Architecture + Cancer by Austin Miles

arChiteCture

CanCer

An Architectural Inquiry of Cancer Care Centers

PRojECT DIRECToR P a u l hi rz el Professor of Architecture

PUBlICATIon TEAm Ke v in h a l l Graphic Design

Ke l s e y J a n c o l a Editor

Ka the rin e K n u ts o n Editor

au s tin M i l es Graphic Design

ÂŠ 2016 All rights reserved. Reproduction in part or whole is prohibited without written permission. Published By The Graduate Architecture Design Studio School of Design and Construction Washington State University, Pullman, Washington 99163-2220 509.335.1373 Cover Image_ Prostate cancer development from healthy cell structure to cancerous cell structure. (D.F. Gleason M.D, 2008.)

Architecture + Cancer

In Memory of Dina Radjabalipour

Architecture + Cancer

ContentS 00

i n tro d u c tio n

Paul Hirzel

healing Light

Kelsey jancola + Katherine Knutson

Wetl a n d s + Ca nc er trea tm en t

Ratana Suon

th e h ea l i n g Po wer of tree s

h e a l i n g G ard en s

50 Samantha Buchman + Emma Gaulke-janowski 64

Stephanie Chimonas + jay Henson II

05 06

i s o l ati o n + Sc al e

William Bilyeu + jannita Bolin

Fis h Watc hi n g

Irene Arzaga + leah Engelhardt

Whe re are Yo u ?

112

Kevin Hall + Austin miles

ha v e a Se a t, h a v e a L a u g h

132

Gerik Dobes + Cody jones

09 10 11

ap p e n d i x : D. ra d j a b al ipo u r

150

Architecture as a Contributor to Healing

Stu d i o Con tribu to rs

152

Graduate Studio 2016

Ded i c ati o n s

Table of Contents

154

intro DuC tio n Architecture + Cancer Paul Hirzel_ Professor + Cancer Survivor

The impetus for this graduate studio project began 2 years ago when a graduate student named Dina Radjabalipour started a research and design project to improve cancer treatment architecture - Dina had been diagnosed with breast cancer during her first year of graduate studies and had to leave school for both chemotherapy and radiation therapy. Unfortunately the treatment environment that she experienced was more a place of despair than hope. The cancer center was filled with blank walled rooms with glaring fluorescent light fixtures, vast areas of vinyl flooring, and the disorientation and fatigue of noisy, long, maze like hallways (See fig. 0.1). Sitting in a windowless infusion room for hours with an IV in her arm left her weak and depressed. Courageously, she ultimately returned to graduate school after treatment in search ultimately of design strategies that could potentially improve these personally debilitating environments. Tragically, her cancer returned during this effort and she passed away in April of 2015 with her work incomplete. This 2016 studio is dedicated to continuing her efforts and endeavors to find new solutions to remedy the negative qualities she experienced – to discover design strategies to create what architect Charles jencks calls “an architecture of hope” (See fig. 0.2). Charles and his wife maggie (who died from cancer in 1995) are noted for their creation maggie’s Centres – special places of support for cancer patients. This research and design effort has great relevance as the demand for new cancer treatment facilities continues to expand. According to the national Health Care Institute approximately 580,000 people in the US died from Cancer in 2014 (second only to heart disease). more than 1.6 million people are diagnosed each year - nearly 1 out of every 2 people in the US will be diagnosed with some form of cancer in their life time. This large number of cancer cases has increased the number of new treatment centers two fold in the last decade. It is critical, that as we design and build these new centers, that their architecture and surrounding landscape employ the best possible environmental strategies - to create places of healing and hopefulness ----versus disease and despair. Building on Dina’s research, the 2016 Studio searched current literature on correlation between architectural qualities and their potential healing

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effects. A case study project of an existing standalone cancer treatment facility in Beloit, Wisconsin was chosen as a typical facility to compare and contrast with nine proposed new facilities (with same program requirements) each focusing on a particular environment quality that has been shown to improve healing. At approximately 20,000 square feet it represented a mid-size ambulatory facility with chemotherapy and infusion, advance radiation therapy, and medical oncology (See fig. 0.3).The eight chapters which follow explain and illustrate the resultant design proposals: Kelsey Jancola + Katherine Knutson bring daylight into the healthcare environment in new and provocative ways. Ratana Suon mixes the twin potential of water and care through the creation of a wetland wedded with a healthcare facility. Samantha Buchman + Emma Gaulke-Janowski show the power of wood (and forests) to heal. Stephanie Chimonas + Jay Henson II explore remarkable benefit of healing gardens– bringing the sounds (and views) of water and vegetation into patient rooms. William Bilyeu + Jannita Bolin find a new important mixing of community with cancer care and how important domestic scale can be to treatment centers. Irene Arzaga + Leah Engelhardt discover new combinations of building types. In response to the importance detractors to cancer treatment (seating for hours in chair), they explore how combining an aquarium and treatment center can benefit both fisheries research and the mesmerizing, soothing observation of fish. Kevin Hall + Austin Miles research the significance of wayfinding and how it can calm the stresses of disorientation. Cody Jones + Gerik Dobes challenge the aesthetic of infusion furniture with humor – showing that all the code requirements for hygiene, safety, and maintenance can be met and still bring a smile of hopefulness. In closing, it is our hope that this effort will provoke greater imagination in the design of new care facilities. And that Dina’s first steps toward a better world for cancer treatment will continue to be carried forward.

Infusion Center

Windowless Infusion Room

0.1_ Dina Radjabalipour treatment experience: Chao Comprehensive Cancer Center, orange, California (Radjabalipour, 2014).

0.2_ maggie Center Glasgow, UK_ (omA, 2006).

0.3_ Beloit Cancer Center, Beloit, Wisconsin (PRA, 2016). Introduction

hea L in G LiG ht Kelsey jancola + Katherine Knutson

1.0_ Image courtesy of lowe, 2014 10

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abStra Ct In an era when more time is spent indoors than any other point in history, making the interior of spaces healthy and comfortable is critical, especially in regards to daylight (lam, 1977 and Health Benefits, 2016). not only are there physical health benefits, it has been proven that people work better and are less stressed in areas of natural light verses those which lack proper daylighting (Heerwagen, 2001). This chapter will analyze the impact of natural light on health, and how this can relate to the design of healthcare centers, specifically that of cancer treatment. The quality of light as an architectural medium will also be discussed - how daylight influences someone’s healing experience, based on the program layout, site analysis, and building skin systems. Current examples of treatment centers such as the Beloit Center in Wisconsin and Yaktman Children’s Hospital in Park Ridge, Illinois, will be critically investigated to see how they can be improved. It is predicted that by designing a roof and skin system that edits and accentuates daylight, that a healthier healing environment will be created - recovery time will be reduced and quality of life will be improved.

“Light is only one of the many aspects of architecture. But light reveals the building, its intentions, its place, its form, its space, and its meaning. Light reveals architecture and, in the best instances, architecture reveals light.” - Marietta S. Millet (Millet, 1996)

Healing light

H3C CH3

CH3 CH3

CH2 HO 1.1_ Chemical structure of Vitamin D3

1.2_ Reception of light through Retina (Sharper Vision Centers, 2016)

the bo DYâ&#x20AC;&#x2122; S reSPonSe to D aY L iG ht Biologically, daylight affects human bodies in two ways. First, light passes through the retina of our eyes, allowing visual perception of a space and affecting our metabolism and our endocrine and hormone systems. Second, it interacts with our skin by way of photosynthesis and produces vitamin D (See Fig. 1.1) (Boubekri, 2008). Psychologically, daylight provides humans with a continuing relationship with the built environment and the outdoors as well as a reassuring orientation as to place, time, and weather (Evans, 1981 and lam, 1986). It offers a sense of spirituality, openness, and freedom from the prison-like confinements and intensity that typically characterize windowless spaces (Edwards and Torcellini, 2002). It is also able to affect mood and

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reduce occurrences of depression, anxiety, and stress, and increase levels of productivity in the workplace by as much as 25% (millet, 1996 and Boubekri, 2008 and Dirckinck-Holmfeld, 2007). Because of this, on both biological and psychological levels, daylight is vital for human health and well-being (See Fig. 1.2) (Velux, 2007).

1.3_ Daylight through Pantheon oculus emulating Roman use of sunlight (The History Hub, 2016)

Fig.1.4_Heliotheraphy through sunbathing (less Complicated, 2016)

Da YL iG ht a S a hea L in G Me D iu M Throughout the history of human existence, sunlight has often been widely recognized as a source of healing and health. Known examples of heliotherapy (using the sun as a therapeutic medium) date back to ancient Egypt. For example, the Ebers Papyrus, one of the oldest surviving Egyptian medical texts, recommends the use of sunlight as medicine (Hobday, 2007). In the classical era, ancient Greek physicians recommended people expose themselves to unclad sun rays. Romans utilized solaria and sunbaths for a wide range of diseases (See fig. 1.3)(Bloch, 1990). Skylights were also widely implemented as a means of introducing additional daylight indoors (lam 1986). In the nineteenth century, following the research and work of

Scandinavian physician niels Ryberg Finsen, heliotherapy was applied as treatment to diseases such as tuberculosis, smallpox, lupus vulgaris, and rickets (See Fig. 1.4) (Bloch, 1990). Around the same time, British nurse Florence nightingale, known as the pioneer of modern nursing, advocated for high levels of natural light in hospitals, saying “Direct sunlight… is necessary for speedy recovery” (Hobday, 2007).

Healing light

1.5_ Example of typical flourescent lighting (Bio Star lighting, 2016)

87%

1.6_ Percentage of what environments the average person spends their time in

t he F L uo reSCent Dar K a Ge S Access to natural light and heliotherapy, especially within healthcare settings, abruptly vanished after World War II when the invention of the fluorescent light bulb reduced daylight to no longer being a critical design element (Hobday, 2007). As described by architectural lighting consultant and professor William lam, “since then, sunlight in architecture has generally been ignored or treated as a problem rather than an opportunity” (lam, 1986). As a result of these “fluorescent dark ages”—a term coined by University of Cambridge professor nick Baker—many people’s daily exposure to sunlight is far under the amount that is recommended (Schoof, 2015). In a study done by Health Benefits, it was found that 87% of most peoples’ lives are spent indoors, with 6% inside a car, and only 7% being outside (See fig. 1.6) (Health Benefits, 2016). It can be said that most people interact with artificial environments more than the natural environment, as most of our time is spent

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under artificial, linear fluorescent lighting instead of sunlight (See fig. 1.5). Specifically in health care outpatient facilities, 86% of lighting consists of linear fluorescent tubes (Energy Characteristics, 2007). This type of lighting has been proven to cause negative health effects such as headaches, eye strain, drowsiness, sleep deprivation, and even mood disorders (Energy Rating, 2015). While modern humans are most often exposed to artificial lighting, a 1986 daylighting preference study by Heerwagen and Heerwagen evaluated whether daylighting or artificial lighting was preferred for overall health benefits and psychological comfort. In every instance, people valued daylighting 50% more than artificial lighting (Heerwagen, 2001). In many situations, our biology and our society appear to be in serious opposition, resulting in damaging consequences to our health (Foster and Ronneberg, 2008).

1.7_ Hospital room overlooking brick wall

1.8_ Hospital room overlooking trees

reCo Gnizin G the qua L it Y o F Da YL iG htin G only in more recent years have efforts been made to reevaluate our attitude towards lighting design. In 1984, a study by Roger S. Ulrich found that patients with hospital rooms which have windows with views of natural scenery have shorter hospital stay times than patients with views of a brick wall (See Figs. 1.7, 1.8) (Ulrich, 1984). The most significant impact of this study is not simply that patients recover faster with access to natural light, but that they recover faster with access to stimulating and dynamic natural light environments. on its most basic level, light is necessary to see. However, through deeper investigation it becomes apparent that the potential quality of light is more significant than simply measuring its quantity and that there is a clear deficiency of building codes in regard to daylighting (Evans, 1981 and Boubekri, 2008). For example, US regulations on hospitals only require windows be provided in rooms where patients stay for more than 23 hours

(Edwards and Torcellini, 2002). While contemporary guidelines treat windows as simple ‘vision strips’ whose only function is to allow a view out, it is equally important to consider both the quantity and quality of light which infiltrates inwards into a space (Evans, 1981). As described by architect Craig Dykers… “light allows us to understand our world by making things visible and by giving us an idea of space and time... The body and the mind interacting with light is one of the sensory conditions that every architect has to contend with if the buildings we create are to foster well-being.” (Dykers, 2015)

In order to rectify current lighting shortcomings and achieve worthwhile spaces, we must first recognize the importance of quality and variety in exposure to natural light and its healing capabilities. only then can we truly create healthy environments. Healing light

1.9_ Kimbell Art museum showing daylighting techniques (Kimbell Art museum, 2016)

1.10_ Kimbell Art museum section diagram (Pinterest.com, 2016)

Cha LL enGin G Da YL iG htin G norM S_

b rin G in G L iF e to L iG ht

CO NT R A DICT IO NS IN DAYL IG HTING DESIG N

T HE KIM BEL L ART M USEUM

In many cases, modern building designs are content to limit their lighting design to just one evaluation: no light or bright light. As described by Architect and Professor William lam, “because it is difficult to judge the quantity of light, lighting design must be based on what one is able to perceive and what one wants to look at—the quality of the luminous environment” (lam, 1986). It is important to note that improvement of lighting conditions does not imply a simple increase in illumination level, and brighter is not necessarily better. Rather, quality is the key to good lighting and a small improvement in the quality of the luminous environment produces better visual performance than a large increase in intensity (lam, 1986 and lam, 1977). The imperative mission is therefore to investigate these qualities and capabilities of daylight in the built environment.

one major architect who accomplishes such investigations into the quality of light is louis Khan. For example, in his Kimbell Art museum, he utilizes the diffusion capabilities of light scoops (See Fig. 1.9 and 1.10) to create an atmosphere which is hailed as being a masterpiece of intuitive daylighting design. To quote architect and author Benjamin H. Evans, “louis Khan has been called the ‘poet of lighting’ because of his sensitivity to the value of daylight in building design and the Kimbell Art museum is the epitome of all in daylighting design that is good” (Evans, 1981).

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1.11_ Interior atrium of Yaktman Children’s Hospital depicting emphasis on daylighting (Crisp, 1998)

1.12_ Yaktman Children’s Hospital showing a typical hospital layout with no consideration for daylighting needs (Crisp, 1998)

T HE YAKTM AN CHILDR EN’S HO SPITA L

UNDERST ANDING T HE QUALITY O F DAYL IG HT

This is in stark contrast to what is most commonly found in contemporary lighting design: a focus on daylight in a single major point of circulation or gathering at the expense of all other areas. The Yaktman Children’s Hospital in Park Ridge, Illinois serves as an ideal example of this paradigm. Its entry pavilion features a three story tall atrium with a sky lit ceiling and a spiral constellation of lights (See Fig. 1.11). However, it appears that all consideration for daylighting design was set aside in its inner corridors and rooms ( See Fig. 1.12) (Crisp, 1998).

The severity of disagreement in these two attitudes represents the contradiction between what daylighting design should strive to become and what it frequently settles to be. The major shortcoming of ordinary approaches to daylighting is that they fail to consider the various idiosyncrasies and qualities oaf light which can possibly be achieved. These qualities are derived from elements such as orientation, time of day, environmental conditions, and perceived intensity (Evans, 1981).

Healing light

1.13_ Sunlight orientation Diagram: north light tends to be softer and cooler, as well as more uniform. South light tends to be more intense and variable.

1.14 Sky cover diagram from left to right: Partly cloudy sky (bright and diffused light), overcast sky (dark, bright, and diffused light), and Clear sky (bright light).

env ironM enta L Co nDitio nS As the sun moves across the sky, it creates a variety of daylight qualities relative to its orientation. At sunrise and sunset, or in East and West directions, daylight typically exhibits high levels of intensity and direct ray paths. During midday, north- and South-facing daylight is known to be a soft, diffused, and uniform condition (See fig. 1.13) (Evans, 1981). Further impacting the perceived quality of daylight is the relative position of the sun in the sky. The position of the sun is measured by its azimuth and altitude - the position angle along the horizon and above the horizon, respectively. These relative positions are dependent on the lattitude and longitude of a site. For example, in Beloit, Wisconsin, the position of the sun is primarily south-facing and its summer sun is at a higher position in the sky than its winter sun (See fig. 1.15). 18

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Further impacting the perceived quality of daylight are overhead sky conditions. This is impacted principally by the sun’s changing position in the sky, but also by the presence of clouds, dust, and pollution. overcast skies, defined as having at least 9/10 of the total sky visually obscured by clouds, typically exhibit light which is diffused and steady. Partly cloudy skies exhibit qualities which are simultaneously intense and diffused and are constantly changing. Finally, clear skies produce light which is typically intense and direct (see figure 1.14). In total, as described by Evans, when these various qualities are transmitted into building interiors they are beneficial because they can “assist people in maintaining a continuing relationship between nature and the subtle biological forces at work in the subconscious mind” (Evans, 1981).

Altitude mAY

jUnE

jUlY

AUGUST

SEPTEmBER

oCToBER

noVEmBER

DECEmBER

1.15_ Sun path movements from 8am to 5pm (the working hours of the Beloit center) for each month of the year.

Sub J e Ctive nature o F D aY L iG ht_ As daylight is transmitted into building interiors, its quantitative properties are easily understood and measured. They are measured primarily in lumen (the total quantity of visible light emitted by a point source of one candle intensity) and foot-candles (the illumination produced by a source of one candle at a distance of one foot, equal to one lumen per square foot) (dictionary. com). While these quantitative properties have distinct and clearly defined

q ua Lita tive Pro P e rtie S

measurements, the dynamic and constantly changing nature of daylight make its subjective qualitative properties a difficult field of study with few, if any, established guidelines concerning its implementation or usage (Boubekri, 2008). To rectify this issue, this study will now attempt to establish a formal six-part index to assess daylightâ&#x20AC;&#x2122;s qualitative properties and guide future daylighting design endeavors.

Healing light

1.16_ linear Accelerator Room (3D City Inc., 2010)

1.17_ Creo Hall (Akira Sakamoto, 2016)

1.18_ The louvre Abu Dhabi museum (nouvel, 2012)

0 1 | no Da YL iG ht :

0 2 | Sha De D D a Y L iG ht :

0 3 | DaPP Le D D a YL iG ht :

<1 Foot-candle

1-30 Foot-candles

10-35 Foot-candles

Interior spaces which totally lack access to daylight demonstrate a correlation with increased levels of depression. In Greece and Rome, physicians called the mood associated with gloom and darkness â&#x20AC;&#x2DC;melancholiaâ&#x20AC;&#x2122; and associated such conditions with lethargy, sadness and despair (Hobday, 2007). Such spaces, are not recommended except for in places which require an absence of natural light.

Shaded spaces demonstrate strong contrasts between light and dark, referred to as chiaroscuro, and are able to achieve an increased understanding of volume and three-dimensionality (Encyclopedia Britannica). They play an important role in observation and can be soft or strong, sharp or diffused. Good shadows are pleasant to see, but bad shadows can destroy sensations of ambiance (Fontenelle, 2008).

Dappled daylight also demonstrates high levels of contrast and increased visual perception by occupants in a space (see shaded light description) (Encyclopedia Britannica). Studies have shown that daylight which passes through a dappled medium has potential to be stimulating, dynamic, and reduce patient hospital stays and healing time (Ulrich, 1984).

Da Y L iG htin G quaLitY in De X The aim of this index is to assess and correlate both the quantitative and qualitative conditions of daylight with respect to its varying visual intensities. It will provide a basic introduction to each intensity type but will not address their subcategories or issues such as color, materiality, artificial lighting, thermal properties, or window sizes. It is important to note that the foot-candle values assigned to each quality type (provided to gauge its visual intensity) were derived specifically from indoor conditions and were determined through measurements taken using the lux meter iPhone App (lux meter, 2015).

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1.19_ light Infused Photography Studio in japan (FT Architects, 2014)

1.20_ Brightly lit living Space (lissoni, 2015)

1.21_ 20 Fenchurch Street (Shirbon, 2015)

0 4 | DiFF uSe D D aY L iG ht :

0 5 | b ri Ght D aYL iG ht :

0 6 | bL in D in G Da Y L iG ht :

20-70 Foot-candles

70-1000 Foot-candles

>1000 Foot-candles

Diffused daylight is created through the use of large light-reflecting surfaces. Its presence creates qualities such as steadiness, consistence, softness, pleasantness, and minimization of visual noise (Evans, 1981). It is able to emphasize the three-dimensionality and shape of a space and, because its contrast levels are subtle and manageable, is often referred to as being ‘good light’ for a wide variety of programmatic needs (Sulonen, 2016).

on a hormonal level, bright light is responsible for the production of serotonin, the neurotransmitter which regulates psychiatric health and battles disorders such as depression, anorexia, bulimia, and social anxiety. Because of this, bright light can create environments of happiness (Boubekri, 2008). It is also known to boost productivity and alertness in task-based environments and is highly desired in the workplace (Evans, 1981 and Boubekri, 2008).

Spaces which exhibit blinding light quickly become uncomfortable on both a visual and hormonal level. Blinding daylight causes interference with one’s visual perception and boosts the body’s production of cortisol, the stress hormone, to abnormally high levels. Such high levels have been linked to suppression of the immune system, depression, cancer, and Alzheimer’s (Boubekri, 2008 and lam, 1986). Because of its negative impacts on human health and visual discomfort, blinding light should be avoided when possible.

Healing light

1.22_ Exterior of Beloit Center (Beloit Health System, 2010)

1.23_ Interior of Beloit Center (Beloit Health System, 2010)

Curre nt b eL oit Can C er t re at Me nt Ce nte r The Beloit Cancer Treatment Center in Beloit, Wisconsin is an idealized case study on daylighting conditions in healthcare environments. The center is approximately 20,000 square feet, and houses radiation therapy, medical oncology, chemotherapy, and treatment rooms varying from private to group settings. (Beloit Health System, 2010). While the center is well known for its excellent care of patients and high quality instruments, it lacks any noteworthy daylighting techniques. As seen in figures 1.22 and 1.23, the Beloit center

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features many large window walls and while they allow in plenty of daylight, they fail to generate any quality of light other than brightness. Architect and author William lam addresses such an attitude in his book Perception and lighting as Formgivers for Architecture, saying “‘quantity’ of the luminous environment is something to mention, but not something for which quality should be sacrificed” (lam, 1977). It appears that the Beloit designers failed to consider this mindset, both on the exterior and interior of their building.

1.24_ Proposed redesign view from meadow.

BUIlDInG loCATIon on SITE

ConTInUoUS DATUm

GAllERY oF lIGHT

WAYFInDInG ToWERS

1.25_ massing development progression

Pro P o SeD treat M ent Ce nte r This proposed redesign of the Beloit center promotes quality of daylight as an architectural medium to facilitate a healing atmosphere. Based on the Ulrich study which demonstrated that patients with access to stimulating daylight environments healed faster, this design seeks to expand and utilize the adjacent forest as a daylight filtering medium to create a dappled effect (see fig. 1.24). The circulation of the treatment center is made to serve as a continuous datum, connecting a series of distinct programatic containers

which together create a gallery of each established lighting type (see fig. 1.25). The lighting index found on pages 11-12 provides a framework for these distinct types of lighting and attempts to reconcile the disconnect between quantity and quality. Such an approach will attempt to create a comfortable, pleasing and desirable environment for healing (lam, 1977).

