Pura Vida : A Physical Therapy Rehabilitation Center

PURA VIDA A Physical Therapy Rehabilitation Center

Florida International University College of Architecture + Arts School of Architecture Interior Architecture, Class of 2014 Thesis Title: Pura Vida Student: Carmen Ferrer Professors: Phillip Abbott & Katie Rothfield Mentor: Claudia Machado

Index Preface...........................................................................................................................................1 The effects of interior design elements in physical therapy environments............................3 I.Introduction................................................................................................................................8 II. Hospital design and healthcare evolution................................................................................6 III. Physical therapy profession.....................................................................................................7 IV. Physical therapy patients.........................................................................................................9 V. Influence of the environment..................................................................................................10 VI. Interior design effects in healthcare settings..........................................................................12 VII. Building codes......................................................................................................................14 VIII. Conclusions..........................................................................................................................15 Annotated bibliography............................................................................................................17 Initial thesis project questions and purpose.................................................................................19 Programming............................................................................................................................33 I. Typology and location...............................................................................................................35 II. History and precedent case studies.........................................................................................38

III. Client/Owner..........................................................................................................................47 IV. Location and site....................................................................................................................50 V. Client/User..............................................................................................................................58 VI. Goals and objectives...............................................................................................................63 VII. Quantitative...........................................................................................................................64 VIII. Site documentation and building selection........................................................................76 Analysis and codes......................................................................................................................81 Building analysis..........................................................................................................................83 Code search..................................................................................................................................89 PURA VIDA.................................................................................................................................97 Afterword.................................................................................................................................137 Bibliography............................................................................................................................139 List of figures...........................................................................................................................144 Acknowledgements.................................................................................................................149

literary review

PREFACE This book is based on the thesis entitled Pura Vida. It shows all the steps that went trhough in order to achieve all the objectives stated. An opportunity for self improvement, this design thesis was a test of knowledge where as a designer, problems were faced and solved.

This book was organized in the way the student proceeded on the thesis, giving the reader the chance to notice how the choices were made and why, as well as how they might have been changed in order to finish the thesis project successfully.

Divided in five sections: literary review, annotated bibliography, programming, analysis and codes, and the project “Pura Vida”, the purpose is to show every step of the captastone from the beginning of the research to the very end which is the development of the conceptual project. Hoping that this book serves as an example for future thesis works where the students can identify what the weakest and strongest parts of this work are, this captastone is showcased so the students can guide themselves in doing a better job.

Pura Vida, explores the possibilities of creating a physical therapy rehabilitation center in a foreign country, Costa Rica, following the American procedures for codes and guidelines of construction and design.

Literary review, the first chapter, is in fact the second step, but for presentation purposes 1

and a far better understanding of the thesis it seem appropriate to put it as first in the organization of the book in order to engage the reader in the work that follows it. Called “The effects of interior design elements in physical therapy environments,” it is a compilation of precedent studies and research on the subject chosen by the student, and how it helps in developing the thesis.

The “annotated bibliography,” which is the very first step in developing the thesis, shows the initial thesis project questions and purpose. It is also a showcase of the articles, books, magazines, and other works on which the student based the capstone project.

“Programming”, as studied in previous courses, is the scope of work where the designer (in this case the student) conducts research to define the scope of work. For this thesis work programming included: typology and location, history and precedent case studies, defining the clients (client/owner, and client/user), location and site, the goals and objectives for the project, a quantitative research, and last but not least the site documentation and building selection.

“Analysis and codes,” were the two last steps before the realization of the conceptual project. In this chapter it is shown the final building analysis and the code search that took place in order to make the project suitable and compliant to the US building codes.

“Pura Vida,” was the name given to the conceptual project due to the location and typology of the same. This chapter contains everything related to the concept and design

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guidelines that were used to guide the designer and the project towards the path desired, and how these were followed and executed to achieve the visions of the student.

As it is called conceptual project, the reader must know that it is not a finalized project.

This is progress work of an ideal that the student developed.

A thesis requires effort, dedication, and hard work. Three semesters were granted for developing this captastone, and with these the supervision of three professors. There was also an outside guidance and collaboration with professionals all of whom possessed many years of experience in their discipline. Even with all the help and time, it never seem like enough to achieve all the goals and objectives proposed. There is so much that one wants to achieve when developing a thesis where all the heart and concentration goes to, but there is never enough time to completely finish all the details and design concepts desired for every single square foot of the building. There is so much that one can do, perhaps an advice is be sure to do what is possible to the best capacity and be proud of it.

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The Effects of Interior Design Elements in Physical Therapy Environments

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I. INTRODUCTION Throughout history, hospitals were considered charitable institutions, but in the early 1900’s they seem to have evolved into scientific research centers, where patient comfort has become of little interest (Sloane, 1994). At the time the best solution was to incorporate the elements of design from a shopping mall into the hospital setting. Shortly after, hospital administrators started asking designers for help on resolving the issue and making the designs more accessible and welcoming to the patients and their families (Sloane, 1994). This design includes the use of hotel-style lobby, commercial spaces, and even retail and restaurant elements (Sloane, 1994). After applying this concept to hospital designs it was noticeable that the hospital was able to “[deliver] a more humane, communal, attractive, and relaxing space in which people can feel comfortable” (Sloane, 1994, p.90). Architectural critic Mitchell Green agrees with the design concept and believes that “[d]esigners are emphasizing customer comfort in high-style surroundings, changing designs to encourage family participation, and creating images which evoke an inviting combination of social life and community education” (Sloane, 1994, p.90).”

Healthcare is one of the most demanding settings to design, as it affects human lives with regards to their psychological, physiological, and spiritual well-being, as well as their safety, hopes and future. Physical Therapy is an important medical branch where patients, through physical healing, are able to regain faith in themselves; they rejuvenate 5

their bodies in ways that they never had before, gain strength and look at life in a positive way. According to Arriaga (1992), the American Physical Therapy Association did an assessment to foresee what the future held for this segment of medicine and found[:] The ability to change and evolve successfully is dependent on an understanding of the environment in which we exist; the factors that will affect change in this environment; and the opportunities, challenges, and threats presented by these factors. Thus, the concept of an environmental assessment has become an integral part of the strategic planning of many organizations and groups. (p.378) Following this assessment, the organization narrowed their research of the future of physical therapy within the healthcare system into the six main areas that would affect Physical Therapy: the economics of healthcare, the demographics of the American population, human resources in physical therapy, the physical therapy profession in the healthcare sector, the shaping of public policy, and the role of the association itself (Arriaga, 1992).

It would be appropriate to assume that interior design would affect some of these areas as well because designers address demographics, employee needs, and even design needs during the schematic planning phase in order to provide a successful design.

The body of knowledge of Interior Design is constantly growing. This is how designers learn of the impacts that interior spaces and their designs have on people. A negative or positive reaction from the users always depends on how the design is executed. Designing for healthcare takes knowledge, effort, and much attention because the space is

literary review being dedicated to people in a vulnerable state of body and mind. Providing the patients of physical therapy with a setting that motivates them is important, it can accelerate their recuperation process, and as for the staff it can result in a space that inspires them to work every day, a space where they go to comfort themselves while trying to help others, as for designers, it is a goal to reach for and to feel proud of once it has been met.

PURPOSE STATEMENT The purpose of this review is to analyze and interpret the existing literature regarding physical therapy settings in relationship to healthcare, and understand the effects of interior design on the recuperation process of physical therapy patients and the environmental factors that promote the healing and rehabilitative process. It is important to study the healthcare environment because research continues to develop and grow, offering new ideas and standards for healthcare professionals and patients alike. This research will uncover the optimum conditions, to encourage a speedy recovery.

SIGNIFICANCE OF LITERATURE REVIEW Based on the findings obtained, this review proposes implications and suggestions related to Physical Therapy settings and the optimum conditions for the patients’ recovery.

American society is constantly changing due to a number of different factors such as human needs, the economy, and technology (Arriaga, 1992). Healthcare facilities can offer people who are recovering from traumatic experiences the opportunity to learn and accept new realities about themselves, and opportunities to reunite families and a means to look at life from a different perspective. To progress in life it is necessary to learn and to apply this new knowledge. Arriaga (1992) believes that healthcare is moving in the right direction[:] Research in the basic and clinical sciences has led to great strides in understanding the machinery of the body and the origins of disease and in developing more effective prevention and treatment methods. Work in the social sciences has improved understanding of the clinician/patient interaction and has led to more effective methods for public, patient, and professional education. Studies in the area of health services research have provided insights into the complex interaction of components of health care delivery. (p.389) It is just as important to understand and improve the patient to client relationship, as it is to research and to further investigate the spatial conditions in which this interaction

occurs, and to prove if in fact the surroundings do have an effect on the physical therapy process and if they affect the outcome of the patient.

II. HOSPITAL DESIGN AND HEALTHCARE EVOLUTION In the early stages of healthcare and hospital care history there was no place for those who needed treatment; the rich would be treated in the comfort of their home and the poor would have nowhere to attend. Facilities and hospitals were opened in the 1800s so the poor could assist and receive proper care. Even if the chances of survival from diseases and wounds were minimal, these places were indented to serve as charity. The hospitals had poor sanitary conditions, lack of staff, and minimal humane treatment quality, but it was the only place to attend hoping that there was a cure for those that couldn’t afford a private physician. W. Gill Wyllie believed that hospitals were a necessity for the homeless and he came to the conclusion that “the majority of our hospitals... are liable to do more harm than good” (Sloane, 1994, p.84).

Influence of Healthcare As healthcare evolved, so did hospitals. With the arrival of new technology (X-ray examination), the wealthy wanted to be considered and be provided with private rooms. The idea was to be able to attend the hospital and receive small surgeries, and for the women to give birth. This opened the possibility of changing the design and layout of the everyday hospital. “Opened in 1885, John Hopkins had five large public wards and two private wards for paying patients separated by gender” (Sloane, 1994, p.84). They were now being built with private rooms fully furnished for the wealthy, and the typical bed to bed accommodations on the wards for the poor. The hiring of trained nurses lowered the mortality rate; nurse reformers found a way of convincing hospital administrators that what people feared the most about hospitals was “the lack of cleanness, efficiency, and sanitation” (Sloane, 1994, p. 84).

Hospital Evolution By the 1900s there were noticeable changes made to the hospital design, it transformed from an establishment of public charity to an establishment of scientific research. The 6

literary review hospital was a medium in which medical students learned patient care through practicing the ongoing treatment of patients under the supervision of expert doctors. This era marked a peak in healthcare as the government got involved into providing funds through the Hill-Burton Act from 1947, and Medicare and Medicaid in the 1960s (Sloane, 1994). Hospital administrators had made accommodations for as many people as they could fit from every class (wealthy, medium, and poor). The main concern was the profit gained instead of the well-being of the patient. To give an overall description of the settings Sloane (1994) quotes on his research: The (private) rooms are right and tastefully decorated, furnished with a single bed, a lounge chair, and a reading table; there are outlets for lamps, television and a telephone.

The general impression is one light, airiness and quiet... The semi-private accommodations have 60 percent more beds in the same floor space... The ward accommodations are crowed with equipment and people, sick and well. (p.87)

tients with the healthy, giving them the opportunity to perform normal activities that made them feel like a part of society again (Sloane, 1994).

Shopping Mall Concept

It was noted that the demographics of the American population would suffer a dramatic change in the upcoming years (mid 90s and beginning of the millennium), caused by the growing number of people migrating, the aging of the population, growing poverty, and cultural diversity, that would give rise to complex health problems (Arriaga, 1994).

“Culture has a powerful influence on health and illness” (Deutsch, Anderson, 2008, p.31). Decisions about illness seem to be influenced by personal experiences, values, and customs on which people base their foundations (Deutsch, Anderson, 2008). Regarding the health care sector Arriaga identified that “[t]he evolution of health care will create change within all facets of the profession, including practice, research, and education” (Arriaga, 1994, p. 380). The physical therapy profession would conduct studies and reasearch centered on the outcome and effectiveness of treatments. This research was predicted to be beneficial to the healthcare sector. Public policy would change and be shaped as groups, individuals and the government would demand. The profession would definitely find challenges in the upcoming years but it would grow, creating job opportunities and recognition in the health care sector (Arriaga, 1994).

Hospitals were looked at as hotels for the sick. The designs of the architecture were contemporary for the hotels in the West. The critics found the buildings to be impersonal, high on costs and uncaring (Sloane, 1994). Hospital administrators went to designers asking for help, that is how the concept of “the shopping mall” came to be. Gillette suggested that the shopping mall “was to offer, in short, that ideal middle ground between city and country, public and private life, which was so often promised for the suburbs but so seldom realized” (Sloane, 1994, p.91). This concept idea placed the “lobby” in the main entrance, it made emphasis on the way finding, commercial spaces and retail stores, restaurants, and even included amenities (comfortable furniture, sculptures, fountains, etc.). This design concept has been used not only for hospitals but also for hotels, offices, and even restaurants. John Billings the designer of the hospital John Hopkins, in 1874 was able to identify in a piece he wrote about Hospital Construction that he never saw a review written from a patients point of view (Billings, 1874). Research on the past on physical environments in hospitals has been focused mostly on staff satisfaction and this one was linked to the service delivery in a specific context (Moushard, Zhao, 2012). As a resultThus, hospital administrators gradually became aware of how the opinion of users could inform hospital building design.

As human needs evolve so do all the things around them, in this case, the healthcare and hospital design has to fit consumers needs. The shopping mall concept became a strong tool for designing hospitals. The shopping mall elements used incorporated isolated pa7

III. PHYSICAL THERAPY PROFESSION “Physical therapy is the core therapy in rehabilitation practice” (Djong et al., 2011). An assessment was done in the 1990s for the American Physical Therapy Association, the purpose was to predict what the future was holding for this profession. Arriaga found six major areas that would affect the profession: economics, demographics, human resources, the profession within the healthcare sector, public policy and the role of association (Arriaga, 1994). The significance of this analysis was to learn what aspects would affect the profession and in which ways.

Physical Therapy has evolved since the 1990s. The body of knowledge keeps growing, the profession is expanding and implementing new kinds of therapies, psychologically and physiologically. The implementation of new therapies benefit the patients (Deutsch, Anderson, 2008). Research in the social sciences has proved to be useful to the understanding of the patient/clinician relationship, this interaction has improved the education of the patient, and the professional (Arriaga, 1994).

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Fig. 1.1: .Children at Tadworht Court Convalescent Home at Great Ormond Street Hospital.

Fig. 1.2: One of the large wards at Debarkation Hospital.

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IV. PHYSICAL THERAPY PATIENTS Human beings are connected in body and mind, one cannot function without the other. “[M]ental processes and the state of the mind can affect the biochemical, immunological, and physical status of the body” (Deutsch, Anderson, 2008, p.84). Many studies in the medical field have proved that a good correlation between the physical and the psychological state can provide great benefits to the well-being of a person.

It has been recognized that stress, depression and anxiety have an important role in causing illness, intensifying symptoms, and interrupting the recovery of the patients (Deutsch, Anderson, 2008).

Psychological Needs Davis (2011) did research on the benefits of rooftop gardens in the physical therapy setting. He used post occupancy evaluation (POE) methods to gather the perspectives and opinions of all the possible users of the spaces, as well as the designers of the space.

All the patients that participated agreed on the garden being valuable to their recuperation. They seemed not to care where the therapy was done but they appreciated spending time outside, where they were able to find themselves after losing their own identities through the recuperation process. One of the patients said “[w]hen you feel better mentally, emotionally, and spiritually, you do physically” (Davis, 2011, p.30). It is clear that the connection between mind and body is strong, therefor it is essential that designers can create a space where this connection can become stronger.

There has always been the myth that being exposed to nature or the natural environment has the ability to heal. Modern research has shown that in fact being exposed to the natural environment can benefit in the healing and recovery of a person (Kaplan, 2001).

It is the state of mind that helps the process of recovery to advance and have positive results. Patients undergoing physical therapy, are in a vulnerable state of mind; they are psychologically wounded, it is necessary for them to find a place that gives them comfort and the chance to meditate and accept their new conditions. Sloane (1994) proposes that reducing the seriousness and anxiety of hospital settings helps in reducing the stress on patients, visitors and the staff. This is to be considered when designing spaces for the healthcare sector.

Patients have discovered that having a peace of mind can help in their recuperation:“spiritual well-being helps emotional problems, which in turn have an effect on physical 9

well-being” (Davis, 2011, p.30). There is a psychological bond to the natural environment that makes a person feel good and rejuvenated. The colors of nature, the wind, the natural sunlight, these are elements that people appreciate and have stated to have made a difference when being in a hospital (Davis, 2011). Studies have also proved that distracting the mind with natural views and sounds when performing painful tests or exercises to a patient can result in the reduction of pain and anxiety (Diette et al., 2003).

Kaplan (2001) noted in her research of the impact of natural surroundings that there is an improvement on health if the windows at home face natural surroundings, with this she proposes to provide window views, gardens and green areas around the building in order to increase human activity in relation with nature.

Psychologically, physical therapy patients need to be at peace with their new reality in order to feel spiritually motivated to advance in their recovery. Natural environments seem to be the catalyst in finding emotional acceptance. Landscape designers and architects have the opportunity to create spaces for these individuals; spaces that could help them be in constant contact with nature and with themselves.

Physical Needs In the past three decades scientists have taken on the task of studying and further exploring the deep connections between mind and body. “Much evidence exists for the powerful impact that the mind has on our physical health and the influence of the body’s condition upon our mental state” (Deutsch, 2008, p.86). It would be appropriate to assume that the rehabilitation depends on both, but mainly the physical recuperation on the positive state of mind.

In physical therapy it is crucial to move the patient as much as possible regardless of the kind of impairment that he/she suffers. Movement is essential to avoid muscle atrophy.

Every treatment goes according to the necessity of the patient (Djong et al., 2011). Some of the activities performed in physical therapy are after the formal assessment of the patient: exercising, transfers, gait, community mobility, stretching, bed-chair transfers, walking on uneven surfaces, and the use of orthotic devices (Djong et al., 2011). Studies have also proposed to use new technologies for rehabilitative exercises, for example the game Wii (Shih, CH. Chen, Shih, CT., 2012). The use of “assistive technology devices, which are designed to assist people with deficits in physical, mental, or emotional functioning, are alternative ways of performing actions, task, and activities” (Shih, CH. Chen, Shih, CT., 2012, p.43). These are only some examples that leave the designer and

literary review architect with an idea of how the setting for physical therapy should be, it gives a window to the imagination to create spaces for specific activities and interactions. It should be taken into consideration that due to the impairments of these patients, the spaces should be ADA compliant.

It is recognized that physical therapy has a vast amount of patients all suffering from different or similar impairments (Djong et al., 2011). When creating a space for this sector of healthcare, many things have to be considered such as but not limited to: the users of the space (patients, staff, visitors), what codes should be followed (ADA), is the location appropriate for its use, how is it going to be managed, and how all of these different factors contribute to the overall effectiveness of the design. Providing the patients with a space that can meet all their needs is a priority for it isa catalyst for the recovery process.

V. INFLUENCE OF THE ENVIRONMENT “Within a therapeutic recreation context, recollections of past recreation experiences may be used to create different levels of physiological arousal and affective conditioning for people with mental and/or physical disabilities.”(Tarrant, Manfredo, Driver, 1994).

“Research suggests a strong association between health outcomes and the physical environment in which a person lives or receives treatment” (Mourshed, Zhao, 2012, p.362).

The environment on which people interact can have an influence on their health, in their moods and emotions. “Many psychiatric healthcare organizations understand how built environments can impact patients[...]” (Doherty, Sell, 2011, p.30). According to many studies, families and patients seek environments that do not look institutionalized. Most hospitals usually do not offer the physical and psychological comfort of being home (Doherty, Sell, 2011). People tend to look for familiar spaces in order to feel comfort and safeness. It is important to provide the people with personal space because it improves the restorative qualities of an environment, and a place that is compatible and coherent.

Favorite place experiences are characterized by the feeling of being away, coherence, fascination and compatibility with the place, which provide a restorative experience to the person (Korpela, Harting, 1996).

In the research conducted by Davis (2011), patients seemed to prefer spending more time outside. They wouldn’t mind where the therapy would take place, either outside on the rooftop garden or inside, but they liked the idea of having an outdoor place to

retreat. The use of the rooftop was considered valuable according to the staff members from the physical therapy department at the hospital. They considered the garden to be a good alternative to working with the patients, but also to be “capable of improving their emotional or spiritual outlook” (Davis, 2011, p.26). In another research Engelke and Frank (2001) identified that there should be planning and designing of public features that encourage to walk and bike which would improve public health.

It is important to look at every perspective of the users of the space, making sure that it makes a positive impact at least to the majority. In other studies it has been identified that the good design execution of a hospital environment can increase the effectiveness and satisfaction of the staff. This leads to a reduction in medical errors and infections that can be acquired in the hospital. Furthermore, it can decrease staff injuries and stress (Mourshed, Zhao, 2012).

Impacts of Natural Environment’s Elements Previous studies based in the context of hospitals and other settings have demonstrated the importance of the role of “the view”. Elements such as windows result in faster recovery or in the reduction of need for health care services (Kaplan, 2001). It is not the window but what people see out of the window that makes a difference in their health.

There is also evidence from other studies that prove that the use of natural elements can enhance the feeling of well-being, so it is essential to maximize the use of windows, skylights and glazing. The sunlight has a positive effect on the well-being of a person (Korpela, Harting, 1996).

Nanda, Eisen and Baladandayuthapani (2008) use the first landmarks found on the impacts of nature views on patients’ recovery from a hospital in Pennsylvania between 1972 and 1981 in their research about the healing effect of visual art on patients[:] Findings showed that surgical patients assigned to rooms with windows and looking out on a natural scene had shorter postoperative hospital stays, received fewer negative evaluative comments in nurses’ notes, and took fewer potent analgesics than matched patients in similar rooms with windows facing a brick building wall. (p.271) Patients, when answering questionnaires regarding the benefits of having a garden in the hospital as a physical therapy center responded that: fresh air, seeing changes while being there, and getting away from the hospital smells to see green were some of the benefits of having this natural setting within the hospital (Davis, 2011).

There is an apparent improvement on people’s health when exposed in some way to nat10

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Fig. 1.3: Physical thetrapy rehabilitation center gym setting.

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literary review ural elements’ views and physical settings. It would not only be beneficial to the patients, but also to their doctors. It is reasonable that this should be used as an advantage for designing healthcare settings.

VI. INTERIOR DESIGN EFFECTS IN HEALTHCARE SETTINGS Empirical research has proved that elements of interior design have influenced the users of a space. This research covers the field of healthcare and the main users of the space.

Slime says that “[t]he idea of ‘place making’ or the provision of an optimum psychological fit between people and their physical surroundings has received renewed interests among the design community” (Mourshed, Zhao, 2012, p.362).

Influence of Interior Design Elements on Users According to Miwa and Hanyu (2006) little research has examined the healing potential related to design. It is said by Blichik that “[g]ood design on its own cannot heal but, it can make science work better” (Frost, 2004, p.S-88). Frost (2004) says in his research that “[l]ighting, offices, public, and private spaces, finishes, wall coverings, acoustics, outdoor seating areas along the meditation path, and water artwork have all been designed to impact positively as people try to change their lifestyle” (p.S-88). With this information it seems that in fact, elements of design do have an effect on people, and if a design is well executed usually the effects have a positive result in the healing process of a person.

Studies have proved that light can impact the health and performance of humans by “enabling performance of visual tasks, controlling the body’s circadian system, affecting mood and perception, and by enabling critical chemical reactions in the body” (Joseph, 2006, p.1). Joseph’s (2006) findings also include that higher levels of lighting are linked with better performance when doing visual tasks and as age increases so does the light requirements. Light can also impact the outcomes in healthcare settings, by controlling the body’s circadian system, it can reduce depression, decrease the length of stay in hospitals, and improves the sleeping and circadian rhythm. It is said to also decrease agitation among dementia patients, ease pain in patients, and improve staff adjustment to night-shift work. There are also findings indicating that the presence of windows in the

workplace and access to daylight result in an increase of satisfaction in the work environment. It has been known for years that the exposure to light is essential for vitamin D in the human metabolism of the body, and exposure to light is also used as a treatment for neonatal hyperbilirubinaemia (Joseph, 2006). Also in the subject of lighting Alexander, Ashton-Miller, Giordani, Guire and Schultz, found evidence in their study that as people age their need for better illumination to perform tasks increases: Because fall risk is increased by the presence of an environmental hazard [as in an uneven walking path, (9)],vision becomes more critical in avoiding a fall when the environment places more demand on vision. Demand is increased in a darkened area, or where there are hazards to be traversed and stepping accuracy becomes critical. (p.1558) In healthcare settings it is also important to know which kind of art and objects to use, the opinion of the users should be considered when selecting the decorations of the space.

