Design Process for Infusion Center Design Studio B Xi Chen January 2016
Design Process for Infusion Center Research Mission
Problem
“In my world of healthcare design,” says Rosalyn Cama, president of Cama, Inc. -- An interior planning and design firm that is steeped in evidence-based design, “The goal first and foremost is to reduce stress.” (Nature-Based Design: The New Green Research Summary, 2)
Inspiration Concept Adjacency Matrix Bubble Plan Block Plan Floor Plan Ask for critique
WAYFINDING
CONTROL
-There is research “Hospital wayfinding and the anxiety factor” showing that wayfinding plays a critical role in healthcare design. Well-designed wayfinding will help release patients’ anxiety. But the way to achieve effective wayfinding is controversial. Nowadays, digital signs, electronic kiosks, and app-based wayfinding have been widely adopted by healthcare centers. However, not everyone is comfortable with those new technologies. Improperly using the technologies will make patients feel lost before the journey even begin. We are still between the shifts from old school wayfinding to digital based wayfinding. (Kristin, 2) -Some people will have a hard time walking a long distance when their body starts aging and getting weak. Knowing that they are headed the right way will help patients not only shoten the distance physically, but also reduce anxiety.
Direction
-Having a serious disease like cancer, has already taken control away from patients’ both physically and mentally. Research shows that “ Much of a patient's stress derives from feelings generated by negative experiences-losing control of privacy and normal routines, feeling vulnerable because their condition diminishes their sense of mastery, fearing an unknown outcome-and is exacerbated by the separation from home. High levels of stress, especially when sustained over time, can have devastating psychological and physical effects, which include depression.” (Kopec,261) An individual’s ability to control his environment influences his sense of well-being. A lack of control many result in increased stress blood pressure and suppressed immune system. (Kim) -Prisoners are punished by taking away their ability to control environment. The theory behind this, according to Shevaun Neupert, an associate professor of psychology at North Carolina State University, is that feeling in control can be partially derived from happiness or satisfaction. She also points out that a low sense of control may lead to less happiness, which in turn would lead to even lower sense of control. (Rivas) But most healthcare centers do poorly in providing patients a sense of control.
BIOPHILIA
Goal: As designers, we have to empathize with the anxiety and stress of patients so we can create a better environment for them. Patients who come to this place are commonly being
informed about their condition. They know that they have cancer. That makes them, no doubt, have a certain level of stress. After patients arrive at a healthcare center, they will be tested to determine if they can stay here for treatment or go home. That makes the time, they wait for results, more anxious. Furthermore, chemotherapy will aggravate their emotion. Besides, being lost, feeling helpless, all the side effects of chemotherapy on the body, and having a hard time finding a nurse for help are all additions to patients’ stress level. My goal is to design an infusion center which can minimize all the troubles listed above and maximize all the functions of an infusion center. Environmental Psychology for Design argued that more negative outcomes from patients whose hospital rooms had a view of a brick wall. It suggest that using psychologically appropriate artwork, such as nature scenes (especially those of water and trees), can also positively affect patient outcomes in an acute care setting by reducing blood pressure, anxiety, intake of pain medication, length of patients' hospital stays, and sadness and depression. (Kopec, 261) There are evidence showing that patients in hospitals where they have a view of pleasant landscapes outside their hospital rooms will also have shorter postoperative stays, require lower doses of painkillers, and experience lower levels of stress. (Kopec, 261) Nature-Based Design: The New Green. Combine LEED metrics with essential biophilic elements, some argue, and you achieve a lasting sustainability, a built environment that uses less energy even as it energizes the people who use it. Adopting proven techniques for creating interiors that connect us with our natural instincts, designers can achieve spaces that help people feel and work better. (Nature-Based Design: The New Green Research Summary, 3)
FEELING -Most healthcare centers use white polyvinyl chloride olastic, which also known as PVC or vinyl, as their main overall material because white color gives patients a sense of cleanliness. This material is also easy to clean and durable. But it also makes the overall environment look cheap and institutional. (Kopec, 258; Kopec, 103) One of the first common healthcare materials to cause widespread concern for health and the environment was vinyl—the most widely used plastic in healthcare. According to Research vinyl pollutes communities at both manufacture and disposal. (Lent) -Not being not able to enjoy their life after decades of hard work and ending up trapped in a healthcare center is very disappointing for patients. They deserve a better environment.