Healing light

no DAYlIGHT <1FC

SHADED 1-30 FC

DAPPlED 10-35 FC

DIFFUSED 20-70 FC

BRIGHT 70-1000 FC

BlInDInG >1000 FC

1.26_ light Index of current Beloit center

0 1.27_ Site plan of current Beloit center

S ite Co M P a riS on_

Curre nt Ca n Ce r Ce nte r

The current Beloit Cancer Treatment Center contains little to no tree cover surrounding its programs. Because of this lack of trees in combination with its vast meadows, there is a resulting condition of bright light in nearly all directions and blinding light resulting from the nearby car dealership (see fig. 1.26 and 1.27).

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100

200

400

No Light <1 fc

no DAYlIGHT <1FC

SHADED 1-30 FC

DAPPlED 10-35 FC

DIFFUSED 20-70 FC

Shaded 1-30 fc

Dappled 10-35 fc

BRIGHT 70-1000 FC

Diffused 20-70 fc

BlInDInG >1000 FC

1.28_ light Index of proposed Beloit center

C B

Fig_ 1.24

C B

100

200

400

1.29_ Site plan of proposed Beloit center

Site Co M PariS o n_

P ro Po Se D Ca n Ce r Ce nte r

To remedy the current issues of overwhelming bright and blinding light conditions, the proposed redesign for the site would add to the adjacent forest to create dappled daylighting conditions in the main circulation datum and adjacent programs. Strategically placed meadows allow for some programs to receive bright, diffused, or shaded daylight depending on the light requirements. To facilitate entrance into the site, two roads have been

created. The north road would serve primarily as a staff entrance while the southern road would provide a direct entrance for patients and visitors. Additional trees were added between the Center and both parking areas and adjacent roads to minimize the blinding light of nearby parking lots, which provides a more tranquil entrance experience into the site (see 1.28 and 1.29).

Healing light

F L O O R PL AN COM PAR ISO N

no DAYlIGHT <1FC

SHADED 1-30 FC

DAPPlED 10-35 FC

DIFFUSED 20-70 FC

BRIGHT 70-1000 FC

BlInDInG >1000 FC

1.30_ light Index of current Beloit center

10 18

5 2

30 17

5 8

3 4

5 5

15 15

BEloIT CAnCER TREATmEnT CEnTER

16 4

8 26

20 13

5 12

11 8

IT CANCER TREATMENT CENTER ate Infusion rooms

15. Lab

8. Storage and clean room

23. Lockers

0 1.31_ Floor plan of current Beloit center

Da YL iG htin G quaLit Y_

Curre nt Cente r

Figure 1.30 above shows sunlight attributes currently found in the Beloit Cancer Treatment Center. Approximately 50% of the center has no access to daylight, 40% of the daylight is bright due to lack of shading or diffusion techniques, and the remaining 10% is blinding from the adjacent west facing pond reflections. There is a clear preference for daylighting characteristics only from the extreme ends of the proposed daylighting quality index, with none of the intermediate traits present.

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1. PRIVATE InFUSIon RoomS 2. SEmI-PRIVATE InFUSIon RoomS 3. GRoUP InFUSIon 4. nURSE STATIon 5. PATIEnT ToIlETS 6. PHARmACY AnD SUPPoRT RoomS 7.KITCHEn 8. SToRAGE AnD ClEAnInG Room 9. lIBRARY 10. WAITInG 11. RECEPTIon 12. WHEElCHAIR WAITInG 13. FInAnCIAl CoUnSElInG 14. AlTERnATIVE THERAPY 15. lAB 16. WoRK STATIon 17. WomEn’S WAITInG Room 18. oFFICE 19. molD 20. ConFEREnCE 21. BIomED 22. TElECom 23. loCKERS 24. STAFF Room 25. RECEIVInG 26. mECHAnICAl 27. EXAm Room 28. lInEAR ACCElERAToR 29. ConTRol 30. FUTURE CT

23 24

21 21 21 21 21 15 21 22 2

6 6

19 19 19 19 18 18 1919 1818 17 1818

16 15

C B

14 13

no DAYlIGHT <1FC

SHADED 1-30 FC

DAPPlED 10-35 FC

DIFFUSED 20-70 FC

BRIGHT 70-1000 FC

BlInDInG >1000 FC

1.32_ light Index of proposed Beloit center

C B 6. Ofﬁce

PRoPoSED CAnCER TREATmEnT CEnTER

1. WAITInG AnD RECEPTIon 2. ToIlET 3. WHEElCHAIR WAITInG AREA 4. WomEn’S SUB WAITInG AREA InClUDInG ToIlET 5. lIBRARY 6. oFFICE 7. SToRAGE, SoIlED AnD ClEAn 8. AlTERnATIVE THERAPY 9. lAB 10. WAITInG/ ConTRol Room 11. FUTURE CT SCAnnER 12. lInEAR ACCElERAToR 13. KITCHEn 14. SToRAGE 15. nURSE STATIon 16. PHARmACY 17. GRoUP InFUSIon Room 18. SEmI-PRIVATE InFUSIon Room 19. PRIVATE InFUSIon Room 20. ConFEREnCE 21. EXAm Room 22. STAFF Room WITH loCKERS 23. BIomED 24. TElECom 25. mECHAnICAl 26. RECEIVInG

11 2 10 9 8 7 6 2 6 4 3

5 2

2 1

100

1.33_ Floor plan of proposed Beloit center

Da Y L iG htin G quaLit Y_

Pro P o S eD Ce nter

Figure 1.32 above shows sunlight attributes of the proposed Beloit Cancer Treatment Center. Approximately 25% of the center would receive diffused daylighting through the use of light shelves as well as translucent screening and shading devices. 60% of sunlight entering the center will be dappled trees or vegetation. Bright light and no daylight areas each encompass 10% of the remaining spaces, with the residual 5% being shaded light. Each of these daylight types are based off of the recommended illuminance levels for the tasks occurring within these spaces (Guth, 2015).

Healing light

LIG HT Q UAL ITY COM PA R ISON

PRIVATE InFUSIon ooms

BlInDInG

BRIGHT

DIFFUSED

DAPPlED

SHADED

nonE

QUAlITY oF lIGHT: PRoGRAm mATRIX

lInEAR ACCElERAToR

SEmI-PRIVATE InFUSIon ooms

WAITInG Room

GRoUP InFUSIon oom

PATIEnT ToIlETS

nURSE se STATIon Station

FUTURE CT

PATIEnT ToIlETS oilets PHARmACY Pharmacy

BIomED

Kitchen KITCHEn

TElECom RECEIVInG

eception WAITInG/RECEPTIon

nURSE STATIon

ary lIBRARY

EXAm RoomS

oilets PUBlIC ToIlETS

SToRAGE oFFICES Ofﬁces

lABoRAToRY atory oom AlTERnATIVE THERAPY

ConFEREnCE Room

Women’s WomEn’SSub SUB Waiting WAITInG

mECHAnICAl

Doctors’ oFFICES Ofﬁces DoCToRS’

STAFF Room

oilets STAFF ToIlETS

1.34_ matrix Illustrating the relationship between program types and qualities of light in the current Beloit center

Da Y L iG htin G Matri X_

Current Ce nter

This matrix (above) illustrates the clear preference for bright or no daylighting in the current Beloit center. As seen above, there are no occurrences of any intermediate qualities of sunlight such as dappled, diffused, or shaded. It appears that only the quantity of natural daylight was considered in sacrifice of any potential quality or correlation to tasks performed within each space. “In place of the foot-candle—commonly used, but inadequate, since it is a measure of only the quantity of light—the [use] of a performance index which correlates with both quality and quantity [is] recommended”. (lam, 1977)

Architecture + Cancer

BlInDInG

BRIGHT

DIFFUSED

DAPPlED

SHADED

nonE

QUAlITY oF lIGHT: PRoGRAm mATRIX

ooms PRIVATE InFUSIon

lInEAR ACCElERAToR

ooms SEmI-PRIVATE InFUSIon

WAITInG Room

oom GRoUP InFUSIon

PATIEnT ToIlETS

seSTATIon Station nURSE

FUTURE CT

oilets PATIEnT ToIlETS Pharmacy PHARmACY

BIomED

Kitchen KITCHEn

TElECom RECEIVInG

eception WAITInG/RECEPTIon

nURSE STATIon

ary lIBRARY

EXAm RoomS

oilets PUBlIC ToIlETS

SToRAGE Ofﬁces oFFICES

atory lABoRAToRY oom AlTERnATIVE THERAPY

ConFEREnCE Room

Women’s WomEn’SSub SUB Waiting WAITInG

mECHAnICAl

Doctors’ oFFICES Ofﬁces DoCToRS’

STAFF Room

oilets

STAFF ToIlETS

1.35_ matrix Illustrating the relationship between program types and qualities of light in the proposed Beloit center

DaYL iG htin G Matri X_

Pro Po Se D Ce nter

This matrix (above) illustrates a wide distribution of daylighting types to be found in the redesign of the Beloit center. Each type of sunlight is correlated to a specific program based on the task demands. Both the quantity and quality of daylight were equally prioritized to generate stimulating and beneficial environments.

Healing light

Fig. 1.36_ Section A cut through proposed Beloit design depicting south facing program space and light catching towers.

Fig. 1.37_ Section B cut through proposed Beloit design hallway near radiation wing.

no DAYlIGHT <1FC

SHADED 1-30 FC

DAPPlED 10-35 FC

Fina L thouG ht S A survey by the American Institute of Architects in 2014 showed that only 32% of all general practitioners and 40% of all psychologists thought that indoor environments have an impact on the health of their occupants (Schoof, 2015). These shamefully low percentages demonstrate the root of the daylighting problem: most people simply do not considerate sunlight to be impactful on health. Even when attempts are made to study and understand daylight in architecture, its subjective nature makes it extremely problematic. As described by author and professor mohamed Boubekri, â&#x20AC;&#x153;Unlike electric lighting where the properties are static, the dynamic and constantly changing aspect of daylight, through interesting from a 30

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Fig. 1.38_ Section C through proposed Beloit design depicting tower space with bright light and adjacent kitchen.

DIFFUSED 20-70 FC

BRIGHT 70-1000 FC

BlInDInG >1000 FC

psychological point of view, has made daylighting a difficult field of study. The changing character of daylight from one minute to the next makes experimental investigations difficult because of concern over conditions of validity and replicationâ&#x20AC;? (Boubekri, 2008). Due to daylights ability to improve physical, psychological, and emotional well-being, there is a fundamental need to further research and establish guidelines for implementing the use of sunlight in architecture (millet, 1996). The capabilities of daylighting design must be advanced and made universal in order to improve the human experience, both within healthcare situations and overall. This index is therefore offered as a step in the right direction.

1.39_ Proposed Beloit design render showing wayfinding tower

Healing light

WorKS C ite D Bloch, mD, Harry. “Solartheology, Heliotheraphy, Phototherapy, and Biologic Effects: A Historical overview.” journal of the national medical Association 82.7 (1990): 517-21. Print. This article gave a detailed overview of the history of sun worship, and sun as a therapeutic medium over the ages. Boubekri, mohamed. “Daylighting, Architecture and Health: Building Design Strategies.” Architectural Press 1 (2008). Print. In this book on Daylighting, Architecture and Health, it describes strategies for building with daylighting, giving previous historical examples of buildings which emphasize daylighting. It then discusses the importance of vitamin D for humans, and touches on how lack of daylighting in buildings can impact one’s psyche. Bukhonov, Pavel. lux meter. Computer software. lux meter in Your Pocket! Vers. 1.3. App Store, 30 Dec. 2015. Web. 25 Feb. 2016. <http://softproekt.net/luxmeter/index.html>. The lux meter app was extremely helpful in determining the lux values for common spaces on campus, which then was used when determining the appropriate lux values when designing a new treatment center. “Chiaroscuro”. Encyclopædia Britannica. Encyclopædia Britannica online. Encyclopædia Britannica Inc., 2016. Web. 25 Feb. 2016 <http://www.britannica.com/art/chiaroscuro>. This encyclopedia provides a definition for the term chiaroscuro. Crisp, Barbara. Human Spaces: life-enhancing Designs for Healing, Working, and living. Gloucester, mA: Rockport Pub., 1998. Print. In Barbara Crisp’s book on human spaces, she identifies the need for humans to have life-enhancing spaces, which she identifies as healing or sustainable environments. She then describes designs that can begin to emulate these spaces, and that as humans we need more spaces that can balance, support, and nature the human spirit. Dirckinck-Holmfeld, Kim. “Framing Daylight.” Daylight & Architecture magazine By Velux Autumn 2007:6 1-7. Print. This article on Framing Daylight discusses the benefits of sunlight on human well-being and health. It further explains the negative health impacts on people who suffer from lack of daylight, and how daylight should be a philosophy that designers seek to live and create by. Dykers, Craig. “light or Dark.” Daylight & Architecture By Velux Autumn 2015:24 1-4. Print. Dykers delves into the history of sunlight, and how the architect needs to bring natural lighting into buildings if they are to foster health and well-being for their occupants. Dykers further stresses the importance of vegetation in regards to natural lighting for buildings. Edwards, l., and P. Torcellini. A literature Review of the Effects of natural light on Building occupants. Tech. Golden, Co.: national Renewable Energy laboratory, 2002. Print. This technical paper portray how daylighting is included in designs in different building types. Specifically, Edwards and Torcellini’s findings on daylighting in healthcare facilities was helpful when looking at the benefits of natural daylight in these spaces. Evans, Benjamin H. Daylight in Architecture. new York: Architectural Record mcGraw-Hill Publications, 1981. Print. In this book, Evans shows a perceptive understanding of the natural effects of daylighting designs, and provides illustrations of elements of good and bad design for architects to follow. He further seeks to depict how we can learn from past designs (pre- 1960’s), which had no choice but to incorporate the use of daylighting and how some of these strategies are still effective even today. Fontenelle, Ciro Vidal. “The Importance of lighting to the Experience of Architecture - the lighting Approach in Architectural Competitions.” Arkitekturskolan (2008). Print. In this article, it outlines the different properties of light through images, text, and illustrations. Frontenelle also lectures on the importance of light in a space, gives examples of architectural spaces that respond to light, and describes how it can completely change a space. “Foot-candle”. Dictionary.com Unabridged. Random House, Inc. 25 Feb. 2016. <Dictionary.com http://dictionary.reference.com/browse/foot-candle>. This dictionary provides a definition for the term foot candle. Foster, Russell G., and Till Ronneberg. “Human Responses to the Geophysical Daily, Annual and lunar Cycles.” Current Biology Spring 2008. Print. This article by Foster and Ronneberg discusses the seasonal, lunar and tidal cycles and how they regulate the biology on earth. This however is in stark contrast to our society, which is becoming increasingly separated from geophysical cycles and the environment. The article then reviews the importance of the natural environment on human health and living, and how the built environment is hindering this. lighting Design: Foot Candle Recommendations. Tech. Guth, 2015. Web. 25 Feb. 2016. <http://www.bristolite.com/interfaces/media/Footcandle Recommendations by Guth.pdf>. This source was used to match appropriate foot candle illumination levels with their corresponding program types. “Health Benefits - national Wildlife Federation.” Health Benefits - national Wildlife Federation. national Wildlife Federation, 1 jan. 2016. Web. 20 jan. 2016. <http://www.nwf.org/What-We-Do/Kids-and-nature/Why-Get-Kids-outside/Health-Benefits.aspx>. In “Health Benefits - national Wildlife Federation”, it discussed the health effects of children spending too much time indoors; including obesity, ADHD, and anxiety. The article further discussed the percentage of time people spend indoors versus outdoors. Heerwagen j. & Heerwagen D. “lighting and Psychological Comfort, lighting Design and Application.” journal of the Illuminating Engineering Society 30.1 (2001): 47-51. Print. In this study by Heerwagen and Heerwagen, it was found that in most instances, people prefer natural daylighting verses being under artificial lights. This is important to our argument as we want to design a building that caters to people’s daylight exposure. Hobday, Richard. “light And life From The Sun.” Daylight & Architecture By Velux Autumn 2007:6 9-15. Print. Hobday explains in this article the impact sunlight has on architecture, and how today many people choose not to be exposed to sunlight for fear of UV exposure. He further reviews the importance and consequences design can have without a careful understanding of the need for designing with natural lighting. lam, William m. C. Perception and lighting as Formgivers for Architecture. new York: mcGraw-Hill, 1977. Print. Perception and lighting as Formgivers for Architecture deals with topics relative to the process of visual perception, biological needs for visually appealing spaces to live and work in, the varying levels of different qualities of light, and finding order in the visual environment. lam, William m. C. Sunlighting as Formgiver for Architecture. new York: Van nostrand Reinhold, 1986. Print. This book outlines the importance natural lighting has on buildings, and how it should be more prominent in designs. lam further discusses many case studies of buildings and how the designs can improve, in addition to strategies and diagrams of the importance of natural light on spaces. “lighting and Health.” Energy Rating. 2015. Web. 11 Feb. 2016. <http://www.energyrating.gov.au/products/lighting/health>. This article discusses the impact of artificial lighting on people, and the side effects that can result from this. The article also goes into more depth on simple steps one can take to minimize UV light exposure from artificial lighting.

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millet, marietta S. light Revealing Architecture. new York: Van nostrand Reinhold, 1996. Print. This book inspires creative solutions to lighting in architecture, both physically and experientially. It further depicts how light is utilized in building design, and the built world as a whole. lastly, light Revealing Architecture summarizes the interaction between the individual and the environment. Schoof, jakob. “Towards A Healthier Indoor life.” Daylight & Architecture By Velux Autumn 2015:24 1-4. Print. The article Towards A Healthier Indoor life by jakob Schoof explains the history behind the way designers choose to include daylighting in buildings. He also calls for action in changing the way healthcare is perceived, and how healthcare buildings do not seem to cater to the needs of the patients. Sulonen, Petteri. light. CreativeCommons.org, 2016. Web. 25 Feb. 2016. <http://www.prime-junta.net/pont/Photography_lessons/g_lesson_6/_light. pdf>. This paper was extremely helpful in discussing the various qualities of lighting in regards to photography. It also provided images which also displayed these qualities of light. Ulrich, Roger. “View through a Window may Influence Recovery from Surgery.” American Association for the Advancement of Science 224 (1984): 420-22. Web. <https://mdc.mo.gov/sites/default/files/resources/2012/10/ulrich.pdf>. In Roger Ulrich’s study on View through a Window may Influence Recovery from Surgery, he performed a study over the span of a decade determining whether patients recover faster in hospital rooms with windows that look out at a garden or look out on a brick wall. His incredible findings were that patients recovered faster and with less medication whose rooms had windows facing the garden than those who looked out the window at a brick wall. “U.S. Energy Information Administration - EIA - Independent Statistics and Analysis.” Energy Characteristics and Energy Consumed in large Hospital Buildings in the United States in 2007. EIA.gov, 17 Aug. 2007. Web. 20 jan. 2016. <https://www.eia.gov/consumption/commercial/reports/2007/large-hospital.cfm>. The U.S. Department of Energy statistics are evaluated in this website, including the average percentage of the types of artificial lighting used in hospitals. This is relevant to our findings as it depicts the poor lighting that is abundant in many health care facilities across the country, and the lack of natural daylighting. Velux. “Velux Insight: learning Through lightness.” Daylight & Architecture By Velux Autumn 2007:6 3-7. Print. In this article, a school designed by White Design in Kingsmead, England was discussed as it portrays excellent daylighting strategies to ensure a pleasant learning environment and enabling the school to have ample energy savings. It furthermore discussed the louvre museum in Abu Dhabi by jean nouvel, and the exquisite daylighting strategies implanted in this building.

iM aGe SourC eS Figure 1.0: lowe, Bryan. out of a Far Country. 2014. Broken Believers. Wordpress.com. Web. 25 Feb. 2016. <http://brokenbelievers.com/2014/11/13/the-far-country/>. Figure 1.2: Understanding Your Eyes. 2016. Sharper Vision Centers, Torrance, CA. Sharper Vision Centers. Web. 27 Feb. 2016. <http://www.sharpervisioncenters.com/ understand_lasik.htm>. Figure 1.3: Pantheon. 2016. The History Hub, Roma, Italy. The History Hub. Web. 27 Feb. 2016. <http://www.thehistoryhub.com/pantheon-facts-pictures.htm>. Figure 1.4: Heliotherapy - Sun Bathing to Heal Various maladies. 2014. less Complicated, leysin, Switzerland. less Complicated. Web. 27 Feb. 2016. <http://www. lesscomplicated.net/health/heliotherapy-and-emperor-julians-oration-to-the-sovereign-sun>. Figure 1.5: US Toy/ Playthings office. 2016. Bio Star lighting, overland Park, KS. Bio Star lighting. Web. 27 Feb. 2016. <http://biostarlighting.com/led-light-projects/>. Figure 1.9: Kahn Films and Images. 2016. Kimbell Art museum, Fort Worth, TX. Kimbell Art museum. Web. 27 Feb. 2016. <https://www.kimbellart.org/architecture/ kahn-building/kahn-films-and-images>. Figure 1.10: Kimbell museum Section. 2016. Pinterest.com, Fort Worth, TX. Pinterest.com. Web. 27 Feb. 2016. <https://www.pinterest.com/pin/397583473330689636/>. Figure 1.11 and 1.12: Crisp, Barbara. Yaktman Children’s Pavillion. 1998. Park Ridge, Il. Human Spaces: life-enhancing Designs for Healing, Working, and living. Gloucester, mA: Rockport Pub, 1998. 172. Print. Figure 1.16: 3D CITY Inc. Architectural Visualizations lInAC Room. Digital image. Youtube.com. 3D City Inc., 6 oct. 2010. Web. 27 Feb. 2016. <https://www.youtube. com/watch?v=UFqm09mph78>. Figure 1.17: Akira Sakamoto Architect & Associates. Creo Hall. 2016. Toyama. World Architects. Web. 27 Feb. 2016. <http://www.world-architects.com/en/projects/ detail_thickbox/24373/plang:en-gb?iframe=true&width=850&height=99>. Figure 1.18: nouvel, Ateliers jean. The louvre Abu Dhabi museum. 2012. United Arab Emirates. Archdaily.com. Web. 27 Feb. 2016. <http://www.archdaily. com/298058/the-louvre-abu-dhabi-museum-ateliers-jean-nouvel>. Figure 1.19: FT Architects. light Infused Photography Studio in japan. 2014. Kanagawa, japan. Humble Homes. Web. 27 Feb. 2016. <http://humble-homes.com/ light-sheds-light-infused-photography-studio-japan/>. Figure 1.20: lissoni, Piero. Brightly lit living Space. 2015. miami, Fl. Entertainment Today. Web. 27 Feb. 2016. <http://www.entertainment-today.net/detail/47914piero-lissoni-plans-luxury-ritz-carlton-residences-for-miami-beach/>. Figure 1.21: Shirbon, Estelle. london’s “Walkie Talkie” Building. 2015. london. Domain.com. Web. 27 Feb. 2016. <http://www.domain.com.au/news/carbuncle-cuplondons-carmelting-skyscraper-voted-worst-building-of-the-year-20150903-gjdyey/>. Figure 1.22 and 1.23: Beloit Cancer Treatment Center. 2010. Beloiit, WI. Beloit Health System. Web. 27 Feb. 2016. <http://beloithealthsystem.org/cancer-center>.