Nanda, Eisen and Baladandayuthapani (2008) conducted research of the perceptions between healthcare patients and students on art for healthcare settings. Patients mainly had a preference for art pieces that contained natural content, while students preferred abstract art (Nanda, Eisen, Baladandayuthapani 2008). The spaces should be designed according to the preferences of the future users of the buildings, leaving aside the preference of the designers.

Mourshed and Zhao (2012) performed a study on the perceptions’ of healthcare providers physical environment design factors in hospitals. Their research had significant findings regarding design elements and the impact these have on the personnel of the hospital. The elements they investigated: illumination, air quality, architectural design, daylight, cleanliness and maintenance, exterior views, furniture layout, plants and landscaping, location and orientation, acoustics, color scheme, cohesiveness of objects, adjacency, spaciousness, thermal comfort. In their literary review it was found that elements of design do have an effect on staff and patient: •

•

Illumination: According to Shikder and Mourshed (2010), adequate illumination (artificial and natural lighting) is required to perform visual tasks; and Buchanan, Barker, Gibson, Jiang, & Pearson (1991) say that it reduces the chance of errors on medicine-dispensing (Mourshed, Zhao, 2012).

Air Quality and Freshness: Air quality and freshness reduce the presence of unpleasant smells Insufficient ventilation was found to decrease work efficiency and productivity according to the findings of Seppänen et al (2006). In 2002 there was found a link between poor air quality and the risk of the increase of nosocomial 12

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•

•

•

•

•

•

infection (Mourshed, Zhao, 2012).

Daylight: In a research in 2008 consucted by Ulrich, it was found that daylight has an impact on the performance of visual tasks and the psychological state of a person. It impacts the patient outcome and provides medical and office workers with restorative benefits (Mourshed, Zhao, 2012).

Furniture: Vischer (2007) said that the ergonomics of furniture can cause longterm muscular or nerve injuries; Tzeng and Yin (2009) found that the majority of patients’ falls were linked to furniture layout (Mourshed, Zhao, 2012).

Acoustics: Dubbs (2004) directly linked to the outcomes of patients to the noise levels of the space; he also said that staff effectiveness increased in quiet settings.

Loud environments result stressful and sufficiently high in interfering with their work according to the findings of Bayo, Garcia & Carcia (1995) (Mourshed, Zhao, 2012).

Color Schemes: Dalke (2006) said that along with lighting, color schemes have an impact in people’s responses to the environment and affect staff morale and quality of healthcare.

Cohesiveness of Objects: The use of art has been found by Stucky and Nobel (2010) to be effective in reducing adverse psychological and physiological outcomes (Mourshed, Zhao, 2012).

Thermal Comfort: Fischer (2006) found that thermal discomfort is related to inadequate nurses’ work ability and Witterseh, Wyon, & Clausen (2004) linked it to the reduction of their productivity (Mourshed, Zhao, 2012).

There is an evident effect on the users from interior design elements on healthcare settings. It is necessary to have these findings from previous research so they can be used on future designs to prevail in the good, safe, and innovative design of healthcare environments.

Space Planning and Architectural Layout In the history of hospitals, the location and orientation of the architecture was thought to be of importance in order for the building to receive the most from the natural surroundings and environment. “John S. Billings’s pavilion design for Johns Hopkins surrounded the buildings with light, air, and sun while separating the patients by illness” (Sloane, 1994, p.85). At the time it was believed that the design had to follow the two main theoretical concepts that guided health care: 1. Natural elements eliminated pollutants in the air, preventing diseases and infections from spreading; and 2. Isolating patients would 13

show that physicians were unable to spread disease within the hospital (Sloane, 1994).

In the research done by Mourshed and Zhao, they found elements rewarding the architecture and landscape that can also affect the users: •

•

•

•

•

•

Architectural Design of the Space: Guenter & Vittori believe that the architectural design goes beyond that of a geometric organization for the space, that it influences the sensory perceptions of the users. They also believe that the spatial designs affect staff retention, and efficiency and productivity (Mourshed, 2012).

Exterior Views: It has been found that views can have a positive effect on the recovery of the patient, even more the views that have natural content. Ulrich (1984) found that “[v]iews to the outside are manifested as positive emotional and physiological changes leading to stress reduction or restorative benefits” (Mourshed, Zhao, 2012, p.364).

Landscaping and Indoor Plants: Plants and landscaping were recognized as contributors of a positive distraction and providers of a pleasant working environment.

Ulrich (1999) says that views of natural settings have an influence on the recovery of patients (Mourshed, Zhao, 2012).

Location and Orientation: According to Zimring (1990) the location and orientation of the space is linked to a series of functions within the space: visual, auditory, thermal, and olfactory environments. The use of a poor location and orientation may lead to a poor way finding system, it may also contribute to staff stress and waste of time (Mourshed, Zhao, 2012).

Adjacency: Long distances between nurse stations and wards has a negative impact on the performance of the nurses and the quality of care to the patients (Mourshed, Zhao, 2012).

Spaciousness: The lack of space has been linked to a stressful environment; O’Neil (1994) believes that it also has an effect on patient satisfaction and staff performance (Mourshed, Zhao, 2012).

Architecture, Interior Design, and Landscape Architecture are professions that are able to make a difference in civilization. The structure and the environments that these three professions are able to build have been recognized through research and investigations to make an impact on people’s lives. In the case of healthcare it has been found that a good design can indeed accelerate the recovery process of patients, and can reduce stress among staff.

literary review Innovative Designs for Healthcare Settings America is constantly changing because of the population, new technologies, and government policies (Arriaga, 1992). It is a world that never stops revolving and evolving.

As humans change so do their needs, and everything around them has to be adapted in order to meet these needs.

Architects, designers and landscape architects are always on the move to make successful projects. It is necessary to have a good design team in order to have a successful design.

Innovation is not something that comes easy, there is always the hunt for new ideas that will bring the wow factor to a space, either by the architecture, the interior design, or the mix of both.

When designing for healthcare, there are numerous things that have to be considered; safety codes, ethical codes, sustainability, technology, logistics, etc. There are other factors that have to be considered; the kind of patients that the space is being designed for, the successful designs of the past that can be used as examples to follow, and the not successful designs that have to be used as examples to avoid making the same mistakes.

An advantage of using the results of research is that these can be later applied in the decision-making process of an evidence-based design (Mourshed, Zhao, 2012).

Hamilton says that “[e]vidence-based design is the conscientious, explicit, and judicious use of current best evidence from research and practice in making critical decisions, together with an informed client, about the design of each individual and unique project” (Davis, 2011,p.16).

Frost (2004) has proposed that “[h]ealth care organizations integrating spa services into its offerings hold greater potential for success than health services in a spa setting” (Frost, 2004, p.S-91). This shows some innovative ideas that could be used when designing for health care institutions. There are also findings about how the use of green design can improve the profits of a hospital, but also the satisfaction of the users (Robeznieks, 2010). On an interview that Robeznieks (2010) did with Allan Bell, the designer of the Dell Children’s Hospital he says[:] We don’t have a whole lot of science behind it,” Bell says. “Is it the building? Who knows?

But, at the old building, you’d look out the window and see the underside of a highway.

Now you see a healing garden. It’s helped us with recruiting doctors and specialists who we could never get before. This is where everyone wants to take their kids now. (p. 28).

In the research conducted by Davis (2011) on the rooftop garden as a setting for physical therapy, he finds the elements of design that were successful and the ones that were not.

Therapy walks for physical therapy, gazebos for groups, ball courts, and outdoor spaces to escape and see the green were some of the things that he found to be successful. On the other hand he found that there was limted access to visibility to the garden, no signage for wayfinding, lack of horticultural therapy, several key plant failures, too many elements in one garden, lack of private and comfortable seating, and a lack of attention to the views off site which proved to be unsuccessful.

There is evidence that shows that the use of new design concepts, and new ideas, help in the growth of the profession, and in the inspiration of students who are the future of the world. In an interview with Bells, he says how the “students from the University of Texas schools of architecture, engineering and interior design regularly tour the hospital, as do groups from Texas A&M and Texas Tech”(Robeznieks, 2010, p.29)

VII. BUILDING CODES When designing for the healthcare sector, there are codes that need to be followed.

Healthcare settings are places that people link to be a center where miracles can occur, it is where people go to be cured and is a place where they feel safe. It is the responsibility of the architects and the interior designers to make the space which is safe for its users and code compliant. Otherwise the administrators of the buildings could be sued for not following the appropriate codes (Patterson, 1997). In previous studies it has been found that priority has been given to fire safety rather than accessibility (Walbe Osteirn et al., 2007). Keyes (2012), after some observations, believes that architects are not properly trained for the Life Safety Code, what they have learned has been through seminars and self-education. On the other hand, Bickenbach, Gray, and Gould (2003) think that design practitioners, landscape architects, city transportation planners, developers and contractors among others have to be recognized when creating built environments that diminish disabilities. Nevertheless, all the codes should be met in an equal manner for the users to have a safe environment and feel free from inequalities.

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literary review ADA The American with Disabilities Act, better known as ADA, was passed as law in the 1990’s. Its objective is to provide people with disabilities with equal opportunities. The perceptions of access among disabled people are really important to be able to evaluate the effects of ADA, and even more when one out of five Americans has a disability (Menzel Baker, Kaufman-Scarborough, 2005). The Access Board, a federal agency, writes the American with Disability Act Accessibility Guidelines (ADAAG) that became enforced when the Department of Justice and the Department of Transportation adopted them (Patterson, 1997).

The Architectural Barriers Act of 1968, makes it mandatory for buildings that had been funded by the government to make the building barriers free. Federal buildings and facilities might not have to follow the ADA but must comply with the Uniform Federal Accessibility Standards (UFAS) which are the minimum guidelines dictated by the Architectural Barriers Act (Patterson, 1997).

Healthcare facilities must comply with ADA since they are open to a wide range of people, among them disabled people. Since physical therapy patients are impaired in some way, it is mandatory to follow at least the minimal accessible guidelines, in order to provide a safe and universal environment.

Fire and Life Safety Codes Fire safety codes are covered by the federal government, state government, and local authorities. The National Fire Protection Association (NFPA) is in charge of producing codes and standards in this area. One of the many is the NFPA 101, which dictates that: “locks and hardware on doors shall be install to permit free escape”; “exits must be marked by a readily visible sign; and any door in a means of egress must be able to swing from any direction to the full use of opening”, and “[d]oors must swing in the direction of egress when serving a room or area with 50 or more occupants” (Patterson, 1997. p.71). All healthcare facilities that receive Medicare and Medicaid funding have to comply with it.

For a project, interior product specification is more than just deciding on colors. It includes choosing products that match the correct codes for the correct applications, says Patterson (1997). It is of great importance for the professionals to always thoroughly investigate the appropriate codes before specifying any material, this is how they will know 15

what complies in one place or what might not comply in another (Patterson, 1997). It is imperative to follow all codes when building healthcare facilities. The safety of its users should be the main concern of the administrators, architects, and designers. There have been cases where the architects do follow the LSC but after the inspection there are codes that have not been met; it is not the fault of the architects but is simply that they do not interpret the LSC as the authorities that inspect the facilities do (Healthcare Life Safety Compliance, 2012).

VIII. CONCLUSIONS Humans have a tendency of being influenced by their surroundings. After analyzing the existing literature on how interior design elements can affect the recovery process of admitted patients in hospitals and other kind of healthcare settings, the findings are that a good design could make for a quicker recovery. Identified by Sloane (1994), Davis (2011), Mourshed and Zhao (2012), and other authors of research used for this literature review, natural elements have a positive effect on the users of hospital settings.

The intent of this literature review is to find as much evidence as possible on how to properly use the elements of design for a healthcare setting, specifically on the physical therapy setting. Not much research has been done on the subject of how interior design can influence and affect the recovery process of physical therapy patients. However, evidence exists about other healthcare settings (mainly hospitals) which could be applied for the one being investigated. Davis’s (2011) research helps in identifying that gardens are of great use for physical therapy, not only for the physical environment that they provide to the patients, but also for the psychological aspect which results in a spiritual escape.

Since the subject is on temporarily or long-term impaired individuals, it is essential to also investigate the codes that a physical therapy setting should comply with. Also limited by the existing literature, the only evidence found were the codes that are to be followed for healthcare settings, such as ADA and Fire Safety Codes according to Patterson (1997).

The Physical Therapy within healthcare is a division that is still in development (Arriaga, 1992). As the world changes and discovers new technologies, so does every aspect of life.

Humans, find in nature, a restorative quality that cannot be find anywhere else (Kaplan, 2001). It is the job of designers to be innovative and create environments that can mix

literary review the use of technology with nature, which could result in the optimal conditions for physical therapy patients to recover in a faster and positive way.

Fig. 1.4: Image on the top right corner, is an example of transition areas in healing garden design.

Fig 1.5: Image below shows the example of path width to comply with ADA in the design of a healing garden.

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Annotated Bibliography

annotated bibliography

Initial Thesis Project Questions and Purpose Purpose Statement The purpose of this literature review is to understand the effects that interior design can have on the recuperation process of physical therapy patients and the environmental factors that promote the healing and rehabilitative process. It is important to study the healthcare environment because research continues to develop, offering new ideas and standards for healthcare professionals and patients alike. This research will uncover the optimum conditions, to facilitate a speedy recovery.

Reading List

Journal by Sage publications.

The purpose of this article is to address the issue of patients’ stated art preferences, and how these compare with the art preferences of those with an art or design background and describes the findings of an art survey containing both best-selling art images and images considered appropriate for health care. There were found significant differences across the three different population’s art preferences.

Findings: • •

1. How can interior elements positively and negatively influence the patients?

Nanda, U. Eisen, S. Baladandayuthapani, V. (2008). Undertaking an art survey to compare patient versus student art preferences. Environment and Behavior, 40(2), 269301.

This article was written by Upali Nanda from the American Art Resources, Sarajane L. Eisen from the Auburn University, and Veerabhadran Baladandayuthapani from the University of Texas. It was published in the year 2008 in the Environment and Behavior 19

•

•

Hospitalized patients preferred images with realistic art like nature views and landscapes than stylized or abstract art. (295) Nature images offering a sensory component, familiarity, and foliage were rated higher than other nature images. Figurative art in a nature setting was also rated highly in patients. Flowers in a nature setting was also rated high, but with a limitation of gender bias. (295) Best selling art and abstract art generated lots of comments from the patients but rated low. Art that generates comments and discussions is not preferred. (295296) Interior design students preferred abstract art with representative and non representative forms. (296)

annotated bibliography Quotations:

Quotations:

“The patient preference for nature and realistic content over abstract or stylized content, even when the latter is high quality (classics) or popular (best selling), supports the previous research on appropriateness of nature content in hospital settings.” (298)

“Despite these limitations, this investigation extends the medical application of distraction therapy and identifies an important low-cost opportunity to enhance bronchoscopy practice.” (947)

“The stated preferences for positive and negative images in health care art can now be validated via clinical-outcome-based studies that test whether artwork with “preferred” image content is more therapeutic.” (298)

“The current investigation lends further support to the importance of addressing pain control and anxiety as distinct considerations during bronchoscopy.” (947)

Diette, G. Lechtzin, N. Haponik, E. Devrotes, A. Rubin, H. R. (2003). Distraction therapy with nature sights and sounds reduces pain during flexible bronchoscopy. The Cardiopulmonary and Critical Care Journal, 123(3), 941-948.

The authors of this study are Gregory B. Diette with accreditations of MD and MHS; Noah Lechtzin accredited with a MD and MHS; Edward Haponik with MD, FCCP, Pulmonary and Critical Care Medicine; Aline Devrotes who is a RN; and Haya R. Rubin who has a MD and a Ph.D., all belonged to the General Internal Medicine at the Johns Hopkins University School of Medicine. The study took place in the year 2003 was published in the Cardiopulmonary and Critical and Care Journal by the American College of Chest Physicians.

The goal of this study is to investigate the impact of using distraction therapy with nature sights and sounds on reducing pain and anxiety and to increase the patient’s satisfaction during a bronchoscopy.

The authors’ theoretical stance (philosophical worldview) is positivist. The authors already knew from previous research that nature sights and sounds would have this effect on the patients, but after conducting their own research they validated this theory.

Findings: • • • •

There is an improvement in pain control with nature sights and sounds. (948) Patients undergoing a FB are proved to be in a state of anxiety. (948) The study demonstrates that pain experienced by patients can be reduced by a pleasant environment but on the other hand anxiety cannot be reduced. (947) The state of anxiety it is induced perhaps by the fear and not by the procedure itself. (947)

Kaplan, R. (2001). The nature of the view from home: psychological benefits. Environment and Behavior, 33(4), 507-542.

Rachel Kaplan, the author of this article, was the Samuel T. Dana Professor of Environment and Behavior in the School of Natural Resources and Environment at the University of Michigan at the time when the article was written. It was published in 2001 by Sage Publications in Environment and Behavior. Funded and sponsored by the USDA Forest Service, North Central Experiment Station and the Urban Forestry Unit.

This study was based on questions and photographs that were completed at apartment buildings in Ann Arbor, Michigan which served to assess how window views were affecting the well-being and the residential satisfaction. Studies have not been done before to analyze the restorative experiences that window viewing could provide to residents; window views and the penetration of sunlight have been related in the increase of satisfaction and well-being.

Findings: • • •

Windows views are important in the improvement of health and well-being. (534) There is a greater improvement on health if the windows face natural surroundings. (540) Windows views, gardens and green areas should be provided around the building to increase human activity in relation with nature. (535)

Quotations: “Nature content contributed substantially and differentially to residents’ satisfaction with nature and with their neighborhood; the availability of gardens and well-landscaped areas was particularly salient to these satisfactions. (539) “There is ample anecdotal support and a growing empirical literature substantiating that windows are favored in diverse settings, including the workplace, schools, hospitals, pris20

annotated bibliography ons, and residential contexts” (509).

“A series of studies carried out in the context of hospitals and prisons has demonstrated the role of view content in the effectiveness of windows in speeding recovery or reducing the needs for health care services (Moore, 1981; Ulrich, 1984; Verderber, 1986;West, 1986)” (509).

Mourshed, M. Zhao, Y. (2012). Healthcare providers’ perception of design factors related to physical environments in hospitals. Journal of Environmental Psychology 32(4), 362-370.

The authors for this article were Monjur Mourshed and Yisong Zhao from the Building Energy Research Group, and the School of Civil and Building Engineering at the Loughborough University, in United Kingdom. Published by the Journal of environmental Psychology in the year of 2012. The research was funded by the UK Engineering and Physical Sciences Research Council via the Health and Care Infrastructure Research and Innovation Centre.

The purpose of this article was to further investigate on filling the gap between what are the perceptions of the users and which are the perceptions of the healthcare providers by exploring healthcare providers’ perception of physical environment design factors in hospitals. Research has suggested a strong association between the physical environment in which a person lives or receives treatment and the health outcomes.

Findings: • • • •

Aspects related to the design for maintenance were perceived to be more important by healthcare providers than those related to spatial design. (366) Environmental design aspects related to sensory perceptions were also ranked as very important. (365-366) Working patterns had significant associations with the perception of maintenance and environmental design aspects. (366) Significant differences among males and females in the perception of the body-contact and sensory. (368)

Quotations: “Research indicates that staff wellbeing, productivity and satisfaction are linked with a hospital’s physical environment, in particular the aspects that are determined during early design stages of a building’s lifecycle.” (362) 21

“There is also a growing body of evidence on the impact of the working environment on healthcare providers’ efficiency, productivity and satisfaction that contribute to patient outcomes.” (362) 2. Do patient recuperation outcomes depend on the type of setting in which they are treated?

Diette, G. Lechtzin, N. Haponik, E. Devrotes, A. Rubin, H. R. (2003). Distraction therapy with nature sights and sounds reduces pain during flexible bronchoscopy. The Cardiopulmonary and Critical Care Journal, 123(3), 941-948.

The authors of this study are Gregory B. Diette with accreditations of MD and MHS; Noah Lechtzin accredited with a MD and MHS; Edward Haponik with MD, FCCP, Pulmonary and Critical Care Medicine; Aline Devrotes who is a RN; and Haya R. Rubin who has a MD and a Ph.D., all belonged to the General Internal Medicine at the Johns Hopkins University School of Medicine. The study took place in the year 2003 was published in the Cardiopulmonary and Critical and Care Journal by the American College of Chest Physicians.

The goal of this study is to investigate the impact of using distraction therapy with nature sights and sounds on reducing pain and anxiety and to increase the patient’s satisfaction during a bronchoscopy.

The authors’ theoretical stance (philosophical worldview) is positivist. The authors already knew from previous research that nature sights and sounds would have this effect on the patients, but after conducting their own research they validated this theory.

Findings: • • • •

There is an improvement in pain control with nature sights and sounds. (948) Patients undergoing a FB are proved to be in a state of anxiety. (948) The study demonstrates that pain experienced by patients can be reduced by a pleasant environment but on the other hand anxiety cannot be reduced. (947) The state of anxiety it is induced perhaps by the fear and not by the procedure itself. (947)

annotated bibliography Quotations:

Quotations:

“Despite these limitations, this investigation extends the medical application of distraction therapy and identifies an important low-cost opportunity to enhance bronchoscopy practice.” (947)

“Effective universal pod design combines openness with good sight lines from staff areas. Circulation corridors must be carefully studied and designed to achieve optimal width-to-length ratios while positioning patient activity spaces such that they can easily be supervised by staff. “ (32) “Deinstitutionalizing design-identifying and applying strategies and best practices that create and non-institutional or residential feel to the treatment environment- is an important step toward supporting a progressive model of behavioral healthcare.” (33)

“The current investigation lends further support to the importance of addressing pain control and anxiety as distinct considerations during bronchoscopy.” (947) Doherty, J. Sell, J.E.(2011). Deinstitutionalizing design: strategies to design a more residential environment for psychiatric patients. Behavioral Healthcare, 31(1), 30-33.

This article was written by Joseph Doherty certified LEED AP and A.I.A, the Principal and Core Group Leader of Array Healthcare Facilities Solutions, and also by Jon E. Sell who was the principal and project designer as Array Healthcare Facilities Solutions. It was written in 2011 and published by Behavioral Healthcare.

The objective of this study was to further investigate how the strategies of deinstitutionalization of healthcare facilities meet the needs of distinct patient populations. There is a movement of turning hospital facilities into a more residential environment, making these spaces innovative, where the planning, architectural and interior design strategies come together in order to make it happen.

Findings: •

• •

A universal room design has become desirable because it can accommodate distinct patient populations and can be adapted in the future for new demographics.

(31) Main street circulation have replaced the double loaded corridor designs because it separates patients, visitors and staff. (31) A three corridor space design has become famous because is a non-institutional design solution, where: visitors arrive to their destinations without passing through the “patient zone”, staff can circulate safely and actively between the patient zone and support spaces, and last but not least the staff can easily access the “off stage” areas. (32)

Korpela, K. Hartig, T. (1996). Restorative qualities of favorite places. Journal of Environmental Psychology, 16(3), 221-233.

Kalevi Korpela a member Department of Psychology at the University of Tampere in Finland and Terry Hartig a member of the School of Public Health at University of California in Berkeley, California, were the authors of this article. It was published in the Journal of Environmental and Psychology in 1996 by the Academic Press. The authors were received grants; the first author received a grant from the Academy of Finland and the Scientific Foundation of the City of Tampere, and the second author received the grant T32 HL07365-14 from the U.S. National Heart, Lung, and Blood Institute.

The study was conducted with the objective of looking at the restorative factors of seven places in order to determine if there is a relationship between the place and the restorative environments.