Design Process for Infusion Center Location San Francisco, California, is a city on the tip of a peninsula, surrounded by the Pacific Ocean and San Francisco Bay. It is known for its hilly landscape, year-round fog, iconic Golden Gate Bridge, cable cars and colorful Victorian houses. The Financial District’s Transamerica Pyramid is its most distinctive skyscraper. In the bay sits Alcatraz Island, site of the notorious former prison.
User According to World Health Organization (WHO), the population of adults over 65 years old around the globe is expected to double in 2050. In the United States, the elderly population will be about 72.1 million. Because aging and physical health problems limite their activity and daily lives, elderly patients are more stressed. (Kim) Helplessness is a central construct control personal (Seligman, 1992). Learned helplessness can develop when a person is repeatedly put into a position where there is no possibility of success; eventually, the person responds by doing nothing-in the belief that he/ she is powerless to improve the situation. (Kopec,136) This population is unique in many ways from their predecessors in that many have a strong internal locus of control, as well as higher expectations. They are also technologically savvy and independent, and they also have the dubious distinction of having one of the highest divorce rates. This means that the aging Baby Boomers are more likely to be single but maintain close social bonds with friends and family who are dispersed throughout the world. (Kopec, 267) Patients with Parkinson’s disease prefer to grip or hold onto something. This is important within design because designers can use chairs with armrests that can be gripped, including rails or grab bars where people are forced to stand in line, and including items with large knobs that can be more easily grasped when a person experiences tremors. (Kopec, 142)
Family
Stress
Control
Old Eyes
Wander
visual privacy
Design Process for Infusion Center Research Mission Inspiration Concept Adjacency Matrix
Design statement The infusion healthcare center will be a balanced space between an open area and a comfortable alcove with natural elements. The contrast between textures and patterns will harmonize with organic shapes. This will help create a healing environment and provide patients a pleasant experience during their treatment.
Bubble Plan Block Plan Floor Plan Ask for critique The use of natural materials and natural geometries, such as fractals and curves, can be highly evocative. Meanwhile it satisfies biophilic design needs. Direct experience of nature includes: light, air, water, plants, landscape, and weather. Indirect experience of nature includes: image of nature, nature material, natural color, mobility and wayfinding, simulating nature lighting and air, naturalistic shape and forms, information richness, and biomimicry‌experience of space and place includes: prospect and refuge, organized complexity, integration of part to wholes, and transitional spaces. Both direct employ (plants) and indirectly (grill work that mimic organic forms) strategies can achieve successful biophilic effect. (Kellert)
Design Process for Infusion Center Research Mission Inspiration Concept Adjacency Matrix Bubble Plan Block Plan Floor Plan Ask for critique
Design Process for Infusion Center Research
Solution
Mission
WAYFINDING
Inspiration Concept
Solution of wayfinding: -If a person is disoriented within a community, he/she can look for cues from street signs, landmarks, or sounds. Within institutional environments, however, orientation cues are usually smaller and much less familiar; this can lead to difficulties in wayfinding. -Material and color can immediately define the space for visitors, it can give visitors their first impression. Is this a safe and welcoming space or just a cold institutional building. (Kopec, 259) -Use wayfinding method at airport -- “Approach of progressive disclosure�. This method shows patients where they need to go next.
