect Robert Lawson was reproached for deficiencies in the curative potential of Seacliff Asylum. Similarly, medical administrator Theodore Gray has received criticism for limiting the development of New Zealand’s wider network of mental hospital care. This dissertation establishes that Lawson and Gray deserve greater recognition for their relative contributions to the architecture created, within New Zealand, for the treatment of mental illness.</p>

One dose of Architecture, taken daily: Building for Mental Health in New Zealand

<p>Thousands of New Zealanders were treated in the nation’s mental hospitals in the late nineteenth and twentieth centuries. Existing research has examined this history of institutionalisation from the perspectives of policy, psychiatric medicine and nursing culture, but to date little has been written about the built fabric of this type of institutional care. This dissertation asks what does the architectural approach taken to Seacliff Asylum (1878-84), Kingseat Hospital (1927-40) and Cherry Farm Hospital (1943-71) indicate about official attitudes to mental illness in New Zealand. Architecture was thought to be capable of performing a curative role in the treatment of mental illness; the administrators of New Zealand’s mental hospitals stated this belief publically in various press releases and reports to the government between 1878 and 1957. This dissertation examines Seacliff, Kingseat and Cherry Farm against current thought regarding the treatment of mental illness and against best architectural practice in mental hospital design. While these three institutions were the jewels in the crown of New Zealand’s mental hospital network, only Kingseat could be considered an exemplary hospital of its time. The compromises that occurred in the construction of Seacliff, Kingseat and Cherry Farm hospitals indicate that meeting the needs of the mentally ill was only one of a number of agendas that were addressed by the officials involved in the design of these institutions. Many of these agendas were peripheral to the delivery of mental health care, such as the political desire for colonial propaganda and professional concerns of marginalisation, and conflicted with the attainment of ideal environments for the treatment of mental illness. The needs of the mentally ill were a low priority for successive New Zealand governments who exhibited a reluctance to spend taxpayer funds on patients who were not considered curable. The architects and medical advisors involved in the design of these facilities did attempt to meet the needs of these patients; however, they were limited by a design and procurement process that elevated political and operational concerns over the curative potential of these hospitals. This dissertation also examines the role of individuals in the design of these institutions. Architect Robert Lawson was reproached for deficiencies in the curative potential of Seacliff Asylum. Similarly, medical administrator Theodore Gray has received criticism for limiting the development of New Zealand’s wider network of mental hospital care. This dissertation establishes that Lawson and Gray deserve greater recognition for their relative contributions to the architecture created, within New Zealand, for the treatment of mental illness.</p>

The Creation of a Birthing Centre: Considering the Prevention of Post-Natal Depression.

<p>This thesis explores the notion of interior architecture as a tool in the prevention on of post natal depression. This research is part of a larger and current theoretical argument that places interior architecture in a catalyst role for the prevention of mental illness. Initial research shows that the act of giving birth and its physical and mental recovery are tightly linked to the potential development of depressive disorder. Accordingly this research will explore the spatial requirements for birthing with the prevention of mental disorder in mind. The design will be developed at the intersection of a series of criteria of spatial qualities in the prevention of depressive orders and evidence based hospital design parameters for birthing. This research aims to establish a comprehensive base guideline specific for the design of birthing centres, focusing on the prevention of post natal depression. The design here presented is a series of tests and assessment of this guideline.</p>

The Creation of a Birthing Centre: Considering the Prevention of Post-Natal Depression.

<p>This thesis explores the notion of interior architecture as a tool in the prevention on of post natal depression. This research is part of a larger and current theoretical argument that places interior architecture in a catalyst role for the prevention of mental illness. Initial research shows that the act of giving birth and its physical and mental recovery are tightly linked to the potential development of depressive disorder. Accordingly this research will explore the spatial requirements for birthing with the prevention of mental disorder in mind. The design will be developed at the intersection of a series of criteria of spatial qualities in the prevention of depressive orders and evidence based hospital design parameters for birthing. This research aims to establish a comprehensive base guideline specific for the design of birthing centres, focusing on the prevention of post natal depression. The design here presented is a series of tests and assessment of this guideline.</p>

Using Virtual Reality (VR) Mock-Ups for Evidence-Based Healthcare Facility Design Decisions