Findings: •

• •

The use of natural elements to enhance the feeling of well-being, maximize the use of windows, skylights and glazing since the sunlight affects in a positive way the well-being of a person. (223) Provide the people with personal space because it improves the restorative qualities of an environment, and a place that is compatible and coherent. (231) Favorite place experiences are characterized by the feeling of being away, coherence, fascination and compatibility with the place, which provide a restorative experience to the person. (230)

Quotations: “Ideas about emotion- and self-regulation provide usually experienced when there are elevations in self-esteem and when previously unassimilable means to join the place 22

annotated bibliography identity concept with restorative environments theory (Korpela, 1989, 1992, material is assimilated into a person’s self-experience. Displeasure is experienced when self-esteem 1995). Emotion-regulation is not only an inner homeostatic process, but one that also involves is diminished or when there is a failure in assimilation (Epstein, 1990). The four principles are all of interaction with the environment (Vuorinen, 1990; Dodge & Garber, 1991; Fuhreret al., 1993; Kaiser, basic importance, and behavior is viewed as a compromise among them (Epstein, 1985). For 1993)”. (222) Rashid, M. Zimring, C. (2008). A review of the empirical literature on the relationships between indoor environment and stress in health care and office settings. Environment and Behavior, 40(2), 151-190.

The authors of this article are Mahbub Rashid an associate professor of design at the University of Kansas; and Craig Zimring an environmental psychologist, also professor of architecture at the Georgia Institute of Technology. The article was published in 2008 in Environment and Behavior by Sage Publications.

This article was based on existent literature which helped to analyze the findings of previous studies related to the relationship between indoor environment quality factors and people or workplace needs in a healthcare and office settings.

Findings: • • •

Lighting, air, noise and temperature affect the psychological stress in both settings: healthcare and office.

Natural lighting has a positive effect on the occupants of the space.

Artificial lighting might have a negative effect on the occupants’ health in both healthcare and office settings.

Robeznieks, A. (2010). Taking the LEED; hospitals and health systems continue to make strides toward “greener” facility design and construction featuring reduced energy consumption. Modern Healthcare, 40(42), 28.

The author of this article is Andis Robeznieks. It was written in 2010 and published in Modern Healthcare by Crain Communications, Inc. The purpose was to have a record of some of the LEED certifies hospitals of the country among them the Dell Children’s Medical Center of Central Texas, that was the first hospital to be certified platinum LEED in the whole world. Taking notes of the water and the energy that the facility can save, the technology, and the benefits that this LEED building 23

has brought to the staff, the patients, and the owners.

Findings: • • • • •

The new hospital uses 30-40% less of water than four of Central Texas hospital of the same size. (2) “The onsite 4.5 megawatt natural gas-fired turbine providing all of the hospital’s electricity is 75% more energy efficient than a coal-fired power plant.” (2) The hospital passed its $75 million donation by other $12 after being certified platinum LEED. (2) Students of Architecture, Engineering, and Interior Design go on tours that benefits them in their education.

Parents are more likely to take their children to the Dell Children’s Medical Central than to any other hospital.

Quotations: “We don’t have a whole lot of science behind it,” Bell says. “Is it the building? Who knows? But, at the old building, you’d look out the window and see the underside of a highway. Now you see a healing garden. It’s helped us with recruiting doctors and specialists who we could never get before. This is where everyone wants to take their kids now.” (1) Sloane, D. C. (1994). Scientific Paragon to Hospital Mall: The Evolving Design of the Hospital. Journal of Architectural Education, 48(2), 82-98.

David Charles Sloane has a PhD and worked at the University of Southern California.

The article was written in 1994 and published by Wiley on behalf of the Association of the Collegiate School of Architecture, Inc. The research was partly funded by a grant from the Lusk Center for Real Estate Development at USC. The purpose of this research was to recount the history of the evolution of hospitals. Analyzing the phases that it has gone through and the approaches that have been used for this institution’s design.

Findings: • •

The evolution of health care has affected the architectural and design concept of hospitals. (82-86) The Shopping Mall approach has changed the design approach, now hospitals are

annotated bibliography

• •

design to encourage family participation and promote social life. (90-91) Creating spatial designs that make the wayfinding easier and do not give the impression of seriousness reduces the stress on the users of the space. (93) The exposure of the architecture to the natural elements, like fresh air and daylight, resulted in the lessening of the spread of diseases. (85-86)

accuracy on stepping into irregular shaped objects.

Findings: •

The results were that indeed the performance time increased with age and also did the cognitive demand. (1558) “The time to perform a stepping accuracy task, such as may be required to avoid environmental hazards, increases under reduced lighting and with increased cognitive demand, the latter disproportionately so in older adults” (1558).

“No other age group interaction effects related to light condition were found, and no gender effects were found”. (1560)

Quotations:

•

“Designers are emphasizing customer comfort in high-style surroundings, changing designs to encourage family participation, and creating images which evoke an inviting combination of social life and community education.” (90)

•

“John S. Billings’s pavilion design for Johns Hopkins surrounded the buildings with light, air, and sun while separating the patients by illness.” (85)

Quotations:

3. What does contemporary research recommend regarding standards within a physical therapy setting?

“Because fall risk is increased by the presence of an environmental hazard [as in an uneven walking path, (9)],vision becomes more critical in avoiding a fall when the environment places more demand on vision. Demand is increased in a darkened area, or where there are hazards to be traversed and stepping accuracy becomes critical.” (1558)

Alexander, N. B. Ashton-Miller, J. A. Giordani, B. Guire, K. Schultz, K. A. ( 2005). Age Differences in timed accurate stepping with increasing cognitive and visual demand: a walking trail making test. Journal of Gerontology, 60A(12), 1558-1562.

Arriaga, R. (1992). American physical therapy Physical Therapy Journal, 72(5), 378-397.

The authors of this study were Neil B. Alexander, James A. Ashton-Miller, Bruno Giordani, Ken Guire and last but not least Albert B. Schultz. Alexdander belonged to the Division of Geriatric Medicine in the Department of Internal Medicine and Institute of Gerontology at the University of Michigan, he also has credentials from Ann Arbor and Veteran Affairs Ann Arbor Healthcare System Geriatric Research Education and Clinical Center in Michigan; Ashton-Miller belonged to the Department of Mechanical Engineering and Applied Mechanics and Institute of Gerontology; Giordani worked at the Department of Psychiatry and Psychology; Guire was a member of the Department of Biostatistics; and Schultz was a member of the Department of Mechanical Engineering and Applied Mechanics and Institute of Gerontology at the University of Michigan as well. The article was published in the Journal of Gerontology in 2005 by the Gerontological Society of America.

The idea the authors had with this study was to investigate the lighting effects and the mental distractions, of young and old individuals, on the stepping performance and the speed. Quantitative methods were used and some of the purposes of the study were to find the effects of aging and dark areas in the stepping accuracy, and to also calculate the

association environmental statement.

The author of this study was Rita Arriaga, a clinical instructor of the Graduate Program in Physical Therapy at the University of California in San Francisco. The author had the assistance of thirteen other staff in order to cover every aspect of the research. The article was published in 1992 by the Physical Therapy Journal.

The purpose of this study was to analyze the factors that would make the field of Physical Therapy change in the decade of the 90s. Since it would be a decade of constant evolution there would be challenges all along the period, for this reason the analyses was made to study the changes stimulated by economic factors, technological advances and the needs of the people.

Findings: •

•

There are six major areas that affect the evolution of this field: The Economics of Health Care, The Demographics of the American Population, Human Resources in Physical Therapy, The Physical Therapy Profession in the Health Care Sector, The Shaping of Public Policy, and The Role of the Association. (54/378) Physical therapy will continue to gain public recognition. Enhancing the image 24

annotated bibliography

•

•

and perception of the profession, however, first will require that the profession develop a strong self-image and a commitment to becoming a leader in health care delivery. (56/380) The profession of Physical Therapy will go under changes that will bring opportunities but it needs to re-define itself in order to be accepted and better understood by the public. (57-58/381-382) The Demographics of the population have a great influence on the subject. During the decade of the 90s there was a growing number of immigrants from different countries, with different cultures and costumes, among other factors that challenged the health care system. (60-61/384-385)

Quotations: “The ability to change and evolve successfully is dependent on an understanding of the environment in which we exist; the factors that will affect change in this environment; and the opportunities, challenges, and threats presented by these factors.” (54/378) Davis, B. (2011). Rooftop hospital garden for physical therapy: a post occupancy evaluation. Health Environments Research and Design Journal, 4(3), 14-43.

The author of this study is B. Davis at the time an assistant professor of the College of Environment and Design at the University of Georgia in Athens. The article was written in the year 2011 and published in the Health Environments Research and Design Journal by the Vendome Group.

The goal of this study is to examine the impact of hospital rooftop gardens on physical therapy patients and staff, to then improve the conditions of these in the future for this specific population. The authors’ theoretical stance is emancipatory, he used a mixed method for this research, where he did observations and mappings collecting scientific data and where he gave out questionnaires to the participants as well.

Findings: • •

25

Patients treated seemed to like the garden setting to perform the therapies and spend time. (41) It is sure that the success of these gardens is due to the continuous involvement of the designer and preservation of a garden’s design integrity and that they might provide the greatest healing benefits to patients as well as a great work environment for hospital employees. (41)

• •

There should be a design of different spaces within the garden so it can meet the needs of specific patients. (42) The use of these rooftop garden resulted in a reduction of stress for the staff.(42)

Quotations: “Increasing the visibility of and physical access to the garden is of great importance. Multiple garden viewing rooms could be created in adjacent buildings. These could be used as atria or conservatory-like waiting rooms or break areas to serve distinct areas of the hospital. In addition, other visible rooftops could be made green, even if only as intensive green roofs for viewing from the garden, observation deck, and hospital windows.” (39) “The power of garden elements such as a bench for sitting, a path for walking, and access to elements of earth and sky were reported as having physical, emotional, spiritual, and social benefits.” (37) Djong, G. Hsieh, CH. Putman, K. Smout, R. J. Horn, S. D. Tian, W. (2011). Physical therapy activities in stroke, knee anthroplasty, and traumatic brain injury rehabilitation: their variation, similarities, and association with functional outcomes. American Physical Therapy Association, 91(12), 1826-1837.

The authors of this study are Gerome Djong who has a PhD, worked at the Center for Post acute Innovation & Research, and at the National Rehabilitation Hospital; C-H Hsieh who has a Phd, and was working in the Center for Post-acute Innovation & Research, and at the National Rehabilitation Hospital; K Putman a physical therapist, with a Phd, and had worked at the Interuniversity Center for Health Economics Research, at the Faculty of Medicine and Pharmacy, and at the Vrije Univertsity Brussel in Belgium; R.J. Smout with a MS and MT, worked at the Institute for Clinical Outcomes Research in Utah; SD Horn has a PhD and worked at the Institute for Clinical Outcomes Research; and W Tian wih a MD and a PhD, worked at the Center for Post-acute Innovation & Research and at the National Rehabilitation Hospital. The study was published by the Amercian Physical Therapy Association in the year 2011.

The purpose of this study was to find the similarities and differences between the therapies of the different treated groups, who presented three different types of injuries, and to examine if the activities performed during the therapy could be associated with the improvement of the impaired patients.

annotated bibliography Findings:

Findings:

• •

•

•

All groups had similar body motor performance.

The patients with knee arthroplasty received the most physical therapy, and the patients with traumatic brain injury received the least physical therapy. (1832) Two of the activities performed were positively linked to the performance of body motor response, and three activities were negatively associated with the motor outcome. (1831-1834)

Quotations: “In the course of their careers, many physical therapists and physical therapy researchers tend to specialize and focus on specific impairment groups such as patients with stroke.

This specialization advances knowledge in a particular field (eg, stroke rehabilitation), which is beneficial for patients and the profession.” (1833) “Despite the study’s limitations, activity-level data, although less granular than desired, provide insight on how time is spent in physical therapy activities are associated with outcome.” (1836) Engelke, P. O. Frank, L.D. (2001). The built environment and human activity patterns: exploring the impacts of urban from on public health. Journal of Planning Literature, 16(2), 202-216.

The authors of this article are Lawrence D. Frank and Peter O. Engelke. Frank has Ph.D. and was assistant professor at the time at the Georgia Institute of Technology, and Engelke was a research associate at the City and Regional Planning Program at the Georgia Institute of Technology. The article was published in 2001 by the Journal of Planning Literature.

This article addressed the influence of the design of urban environments and the effect that causes on public health through the walking and biking of the residents. Previously quality of life and the link to the built environment have not been the focus of a study, but the planning of automobile traveling, disregarding the importance of human exercising activity. The findings of this research were based on previous studies, and the methodology used was the review of land use, planning and transportation and the investigation of the ties between non-motorized travel and design features and how they affect public health.

The authors identified that there should be planning and designing of public features that encourage to walk and bike which would improve public health. (202)

Shih, CH. Chen, LC. Shih, CT. (2011). Assisting people with disabilities to actively improve their collaborative physical activities with Nintendo Wii Balance Boards by controlling environmental stimulation. Research in Developmental Disabilities, 33(1), 39-44.

Ching-Hsiang Shih, Ling-Che Chen, and Ching-Tien Shih were the authors of this study and article; Ching-Hsiang Shih and Chen belonged to Department of Special Education at the National Dong Hwa University in Taiwan, and Ching-Tien Shih was from the Department of Electronics Engineering and Computer Science at the Tung Fang Design University also in Taiwan. The article was published in the year 2012 in Research in Developmental Disabilities Journal.

The purpose of this study was to extend previous research done on Wii Balance Boards application, which was conducted on four people (who were obese) with developmental disabilities. The study adopted the latest software technology with three Wii Balance Boards to detect the participants’ collaborative physical activities in order to assess whether they would be able to actively increase their these activities efficiency.

Findings: •

•

•

The use of “assistive technology devices, which are designed to assist people with deficits in physical, mental, or emotional functioning, are alternative ways of performing actions, task, and activities.” (43) With the help of assistive technologies, people with disabilities, can gain additional accessibility, and use their abilities more effectively to participate more in their societies, also to achieve optimal functional ability and independence and improve their quality of life. (43) Many commercial products like mousses and Wii remote controls can be turned into assistive devices with an improvement in the design and technology that can be suitable for persons with disabilities. (43)

Quotations: “All participants had poor walking ability, moved very slowly, were obese and were lacking in the desire to exercise. With the guidance of the research assistant, they learned to 26

annotated bibliography follow simple orders and carry out specific physical activities (i.e., walking to the specific location and standing there, according to the instructions) in order to obtain their preferred environmental stimulations (e.g., playing their favorite videos). Their parents had given formal consent for their involvementin this experiment.” (40) “Assistive technology devices, which are designed to assist people with deficits in physical, mental, or emotional functioning, are alternative ways of performing actions, task, and activities.” (43) “Further studies are necessary to extend this study’s application to more application fields concerning people with disabilities, such as obtaining the desired environmental stimulation by following more complex instructions and performing more complex physical activities and exercises, and so on.” (43) 4. What type of materials, colors, lighting, and organization promote and stimulate the recuperation process?

Frost, G. (2004) The spa as a model of an optimal healing environment. The Journal of Alternative and Complementary Medicine, 10(1), S85-92.

Quotations: “The combination of specific educational programs, medical, behavioral, nutritional and exercise consultations, spa treatments, and first-hand practice with healthy behaviors leads to an increased feeling of individual empowerment and well-being, and improved emotional and physical well-being.” (S-91) “Good design on its own cannot heal, but it can make science work better.” Lighting, offices, public and private spaces, finishes, wall coverings, acoustics, outdoor seating areas along the meditation path, and water artwork have all been designed to impact positively as people try to change their lifestyles.” (S-88) “A difficult but important challenge for designers is to be sensitive to such group differences in orientations, and try to assess the gains or losses for one group vis-à-vis the other in attempting to achieve the goal of psychologically supportive design.” (S-88) Miwa, Y. Hanyu, K. (2006). The effects of interior design on communication and impressions of a counselor in a counseling room. Environment and Behavior, 38(4), 484-502.

Findings:

Yoshiko Miwa a member of Nagoya University at Chikusa-ku in Japan, also a counselor in Mie; and Kazunori Hanyu who has a Ph.D and was a associate professor at the College of Humanities and Sciences in the Nihon University in Tokyo, were the authors of this article. The article was published in the year 2006 in Environment and Behavior by Sage Publications.

The purpose of this study was to investigate the effects of lighting and interior design on a patient’s communication, feelings, and impressions of the counselor. It is possible that the interior design of a space has an influence on the treatment of a patient. Previously research has been done on the evaluation on the pleasant aspect of multiple interior design elements but not on individual design elements.

•

Findings:

An article written by G. Frost who has a Ph.D. and was one of the main personnel of the Canyon Ranch Health Resorts. It was published in the year 2004 in the Journal of Alternative and Complementary Medicine by Mary Ann Liebert, Inc. publisher.

The goal of this study is to discuss the factors that contributed to healing environments at spas. Preventive therapies and wellness have been linked before to reduce sickness, decrease the use of prescribed drugs, and the improvement of physical, mental and spiritual health.

•

27

Incorporating spa services and facilities into healthcare settings can promote healing on the patients. (S-89) To create an optimal healing environment is a spa it is necessary to: have a dedicated caring staff at all levels, have a mission driven organization that will not compromise, and have a sound business model and leadership that will ensure permanency. (S-85)

• •

The authors discovered that dimmed lighting made the patients feel secure and relaxed, giving opportunity to develop positive feelings towards the counselor. (484) They also found to be important the education of the professionals about how the interior design environment can influence the psychology and therapy. (484)

annotated bibliography Quotations: “The effects by aesthetic interior design may be likely to become more significant through the interaction of visual quality with interpersonal factors and longer-term exposure”(486).

Joseph, A. (2006). The impact of light on outcomes in healthcare settings. The Center for Health Design, Issue 2, 1-12.

The author of this study is Anjali Joseph, with a Ph.D., and the Director of Research at the Center for Health Design. The paper was published in the year 2006 by the Center for Health Design and it was funded by a grant from the Robert Wood Johnson Foundation.

The objective of this study was to identify the mechanisms by which light impacts human health and performance and also to review the literature linking both kinds of light, daylight and artificial light, with health outcomes in healthcare settings. The study was based in journals articles from other fields like architecture, psychology, ergonomics, medicine, etc.

Findings: •

•

•

Light can impact human health and performance in different ways: by enabling performance of visual tasks, controlling the body’s circadian system, affecting mood and perception, and by enabling critical chemical reactions in the body. (1) Light can help to reduce depression among patients, decrease the length of stay in hospitals, improve sleep and circadian rhythm, lessen the agitation among dementia patients, ease pain, and improve adjustment to night-shift work among staff. (1) The use of windows for daylight has proven to increase satisfaction in the work environment. (1)

Quotations: “Light is critical to human functioning in that it allows us to see things and perform activities. But it is also important because it affects human beings psychologically and physiologically.” (2) “There is strong evidence that light is critical to human functioning and can be extremely beneficial to patients as well as staff in healthcare settings. Adequate lighting conditions are essential for performance of visual tasks by staff in hospitals, and poor lighting conditions can result in errors.” (9)

“Clearly, an important goal for facility designers should be to fulfill human needs for light and provide a high-quality lighted environment.” (10) Sloane, D. C. (1994). Scientific Paragon to Hospital Mall: The Evolving Design of the Hospital. Journal of Architectural Education, 48(2), 82-98.

David Charles Sloane has a PhD and worked at the University of Southern California.

The article was written in 1994 and published by Wiley on behalf of the Association of the Collegiate School of Architecture, Inc. The research was partly funded by a grant from the Lusk Center for Real Estate Development at USC. The purpose of this research was to recount the history of the evolution of hospitals. Analyzing the phases that it has gone through and the approaches that have been used for this institution’s design.

Findings: • • • •

The evolution of health care has affected the architectural and design concept of hospitals. (82-86) The Shopping Mall approach has changed the design approach, now hospitals are design to encourage family participation and promote social life. (90-91) Creating spatial designs that make the wayfinding easier and do not give the impression of seriousness reduces the stress on the users of the space. (93) The exposure of the architecture to the natural elements, like fresh air and daylight, resulted in the lessening of the spread of diseases. (85-86)

Quotations: “Designers are emphasizing customer comfort in high-style surroundings, changing designs to encourage family participation, and creating images which evoke an inviting combination of social life and community education.” (90) “John S. Billings’s pavilion design for Johns Hopkins surrounded the buildings with light, air, and sun while separating the patients by illness.” (85) Tarrant, M. A. Manfredo, M. J. Driver, B. L. (1994). Recollections of outdoor recreation experiences: a psychophysiological perspective. Journal of Leisure Research, 26(4), 357.

The purpose of this study was to compare the recollections of subject-selected preferred active and passive outdoor recreation experiences with the recollections of a distressful 28

annotated bibliography exam condition using psychophysiological measures. Psychophysiology is an exploration of the relationship between verbal reports and behavioral responses.

Findings: •

Findings: • •

•

The results of the experiment are consistent with both Lacey’s “rejection-intake” hypothesis of arousal and Selye’s theory of stress. (7) In this study the recollections of the active recreation experience produced moderate elevations in heart rate which contribute to improve cardiovascular functioning (Froelicher &Froelicher, 1991) and increased positive mood which is linked to improved self-esteem, lowered depression, enhanced immune responsiveness and reduced suicide rates. (7) “Within a therapeutic recreation context, recollections of past recreation experiences may be used to create different levels of physiological arousal and affective conditioning for people with mental and/or physical disabilities.” (7)

Quotations: “Benefits, defined as improvements in condition (Driver, Brown &Peterson, 1991), include outcomes such as enhanced mental and physical health, increased positive mood, development of self actualization, and reduction of negative stress.” (7) 5. What building code requirements must be considered in the healthcare setting?

In the Physical therapy setting?

Billings, J.S. (1874). Notes on hospital construction, public health reports and papers of the american public health association meeting. New York: Hurd and Houghton.

Gray, D. Gould, M. Bickenbach, J. (2003). Environmental barriers and disability. Journal of Architectural and Planning Research, 20(1), 29-37.

The authors of this article are David B. Gray, Mary Gould, and Jerome E. Bickenbach. It was published in the year 2003 in the Journal of Architectural and Planning Research.

The purpose of this study was to explore the views on the barriers and the facilitators to fill participation in major life activities for those people who have disabilities using focus groups of people with mobility impairments, their significant others, healthcare professionals, and built environment professionals.

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•

Design practitioners, landscape architects, city transportation planners, developers and contractors, among others have to be recognized when creating built environments that mitigate disabilities. (35) There is and intermediation between intermediate consumers (builders) and end-user consumer (people with disabilities) before the building process, that makes an integration of knowledge and interest, that result in built environments that meet a wide range of the public and government concerns. (35)

Quotations: “The concept that environmental factors constitute an essential scientific component of disability has led the World Health Organization (WHO) to include environmental factors as part of its revised classification instrument, the International Classification of Imnpairments, Activities and Participation:A Manual of Dimensions of Disablement and Healtl7 (ICIDH-2 Beta One, WHO, 1997). In this document, the environmental factors are considered as either facilitators or barriers to participation for persons with impairments or activity limitations.” (30-31) “The Americans with Disabilities Act provides a basis for going beyond simple compliance with minimal building codes in assuring access to buildings by allowing designers to provide for equivalent facilitation of building access. But in order to achieve equivalent facilitation, designers, builders, building owners, and others involved in construction of the built environment have had to learn from the people affected by building design.

People with and without disabilities may have differing views of what is needed for access to and use of building spaces.” (31) Keyes, B. (2012). Fire barrier management, ICC building codes, and more. Healthcare Life Safety Compliance, 14(4), 9.

Written by Brad Keyes the Senior Editor of the Journal, where he offers every month a small article about his thoughts, comments, and concerns on issues about healthcare life safety. This article was written in the year 2012 and published in Healthcare Life Safety Compliance Journal.