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WetLanDS + CanCer treatMent Combining Wetlands + Cancer Care Centers Ratana Suon

Fig. 2.0_ Wetland and infusion room (Wisconsin Wetlands Association, 2016)

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abStra Ct â&#x20AC;&#x153;Depending on climate, the quality of light, geology, soil and a host of other factors, water can be reflective and moody, crystalline and sparkling, auditory and awesome. It is without question the supreme sculptor of our environment, and a seductive attraction of most wilderness areas.â&#x20AC;? Craig Campbell, an influential landscape architect and site planner (Campbell, 1978). Water can be included in the design heath of care environments for both aesthetic and practical purposes. It can be implemented in the form of a rain water collection garden, a hydroelectric power garden, an outdoor spa or a wetland. Each function has its own beauty and benefits. This chapter focuses on the benefits of one of these strategies wherein an existing cancer treatment center in Beloit, Wisconsin will be redesigned to include a wetland as research revealed that the physiography of Beloit is ideal for wetland construction. The soil consists of thick drumlin deposit, ground-moraine (till composed of sand and silt) which is often compact and impervious. The climate is warm and humid in the summer and cold in the winter with adequate precipitation. This design hopes to show the many benefits of wetlands being included in healthcare facilities: 1. as catchment areas, which collect and filter storm water runoff from the surrounding neighborhoods, 2. as habitats for biodiversity, 3. as opportunities for viewing water, vegetation and wildlife by cancer patients and healthcare staff. W

Wetlands + Cancer Treatment

50 100

200

Primary Road Secondary Road

Water flow direction main Entrance

Fig. 2.1_ Existing site plan of Beloit Cancer Care

Site as the catchment area Small pond Asphalt surface ImAGE

large hard surface

Site

Fig. 2.2_ Diagram illustrates adjacent hard surfaces.

eXiS tin G Site ana LYSiS The existing site plan has a small artificial pond at the southwest side of the building, which elongates along the infusion wing to allow views by cancer patients (See figs. 2.1 - 2.3).

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Fig. 2.3_ Zoomed in site plan of Beloit Cancer Care

5 inch 80 F 4 inch 60 F 3 inch 40 F 2 inch

20 F

0F Fig. 2.4_ Beloit Climate Data based on U.S. Climate Data

1 inch

jan

Feb

mar

Apr

Low

may jun High

jul

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Sep

oct

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Fig. 2.5_ Climate Data map showing physiography in Rock County, Wisconsin (Geology and Ground-Water Resources of Rock County Wisconsin)

ana LYSiS o F Ph YSio G ra P hY o F b eL oit Beloit has warm humid summers and cold, snowy winters. Its temperature and precipitation are slightly above the average for the State of Wisconsin. The average annual temperature is about 48 degrees Fahrenheit. The total yearly precipitation averages about 32 inches (See fig. 2.4). The growing season averages 175 days (from April 25th to october 16th). more than 60 % of the annual precipitation falls as rain during this growing season.

The average snowfall is about 30 inches, which is equivalent to about 8% of the average annual precipitation. The water table is 150 feet below the surface(Geology and Ground-Water Resources of Rock County Wisconsin) (See fig 2.5). This climate condition is favorable for a constructed wetland because the snow-melt and rain in the spring, summer and early fall provide a sufficient source of water.

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High precipitation is favorable for constructed wetlands Average annual snowfall 30 inches

Average annual precipitation 32 inches 60% comes from rain Compact soils slow down discharging speed which is good for wetlands Ground-moraine an irregular blanket of till (clay, sand and silt)

Glacial outwash

Land surface

Aquifer

ancestral Rock River Valley

Fig. 2.6_ Summary of Beloit climate and physiography

Fig. 2.7_ Quality wetlands in Southeast of Wisconsin ( Wisconsin Wetlands Association, 2016)

anaLYSiS oF nearbY WetLanDS Beloit is located in the ancestral Rock River Valley, which has been filled to a depth at least 396 feet with soil consisting of thick ground-moraine and drumlin deposit (Geology and Ground-Water Resources of Rock County Wisconsin) (See fig. 2.6). Ground-moraine consists of an irregular blanket of till deposited under a glacier. Composed mainly of clay and sand, it is the most widespread deposit of continental glaciers. The till is often compact and impervious and is favorable for a constructed wetland because it slows down discharging speed and creates inundated surfaces which provide habitats for wetland species. 38

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Because of farming practices, and suburbanization of Rock River Valley, many of the wetlands have been destroyed or filled in. The only remaining wetland areas in Beloit are located along the Rock River ,Turtle Creek and parts of 2 lakes near South Beloit municipal Park (See fig. 2.8). less than 8 percent of the total land area in Rock county is marshland or swamp. The closest quality wetlands are lulu lake ( in Walworth county) and Sugar River Flood Plain Forest ( in Green county) (See fig. 2.7 and 2.9).

Fig. 2.8_ Wetlands in Beloit (Google maps, 2016).

Wetlands

Fig. 2.9 _ Example of nearby wetland (Emmerich, 1999). lulu lake featuring wetland types sedge meadow, fen, low prairie, shrub car, and open bog (Wisconsin Wetlands Association, 2016).

Wetlands + Cancer Treatment

The flowering plants provide fragrance and rich color palettes year round. This quality is important to make wetlands attractive. Besides plant species, these two types of wetland bring birds, butterflies, dragon flies, squirrels and owls. These animals can benefit local peoples because dragon flies eat mosquitoes, birds produce soothing sounds, and butterflies and squirrels makes wetland scenes lively. last of all, they can be easily constructed. The other types of wetlands require a lot more time and money to build and are therefore less appropriate.

DWARF lAKE IRIS (cravillion, 2016).

HInEâ&#x20AC;&#x2122;S EmERAlD DRAGonFlY (mierzwa, 2016).

Fig. 2.10_ Ridge and swale wetlands (Carolyn morgen, 1997.) CAnADA WARBlER (Arniworks, 2016).

2.11_ Rare and specialized plants: Ridge-and-swale wetlands have dry sandy ridges which alternate with wet areas called swales. This type of wetland is extremely rare. These alternating dry and wet conditions provide for great diversity of plants and animals in a small area. They provide important habitats for the fourtoed salamander, northern flying squirrel, Canada warbler, and black-billed cuckoo as well as for many other migratory birds.

CRAYFISH BURRoW (grall, 2016).

The ridges sanctuary alone boasts nearly 500 plant species, including the rare and federally threatened Dwarf lake Iris that is unique to coastal habitats in the great lakes. It also supports endangered animals such as the Hineâ&#x20AC;&#x2122;s emerald dragonfly. noRTHERn FlYInG SQUIRREl (Ghosh, 2016).

BlACK BIllED CUCKoo (Burns, 2016).

Fig. 2.11_ Typical flora and fauna that can be found in ridge and swale wetlands.

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2.13_ Sedge meadow: Sedge meadows are dominated by wildflowers and grasslike plants called sedges. Sedge meadows often occur between upland and lakes, river and streams. This type of wetland serves as a home to three bird species commonly associated with sedge meadows: northern Harrier, American bittern, and sedge wren. It also houses butterflies, numerous reptiles, and insects.

noRTHERn HARRIER (northern Harrier, 2016).

TURTlEHEAD (purdue University, Fort Wayne, 2016).

BAlTImoRE CHECKERSPoT (Perry, 2016).

joE-PYE WEED (Dave’s Garden.com)

Fig. 2.12_ Typical flora and fauna that can be found in sedge meadow wetlands.

Fig 2.13: Sedge meadow wetland flora and fauna (Schatner, 2016.)

Dragonflies play a very important role in nature. They eat smaller flying insects, including mosquitoes, bitting flies and gnats. Dragonflies are an important food source for larger aquatic animals such as fish and they can add beauty to our world. Hines’s Emerald Dragonfly and Dwarf lake Iris are two species listed in the Wisconsin endangered species list and this wetland would serve to increase their population.

What WetLanD iS beSt For beLoit ? DeFinition_ “Wetlands are land areas that are periodically flooded or covered with water.” A wetland is defined by the U.S. Army Corps of Engineers (USACE) 1987 wetland manual as “ areas that are inundated or saturated by surface or ground water at a frequency and duration sufficient to support and that under normal circumstances do support, a prevalence of vegetation typically adapted for life in saturated soil conditions. Wetlands generally include swamps, marshes, bogs and similar areas” (lopez Richardo D. 2016).

beneFitS_ Carbon Cycling: Wetlands are significant carbon reservoirs and serve to alleviate global climate processes through sequestration and release of fixed carbon which is contained in standing crops of vegetation and in litter, organic soil and sediments. Wildlife Habitat: “Wetlands are reservoirs for biodiversity which have many links to human well-being.” Wetlands act as a home to fish, amphibians, various birds and certain mammals. Furthermore, many of the US breeding bird populations such as ducks, geese, woodpeckers, hawks, wading birds and many songbirds feed, nest and raise their young in wetlands. Wetland Ecosystem Regulating Services: Wetlands reduce flooding by

absorbing rain water and by slowing down the downstream flow of floodwater. Wetland Ecosystem Provisioning Services: many wetlands contribute to recharging groundwater aquifers. Plants, microbes and soils in wetlands effect local water quality by removing excess nutrients, sediments and toxic chemicals, thereby improving water quality for nearby humans and biota. Wetland Ecosystem Cultural Services: Wetlands have recreational, historical, educational, aesthetic and other cultural values that are held by the public. (lopez Richardo D. 2016). A valuable asset for Cancer Care Centers: wetlands improve viewing proximity to water, vegetation and wildlife for cancer patients and healthcare staff.

tYPoLoGieS_ There are many different types of wetlands such as fens and bogs, sedge meadows, forested wetlands, marshes and deep water wetlands, shrub thickets wetlands, and other rare specialized wetland types. Based on the above analysis, the most suitable wetland types for the Beloit Cancer Care Center are the sedge meadow type and ridge-and-swale type primarily because these two types allow native flowering plant species to grow.

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01: Cut out to create water catchment area

02: Cut and fill process to create landform similar to a ridge and swale wetland

03: Push up some parts of the edge of the site to create natural fence

04: Use hill to block direct views into the site

05: Smooth the edges

06: Put the longest facade along southeast and northwest axis to get natural sunlight

07: Create boundary for visitor parking

08: Arrange the building around the hill with loading dock, drop off area, service, and staff parking below grade.

Fig. 2.14_ Site Plan Design Process.

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Storm water runoff water

Fig. 2.15_ Illustration Diagram shows how runoff water from the neighboring area is collected

Existing

Proposed

Fig. 2.16_ new ponds collect runoff water from the neighboring areas.

We t LanDS Co nS tru Ction Wetland construction can be successfully done only on a site where conditions exist which can produce and sustain a wetland (See fig. 2.14). Consequently, creation is more difficult than restoration. A term commonly associated with wetland creation is â&#x20AC;&#x153;constructed.â&#x20AC;? A constructed wetland is a wetland created specifically for the purpose of treating wastewater, storm water, acid mine drainage, or agricultural runoff (Hammer, 1989). The most important factor to sustain constructed wetlands is the source of water (See fig. 2.15). There are three main sources of water for wetlands precipitation , ground water, and water moving across the surface.

To create sedge meadow wetland, efforts must be made to keep the site flooded seasonally, create water-logged soils, and control the spread of competing shrubs and trees. To create ridge-and-swale wetland, efforts should be made to use earthwork to create an uplifting hill or series of parallel ridges, create various depths of water levels, create water-logged soils to create inundated area, and strategically plant trees on dunes and prairies species in the created inundated areas (See fig. 2.16).

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Fig. 2.17_ Proposed Site Plan

Fig. 2.18_ Southeast Perspective View

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100

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Rooftop Garden

level 3

Stair case and Elevator laboratory, doctorâ&#x20AC;&#x2122;s office, toilets

Private Infusion Room

Stair case and elevator linear Accelerator with control

Future CT Scan level 2 Conference Room, Staff office, and support Room Group Infusion Room nurse station, exam rooms,and storage room

Pharmacy and support rooms Storage and Clean Room

mechanical Semi Private Infusion Room Alternative Therapy Room Staff and service parking Storage, Soiled room and toilets Reception level 1

Fig. 2.19_ Schematic floor plans

P ro P o SeD treat M ent Ce nter The building is elongated along the southwest and northeast axis in order to get natural sunlight. large windows are strategically placed to maintain outlooks to the adjacent wetlands and provides patients with aesthetically pleasing views (See figs. 2.17-2.18). The flat terraces were turned into rooftop gardens which can be accessible from both sides of the building. Skylights were used to bring light into staff parking, drop off and service areas. Conference rooms, staff offices, infusion rooms , and the pharmacy are all located on the north side of the building to receive softer light and exterior views to the wetlands (See fig. 2.19).

Wetlands + Cancer Treatment

Screen for privacy

Visitor Parking

Service Entrance

Fig. 2.20_ northeast perspective view

Fig. 2.21_ Section A

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Fig. 2.22_ View to wetland from group therapy room.

â&#x20AC;&#x153;Water can lend two aspects to the garden not readily available through other means: movement and sound. The movement of water is like the movement in a mandala. Movement can liberate a stream of thoughts. It makes us feel calm, alive and awareâ&#x20AC;? - Eido Shimano Roshi (Mosko. M, 2003)

Wetlands + Cancer Treatment

WorK S C ite D Campbell, Craig S. Water in landscape Architecture. new York: Van nostrand Reinhold, 1978. Print. This source discusses water in landscape architecture design, and provides examples of excellent water design. Campbell further offers guidelines on how to effectively use water in architectural design. mosko, martin Hakubai., and Alxe noden. landscape as Spirit: Creating a Contemplative Garden. new York: Weatherhill, 2003. Print. landscape as Spirit: Creating a Contemplative Garden is an excellent resource to understand what contemplative gardens are. The book incorporates multiple principles from different culture’s garden designs and explains how to arrange gardens by their materiality. Keddy, Paul A. Wetland Ecology: Principles and Conservation. Cambridge, UK: Cambridge UP, 2000. Print. This book is an introduction into wetland ecology, from basic principles to advanced applications. Keddy stresses the need for wetland restoration, and gives numerous examples from around the world. “Wetlands of Wisconsin.” Wisconsin Wetlands Association. Web. 19 Apr. 2016. This website provides information about wetlands in Wisconsin and the different programs related to wetland restorations. The Wetland Association of Wisconsin was founded to protect, restore, and create recreationally pleasing activities in wetlands. This is accomplished through science based programs, education and advocacy. US department of agriculture. “Soil survey of Rock County, Wisconsin”: Washington Printing office.1920.Print In this soil survey of Rock County, it contains information regarding climate, soil quality, and hydrology. This source was vital for understanding the geology of the region, and understanding the site specific elements that would impact the final design. lopez, Ricardo D. Wetland landscape Characterization: Practical tools, methods and approaches for landscape Ecology (2nd edition).Boca Raton,Fl, USA: CRC Press, 2013. Web. 23 February 2016. In this source, author Ricardo lopez addresses the need for characterizing wetlands, due to the growing interest in understanding the services that they can provide. He further depicts how wetland methods, tools, and approaches can be further effectively integrated to respond to current issues.

Architecture + Cancer

aDDitionaL rea D inGS Balneaves, lynda G., linda j. Kristjanson, and Douglas Tataryn. “Beyond Convention: Describing Complementary Therapy Use by Women living with Breast Cancer.” Patient Education and Counseling 38.2 (1999): 143-53. Web. Bath Views: Six Bath Views from Six Architects. Tokyo: ToTo, 2009. Print. Charlson, mary E., joseph loizzo, Alyson moadel, miles neale, Chayim newman, Erin olivo, Emily Wolf, and janey C. Peterson. “Contemplative Self Healing in Women Breast Cancer Survivors: A Pilot Study in Underserved minority Women Shows Improvement in Quality of life and Reduced Stress.” BmC Complementary and Alternative medicine BmC Complement Altern med 14.1 (2014): 349. Web. Childs, Craig. The Secret Knowledge of Water: Discovering the Essence of the American Desert. Seattle, WA: Sasquatch, 2000. Print. Davis, B. E. “Rooftop Hospital Gardens for Physical Therapy: A Post-occupancy Evaluation.” HERD: Health Environments Research & Design journal 4.3 (2011): 14-43. Web. Emoto, masaru. “Healing with Water.” The journal of Alternative and Complementary medicine 10.1 (2004): 19-21. Web. Hofmann, Stefan G., Paul Grossman, and Devon E. Hinton. “loving-kindness and Compassion meditation: Potential for Psychological Interventions.” Clinical Psychology Review 31.7 (2011): 1126-132. Web. Huisman, E.r.c.m., E. morales, j. Van Hoof, and H.s.m. Kort. “Healing Environment: A Review of the Impact of Physical Environmental Factors on Users.” Building and Environment 58 (2012): 70-80. Web. Karnik, m., B. Printz, and j. Finkel. “A Hospital’s Contemporary Art Collection: Effects on Patient mood, Stress, Comfort, and Expectations.” HERD: Health Environments Research & Design journal 7.3 (2014): 60-77. Web. lohrer, Axel. Designing with Water. Basel: Birkḧuser, 2008. Print. Wong, Eva. Feng-shui: The Ancient Wisdom of Harmonious living for modern times. Boston: Shambhala, 1996. Print. Yu, Tiing, Hui ling Tsai, and ming liang Hwang. “Suppressing Tumor Progression of In Vitro Prostate Cancer Cells by Emitted Psychosomatic Power Through Zen meditation.” The American journal of Chinese medicine Am. j. Chin. med. 31.03 (2003): 499-507. Web.

iM aGe SourC e Figures 2.0 and 2.9: “Wetlands of Wisconsin.” Wisconsin Wetlands Association. Web. 19 Apr. 2016. Figure 2.10: Plunkett Raysich Architects, llP. Beloit Cancer Center. 2016. Wisconsin. Figure 2.11 + Figure 2.12: Butterfly - Photo courtesy of matt Perry “Bring the Baltimore Checkerspot Butterfly Back to Campus.” Past Projects. Web. 28 Apr. 2016. Dragonfly - Photo by Ken mierzwa. Courtesy of Wikipedia Commons. “Ken mierzwa.” Ken mierzwa. Web. 28 Apr. 2016. northern Harrier – Courtesy of Stubblefieldphoto @ Dreamstime.com “northern Harrier (Circus Cyaneus).” northern Harrier. Web. 28 Apr. 2016. Black billed Cuckoo: Courtesy of jim Burns “Black-billed Cuckoo Songs and Calls.” - larkwire. Web. 28 Apr. 2016. Canada Wabler: Courtesy of ArniWorks “maine – Epilogue.” ArniWorks Photography maine Epilogue Comments. 2013. Web. 28 Apr. 2016. Crayfish: Courtesy of George Grall “An Upland Burrowing Crayfish by George Grall.” Fine Art America. Web. 28 Apr. 2016. Squirrel: Courtesy of Anwiksha Ghosh “northern Flying Squirrel.” Animal Spot. Web. 28 Apr. 2016. Dwarf lake Iris: Courtesy of Ken Cravillion “Wildflowers: Dwarf lake Iris, large Pedaled Trilluim, Violets, Etc....” Wildflowers: Dwarf lake Iris, large Pedaled Trilluim, Violets, Etc.... Web. 28 Apr. 2016. joe Pye Weed : Courtesy of Davesgarden.com “PlantFiles Pictures: Sweet joe Pye Weed (Eutrochium Purpureum) by Hczone6.” Dave’s Garden. Web. 28 Apr. 2016. Turtlehead: Courtesy of Purdue University Fort Wayne “native Trees of Indiana River Walk.” native Trees of Indiana River Walk. Web. 28 Apr. 2016.

Wetlands + Cancer Treatment

the heaL in G P o We r o F tree S Samantha Buchman + Emma Gaulke-janowski

Fig. 3.0_ Wisconsin Forest (WDnR, 2015).

Architecture + Cancer

abStra Ct Shinrin-Yoku, otherwise known as â&#x20AC;&#x153;forest bathing,â&#x20AC;? is a concept coined by the japanese ministry of Agriculture, Forestry, and Fisheries, that examines the emotional and physical benefits of immersing an individual in a forest. It is this perspective that influenced our proposal for the redesign of a cancer care center in Beloit, Wisconsin. Using the forest as the setting for a new facility, and wood as its primary building material, our goal was to demonstrate the (evidence based) design benefits of a material often overlooked in healthcare.

The Healing Power of Trees

ho W the ForeSt C an he a L The study, “The Physiological Effects of Shinrin-Yoku” otherwise known as “forest bathing,” a term coined by the japanese ministry of Agriculture, Forestry, and Fisheries, found that immersing an individual in a forest, if only for five minutes, has both physical and emotional benefits (Storey, 2014). one of the many benefits is that breathing in the fresh air found in forests includes breathing in natural antibacterial chemicals, called phytoncides, that are released from trees and allow the body to increase white blood cells, crucial to fighting cancer. As this notion of “forest bathing” has traveled the world, researchers in Finland defended the phenomena. “Human beings have lived in the natural environment for most of the five million years of their existence. Therefore, their physiological functions are more suited to natural settings. This is the reason why the natural environment can enhance relaxation (PlanetArk).” Robin Guenther , an award winning architect who focuses on healing environments and healthcare design explains that “people can and should experience a positive, restorative natural setting” (Guenther, FAIA, lEED AP,2013).

Building Dominates

Forest Bathing

Fig. 3.1_ The difference between a building that dominates and the forest dominates, allowing people to “forest bath.”

Roger Ulrich performed a well-known study in 1984, where he compared patients’ recovery relative to their connection to nature, and concluded that those who had stronger connections to nature, specifically trees, healed faster and more pleasantly (Guenther, 2013). Ulrich, also found that having trees outside the facility and visible for patients to view and experience from indoors can help to relieve stress and pain (Guenther, 2013), similar responses to immersing a patient in a forest. When immersed in a forest, individuals have expansive views to trees. In contrast, when a building dominates the site, views to trees do not exist, illustrated in figure 3.1. like architecture, trees have the ability to influence the understanding of space, strengthening spatial relationships within the space. Figure 3.2 shows how trees can overlap with the architecture, blurring the distinction between the two. The space under the tree is simple, pure, natural, and sought for comfort, relaxation, and well-being (Hirzel, 2006). Similarly to how trees and forests provide healing benefits, the primary material in a forest, wood can evoke feelings of warmth, comfort, and relaxation in people, emotions shown to reduce stress, anxiety, and recovery times in cancer treatment facilities (Rice, Kozak, Meitner, and Cohen, 2006). Architect Randy Guillot explains “By acknowledging the landscape, the building becomes part of the landscape. Its an inside-outside kind of building. People actually take their treatments outside. The building allows for that” (Guenther, 2013). The relationships between building and forest are shown in Figure 3.3.

Forest

Columns

Fig. 3.2_ The trees and architecture can overlap with the use of columns following the grid of the forest..

Tree goes through building

Tree becomes the support

Building becomes the support

Fig. 3.3_ The three relationships between forest and building.

Architecture + Cancer

Fig. 3.4_ monica Gibbs lives next to a polyvinyl plant in southern louisiana and needs to wear a breathing mask. She has suffered from respiratory problems since birth (Stone, 2001).

Wh Y S houLD W oo D be u S e D in Ca nCer Care FaCiL itie S In cancer centers, the issue of materiality extends beyond creating a therapeutic environment. It also affects the health of the planet. Using wood, a local and natural material, prevents other materials from being produced which may release harmful toxins into the air.