Adjacency Matrix Bubble Plan Block Plan
Three-dimensional sign
Large sign with different colors
Floor Plan Ask for critique
Rhythm created by organic shape to lead a direction
Healthcare facilities are replacing outdated carpet, falling vinyl or looking for a way to extend the life of concrete floor. High performance coating systems offer many benefits. They are seamless to achieve pathogen control. Due to bacteria and viruses medical facilities adhere to stringent cleaning and sanitation regiments that can damage many types of flooring. High performance coding systerms can be impressively resistant to these. The benefits also include reducing physical strain on workers and still offer mobility for wheelchairs. It can be made in custom colors and blends with logos and wayfinding messages. This flooring offers high performance and durability, environmentally compliant and sustainable, low maintenance and reduced maintenance cost. (Daukus)
A note of caution to designers on finishes and upholstery: The scientific community has known vinyl and rubber products to contain highly toxic carcinogenic compounds (phosphorous, arsenic, and antimony) since the 1960s, although the mainstream media and general population continue to behave as if they are unaware of the significant health hazards of these products cancer, liver failure, and endometriosis; Thornton, 2002), that are typically found covering our baby cribs, sofas, car seats, and entire football fields. Designers must therefore refrain from adding these materials into any health care environment because patients are more at risk due to longer exposure times to the chemical off gassing of vinyl or rubber. (Kopec, 269)
Sign on the floor
When considering safety and security issues within the wayfinding program, it is important to consider the following: 1. Clearly marked building evacuation routes 2. Locations of safe areas of refuge. 3. Exits leading to the outdoors 4. Configuration of the corridor system 5. Adequate lighting on and around directional signs 6. Placement of signs in areas where people expect to find them. There are three distinct zone types: 1. Unrestricted zones: might include spaces such as lobbies, reception areas, certain personal and administrative offices, and public meeting rooms. 2. Controlled zones: require a valid purpose for entry such as administrative offices, staff dining rooms, security offices, office working areas, and loading docks. 3. Restricted zones: sensitive areas limited to staff and individuals assigned to space within those areas. They include areas such as sensate record storage areas, control rooms, special equipment and other sensitive work areas. (Kopec, 148)
Design Process for Infusion Center CONTROL
Screen for visual privacy
Solution of control What do we do when we get injured outdoors? - We seek shelter, or a place that has visual access to wide open spaces but semi-enclosed to protect ourselves from bad weather and potential danger. -Since chemotherapy can lead to side effects of making patients feel extremely cold or hot. It will be ideal to have some level of thermal control for patients. -Patients need easy access to medical assistance.
Steelcase infusion chair has heated seating
Designers can provide specific living components that give residents greater control over their lives, such as layouts that allow them to move easily and freely throughout the environment. Feelings of autonomy can be increased by homey, inviting environments that provide various means for residents to increase physical strength, to decrease mental stressors, and to maintain social connections. Researchers recommend creating a non-institutional atmosphere that includes outdoor spaces, and advocate using rich colors to enhance social areas. In long-term care facilities, designers should consider incorporating residents’ personal objects into public spaces, providing opportunities for residents to enjoy agreeable aromas (from sources such as cooking, flowers, and herbs), and designing workspaces that enable residents to be involved in the facility’s daily operations (e.g., answering telephones) to give them a sense of inclusion and control. (Kopec, 263)
Digital screens have fireplace option or fish tank option
Patients who do not feel they have control may be more likely to have outbursts. Many illnesses and medications can alter a person’s behavior and in some cases cause that person to become violent toward medical staff, other patients, and himself/herself... Although there are many laws pertaining to the use of restraints by medical staff, the health care designer’s role is to simply ensure the least invasive provisions for environmental and physical restraints, as well as spaces and furnishings that would not hurt a patient who has temporarily lost self-control. …(Kopec, 260) Chairs with wide seats, and solid arms, or occasional small sofas maximize personal space and allow for a sick person to lean on and be comforted by a loved one. (Kopec, 269)
Design Process for Infusion Center Research Mission
FEELING
Inspiration
Solution of overall environment feel: -Get color inspiration from nature. Don't overuse color, and recognize that white space is not common in nature. -Use a variety of organic shapes, textures and patterns to mimic the rhythm of nature and create an interesting space. -Mimic nature, natural light, and nature sounds.