The article talks about fire barrier management, modifying the ICC building codes, and fire alarm technicians on staff. Keyes talks about the flukes he has found in these three subjects and to his experience what he thinks it should be done about it.

annotated bibliography Findings: •

• •

The 2 hours course given by the firestop manufacturer for the maintenance staff in order to receive a certificate that declared them as properly trained to install the products, is not properly working because the staff forgot what they learned within about a week. (9) Architects are not properly trained about Life Safety Code, what they have learned has been through seminars and self-education. (9) Some of the fire alarm contractors don’t know or understand the NFPA 72, it is important that they take courses and seminars in order for them to know this material and avoid problems from surveyors or inspectors about the testing techniques and documentation of the reports they have to do. (9)

patients each year, approximately 200 physicians and 890 nurses that worked in the building.

Findings: •

• •

•

Quotations: “When I started my career in facilities management 34 years ago, fire barrier management was not a topic of much concern for us. Primarily, our staff filled whatever holes we found in a rated wall with insulation and covered it with a skim coat of joint compound-not a suitable system by any means.” (9) “Architects who design hospitals are trained in the ICC building codes, but not so much on the LSC.” (9) Walbe Ornstein, S. Ono, R. Lopes, M. E. Monteiro, R. Z. (2007). Health care architecture in são paulo, brazil: evaluating accessibility and fire safety in large hospitals.

International Journal of Architectural Research, 1(1), 13-25.

The authors of this study are Sheila Walbe Ornstein, Rosaria Ono, and Maria Elisabete Lopes and are grateful for the valuable cooperation of the management of the Orthopedics and Traumatology Institute of the São Paulo General Hospital who provided the research team with this a great opportunity for study, and also for the efforts made by Mr. Tomaz Puga Leivas in putting the research project into practice. The coordinator of this study, Dr. Sheila Walbe Ornstein, also offered her thanks to the National Scientific and Technological Development Board, as a scholarship holder of that institution.

This article is a description and discussion of the procedures of scientific and technical interest for applying a Post Occupancy Evaluation, especially questions related to accessibility and fire safety in specialized and complex hospital buildings. The hospital chosen was one of the most important hospital of Latin America, with around one million

•

The authors saw that in the case of hospital buildings and similar architectural designs, it is important and effective to apply the POE focused on the topics of accessibility and fire safety, which often overlap in terms of problems and solutions. (24) The priority given to fire safety is higher than the priority given to accessibility. (21) The general areas of circulation, admittance and surgery areas, access doors, as well as elevators, have proper dimensions that enable persons in wheelchairs to maneuver or be maneuvered. (17) “There were problems found with the stairways, with inadequate dimensions, railings and floors, and the absence of visual or tactile signs.” (17) The building did not have a sprinkling system or fire extinguishers since it had started implementing the codes recently. (18)

Quotations: “Although the POE has been used in academic circles in Brazil since 1984 (Roméro; Ornstein, 2003), only in the 1990s did research in the field of performance evaluation begin, more specifically in relation to POEs focused on hospital buildings. Especially important in this process were studies published by Preiser (1998) on hospital systems in the USA, Europe and Israel. Preiser, an architect (Preiser; Vischer, 2005), and Bechtel (1997), an environmental psychologist, introduced the concept of inter-disciplinarity between architecture and urbanism and other subjects, and the need to include users’ perceptions in research on built environments.” (13) Kaufman-Scarborough, C. Menzel Baker, S. (2005). Do people with disabilities believe that the ADA has served their consumer interests? The Journal of Consumer Affairs, 39(1), 1-26.

The authors of this article were Carol Kaufman-Scarborough at the time was an associate professor of marketing at Rutgers University School of Business in New Jersey; and Stacey Menzel Baker was also an assistant professor of marketing in the Department of Management & Marketing at the College of Business Administration in the University of Wyoming. It was published on the Journal of Consumer Affairs in 2005 by the American Council of Consumer Affairs. The article was also funded and sponsored by 30

annotated bibliography the National Center for Medical Rehabilitation Research, the National Institute of Child Health and Human Development, and Sociometrics Corporation Gran.

The objective of this study was to determine how disabled people perceive accessibility and the effect of the American with Disabilities Act, better known as ADA. There is the possibility that out of 5 people in this country one has some kind of disability what makes them a big minority. The ADA was passed into law in 1990 and its objective was to provide people with disabilities with equal opportunities as everybody else. The perceptions of access among these individuals are really important to be able to evaluate the effects of ADA. Findings: • • • •

•

Of the number of the participants in the study only 54% reported knowing about a law that regarding disabilities. (12) Only 32% of those who knew about the law felt a difference in their life after the law and other 60% saw no change regarding them. (12) Proposition 1: Consumers who are aware of ADA are more likely to perceive positive changes than the ones who are not aware. (12) Proposition 2: Consumers aware of the ADA perceive positive changes in: public transportation, public facilities, theaters, and stores, public attitudes toward the disabled, media portrayal, and advertising inclusion than people who are not aware of ADA. (13) The implementation of ADA is incomplete and specifically in the education of people with disabilities about their consumer’s rights.

Quotations: “As anticipated, respondents indicated feelings of exclusion from various activities due to personal factors in addition to feeling that access has been enhanced through improvements in environmental factors.” (14) “The results indicate that consumers with disabilities believe that ADA has served their consumer interests in a variety of ways since its enactment, including increased access to commercial venues, improvements in public transportation, theaters, stores, public attitudes toward the disabled media portrayals, and inclusion of disabled people in advertising. However, the results also demonstrate gaps that need to be addressed if the ADA is to create benefits proponents envision for people with disabilities.” (21)

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Patterson, M. (1997). Know the codes. Buildings, 91(5), 68.

The author of this article is Maureen Patterson who at the time of the publication was an associate editor of Building Magazines. The article was published in 1997 by Buildings Journal.

The objective of the article was to recognize the importance of following building codes as interior designers, facility manager, etc. Also to mention the most important codes that should be followed in order to have a successful interior project, not only the safety but also the job of the designers might be on jeopardy if the appropriate codes for the type of project are not followed correctly.

Findings: •

•

• •

For a project interior product specification is more than just deciding on colors: It includes choosing products that match the correct codes for the correct applications. (1) The professionals should always thoroughly investigate the appropriate codes before specifying any material, this is how they will know what complies in one place or application might not comply in another. (1) It is very important the following of codes and standards because is not only beneficial for good construction but it is a matter of life or death for a building. (1) Facilities might not be allowed to open if they don’t follow the correct codes, and the owners could be sued for not following these. (1)

Quotations: “It requires that commercial facilities and public accommodations and state and local government facilities be designed, built, and altered to be accessible, to meet guidelines that our agency establishes.” (2)

annotated bibliography

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Programming

programming

I. TYPOLOGY AND LOCATION The purpose of this capstone is to improve the existing physical therapy healthcare settings and to improve the effects that interior design has on the recuperation process of physical therapy patients. It is important to study the healthcare environment because research continues to develop and grow, offering new ideas and standards for healthcare professionals and patients alike. This Capstone will not only provide the patients of physical therapy with the optimal conditions for a fast recovery, but also with an interactive space to improve their social relationships.

The main typology for this project is healthcare, but also including some hospitality settings to soften the sterile environment of a healthcare facility. The idea is to create a facility that can be interactive for all its users, providing healthcare but also some of the activities of a normal daily life. The ideal setting would be a facility which would provide the patients with a space in which they may receive the proper care, and promote an environment socialization and rehabilitation. The use of common areas like a cafe bistro and a lounge can improve the interaction among the users and the social skills of the patients.

There is the thought of having a main feature in this project which will be a garden that will have different activity areas for individual and social interactions, zoning it in two categories: public, and semi-private. The garden can be used for therapy exercises, for social meetings, individual self reflection and finding, among other things. There will also be a main reception/lobby area, a zone that will provide the users with some kind 35

of entertainment, and the normal areas within a rehabilitation facility: gym, treatment rooms, offices, etc. This facility will provide services for all kinds of physical therapy, ranging the time of stay from one day to maybe 6 months, so it is important to provide housing for patients with a special condition.

Healthcare facilities have always been looked at as the place for the sick and dying (Sloane, 1994), and it doesn’t have to be this way. People should not be isolated because they are sick or dying, that’s why it is important to create a facility that doesn’t make them feel excluded, but a facility that provides as much from the world outside the walls of the facility.

DIAGRAM The purpose of this diagram is to give an idea of the zoning within the space, and some of the adjacency needed. It still needs to be developed, but most likely it will have an axial circulation, but every space will be adjacent to the main feature that will be the inside garden.

LOCATIONS During the information gathering part of this thesis, there was plenty of proof found about the importance of nature’s role in the recovery of patients (Arriaga, 1992). For this reason it is important to locate the project in a place that is rich in nature. Costa Rica

programming

OFFICES

LIVING AREA / PATIENT ROOMS

LOUNGE AREA

CENTRAL GARDEN

GYM

SOCIAL ZONE

LOBBY / RECEPTION

TREATMENT ROOMS

CAFE BISTRO

Main spaces Other areas OFFICES

LIVING AREA / PATIENT ROOMS

LOUNGE AREA

CENTRAL GARDEN

GYM

SOCIAL ZONE

LOBBY / RECEPTION

TREATMENT ROOMS

CAFE BISTRO

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programming can be a great location for the development of this project, it is a country full of nature and beauty, but is also a country in need of health professionals. Costa Rica is one of the countries that has internship programs with other countries like US, where students go for a short period of time to practice their knowledge with the habitants of small towns who don’t have the resources or money to get properly treated.

Researching for a country where to place the project, I found an article explaining about the need of this profession in developing countries in Africa. Zambia was one of the countries that only had 300 physical therapist professionals when it has double the size of Massachusetts, and where every year 75 therapists graduate from the Boston University (Cyrana, 2011). In comparison to a developed country we see the difference in the assistance that they are getting and how much this facility would mean to the habitants of undeveloped countries.

Wherever the project is placed, it will result in a beneficial gain to the community. It is a facility that will provide the therapy for those who need it no matter the kind of injury, the only purpose is to better the conditions of these people so they can create a living as close to normal as possible.

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programming

II. HISTORY AND PRECEDENT CASE STUDIES Historic Development of Physical Therapy Early History The history goes back to ancient Greek culture and Hippocrates’ influence as the father of Western medicine (Network Synergy Group).

After the 16th Century • •

By the 1500s – 1700s, in Europe the use of exercise was in progress for the treatment of muscle and bone disorders and disabilities.

In the 1800s, exercise and muscle were reinterpreted and with new education these exercises were utilized for a variety of orthopedic diseases and injuries.

Since the 20th Century •

• • • • •

By the 1917, the US joined World War I and the Army recognized the need of rehabilitation services for soldiers that have been injured during battle. This resulted in the development of 15 “reconstruction aide” training programs that responded to the need of having medical workers with expertise in rehabilitation. The programs were created by a special unit of the Army Medical Department, the Division of Special Hospitals and Physical Reconstruction. Later on the profession was recognized as of physical therapy.

Physical therapy gains recognition and validation by the public in the 1920s.

In 1946 with the Hill Burton’s Act increased in-hospital based practice for physical therapists and so did its demand.

The 1950s was a critical time for the profession in terms of gaining independence, autonomy, and professionalism. By 1959, 45 states had regulations.

Since the 1950s physical therapists have found new opportunities and a few more options to improve patient function with developments in interventions.

These professionals help individuals of all ages to have optimal functioning and quality of life, meanwhile they also ensure the patient’s safety and apply evidence-based education to provide efficient and effective care.

Fig. 3.1: Map of Zambia in the African Continent.

Fig. 3.2: Image depicting the culture of the Zambia country.

Fig. 3.3: Map of Costa Rica, in red Nosara the possible location for the project.

Fig. 3.4: Image depicting the costa rican culture and folklore.

Fig. 3.5: Portrait of Hypocrates the father of medicine.

Fig. 3.6: Old setting of a physical therapy center.

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programming Historic Development of Hospitality Early History

Morphology: The building has a shape that is appropriate for the typology and that makes it logical and functional. It has an easy circulation path, is small, and accessible.

•

Activities of the Space:

•

It starts in ancient Greece where the guests’ rights were established and accepted by the different cultures of the Greek world.

In Ancient Rome, businessman used to travel, and these were also to be known as one of the first culture that would travel for pleasure.

Middle Ages • •

By the Middle Ages hospitality was more about providing shelter, food, and safety to travelers.

In the year 1282, in Florence the Innkeepers transformed hospitality into a business, which spread to other cities like Rome.

After the 16th Century • •

The inns and taverns became popular among the nobility.

By the 18th century coffee houses were very popular In Europe, so it was incorporated in the inns.

The combination of Hospitality and Healthcare

1.

2.

3.

4.

5.

Classical physiotherapy Medical exercise therapy Massage Sale of training Sale of therapy utensils

Thomas Plöckinger-Schatzl and his team have been on the business for a while, so they decided to expand the services offered to more than just classical physiotherapy. On the process of integrating the previous and the new services it was necessary to really think the about the building of the facility. Schneider & Lengauer developed a space solution that integrates the requirements and providing a simple, smooth and barrier-free organization of all the areas.

The designers took into consideration the safety of the users, they made the space accessible and clean. The simply and functionally designed the therapy rooms which are separated by an atrium, as are the sports and cardiac medicine training area. One of the intentions was to provide the center with enough natural lighting and with views that had calming and soothing properties to make the patients focus on their therapies.

For the past few years architects have tried to interconnect these two typologies with the intentions of making the patient experience more appealing and comfortable. The method is to provide guest-focused care and the design approach looks at the patient as a guest.

Precedent Study 1- Physiotherapy and Rehabilitation Centre PUR Totality: The building is complete because the design has adequately addressed the functional requirements related to the activities taking place.

Unity: The building appears to be cohesive, the use of subtle colors and the overall use of windows throughout the building to the surroundings and natural elements makes it tie together.

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Fig. 3.7: Floorplan of the Physiotherapy and Rehabilitation Centre PUR.

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Fig. 3.8: Front view of the building, showing the main entrance to the space.

Fig. 3.9: Back view of the building, showing the small terrace accessed through the gym.

Circulation Diagram

Adjacency Diagram

Private Semi-Private Public/Common Areas

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programming Case Study 2- Rooftop Hospital Garden for Physical Therapy Totality: The specific space is not complete because the design doesn’t cater for every necessity of the patient but on the other hand it was recognized to be good for the activities performed there.

Unity: The space was a good design solution, it gave purpose to an uninhabitable space and it did it in a way that connects the other parts of this hospital.

The name of the Garden is Rooftop Therapy Park. It is located two stories above the main level, on the rooftop of the surgery center at Fort Sanders Regional Medical Center in Knoxville, Tennessee. The eastern side of the garden provides the users with an obstructed view of the downtown of the city. The garden was mainly created for the use of the rehabilitation center’s patients and healthcare professionals which is located two floors above to the east.

The rehabilitation center that is two levels above provides treatments including physical, occupational, recreation, and speech therapy for patients. The rooftop garden was created with the intentions of providing a rehabilitation setting for patients, a well-located outdoor option for physical rehabilitation in addition to a unique space for visiting with family and friends.

When it comes to the design some of the things that are successful about this garden are: the therapy walk for physical therapy, the Gazebo for group meetings and interaction, the ball court for gaming and exercising, and in overall being an outdoor green area to escape to. Some of the things that did not work for this design were: the limited access and the visibility from other points of the hospital, no using a proper signage system for the wayfinding, and the lack of private and comfortable seating. It was a good concept overall but it wasn’t properly executed.

Fig. 3.10: Front view of the Rehabilitation center from the Fort Sanders Regional Medical Center.

Activities of the space: 1.

2.

3.

4.

5.

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Physical rehabilitation A place to visit with family and friends Horticulture therapy Basketball gaming Therapy walk

Fig. 3.11: View of the rooftop garden.

Fig. 3.12: Plan view of the rooftop garden.

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Semi-Private Public/Common Areas

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programming Case Study 3- Palafito del Mar Hotel Totality: The building is complete, the design is exquisite and appropriate for the typology.

Unity: The design elements of this Boutique hotel are sleek and minimalist. Every aspect of the design is interconnected and well executed. Is a warm space, very natural and easy to move around for the size of the building and for the simplicity of the wayfinding.

Morphology: For this building the morphology is so out of the ordinary that it goes perfect with the concept, with the site and with the demographics of the area.

This Boutique hotel is designed by Eugenio Ortuzar and Tana Gebauer. It is located in Chiloe, an island of Chile. The idea was to revitalize a degraded neighborhood creating locations that could be targeted by tourism. The site is spectacular, is the waterfront, so the building merges with the sea, giving great views and restorative qualities to the space.

This restoration qualities are not only good to the users but also to the community.

The building has an approximate of 380 square meters. The hotel has a central circulation that falls under a skylight. It features a living room that makes the experience homey like because of the warmth of the materials and the seating layouts.

Assessment Overall the findings of these case studies about the typologies that I am using suggest that there should always be provided different types of spaces when it come to privacy.

The users should be provided with private, semi-private, and public accommodations, so at all times they can feel some level of comfort when performing the activities they would like or that they have to do. Mainly the circulation used for the three case studies were axial and central, which it makes evident that complicated floor plans are not a necessity, something simple for the way finding is the best solution. Adjacency is always a key player when space planning, so it is important to create the correspondent adjacencies in order to facilitate the users the wayfinding.

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Fig. 3.13: Image above shows the boutique hotel from the lake.

Fig. 3.14: This image shows a better view of the context surrounding the hotel.

Fig. 3.15: First floorplan of the hotel.

Fig. 3.16: Second floorplan.

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Private Semi-Private Public/Common Areas

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Fig. 3.17: Another view from the lake shows the access from the lake by small boats, and the wood posts that hold the structure in place.

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Fig. 3.18: MAde with the feeling of a home, this image shows the lounge area or the living room area of the hotel, where it provides the users with a great view to the lake.

Fig. 3.19: Hallway of the guests’ rooms on the second floor. The wooden details in the environment makes it feel as a spa retreat.

Fig. 3.20: Main entrance view from the second floor. The main entrance has direct access to the check-in area and the second floor.

Fig. 3.21: View of main entrance from the exterior.

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III. CLIENT/OWNER Narrative Martha Jones was born in Washington D.C. in the 1960’s. She practiced sports since the childhood all the way to her teenage years. The love for sports was something that led her to coach synchronized swimming for more than 30 years. As she got to her forties, she decided to make a slight turn in her career and started to study to become a Massage Therapist. She practiced for a good 7 years while she was studying something that inspired her more to help others, Physical Therapy.

From all her years of experience dealing with injured athletes and with people that had suffer small injuries caused by car accidents, she knows the difference that physical therapy can make in someone’s life. Physical therapy treats many kinds of injuries, but the optimal objective is to improve the way of life for a person that has restricted movement.

With her expertise and the financial support of a friend, Martha is opening a physical therapy center in Costa Rica. She has chosen Costa Rica because of the particular needs of this country and because as she gets older she would like to retire and supervise the work that has been done in order to help this community.

Martha is a simple person that sometimes because of her job requires massage therapy herself. She enjoys watching the sunsets whenever given the chance, reading a book every once in a while, as well as drinking some wine to celebrate life and success. Her dream has always been to explore other countries and get submerged in the culture.

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programming Questionnaire

5. The overall design should be...

Interview done to Martha Julia, Massage therapist 1. Choose the two styles that describe your taste the most‌

6. What is the feeling that you want to give to the spaces?

I do not have a particular object but I have always liked things, clothes and art that resemble nature and natural things.

I have no experience dealing with interior design, but there is something that always bothers me about these kind of centers, at least some of the ones that I have visited, they are always closed and claustrophobic. It is important for the patient and the therapist to be in an ample space with natural lighting if possible.

Now when designing this center you have to be careful because there is a good amount of equipment that has to be fixed to the wall for the therapies.

3. The settings offered at the center should include...

7. The color palette should be...

2. Is there a particular piece of art, furniture, or clothing in your personal space or life that could truly describe your style? Describe it...

8. What colors would you like to see?

4.What other suggestions would you give for this kind of facility?

I am not sure if you know that some of the equipment used for the therapies has a range of colors that are used to identify the resistance and weight of these.

I think that the colors implemented for the interiors should be neutral and maybe traditional colors, but the colors for the furniture and smaller things should be more colorful so there is a contrast in the space.

I don’t really know which colors I would like to see there but maybe you should do a small study about the colors that could be stimulating for the patient.

From the list that you provided before I think it covers the most important spaces this facility really needs.

If you will include stay rooms for the family of the patients maybe a mini spa should be good for them.

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programming 9. The ambient lighting should be...

Comment: Depending in the space that you are working on. There should be always bright light to stimulate the patient, natural if possible.

15. The stay rooms should include...

Comment: If you are going to have rooms for the patients there should be a service for food to be delivered to their rooms, like in hospitals.

16. Should the stay rooms give a feeling of a hotel or healthcare setting?

10. The furniture selection should be...

It would be really nice to have a room that feels that you are in a hotel, it would improve the experience of the patient. You have to consider that there are equipments that have to be used in the rooms for the therapy.

17. Which benefits do you think an interactive garden should bring to this facility?

11. The lobby/waiting area should be...

I think it would be good for the patient to receive the therapy in a natural environment which sometimes is more stimulating that an enclosed setting at least for gait training, which is walking.

18. Do you think the facility should use sustainable materials?

If is possible yes. It is good for both people of the environment.

12. What are some ideas that you would like to implement in this area?

I would like to see something like a hotel lobby, not the typical hospital or healthcare waiting area that depresses you.

13. What is comfortable to you?

A space that is ample, high ceilings, and cozy furniture.

14. What are three words that should describe the feeling of the space that you are trying to achieve?

Spacious, Illuminated and Comfortable.

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19. Based on the selection of the site you consider nature to be a key player in this project. In which spaces would you like to implement the views to the natural elements? List in order of importance from 1 to 5.

1.

2.

3.

4.

5.

Stay rooms for patients Gym Therapy Area Pool Lobby/ Waiting

programming Client’s Goals and Objectives • • • • •

Use of natural lighting Exposure to nature views for patients Ample spaces with high ceiling if possible Implement sustainability Comfortable space for the patients

Design Guidelines • • • • • • • • • •

From previous studies the floorplan should have a simple circulation, using maybe central or axial, trying to avoid awkward paths.

Adjacencies are important for the therapy different settings.

Natural lighting is very important for this facility, so it should be used where patients spend the most time doing therapy.

The colors of the walls should be soothing and calm but the furnishing should contrast and be exciting.

The garden is a good thought for the patients, and there should be included the three levels of privacy (public, semi-private, private).

A small spa can be included for the families of the patients if they are going to spend time there.

A breakroom should be provided for staff even though that it wasn’t mentioned.

Locker rooms should be added for both females and males.

Acoustics is most important in the treatment rooms and offices.

The facility has to be ADA compliant.

IV. LOCATION AND SITE Chapter Summary The process of programming has a few steps that are important to know during the process of information gathering, just in order to have the perfect amount of information, avoiding having too much or too little.

The chapter gives two principles that help into “testing the relevance of facts” (pg.119).

First principle is to make sure that the information gathered can help into achieving your goals and objectives. The second principle is to ask how the designer could use the information.

A programmer has to take into account the value systems, and the accuracy of the information, these are things that influence the project and could change things around.

The data that is gathered has to be turned into useful information that will only help the programming process to advance and be accurate.

Facility users will be the most important information that can be gathered, after all they will be the ones using the building and interacting with it almost every day. This step is known as “human factor programming or functional programming” (pg. 125) Creating a user profile for each type of user is the most helpful aspect that makes the programmer organize the information about the clients and users.

When gathering information about the users, it is also important to know about the social and organizational networks that tie the users together. It is never good to just assume things by experience, because it can be wrong and it can lead to the failure of the project.

Projections could be the most difficult to obtain: the future costs, the growth of the staff and population, etc. These are things that need to be thought of just to meet the future need od space in the building.

Another important point is the activities that the users will be doing in the facility. When and where; this way the programmer can have an idea of the hours of operation, the schedules, the most important activities, and things like this that even though they might appear as unimportant on the contrary they really important because it helps on the importance that the designer gives to these spaces that the users use the most and is what really define these spaces and what make it work.