The use of wood also prevents other hazardous materials, such as vinyl, from being used in healthcare facilities (See fig. 3.4). From manufacturing, to installing, and routine cleaning, vinyl releases harmful VoCs and carcinogens into the atmosphere. For example, those in Cancer Alley, louisiana are surrounded by polyvinyl production plants and its residents have the second “Lloyd Dean, CEO, Catholic Healthcare West explains that “There is direct highest cancer rate in the country. nearly “91 percent of residents said they link between healing the individual and healing this planet. We will not have were experiencing health complications they believe to be related to the healthy individuals, healthy families, and healthy communities if we do not manufacturing plants releasing toxins (Gale, 2006).” Robin Guenther, recipient have clean air, clean water, and healthy soil (Rossi and Lent, 2014).” of The Center for Health Design’s Changemaker Award explains that through its lifetime, vinyl, like so many other widely used materials, “are not only Unfortunately, the use of wood products has been limited in healthcare unsustainable in terms of sheer quantity; many products have negative life cycle design. There is fear of using wood because it is difficult to keep clean and health impacts (Guenther, 2013).” To ensure surfaces remain free of bacteria, as a consequence can become a home for dangerous bacteria. Author of they are cleaned and stripped routinely with harsh and dangerous chemicals. Healthcare Interiors, Paige lozier explains that when finished or imbedded with a silver ion, (a natural and highly effective antimicrobial agent) wood can “The very building materials we use to shelter and nurture our patients and the inhibit the growth of microorganisms, protecting against microbes, pathogens, medical devices with which we attempt to heal them contribute chemicals to and bacteria such as E. coli and Staph. Wood can also suppress the growth the air they breathe that can cause the diseases we seek to cure (Rossi and of harmful mold, mildew, and fungus that can cause disease (Paige lozier, Lent, 2014).” CRAnE). The Healing Power of Trees

Fig. 3.5_ Vinyl in medical Exam Room (PRA, 2016.)

Fig. 3.8_ Wood Veneer in medical Exam Room (PRA, 2016.)

Fig. 3.6_ Vinyl in Group Infusion (PRA, 2016.)

Fig. 3.9_ Wood Veneer in lobby (PRA, 2016.)

Fig. 3.7_ Vinyl in Radiation (PRA, 2016.)

Fig. 3.10_ Trees in Entrance (PRA, 2016.)

De S iG n P ro Po SaL-a naLYSi S o F e X iS tin G Site a n D b ui LDinG ConD itionS located in Beloit, Wisconsin, the Beloit Cancer Center was used as a case study for material selection. In addition to analyzing the local ecological impacts of forests, interior and exteriors were analyzed to compare current site conditions related to wood. The following images analyze the materials within the Beloit Cancer Center and the site (See figs. 3.5-3.11). The Beloit Cancer Centerâ&#x20AC;&#x2122;s primary floor material is vinyl. While there is an understanding that the presence of wood is soothing to patients, there is no natural wood visible to users. 54

Architecture + Cancer

Rendering viewpoint

Fig. 3.11 Existing site trees in relation to site context

100

200

The Healing Power of Trees

400

ExPANSION O F Ex IST ING FO R ESTS

oak

hickory

basswood

Maple

oak-hickory, maple-basswood, and aspen-birch are the most common forests. oak-hickory accounts for 4.2 million acres followed by maple-basswood forest type with 3.7 million acres.

past

present

mixed coniferous-deciduous forest Deciduous forest Beloit Fig. 3.12_ Historical research on expansion of existing forests (WDnR, 2016).

PROPOSED FO R EST Silver Maple(acer saccharinum)

basswood (tilia americana)

• • • •

• • • • • • • •

Height up to 100 feet Diameter 3 feet or more Trunk usually short and divided into a number of limbs Found in the southern 2/3 of the state

Height 60 to 80 feet diameter of 1 to 3 feet Trunk continues straight into top of dense rounded crown Stump sprouts readily 4 to 5 stems originating Common throughout the state leaves Alternate; length and width 4 to 6 inches heart-shaped

Fig. 3.13_ Forest used in redesign (WDnR, 2016).

De S iG n Pro P o SaL -the e X P anSion oF the ForeS t Historically, maple and basswood trees were dominant in the southern region of Wisconsin, but over time they were replaced by farming and urbanization (Wisconsin Department of natural Resources, 2015). Figure 3.11 shows existing tree conditions at the Beloit Cancer Center. The proposed design reintroduces the forest onto the current site. Based on the historical data of Southern growing forests (See fig. 3.12), silver maple and basswood trees were used as the forest expanded. Further analysis of the trees was conducted, seen in figure 3.13, to determine the planting pattern (existing site trees were preserved). It should be noted that trees have a variety of ecological and environmental benefits, illustrated in figure 3.14, beyond aesthetics. 56

Architecture + Cancer

B ENEF ITS O F TR EES

Trees can create shade.

Trees create an ecosystem to provide habitat birds and other animals.

and food for

Hospital patients have been shown to recover from surgery more quickly when their hospital room offered a view of trees.

Trees absorb carbon dioxide and potentially harmful gasses.

Deciduous trees block sunlight in the summer and sunlight warm your home in the winter.

Trees can reduce air temperature by blocking sunlight.

Fig. 3.14_ Benefits of Trees

The Healing Power of Trees

Fig. 4.23

Fig. 4.22

Fig. 4.24

Fig. 4.21

0’

25‘

50’

100’

Fig. 3.15_Site Plan

Existing Trees Basswood Trees Maplewood Trees

re De S iG n The new design of the Beloit Cancer Center provides both patients and visitors all wood interiors and views of the forest. The program is divided into pavilions embedded within the forest, (See fig. 3.19). The pavilions allow for views of the forest and the opportunity to “forest bath” while journeying through each stage of cancer treatment. Expansive glazed walkways (See fig. 3.18) weave through the site trees. At the end of some of the walkways, the patient can leave the building and enter the forest. Wood as the primary building material literally brings the materiality of the Wisconsin forest into the building. 58

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The forest and the Cancer Center are protected with a “ha-ha wall”(See fig. 3.20) that allows for privacy while also allowing undisturbed views of the forest. From the moment the patient or user enters the site, they are engulfed in the forest. (See fig. 3.15).

Fig. 3.16_Existing Tree Condition

Fig. 3.17_Proposed Tree Condition

Fig. 3.18_Paths through the forest

Fig. 3.19_ Proposed pavilions in relation to the new and existing forest.

Fig. 3.20_Site Section - Columns and tree trunks blur the perceived inside/outside. The ha-ha wall on the far right provides privacy from the street.

The Healing Power of Trees

Fig. 3.21_ View of entrance

Fig. 3.22_ Section perspective of walkway and forest grid

Architecture + Cancer

Fig. 3.23_ View of looking at group infusion and small group rooms.

Fig. 3.24_ â&#x20AC;&#x153;Bathing in the forestâ&#x20AC;?, wood is used as the primary material for columns, floors, and ceilings.

The Healing Power of Trees

WorK S C ite D Gale, Thomson. “Cancer Alley, louisiana.” Cancer Alley, louisiana. Thomson Corporation, 2006. < http://www.pollutionissues.com/Br-Co/Cancer-Alley-louisiana.html>. The report explores the 100 mile stretch along the mississippi River, known as Cancer Alley. Home to the second highest cancer rates in the nation, Cancer Alley is a low income string of communities affected by the endless industrial plants releasing harmful chemicals and contaminating the air and groundwater supply. The report illustrates the damage chemicals and toxins can have on humans. Guenther, Robin, and Gail Vittori. Sustainable Healthcare Architecture. 2nd ed. Hoboken, nj: john Wiley & Sons, 2013. Robin Guenther’s and Gail Vittori’s book about sustainability in healthcare design examines in addition to movements towards sustainability in design, analyzes case studies of healthcare facilities around the world that focus on sustainability and the benefits it has on the experience of the facility for both the patient and healthcare professionals. Hirzel, Paul, ed. Trees. Pullman: Site Design Studio Washington State University, 2006. A compilation of various graduate student research, the book provided a vast overview of trees and all the different characteristics of trees. Trees have the ability to affect so much of the built environment. lozier, Paige. “Choosing Furnishings and Finishes That Aid Infection Control.” Healthcare Interiors (n.d.): CRAnE. The article analyzed the juxtaposition of goals that designers face; trying to balance the health requirements with providing a beautiful design that inspires healing. The article discusses how to bring luxury into healthcare design and improve infection control. Planet Ark. “make It Wood- Housing, Health, Humanity.” (2012): Web. Planet Ark, an organization that strives to education people about the health of the planet and the impact it has on people, released the article about the importance of wood. Using Canadian, Austrian, Australian, and Finnish studies conducted measuring the influence of wood and its comforting properties. Humans have an innate connection to wood, as it is a primary element in that humans have used to make safe structures since early civilization. It is comforting, soothing, and has health benefits. Rice, jennifer, Robert A. Kozak, michael j. meitner, and David H. Cohen. “Appearance Wood Products and Psychological Well-Being.” (2006). The study conducted focused on the psychological affects of wood and wood products on people and their well-being. It explores the phenomenon of wood and how people interact with wood products to improve their well-being. Rossi, mark, PhD, and Tom lent. “Creating Safe and Healthy Spaces: Selecting materials That Support Healing.” Center for Health Design, Sept. 2014. mark Rossi and Tom lent’s report focuses on the need for selecting materials in healthcare environments that support healing. They identify that the current problem is that healthcare facilities are among leaders in consumption of materials, but do not consciously choose materials that promote healthier spaces. They propose a set of steps for future designers and healthcare professionals to follow to ensure that the materials choices being made are smarter. Rossi and lent breakdown the lifecycle of materials and the chemicals and toxins they contain and release from manufacturing and installation through maintenance, contrasting them to healthier alternatives. Storey, Colleen m. “Want to Prevent Cancer- Take a Walk in the Forest- Studies on “Forest Bathing”” Renegade Health. n.p., 2 july 2014. <http://renegadehealth.com/blog/2014/07/02/ want-to-prevent-cancer-take-a-walk-in-the-forest-studies-on-forest-bathing>. Forest Bathing is a phenomenon where an individual is immersed in a forest and experiences health benefits. Starting in japan, the phenomena has traveled the globe. one of the benefits is improved immune system and increase white blood cell count, both crucial for cancer patients. Wisconsin Department of natural Resources. “Ecological landscapes of Wisconsin.” n.p., 10 Sept. 2015. <http://dnr.wi.gov/topic/landscapes/book.html>. The large database provided by the Wisconsin Department of natural Resources that outlines the ecological landscapes in Wisconsin, the historical landscapes, how and why they have been changed. The database describes several types of forests, benefits, and suggestions for future development of ecological landscapes. The database became a resource for learning about local ecological issues.

Architecture + Cancer

a DDitiona L rea DinGS “‘Architecture Is not About Form’ Peter Zumthor Interview.” Dezeen magazine. n.p., 6 Feb. 2013. <http:/ www.dezeen.com/2013/02/06/peter-zumthor-at-the-royal-gold-medal-lecture-2013/>. Dickens, Brandon. “A Cruel Irony: Sick Building Syndrome in Healthcare Facilities.” GBRI A Cruel Irony Sick Building Syndrome in Healthcare Facilities Comments. Green Building Research Institute, 07 july 2014. <http://www.gbrionline.org/cruel-irony-sick-building-syndrome-healthcare-facilities>. Ferenc, jeff. “Gaining Traction.” new Flooring Is Gaining Traction. Health Facilities management, 1 july 2011. <http://www.hfmmagazine.com/display/HFm-news-article.dhtml?dcrPath=%2Ftemplatedat%2FHF_Common%2FnewsArticle%2Fdata%2FHFm%2Fmagazine%2F2011%2 Fjul%2F0711HFm_ FEA_marketplace>. Forest Trees of Wisconsin: How to Know Them. madison, WI: Dept. of natural Resources, Division of Forestry, 2003. Wisconsin Department of natural Resources. 2003. Guenther, Robin, and Anna Gilmore Hall. “Healthy Buildings: Impact on nurses and nursing Practice.”The online journal of Issues in nursing. The American nurses Association, Inc, 31 may 2007. <http:/www.nursingworld.org/mainmenuCategories/AnAmarketplace/AnA Periodicals/ojIn/TableofContents/Volume122007/no2may07/HealthyBuildings. aspx>. Guenther, Robin, and Gail Vittori. Sustainable Healthcare Architecture. Hoboken, nj: john Wiley & Sons, 2008. “Healthier Planet, Healthier People: Hospitals Go Green to “First, Do no Harm”” Herman miller Inc. Hermanmiller Healthcare, 2009. <http://www.continentaloffice.com/hubfs/ Resources/ eBook/ Healthcare Filter/wp_GreenHospitals.pdf?t=1454096631292>. Krump, Brad, AIA, EDAC, and jason nordling, AIA. Supporting the Psychosocial needs of Cancer Patients Through Design. BWBR, october 2012. lavy, Sarel, PhD, and manish K. Dixit, PhD. “Wall Finish Selection in Hospital Design: A Survey of Facility managers.” HERD journal 5.2 (2012). “occupational Asthma in Health Care Professionals.” occupational Health & Safety. n.p., 1 Sept. 2003. <https://ohsonline.com/Articles/2003/09/occupational-Asthma-in-Health-Care-Professionals aspx?Page=4>. newitt, Valerie neff. “Asthma in Healthcare.” Asthma in Healthcare. Advance Healthcare network, 24 nov. 2014. <http://respiratory-care-sleep-medicine. advanceweb.com/ Features/Articles/Asthma-in- Healthcare.aspx>. o’Connor, Anahad. “The Claim: Exposure to Plants and Parks Can Boost Immunity.” The new York Times. n.p., 5 july 2010. <http://www.nytimes.com/2010/07/06/health/06real.html?_r=1>. Poulin, Cherise, AIA. “Chapter 13-A.” Interior Design for Health Care : Perkins + Will, n.d. 247-60. Print. “Toxic materials.” Health Care Without Harm. n.p., n.d. Web. 12 Feb. 2016. Ulrich, Roger. “Evidence-based Environmental Design for Improving medical outcomes. In Proceedings of Healing by Design: Building and Healthcare in the 21st Century.” mcGill University Health Center: montreal, 2000. “Vinyl: The Poison Plastic.” Workgroup for Safe markets.n.d. Web. 12 Feb. 2016. Wisconsin Department of natural Resources. “Wisconsin’s Forests: A Quick overview” n.p., 10 Sept. 2015. <http://dnr.i.gov/>.

iM a Ge SourC eS Figure 3.0: Wisconsin Department of natural Resources. “Ecological landscapes of Wisconsin.” n.p., 10 Sept. 2015. <http://dnr.wi.gov/topic/landscapes/book.html>. Figure 3.4: Stone, leslie. monica Gibbs. 2001. GreenPeace. Figures 3.5 to 3.10: Plunkett Raysich Architects, llP. Beloit Cancer Center. 2016. Wisconsin. Figures 3.12 and 3.13: Wisconsin Department of natural Resources. “Ecological landscapes of Wisconsin.” n.p., 10 Sept. 2015. <http://dnr.wi.gov/topic/landscapes/book.html>.

The Healing Power of Trees

heaL in G GarDe nS Stephanie Chimonas + jay Henson II

Fig. 4.0_ Render of entrance view into exterior forest 64

Architecture + Cancer

abStra Ct Although gardens have been a vital part of the healing process throughout history and a recent research study has shown that using nature as a contemporary catalyst for healing is extremely effective, gardens have been ostentatiously left out of healthcare facilities. Those that do include outdoor spaces are poorly designed and under utilized. According to Roger Ulrich, a professor and director of the Center for Health Systems and Design at Texas A & m University, â&#x20AC;&#x153;Supportive gardens in health care facilities potentially can be an important adjunct to the healing effects of drugs and other modern medical technology, and help improve the overall quality of care.â&#x20AC;? (Erikson, 12). Patients who have access to the outdoors, or even just a view of it, are physically and spiritually healthier and undergo less emotional distress than those who do not. This concept is especially important in cancer centers, where itâ&#x20AC;&#x2122;s so easy to feel a loss of self within the joyless walls of an infusion room. our design proposes to use healing gardens within cancer centers to help patients destress.

Healing Gardens

“A healing garden can serve as restorative resource, helping patients, visitors, and staff alike to cope better with stress experienced in connection with their own or others’ illness.” -Roger Ulrich, Director Center for Health Systems and Design, Texas A&M University

“The simple fact that healing gardens now exist in widely varying health-care settings shows that they are allied with a broad conception of health, one that recognizes that a person can move between greater and lesser degrees of health along a diverse physical, mental, and social continua.” -Terry Hartig, Professor Department of Psychology, Uppsala University

Fig. 4.1_ The Retreat in York is a psychiatric hospital open today and was built to improve care for Quakers in 1796 (Carter, 2014).

intro DuC tio n Utilizing nature to encourage healing, both physically and spiritually, is not a new idea. For example, in Victorian Britain, gardens were almost always utilized in psychiatric facilities. Zen Gardens have existed in Eastern cultures for centuries. William Ramsey, professor at the University of Georgia’s College of Environment and Design, states “Zen gardens don’t just help healing of the body, or better said physical illnesses, it is believed that Zen gardens also have a positive and healing effect on emotional wellbeing” (Ramsey, 2005.) (See figs. 4.1 - 4.2). In more recent times, however, healing gardens have been ostentatiously left out of healthcare facilities. Those that do include indoor spaces are poorly designed and under-utilized. According to Roger 66

Architecture + Cancer

Ulrich, a professor and director of the Center for Health Systems and Design at Texas A&m University, “Supportive gardens in health care facilities potentially can be an important adjunct to the healing effects of drugs and other modern medical technology, and help improve the overall quality of care.” (Ulrich, 1987.). Studies done over time have repeatedly found that natural environments reduce stress within built environments, which shows evidence to the importance of restorative respite in healthcare.

Fig. 4.2_ Saiho-ji by Gyoko in Kyoto, japan is an early example of a japanese Zen Garden (Ramsey, 2005).

“The garden is an oasis of peace and tranquility. It’s the first time I’ve felt like a human being in two weeks.” -Patient with bladder cancer

“You have to have spaces that by their very nature are optimistic. You have to have natural light, and access visually and actually to the outdoors. You need to create an environment that promotes a psychological well-being, so the patients feel like human beings who have a chance to get better.” -Molly Ferguson, Professor Therapeutic Horticulture, University of Minnesota

Healing Gardens

Fig. 4.3_ moores Cancer Center, UCSD utilizes an interior garden

Fig. 4.4_ Water stone sculpture provides soothing sounds (Frusca, 2006).

Fig. 4.5_ Hardscape elements contrast with Fig. 4.6_ long grasses in the wind provide healing vegetation (Frusca, 2006). sounds (Frusca, 2006).

Pre CeD e nt S A relevant case study to this topic is the moores Cancer Center, UCSD, California (See fig. 4.3). The moores Center is an outpatient facility with outdoor spaces dedicated to meditation and healing. one such space, the bamboo garden, was examined as a precedence. This garden focuses on privacy, and comfort. First, it is placed in the center of the building and is easily seen from the entrance. This allows it to be seen as the heart of the facility. To encourage privacy, there are large hedges around the perimeter and all seating has its back turned to the building. The glass into infusion rooms is tinted, as well, so patients can gaze out into the garden without sacrificing their privacy. 68

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Some guidelines (See figs. 4.4 - 4.6) given by â&#x20AC;&#x153;Healing Gardens: therapeutic benefits and design support,â&#x20AC;? and by the Sustainable Urban landscape Information Series at The University of minnesota have been researched and observed by this design. The most prominent recommendations were for the lack of an incline and easy wheelchair access for patients traveling with walkers or wheelchairs, a garden that will be easily and inexpensively maintained, and winding pathways that close into a loop so patients will not get disoriented. Sunlight and shading was also a major consideration, and allowing for patients to experience both sunny and shaded areas was important. Some other recommendations included dark walking surfaces to reduce glare, the opportunity for environmental distractions, and a moment of privacy and solitude.

“Providing exterior paths with a minimum 8-foot width accommodates the turning radius of a wheelchair and ease of two-way foot traffic” -Molly Ferguson, University of Minnesota

Fig. 4.7_ 8’ Exterior Walkway to allow wheelchair accessibility

“Limit grade changes in most highly used outdoor areas. The slope of a walk must not exceed 5% or 1 foot of rise for 20 of feet length.” -Molly Ferguson, University of Minnesota

Fig. 4.8_ minimal grade change for ease of movement through site

“Healing landscapes can be located in or outdoors, but to qualify as healing “gardens” they should have real nature such as plants and/or water features.” -Marcus and Barnes, 1999

Fig. 4.9_ Visible healing gardens from spaces such as infusion rooms

According to Terry Hartig, a professor within the department of Psychology at Uppsala University states “healing gardens aren’t just beneficial to patients, but also to visitors and staff who are also coping with their effects of illnesses, specifically cancer” (Hartig, 2006). Cancer patients have been cited making comments about how being in outdoor or natural settings has decreased their stress, given them a sense of peace, and sometimes even given them the motivation to fight their illness. Gardens within healthcare facilities that have been well designed can reduce the need for pain medications and help in the rehabilitation process. The challenge, now, revolves around the best way to design a garden specifically for cancer patients that maximizes the benefits of the outdoors while minimizing any amount of stress or discomfort.

“Restorative gardens first appeared in Europe around the middle Ages. Hospitals and monasteries for the sick and insane often incorporated courtyards which served as places for reflection, growing food and herbs for consumption and medicinal use, and growing flowers for use in ceremonies” (Koschnitzki, 2014).

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Fig. 4.10_ The given site is adjacent to an existing forest.

Fig. 4.11_ Extending the native forest pattern through the given site.

Fig. 4.14_ Healing Gardens (Water, Seasonal, and Water) are placed on site.

Fig. 4.15_ The curvilinear form surrounds the healing gardens.

Site D eveL oPM ent The site plan developed in the following order. The site is situated between two adjacent commercial businesses and an existing forest (See fig. 4.10). The neighboring native forest pattern was extended across the site (See fig. 4.11). Visitor parking was placed on the Southeast corner of the site. A service road branches off the existing north access road and goes into the basement level where receiving and mechanical programming will be located (See fig. 4.12). Pedestrian pathways are added (See fig. 4.13). A series of three open-air healing gardens were then placed on the site to â&#x20AC;&#x153;promote restorative healingâ&#x20AC;? (Ulrich, 1987.) (See fig. 4.14). A curvilinear exterior wall meanders through the forest surrounding the interior healing gardens. 70

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From the exterior, the curvilinear form gives the illusion of a smaller, less intimidating building. Contrasting with the curved exterior the interior garden forms follow the orthogonal geometry of the patient rooms (See fig. 4.17). A double circulation circuit (one outside and one inside) circumambulates around the facility.

Fig. 4.12_ Roads for visitors and service access to basement receiving level.

Fig. 4.13_ Pathways for pedestrians

Fig. 4.16_ A continuous circulation circuit follows the exterior wall.

Fig. 4.17_ Rooms are oriented to the healing gardens.

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Fig. 4.19_ Pro | Infusion rooms look onto garden, rather than exterior.

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Fig. 4.20_ Pro | Exterior entry allows views from outside to inside, to outside.

Co M P a riS on The proposed design has three themed gardens: seasonal vegetation, water, and wildlife (See fig. 4.18). Infusion rooms border the gardens (See fig. 4.19). To promote privacy, tinted glass and vegetation is used (See fig. 4.20). According to m. Susan Erickson, the undulating form (particularly at the entrance) allows layered inside and outside views. According to Erickson, the Program Coordinator of the College of Design at Iowa State University, â&#x20AC;&#x153;blending the transitions between indoors and outdoors is crucial to

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enhancing wellness in healing spacesâ&#x20AC;? (Erickson). The main circulation path follows the outside wall of the building, creating an easily-navigated closed loop (See fig. 4.21). This allows patients to feel as if they are in the forest when they are traveling from one space to another. These features contrast with the existing Beloit Center whose infusion rooms lack privacy (See fig. 4.22) and has mostly windowless corridors (See fig. 4.23).