(1) Background: There are many complexities and trade-offs that design teams consider when designing or renovating a built environment for healthcare. Virtual reality (VR) mock-ups can allow design teams to evaluate the planned design. This study aimed to examine the overall value of using VR mock-ups to conduct a simulation-based mock-up evaluation. (2) Methods: Data collected from scenario enactments within a VR mock-up was compared to data collected from an existing medication room with the same design to assess predictive validity. Outcomes regarding quality and patient safety were also examined as a result of design modifications to the VR mock-up which were identified through a post-occupancy evaluation (POE) of the existing medication room. Survey data from participants, hospital design stakeholders, and POE recommendation recipients captured perceptions regarding the evaluation process. Specifically, this included perceptions regarding mock-up and scenario realism as well as utility of the evaluation process. (3) Results: Evidence-based data collected using the VR mock-up accurately assessed workflow (link analysis), bumps, impediments, interruptions, and task completion times. Collecting data pertaining to selection errors and equipment placement were identified after procuring the VR software and therefore the accuracy of these measures was not assessed. Searching behaviours were not possible to capture using the VR software. A 506% return on investment was achieved through the VR mock-up evaluations. (4) Conclusion: Organizations should consider what evaluation objectives are planned and how they will be measured for a mock-up evaluation to determine if VR is appropriate.

AUTHENTICITY IN BUILDING ADJUSTMENT SIMULATION (Case Study: Emergency Room of St. Elizabeth Hospital Semarang, Indonesia)

This paper aims to simulate adjustments for new functions in hospitals that respect the authenticity of cultural heritage buildings. The development of heritage buildings should be integrated, especially in adjusting building functions, such as room arrangement. The emergency room is a vital function for hospital services, and consideration is needed to arrange procedures. The research method chosen in this research is descriptive qualitative with a case study in the Magdalena Daeman building St Elizabeth Hospital. Design simulation can be realized by adjusting the standard emergency room requirements into the layout of the building. Additionally, cultural heritage buildings should be maintained to be used in operational functions by carrying out development. This study's results can be a guideline in developing new functions of cultural heritage buildings that meet the conservation technique guidelines.

Patients’ and Nurses’ Experiences of All Single-Room Hospital Accommodation: A Scoping Review

Aim and Objective: To identify, examine, and map literature on the experiences of single-room hospital accommodation, exploring what is known about how single-room accommodation in hospitals is viewed by patients and nurses. Background: Worldwide, hospital design is changing to mainly single-room accommodation. However, there is little literature exploring patients’ and nurses’ experiences of single-room designs. Design: Scoping review following the Joanna Briggs Institute guidance on scoping reviews. Methods: We conducted the search in medical databases for scientific and gray literature. The four authors independently used a data extraction tool to include sources from the searches. The sources were discussed during the process, and in case of a disagreement between two reviewers, the third and fourth reviewer would be invited to participate in the discussion until consensus was achieved. Results: We included 22 sources published during the period 2002–2020, with a majority ( n = 16) during the period 2013–2020. The sources were distributed on 10 different countries; however, England dominated with 14 publications. We found three main maps for reporting on patients’ experiences: (1) personal control, (2) dignity, and (3) by myself. For the nurses’ experiences, we found four main maps: (1) the working environment, (2) changes of nursing practice, (3) privacy and dignity, and (4) patient safety. Conclusion: We suggested that patients’ and nurses’ experiences are predominantly interdependent and that the implications of single-room accommodation is a large and complex issue which goes beyond hospital design.

Why hospital design matters: A narrative review of built environments research relevant to stroke care

Healthcare facilities are among the most expensive buildings to construct, maintain, and operate. How building design can best support healthcare services, staff, and patients is important to consider. In this narrative review, we outline why the healthcare environment matters and describe areas of research focus and current built environment evidence that supports healthcare in general and stroke care in particular. Ward configuration, corridor design, and staff station placements can all impact care provision, staff and patient behavior. Contrary to many new ward design approaches, single-bed rooms are neither uniformly favored, nor strongly evidence-based, for people with stroke. Green spaces are important both for staff (helping to reduce stress and errors), patients and relatives, although access to, and awareness of, these and other communal spaces is often poor. Built environment research specific to stroke is limited but increasing, and we highlight emerging collaborative multistakeholder partnerships (Living Labs) contributing to this evidence base. We believe that involving engaged and informed clinicians in design and research will help shape better hospitals of the future.