Site analysis is a key player in programming, because it gives the designer a set of constraints but also a set of solutions, with which the designer has to play with and find a balance that will make the facility use the most of the surroundings and this can be found at the synthesis of the site analysis process. When working on site analysis, the designer 50

programming has to look at: site context, legal description, zoning, traffic, utilities, topography, views, built features, soil conditions, vegetation and wildlife, sensory characteristics, aesthetic qualities, and cultural implications of the site. All of these together make the designer use the most of the site that the building is located on.

Other two factors that need to be considered when working in a site that is not familiar to the designer are the climate and energy. The climate of a site usually is a major part of the design problems. The energy from the sun at the site is also an important consideration, it can affect the aesthetics and the amount of artificial energy that a building might use.

Code information is often excluded from the programming set, but if it is included the designer has to make sure that the design follows and meets the codes of the country that the facility is being built on.

Programming is a process that has to be done through, in order to not miss any important details that can affect the design. The designer has to decide when the information is relevant to the project or not, and in which way it can be used. Programming is the first phase of design and it has to be properly executed for the project to be a complete success.

Political Organization Costa Rica is a country with a Democratic political system. Similar to the US it is divided into three branches to divide the powers, having a legislative, executive and judicial branch (Political Structure, n.d.). The administrative divisions in Costa Rica consist of 7 provinces that include: San Jose, Alajuela, Heredia, Cartago, Guanacaste, Puntarenas, and Limon. These provinces are then further divided into different cantones (Political Structure, n.d).

There are presidential and legislative elections every four years. This country has a multi-party system with around thirteen parties. The three main political parties are the Social Christian Unity Party (PUSC), the National Liberation Party (PLN), and the Citizen Action Party (PAC); the PLN and the PUSC hold 97% of the votes (Political Structure, n.d).

The city of Nosara is communal, it seems to have a strong tie among its residents. Most of the residents of the area strive for the same goals which are to preserve the natural environment, being sustainable, and create projects that benefit the community.

Design Guidelines • Create a sustainable design • Incorporate nature in the design and blend in with the site • Create spaces that can be used by the community 51

The Economic Environment/Support Costa Rica is known as the “Switzerland of Central America,” this is because of the stable economy, democratic government, and peaceful society with no need for a military that it has earned this name.

The economy of Costa Rica depends mainly on tourism, agriculture, real estate, investment and business, commodity and electronics manufacturing, and trading industries.

It has a good transportation system and a very well developed banking system.

The City of Nosara is well known for its real estate, many of the properties in that area belong to North Americans, that’s what gave the opportunity for the American Project to develop, which has improved the area economically and aesthetically. It also depends on tourism, many people travel for surfing and to attend to the Yoga and Wellness centers located in the area.

Design Guidelines • Make the facility for the use of all the residents and possibly foreign visitors.

• Have an educational system for the users of the space about the surroundings business that can be of use to them.

• Use local resources for the construction and maintenance of the facility.

The Cultural and Social Underpinning The people of Costa Rica call themselves “Ticos” and are known to be welcoming and friendly. Their culture is vibrant and well influenced by the Roman Catholic Church.

Spanish is the main language but English is widely spoken along the Caribbean Coast and among the younger population.

In Nosara there is a wide population of North Americans that own mainly residential properties, but there are also the population of the Ticos. This city is a communal city, where many activities are created for the community and for the entertainment of the tourists. There are some Universities close to it, but unfortunately it doesn’t have a hospital close to the area. Mainly it has wellness and yoga centers. It is a good opportunity to incorporate a healthcare facility that even though is not a hospital it can provide the community with services that can be really appreciated. There have been programs (and still are) of internships for physical therapists that travel to this area to offer free services, and the communities do take advantage of this.

Design Guidelines • Provide accommodations for different cultural types.

programming • • •

Provide educational services about the importance of physical therapy for the wellbeing of a person.

Provide accommodations for different time of stay (foreign patients, or local).

Create an inviting atmosphere for those who are just passing through and want to take a peek, in order to promote the services.

The Geographic Characteristics Costa Rica has 51,100 sq. km, and is the second smallest Central American country.

It is a mountainous country, located between the Caribbean Sea to the East and the Pacific Ocean to the West. It is positioned on the Central American Isthmus 10˚ North of the Equator and 84˚ West of the Prime Meridian. It borders Panama to the south and Nicaragua to the North.

Nosara is located in Guanacaste in the Peninsula of Nicoya along the Pacific Coast. The Pacific Coastline is characterized by its lagoons, the hills and high cliffs that reach into the sea, the tidal variations, the beautiful rain forest and also the dry forest to the north.

Costa Rica is also known for its mountains; the Cordillera de Guanacaste is the most northwestern mountain range, it consists of an amazing chain of volcanoes.

Design Guidelines • Consider seismic movement for architectural structure.

• Use solar energy for illumination source during the day • Take advantage of wind currents for ventilation on possible outside areas.

The Architecture of the Area The architecture of this area uses natural materials. Architects are trying to create sustainable designs to promote it and to blend in the architecture with the sites. Wood and stones are just main materials that can be seen in the structures, and also the use of wide glass windows to take advantage of the sun. There can also be seen traditional architecture where gable roofs and ionic columns can be seen in the facades. This region, and the country in general, is modernizing really fast, so new designs can be spotted in that zone.

Design Guidelines • Sustainable design (architecture and interior).

• Modern design, it has to be similar to the resorts around the area to make the users feel like they are in a resort not a healthcare facility

The Decision of the Actual Site Site Analysis Site Context: Apdo 97, 5233 Nosara, Costa Rica The city of Nosara is located in the Province of Ganacaste, Costa Rica. It is a few kilometers off the pacific coast and with directly adjacent to Playa Pelada. It is surrounded with Resorts, private Ranchos, and the houses of locals. There are a few universities and national parks around the area.

Zoning The area is not very highly populated for what it can be observed in the maps, but cities that are close to the coast are usually this way in Central America.

Traffic One of the main roads passes real close to the site which gives good access for cars and busses. There is also an airport in the main city, which gives opportunity for travelers in seek of this service offered at the center, to travel by airplane.

Topography The topography of the region usually that consists of gentle slopes, flatlands, and steep ocean view points. What happens with this is that it allows to the development of both ocean view and mountain view lots.

Views Most of the views of this are to natural landscapes. There can also be properties spotted, either of resorts, or house owners. The images provided in the following pages are some of the views that can be seen around the area.

Built Features The benefits of this site is the nature that surrounds it. Typically nature is linked to the improvement of people’s health, it is a great site to develop this healthcare project. There is ample space at the site to have a good design and to add things that might be needed for the visitors and attendees, like parking lots.

Soil Conditions The soil conditions of this city are mainly good for cattle pasture, some deforestation occurred but the landowners of the area made sure to reforest the area again to keep the beauty. Nosara is considered one of the green zones of greatest beauty in all of Costa Rica. It has thick rich forest which grows in areas that were once razed to benefit the 52

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Fig. 3.22: Close up of Nosara map, the chosen location, showing some views of the surrounding areas. The map also shows the main street 160.

Fig. 3.23: Playa Pelada, the closest beach to the location where many retreat centers take their guests for exercises and surfers might be seen.

Fig. 3.24: Entrance of the Hotel Rancho Suizo.

Fig. 3.25: Nosara Wellness , it is a Yoga Retreat center where the project will be located.

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Fig. 3.26: Google Earth map of Nosara, A shows the exact location for the project.

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Fig. 3.27: Topographic map of Nosara.

programming cattle. An American Project, which includes lots of land in the northern end of Playa Guiones, Playa Pelada and some of the hills, is a good example of responsible planning and development. There is a large number of homes that exist in the area, but the first time a visitor gets there he/she can still feel isolation and surround him/herself with an untouched tropical environment.

Climate Nosara has a tropical weather condition. The summer months are the hottest for this city, sometimes reaching temperatures of 90 degrees. From the month of May to the month of October is when it rains the most accumulating up to more than 200 mm of water.

Vegetation and Wildlife There is a wildlife refuge close to this city, but still the residents have made sure to keep the natural environment safe trying to avoid unnecessary development and being careful of what is built around the area. Parrots, armadillos, monkeys and toucans are just some of the animals that have been spotted in the area.

Sensory Characteristics This city is mainly residential but it also has resorts, so noise wouldn’t be a problem, not to mention that the properties are not next to each other, there is always land surrounding them. Mostly what would be heard is the sound of the animals, and the wind moving the vegetation.

Aesthetic Qualities • Some of the aesthetic qualities for this area are: • Nature : forests, beaches, and rivers.

• Cultural elements of the natives • Tourist locations Cultural Implications The city is a mixture of natives and Northern Americans who own land there, so it is a constant exchange of cultures. It also has to be taken into account that is a tourist destination, many young people go for surfing at Nosara beaches.

Site Section Criteria • The surroundings need to have a stable walking setting for the future users.

• Needs to be known by all the locals, and surrounding cities (more visible to some extent).

• Open to the use of all the residents and travelers.

• Surrounded by nature.

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programming Solar Data Design Guidelines • Integrate the architecture with the environment.

• Make the building visible to the by passers to make them interested and promote the facility.

• Take into account the wildlife and prevent endangering it.

• Create a good landscape design that can improve the site.

• Create good relationships with the surrounding businesses.

• Promote wellness through the design.

Fig. 3.28: Map of the Peninsula of Guanacaste showing the sun path for the location.

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Fig. 3.29: Google Earth Map of the Peninsula showing the sun path for the location of the project.

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V. CLIENT/USER Facility Users •

Administration: 1.Executive Director, 2. Site Manager, 3. Financial Assistance,

•

Clinical Staff: 1. Physical Therapist (PT), 2. Physical Therapist Assistant (PTA), 3. Physical Therapy Aide (PT Aide), 4. Occupational Therapist (OT), 5. Occupational Therapist Assistant (OTA), 6. Doctor, 7. Nurse, 8. Nutritionist.

• • •

Patients Visitors Staff: custodial and kitchen

QUESTIONNAIRE 1 User: Patient Name: Andry Fuentes 1. At which age you had to attend to this kind of facility ?

When I was 15.

Physiological and psychological 2. Which kind of impairments or injuries you had? Did you need any special accommodations for these injuries?

I was hit by a car and my injuries were: dislocated shoulder, rib fracture, jaw dislocation, wrist fracture, body road burn, and a broken eye socket. But I only attented therapy for the dislocated shoulder.

3. How long were you treated for? Due to your injuries did you have to stay at the facility? If so how long did you stay?

I spent a week in the hospital and went 3 times for therapy.

4. How did the environment feel? (Sterile, comfortable, cold, etc.)

Sterile, like all hospitals feel.

5. Is comfort more important than style in this kind of setting? What it is comfortable to you?

Yes I think having a comfortable space is important. I would think something that feels like home is comfortable.

6. What kind of illumination was important for you to have? For example: natural lighting or artificial lighting.

I think that both. Is just nice to have the sunlight coming in the space you are, and artificial lighting is good for when you don’t have the natural lighting or when that one is not enough.

7. Do you think that acoustical tolerance is important in this kind of setting? For example: Would you feel important not to have the nearby users listen to you conversations...

Yes, I believe that some type of privacy is needed.

Security considerations 9. Do you think that the wayfinding was important? Like the use of signage and the ambient conditions to enhance directions?

Well usually hospitals are confusing, so it is important to have a good wayfinding so you can get to the place without asking a million times how to get there.

10. Did you find important to have an enclosed space to for a higher level of privacy?

At the same time you think this enclosure provides with a sense of security?

When I was in the hospital yes, I liked having a higher level of privacy because I really wouldn’t feel comfortable having other people looking at me with all my injuries.

11. What kind of views would you have liked to have found in the space?

Views to the outside. It doesn’t matter if it was urban or landscape just having a view to the outside world.

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programming 12. Is personal space necessary? Explain why.

I believe is necessary, sometimes you just want to be left alone to rest, or to think.

13. Is it important to be able to differentiate public, semi-public, and private spaces?

Why? Yes! I don’t think it is right to walk into some people’s conversation because you were not able to tell that it was a private setting.

14. Was it important to have some kind of interaction with other space users?

Yes sometimes is nice to talk to other people. I like to talk a lot so it is necessary to have some kind of interaction.

Belonging and self esteem

accident where you are walking and a woman just hits you out of nowhere.

22. Is family support interaction important to the user?

Yes! Is good to know that you have your family supporting you at all times and helping you.

23. Is flexibility of the setting important? For example: having movable seating, control of lighting and acoustics, etc.

Well I think for the rooms of the hospital yes. Sometimes the people who stays with you needs to move the furniture around.

QUESTIONNAIRE 2

15. Does support play an important role among the users of the space? Why? I think so. Is important to receive support from the therapist or the other patients.

User: Clinical Staff Name: Margarita Age: 50

16. How significant was privacy for communication?

Well sometimes you don’t want other people listening to what the doctors or therapist have to tell you, so I think is important to have privacy for this kind of conversations.

1. What is your field of expertise?

Physical Therapy

Self actualization / individual needs

2. Where have you worked in this and how many years of experience you have?

I worked in Colombia as a PT, and in US in a rehab center as an aid.

17. Where do you think comfortable areas are important?

Well if you are staying in the hospital and you want to leave the room because it makes you depressed just to be there, is good to have lounge area close.

18. Should the environment provide both public and private places for people to gather?

Yes it should provide with both settings.

19. Is the attitude a key player in the rehab process?

Yes is important to be positive so you can have good outcomes.

20. Do you think that liking or disliking the setting had an impact in your treatment process? Explain why.

Yes it does have an influence. Sometimes you dislike the place so much that you just want to be out of there. At least that is how it went for me.

21. Should the environment feel safe and secure?

You always want to feel safe, wherever you are, even more after being the victim of an 59

Physiological and psychological 3. List all the activities you do in this position.

• Diagnose and manage movement dysfunction and enhance physical and functional abilities.

• Improve optimal physical function and optimal wellness and fitness and optimal quality of life as it relates to movement and health.

• Prevent symptoms and progression of different types of impairments, functional limitations, and disabilities that may be the result from disorders, conditions, diseases or injuries.

• Taking notes of the patient history • Conducting reviews • Performing tests that help identifying potential and existing problems.

• Conducting re-examinations of patients in therapy progress • Discharge plans

programming 4. Who do you work with?

In Colombia as a PT I worked closest with the PTAs, but also with the Aid. In US I worked in a Rehab center where I was an Aid and I worked the closest with the PTAs. 5. Is comfort important in the developing of the therapies? Explain why.

Yes I believe is important because you always have to look after how the patient feels.

If the environment is not comfortable for them it might be a setback in their progress.

6. On your perception how can you describe comfort? What is a comfortable environment or space for you?

For me a place that feels homey and warm. I don’t really know how to describe it.

7. Do you think that implementing sensory stimulation (aroma, sounds, visuals, etc) is useful and helps the progress of therapy? Why? It would be good for both the patients and the therapists, I think is a nice thought just to keep a good environment.

8. What are some of your color choices for a setting like this?

I think neutral colors could be good, and the greens and blues. For this settings is always good to resemble nature, maybe also colors that can motivate the users, you are the expert on that.

9. What kind of illumination was important for you to have? For example: natural lighting or artificial lighting. Within artificial lighting what was a “must have”: general or task lighting?

Both of these lightings are important. Natural lighting is very good for anyone, and it has restorative qualities. Now for some other things it is important to have artificial lighting.

This is a setting that needs a lot of lighting, for the kind of activities that are performed inside.

10. Regarding acoustics, what are the privacy needs within the space?

I think privacy is most important for the offices, for the individual therapy rooms, and of course for what you are thinking of doing the rooms.

Security considerations 12. Which adjacencies are important in this kind of setting? For example: having the therapy rooms close to the gym, as having the lockers close or inside the bathrooms...

Yes I think the therapy rooms should be close to the gym and the pool. Also is reasonable to have the lockers adiacent to both therapy rooms, gym and pool.

13. Do you think that the wayfinding was important? Like the use of signage and the ambient conditions to enhance directions? Explain why.

Yes signage is always good to orient anybody. Remember we treat any age range so for the elderly is good to have a clear wayfinding.

14. Did you find important to have an enclosed space to for a higher level of privacy?

At the same time you think this enclosure provides with a sense of security?

It depends... For example for our break time when we have to eat of course we want some privacy, we don’t want other patients to be looking at us when we are in our own time. It doesn’t have to be necessarily enclosed but, yes privacy is important. If it is for a patient room then yes an enclosed environment is good, but always providing some kind of view so it doesn’t make it claustrophobic.

15. What kind of views would you have liked to have found in the space?

I think views of the natural environment are always great. It makes you relax and feel peace.

16. Is it important to have a personal space within this space? Explain why.

Yes, sometimes you need to retreat and spend time with yourself.

17. What is the perceived need for territorial boundaries (personalizing of office, workspace, etc.)?

I think that is always good to know that you have your own corner anywhere you go. So if you have your own office is good to personalize it to feel that is yours, that is your space.

18. Is there a need for

11. What kind of communication devices are needed (phone, intercom, etc.)?

In the offices the things we use are the phones. a computer, and printer.

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programming If you selected agree, explain why.

Well all of the above are important mainly for the patients; because it is important to provide a secure environment for these people. Many of them need assistance sometimes so is good to make it easier for them.

26. Do you think that liking or disliking the setting has an impact in the rehab process? Explain why.

Yes it could have an impact, because you don’t want to go to a place that you dont like and you don’t feel good.

19. Is it important to be able to differentiate public, semi-public, and private spaces?

Why? I believe so. You want to be able to know when you can go to a space to have a private conversation if you need to, for the privacy of whoever it is that you are treating. If you want to socialize either with your co-workers or the patients is good to know which pace is good for that too.

27. Should the environment feel safe and secure?

Yes! I don’t think anyone likes to feel the opposite.

28. How is family support interaction important to the patient?

Family has to support always. For patients sometimes that is the most important thing.

20. Is it important to have some kind of interaction with other space users?

Interaction is always good, for the patients and for the staff. You want to know that there are people you can go to for talking, for help, etc.

21. Does the environment need to support a variety of activities? Name the top 3 that come to your mind.

Different kind of therapies, break areas, lounges Belonging and self esteem needs 22. Should the user be able to control the environment (lighting, temperature, etc.)

I think just the staff, not the patients.

23. In the relationships that are created among the users, is it important to have physical and psychological support among these? Explain.

Yes! Physical support is much needed in this kind of settings, many patients need the help of the therapists and sometimes of a friend. The same thing for psychological, support is a main key player in the recuperation and the progress of therapy.

24. How significant is privacy for communication in this kind of setting? Explain It is important to have a private setting to talk to the patient about their own case.

Self actualization / individual needs 25. Is the attitude a key player in the rehab process?

Oh yes! if you have a bad attitude you will never progress fast; and it goes for both the therapist and the patient.

61

29. Should different setting of privacy be provided for both clinical staff and patients? An environment that can create a sense of (Check on the ones you think they need this feeling)

30. Is flexibility of the setting important? For example: having movable seating, control of lighting and acoustics, etc. Explain why.

Yes, it can always be good to have furniture that you can move around. Now I don’t think that some of the equipment used should be movable, it has to be secured for the therapy.

31. Name some spaces that you would have liked to have in your past working environments. For example: a cafe, an internal garden where to practice therapy, etc.

I think a garden would be fantastic and very good for implementing therapies there

programming USER PROFILES AND ACTIVITIES

REQUIREMENTS

The clinical staff include the different types of therapists and their assistants (PT, PTA and Aides) the doctors and nurses.

PT: interpret physician’s orders and based on that perform evaluations and assessments; they also design and implement a plan of care; they maintain treatment and progress records; drafts and present reports of the patient’s status; last but not least they collaborate with other team members in order to reach the patient’s goals.

PT Assistants: put into practice occupational therapy (OT) and physical therapy (PT) services for patients under the supervision of an occupational therapist (OT) or physical therapist (PT). These services include structured assessments, treatment and documentation.

Doctor: or physician assesses the patient and refers to the therapist. He follows up the progress of the patients and is there for emergencies.

Nutritionist: Helps to keep a healthy diet for the patients.

Nurse: is responsible for the delivery of patient care through: assessments, planning, implementation and evaluation. It is also her duty to direct and guide the patient and its family teaching and activities of additional personnel while maintaining professionalism and the training. One for the day shift and 1 for the night shift, and one on call.

The staff are the ones in charge of keeping the facility running and in proper conditions.

Kitchen Staff: There will be a chef and four other assistants that will help prepare meals and provide the food for the cafe.

Staff: Housekeeper, groundskeeper, technician, phone operator, receptionist.

DESIGN GUIDELINES • • • • • • • •

Patients and clinical staff need privacy Flexible arrangements for common spaces and private spaces.

Natural lighting Artificial for ambient and task lighting is also needed Neutral colors and natural like colors Easy wayfinding for patients and visitors Open spaces that feel ample Natural elements through the design 62

programming

VI. GOALS AND OBJECTIVES

•

Mission and Vision Statement

What feeling should the environment have?

• Open spaces that makes the environment feel ample, like the lobby, cafe, interior garden and gym.

• Bring positive energy to the environment through colors, lighting, and graphics.

• A warm and restorative feeling that can be achieved through the resemblance of the design to nature.

The objective of this thesis is to create a physical therapy center that can accommodate inpatients and outpatients in an inspiring environment that motivates them to recuperate at a faster speed. Providing these users not only with the healthcare attentions settings that they need but also with hospitable accommodations that would make the space feel less sterile and more welcoming. The clinical staff is passionate about achieving their goals of getting people to feel and to move better, so is important to create an environment that not only motivates the patients but also the staff.

Goals and Objectives Organizational What do you want the environment (business, company, and project) to do for the design effort?

• • • • •

Create a space for patients that inspires them and motivates them to exercise and progress therapy in a faster way.

Highlight and promote sustainable design as is being implemented in the community.

Provide new arrangements that would make the space practical and interactive for the patients and the clinical staff.

Create a colorful environment that reflects the culture of the city and country.

Use creative approaches of design to make the facility fit its purpose through functionality.

Form What is the image desired – the aesthetic framework?

•

• •

63

Bring as much as possible natural lighting into the space to help reduce energy costs and provide views to the natural landscapes surrounding the building, through windows, skylights, and the use of screen wall partitions.

Use neutral but also vibrant colors, resembling nature through the use of different textures and finishes.

Merging the outside landscapes with the interiors in order to incorporate the restorative qualities of nature into the facility, for example like the interior garden.

A feel of rustic modern design that relates to the architecture of the area, that also promotes the sustainable practices of the area.

Function What are the major activity goals?

• • •

Keep promoting the sustainable lifestyle that the city is trying to implement Inspire the users of the space towards achieving their goals through therapy Teach the patients how to properly take care of themselves

What are the unique activity related goals?

• •

Guests from other countries to visit and hopefully use the facility.

Promote sustainable design through the use of materials and alternative technology.

Economy Quantity and Quality issues – Quantity space vs Quality of construction • •

Utilize as much space for therapies, make the facility functional towards this direction.

Safe facility that meets ADA guidelines.

Initial cost vs. life cycle costs related goals and objectives •

Reduce energy and water costs through alternative technology, for example the use of solar panels and the Water efficiency products.

Conservation issues – green design related goals • • • •

Green certified products HOV paint Natural lighting and Solar energy panels Recycled materials

programming • •

FSC Wood Water efficient products

Time Planning for growth • Future expansions through Latin America and Africa for the growth of physical therapy and the help of the limited resources communities.

Long range goals – related to future design intervention • Inspire the users to implement sustainability in their daily life • Inspire other individuals to make projects like this for the growth of a particular typology that can help communities that are economically challenged and deprived of this service.

VII. QUANTITATIVE

executive office have the minimum square footage will most likely they will be provided with a little bit more space than the clinical department.

Clinical Department The clinical staff are the people in charge of attending the patients. In this section we find the therapists, their assistants and aids; the nurses, the doctor, the clinical director, the outpatient manager, among others that deal in a daily basis with the patients. This department will be distributed in different areas since it contains offices, massage rooms, nurse stations, examination rooms, etc. The doctor and the nurses are most likely to be adjacent to the inpatient section.

Therapies In this section are found the different settings that will be used for therapies. Among these we find: the gym, the pool, the interior garden, and the treatment rooms. They all have to be adjacent to each other and accessible for the patients. A exact setting will be provided for the inpatient section but with smaller square footage.