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Fig. 4.21_ Site Plan | Case Study Beloit Cancer Care Center

Fig. 4.22_ Con | Infusion rooms face exterior, creating little privacy.

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Fig. 4.23_ Con | Double-loaded corridors create windowless walks.

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Ga rD e nS in FL uenC e ForM The form of the building is curvilinear ( See fig. 4.24), in order to facilitate the feeling of “hiding” in the forest. When orbiting the building, the viewer can only see a portion of its true form at any time, making it seem to be a less intimating human-scale facility. By creating a curvilinear-shaped building, it also helps a patient break away from the rigid grid of the city. The shape of the building is informed by the needs of the gardens within, making them the main focus of the design. The entrance punches through the building, giving an experience of walking through the forest. There is a bottle-neck in the form at the entrance point, so the patients can see through the building to the forest on the opposite side. The location of gardens is based on plant sunlight or privacy needs. 74

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The Seasonal garden includes (See fig. 4.25) plants such as the Apple Serviceberry which produces white star-shaped flowers from April to may, and green-red blooms in the fall. The Pagoda Dogwood also appears in this garden and its flowers range from white colored blossoms to blackberries in the summer, and maroon blossoms in the fall. The indigo bush produces deep purple and gold stamen flowers, which gives the garden an exquisite contrast. Lastly, heart shaped evergreen leaves cover the ground, which creates a dynamic atmosphere. The Water garden contains a large reflecting pool which provides a sense of calm and meditation for the occupants (See fig. 4.26). Precipitation enhances the experience as moving water has proven restorative benefits (Erickson, 2006).

Fig. 4.25_ Seasonal Garden “A healing garden can serve as a restorative resource, helping patients, visitors, and staff alike to cope better with stress experienced in connection with their own or others illness” (Erikson, 2006).

Fig. 4.26_ Water (Sky) Garden “Provide a water feature. Water is a soothing agent. Still water can provide a setting for meditation or prayer while the sound and view of moving water is undeniably restorative” (Erikson, 2006).

Fig. 4.27_ Wildlife Garden “...nature settings will tend to be more effective in promoting restoration if they possess the following characteristics, verdant plants, savanna-like properties (scattered trees, grassy understory, unthreatening wildlife (marcus, 1999).

The Wildlife garden contains a host of plants specifically tailored to attract humming birds, butterflies, and shrikes, among other bird species. Flora in this garden includes the Black Widow, Roughleaf Dogwood, American mountanash, Spicebush, American Cranberry bush, Wild Columbine, Swamp milkweed, and Wild Bergamot. These contain vibrant colors in the summer, such as yellows, whites, and pinks, and red and orange hues in the fall (See fig. 4.27). many also produce fruit which attracts many native bird species, which are not only pleasing to look at, but provide patients with a auditory distraction from their treatments.

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WorK S C ite D Burton, Adrian. “Gardens That Take Care of Us.” The lancet neurology 13.5 (2014): 447-48. Web. This journal article addresses the theory that gardens can be therapeutic, and explores the possibility that “healing gardens” have a profound effect on health outcomes. The lancet neurology is a leading scientific journal, and although its main focus is on neurological problems, much of the research done in this article applied to healing gardens as a whole. Cooper marcus, Clare, and Valente, Renata. “Healing Gardens: Design Processes and Realizations of Beneficial Environments.” (2015). Web. This essay explores how healing gardens can be utilized in healthcare facilities that already exist without those types of spaces. It looks at several published sources and delves extensively into research done by a wide range of designers and healthcare professionals. There are also several case studies introduced in this article, which also offers a critique of their designs. Erikson, jane. “Cancer Centers, Hospitals Using Gardens to Help Patients Heal.” oncology Times 28.8 (2006): 12-14. Print. By choosing an article published in oncology Times, there results an amount of clarity as to how these gardens can be utilized in a cancer-specific facilities. This article, specifically, explores the qualitative attributes of healing gardens and refers to experiences shared by cancer patients and staff in cancer care facilities. Fergeson, molly. “Healing Gardens.” SUlIS: Sustainable Urban landscape Information Series. University of minnesota: Extension. Web. 31 mar. 2016. The University of minnesota’s landscape architecture program did extensive research on healing gardens, which was then published on their website. This web page outlines a considerable number of recommendations for different types of gardens, complete with well-researched sources and diagrams. Frusca, ZImmer Gunsal. “Rebecca and john moores UCSD Cancer Center lA jollA, CA.” Healthcare Design. n.p., 1 Sept. 2006. Web. 12 mar. 2016. This website spotlights the moores Cancer Care Center, UCSD and in particular, the gardens located within the building footprint. Hartig, Terry, and marcus, Clare Cooper. “Essay: Healing Gardens—places for nature in Health Care.” The lancet 368 (2006): S36-37. Web. This article, written for a medical journal, is written as champion piece for healing gardens. The author is a well-known strong advocate for healing gardens, and this article present thorough research as to the positive effects of healing gardens in healthcare. Koschnitzki, Ken. “Healing Gardens.” Encyclopedia of Quality of life and Well-Being Research (2014): 2-4. Web. 6 mar. 2016. Describes the healing process and the effects on gardens on the quality of life. marcus, Clare Cooper., and Barnes, marni. Healing Gardens : Therapeutic Benefits and Design Recommendations. new York: Wiley, 1999. Print. Wiley Ser. in Healthcare and Senior living Design. This book was written by one of the foremost authorities on healing garden design. It describes research, history, different types of healing gardens, and includes an exhaustive list of design recommendations. marcus, Clare Cooper, naomi A. Sachs, and Roger S. Ulrich. Therapeutic landscapes: An Evidence-based Approach to Designing Healing Gardens and Restorative outdoor Spaces. Hoboken, nj: Wiley, 2014. Print. This book utilizes what history has taught designers about principles behind healing gardens and restorative outdoor spaces. Roger Ulrich gives his perspectives in design and suggestions towards dos and do-nots on the realm of healing gardens. Ramsey, William. The Power of Zen Gardens. Boston, ma, 2005. Print. This textbook by William Ramsey for a course taught by himself, deals with the issue of zen gardens, both dry and not, in a way that converys the idea that their capabilities could be beyond spiritual. “Regional Plant list - michigan, mI, Wisconsin, WI, Eastern minnesota, mn.” Regional Plant list - michigan, mI, Wisconsin, WI, Eastern minnesota, mn. n.p., 2004. Web. 3 Apr. 2016. This website is a “starter” list of native plants for michigan, Wisconsin, and eastern minnesota. It is intended for residential or commercial landscapers who want to create attractive and varied native landscapes.

iM aGe SourC eS Figure 4.1: Carter, George. “York Retreat Psychiatric Care Garden.” County Asylums. n.p., 2014. Web. Figure 4.2: Ramsey, William. The Power of Zen Gardens. Boston, ma, 2005. Print. Figures 4.4 to 4.6: Frusca, ZImmer Gunsal. “Rebecca and john moores UCSD Cancer Center lA jollA, CA.” Healthcare Design. n.p., 1 Sept. 2006. Web. 12 mar. 2016.

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Fig. 4.28_ Walkway circuit facing exterior forest

Healing Gardens

iSo Lation an D SC a L e Connecting Cancer Care Centers to Community William Bilyeu + jannita Bolin

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abStra Ct The focus of this chapter is to critique the conditions of isolation and scale within current cancer care centers. As a generic case study, the Beloit Health System University of Wisconsin Cancer Care Center is used to study potential deficiencies which maybe present in todayâ&#x20AC;&#x2122;s institutional healthcare facilities. These may include disconnections to the surrounding context as well as environments which are out of human scale -- buildings, parking lots, walkways, and gardens. The aim is to create a flourishing community in direct proximity to a cancer care center by integrating additional site programs -- retail, housing, and outdoor spaces -- while, at the same time, being responsive to the surrounding neighborhood, streets, water, and vegetation.

Fig. 5.0_ Proposed Exterior View of Connected Community

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Fig. 5.1_ Willowbrook methodist Hospital is an example of an institutionally designed hospital.(HoK, 2012).

Fig. 5.2_ An example floor plan showing dead centers seen in block hospitals (levett, 2012).

Fig. 5.3_ Institutional design qualities are shown from left to right: Symmetry, Repetition, monumentality, nontransparency, and Anti-contextualism.

intro DuC tio n Beginning in the 1960’s, the focus of healthcare expansion moved towards improvements of technological, medical, and institutional realms. As hospitals grew more specialized, they grew exponentially in size and spatial complexity. The sophisticated lighting, heating, ventilation, and HVAC encouraged the shift to large “block hospitals” with vast windowless regions at the center of each floor, (See figure 6.2) (Verderber, 2000). Block hospitals became popular due to the large capacity and efficiency of locating patient rooms on the exterior while placing circulation and public spaces on the interior of each stack-able floor plate. As the generic block hospital quickly filled to capacity with people, services, and high technology, comparatively 80

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little thought was given to the experiential qualities of buildings -- natural daylight, scale, or meaningful connections to the local environment (Verderber, 2000). Instead, the hospital became a metaphor for the institution, where it limited its architectural language to a visual expression of its formal implications, power, strength, and performance. An example can be seen in figure 5.1 where the Willowbrook methodist Hospital’s facade uses an exaggerated scale to impersonate a classical design scheme, demonstrating the power of the institution. Figure 5.3 shows the major qualities associated with institutional buildings which are -- symmetry, repetition, monumentality, nontransparency, and anti-contextualism.

Fig. 5.4_ Beloit exterior view shows existing site conditions (Scherbel, 2010).

CEnTRAl AXIS Fig. 5.5_ Floor plan of Beloit shows building programs located compactly under one roof following a similar institutional design scheme as the block hospitals (Scherbel, 2010).

Fig. 5.6_ lobby + Reception area of Beloit shows isolation from surrounding context while inside the building (Scherbel, 2010).

As a case study, the Beloit Health System University of Wisconsin Cancer Care Center was chosen because of its location within the suburban environment, size of program, and institutional design qualities. Symmetry is shown in the floor plan of figure 5.5, where the relative geometry of the building is flipped down the central access (shown as the dashed grey line). Repetition is shown in the exterior view of figure 5.4 and the floor plan where design elements such as columns, windows, and rooms are repeated in a linear rhythm, monumentality is shown in the reception image of figure 5.6 as well as the exterior view where the environment is scaled out of proportion to the human size. non-transparency is shown in the exterior and reception images where views into and out of the building are limited. Anti-contextualism is shown in the exterior image where the building and

site have no interaction to the surrounding neighborhood. These institutional qualities result from the issues of isolation and scale between the site and surrounding environment.

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Fig. 5.7_ The suburban highway condition shows that the large scale buildings off of the freeway are placed separately from one another impacting the sense of community.

Fig. 5.8_ The current site condition shows that the building is placed in the center of the site with no relation to surroundings.

iS o La tion Isolation in architecture can be an issue when a building acts independently from its surroundings -- neighbors, streets, water, and vegetation. Influenced by modernist and corporate applications, the isolation of public buildings creates spaces which are unworthy of human affection (Kunstler, 1996). This issue is often seen at the suburban scale, where developments explicitly initiated the abandonment of any superior, contextual framework to give way to the automobile and interstate highways (Eckert, 1993). Shown in figures 5.7 and 5.8, the Beloit Health System University of Wisconsin Cancer Center and the nearby developments located off of Interstate - 90 are representative of this anti-contextual scheme. The buildings highlighted in red are located 82

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away from the street and neighboring sites due to the setbacks created from the parking lots (red hatch). modern zoning and setbacks of buildings from the street allow the parking lots to become the â&#x20AC;&#x153;welcomeâ&#x20AC;? sign to motorists isolating the buildings from one other and removing their contextual relationship (Kunstler, 1996).

Fig. 5.9_ The livsrum Cancer Counseling Center is a representation of Critical Regionalism with its resemblance and geometric relationship with the nearby residential condition (lake, 2013).

Fig. 5.10_ The Healthcare Village is a representation of the village concept with the close proximity of building placements and geometric similarities (Sharpe, 2014).

While it is natural to assume that inserting beautiful landscaping within the site would boost the patient’s emotional and psychological well being, Brian lawson, the author of the article Healing Architecture claims otherwise. He states that “there was no evidence that, in general, patients wanted classically beautiful views. If anything, it is views of everyday ordinary life that seem in demand. Views in which something happens seem desirable, and views that enable conversation between patients of the events unfolding.” This idea can be accomplished by incorporating the site into an integral piece of the surrounding community by either responding to the sites surroundings -- regionalism -- or transforming the site into a destination -- village.

Responding to individual and local architectonic features of a particular place is the approach of critical regionalism (Frampton). This concept can be executed in a variety of ways -- use of local materials, response to climate, or embracing the community. As an example figure 5.9 shows the livsrum Cancer Counseling Center, which mimics nearby residential roof lines and uses environmentally friendly building materials to promote a healthy environment. Figure 5.10 shows the healthcare village which utilizes an integrated plan and design of the “village concept”, creating a walkable environment that makes the campus a beacon of wellness to the community (Campobasso).

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Parking Garden Building

Fig. 5.11_ The parking, garden, + building relationships between the current Beloit Cancer Care Center and the surrounding residential neighborhood shows the difference between an environment scaled for the community and an environment scaled for the automobile.

S Ca L e Scale in architecture can be an issue when the size relationship between site elements and neighboring conditions become disjointed from one another. As represented in figure 5.11, the existing relationship of parking, gardens, and buildings on the Beloit Cancer Center site are grossly out of scale to the residential condition located in the surrounding neighborhoods. leading to thoughts that bigness is inescapable Peter Davey, editor of the Architectural Review, believed that â&#x20AC;&#x153;Since the beginning of the Industrial Revolution, civilization has been inexorably set on a course to increase size. Cities become ever larger and more land-hungry, ... corporations have to become bigger and bigger so that they can compete with a hope of success in the global market.â&#x20AC;?. 84

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Fig. 5.12_ Reducing the proximity between various programmatic buildings -- such as housing, retail, and medical spaces -- to limit the need of automobiles for transportation will increase a neighborhoods sense of community.

Fig. 5.13_ Dividing large masses into several smaller masses allows for the architecture to be representative of a human scale.

one method of countering this tendency for bigness is to reduce distances between programs. In figure 5.12 you can see the concept of reducing proximity between programs -- such as housing, retail, and medical spaces -- to limit the need of automobile transportation; this allows for greater personal community interaction which creates a space that feels more lively and populated. Dividing the mass of big buildings into several smaller ones allows for greater spatial organization possibilities of programs (Evans, 1998). An example can be seen in figure 5.13 where the mass of the Beloit Cancer Center is divided into several smaller pieces allowing for the programs better interaction with the site.

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Fig. 5.14_ Create an environment which is representative of the human scale; building heights limited to two-stories and the distance between buildings close enough to walk.

Fig. 5.15_ Use elevation on the site to promote a public-private continuum; ground level spaces are intended as public use (lobbies, Retail, Street + Parks), while elevated spaces are intended as private use (Infusion + Radiation, Residences).

Fig. 5.16_ Have the site represent a sustainable and healing environment towards its natural context; use architecture to collect rain-water, provide roof-top greenery, and collect solar energy.

Pro Po SeD S o Lution our design aims to address the issue of isolation and scale by creating a neighborhood development that is pedestrian-oriented that combines housing and transit in close proximity to retail, amenities, and outdoor spaces. Incorporating a range of programs such as commercial, offices, park spaces, and mixed housing types allows both the density and diversity of a vibrant neighborhood to be maintained and civic and economic realm to be strengthened. To encourage the integration of public and private development, figure 5.15 describes how the commercial low rise buildings on site house retail on ground floor and office space above to respond to street life while maintaining its mixed use. 86

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Fig. 5.17_ Enhance the sense of community of the neighborhood; provide site access to neighbors, include a public transit stop, allow visibility into site.

Fig. 5.18_ Create a hierarchy of streets on the site; primary roads have two directions of travel, secondary roads have one.

Fig. 5.19_ Include multiple programmatic uses on the site -- cancer center, retail, offices, housing, and public park-space -- enhances community interaction and increases site income generated.

â&#x20AC;&#x153;First, design excellence creates the potential for a building to be a neighborhood focal point. If the building is inspiring, people will be drawn to it. Buildings designed with a sense of transparency help the community see in and staff to see out, thus figuratively drawing in the community to consider health and wellness. Healthcare buildings should have the appearance of being healthy and sustainable. Providing walkable communities and campus environments are essential aspects of overall health and wellnessâ&#x20AC;? (Chiu, 2014).

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Fig. 5.20_ Proposed Cancer Center Plan

Fig. 5.21_ Exterior View of Entrance.

Pro P o S eD S o Lution The design proposal aims to connect the Beloit Cancer Care Center to the greater community through introducing programs within the cancer center. In figure 5.20, the floor plan shows public and private spaces being separated by series of ramps. Public communal spaces such as cafĂŠ, library, and lobby are located at ground level in order for programs such as public and private infusion, exam, patient waiting rooms, and nurse station to be elevated above ground level. This spatial hierarchy is influenced by the range of programs within buildings ranging from spaces with a sense of solitude and intimacy to small group meetings, to places that foster interaction with the public (Evans, 1998). 88

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PlAZA VIEW

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Fig. 5.22_ Infusion Room: Views to plaza and cafe entrance.

Fig. 5.23_ Cafe/ Split level

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N Fig. 5.24_ The existing site plan of the Beloit cancer center shows the relative isolation of the building in the center of the site ignoring the neighboring site conditions.

Site C oM PariS onS The proposed site design is organized using grid patterns to divide the site into blocks. multiple buildings are placed within the blocks to mimic a neighborhood scale. Unlike the current plan of the Beloit Cancer Center, the proposed design features diagonal parking to promote a pedestrian friendly street conditions. This strategy eliminates large parking lots and allows the buildings to be located within close proximity of each other. In Figure 5.25, the public domain can be distinguished from the private through the roof planes. Buildings such as the Cancer Center and several retail buildings on site features green roofs and solar panels as sustainable 90

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strategies to the site. In contrast, the residential townhouses have gable roofs in order to help drainage from precipitation. Additionally, a diverse economic, public, civic life is fostered by three outdoor gathering spaces with surrounding buildings. These areas include a plaza, community garden, and neighborhood Park and playground. To maintain the siteâ&#x20AC;&#x2122;s larger connectivity, the bus drop off located on the west faĂ§ade of cancer center connects the community back to downtown Beloit.

Fig. 5.25_ The proposed site plan of the design shows the overall idea of creating a community through introducing extra programs, allowing neighbors to access the site, and engaging the street condition.

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Fig. 5.27_ The existing site section is a single building type surrounded by parking.

Site C oM PariS onS Figure 5.26, shows the existing Beloit Cancer Care Center isolated from the main Street and adjacent vegetation. In figure 5.28, the private spaces are elevated 30 inches off the ground separating the cafe and reception areas from the infusion areas. This subtle change in elevation allows the infusion areas to become the place of prospect and refuge where patients can look out onto the cafĂŠ and lobby spaces below, as well as, the community beyond the cancer care center without being exposed. Thus, patients are elevated off the street level giving them a sense of privacy from the outside yet opportunity to view out at daily 92

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activities â&#x20AC;&#x201C; bus drop off, kids playing, people running, and so on. Sustainable design strategies can be observed through the section of the proposed design. In figure 5.28, the roofline of the cancer center follows the transition between public and private space. The change in elevation of the roof plane allows for a clerestory window to bring in additional daylight to illuminate the interior spaces. Additionally, the clerestory allows the patient to view the green roof feature and the sky during treatment.

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Fig. 5.29_ The proposed site section is a mix of building types; residential, retail, and commercial.

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WorK S C ite D Bergdoll, Barry, Colin St john Wilson, Sergiusz michalski, and Richard macCormac. “monument: Antimonument.” Architectural Review oct. 2002: 89-96. Print. This article explores the ideas of what architectural features help determine whether a building is monumental and discusses ways in which monuments can be designed using modernism’s ambiguous design methods. Historically monuments have highly visible symbolism and meaning behind their designs in order to help the public understand what it is they are observing. Campobasso, Fred. “Healthcare Villages - A Growing Trend Across America.” Insight from Hindsight 11 (2014): 1-6. navigant Construction Forum. Web. 7 Feb. 2016. This article introduces The Healthcare Village as the new healthcare delivery model where it offers mixed-use neighborhood setting with retail, commercial, education, residential, and wellness service in which benefits the community that it serves as a beacon of wellness. The village concept creates a people friendly environment that is walkable that enhances the health and wellbeing of the people. Chiu, Stan, and Patrick Thibaudeau. “Fresh Perspectives: The Human Scale In Sustainable Healthcare Design.” medical Construction and Design 2 oct. 2014: n. pag. mCD. Web. 7 Feb. 2016. Discusses the current focus of sustainable design approach in creating and elevate design that promote and prioritizes patient health and community well-being through looking at sustainable design strategies in relation to human scale and experience rather than only focusing on the actual building performance and energy analysis of energy, water, waste, and land. Davey, Peter. “Bigness.” Architectural Review Aug. 2002: 32-33. Print. This article introduces the ideas as to why bigness has become a major problem of contemporary architecture. Davey explains that building programs have become larger while the architectural creativity towards the design has not followed suit. The scale of architectural geometries needs to be scaled down to restore human scale within the urban environment to regain people’s senses of scale and place. Evans, Gary W., and janetta mitchell mccoy. “When Buildings Don’T Work: The Role of Architecture In Human Health.” journal of Environmental Psychology 18.1 (1998): 85-94. Print. This article explores the role of architecture in human health to get a better understanding of the psychological stress and other taxing affects caused by architectural dimensions and details. Stress was reduced by allowing the built environment to be transparent where the public can easily grasp the concept of what the building houses and allowed them to experience familiarity with their surroundings. Finch, Paul. “A SEnSE oF IDEnTITY.” Architectural Review mar. 2008: 29. Academic Search Complete. Web. 3 Feb 2016. The text states that identity and architecture is closely linked focusing on the development of building’s identity in which arises out of context in which the building sits, not only site specific but the architecture becomes an absorption and reflection of cultural, economic, and sociological forces. Frampton, Kenneth. “Towards A Critical Regionalism: Six Points for an Architecture of Resistance.” The Anti-Aesthetic: Essays on Postmodern Culture. Ed. Hal Foster. Port Townsend, WA: Bay, 1983. n. pag. Print. Frampton critiques modernist architecture through its universal, industrial resulting in homogeneous forms of architecture that resists its local context. His paper discusses critical regionalism as a design approach that calls for place-conscious architecture that makes connection with its culture through embracing the use of traditional building methods and local materials and nature through topography, climate, context, light and tectonic forms. jencks, Charles. “How Big Is Bad?” Architectural Review Aug. 2002: 66-69. Print. This essay explores the characteristics of modern culture and how the global market and increasing populations are requiring bigger and bigger buildings. jencks argues that bigness leads to boredom and anomie, this is because big buildings require a large investment which developers do not want to take chances on. Kunstler, james Howard. Home from nowhere: Remaking our Everyday World for the Twenty-first Century. new York: Simon & Schuster, 1996. Print. This book discusses the transition of our built landscape from the American Dream of tiny house in the prairie to the rise of automotive industry and the suburban sprawls. The author makes connection with our human desire to live in authentic and meaningful place and provides a thorough analysis and examples of traditional design and planning strategies in order to restore the city’s neighborhood and create a sense of place. lawson, Bryan. “Healing Architecture.” Architectural Review mar. 2002: 72-75. Print. The author discusses new reports which explain how patient treatment and behavior can be improved with new architecture. These findings are backed up with research data that indicate patients are more content, perceive that they got better care, and requested less pain-killing medication in a variety of environments which were recently renovated. The environments were retrofitted with design strategies that focused on patient privacy and exterior views. martin, Daryl, Sarah nettleton, Christina Buse, lindsay Prior, and julia Twigg. “Architecture and Health Care: A Place for Sociology.” Sociology of Health & Illness 37.7 (2015): 1007-022. Wiley online library. Web. 01 Feb. 2016. This journal entry discusses the architecture and buildings used in healthcare with their effects on health and illness on the patients. The authors hope to determine substantive and methodological issues that can inform a distinctive sociology of healthcare design, similar to the ones developed for the hospitality industry. Slessor, Catherine. “Small Is Human.” Architectural Review Sept. 2002: 42-43. Print. This article discusses the virtues of smallness and how they add to the pleasure of daily life, while including lessons for architects to incorporate into their designs in order to comply with this design strategy. Small architecture is psychologically accessible to its users by being eccentric, particular, and fiddly this is why the author believes size of the built environment is so important. Verderber, Stephen, and David j. Fine. Healthcare Architecture In An Era of Radical Transformation. new Haven, CT: Yale UP, 2000. Print. This book identifies six periods in architectural history of healthcare architecture and thoroughly analyzes the trends and transformation of healthcare design in response to social, economic, and technological factors from ancient, medieval, and renaissance, to modern mega-hospitals and virtual health-scape. Zeisel, john. Social Science Frontiers: occasional Publications Reviewing new Fields for Social Science Development. new York: Russell Sage Foundation, 1975. Print. This publication is a specific research topic which explores sociology and architectural design; it goes in depth with the social effects on the public within the built environment. The primary area which design can improve social interaction is by defining the level in which each space falls within the public- private continuum. The author provides a five step guideline to translate the social research into design responses that are socially inclusive.