Concept Adjacency Matrix Bubble Plan Block Plan Floor Plan Ask for critique
Nature photograph with window frame
Wood can make the space feel warmer
Nature illusion created by tree sculpture Researchers recommend garden features that can be viewed or touched as a means to promote interaction among patients and health care workers. Some suggest that these natural spaces may be appropriate for areas where medical consultations and some treatments occur (Sherman et al., 2005). Roger Ulrich’s (1984a) findings indicate that psychologically appropriate artwork, such as nature scenes (especially those of water and trees), can also positively affect patient outcomes in an acute care setting by reducing blood pressure, anxiety, intake of pain medication, length of patients’ hospital stays (Friedrich, 1999), and sadness and depression. Gardens and other similar amenities tend to work best, however, when they allow for socialization or afford comfortable seating near views and sounds of nature (Sherman et al., 2005). Features might include fountains, shaded seating, garden paths, and secluded sitting areas. Patients in hospitals who have a view of pleasant landscapes outside their hospital room also have shorter postoperative stays, require lower doses of painkillers, and experience lower levels of stress. Conversely, nursing reports revealed more negative outcomes from patients whose hospital room had a view of a brick wall.” (Kopec,261-262) As part of the overall facility design, it is important to include visual access to surrounding garden spaces through the use of tinted windows or small private patio areas. Also sitting areas that allow an individual to view green spaces from both inside and outside the facility should be part of the designs programming. (Kopec,263) Provide a system to bring in soft soothing sounds that will help to take the patient’s mind off of his/her condition. (Kopec, 269)
Design Process for Infusion Center Research
Infusion Center Programming:
Mission
Main lobby with reception, check in, check out Waiting area for at least 15 people Administrative area with insurance office, scheduler, nurse manager, and office manager (6 people), small meeting area and copy/ office supplies 2 Additional lounge areas that maybe used for private waiting, family waiting, staff lounge, 3rd work area 25 Infusion chair with guest areas (semi private) 4 Infusion room 2 procedure room (also used as injection room) Nurse station near patients Lab with 2 blood chair 300 square feet 1 pharmacy 900 feet 2 consultation/ education room close to check-in and check-out. Boutique for patients and their advocates Café or nutrition center Nurse lounge Landing sites for oncology team
Inspiration Concept Adjacency Matrix Bubble Plan Block Plan Floor Plan Ask for critique
According to the brochure “What to Expect...a Guide to Cancer Infusion Therapy.”, patients should check their temperature on a routine basis. Patients and patients’ partners should not get pregnant during chemotherapy. Patients can stock up on items they may need at home after treatment such as: dressing supplies, medications, food and beverages. If hair loss is expected, it is a good idea to buy a wig. Staff lounges are an important aspect of a health care facility because they allow the medical staff to escape the high stress conditions associated with people who are ill. Also, because many medical staff personnel are required to work long shifts, these lounges should accommodate the ability of staff to take short naps. (Kopec, 270) It is important that medical staff be given spacious and comfortable lounges where they can converse with colleagues, read a book, speak with a friend on the phone, and so on. This should be done without the fear of invasion from a patient or a patient's family member. The goal is to provide the employee with a refuge from the stressors associated within his/her job. Within this sanctuary could be a library with Internet access to major medical journals and other publications. Libraries where employees can look up answers to questions they are unsure of contribute to the overall professionalism of the employee and the institution. Another consideration, is the provision of a secluded outdoor patio where staff can enjoy fresh air and sunlight, as well as the provision of food and dining areas for groups and small secluded single tables for a staff member to enjoy his/her meal in private. (Kopec, 272)
Design Process for Infusion Center Research Mission Inspiration Concept Adjacency Matrix Bubble Plan Block Plan Floor Plan Ask for critique
Flow
Design Process for Infusion Center
Bubble Plan In one study done by Walch et al., (2005), patients who had undergone elective cervical and lumbar spinal surgeries were either postoperatively admitted to a bright or dim side of the same hospital unit. Patients staying on the bright side of the hospital were exposed to approximately 46 percent higher intensity level of sunlight. These patients on average experienced less perceived stress and took 22 percent less pain medication per hour (Walch et al., 2005) A similar retrospective study of patients in a cardiac intensive care unit found that female patients stayed in the hospital an average of one day less when they recovered in rooms that received more sunlight (Beauchemin & Hays, 1998) Studies of institutionalized older adults, who are generally confined to their rooms with very little exposure to sunlight, suggest that several changes occur in brain chemistry and circadian rhythms, leading to depression (Sumaya, Rienzi, Deegan, & Moss, 2001). When researchers exposed depressed institutionalized adults to bright light treatment for 30 minutes per day for five consecutive days, they found that the patients' became less depressed and began to resume activities levels similar to that of their peers.