Nourishment Department This department is solely for the nutritionist, who have to properly guide the patients with diets that will help them to maintain a healthy lifestyle. This department is composed of 3 offices and should be adjacent to the therapists’ offices and to the gym.

Lobby

Inpatient

The lobby is the place of arrival of this facility. Is the space that gives the first impression to whomever that visits the facility. Here there will be waiting arrangements that will accommodate up to 15 people and the reception desk who will afford 4 people. This space will be adjacent to the Café for the convenience of the visitors.

This section is for the patients that travel to assist and receive treatment in this facility; it is also for patients that have a more concerning shape and injuries and need therapies more often. They will have accommodations as if they were in-patient, they will have their own separate therapy settings, and their own clinical staff.

Administrative

Activities

The administrative section is where the offices for administration will be found. The Executive director, General Manager, Admissions Director, Director of Operations, and the Programs Manager. These people keep the center running, so they need to be in a private set up and adjacent to each other. This department will be adjacent to the lobby. The

The purpose of this section is to provide the users of this facility with other activities other than just therapy and work. It is important to provide the staff with areas where they can go for a break or a coffee to alleviate stress, as well for the patients. This department or section includes a cafe bistro with a kitchen, lounge areas, and a gift shop.

64

programming

65

programming

66

programming

129

REQUIREMENTS

DEPARTMENT

Lobby

Administration Offices

67

SPACE

DESCRIPTION

SIZE

ADJACENCIES

EQUIP

ELECTRIC

Reception

Open Area

16 x 20

Waiting Area

Open Area

15x15

Executive Director

Enclosed Office

9 x 9

All areas from the same department

Comp, Phone, Printer

Duplex Outlet, Data Voice, Light switch

General Manager

Enclosed Office

9 x 9

All areas from the same department

Comp, Phone, Printer

Admissions Director

Enclosed Office

9 x 9

All areas from the same department

Comp, Phone, Printer

Director of Operations

Enclosed Office

9 x 9

All areas from the same department

Comp, Phone, Printer

Programs Manager

Enclosed Office

9 x 9

All areas from the same

Comp, Phone,

Duplex Outlet, Data Voice, Light switch Duplex Outlet, Data Voice, Light switch Duplex Outlet, Data Voice, Light switch Duplex Outlet,

FURNITURE

THERMAL

ACOUSTIC

LIGHTING

COLOR

MATERIALS/ FINISH

MECHANICAL

SECURITY

PLUMBING

DOOR/ WINDOW

Waiting Area, Comp, Administration phone, offices printer, fax Reception, Gift N/A Shop, Lounge, Cafe Bistro

Duplex Outlet

Reception TCͲ1 desk, chairs Comfortable

Some Acoustic Privacy

Ambient

Neutral and Accent

Sustainable and organic

HVAC Integrated into Ceiling

Emergency lights, Camera

N/A

N/A

Duplex Outlet

Various seating: Chairs, sofa, bench coffee tables Desk, desk chair, 2 guest chairs credenza, file cabinet, storage, coffee table Desk, desk chair, 2 guest chairs credenza, file cabinet, coffee table Desk, desk chair, 2 guest chairs credenza, file cabinet, coffee table Desk, desk chair, 2 guest chairs credenza, file cabinet, coffee table Desk, desk chair, 2

TCͲ1 Comfortable

Some Acoustic Privacy

Ambient

Neutral and Accents

Sustainable and organic

HVAC Integrated into Ceiling

Emergency lights, Camara, sprinklers

N/A

TCͲ1 Comfortable

Acoustic Privacy

Ambient, Task

Neutral and Accent

Sustainable and organic

HVAC Integrated into Ceiling, Thermostat Control

Emergency lights, sprinklers

N/A

Hollow core or Glass

TCͲ1 Comfortable

Acoustic Privacy

Ambient, Task

Neutral and Accent

Sustainable and organic

HVAC Integrated into Ceiling, Thermostat Control

Emergency lights, sprinklers

N/A

Hollow core or Glass

TCͲ1 Comfortable

Acoustic Privacy

Ambient, Task

Neutral and Accent

Sustainable and organic

HVAC Integrated into Ceiling, Thermostat Control

Emergency lights, sprinklers

N/A

Hollow core or Glass

TCͲ1 Comfortable

Acoustic Privacy

Ambient, Task

Neutral and Accent

Sustainable and organic

HVAC Integrated into Ceiling, Thermostat Control

Emergency lights, sprinklers

N/A

Hollow core or Glass

TCͲ1 Comfortable

Acoustic Privacy

Ambient, Task

Neutral and Accent

Sustainable and organic

HVAC Integrated

Emergency lights,

N/A

Hollow core or

129 programming

REQUIREMENTS

DEPARTMENT

Lobby

Administration Offices Clinical Department

SPACE

DESCRIPTION

SIZE

Reception

Open Area

16 x 20

Waiting Clinical Area Director

Open Area Enclosed Office

15x15 9 x 9

Executive Physical Director Therapist

Enclosed Enclosed Office Office

9 x 9 9 x 9

ADJACENCIES

EQUIP

ELECTRIC

FURNITURE

THERMAL

ACOUSTIC

LIGHTING

COLOR

MATERIALS/ FINISH

MECHANICAL

Duplex Data Outlet Voice, Light switch Duplex Duplex Outlet Outlet, Data Voice, Light switch Duplex Duplex Outlet, Outlet, Data Data Voice, Voice, Light Light switch switch Duplex Duplex Outlet Outlet,

Reception guest chairs desk, chairs credenza, file cabinet, coffee table Various Desk, desk seating: chair, 2 Chairs, sofa, guest chairs bench credenza, coffee file cabinet, tables coffee table Desk, desk Desk, desk chair, 2 chair, two guest chairs guest chairs credenza,

TCͲ1 Comfortable

Some Acoustic Privacy

Ambient

Neutral and Accent

Sustainable and organic

HVAC into Ceiling, Integrated Thermostat into Ceiling Control

Emergency sprinklers lights, Camera

N/A

N/A Glass

TCͲ1 Some TCͲ1 Acoustic Comfortable Acoustic Comfortable Privacy Privacy

Ambient Ambient, Task

Neutral and Neutral and Accents Accent

Sustainable Sustainable and organic and organic

HVAC HVAC Integrated Integrated into Ceiling into Ceiling, Thermostat Control

Emergency Emergency lights, lights, Camara, sprinklers sprinklers

N/A N/A

Hollow core or Glass

TCͲ1 Acoustic TCͲ1 Acoustic Comfortable Privacy Comfortable Privacy

Ambient, Ambient, Task Task

Neutral and Neutral and Accent Accent

Sustainable Sustainable and organic and organic

HVAC HVAC Integrated Integrated into Ceiling, into Ceiling, Thermostat Thermostat Control Control

Emergency Emergency lights, lights, sprinklers sprinklers

N/A N/A

Hollow Hollow core or core or Glass Glass

TCͲ1 Some TCͲ1 Acoustic Comfortable Comfortable Acoustic Privacy Privacy

Ambient, Ambient, Task Task

Neutral and Neutral and Accent Accent

Sustainable Sustainable and organic and organic

HVAC HVAC Integrated Integrated into Ceiling into Ceiling,

Emergency Emergency lights, lights, sprinklers sprinklers

N/A N/A

N/A Hollow core or Glass

TCͲ1 Comfortable

Ambient

N/A

Sustainable and organic

N/A

N/A

TCͲ1 Comfortable Privacy TCͲ1 Some Comfortable Acoustic Privacy

Ambient, Task Ambient

Neutral and Accent Neutral and Accent

Sustainable and organic Sustainable and organic

Emergency lights, sprinklers Emergency

N/A

Hollow core or N/A Glass

TCͲ1 Acoustic TCͲ1 Acoustic Comfortable Privacy Comfortable Privacy

Ambient, Ambient, Task Task

Neutral and Neutral and Accent Accent

Sustainable Sustainable and organic and organic

TCͲ1 Acoustic TCͲ1 Acoustic Comfortable Privacy Comfortable Privacy

Ambient, Ambient/ Task Dimmable

Neutral and Neutral and Accent Accent

Sustainable Sustainable and organic and organic

Ambient, Task

Neutral and Accent

Sustainable and organic

SECURITY

PLUMBING

DOOR/ WINDOW

Waiting Area, Comp, department Printer Administration phone, offices printer, fax Reception, Gift N/A Therapists, Comp, Shop, Lounge, Doctor, Phone, Cafe Bistro Outpatient Printer Manager, Medical Coordinator All areas from Comp, Comp, Gym, Therapy the same Phone, Phone Rooms, department Printer Massage Rooms

PT Assistant General Manager

Open Work Enclosed Area Office

8 x 8 9 x 9

PT Aide

Open Work Area

3 x 3

Admissions Director Nurse Station

Enclosed Office Open Work Area

Director of Doctor Operations

Enclosed Enclosed Office Office

9 x 9 9 x 9

All areas from Inpatient the same Department department

Comp, Comp, Phone, Phone, Printer Printer

Programs Massage Manager Rooms

Enclosed Enclosed Office Area

9 x 9 9 x 9

Comp, N/A Phone,

Medical Coordinator

Enclosed Office

9 x 9

All areas from PT, PTA, the same Treatment rooms, Massage rooms, Gym Offices of the same department

9 x 9

9 x 9

Gym, Therapy All areas from Rooms, the same Massage department Rooms Gym, Therapy Rooms, Massage All areas from Rooms the same Inpatient department Department

N/A Comp, Phone, Printer N/A Comp, Phone, Comp, Printer Phone, Printer

Comp, Phone, Printer

Data Voice, N/A Light switch Duplex Outlet, Duplex Data Outlet, Voice, Data Light Voice switch Duplex Duplex Outlet, Outlet, Data Data Voice, Voice, Light Light switch switch Duplex Duplex Outlet, Outlet, Light Switch

file cabinet, storage, coffee table Desk, desk Desk, desk chair, two chair, 2 guest chairs guest chairs credenza, N/A file cabinet, coffee table Desk, desk chair, 2 BuiltͲin guest chairs counter, credenza, chairs, desk, file cabinet, filing coffee table cabinets Desk, desk Desk, desk chair, 2 chair, 2 guest chairs guest chairs credenza, credenza, file cabinet, file cabinet, coffee table coffee table Desk, desk Massage chair, 2 table, storage cabinet

Duplex Outlet, Data

TCͲ1 Desk, desk Comfortable chair, 2 guest chairs

Some Acoustic Privacy Acoustic

Acoustic Privacy

Thermostat HVAC Control Integrated into Ceiling HVAC

Integrated HVAC into Ceiling, Integrated Thermostat into Ceiling, Control Thermostat Control HVAC HVAC Integrated Integrated into Ceiling, into Ceiling, Thermostat Thermostat Control Control

lights, Emergency sprinklers lights, sprinklers

Emergency Emergency lights, lights, sprinklers sprinklers

N/A N/A

Hollow Hollow core or core or Glass Glass

HVAC HVAC Integrated Integrated into Ceiling, Thermostat Control HVAC Integrated into Ceiling,

Emergency Emergency lights, lights, sprinklers

N/A N/A

Hollow Solid core or Core

Emergency lights, sprinklers

N/A

Hollow core or Glass

N/A

68

129 programming

REQUIREMENTS

DEPARTMENT

Lobby

Administration Offices

Therapies

SPACE

DESCRIPTION

SIZE

Reception

Open Area

16 x 20

Waiting Outpatient Area Manager

Open Area Enclosed Office

15x15 9 x 9

Executive Examination Director Rooms

Enclosed Enclosed Office Space

9 x 9 9 x 9

Conference General Manager

Enclosed Area Enclosed Office

Treatment Rooms Admissions Director

ADJACENCIES

EQUIP

FURNITURE

THERMAL

ACOUSTIC

LIGHTING

COLOR

MATERIALS/ FINISH

MECHANICAL

Duplex Outlet voice

Reception desk, chairs credenza, file cabinet, coffee table Various Desk, desk seating: chair, 2 Chairs, sofa, guest chairs bench credenza, coffee file cabinet, tables coffee table Desk, desk BuiltͲin chair, 2 Counter, guest chairs stretcher credenza, file cabinet, storage, Conference coffee table table, seats Desk, desk for 10 chair, 2 guest chairs credenza, file cabinet, Small coffee table Therapy Desk, desk Tools chair, 2 guest chairs credenza, Exercising file cabinet, Tools coffee table Desk, desk chair, 2 Assisting guest chairs Mechanical credenza, Chair file cabinet, coffee table Desk, desk N/A chair, 2

TCͲ1 Comfortable

Some Acoustic Privacy

Ambient

Neutral and Accent

Sustainable and organic

HVAC Integrated Thermostat into Ceiling Control

Emergency lights, Camera

N/A

N/A

TCͲ1 Some TCͲ1 Acoustic Comfortable Acoustic Comfortable Privacy Privacy

Ambient Ambient, Task

Neutral and Neutral and Accents Accent

Sustainable Sustainable and organic and organic

HVAC HVAC Integrated Integrated into Ceiling into Ceiling, Thermostat Control

Emergency Emergency lights, lights, Camara, sprinklers sprinklers

N/A N/A

Hollow core or Glass

TCͲ1 Acoustic TCͲ1 Acoustic Comfortable Privacy Privacy Comfortable

Ambient, Ambient Task

Neutral and Neutral Accent

Sustainable Sustainable and organic and organic

Emergency Emergency lights, lights, sprinklers sprinklers

N/A Plumbing requireme nt for sink

Hollow Solid core or Core Glass

TCͲ1 Acoustic Comfortable Privacy TCͲ1 Acoustic Comfortable Privacy

Ambient

Neutral and Accent Neutral and Accent

Sustainable and organic Sustainable and organic

Emergency lights, Emergency sprinklers lights, sprinklers

N/A

Ambient, Task

N/A

Hollow core or Hollow Glass core or Glass

TCͲ1 Acoustic Comfortable Privacy Acoustic TCͲ1 Comfortable Privacy

Ambient, Task

Neutral and Accent Neutral and Accent

Sustainable and organic Sustainable and organic

Ambient

Neutral and Accents

Ambient, Task Ambient

Neutral and Accent Neutral and Accent

Sustainable and organic, rubber Sustainable floors and organic Sustainable and organic

HVAC HVAC Integrated Integrated into Ceiling, into Ceiling, Thermostat Thermostat Control Control HVAC Integrated HVAC into Ceiling, Integrated Thermostat into Ceiling, Control Thermostat Control HVAC Integrated HVAC into Ceiling, Integrated Thermostat into Ceiling, Control Thermostat HVAC Control Integrated into Ceiling HVAC Integrated HVAC into Ceiling, Integrated Thermostat into Ceiling Control HVAC HVAC Integrated Integrated into Ceiling HVAC Integrated into Ceiling

Emergency Emergency lights, lights,

sprinklers Emergency lights, sprinklers

HVAC Integrated

Emergency lights,

SECURITY

PLUMBING

DOOR/ WINDOW

Waiting Area, Comp, Administration phone, offices printer, fax Reception, Gift N/A Offices of the Comp, Shop, Lounge, same Phone, Cafe Bistro department Printer

All areas from Inpatient/ the same Outpatient department Departments

Comp, Sink, Phone, Towel Printer dispens er

12 x 12

Offices

9 x 9

All areas from the same department

Comp, Phone, Comp, Printer Phone, Printer

Enclosed space Enclosed Office

11 x 11

All areas from the same All areas from department the same department

Sink, Towel Comp, dispens Phone, er Printer

Gym

Open Area

27 x 27

N/A

Director of Operations Pool

Enclosed Office Open Area

27 x 27

All areas from the same department All areas from the same All areas from department the same

Comp, Phone, N/A Printer

All areas from All areas from the same the same

Comp, N/A Phone,

9 x 9

9 x 9

department

Programs Pool Deck Manager

69

ELECTRIC

Enclosed Open Area Office

9 x 9 20 x 20

Lockers

Semi Enclosed Area

23 x 23

Interior Garden

Open Area

20 x 20

department All areas from the same department

Central point/ All areas from

N/A

N/A

Duplex Duplex Outlet Outlet, Data Voice, Light switch Duplex Duplex Outlet, Outlet, Data Light Voice, switch Light switch Duplex Outlet, Duplex Data Outlet, Voice, Data Light Voice, switch Light Duplex switch Outlet, Duplex Light Outlet, Switch Data Voice, Duplex Light Outlet, switch Light Duplex Switch Outlet, Pool Data Heater, Voice, Assisting Light Mechani switch cal Chair Duplex N/A Outlet,

Duplex Outlet, Light Switch N/A

Lockers, benches N/A

TCͲ1 Comfortable

Low Acoustic Privacy TCͲ1 Acoustic Comfortable Privacy TCͲ1 Low Comfortable Acoustic Privacy

Ambient

TCͲ1 Acoustic TCͲ1 Low Comfortable Acoustic Privacy Comfortable Privacy TCͲ1 Some Comfortable Acoustic Privacy

Ambient, Ambient Task

Neutral and Neutral and Accent Accent

Sustainable Sustainable and organic and organic

Ambient

Neutral and Accent

Sustainable and organic

TCͲ1 Comfortable

Ambient

Neutral and Accent

Sustainable and organic

Some Acoustic

Emergency lights, Emergency sprinklers lights, sprinklers

Plumbing requireme N/A nt for sink

Solid Core Hollow core or Glass

Emergency lights, sprinklers Emergency lights, Emergency sprinklers lights,

N/A

N/A

N/A

Hollow core or N/A Glass

sprinklers

Plumbing requireme nts for pool N/A N/A

Hollow N/A core or

Plumbing requireme nts for showers

N/A

N/A

129 programming

REQUIREMENTS

DEPARTMENT

Lobby

Nourishment Department

Administration Offices

Inpatient

SPACE

DESCRIPTION

SIZE

Reception

Open Area

16 x 20

Director of Nutrition Waiting

Enclosed Office Open Area

15x15

ADJACENCIES

EQUIP

ELECTRIC

FURNITURE

THERMAL

ACOUSTIC

LIGHTING

COLOR

MATERIALS/ FINISH

Some Privacy Acoustic Privacy Acoustic Privacy Some

Ambient

Neutral and Accent

Sustainable and organic

Ambient, Task Ambient

Neutral and Accent Neutral and

Sustainable and organic Sustainable and organic

MECHANICAL

SECURITY

PLUMBING

DOOR/ WINDOW

Area

Nutritionist Executive Director

9 x 9

Waiting Area, Comp, the same Administration phone, department offices printer, All areas from Comp, fax the same Reception, Gift Phone, N/A department Printer Shop, Lounge, Cafe Bistro

Open Work Area Enclosed Office

9 x 9 9 x 9

All areas from the same All areas from department the same

Comp, Phone, Comp, Printer Phone,

All areas from the same department All areas from

Phone, TV,

department

Dormitories

Enclosed Room

8 x 8

General Manager

Enclosed Office

9 x 9

Exam Room

Enclosed Space

12 x 12

Admissions Director Massage Room

Enclosed Office Enclosed Space

9 x 9

Director of Gym Operations

Enclosed Open Area Office

9 x 9 19 x 19

Pool

Open Area

19 x 19

Programs Pool Deck Manager

Enclosed Open Area Office

9 x 9 17 x 17

Lockers

Semi Enclosed Area

19 x 19

Interior

Open Area

14 x 14

9 x 9

the same department All areas from the same department

All areas from the same All areas from department the same department All areas from All areas from the same the same department department All areas from the same department All areas from All areas from the same the same department All areas from the same department

Central point/

Printer

Comp, Phone, Printer Sink, Towel dispens er Comp, Phone, N/A Printer

Comp, N/A Phone, Printer

N/A Comp, N/A Phone,

N/A

N/A

Duplex Outlet

Reception TCͲ1 desk, chairs Comfortable

Duplex Outlet, Duplex Data Outlet Voice, Light switch Duplex Outlet, Duplex Data Outlet, Voice, Data Light Voice, switch Light Duplex switch Outlets, Light Duplex Switch Outlet,

Desk, desk chair, 2 Various guest chairs seating: credenza, Chairs, sofa, file cabinet, bench coffee table coffee Desk, desk tables chair, 2 Desk, desk guest chairs chair, 2 credenza, guest chairs file cabinet, credenza, coffee table file cabinet, Bed, storage, credenza, coffee table storage Desk, desk cabinets, chair, 2 chair guest chairs BuiltͲin credenza, Counter, file cabinet, stretcher coffee table

Data Duplex Voice, Outlet, Light Light switch Swicth Duplex Outlet, Duplex Data Outlet, Voice, Data Light voice switch Duplex Duplex Outlet, Outlet Data Voice, Pool Light Heater switch Duplex N/A Outlet,

Duplex Outlet, Light Switch N/A

TCͲ1 Comfortable TCͲ1 Comfortable

Acoustic Privacy

TCͲ1 Acoustic Comfortable Privacy TCͲ1 Acoustic Comfortable Privacy

Ambient, Task Ambient,

TCͲ1 Comfortable

Acoustic Privacy

TCͲ1 Comfortable

TCͲ1 Comfortable

Accent

Sustainable and organic Sustainable and organic

Ambient, Task

Neutral and Accents

Sustainable and organic

Acoustic Privacy

Ambient, Task

Neutral and Accent

Sustainable and organic

Acoustic Privacy

Ambient, Task

Neutral

Sustainable and organic

Ambient, Task Ambient, Dimmable

Neutral and Accent Neutral and Accent

Sustainable and organic Sustainable and organic

Ambient, Ambient Task

Neutral and Neutral and Accent Accents

Ambient

Neutral and Accent

Sustainable Sustainable and organic and organic, rubber floor Sustainable and organic

Ambient, Ambient Task

Neutral and Neutral and Accent Accent

Sustainable Sustainable and organic and organic

Ambient

Neutral and Accent

Sustainable and organic

Ambient

Neutral and

Acoustic Desk, desk TCͲ1 chair, 2 Comfortable Privacy Massage TCͲ1 Acoustic guest chairs Comfortable Privacy table, credenza, storage file cabinet, cabinet coffee table Desk, desk Exercising chair, 2 tools guest chairs credenza, Assisting file cabinet, Mechanical coffee table Chair Desk, desk Assisting chair, 2 Mechanical Chair Lockers, benches

Benches,

TCͲ1 Acoustic TCͲ1 Low Comfortable Privacy Comfortable Acoustic Privacy TCͲ1 Low Comfortable Acoustic Privacy TCͲ1 Acoustic TCͲ1 Low Comfortable Privacy Comfortable Acoustic Privacy TCͲ1 Some Comfortable Acoustic Privacy

TCͲ1

Accents

Some

Task

Neutral and Accent Neutral and

HVAC into Ceiling Integrated into Ceiling HVAC Integrated HVAC into Ceiling, Integrated Thermostat into Ceiling Control

Emergency sprinklers lights, Camera Emergency lights, Emergency sprinklers lights,

HVAC Integrated HVAC into Ceiling, Integrated Thermostat into Ceiling, Control Thermostat

Emergency lights, Emergency sprinklers lights,

N/A

N/A

N/A

Hollow core or

Glass

N/A

Camara, sprinklers

N/A N/A

sprinklers

Hollow core or Hollow Glass core or Glass

Control HVAC Integrated into Ceiling, HVAC Thermostat Integrated Control into Ceiling, HVAC Thermostat Integrated Control into Ceiling, Thermostat HVAC Control Integrated HVAC into Ceiling, Integrated Thermostat into Ceiling, Control Thermostat Control HVAC HVAC Integrated Integrated into Ceiling, into Ceiling Thermostat HVAC Control Integrated into Ceiling HVAC HVAC Integrated Integrated into Ceiling HVAC Integrated into Ceiling

Emergency lights, Emergency sprinklers lights, sprinklers

N/A

Emergency Emergency lights, lights, sprinklers sprinklers Emergency lights, sprinklers Emergency Emergency lights, lights, sprinklers Emergency lights, sprinklers