Architecture + Cancer

a DDitiona L reSourC eS Bloomer, Kent C., Charles Willard moore, and Robert j. Yadell. Body, memory and Architecture. new Haven: Yale U, 1975. Print. Canizaro, Vincent B. Architectural Regionalism: Collected Writings on Place, Identity, modernity, and Tradition. new York: Princeton Architectural, 2007. Print. naff, Clay Farris. Cancer. Detroit: Greenhaven, 2008. Print. Psarra, Sophia. Architecture and narrative: The Formation of Space and Cultural meaning. milton Park, Abingdon, oxon: Routledge, 2009. Print. Wang, Zhe, michael Pukszta, natalie R. Petzoldt, and jennifer Hendrich Cayton. â&#x20AC;&#x153;Cancer Treatment Environments: From Pre-design Research to Post-occupancy Evaluation.â&#x20AC;? Design & Health Scientific Review (2011): 68-74. july 2011. Web. 15 jan. 2016.

iM a Ge SourC eS Figure 5.1: Willowbrook methodist Hospital. Digital image. HoK. 2012. Web. 01 mar. 2016. <http://www.hok.com/uploads/2012/03/29/methodist-willowbrook-light01.jpg>. Figure 5.2: levett, Carly. Hospital Floor Plan. Digital image. 2012. Web. 01 mar. 2016. <http://archinect.com/people/project/50110529/amplatz-children-s-hospital-at-university-of-minnesota/50122549>. Figures 5.4 to 5.6: Beloit Cancer Center. Digital image. Plunkett Raysich Architects. n.p., 2010. Web. 01 mar. 2016. <http://prarch.com/our-work/healthcare/ambulatory-care/beloit-cancer-center>. Figure 5.9: lake, Quintin. livsrum Cancer Counseling Center. Digital image. 2013. Web. 01 mar. 2016. <http://images.adsttc.com/media/images/52cb/a202/e8e4/4e3a/3c00/0075/large_jpg/PoRTADA.jpg?1389076984>. Figure 5.10: Sharpe, Danny. Healthcare Village. Digital image. 2014. Web. 01 mar. 2016. <https://bdaily.co.uk/industrials/18-11-2014/final-phase-of-healthcare-village-begins/>.

Isolation + Scale

Fi Sh Wat Chin G Healing benefits of watching fish Irene Arzaga + leah Engelhardt

abStra Ct_ our focus on Cancer Care Centers came from two research sources: detractant research, how “the potential calming effect of positive distractions is...their most important contribution to the healthcare experience” (Hoffman, 2014) and the benefits of watching fish. According to new research published in the journal, Environment & Behavior, “people who spend time watching aquariums and fish tanks could see improvements in their physical and mental wellbeing” (Smalley, 2015). Using these research findings our design proposal blends an unusual mix of native fish hatchery, community aquarium and cancer care center, benefitting both the cancer patients and fishery rejuvenation in the state of Wisconsin.

Fig. 6.0_ Interior view of private infusion room overlooking fish hatchery. Fish Watching

Fig. 6.1: colorful trees (Yalca), Fish Hatchery (Cleghorn), Fish Tank (lee, 2015)

intro DuC tio n It is widely accepted that the interaction between the client and physician is central to developing an environment of healing. Although this interaction is of vital importance, the patient-doctor relationship should not be the only factor when establishing a healing environment. medical centers tend to focus heavily on the services provided more than patient care environments, however it has long been known that the environment can significantly contribute to the health and healing of the patients (Ruburt, 2016.) ( See Fig. 6.1). Because “the physiological effects of stress negatively affect patients’ ability to heal” it is important to focus on creating a stress free environment (Rubert, 2016.). mary Ann la Torre, an acute care clinical nursing specialist and registered nurse, agrees stating that, “the surrounding environment can have an impact on healing by significantly reducing stress as well as empowering 98

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the client” (la Torre, 2006). Elements such as views of nature, natural light, soothing colors and therapeutic sounds have all been demonstrated to enhance the healing process due to their ability to reduce stress (Altimier). “Particularly for a child,...visits can be among the most physically and emotionally exhausting of a grueling regimen that can go on for years” (Hoffman, 2014). many people find healthcare facilities cold, sterile, and lifeless. “You could be in the hospital a month and never see anything alive,” complained patient participant, Kelly as she explains the importance of having reminders of life. A study that examines the influence of positive distraction on the behavior and activity of children in two clinic waiting areas found that “the introduction of distraction conditions was associated with more calm behavior and less fine and gross movement, suggesting significant calming effects associated with the distraction conditions” (Pati, 2011).

Fig. 6.2_ “Watching the fish swimming in the aquarium with their dazzling colors can induce a deep relaxation state. This is extremely therapeutic as it takes away the anxiety and clears the mind of all unnecessary thoughts” (Pokharkar, 2015).

oFig. 6.3_ This practice of gazing at the aquarium and watching beautiful ornamental fishes swim in shoals, triggers neurochemicals in the brain called ‘GABA’ which is an amino acid acting as a neurotransmitter in the CnS. It acts by inhibitors slowing the nerve transmission in the brain, reducing anxiety, hence called as Anti-anxiety neurochemical (Pokharkar, 2015).

H 3n +

Gamma-aminobutryic acid (GABA)

Fish Watching

Decrease in heart rate

Fig. 6.4_ Experts from the national marine Aquarium (nmA), Plymouth University, and the University of Exeter found, after assessing physical and mental responses to tanks with varying numbers of fish, that heart rates lowered by 3 percent with an aquarium with just rocks and plants. When fish were introduced, patient heart rates again decreased, lowering 7 percent. A drop in blood pressure by 4 percent was also noted (Knapton 2015).

be ne F it S o F FiSh There has been a significant amount of research into the benefits of watching fish. In a 1986 issue of the Wall Street journal, it was reported that, “aquarium sales had increased due to research indicating aquarium viewing reduced blood pressure” (Kidd, 1999). In fact, Deborah Cracknell, lead research at the national marine Aquarium went further stating that, “Exposure to underwater settings may actually have a positive impact on people’s well-being.” (Knaption, 2015). Dr. Aaron Katcher, a psychiatrist, along with his colleagues Herman Segal and Alan Beck were part of a study looking at the relationship between waiting room fish tanks and blood pressure. They reported that watching a tank of fish had the potential to reduce anxiety in medical and dental waiting rooms. In their study, Katcher and his team asked subjects to watch fish swimming in an aquarium. With frequent pressure checks, 100

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all subjects exhibited a decrease in blood pressure (Kidd, 1999). Their conclusion indicated that, “patients who watch the fish closely for 15-20 minutes are more relaxed and less anxious about an office visit than patients who glance briefly at the fish and then ignore them” (Kidd, 1999). This study also suggested that a peaceful fish aquarium instills a sense of calm; providing a sense of safety (Kidd, 1999). Another study conducted with home aquarium owners found that, “66% of the owners claimed their fish calmed them, helped them to relax, and reduced their stress” (Kidd, 1999)(See fig. 6.5). It is evident that the introduction of something as simple as a fish tank can have considerable, positive effects on patients. It can be further deduced that patients of any cancer care center would benefit greatly from such an addition of community aquarium (See fig. 6.6).

(Durr, 2014)

(Clanton)

Fig. 6.5_ â&#x20AC;&#x153;Fish movement is the key thing that brings an aquarium to life creating different types of energies. It is the movement of the fish that makes an aquarium a dynamic feature that has an impact not only on the space but the people that come into contact with it: (Gordon-Bekford, 2013).

(nik, 2016)

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Fig. 6.6_ Venn Diagram indicating the three proposed facilities that are blended together to form an innovative Cancer Care Center.

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Fig. 6.7_ Site Plan of the proposed Cancer Care Center. Cancer Care Center Entrance

Community Aquarium Entrance

ProPoSeD DeSiGn: Site DeveLoPMent The site is divided into two parts. Half of the site along the two street edges in the north and east, are or-ganized along a grid, while the western half extends an existing forest to the edge of the building. Taking a similar approach to the current cancer center where there are some views to a pond, the new proposed design will have a variety of ponds all along the Eastern edge. In addition to an aquarium, these ponds will hold a fish hatchery. A fish hatchery study was conducted reporting that Wisconsin benefits from a “$2.75 billion in economic impact, 30,000 jobs and the $196 million in local and state tax revenues” all due to fishing (DnR, 2016). Incorporating a fish hatchery with fish native to the state of Wisconsin, is a critical investment to

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n 50’

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help meet the future stocking needs. The fish not only become a display to be viewed, but a learning opportunity for both the cancer care and aquarium visitors. The fish native to Wisconsin are shown in figure 6.8. Introducing multiple ponds provides more patients with pond views than the original plan. Parking aligns on the north and south edges of the ponds indicating the two separate entrances. The Cancer Care Center’s entrance will be towards the northwest edge of the site. This was seen as a more private entrance for patients. The community aquarium entrance is from the east and is more visible from the street (See figure 6.7).

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Fig. 6.8: Common native fish of Wisconsin (Wisconsin, 2015).

Fig. 6.9: A comparison of the existing center to the proposed, hightlighting the water pond(s) on site.

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Fig. 6.10_ Plan diagram highlighting the infusion rooms adjacency to ponds.

Fig. 6.11_ Section diagram showing shared aquariums between the two floors.

Fig. 6.12_ A section cut showing the overlap of the aquarium tanks and the cancer care center.

a ne W Can Cer Care Cente r F or b e L oit The redesign of this center incorporates multiple opportunities for fish viewing- aquarium tubes are extruded up through the Cancer Centerâ&#x20AC;&#x2122;s floor, becoming a place of connection between the two levels; additional fish tanks are included within the Cancer Center to provide patients with multiple views of fish (See figs. 6.11 -6.12). The infusion rooms are located on the east side of the Cancer Care Center so they can overlook the fish ponds (See Figs. 6.10, 6.13 - 6.15). The ponds enable fish rearing for consumption and conservation

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Fig. 6.13_ Waiting area looking out to the ponds.

Fig. 6.14_ Private Infusion Room.

Fig. 6.15_ Hallway experience along the SemiPrivate Infusion Rooms to the left.

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Fig. 6.16_ Care Departments will have their own waiting areas. Shown here is the Radiation Therapy waiting area with the view of the forest beyond and two shared aquarium tanks.

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1. Fig. 7.16 2. Fig. 7.18 3. Fig. 7.20 4. Fig. 7.22 Plan location of Renderings 106

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Fig. 6.17_ The first shared aquarium becomes a floor for the Cancer Care Center.

Fig. 6.18_ The main reception area floats above the ponds.

Fig. 6.19_ The second shared aquarium extrudes further becoming a table.

Fig. 6.20_ A Cafe directly off the waiting area has an aquarium bar.

Fig. 6.21_ The third shared aquarium extrudes to become a full height wall tank.

Fig. 6.22_ The Chemotherapy and Infusion Center waiting areas share an aquarium tank and a full wall aquarium. Fish Watching

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Fig. 6.23_ Plan location of Renderings

Fig. 6.28_ Interactive teaching tanks (Kram-bc, 2008).

Fig. 6.24_ Cancer Care Center Entrance

Fig. 6.31_ Fish Wall looking into the fisheries (jim G, 2009),

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Fig. 6.26_ Aquarium water tunnel fully surrounded by water (Wallpaper, 2016).

Fig. 6.27_ An additional water tunnel (l’aquarium, 2016).

Fig. 6.29_ Base off one of the shared tanks (Big, 2016).

Fig. 6.30_ Corner “hands-on” exhibition (Kalamari, 2012).

Fig. 6.32_ Another Fish Wall looking east (Coral, 2016).

Fig. 6.33_ Another Fish Wall looking east (Aquarium, 2016). Fish Watching

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Tank as a Display Interacive Pool - Aquarium

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WorK S C ite D Altimier, leslie B. “Healing Environments: For Patients and Providers.” newborn and Infant nursing Reviews 4.2 (2004): 89-92. Print. An analysis on healing environments and suggestions for improvement. “Aquariums Reduce Stress.” Sound-mind.org. Sound-mind.org. Web. 13 Apr. 2016. <http://www.sound-mind.org/aquariums-reduce-stress.html#.Vw4KpTArKhe>. Description on “Who aquariums are beneficial to” and the steps to design. Hoffman, jan. “Infusionarium Aims to Take Trauma out of Chemotherapy for Young.” Well. The new York Times, 15 Dec. 2014. Web. 13 Apr. 2016. Describes the long treatment process and a plan of one cancer center’s focus on a positive distraction. Kidd, Aline H., and Kidd, Robert m. “Benefits, Problems, and Characteristics of Home Aquarium owners.”Psychological Reports 84.3 (1999): 998. Print. Study on home aquarium owners. Kinver, mark. “Aquariums ‘deliver Significant Health Benefits’” BBC. BBC, 30 july 2015. Web. 13 Apr. 2016. Significant benefits of fish tanks. Significant benefits of fish tanks. Knapton, Sarah. “Fish Tanks do Keep You Calm at Dentist Edition 2].” The Daily Telegraph: 11. jul 30 2015. ProQuest. Web. 13 Apr. 2016. Study on waiting room fish tanks. la Torre, mary Ann. “Creating a Healing Environment.” Perspectives in Psychiatric Care 42.4 (2006): 262-64. Print. The importance of creating healing environments and the beneficial qualities for patients. Pati, Debajyoti, and Upali nanda. “Influence of Positive Distractions on Children in Two Clinic Waiting Areas.” HERD 4.3 (2011): 124-40. Web. Web. Study on two clinical waiting areas focusing on the role of distractions. Gordon-Beckford, Akil. “Clinical Benefits of Aquarium Design.” SBID. SBID, 16 Sept. 2013. Web. 14 Apr. 2016. Statistics on the benefits of aquariums. Pokharkar, omkar. “The AQUARIUm Therapy: Positive Effects of Fish-Keeping on Health and life.” International journal of life Sciences Research 3.2 (2015): 46-51. Research Gate. Web. 13 Apr. 2016. The science behind positive distractions. Rubert, Renee, and melissa l. Hutchinson. “Creating a Healing Environment in the ICU.” Ed. l. Dianne long. jB learning. 27-39. jB learning. jB learning. Web. 13 Apr. 2016. Creating Healing Environments and their importance. Smalley, lex. “Aquariums Deliver Health and Wellbeing Benefits.” EurekAlert! American Association for the Advancement of Sciences, 29 july 2015. Web. 14 Apr. 2016. Study looking at fish and the benefits of aquariums. Vickery, Christine. “Cancer Center Design from a Patient Perspective.” Cancer Center Design from a Patient Perspective. Healthcare Design, 20 Apr. 2009. Web. 13 Apr. 2016. learning about Cancer care Design from a Patient Perspective.

iM a Ge SourC eS Figure 6.1: “Yalca Fruit Trees.” Yalca Fruit Trees. Yalca Fruit Trees. Web. 27 Apr. 2016. <http://www.yalcafruittrees.com.au/product-category/sugar-maple-trees/>. “Cleghorn Springs State Fish Hatchery.” South Dakota Game, Fish and Parks. South Dakota Game, Fish and Parks. Web. 27 Apr. 2016. <http://gfp.sd.gov/fishing-boating/hatcheries/cleghorn-hatchery.aspx>. lee, Rik. “The Hidden Health Benefits of Aquariums and Fish Tanks.” Hellawella.com. Hellawell, 30 july 2015. Web. 27 Apr. 2016. <http://www.hellawella.com/hidden-health-benefits-aquariums-and-fish-tanks>. Figure 6.5: nik & leah. looking at the Fish Tank during Post-hydration. 2016. Rebazumberge Blog.<https://rebazumberge.com/2016/02/22/chemo-day-1/>. Clanton, john. life Is Real. jim Chastain-life Is Real Blog, oklahoma City <http://newsok.com/gallery/500358/pictures/534050>. Durr, jon. 2014. miami Herald, miami. <http://www.miamiherald.com/news/local/community/miami-dade/downtown-miami/article2956143.html>. Figure 6.8: “Wisconsin Department of natural Resources.” Fishes of Wisconsin. Wisconsin Department of natural Resources, 28 Dec. 2015. Web. 14 Apr. 2016. Figure 6.25 and 6.32: The Coral Reef Tanks. Bjornandannette, Copenhagen Aquarium.< https://bjornandannette.wordpress.com/aquaria/copenhagen/>. Figure 6.26: Aquarium Wallpaper 23. HD Wallpaper Pics.< http://hdwallpaperpics.org/aquarium>. Figure 6.27: “l’Aquarium Barcelona.” l’Aquarium Barcelona |. Aspro Parks. Web. 26 Apr. 2016. <http://www.aquariumbcn.com/?lang=en>. Figure 6.28: Kram-bc. Ucluelet mini-Aquarium from Inside. 2008. Wikimedia Commons. Figure 6.29: Big Aquarium ltd. Pet Supply Store. < https://plus.google.com/116550771848999436545/about>. Figure 6.30: Kalamari. Idaho Aquarium. 2012. Photo Blog.< http://www.photoblog.com/Kalamari/2012/01/01/idaho-aquarium.html>. Figure 6.31: G, jim. monterey Bay Aquarium. 2009. Wikimedia Commons. < https://commons.wikimedia.org/wiki/File:DSC26492,_monterey_Bay_Aquarium,_California,_USA_(4858411623).jpg>. Figure 6.33: Aquarium of the Pacific, long Beach. Web. <http://www.aquariumofpacific.org/>.

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Where are You? Circulation Empowering a Sense of Place Kevin Hall + Austin miles

8.0_ lost in the maze(Dreamstime, 2016.

abStra Ct one of the choices for cancer treatment is infusion therapy, where medication is administered through a connection port and needle that goes into the body. This requires a patient to be seated for long periods of time. Being in these chairs and receiving treatment can cause stress, escalating from an expected level to one that interferes with treatment, and affects all parts of life (American Cancer Society, 2015). To combat the stresses of cancer, one possible solution found was humor. norman Cousins, a comedian who went through cancer treatment, credited his recovery from cancer to humor, references “Albert Schweitzer [a French-German physician, who won a nobel Peace Prize for his idea of the “Reverence for life”] who always believed that the best medicine for any illness he might have was… a good sense of humor” in his book Anatomy of an Illness (Roman and Cousins, 1982). It is from this perspective that we propose to use different styles of humor to design medical furniture that, we hope, helps provide an up-lifting supplement to those going through treatment.

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Image Source: left(Zombiepedia, 2016), right(Hotel Hampton Inn, 2016).

Fig. 7.1 Entrance_ “Up close it looks like an over-sized Hampton Inn with low-lit grounds and paved contemplation paths leading into the woods (Ford, 2014).”

Image Source: left(Guideposts, 2014), right(Toronto Airport, 2016).

Fig. 7.2 Waiting Room_ “of all the problems with the U.S. health-care system, one of the most vexing for patients is simply sitting in the waiting room. It’s the health-care equivalent of being stuck on the tarmac in a crowed plane (The Doctor Will See You Eventually, 2016).

introDuC tion As Pulitzer Prize winning author Richard Ford states in his recent book entitled let me Be Frank With You... “nothing is bleaker than the stingy, unforgiving one dimensionality of most of these places; their soul-less vestibules and unbreathable antiseptic fragrances, the dead eyed attendants and willowy end-of-the-line-preclusiveness to whatever’s made life be life but that now can be forgotten.” By “most of these places,” Ford is referring to health care facilities, and many people are all too familiar with the vernacular of such facilities that appear to their users as, to quote Ford, “oversized Hampton-Inns” (See fig. 7.1) (Ford, 2014). 114

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Image Source: left(Stock, 2016), right(How Stuff Works, 2007).

Fig. 7.3 Corridor_ “no where is the chronic underfunding more evident than in the hallway. With floors of slat grey and the walls of dove, the hallway has as much personality as the rest of the facility (A Description of a Hospital Hallway, 2015).”

As health care has advanced, its focus has been primarily to address the physical treatment methods of patients. This has resulted in a vast range of equipment and produces a highly complex environment. Studying cancer treatment specifically, there is no single regimen, and the process is eminently decentralized. Patients often find themselves navigating through a number of different locations during the course of a single visit (Brown and murphy, 2016). The buildings that have become beacons for such treatment shuffle patients from one regimen to the next with no tangible understanding of place or direction. Upon a patient’s arrival, as they pass through the “soul-less vestibule,” they arrive at check-in counters and waiting rooms (See fig. 7.2) that feel like airport terminals, only no one is going anywhere. This is it.

Image Source: left(mSKD, 2016), right(How Stuff Works, 2007).

Image Source: left(Pickles, 2015), right(one Flew over the Cuckoos nest, 1975).

Fig. 7.4 Exam Room_ “The exam room is as devoid of beauty as I am of hope. Its walls are simply cream, not peeling or dirty, just cream (A Description of a Hospital Hallway, 2015).”

Fig. 7.5 Radiation Treatment_ “It was just come in, gown off, lie down, arm up there, measure, measure, measure, out of the room, boom, boom, boom” (Alibhai and Henrette, 2015).

Image Source: left(live-strong, 2015), right(one Flew over the Cuckoos nest, 1975).

Fig. 7.6 Chemotherapy_ “Patient describing “chemo-brain”_ “… I cannot express what the feeling is but I know, not myself, not my mind, not my smartness, …sometimes I feel that I become stupid I can’t concentrate (Alibhai and Henrette, 2015).”