(Kopec, 273) Clinical trials are underway at St. Francis Country House to evaluate the efficacy of using daylight – mimicking LEDs to stimulate human receptivity to the non-visual aspects of light to enhance cognitive functioning and improve healthcare outcomes for the older adults in residence there. Research has showed that individuals working in nature sunlight are more productive, more effective, and happier than those who work under the current generation of artificially generated lights…Natural changes in daylight synchronizes the body’s various circadian rhythms, which regulate all aspects of physiology and behavior, such as sleeping and eating patterns, brain wave activity and hormone production. Disrupting circadian rhythms can lead to jetleg, Seasonal Affective Disorder (SAD), delayed sleep phase syndrome (DSPS), and is implicated in various disease and disorders, including cancer. Furthermore the Council on Science and Public Health recognizes that exposure to excessive light at night, including ex¬tended use of various electronic media, can disrupt sleep or exacerbate sleep disorders, especially in children and adolescent. (Ellis, 275) Healing gardens mean green spaces in healthcare that specifically aim to improve health outcome. Healing gardens provide a place of refuge and promote healing in patients, families, and staff. Many studies shows that after a stressful event, images of nature very quickly produce a calming effect. Nature is fundamentally linked to our human spiritually. As experienced in New York and Philadelphia, gardening can transcend severe social problems to create a sense of community. It increases more neighborly connection and reduces vandalism. (Kreitzer)
Design Process for Infusion Center Research Mission Inspiration Concept Adjacency Matrix Bubble Plan Block Plan Floor Plan Ask for critique One of the more prominent safety concerns is the control of pharmaceuticals. Because drug abuse now spans all segments of society including physicians, nurses, and patients, the careful monitoring of pharmaceutical dispensaries and administration of medication are priorities. An innovative approach to this issue is dispensaries similar to vending machines that dispense appropriate medicine to the health care worker depending upon each patient’s medical needs. Of course each health care worker would have to log into the machine, thus providing a record of what medication was received, how much was administered, and for which patient. (Kopec, 260)
Patient use Family use Staff use
Design Process for Infusion Center
Design Process for Infusion Center Research Mission Inspiration Concept Adjacency Matrix Bubble Plan Block Plan Floor Plan Ask for critique
Design Process for Infusion Center Seating area in corridor and pathway: Providing a variety of seating to accommodate is significant contributor to improve social interaction. (Kim)
Window space in any building is limited and, therefore television screens can be added to the waiting room to augment limited window space. (Kopec, 269) According to the brochure “What to Expect...a Guide to Cancer Infusion Therapy.” During the treatment patient may surfer fever, burning or pain when urinating, diarrhea, vomiting, shaking and chill, unusual coughing. These potential symptom more restroom, seat heating and easy access to healthcare provider.
Considerations might include flat panel computer monitors with larger screens, ergonomically designed chairs and desks, adequate lighting levels, reduction in glare and air purification systems to reduce the inhalation of chemical cleansers and disinfectants, and flooring materials that provide some cushion for those who are on their feet all day (Rubber Flooring) (Kopec, 270)
Many windows. When people have a nonthreatening scene to look at, they can lose themselves in their thoughts, thus bringing down their anxiety levels; however, the designer should be aware of issues such as glare and solar gain, and make the necessary shading provisions.(Kopec,269)
Many people who go to emergency rooms have high levels of anxiety and can benefit from private spaces.(Kopec, 269) Edge rounded furniture can prevent and alleviate injuries when patient fall. (Kim) Handrail and guardrail in corridors and pathways are considered supportive factors for fall prevention in healthcare setting. (Kim) Grab bars in all health care environments, the provision for grab bars throughout the facility is highly recommended of today come in an assortment of colors and designs so they do not have to detract from the overall design of the facility. Instead, they can be used to enhance the overall environment. The diameter or width of the gripping surface of a grab bar should be 1-1/4 inches to 1-1/2 inches. The shape of the bar can deviate from the standard cylindrical shape, but the gripping surface should still be between 1-1/4 in to 1-1/2 inches. When grab bars are mounted adjacent to a wall, the grab bar must be at least 1-1/2 inches.(Kopec, 270)
Recognizable cues such as signs and colors for people to rely on while wayfinding should be selected with care. (i.e., a color scheme that is too dull, too bright, or too busy) In many environments the risk of injury from falling is a serious problem… Note, however, that even safety devices can be sources of risk to elderly people with canes and others who have poor depth perception; handrails and grab bars often blend into the background, which is especially problematic in bathing areas. (Kopec, 274) Easy access to care provider: Fall happened when patients were alone without observation or assistance. (Kim) Social environments with comfortable and moveable furniture provide an increase in elder’s social relationship as well as improve eating behaviors and psychological well-being. (Kim)
Sliding door: Inappropriate door openings have a negative impact on fall. (Kim) According to the brochure “What to Expect...a Guide to Cancer Infusion Therapy.” to get ready for treatment, patient should first review information and know resources before treatment starts. There will be a lot of information needs to review and choosing a care provider to support patient and information gather is recommended. It means an education room should be close to the entry and it should be capable for 2-3 people with large surface and digital screen.