N/A N/A

Hollow N/A core or Glass

Plumbing requireme nt for pool N/A N/A

N/A

HVAC

Emergency

Emergency lights, sprinklers Emergency

lights, sprinklers Emergency lights, sprinklers

N/A

Solid Core

N/A

Hollow core or Glass Solid Core

Plumbing requireme nt for sink N/A

Plumbing requireme nts for showers

Hollow core or Solid Glass Core

Hollow N/A core or

N/A

N/A

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129 programming

REQUIREMENTS

DEPARTMENT

Lobby

Activities Administration Offices

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SPACE

DESCRIPTION

SIZE

Reception

Open Area

16 x 20

Waiting Area

Open Area

15x15

ADJACENCIES

EQUIP

ELECTRIC

FURNITURE

THERMAL

ACOUSTIC

LIGHTING

COLOR

MATERIALS/ FINISH

MECHANICAL

SECURITY

PLUMBING

DOOR/ WINDOW

Garden Executive Director Cafe Bistro Kitchen

Enclosed Office Open Area

Waiting Area, Comp, Administration phone, offices printer, fax Reception, Gift N/A Shop, Lounge, Cafe Bistro

All areas from All areas from the same the same department department 17 x 17 Kitchen, Lobby, Lounge 9 x 9

Enclosed Space Enclosed Office

26 x 26

Cafe Bistro

9 x 9

Gift Shop

Enclosed Area

20x25

All areas from the same department Cafe Bistro, Lounge, Lobby

Admissions Director

Enclosed Office

9 x 9

Lounge

Open Area

15 x 15

Director of Operations Staff Break Room

Enclosed Office Semi Open Area

9 x 9 15 x 15

Programs Manager

Enclosed Office

9 x 9

General Manager

Comp, Phone, Printer N/A

Sink, Oven, Comp, Cook Phone, top, Printer Fridge Comp, phone

All areas from the same department Inpatient, Gift Shop, Cafe Bistro All areas from the same Interior department Garden, Therapy Areas, Office Areas

Comp, Phone, Printer N/A

All areas from

the same

Comp, Phone,

Comp, Phone, TV Printer

Duplex Outlet

Reception TCͲ1 desk, chairs Comfortable

Some Acoustic Privacy

Ambient

Neutral and Accent

Sustainable and organic

HVAC Integrated into Ceiling

Emergency lights, Camera

N/A

N/A

Duplex Outlet

Various seating: Chairs, sofa, bench coffee tables Desk, desk chair, 2 guest chairs Tables, credenza, chairs file cabinet, storage, BuiltͲin coffee table counter, Desk, desk builtͲin chair, 2 cabinets, guest chairs credenza, Desk, file cabinet, Storage, coffee table Display Desk, desk Cabinets chair, 2 guest chairs credenza, Different file cabinet, seating coffee table Arrangemen Desk, desk ts chair, 2 Kitchenette, guest chairs Tables, credenza, chairs file cabinet, coffee table Desk, desk chair, 2

Some Acoustic Privacy

Ambient

Neutral and Accents

Sustainable and organic

HVAC Integrated into Ceiling

Emergency lights, Camara, sprinklers

N/A

Accents Neutral and Accent Neutral and Accents

Sustainable and organic Sustainable and organic

Integrated HVAC into Ceiling Integrated into Ceiling, HVAC Thermostat Integrated Control into Ceiling HVAC Integrated HVAC into Ceiling Integrated into Ceiling, Thermostat HVAC Control Integrated into Ceiling, HVAC Thermostat Integrated Control into Ceiling, Thermostat HVAC Control Integrated into Ceiling HVAC Integrated HVAC into Ceiling, Integrated Thermostat into Ceiling, Control Thermostat Control HVAC

Integrated

lights, Emergency sprinklers lights, sprinklers Emergency lights, sprinklers Emergency lights, Emergency sprinklers lights, sprinklers Emergency lights, sprinklers, Emergency camara lights, sprinklers Emergency lights, sprinklers Emergency lights, Emergency sprinklers lights, sprinklers

N/A

Hollow core or Glass N/A

Duplex Outlet, Data N/A Voice, Light switch Duplex Outlet, Duplex Light Outlet, switch Data Voice, Duplex Light Outlet, switch Data Duplex Voice, Outlet, Light Data switch Voice, Duplex Light Outlet switch Duplex Outlet, Duplex Data Outlet, Voice, Light Light Switch switch Duplex Outlet,

TCͲ1 Comfortable

Comfortable Acoustic TCͲ1 Acoustic Privacy Comfortable Privacy TCͲ1 Some Comfortable Acoustic Privacy TCͲ1 Some Comfortable Acoustic TCͲ1 Acoustic Privacy Comfortable Privacy TCͲ1 Comfortable

Some Acoustic Privacy Acoustic TCͲ1 Comfortable Privacy

TCͲ1 Comfortable

Some Acoustic Privacy TCͲ1 Acoustic Comfortable Privacy TCͲ1 Some Comfortable Acoustic Privacy TCͲ1 Comfortable

Acoustic Privacy

Ambient, Task Ambient

Ambient

Neutral

Ambient, Task

Neutral and Accent

Sustainable and organic Sustainable and organic

Ambient, Task, Accent

Neutral and Accents

Sustainable and organic

Ambient, Task

Neutral and Accent

Sustainable and organic

Ambient, Accent

Neutral and Accents

Sustainable and organic

Ambient, Task Ambient, Task

Neutral and Accent Neutral and Accents

Sustainable and organic Sustainable and organic

Ambient,

Task

Neutral and

Accent

Sustainable

and organic

Emergency

lights,

N/A Plumbing requireme N/A nts for kitchen N/A N/A

N/A

Solid Core Hollow core or Glass Sliding Glass Doors Hollow core or Glass N/A

N/A Plumbing requireme nt for kitchenette

Hollow core or Hollow Glass core or Glass

N/A

Hollow

core or

programming

The diagram above shows the overall adjacency of all the spaces for this program. On the following pages are shown the adjacencies preferred for each department. From left to right on page 78 are the inpatient department adjacencies and the clinical department adjecencies. On page 79, from top to bottom are the administrative offices adjacencies, the activities adjecencies, and therapies adjecencies. It has to be taken into account that these adjecencies might change after analyzing the building.

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programming

73

programming

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programming

Fig. 3.30: Possible location for the building in the site and sun path.

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Fig. 3.31: Close up of the building on the site.

programming

VIII. SITE DOCUMENTATION AND BUILDING SELECTION Building analysis on existing site The analysis on the right shows some of the main things that need to be considered when choosing a building, such as: sun trajectory, main circulation of pedestrians, direct views to the outside, water features and wind traveling tunnel.

These are the conditions of the existing building in its site, a new analysis has to be done to see how these elements are affected or reinterpreted in the new site selection.

The highlighted area would be the portion of the building that is going to be used for the thesis. Nevertheless, the other portion of the building might be used for possible future expansion.

The typology of this project is Healthcare, more specifically a Physical Therapy setting.

It is important to provide the user with a building that is interactive and has exposure to nature views. This building has a creative shape that can provide good options to the users, for views and space layouts.

According to the owner exposure to nature was necessary in order to take advantage of the restorative qualities that it possesses. This building has a store front facade which it provides with exposure to nature. It also has a beautiful courtyard that gives the opportunity to create a central garden that can be enjoyed by all the users, and what can give even more exposure to nature.

The building is modern and fits with the location; and its new design would incorporate sustainable materials. The culture of the region is trying to implement sustainable practices and the architecture keeps growing and developing into sleek and modern buildings.

The complete building is practically a perfect match for the site, it fits well with the context and shape. It has direct access to one street that derives from the main route, and is accessible to the residences close to the area.

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programming

Fig. 3.32: Aerial view of the building in its existing site on FIU Campus.

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programming

Fig. 3.33: North elevation view of the building in its existing site at FIU.

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programming

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programming

Fig. 3.34: Courtyard view from the roftop of the building. This image shows the water features and green areas on the courtyard.

Fig. 3.35: Perspective of the main entrance of the building.

Fig. 3.36: Interior view of the main entrance to the space.

Fig. 3.37: Access to the building from the back.

Fig. 3.38: Interior view of the main hallway and lounge spaces.

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Analysis & Codes

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analysis & codes

BUILDING ANALYSIS

Fig. 4.1: Existing floorplan of the building.

Fig 4.2: Image with number 2. Close view of main entrance.

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analysis & codes

On the previous page to the left is shown the current floorplan of the building, giving an idea of how the space planning works; it is also shown an analysis of the wind flow in the existing site.

The numbers located on the floorplan are used to identify where the photos, that are shown below the floorplan, were taken from and what can be seen from those perspective.

Below, on this page, are shown the elevations of the overall building. From left to right: South and North on the top, and West and East elevations on the bottom. These are useful to understand the structure of the building and to study where the sunlight is able to come in.

Fig. 4.3-4.6: Elevations of the building.

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analysis & codes

LEVEL 1

7,296 SQFT

17,085 SQFT

10,103 SQFT

On this diagram, it is shown the square footage of the portion of the building that will be used for this project. It is the firs floor, and given that the project is still in development, other parts could also be used .

EGRESS

LEVEL 1

7,296 SQFT

17,085 SQFT

10,103 SQFT

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This diagram shows the analysis of the structure; where the columns have been aligned to study possible space planning, the main structural walls were highligthed to know what cannot be touched, and the means of egress are shown to see the main entances and exits.

analysis & codes

DIR CETCSTU SNU N DEI R LIG L IHGT H T M EM CEHCAHNAI C NA I CLA L PLP U LMUBMI NB G ING

LEVEL 1

7,296 SQFT

17,085 SQFT

10,103 SQFT

This diagram shows where the main source of daylight are, the location of mechanical rooms and the main pumbing walls.

PUBLIC PRIVATE

LEVEL 1

7,296 SQFT

17,085 SQFT

10,103 SQFT

The purpose of this diagram is to show the private and public areas of the existing layout of the building.

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analysis & codes

Circulation, nodes and arrivals are just some of the things that designers use to make an impact on the user. This diagram shows some of these elements in the existing layout of the building.

This diagram shows the sun path on the building in the existing site.

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analysis & codes

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analysis & codes

CODE SEARCH

•

Building Construction Type and Occupancy

•

•

•

• •

•

What is the construction type?

The construction types are I and II. What is the occupancy classification for the uses of you program?

The occupancy classification is I-2 Institutional, Healthcare.

What is the occupancy load per floor?

Formula (Occupant Load = Floor Area (Sq.ft) / Load Factor) First Floor: Total Sq. Ft. = 12,945 /100 gross = 129.45 occupants Second Floor: Total Sq. Ft. = 4140 / 240 gross = 17.25 occupants Is your building equipped with an automatic sprinkler system?

Yes it has an automatic sprinkler system.

• •

•

Egress • • • • • •

• •

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What is the minimum number of exits from the different spaces in your project?

The minimum is 2 doors for the first floor and 3 for the second floor.

What is the maximum common path of travel distance for your building?

The maximum should not exceed from 100 feet.

What is the maximum total travel distance to an exit for your building?

The total travel distance is 250 feet maximum.

What is the minimum number of exits for each floor?

The minimum number of exit doors is 2.

Using the diagonal rule, what is the minimum distance between exits?

The minimum is 250 feet.

What is the minimum fire rating for: Exit access corridor partitions – ½ to 1 hour Exit enclosures – 2 hours What is the minimum exit door size?

The minimum size is 36 inches but with a 32 inches of clear width.

What is the project’s minimum width for level access corridor (.2” times the occupant load)?

It is not less than 44 inches. If the occupant load is less than 50 people shall not be less than 36 inches in width.

•

•

• •

What is the project’s minimum width for vertical exit path?

The minimum width is 36 inches.

What is the minimum width of level exit access and exit corridors (FBC)?

It should not be less than 44 inches.

What is the minimum width for the vertical exit paths (FBC)?

The minimum width is 44 inches.

What is the minimum exit corridor ceiling height?

The minimum is 90 inches / 7 feet 6 inches.

What is the maximum length of a dead –end corridor (sprinkler or non –sprinkler)?

The maximum lenght is 20 feet.

What are the requirements for a smoke enclousres?

Limited openings are allowed in the smoke barrier, additional mechanical functions are required for ventilation and air circulation, and a smoke detector which will activate the ventilation system and automatically closes all doors with a closing device.

Where should you locate emergency lighting for your project?

Emergency lighting must be present in the means of egress. It typically must be at floor level on the path of egress.

Where should you place exit signage for your project?

Signage should be provided with enough lighting for a safety evacuation of the building.

What is the minimum exit sign illuminaition level?

The minimum exit sign illumination is 5 foot candles.

What are the spacing and location requirements for sprinkler heads?

An engineer typically determines which type of sprinkler system to use. Using the codes and the NFPA standards, the engineer also determines the size and number of pipes and the spacing of the sprinkler heads.

Doors • •

What is the maximum width for an exit door (leaf)?

The maximum is 48 inches nominal.

What are the threshold requirements for doors?

The requirement is of 80 inches.

analysis & codes •

What are the doors swing requirements for exits and exit corridors [at maximum opening protrusions]?

The requirements is of 90 degrees (1.57 radius) providing a 32 inch clearance width.

•

Stairs • • • •

• •

What is the minimum headroom for a stairway?

The minimum is 80 inches from the edge of the nosing.

What is the maximum allowable height between landings?

The maximum allowable height is 12 inches.

What is the minimum landing requirement for a staircase with a straight run?

The minimum requirement is 48 inches for a straight run.

What are the maximum and minimum riser heights for a riser in a commercial project?

The requirements are 4 inches minimum and 7 inches maximum What is the minimum tread length in a commercial project?

The minimum is 11 inches.

What is the formula for determining the riser/thread relationship?

Formula: 2 Risers + Thread = 25

•

•

•

What is the required minimum guardrail height?

Guardrails shall not be more than 30 inches measured vertically to the floor or grade below at any point within 36 inches horizontally to the edge of the open side.

Required guards shall not be less than 42 inches in height, measured vertically above the adjacent walking surfaces, adjacent fixed seating or the line connecting the leading edges of the treads.

What are the requirements for maximum openings in handrails?

They shall not have openings which allow passage of a sphere 4 inches in diameter from the walking surface to the required guard height.

What are the requirements for handrails in relationship to wall surface?

There shall be a minimum of 11/2 inches of clear space between a handrail and a wall or other surface. Any sharp or abrasive elements should not be adjacent to the wall or handrail.

What are the required along with a handrail for stairways?

Intermediate handrails: Stairways shall have intermediate handrails located in such a manner that all portions of the stairway width required for egress capacity are within 30 inches of a handrail.

Handrails

Ramps

•

•

•

What is the required handrail extension for a commercial stairway: Top of stairways?

It shall extend horizontally above the landing 12 inches (minimum) beginning directly above the first riser nosing.

Bottom of stairways?

The handrails shall extend at the slope of the stair flight for a horizontal distance at least equal to one tread depth beyond the last riser nosing. Extension shall return to a wall, guard, or the landing surface, or shall be continuous to the handrail of an adjacent stair flight.

What is the required stairway handrail height?

The height shall be 34 inches minimum and 38 inches maximum vertically above walking surfaces, stair nosing’s, and ramp surfaces. These shall be at a consistent height above walking surfaces, stair nosing’s, and ramp surfaces.

•

• •

What is the minimum ramp width?

The minimum ramp width is 36 inches.

What are the requirements related to ramp landings?

The minimum landing length is of 60 inches, there should be a maximum of 30 inches rise before landing. A landing is required every time there is a change in direction, and a landing should be the same width of the ramp no less than 60 inches. A landing is required for every rise of 30 inches and or a run of 30 feet.

What is the maximum slope for a ramp?

The maximum slope of a ramp should be no steeper than 1:12 horizontal.

What is the recommended slope for a ramp?

The recommended slope for a ramp is of 1:12 in inches.

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analysis & codes Finishes •

•

•

In the building equipped with sprinklers, what is the interior finish maximum flame spread index for enclosed vertical exits?

It should be Class C: Flame spread index: 76 – 200, smoke developed index 0-450 In a building equipped with sprinklers, what is the interior finish maximum flame spread index for other exit ways?

The interior finish should be Class B: Flame spread index: 26 – 75, smoke developed index 0-450 List the material classes and the testing requirements for the finishes in different areas of the project.

All flooring finishes and floor covering materials should be tested by an agency according to the NFPA 253. Interior walls and ceiling finishes should be tested to meet the NFPA 286. Upholstery should be tested to the NFPA 260 and NFPA 261.

Elevators •

• •

•

•

Elevator requirements?

Elevators are not required as a mean of egress. Elevators are required on the ADA guidelines.

Elevator locations should be?

Elevators should be located in the core of the building.

What is the minimum elevator width?

The minimum width for elevators is 80 inches and it should be enclosed by firewalls.

What are the minimum inside dimensions for elevators?

The minimum inside dimension of an elevator cart should be 51 inches to the wall and 54 inches to the door with a 36 inches minimum of door opening.

What are the code and ADA requirements for elevator buttons and signage?

1. Call buttons should be 3/4 inch minimum.

2. Keypads should be in a standard telephone keypad arrangement.

3. Signal ( ) fixtures should be centered at 72 inches minimum above the finish floor. The signal elements should be 2 1/2 inches in length minimum (measured along the vertical centerline of the element). Signals should be visible from the floor area and adjacent to the hall call button.

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4. Audible signals should sound once for the up direction and twice for the down direction.

5. Floor designations should be provided on both jambs of elevator hoistway entrances. Floor designations should be provided in tactile characters and braille. Tactile characters should be 2 inches high minimum and a tactile star should be provided on both jambs at the main entry level.

6. Hoistway and Elevator Entrances. The hall call buttons should be mounted 42 inches from the floor to the centerline between the buttons.

7. Visual elements should be at least 2-1/2 in dimension.

8. All elevator hoistway entrances should have raised and braille floor designations provided on both jambs. The centerline of the characters should be 60 in above finish floor.

Toilets • •

•

•

•

•

How many toilet stalls are required for each level of your project?

Healthcare: Non-ambulatory – 1 per 15 and Ambulatory – 1 per room What are the sq. feet requirements related to the toilet and accessible lavatory?

Water closet: 60”w x 56”d clear floor space Lavatory: 30”w x 48”d clear floor space, allowing for necessary toe/knee clearance What are the grab bare requirements related to the toilet and accessible lavatory?

Grab Bar Heights: 18 inches to 20 inches – Ages 3-4 20 inches to 25 inches – Ages 5 through 8 25 inches to 27 inches – Ages 9 through 12 What is the minimum stall width? (Non-ADA accessible) Standard toilet stalls with a minimum depth of 56 inches should have wall-mounted water closets. If the depth of a standard toilet stall is increased at least 3 in, then a floor-mounted water closet may be used.

What is the height range for a toilet seat?

Toilet Seat Height: 11 inches to 12 inches – Ages 3-4 12 inches to 15 inches – Ages 5 through 8 15 inches to 17 inches – Ages 9 through 12 How far should the centerline of a toilet be from the side wall?

It should be 16 inches to 18 inches from the wall.

analysis & codes •

•

What is the minimum wheelchair turning radius (unobstructed) requirement?

Turning spaces may be either a 60 inch circular space or a T-Shaped turning space within a 60 inch square minimum with arms and base minimum 36 inches wide.

Entry doors for a toilet stall must be how wide?

According to ADA standards there must be a clear width opening of 32 inches minimum with the door open 90 degrees. Out-swinging doors approached from the latch side must have an access aisle 42 inches wide minimum; other approaches require an access aisle 48 inches wide minimum. It is recommended that all out-swinging doors close completely as a partially open door may encroach into the required maneuvering clearances and impede access.

ADAAG [FBC Chapter 11] •

Space Allowance Floor Surfaces: Changes in level cannot happen, unless less than 1:48 Size: Clear floor space shall be 30 inches (minimum) by 48 inches (minimum)

•

Parallel Approach Alcoves shall be 60 inches wide [minimum] and the depth 15 inchesor deeper

•

Knee and Toe Clearance

Fig. 4.9: “Maneuvering Clearance in an Alcove, Parallel Approach.”

Toe Spaces under an element between the finish floor and 9 inches above the floor.

Maximum Depth: Clearance should extend 25 inches.

Space extending over 6 inches beyond is allowed when knee clearance at 9 inches above the finish floor is not considered toe clearance.

Width: should be at least 30 inches wide.

Knee • • •

Fig. 4.7: “Clear Floor or Ground Space.”

•

Maneuvering Clearance Forward Approach: Alcoves shall be 36 inches wide (minimum) and the depth must be over 24 inches

Fig. 4.8: “Maneuvering Clearance in an Alcove, Forward Approach.”

• •

Space under an element between 9 inches and 27 inches above the finish floor.

Maximum Depth: Should extend 25 inches under an element at 9 inches above the finish floor.

Minimum Depth Requirement: When the knee is under an element, clearance should be 11 inches deep (minimum) at 9 inches above the finish floor and 8 inches deep (minimum) at 27 inches above the finish floor.

Clearance Reduction: Knee clearance is allowed room at a rate of 1 inch depth for each 6 inches height.

Width: Shall be 30 inches wide (minimum).

Fig. 4.10: “Toe Clearance.”

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analysis & codes •

Reach Ranges Forward Reach - Unobstructed: 48 inches height and 15 inches above ground

•

Accessibility Routes Walking surfaces should not be steeper than 1:20.

•

Protruding Objects - Objects with edges more than 27 inches and no more than 80 inches above the finish floor shall protrude no more than 4 inches horizontally in a circulation path.

- Free-standing objects shall overhand circulation paths 12 inches maximum when located at a minimum of 27 inches and 80 inches above the finish floor - Vertical clearance: 80 inches minimum

•

Ramps - Ramps should not be steeper than 1:12 - Cross Slope should not be steeper than 1:48 - Clear Width: 36 inches minimum - Rise: 30 inches maximum - Landings: Top landing 60 inches by 60 inches, bottom landing 72 inches in the direction of the ramp, intermediate landing 60 inches long in the direction of the ramp and 60 by 60 when there is a change in the direction of the ramp.

- Length: shall have a clear landing of 60 inches minimum - Change in Direction: clear landing of 60 inches by 60 inches minimum - Handrails: must have with a rise greater than 6 inches

•

Doors

- Obstructed High Reach: 48 inches maximum with 20 inches depth Side Reach Unobstructed: 48 inches maximum height and 15 inches minimum above the ground

Obstructed High Reach - Height: 34inches - Maximum depth: 24 inches - High Side: 48 inches maximum for a reach of 10 inches - Reaches over 10 inches must have 24 inches maximum

- Revolving Doors, Gates, and Turnstiles: shall not be part of an accessible route.

- Clear Width: 32 inches minimum from the face of the door to the stop at 90 degree. opening. Openings more than 24 inches deep shall provide a clear opening of 36 inches minimum.

Fig. 4.11: “Unobstructed Forward Reach.”

Fig 4.12: “Unobstructed Side Reach.”

Fig 4.13: “Obstructed High Side Reach.”

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analysis & codes •

Maneuvering Clearance

Fig. 4.14: “Maneuvering clearances at manual swinging doors and gates.”

Fig 4.15: “Continued maneuvering clearances at manual swinging doors and gates.”

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analysis & codes •

Sliding, Folding, and Without Doors

- Doors in a Series: the distance between two hinged doors in series shall be 48 inches minimum plus the width of the doors into the spaces.

•

Drinking Fountains - Spout Height: 36 inches above finished floor - Spout Location: 15 inches from vertical support and 5 inches from the edge - Water Flow: 4 inches high of water flow and shall be located 5 inches from the unit - For the Standing Positions: 38 inches minimum and 43inches maximum above the finished floor

Sustainability Guidelines Include information relating to the following: • •

Fig. 4.16: “Maneuvering clearances at doorways without doors, sliding doors, gates, and folding doors.”

Fig 4.17: “Maneuvering clearances at recessed doors and gates.”

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•

Energy efficiency - Use of natural energy. Incorporate this energy efficiently and safely for responsible use.

- On-site energy production must be considered and used in the design.

- Water heating systems should be from renewable resources and incorporated into the design.

•

Site and Water - Effort to eliminate the concept of waste. Evaluate and optimize the full life-cycle of products and processes.

- Buildings designed to be flexible accommodating many human purposes.

- Water use must be carefully accounted for throughout the entire design process - Potable water consumption should only be used for life-sustaining functions.

•

Indoor Environmental quality - Air pollution implications of all design systems will be considered in the evaluation of designs. General air quality issues should also be considered to insure that no off-site or on-site air pollution results from the design.