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next it’s a trip through the double loaded corridor (See fig. 7.3) into one of the prison cells labeled as an examination room (See fig. 7.4). Afterward it’s off to the rumble of radiation treatment (See fig. 7.5), or a chemotherapy session (See fig. 7.6) that paralyzes you into a daze recalling scenes out of one Flew over the Cuckoo’s nest. The spaces described may be the last thing one visualizes as they think about a healthy environment, but they are the alarming reality of the current condition. Healthcare institutions tend to be characterized by oppressive corridors; minimizing dedicated circulation space might be seen as a priority in such a project. However, the aim here is to understand how wayfinding can be attributed

to a celebration of the healing process. Such spaces may be thought of as a beautiful sculpture gallery awaiting for its exhibits to arrive, rather than an “oversized Hampton Inn” (murphy, 2015). Chapter seven (Where are You), addresses wayfinding through three phases; research identifying satisfactory wayfinding components; site analysis that adopts such components; and a prototype design that applies programmatic spaces.

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Fig. 7.7_ Knowing where you are in a building or environment (What is Wayfinding, 2012).

Fig. 7.10 Path_ Knowing where you are in a building or environment (White, 1999).

Fig. 7.8_ Knowing where the desired location is (What is Wayfinding, 2012).

Fig. 7.11 Place_ Rooms, Plazas, and gardens becoming the desired location (White, 1999).

Fig. 7.9_ Knowing how to get there from your current location (What is Wayfinding, 2012).

Co M PonentS + eL e M ent S Initial research aimed at dissecting the definition of wayfinding resulted in a series of components that distinguished both the human and architectural understandings of wayfinding. From the human perspective, the components break down wayfindingâ&#x20AC;&#x2122;s definition through a study of spatial problem solving. Wayfinding is simply knowing where you are in a building or an environment (See fig. 7.7), knowing where your desired location is (See fig. 7.8), and knowing how to get there from your current location (See fig. 7.9) (What is Wayfinding, 2012). This human understanding of wayfinding can then be translated into architectural forms that can be dissected as being either a path, portal, or

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Fig. 7.12 Portal + Catalyst_ Gateway that transitions one between path and place initiated by the human catalyst (White, 1999).

place. Paths are the streets, walks, corridors, etc. that define how one arrives at their desired location (See fig. 7.10). The places are rooms, plazas, and gardens that become oneâ&#x20AC;&#x2122;s desired location (See fig. 7.11), and the portals are the gateways that transition one between path and place (See fig. 7.12) (White, 1999). With this, both the human and architectural understandings of wayfinding connect with each other. However, architecture can further assist the users travel between path, portal and place. For each of these architectural components, there are several architectural elements (both good and bad) that can be used to express wayfindingâ&#x20AC;&#x2122;s definition through building forms(See figs. 7.13 - 7.21). The end aim is to promote a clear wayfinding experience. An analysis of these elements begins to demonstrate what

PATH ElEmEnTS

Fig. 7.13_ junction at right angle_ directionally neutral. not to be recommended (loidi and Bernard, 2003).

Fig. 7.14_ movement meets path at acute angle_ directs to the open angle (loidi and Bernard, 2003).

Fig. 7.15_ joint in the path_ interrupting a long run of path (loidi and Bernard, 2003).

PlACE ElEmEnTS

Fig. 7.16_ niche â&#x20AC;&#x153;byâ&#x20AC;? the path_ neither part or separate from path. not to be recommended. (loidi and Bernard, 2003).

Fig. 7.17_ Stopping place along path_ maintains link with direction of path (loidi and Bernard, 2003).

Fig. 7.18_ Stopping place at curve apex_ maintains link with direction of path (loidi and Bernard, 2003).

PoRTAl ElEmEnTS

Fig. 7.19_ Path meets the boundary at right angle. not to be recommended (loidi and Bernard, 2003).

Fig. 7.20_ Addition to the boundary directing users (loidi and Bernard, 2003). .

Fig. 7.21_ Swung addition to the boundary directing users (loidi and Bernard, 2003).

forms are neutral to the users movement (See figs. 7.13, 7.16, 7.19), as well as the forms that promote clarity of movement (See figs. 7.14, 7.15, 7.17, 7.18, 7.20, 7.21). With this understanding, a building that promotes clear wayfinding should aim to eliminate the amount of elements that control a users movement and advocate for those that allow for clarity of movement.

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Fig. 7.22 Catalyst of movement_ Foundation of human wayfinding by definition.

Fig. 7.25 Auxiliary Connections_ once in a desired space, auxiliary zones can emerge.

Fig. 7.23 Possible locations_ multiple spaces exist in any environment.

Fig. 7.26 Altered Perspective_ Desired location becomes new current location.

Fig. 7.24 Desired location_ User intuition to attract to some spaces over others.

Fig. 7.27 Flexibility Adaptations_ Allowing for continued transition to new desired locations.

n av iGationaL intuitio n To further develop the definition of wayfinding, a series of subcomponents were generated to obtain a greater expertise of how a users intuition influences their transition through a given environment (See figs. 7.22-7.27). By definition, wayfinding encompasses the movement of a user from a current location to a desired location (See fig. 7.22). With this the user is the catalyst to all movement. However, the definition only focuses on the users movement to a singular destination when the reality is that there is always a multitude of possible location that an individual can interact with (See fig. 7.23). Among the multitude of possible locations there are a select number that become desired locations to the user over others (See fig. 7.24). An example of such

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desired locations could begin to take shape under a major programmatic zone, while secondary zones would be viewed as less significant. Upon a users arrival to a desired location a series of auxiliary spaces can become visible that may not have been visible from the users original location (See fig 7.25) (Foltz, 2013) As the user transitions through the space, the once desired location becomes the users current location (See fig 7.26). This results in a change of perspective that resets the user movement. By doing so the user now faces the dilemma of determining how to move to a next desired location. This analysis is critical to achieving a design that promotes a clarity to the wayfinding experience. This establishes a rational for the importance of

12-15 1 12-15

Fig. 7.28_ Horizontal Field of Vision (loidi and Bernard, 2003).

Area of lost Depth Perception

Fig. 7.29_ Automatic Perception Along a Path (loidi and Bernard, 2003).

Fig. 7.30_ Subdivided Field of Perception (loidi and Bernard, 2003).

maximizing the flexibility of circulation within an environment to give the user a clear transition to the next desired location (See fig. 7.27). Another key component that works in tandem to a users instinctual senses toward wayfinding is the sense of site. Physiologically humans are limited to a specified range where objects are recognizable to the viewer (See fig. 7.28). Within a field of approximately 30-36 degrees, shapes will be relatively sharp, but reaching out beyond 120 degrees the eye can only perceive movement (loidi and Bernard, 2003). This component of the human vision field can directly correlate to the architectural elements (both good and bad) of a path. As described by mark Foltz of m.I.T._â&#x20AC;&#x153;Subdividing a path into regions with a distinct set of

visual attributes will assist the user in wayfinding. When the navigator moves from one region to another, the shift in the character of the path is a fact that informs them of their location along the boundary of two regionsâ&#x20AC;? (Foltz, 2013). With this, the elements of a path demonstrate that a straight path delivers little visual cues to how a user should transition. (See fig. 7.29), Working in tandem, a curvilinear path subdivides a users vision, constantly prompting them of their location and giving them a greater sense of spatial understanding (See fig. 7.30).

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Fig. 7.31_ Water’s path over steep slope.

White River Falls_ oregon (Travel oven, 2016).

Fig. 7.32_ Water’s path through a riven.

Colorado River Valley_ Arizona (Roadtrippers, 2016).

Fig. 7.33_ Water’s path across a gradual slope.

Cedric Favero_ Upper okavango_ Botswana (Upper okavango, 2015).

Site a na LYSi S Through the research of the fundamental elements of components that define wayfinding, a key component that is prevalent on all accounts is the path that facilitates a users flow from one location to the next. As the focus shifts to apply wayfinding to a particular site, there are similar natural paths that can be detected; anything that encompasses movement has a particular flow or path that it travels across. Water runoff is a prime example of such a flow that naturally travels across a site. Similar to the human intuition of wayfinding, water also encompasses behavior elements (such as relationship to topography) that facilitates water flow from one location to the next (See fig. 7.31-7.33).

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“When water flows, its profile is evocative of the innermost nature of landscape. Where water is able to dominate, it cuts and grinds its way into the earth. These actions trace a record of a living force” (Wolman, 1969). With this, water is also perhaps the most important element for human existence, and the flow of water from man’s early history has symbolized the passage of time (Burton and Tetlow, 1974). Based upon these relationships of water and human flow, a water runoff analysis was generated to study how water would drain across the topography, specific to a given site (See fig. 7.34).

Fig. 7.34_ Beloit, Wisconsin Water Runoff Flow Based off Topographical Slope on given site.

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Fig. 7.35_ Water Runoff Flow_ Site Specific.

Fig. 7.38_ Resting places located at the rotation of circulation mimicking wayfinding elements.

Fig. 7.36_ Circulation path and parking placement merging both water flow and human wayfinding.

Fig. 7.39_ Sizing resting points along the circulation path.

Fig. 7.37_ Fragmenting core circulation path to correlate to human vision field.

Fig. 7.40_ Programmatic spaces framing the resting points along the path.

PrototYPe DeveLoPMent Focusing on the flow of water runoff on the given site in Beloit, Wisconsin was used to inform the appropriate placement of elements on the site. The flow of water runs predominantly south to north perpendicular to the contour with the south end of the site being the highest point (See fig. 7.35). With this, the core circulation path was placed parallel to the direction of the water flow to merge both water flow and human wayfinding (discussed on page 121). The parking was then placed perpendicular to the core circulation so that each user would have a similar view of the main entrance (See fig. 7.36). Due to the humans field of vision (discussed on page 119), the next step subdivided the core circulation path into shorter distances to decrease the amount of information users must intake at a single time (See fig. 7.37). 122

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The bends in the circulation path became clear resting points as explained on page 117 (See figs 7.38 + 7.39). Programmatic spaces were then sized and placed along the core circulation path framing the resting points (See figs. 7.40, 7.41). next, the existing forest to the west was extended to the building to frame views from the resting places (See fig. 7.42). The roofs were sloped to drain toward the north end of the path (See fig. 7.43). To collect the water, a reservoir was added to the east of the building (See fig. 7.44). This allowed for lake views to the east and forest views to the west. next, parking and walking paths were sized and located (See fig. 7.45) A tree grid was then placed around the reservoir and parking contrasting with the forest to the west and framing the main entrance of the building to the south (See fig. 7.46).

Fig. 7.41_ Circulation path from parking through building.

Fig. 7.44_ Reservoir collects roof water drainage and frames resting point views.

Fig. 7.42_ Existing forest extended to building framing views of the resting point.

Fig. 7.45_ Sizing and locating parking and walking paths.

Fig. 7.43_ Roof slopes moving water drainage across the core circulation path.

Fig. 7.46_ Tree grid around parking and reservoir derived from surrounding context.

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Fig. 7.47_ main entrance perspective from the parking lot.

De S iG n Pro Po SaL The resulting design orients itself along one core circulation path. The singular circulation provides users with a clear path to treatment areas (See fig. 7.48). The resting points along the bends in the path serve as the lobbiesâ&#x20AC;&#x2122; and family gathering zones.

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1. EnTRY/CIRCUlATIon PATH 2. EXAm RoomS 3. FACUlTY oFFICES + SToRAGE 4. WAITInG/BREAKoUT ZonES 5. PATIEnT SERVICES 6. CHEmoTHERAPY TREATmEnT 7. RADIATIon TREATmEnT

7. 4.

6. 5. 4. 4. 3.

2. 1.

Fig. 7.48_ Site Plan

0 SCAlE: FEET

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Fig. 7.50_ Breakout spaces as is for Beloit design (left) and breakout spaces utilized in the prototype design (right).

Fig. 7.51_ Corner condition as is for Beloit design (left) and Corner condition utilized in the prototype design (right).

Fig. 7.49_ Circulation path as is for Beloit design (left) and circulation path utilized in the prototype design (right).

De SiG n Co M PariSon The prototypes design also adopts several architectural elements from the research phase of appropriate path, portal, and place conditions described on page 116-117. These elements can be used to compare the current Beloit Cancer Care Center to the prototype design proposed. A main distinction is the alteration to the core circulation patterns. The standard method utilizes a strait path that overwhelms users with a loss of depth perception. However, the new design fragments the path along a curve allowing for resting points to frame views and give users visual cues to what lies ahead programmatically (See figs. 7.49, 7.53, 7.54). This configuration of resting places also improves visibility

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(See fig. 7.50, 7.52). The path does not utilize any 90o corners that are visually neutral to a users direction, but instead utilizes an acute angle so that a comprehensible direction is maintained (See fig. 7.51).

Fig. 7.52_ Perspective of core circulation at path bend.

Fig. 7.53_ Resting space extending into the forest.

Fig. 7.54_ Resting space extending out to the lake.

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LINEAR ACCELERATOR

GROUP INFUSION ROOM

CONTROL ROOM MEN'S RESTROOM FUTURE CT SCANNER

RECIEVING/ STORAGE

WOMEN'S RESTROOM SEMI-PRIVATE INFUSION ROOM

PRIVATE INFUSION ROOM

PHARMACY PRIVATE INFUSION ROOM

STORAGE

LIBRARY LAB

MEN'S RESTROOM

WOMEN'S RESTROOM

CONFERENCE ROOM

SOILED/ CLEAN STORAGE

ALTERNATE THERAPY ROOM

STAFF ROOM EXAM ROOM

NURSE STATION

WHEELCHAIR STORAGE

EXAM ROOM

TELECOM ENTRANCE/ RECEPTION

BIOMED KITCHEN

EXAM ROOM

DOCTORS OFFICE DOCTORS OFFICE

EXAM ROOM DOCTORS OFFICE EXAM ROOM

EXAM ROOM

DOCTORS OFFICE

DOCTORS OFFICE STAFF RESTROOM

Vehicular Circulation Interior Circulation Exterior Circulation

Fig. 7.55: Simplified circulation of proposed site plan.

Co nCLuS ion Drawing from the effective wayfinding theories, the design is able to establish a singular clear path, portal, and place (See fig. 7.55) that eliminates the 90o maze like structures that often occur in typical healthcare facilities (See fig. 7.56). Furthermore, through clearly defined parking and walking paths the exterior wayfinding is also simplified and enhanced. over all, from arrival to departure, the new design shows how circulation can becomes an informative tool to guide users transitioning between and through programmatic spaces.

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Vehicular Circulation Interior Circulation Exterior Circulation

Fig. 7.56: Existing site plan for Beloit, Wisconsin cancer care center.

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WorK S C ite D Alibhai, Shabbir, Henrette Breunit, and martina Puts. “one Day at a Time.” Science Direct. n.p., 2015. Web. 7 Feb. 2016. <http://www.sciencedirect.com/science/article/pii/S0145212614003804>. Examined and interview cancer survival patients documenting the continued struggle with regards to health and function. The qualitative analysis focused on both young and elderly cancer patient survivors and there emotional experiences regarding the their treatment. This date over a large medium of patients was then translated into quantitative values to analyze the overall treatment and recovery of a wide range of patients. “Cancer Center now open.” Cancer Center. n.p., n.d. Web. 10 Feb. 2016. <http://beloithealthsystem.org/cancer-center>. Use as a comparison tool to the existing $11.6 million cancer center constructed on the same site in Beloit, Wisconsin as the prototypical design is proposed for. Research here outlines the basic treatment needed for each patient as well as the programmatic spaces to specifically address the care and treatment of cancer patients. “A Description of ‘a Hospital Hallway’” Descriptionari.com. n.p., n.d. Web. 08 Feb. 2016. <http://www.descriptionari.com/quotes/a-hospital-hallway/?h=hallways>. Descriptive quotations written by patients experience in health care and treatment environments. Patients descriptions can be extremely provocative and create a vision to the reality of the feeling and emotions that are invoked by such spaces. Devlin, Ann. “Wayfinding in Healthcare Facilities: Contributions from Environmental Psychology.” Behavioral Sciences 4.4 (2014): 423-36. Web. <http://www.healthcaredesignmagazine.com/article/wayfinding-healthcare-environment>. Alludes to a praedium shift of wayfinding within Health care facilities and realization that signage alone are and inadequate solution. The article describes key challenges that must be understood about how patients and visitors recieve information about their pending doctor appointments, medical procedures, or other interactions with the facility. While some of the solutions may be the architecture and design related, there are also methods such as technology advancments that are giving patients a clearer understanding of where they are and where they need to move within such heath care facilities. Foltz, mark. “5. Design Principles for Wayfinding.” 5. Design Principles for Wayfinding. n.p., n.d. Web. 19 jan. 2016. <http://www.ai.mit.edu/projects/infoarch/publications/mfoltz-thesis/node8.html>. Demonstrates five design principles about how to design wayfinding into architecture. The principles that stood out the most from this article would be creating a wellstructured path and using landmarks to provide orientation cues and memorable locations. Creating a well-structured path are continuous paths that have a clear beginning, middle and end when being viewed in either direction. A well-structured path maintains the navigator’s orientation to the next landmark along the path and the distance to the eventual ending. Using landmarks as a wayfinding tool creates visual cues and milestones that help distinguish certain areas from Ford, Richard. let me Be Frank with You. london: Bloomsbury, 2014. Print. Pulitzer Prize winning author describes in his fictional novel the aspects of ageing and dying that elude to the way all humans move to a “default self” when dealing with such a dilemma. Ford paints provocative visualization in chapter 3 of the struggles of not only of the concept of approaching death, but also how loved ones approach and visualize death as it begins to occur. GnU Group, matthew Brown, and Phil murphy. “Wayfinding in the Healthcare Environment.” Wayfinding in the Healthcare Environment. n.p., n.d. Web. 01 Feb. 2016. <http://www.healthcaredesignmagazine.com/article/wayfinding-healthcare-environment>. Graphic Design firm (GnU) is a leader in healthcare facilities signage. The article outlines specifically the new approaches that design is applying to wayfinding within health care facilities and how it can increase customer satisfaction, and result in staff spending less time giving directions to patients. The article also demonstrates how new signage technology can also improve the efficiency of how patients arrive to appointments on time. Heathy Circulation. murphy, Richard, Architectural Review. november 2011, Vol. 230, Issue 1377 Web. Feb. 2016. <http://web.a.ebscohost.com/ehost/detail/detail?sid=d2c6e22e-60e9-41a7-ace9-39bd0314ada1%40sessionmgr4001&vid=0&hid=4207&bdata=jnnpdGU9ZWhvc3QtbGl2ZQ %3d%3d&preview=false#An=67158604&db=a9h>. Evaluation of the architectural design of the maggis’s Glasgow Gartnavel Centre, a cancer patient center located on the grounds of Gartnavel hospital in Glasgow, Scotland, funded by the maggie’s Centres cancer patient organization and designed by the omA architectural firm. The artical describes that there is no core circulation within the building and that the space feels more like an empty art gallery than a center focused on the care of cancer patients. litton, R. Burton., and Robert j. Tetlow. Water and landscape: An Aesthetic overview of the Role of Water in the landscape. Port Washington, nY: Water Information Center, 1974. Print. Emphasizing the aesthetic aspects of water in the landscape, this report explores the contribution of water to the environments and recreation and everyday life. To identify the values of water in this role, a classification framework is developed for native characteristics and man-made changes to be considered together. The scope of the study includes evaluation based on quality recognition and makes recommendations for needed policies, planning guidelines, and research. loidl, Hans-Wolfgang, and Stefan Bernard. opening Spaces: Design as landscape Architecture. Basel: Birkḧuser-Publishers for Architecture, 2003. Print A study that breaks down individual components that describe how the Human arrives, moves and walks through a space. From the understand of the physiological of the human in relation to vision and depths of field, to how paths can transition between one another to promote or neutralise a space. This study demonstrates a variety of techniques that are seen as appropriate to promoting health wayfinding. Design techniques demonstrated range from landscaped designs to architectural forms. moore, Charles Willard, and jane lidz. Water and Architecture. new York: H.n. Abrams, 1994. Print Studies and investigates the capabilities and limitations of water as an element in architectural composition. It investigates the medium itself, and the effect it has on man’s mind, on his society, and on his works. It examines the form water takes, in combination with land forms, with plants, with sculpture, light, sound, and fire to create spectacle. “The Doctor Will See You Eventually.” WSj. n.p., n.d. Web. 07 Feb. 2016. <http://www.wsj.com/articles/SB10001424052702304410504575560081847852618>. Wall Street journal Article referring to current issuse with the U.S. health-care system. It explains the taxing process patients experience sitting in doctor’s waiting rooms, being ushered into examination rooms where they wait some more, which only adds to a patients aggravation. “What is wayfinding?” University of michigan, n.d. Web. 19 jan. 2016. <http://www.umich.edu/~wayfind/supplements/moreinfoframeset.htm>. Wayfinding is not just signs on the wall or directions of how to get there. Wayfinding can be described as spatial problem solving. It is all about knowing where you are in a building, where you need to get to and how you are going to get there. Good wayfinding systems give strong indicators and clues of where the user is and where to go. Poor wayfinding systems occur when the user does not have enough information to understand where they are in the building or where to go which causes confusion and frustration amongst the users. White, Edward T. Path, Portal, Place: Appreciating Public Space in Urban Environments. Tallahassee, Fl: Architectural media, 1999. Print. Demonstrates and explains with examples and illustrations tree types of public spaces (path, portal, and place) that users transition through daily. Paths, portals and places make up a majority of meaningful exterior space in urban environments. The places are plazas, courts gardens and parks. Portals are the gateways into the places. And paths are the boulevards, avenues streets, walks, and alleys that connect the places and knit the city together. Wolman, Abel. Water, Health, and Society; Selected Papers. Bloomington: Indiana UP, 1969. Print. Explains in detail the physical need for water for human survival and how it is deeply connected to the environment that we consume ourselves in. The research goes into explain that history shows little efforts of concern to the environment with regards to how water infrastructure has developed over the past century. It also eludes to some of the plausible solutions to the issue as a deepened concern is beginning to rise. 130

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aDDitiona L reSourC e S Dhand, Suneel. “Designing a Better Hospital - Suneel Dhand | Doctor & Author.” Suneel Dhand Doctor Author RSS. n.p., 2014. Web. 19 jan. 2016. <http://suneeldhand.com/2014/05/06/designing-a-better-hospital/>. Hind, mary j. “Designing for Health: Improving the Patient Experience in Chemotherapy Suites.” Contract Design. n.p., 01 Aug. 2012. Web. 2 Feb. 2016. <http://www.contractdesign.com/practice/healthcare/Designing-for-Health-7493.shtml>. Huelat, Barbara. “Wayfinding: Design for Understanding.” Wayfinding: Design for Understanding. n.p., 2007. Web. 19 jan. 2016. <https://www.healthdesign.org/chd/research/wayfinding-design-understanding>. “The Importance of Healthcare Wayfinding for Hospitals | l&H Sign Company, Philadelphia, PA.” lH Sign Company. n.p., 02 Apr. 2014. Web. 19 jan. 2016. <http://www.lhsigns.com/importance-wayfinding-hospitals.html>. landro, laura. “A Cure for Hospital Design.” WSj. Wall Street journal, n.d. Web. 19 jan. 2016. <http://www.wsj.com/articles/SB10001424052702303743604579355202979035492>. maddox, lucy. “Can the Design of Hospitals Help Patients Recover Faster?” Gizmodo. n.p., 2014. Web. 19 jan. 2016. <http://gizmodo.com/can-the-design-of-hospitals-help-patients-recover-faste-1663083331>. muhlhausen, john. “Wayfinding Is not Signage.” (2006): n. pag. Web. 17 jan. 2016. http://dlpotts.iweb.bsu.edu/arch263/310files/310-Reading11-Wayfinding.pdf.