Color tone, combination, proportion and placement is key in any project both from a visual perspective and for overall behavioral effects. In regards to assisted living for the elderly, one should apply an interior color palette that facilitates improved memory, independence, and comfort, and helps compensate for physical and cognitive losses. Color appear gray with shade variations are hard to see. (2015 design trends: design for an aging population) Therefore my design will use bright color in wayfinding and natural color for sooth and calm patient.
Wayfinding Control Feeling other
Design Process for Infusion Center Research Mission Inspiration Concept Adjacency Matrix Bubble Plan Block Plan Floor Plan Ask for critique Oftentimes people who visit emergency rooms are bleeding, vomiting, or incontinent; therefore, flooring and upholstery materials should inhibit absorption and be easily cleaned Chairs. (Kopec, 269) Another design challenge lies in the selection of surface materials. Materials and adhesives that peel, flake, or crack creates maintenance issues as well as potential for harm (Sloaneet al., 2002). All finishes should be durable and functional for the space. Details such as door frames, casework, and finish transitions must be designed and installed to avoid the potential for dirt accumulation. Areas with hard-to-clean crevices and joints should be avoided, and new antimicrobial surfaces might be considered for appropriate locations; however, it should be noted that antimicrobial surfaces by themselves are not a solution to infections rates. (Kopec,273)
*no sinks (25 feet between sinks) *Material not appropriate (the mash of screen) *Extra-large restroom for patients *Closed conference room for oncology team and nurse station *Waiting area needs to be close to lab and the infusion chairs *Be aware of entry should not be behind furniture *Pharmacy with regular shape *CafĂŠ should not open or close to infusion chair
Design Process for Infusion Center
SteelCase campfire screen: Mesh is not qualified to use in healthcare center
Lumicor: Coastal + Cameo* is a better option
Inhibits microbial growth
Easy to install
Class A fire rating
Minimum 40% recycled content
Durable finish
Design Process for Infusion Center
MEETING ROOM INFUSION CHAIR
3RD WORK STATION
BOUTIQUE
REST ROOM
PRIVATE PRIVATE PRIVATE INFUSION INFUSION INFUSION NURSE STATION
WAITING AREA PRIVATE INFUSION
PRIVATE ALCOVE REST ROOM INFUSION CHAIR
PROCEDURE MECHANICAL ROOM
LAB
PROCEDURE
CAFE OFFICE EDUCATION WAITING AREA CONSULTATION ENTRY
FRONT DESK
PHARMACY
Design Process for Infusion Center
Design Process for Infusion Center Anonymous, “Nature-Based Design: The New Green Research Summary ” Herman Miller, Inc. Zeeland, Michigan Anonymous, “2015 design trends: design for an aging population” Print. Anonymous, “Hospital Wayfinding and the Anxiety Factor.” Healthcare Design. Ed. Kristin D Zeit. 6 Feb. 2014. Web. 1 Dec. 2015. Anonymous, “What to Expect...a Guide to Cancer Infusion Therapy.” Print. Daukus, Sophia. “How Flooring Supports the Needs of Today’s Medical and Healthcare Facilities.” Healthcare Facilities Today. 