iM a Ge SourC eS Figure 7.0: “3d man lost in the maze.” 3d man lost In The maze Stock Illustration. n.p., n.d. Web. 26 Apr. 2016. <http://www.dreamstime.com/stock-illustration-d-man-lost-maze-rendering-confused-person-finding-path-white-person-people-image60918941>. Figure 7.1a: “Hospitals.” Zombiepedia. n.p., n.d. Web. 26 Apr. 2016. <http://vignette1.wikia.nocookie.net/zombie/images/1/18/Hospital.jpg/revision/latest?cb=20160329114824>. Figure 7.1b: “Hotel Hampton Inn & Suites-Country Club Plaza, Kansas City, United States.” Booked.net. n.p., n.d. Web. 26 Apr. 2016. <http://www.booked.net/hotel/hampton-inn-suites-country-club-plaza-kansas-city-mo-31290>. Figure 7.2a: ”A Prayer for Those Who need Comfort.” Guideposts. n.p., 25 mar. 2014. Web. 26 Apr. 2016. <https://www.guideposts.org/faith-in-daily-life/daily-devotions/a-prayer-for-those-who-need-comfort>. Figure 7.2b: “Toronto Airport Photos.” Toronto Airport Photos. n.p., n.d. Web. 26 Apr. 2016. <http://www.sleepinginairports.net/album/toronto-airport-photos.htm>. Figure 7.3a: “Hospital Hallway.” Stock Photography. n.p., n.d. Web. 26 Apr. 2016. <http://www.dreamstime.com/stock-photography-hospital-hallway-image1435652>. Figure 7.3b: “How Prisons Work.” HowStuffWorks. n.p., 24 jan. 2007. Web. 26 Apr. 2016. <http://people.howstuffworks.com/prison1.htm>. Figure 7.4a: “mKSD Architects.” mKSD Architects. n.p., n.d. Web. 26 Apr. 2016. <http://www.mksdarchitects.com/project/st-lukes-hospital-health-network-medical-clinic/>. Figure 7.4b: “How Prisons Work.” HowStuffWorks. n.p., 24 jan. 2007. Web. 26 Apr. 2016. <http://people.howstuffworks.com/prison1.htm>. Figure 7.5a: mailonline, Kate Pickles For. “Does End-of-life Chemotherapy Do more Harm than Good? Associated newspapers, 24 july 2015. Web. 26 Apr. 2016. <http://www.dailymail.co.uk/health/article-3173307/Does-end-life-chemoths-gruelling-treatment-cancer-patients-WoRSE-quality-life-going-without.html>. Figure 7.5b: VInCEnTAlEX89. “one Flew over The Cuckoos nest - I Want my Cigarettes Full Scene - 1080p Full HD.” YouTube. YouTube, 22 may 2013. Web. 26 Apr. 2016. <https://www.youtube.com/watch?v=xlVSohBg_yA>. Figure 7.6a: “Chemo & Radiation Side Effects With a Brain Tumor.” lIVESTRonG.Com. lIVESTRonG.Com, 05 Aug. 2015. Web. 26 Apr. 2016. <http://www.livestrong.com/article/162063-chemo-radiation-side-effects-with-a-brain-tumor/>. Figure 7.6b: VInCEnTAlEX89. “one Flew over The Cuckoos nest - I Want my Cigarettes Full Scene - 1080p Full HD.” YouTube. YouTube, 22 may 2013. Web. 26 Apr. 2016. <https://www.youtube.com/watch?v=xlVSohBg_yA>. Figure 7.31: “Top 30 Unique and Extraordinary Places in World.” Travel oven. n.p., n.d. Web. 26 Apr. 2016. <http://traveloven.com/top-30-unique-and-extraordinary-places-in-world/>. Figure 7.32: “South Rim of Grand Canyon.” Roadtrippers. n.p., n.d. Web. 26 Apr. 2016. <https://roadtrippers.com/places/57591/photos/0?lat=40.80972&lng=-96.67528&z=5>. Figure 7.33: “Upper okavango.” Flickr. Yahoo!, n.d. Web. 26 Apr. 2016. <https://www.flickr.com/photos/nomadcom/2827647528>.

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have a Seat, ha ve a L a u G h Gerik Dobes + Cody jones

What’s wrong Emp? Crack a smile...

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Its so boring here, nothing ever hap---

Whoa... Awesome

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Fig 8.0_“Infusion-500”

abStra Ct one of the choices for cancer treatment is infusion therapy, where medication is administered through a connection port and needle that goes into the body. This requires a patient to be seated for long periods of time. Being in these chairs and receiving treatment can cause stress, escalating from an expected level to one that interferes with treatment, and affects all parts of life (American Cancer Society, 2015). To combat the stresses of cancer, one possible solution found was humor. norman Cousins, a comedian who went through cancer treatment, credited his recovery from cancer to humor, references Albert Schweitzer (a French-German physician, who won a nobel Peace Prize for his idea of the “Reverence for life”) who always believed that the best medicine for any illness he might have was… a good sense of humor” in his book Anatomy of an Illness (Roman and Cousins, 1982). It is from this perspective that we propose to use different styles of humor to design medical furniture that, we hope, helps provide an up-lifting supplement to those going through treatment.

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Fig. 8.1_ Examples of standard infusion chairs in medical environments. (Georgetown Community Hospital, 2016).

Fig. 8.2_ Examples of standard infusion chairs in medical environments (Georgetown Community Hospital, 2016).

intro DuC tio n When going through infusion treatment, one must sit in a chair for long periods of time, ranging from fifteen minutes to eight hours depending on the patient and the extent of the treatment (Wang, Pukszta, and Cayton 2011). Standard infusion chairs, seen in figures 8.1 and 8.2, are designed solely to meet medical standards. These minimum medical attributes make dealing with the infusion treatment process a stressful and challenging time, as there is limited control of what the patient can do (Wang, Pukszta, and Cayton 2011). The resulting increased physical stresses faced from cancer treatment then manifest themselves in the form of fatigue, hair loss, and weight change (American Cancer Society, 2015). Although, current chair designs are based on regulations that dictate shape and material, these

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limitations should not stop their redesign to improve a patientâ&#x20AC;&#x2122;s treatment experience. In fact, by adding humor to these chairs, it is possible to follow the required design regulations and simultaneously give patients the gift of laughter. Dr. William Ben Strean, professor at the University of Alberta, states that laughter has been shown to reduce stress, decrease heart rate, and lower oneâ&#x20AC;&#x2122;s blood pressure (Strean, 2009). Therefore it is the belief of this research that an effort should be made to promote the positive effects of laughter through the integration of humor into infusion centers.

SteeLCaSe eMPath FeatureS Central lock (dual-sided) Back recline paddles Footrest control lever molded urethane upper arms

Casters Footrest scallop Bumpers

Fig. 8.3_ Sample infusion chair which takes patient needs into consideration (Georgetown Community Hospital, 2016).

the in FuS ion Ch air Because patients often need to sit in infusion chairs for extended periods of time, their design is critical to the treatment process. However, the design and functions of infusion chairs are standardly held to a minimum standard while the many helpful features a patient may want are considered to be optional. In a focus group of cancer patients, it was discovered that patients want “A sense of control…because cancer takes away your control” (Wang, Pukszta, and Cayton, 2011). Specifically, they wanted increased control over light, sound and temperature. Unfortunately, these functions are not always put into chairs because they are not considered to be a part of the minimum set of standards. This minimum is due to furniture having to meet stringent design criteria that has been placed upon all medical furniture

equipment (malone and Dellinger, 2011). one chair that does manage to meet all criteria and still push the boundaries of infusion chair design is the Steelcase Empath (See fig. 8.3). The Empath is the result of 2000 plus hours of research and observation into patient interaction and seating (Steelcase, 2016). This chair could be seen as a suitable example of what can be accomplished when chair designs reach beyond the baseline standard requirements.

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Fig. 8.4_ Reduce Surface Contamination.

Fig. 8.8_ Decrease patient, family, and staff stress and fatigue.

Fig. 8.5_ Reduce patient falls + associated injures.

Fig. 8.9_ Improve staff efficiency + communication.

Fig. 8.6_ Decrease medication errors.

Fig. 8.10_ Improve environmental safety.

0 years

Fig. 8.7_ Improve communication and support for patients and family members.

5 years

Fig. 8.11_ Represent the best investment.

inFuS ion Chair Criteria one major challenge in designing infusion chairs is that there is a set of strict criteria for design: a checklist of recommended design features to be used in the development of treatment furniture. Developed by The Center for Health Design (The Center for Health Design is a non-profit organization of designers and healthcare professionals who are focused on improving the quality of healthcare through the built environment), the checklist includes eight qualities to be considered which serve as a base line for how infusion chairs are to be designed (See figs. 8.4 - 8.11) (malone and Dellinger, 2011). These criteria are only the minimum requirements, and therefore do not always represent the best for patients’ health. For example, many of the 136

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criteria, such as “represent the best investment” (See fig. 8.11) and “improve staff efficiency” (See fig. 8.10) deal with financial issues of treatment centers, but not directly with patient health (malone and Dellinger, 2011). This can create situations where the furniture becomes the best option for the treatment centers but not for the patients. This may cause an increase in patient anxiety, thereby justifying the need for more infusion chair designs to go above the minimum standards (malone and Dellinger, 2011).

Vinyl material, tinted neutral color, solid and stiff

Plastic arm rest, tinted neutral color

Steel Infusion bag stand, connected to chair

Vinyl material, tinted neutral color, solid and stiff

Plastic seat recliner handle

Plastic caster wheels Fig. 8.12_Features of the Steelcase Empath infusion chair

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AnXIETY

numerical Rating Scale Score (based on Hospital Anxiety Depression Scale)

3.42

2 2.19

2.10 1.94 1.48

Baseline

1st

2nd

3rd

4th

Fig. 8.13_ Graph showing the effect of laughter on patient anxiety levels

Session of Therapeutic laughter Program

DEPRESSIon

numerical Rating Scale Score (based on Hospital Anxiety Depression Scale)

3.48

2 1.77

1.84

1.74 1.65

Baseline

1st

2nd

3rd

4th

Fig. 8.14_ Graph showing the effect of laughter on patient depression levels

Session of Therapeutic laugter Program

STRESS

numerical Rating Scale Score (based on Hospital Anxiety Depression Scale)

3.32

2 1.65

1.58

1.26

Baseline

1st

2nd

3rd

4th

Session of Therapeutic laugter Program

Fig. 8.15_ Graph showing the effect of laughter on patient stress levels

huM or aS a So Lution With all of the issues and concerns that come with infusion chairs, there is a critical need to help patients feel better. one method that is starting to gain notoriety is the use of humor as a supplement to the treatment process. A 2015 study in which researchers promoted a laughing regiment to a cancer patient’s treatment showed significant drops in anxiety, depression, and stress (See figs. 8.13-8.15) (S. H. Kim, Y. H. Kim, and H. j. Kim, 2015). The scores for the test were based on an eleven point scale of anxiety, depression, and stress. A score of 1 was registered as the lowest on the scale, and 11 was the highest number possible. In all cases, implementation of a laughter regiment reduced patient scores.

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In addition, exposure to humor can provide patients with a more positive treatment experience. When interviewing a former cancer patient on whether they had been exposed to any humor, they responded “once back in the room, nurses would crack jokes and include the patients in them. The laughter helped to make it not seem like a place of doom” (Crape, 2016). Humor allows for patients to feel more comfortable about their environment, and allows them to feel positive in the space (malone and Dellinger, 2011).

Fig. 8.16_ The Pee-Wee Herman Chair (Chair, 2016).

Fig. 8.19_ The monster Chair (Wanders, 2014).

Fig. 8.17_ Frank Schreiner. Consumer’s Rest. c. 1983. (Fiell, 1997)

Fig. 8.20_ Allen jones. Chair-Sculpture. c. 1969 (Fiell, 1997)

Fig. 8.18_ Salvador Dali. mae West Sofa, c. 1936 (Fiell, 1997).

Fig. 8.21_ Studio Simon. omaggio ad Andy Warhol, c. 1973 (Fiell, 1997)

Chair Pre CeD enCe Integrating humor into the design of chairs has a long history. For example “Chairy”, seen in figure 8.16, from television show Pee Wee’s Playhouse was enjoyed by wide audiences. other chair designs have also employed humor in their creations (See figs. 8.17 to 8.21). These case studies each successfully marries the necessary functions of a chair with the added supplement of humor and serve to inspire future designs offered in this chapter.

Four chairs are proposed- each with a different theme and context. The “sedia auto,” “cancer hunter,” “treatment’s a beach,” and “I spy with my little eye” each explores a different form of exaggeration and contrast, which are crucial attributes of humor.

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Fig. 8.22_ Render showing how the Sedio Auto chair embodies the spirit of the racecar

Fig. 8.23_ The blend of infusion chair and sports car gives a sleek and sexy appearance to a standard medical design

“S e D ia auto ” Chair The “Sedia Auto” chair, (See figs 8.22 to 8.28), replaces the castor wheels found on standard infusion chairs with oversized sports car wheels, and is designed to appear like a high end sports car, bringing an element of luxury to the treatment experience.

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Ergonomic vinyl race car seat forms to human body

metal and wood recliner handle

Fig. 8.24_ Sedia Auto in its semi private â&#x20AC;&#x153;garageâ&#x20AC;? infusion room.

Rubber street wheels give smooth ride on any surface

Fig. 8.25_ Elements of the Sedia Auto chair

Fig. 8.26_ Spoiler can act as a shelf for nurses equipment. Fig. 8.27_ larger tires allow use on outdoor terrain.

Fig. 8.28_ larger tires also allow easier movement on conventional surfaces.

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Fig. 8.29_ The cancer hunter hiding in the Wisconsin wilds.

Fig. 8.30_ By disguising the infusion rack as a tree, the medical equipment is hidden, reducing patient stress, and can be removed to create a forest feeling in a room.

“Ca n Cer hunter” Chair The “Cancer Hunter” chair, (See figs. 8.29 to 8.33), expands the color pallet of the standard Steelcase Empath chairs, and investigates camouflage patterns for those patients who may wish to blend in for the successful hunt.

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Disconnected infusion bag stand, modeled after native spruce tree

Plastic arm rest, tinted in matching color with aesthetic grass ornament

Vinyl material, colored in tree pattern and natural colors (Realtree camouflage)

Fig. 8.31_ Infusion room example.

Fig. 8.32_ Elements of the Cancer Hunter chair

Fig. 8.33_ medical equipment disguising trees are made to be removable

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Fig. 8.34_ Have a seat, crack a cold one, take a nap.

Fig. 8.35_ The infusion rack is disquised as an umbrella.

Fig. 8.36_ The cooler attached from the side gives patients a convenient place to store personal items.

“t re a t Me nt’ S a b eaCh” Cha ir The “Treatment’s a Beach” chair, (See figs. 8.34 to 8.42), examines the materiality of infusion chairs by replacing the padding stuffed material with the light and airy material of beach furniture.

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Fig. 8.37_ material Contours to users body.

material is stretchable and contours to patients bodies, removable for easy cleaning

Steel infusion bag stand, modeled after a beach umbrella

Arm rests reflect beach chair style

Fig. 8.38_ Infusion room example.

Fig. 8.40_ The beach chair gives a more airy and open feel.

Fig. 8.39_ Elements of the “Treatment’s a Beach” chair

Fig. 8.41_ Conventional chair padding.

Fig. 8.42_ The “Treatment’s a Beach” chair replaces conventional padding with stretch fabric seating.

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Fig. 8.43_ “I spy with my little eye” playing hide and seek in a bustling market.

Fig. 8.44_ Fall: Various seasonal items can be added.

Fig. 8.45_ Spring: Various seasonal items can be added.

“i S P Y W ith M Y L itt L e eY e ” Cha ir The “I Spy with my little Eye chair”, (See figs. 8.44 to 8.46), explored the potential of making a transparent chair with multiple compartments. Depending on the occasion the compartments can be filled with ornaments, plants, etc.

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Fig. 8.46_ The chair can become a terrarium.

Fig. 8.47_ Infusion room example.

Fig. 8.48_ See Through, Easily Cleanable material, Viewable From All Angles.

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Fig. 8.49_ Room for laughter: the collection of humor chairs in a group infusion setting.

â&#x20AC;&#x153;Above all what matters is to not lose the joy of living in the fear of dying.â&#x20AC;? -Maggie Keswick Jencks

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WorK S C ite D “Distress in People With Cancer.” American Cancer Society (2015): 1-16.American Cancer Society. American Cancer Society, 8 june 2015. Web. 4 Apr. 2016. Article looking at what causes stress within a cancer patient and the steps that can be taken to reduce these stressors. “Empath Healthcare Patient Recliner Chairs - Steelcase.” Steelcase Emapth. Steelcase. Web. 13 jan. 2016. Website showing the details of the Steelcase Empath chair. In addition, it talks about the research that Steelcase had done with looking at Infusion chairs. GCH Cancer Center Room. Georgetown. Georgetown Community Hospital. Web. 26 jan. 2016. Images source citation. “Home.” maggie’s Centres. The maggie Keswick jencks Cancer Caring Centres Trust. Web. 13 Apr. 2016. Website containing information about maggie’s Centers and about maggie jencks. There are resources and additional information for those going through treatment. Crape, Gail. “Interview with a Cancer Survivor.” Telephone interview. 8 Feb. 2016. Interview with Gail Crape and her experiences with the treatment she had. S. H. Kim, Y. H. Kim, and H. j. Kim, “laughter and Stress Relief in Cancer Patients: A Pilot Study,” Evidence-Based Complementary and Alternative medicine, vol. 2015, Article ID 864739, 6 pages, 2015. doi:10.1155/2015/864739 Research showing the effects of putting a laughter regiment into the treatment of those who are going through cancer treatment. malone, Eileen B., and Barbara A. Dellinger. “Furniture Design Features and Healthcare outcomes.” The Center for Health Design (may 2011). Web. Article talking about a checklist that is used to determine what is necessary for the design of healthcare furniture. Roman, lawrence, and norman Cousins. Anatomy of an Illness. los Angeles: Hamner/Gershwin Productions, 1982. Print. A book from norman Cousins’s perspective of going thorough cancer treatment. He talks about how the use of humor had helped him get through his treatment. Strean W. B. laughter prescription. Canadian Family Physician médecin de Famille Canadien. 2009;55(10):965–967. Article looking ate the effects that laughter has on people as well as the effect is has on people going through treatements.. Wang, Zhe, michael Pukszta, and jennifer Hendrich Cayton. “Cancer Treatment Environments: From Pre-Design Research to Post-occupancy Evaluation.”Design & Health Scientific Review july 2011: 68-74. Print. Research that focuses on the patients need in Cancer treatment environments. the authors also give strategies in how to design environments for care.

iM aGe SourC eS Figures 8.1 to 8.2: GCH Cancer Center Room. Georgetown. Georgetown Community Hospital. Web. 26 jan. 2016. Figure 8.3: Empath Healthcare Patient Recliner Chairs. Digital image. Steelcase Empath. Steelcase, 2015. Web. Feb. 2016. Figures 8.13 to 8.15: S.H. Kim, Y.H. Kim, and H.j. Kim, “laughter and Stress Relief in Cancer Patients: A Pilot Study,” Evidence-Based Complementary and Alternative medicine, 2015. Figure 8.16: Chair from the Pee-Wee Herman Show. Digital image. Pee-Wee Herman Chair. Flickr. Web. 17 Feb. 2016. Figures 8.17 and 8.18: Fiell, Charlotte, Peter Fiell, Simone Philippi, and Susanne Uppenbrock. 1000 Chairs. K̈ln: Taschen, 1997. Print. Figure 8.19: Wanders, marcel. The monster Chair. Digital image. A Work of Gothic Inspiration: The “monster Face” Chairs by marcel Wanders. popartdecorations.com. 4 nov. 2014. Web. Figures 8.20 and 8.21: Fiell, Charlotte, Peter Fiell, Simone Philippi, and Susanne Uppenbrock. 1000 Chairs. K̈ln: Taschen, 1997. Print.

Figures 8.23 to 8.25: lamborghini. Digital image. lamborghini news. Car magazine. Web. 12 Feb. 2016. Figures 8.35 to 8.37: Hunters. Digital image. Realtree Camouflage. Cabela’s outfitters. Web. 12 Feb. 2016. Figures 8.46 to 8.48: Beach life. Digital image. Beach living. Travel and leisure magazine. Web. 12 Feb. 2016. Figure 8.58: Thompson, Colin. looking for Atlantis. new York: Knopf, 1997. Print. Figure 8.59: Fiell, Charlotte, Peter Fiell, Simone Philippi, and Susanne Uppenbrock. 1000 Chairs. K̈ln: Taschen, 1997. Print.

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aPPenDiX Architecture as a Contributor to Healing Dina Radjabalipour

on may 7, 2014 Dina Radjabalipour presented to her graduate project committee a preliminary design for the Chao Comprehensive Cancer Center in orange, California. Based on her somber personal experience with cancer treatment at this facility, she proposed a more hopeful transformation of this facility - from a mostly closed windowless 4 story box to a more open combination of gardens and rooms (See fig. 9.1+ 9.2). Using evidence based design sources which clearly correlated the healing benefits of seeing (and hearing) water, vegetation, and daylight, she skillfully created a three dimensional weaving of treatment and waiting rooms with outdoor gardens, Tragically Dina’s cancer returned before she was able to complete her project - she died of breast cancer less than one year later on April 14, 2015. This book is dedicated to her memory and endeavors to continue her quest for more humane, hopeful environments of healing.

Fig. 9.1_ The typical closed cancer care center “left” is expanded to make room for gardens of water, vegetation, and day lighting “right.”

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Fig. 9.2_ Size and location of the various rooms are optimized to include day lighting.

Fig. 9.3_ Enlarged View of the mixing of interior waiting rooms and exterior gardens.

Architecture as a Contributor to Healing

Fig. 9.5_ Preliminary rendering of rooms and gardens

Fig. 9.4_ Concept plan for infusion center: gardens alternate with patient rooms.

Fig. 9.6_ Physical model.

Fig. 9.7_ Quotes From Dina’s Research

“Nature promotes reflection on the continuity of life and offers positive distraction from the anxiety and stress from hospital.” - Kaplan and Kaplan (1990). “Restoration from the stressed state is manifested within 3 minutes, sometimes as fast as several seconds, when a naturebased element is introduced into the space.” - Katcher, Segal, and Beck (1964). “Stress-reducing or restorative benefits of views of nature are manifested as constellation of positive emotional, psychological, and physiological change.” - Ulrich (2008). “Water features have a claiming effect and help reduce stress.” - Joseph (2006). “Patients experience less pain when exposed to higher levels of daylight.” - Malenbaum, keefe, Williams, Ulrich, and Somers (2006).

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i re n e arz ag a

Wi l l ia m bi l y e u

J a n n i ta bo l i n

Ste p h a n i e Chi m on a s

G e rik Do be s

L e a h e n g e l h a rdt

J a y h e n s o n ii

Ke l s e y J a n c o la

em m a Ga u l k e -J ano ws k i

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r a tana Su o n 153

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I n l o v in g m em ory of tho s e who ha v e p a s s ed an d tho s e who ha v e s u rv i v ed the ba ttl e with c an c e r.

Ga l e Crape Vi rgin ia Cubi n e Sa n di K e rwin El l woo d Cas s iu s Hi rz el Nan c y K . M i l e s Pa tjaree Pan ran gs e e R ae Sets u k o Sei tz M arli n Suo n T i n a To rrey Carol W y a tt

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Architecture Graduate Research Studio 2016 School of Design + Construction Washington State University, Pullman, Washington 99163-2220 509.335.1373