12 Aug. 2015. Web. 5 Dec. 2015. Ellis, Eugenia V, Elizabeth W. Gonzalez, David A. Kratzer, and Donald L. McEachron. EBD Using Daylight-Mimicking LEDs for Improved Health Outcomes in Older Adults at St Francis. Drexel U, Philadelphia, Pennsylvania Philadelphia U, Philadelphia, Pennsylvania. 275. Print. Kellert, Stephanie R. “What Is and Is Not Biophilic Design.” Biophilic Design (2015). Metropolismag. Web. 1 Dec. 2015. Kim, Daejin, Jae Hwa Lee, and Mikyoung Ha. “Exploring Perceptions of Designers and Medical Staff in South Korea about Design Elements for the Elder-Friendly Hospital.” Journal of Interior Design 39.4 (2014): 15-32. Wiley Online Library. Interior Design Educators Council. Web. 1 Dec. 2015. Kopec, David Alan. “Health Care Environments.” Environmental Psychology for Design. 2nd ed. New York: Fairchild, 2012. 103 Print. Kopec, David Alan. “Health Care Environments.” Environmental Psychology for Design. 2nd ed. New York: Fairchild, 2012. 136 Print. Kopec, David Alan. “Health Care Environments.” Environmental Psychology for Design. 2nd ed. New York: Fairchild, 2012. 148. Print. (2) Kopec, David Alan. “Health Care Environments.” Environmental Psychology for Design. 2nd ed. New York: Fairchild, 2012. 148. Print. (2) Kopec, David Alan. “Health Care Environments.” Environmental Psychology for Design. 2nd ed. New York: Fairchild, 2012. 261. Print. Kopec, David Alan. “Health Care Environments.” Environmental Psychology for Design. 2nd ed. New York: Fairchild, 2012. 261-262. Print. Kopec, David Alan. “Health Care Environments.” Environmental Psychology for Design. 2nd ed. New York: Fairchild, 2012. 263 Print. (2) Kopec, David Alan. “Health Care Environments.” Environmental Psychology for Design. 2nd ed. New York: Fairchild, 2012. 258. Print. Kopec, David Alan. “Health Care Environments.” Environmental Psychology for Design. 2nd ed. New York: Fairchild, 2012. 259. Print. Kopec, David Alan. “Health Care Environments.” Environmental Psychology for Design. 2nd ed. New York: Fairchild, 2012. 260. Print. (2) Kopec, David Alan. “Health Care Environments.” Environmental Psychology for Design. 2nd ed. New York: Fairchild, 2012. 261. Print. Kopec, David Alan. “Health Care Environments.” Environmental Psychology for Design. 2nd ed. New York: Fairchild, 2012. 267. Print. Kopec, David Alan. “Health Care Environments.” Environmental Psychology for Design. 2nd ed. New York: Fairchild, 2012. 269. Print. (7) Kopec, David Alan. “Health Care Environments.” Environmental Psychology for Design. 2nd ed. New York: Fairchild, 2012. 270. Print. (3) Kopec, David Alan. “Health Care Environments.” Environmental Psychology for Design. 2nd ed. New York: Fairchild, 2012. 273. Print. Kopec, David Alan. “Health Care Environments.” Environmental Psychology for Design. 2nd ed. New York: Fairchild, 2012. 273. Print. (2) Kopec, David Alan. “Health Care Environments.” Environmental Psychology for Design. 2nd ed. New York: Fairchild, 2012. 274. Print. Kreitzer, Mary Jo. “What Are Healing Gardens? | Taking Charge of Your Health & Wellbeing.” Taking Charge of Your Health & Wellbeing. Web. 5 Dec. 2015. Lent, Tom. “Next-Generation Materials for Healthy Hospitals.” Healthcare Design. 2006. Web. 1 Dec. 2015. Rivas, Anthony. “Having A Sense Of Control Over One’s Life Leads To Longevity, Especially In The Uneducated.” Medical Dairy. 8 Feb. 2014. Web. 1 Dec. 2015.