- Building design must accommodate ventilation systems suitable to the issues of air quality. This may involve strategies which show concern for dangerous

Recessed Doors

analysis & codes outdoor air conditions as well as efficient indoor air exchange.

•

Materials - Materials should be considered for their sustainability. All materials should be considered in terms of their embodied energy and characteristics of toxicity, potential off-gassing, finish and maintenance requirements.

- Recycling of materials is essential. But recycled materials should not be encouraged if they are the result of a product designed for disposability. .

Universal design Principles • • • • • • •

Equitable Use: The Design is useful and marketable to any groups of users Flexibility of Use: The design accommodates a wide range of individual preference and abilities Simple and Intuitive Use: Use of design is easy to understand Perceptible Information: The design communicates necessary information effectively to the user Tolerance for error: The design minimizes hazards and the adverse consequences of accidental or unintentional actions Low Physical Effort: The design can be used efficiently and comfortably Size and Space for Approach and Use: Appropriate size and space is provided for approach and use.

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Pura Vida

literary review

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pura vida

The red eyed tree frog is native to rainforests in central america. Full of bright colors that make it catchy to the eye but not poisonous, it relies on camouflage to protect itself. The life cycle of this amphibian, is a transition from the first moments to when it reaches independence. A process of different levels of connection, learning and growth.

Their slogan “pura vida” means “pure life.” Identifies costa ricans because they enjoy the exposure to nature making the most out of it. This country is well known for its surfing beaches, the yoga and wellnes centers close to the coasts.

Costa rica is known to be the most developed country in central america. The architecture has been traditional but from a few years back its architecture has leaned towards modern and sustainable design. The residents use natural resources and try to be pro-active about sustainable practices.

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pura vida

CONCEPT STATEMENT Nature is unpredictable, it amazes with its unique creations. It is inspiring, always showing unexpected ways of evolution and survival. It is relaxing, providing an infinity of elements that make you disconnect from any worries. Nature is birth.

MISSION STATEMENT A facility with a sustainable environment that relates to the local culture and nature. Step by step, the patients of this space will make transitions to reach their ultimate goals by connecting to the care givers.

DESIGN GUIDANCE - Provide relationships that would make the space functional and interactive for the users.

- Create an environment that reflects the local culture and nature, using textures, finishes and graphics.

- Bring natural lighting to reduce energy costs and provide views to the natural environment surrounding the facility.

- Open spaces in order to make the environment feel spacious and illuminated.

- Promote sustainable design through materials and alternative technologies.

- Follow the Reduce, reuse, recycle rule.

- Inspire the users towards achieveing their goals.

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Fig. 5.9-5.14: These images show the progress work of the concept/materiality model of this project.

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learning, growth and harmony = well being

dynamic, enthusiasm and endurance = active

inspiration, sincerity and spirituality = soothing

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The adjacency diagram shown below, is the initial analysis of the adjacencies that should exist within the space. There should be taken into consideration that depending on the square footage of each space the spaces might change around in order to make the overall layout work.

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The block diagram shows the square footage of the spaces and how the circulation should work. As mentioned before in the other diagram, this is just the initial accommodation of the departments and each space, these might change according of the affordance of the building for each space.

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SQUARE FOOTAGE PLAN

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The idea of the schematic diagram is to show every room with its square footage.

This is the final partition plan, and it is easier to read and identify each space; there is a color legend that differentiates the private, semi-private, and public spaces.

The blue areas are private, the orange areas are semi-private, and the green areas are public.

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EAST ELEVATION

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FIRST FLOOR 111

pura vida

112

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SECOND FLOOR 113

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SECTION 1

SECTION 2

SECTION 3

For section 1 and 2, look at the plan in the previous pages

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REFLECTED CELING 1 FLOOR 115

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CELING 2 FLOOR 116

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ELEVATION D

ELEVETION C - OFFICES

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ELEVATION F

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The reception has a kid friendly zone, where parents can sit and wait while the children play. It is mainly a slightly furnished area with a playful carpet pattern.

There is also a wall with nitches for the kids to sit and hide, and smaller one to accomodate books and toys.

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Fig. 5.15: Lobby of the building, main desk and children friendly zone.

Fig. 5.16: View of the lounge and waiting area adjacent to the lobby.

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The circularELEVATOR elevatorHAS hasA RADIUS a radius diameter of THE CIRCULAR DIAMETER OF 6’-5”, GIVING ENOUGH 6’-5”, giving enough space for a wheelchair SPACE FOR A WHEELDCHAIR TO FREELY ROTATE. to freely rotate. HAS A RADIUS THE CIRCULAR ELEVATOR DIAMETER OF 6’-5”, GIVING ENOUGH SPACE FOR A WHEELDCHAIR TO FREELY ROTATE.

THE CIRCULAR ELEVATOR HAS A RADIUS DIAMETER OF 6’-5”, GIVING ENOUGH SPACE FOR A WHEELDCHAIR TO FREELY ROTATE.

TheTHEstairs toHAVE haveVIEW view both sides the pool and lobby.

It OF is made of wood, STAIRSare AREdesigned DESIGNED TO TO to BOTH SIDES THE POOL AND LOBBY. IT IS MADE WOOD,finished CONCRETEin FINISHED WHITE AND METAL HANDRAILS. CONCRETE STEPShave HAVE a A small SMALL overhang concrete whiteINand metal handrails.

TheTHEconcrete steps OVERHANG FORto ANhide INCH the LONG TO HIDEof THEthe ACCENT OF THE LED of an inch long accent led lighting . LIGHTING. 121

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Fig. 5.17: The lobby of the inpatient center.

Fig. 5.18: The water feature behind the elevator.

Fig. 5.19-5.23: Different views of the stairs’ design.

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This lounge area provides the users with a space that feels like an outdoor area. The users come to this space for relaxation, breaks, and socializing with each other.

Columns are made seen as if they were trees growing from the grassy floor. The circulation is made of wood to give the idea of a board walk outdoors.

The colors chosen are green, orange and neutrals, giving a perfect mixture of brightness and warm to the space.

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Fig. 5.24: Lounge located in the inpatient center.

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The patient rooms more than a patient room feels like a guestroom.

These rooms are designed for people that need to stay in order to do their therapy. As any american physical therapy center this belongs to the inpatient center where only the patients staying have access to this building facility.

With different sizes and arrangements, these rooms provide for different financial situations.

Room shown on the left: • Accomodates one patient and a guest • Shared bathroom • Lounge chair/sleeper • Millwork: desk, small closet, drawers.

• Small table serves as dining table.

• Entertiment: tv

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Fig. 5.25: The elevations of the patient room.

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Fig. 5.26-5.28: Different perspective views of the patient room

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Fig. 5.29: View of the office hallway in the outpatient center.

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Fig. 5.30: View of the cafe bistro located in the outpatient center. This cafe offers small plates and snacks but its main purpose is to provide the users with a place where to escape for a little bit to have a chat and rest.

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Fig. 5.31: The dining area, located on the second floor of the inpatient center, provides the patients and their family with a place where to escape from the rooms to have some family time.

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Fig. 5.32: The gift shop in the outpatient center, was created to sell products that are organic and pro health, not only for the patients but also for the visitors and staff.

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pura vida Materials

Most of the materials used for this project are sustainable or green friendly. One of the requirements for the thesis was to have a 75% of sustainable resources.

Some of the examples include; the vinyl tiles used for the flooring which have recycled materials and are a hundred percent recyclable; fabrics some of which have; post industrial recycled content; post consumer recycled content; and greenguard certified. The carpet tiles are a hundred percent recyclable and recieved third parties certifications and could contribute to LEED points.

Being a health care center there are other requirements that have to be followed to make it a safer environment, for example: using vinyl floor for some areas and nanotex treated and with acrylic backing fabrics. There is also the slip resistant flooring on the areas around the pools, bathrooms and lockers.

These are just a few examples of the qualities that the materials of this project have. The following is a list of some of the companies that were used for the realization of this conceptual project: Maharam, Knoll, Architex, Kravet Contract, Shaw Contract Group, Centiva, FilzFelt, Matsinc, Skyline Design, among others that had great products.

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Fig. 5.33-5.34: Materials Board.

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“... [C]hange emphisizes what is happening to us while transition emphisizes opportunity for growth within.�

-William Bridges-

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Fig. 5.35: Some of the materials used for the project.

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AFTERWORD Pura vida is a project that was created not only for the benefit of the community of Nosara, but it was also created thinking on the experience that the users would have in this space. Research enabled me to find problems that healthcare settings like physical therapy rehab centers (and other institutions) were having, and it was not a surprise that the designs were not only lacking qualities on the perceptions of the patients but also on the perceptions of the staff. With this in mind I tried to create an environment that would be comfortable and appealing for both type of users, because the success of a design relies on how well the users feel on the space after it is created, not only on how beautiful it looks.

I thought of small details that could offer the users some kind of interaction, like creating a children friendly zone in the reception, a quote wall in the offices, small lounges in the hallway of the patient rooms, and even a small library section on the main lounge.

I tried using materials and natural elements that would soften up the sterile ambiance of a healthcare facility, for example: wood, grass walls, and water elements. These materials and elements not only softened up the space but also gave the idea of being outdoors, and collaborated on giving the restorative qualities that some indoor areas were lacking for not having outside views or daylight.

Nature, being my main source of inspiration not only because of its restorative qualities but also for its beauty and the location where the project was, helped in developing great spaces.

There were many points of this project that it was just not possible to get to, for example the use of natural resources to provide water and electricity to the facility. These were points that even though I didn’t get to develop, were thought of for making a sustainable facility not only for the well being of the users but also for the well being of the natural environment surrounding the site.

Thinking in shapes and sequences or patterns found in nature, I tried creating a fun space planning layout that would keep the walk through the space interesting but with an easy way finding; at the same time a space planning that would keep the levels of privacy needed within the space. Analyzing the meaning and qualities of colors helped identifying in the space what was active or calm, and what was public or private.

Pura vida was not an easy project, it took time and many changes to achieve what was wanted. After all, I have to recognize that it was more a team work than an individual work, counting with my own effort and all the valuable advices from the professors, mentor, and classmates made this project possible, because having an outside perspective is better than always having the same perspective.

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I hope that my work serves as an example for others for its good elements but also for its errors. One advice I would like to offer is to always try to develop the surroundings of your buildings, take that one more step because it can make a big difference in the success of the design.

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LIST OF FIGURES Fig. 1: The Effects of Interior Design Elements in physical therapy environments..................................................................................................................................................................................................3 Reprinted and retrieved from http://zodevdesign.com/gallery.php Fig. 1.1: Children at Tadworht Court Convalescent Home at Great Ormond Street Hospital..................................................................................................................................................................................8 Reprinted and retrieved from Museum & Archives Service.Great Ormond Street Hospital.show2013.rca.ac.uk Fig.1.2: One of the large wards at Debarkation Hospital............................................................................................................................................................................................................................................8 Reprinted and retrieved from.http://history.amedd.army.mil/booksdocs/wwi/MilitaryHospitalsintheUS/chapter23figure157.jpeg Fig 1.3: Physical thetrapy rehabilitation center gym setting.....................................................................................................................................................................................................................................11 Reprinted and retrieved from http://physical thetrapy rehabilitation center.chmccook.org Fig. 1.4: Image on the top right corner, is an example of transition areas in healing garden design.....................................................................................................................................................................16 Reprinted and retrieved from http://allthingswildlyconsidered.blogspot.com/2011/12/vision-of-gardens-of-solace.htm Fig 1.5: Image below shows the example of path width to comply with ADA in the design of a healing garden....................................................................................................................................................16 Reprinted and retrieved from http://allthingswildlyconsidered.blogspot.com/2011/12/vision-of-gardens-of-solace.htm Fig. 2: Annotated Bibliography.................................................................................................................................................................................................................................................................................17 Reprinted and retrieved from http://libguides.enc.edu/annotatedbib/definition Fig. 3: Programming.................................................................................................................................................................................................................................................................................................34 Reprinted and retrieved from http://www.kadairconditioning.com/location-map/ Fig. 3.1: Map of Zambia in the African Continent....................................................................................................................................................................................................................................................36 Reprinted and retrieved from http://www.globalhealthreflections.wordpress.com Fig. 3.2: Image depicting the culture of the Zambia country....................................................................................................................................................................................................................................37 Reprinted and retrieved from http://www.zambiatourism.com Fig. 3.3: Map of Costa Rica, in red Nosara the possible location for the project......................................................................................................................................................................................................37 Reprinted and retrieved from http://costaricaprize.com/costa-rica/ Fig. 3.4: Image depicting the costa rican culture and folklore.................................................................................................................................................................................................................................37 Reprinted and retrieved from http://thecostaricanews.com/eight-things-to-consider-for-your-costa-rica-vacation-package/12736 Fig. 3.5: Portrait of Hypocrates the father of medicine.............................................................................................................................................................................................................................................38 Reprinted and retrieved from http://www.osmanian.com/2011/02/hippocrates.html Fig. 3.6: Old setting of a physical therapy center.......................................................................................................................................................................................................................................................38 Reprinted and retrieved from http://penrehab.com/2011/01/a-brief-history-of-physical-therapy/ Fig. 3.7: Floorplan of the Physiotherapy and Rehabilitation Centre PUR...............................................................................................................................................................................................................39 Reprinted and retrieved from http://www.archdaily.com/265641/physiotherapy-and-rehabilitation-centre-pur-schneider-lengauer/ Fig. 3.8: Front view of the building, showing the main entrance to the space.........................................................................................................................................................................................................40 Reprinted and retrieved from http://www.archdaily.com/265641/physiotherapy-and-rehabilitation-centre-pur-schneider-lengauer/ Fig. 3.9: Back view of the building, showing the small terrace accessed through the gym......................................................................................................................................................................................40 Reprinted and retrieved from http://www.archdaily.com/265641/physiotherapy-and-rehabilitation-centre-pur-schneider-lengauer/ Fig. 3.10: Front view of the Rehabilitation center from the Fort Sanders Regional Medical Center.......................................................................................................................................................................41 Reprinted and retrieved from https://www.google.com/maps/@35.957132,-83.936305,3a,75y,334.2h,92.65t/data=!3m4!1e1!3m2!1ssi2bTBy9sK56Cj47V_Eylw!2e0 Fig. 3.11: Plan view of rooftop garden.....................................................................................................................................................................................................................................................................42 Davis, B. (2011). Rooftop hospital garden for physical therapy: a post occupancy evaluation. Health Environments Research and Design Journal, 4(3), 14-43

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Fig. 3.12: View of the rooftop garden........................................................................................................................................................................................................................................................................42 Davis, B. (2011). Rooftop hospital garden for physical therapy: a post occupancy evaluation. Health Environments Research and Design Journal, 4(3), 14-43 Fig. 3.13: Image above shows the boutique hotel from the lake..............................................................................................................................................................................................................................43 Reprinted and retrieved from http://www.archdaily.com/395716/palafito-del-mar-hotel-eugenio-ortuzar-tania-gebauer/1 Fig. 3.14: This image shows a better view of the context surrounding the hotel.......................................................................................................................................................................................................43 Reprinted and retrieved from http://www.archdaily.com/395716/palafito-del-mar-hotel-eugenio-ortuzar-tania-gebauer/1 Fig. 3.15: First floor plan of the hotel........................................................................................................................................................................................................................................................................44 Reprinted and retrieved from http://www.archdaily.com/395716/palafito-del-mar-hotel-eugenio-ortuzar-tania-gebauer/1 Fig. 3.16: Second floor plan of the hotel...................................................................................................................................................................................................................................................................44 Reprinted and retrieved from http://www.archdaily.com/395716/palafito-del-mar-hotel-eugenio-ortuzar-tania-gebauer/1 Fig. 3.17: Another view from the lake shows the access from the lake by small boats, and the wood posts that hold the structure in place..........................................................................................................45 Reprinted and retrieved from http://www.archdaily.com/395716/palafito-del-mar-hotel-eugenio-ortuzar-tania-gebauer/1 Fig. 3.18: Made with the feeling of a home, this image shows the lounge area or the living room area of the hotel, where it provides the users with a great view to the lake.....................................................46 Reprinted and retrieved from http://www.archdaily.com/395716/palafito-del-mar-hotel-eugenio-ortuzar-tania-gebauer/1 Fig. 3.19: Hallway of the guests’ rooms on the second floor. The wooden details in the environment makes it feel as a spa retreat.....................................................................................................................46 Reprinted and retrieved from http://www.archdaily.com/395716/palafito-del-mar-hotel-eugenio-ortuzar-tania-gebauer/1 Fig. 3.20: Main entrance view from the second floor. The main entrance has direct access to the check-in area and the second floor.................................................................................................................46 Reprinted and etrieved from http://www.archdaily.com/395716/palafito-del-mar-hotel-eugenio-ortuzar-tania-gebauer/1retrieved from http://www.archdaily.com/395716/palafito-del-mar-hotel-eugenio-ortuzar-tania-gebauer/1 Fig. 3.21: View of main entrance from the exterior...................................................................................................................................................................................................................................................46 Reprinted and retrieved from http://www.archdaily.com/395716/palafito-del-mar-hotel-eugenio-ortuzar-tania-gebauer/1 Fig. 3.22: Close up of Nosara map, the chosen location, showing some views of the surrounding areas. The map also shows the main street 160............................................................................................53 Reprinted and retrieved from https://www.google.com/maps/place/Nosara, Costa Rica/@9.9772828,-85.6543922,3336m/data=!3m1!1e3!4m2!3m1!1s0x8f9e5390861f64b9:0xfdc77634e4481c5f Fig. 3.23: Playa Pelada, the closest beach to the location where many retreat centers take their guests for exercises and surfers might be seen...................................................................................................54 Reprinted and retrieved from http://www.panoramio.com/photo/28969245 Fig. 3.24: Entrance of the Hotel Rancho Suizo.........................................................................................................................................................................................................................................................54 Reprinted and retrieved from http://www.tripadvisor.com/LocationPhotoDirectLink-g656474-d301319-i19872087-Hotel_Rancho_Suizo_Lodge-Nosara_Province_of_Guanacaste.html Fig. 3.25: Nosara Wellness , it is a Yoga Retreat center where the project will be located.......................................................................................................................................................................................54 Reprinted and retrieved from https://www.google.com/maps/place/Nosara,+Costa+Rica/@9.958333,-85.6685,3a,75y,90t/data=!3m5!1e2!3m3!1s54345309!2e1!3e10!4m2!3m1!1s0x8f9e5390861f64b9:0xfdc77634e4481c5f Fig. 3.26: Google Earth map of Nosara, A shows the exact location for the project..................................................................................................................................................................................................55 Reprinted and retrieved from http://www.panoramio.com/photo/54345309 Fig. 3.27: Topographic map of Nosara.....................................................................................................................................................................................................................................................................55 Reprinted and retrieved from https://www.google.com/maps/@9.9537955,-85.6685023,15z/data=!5m1!1e4 Fig. 3.28: Map of the Peninsula of Guanacaste showing the sun path for the location..........................................................................................................................................................................................57 Reprinted and retrieved from http://www.suncalc.net/#/9.9576,-85.6687,14/2014.08.11/16:22 Fig. 3.29: Google Earth Map of the Peninsula showing the sun path for the location of the project.......................................................................................................................................................................57 Reprinted and retrieved from http://www.suncalc.net/#/9.9576,-85.6687,14/2014.08.11/16:22 Fig. 3.30: Possible location for the building in the site and sun path......................................................................................................................................................................................................................75 Fig. 3.31: Close up of the building on the site..........................................................................................................................................................................................................................................................75

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Fig. 3.32: Aerial view of the building in its existing site on FIU Campus..................................................................................................................................................................................................................77 Reprinted and retrieved from http://www.amavanpheu.com/investigacion.html Fig. 3.33: North elevation view of the building in its existing site at FIU....................................................................................................................................................................................................................78 Reprinted and retrieved from http://www.archdaily.com/?p=115555 Fig. 3.34: Courtyard view from the rooftop of the building. This image shows the water features and green areas on the courtyard...........................................................................................................................79 Reprinted and retrieved from. http://www.archdaily.com/?p=115555 Fig. 3.35: Perspective of the main entrance of the building.......................................................................................................................................................................................................................................79 Reprinted and retrierved from https://www.flickr.com/photos/fiu/2243751657/in/photostream/ Fig. 3.36: Interior view of the main entrance to the space............................................................................................................................................................................................................................................79 Reprinted and retrieved from http://www.archdaily.com/?p=115555 Fig. 3.37: Access to the building from the back...........................................................................................................................................................................................................................................................79 Reprinted and retrieved from http://www.worldbuildingsdirectory.com/project.cfm?id=110 Fig. 3.38: Interior view of the main hallway and lounge spaces...................................................................................................................................................................................................................................80 Reprinted and retrieved from http://www.archdaily.com/?p=115555 Fig. 4: Analysis and codes..............................................................................................................................................................................................................................................................................................82 Reprinted and retrieved from http://www.freegreatpicture.com/architectural-landscape-design/d-architectural-design-15081 Fig. 4.1: Existing floorplan of the building...................................................................................................................................................................................................................................................................83 Reprinted and retrieved from http://www.archdaily.com/?p=115555 Fig 4.2: Image with number 2. Close view of main entrance.......................................................................................................................................................................................................................................83 Reprinted and retrieved from http://business.fiu.edu/interamericanscf2012/venue.cfm Fig. 4.3-4.6: Elevations of the building........................................................................................................................................................................................................................................................................84 Reprinted and retrieved from http://www.archdaily.com/?p=115555 Fig. 4.7: “Clear Floor or Ground Space.”......................................................................................................................................................................................................................................................................92 Reprinted and retrieved from http://www.access-board.gov/guidelines-and-standards/buildings-and-sites/about-the-ada-standards/ada-standards/chapter-3-building-blocks Fig. 4.8: “Maneuvering Clearance in an Alcove, Forward Approach.” .........................................................................................................................................................................................................................92 Reprinted and retrieved from http://www.access-board.gov/guidelines-and-standards/buildings-and-sites/about-the-ada-standards/ada-standards/chapter-3-building-blocks Fig. 4.9: “Maneuvering Clearance in an Alcove, Parallel Approach.”...........................................................................................................................................................................................................................92 Reprinted and retrieved from http://www.access-board.gov/guidelines-and-standards/buildings-and-sites/about-the-ada-standards/ada-standards/chapter-3-building-blocks Fig. 4.10: “Toe Clearance.” ..........................................................................................................................................................................................................................................................................................92 Reprinted and retrieved from http://www.access-board.gov/guidelines-and-standards/buildings-and-sites/about-the-ada-standards/ada-standards/chapter-3-building-blocks Fig. 4.11: “Unobstructed Forward Reach.”..................................................................................................................................................................................................................................................................93 Reprinted and retrieved from http://www.access-board.gov/guidelines-and-standards/buildings-and-sites/about-the-ada-standards/ada-standards/chapter-3-building-blocks Fig 4.12: “Unobstructed Side Reach.” .........................................................................................................................................................................................................................................................................93 Reprinted and retrieved from http://www.access-board.gov/guidelines-and-standards/buildings-and-sites/about-the-ada-standards/ada-standards/chapter-3-building-blocks Fig 4.13: “Obstructed High Side Reach.”....................................................................................................................................................................................................................................................................93 Reprinted and retrtieved from http://www.access-board.gov/guidelines-and-standards/buildings-and-sites/about-the-ada-standards/ada-standards/chapter-3-building-blocks Fig. 4.14: “Maneuvering clearances at manual swinging doors and gates.”...............................................................................................................................................................................................................94 Reprinted and retrieved from http://publicecodes.cyberregs.com/st/fl/st/b1600v10/st_fl_st_b1600v10_4_sec004.htm Fig 4.15: “Continued maneuvering clearances at manual swinging doors and gates.”..............................................................................................................................................................................................94 Reprinted and retrieved from http://publicecodes.cyberregs.com/st/fl/st/b1600v10/st_fl_st_b1600v10_4_sec004.htm Fig. 4.16: “Maneuvering clearances at doorways without doors, sliding doors, gates, and folding doors.”...............................................................................................................................................................95 Reprinted and retrieved from http://publicecodes.cyberregs.com/st/fl/st/b1600v10/st_fl_st_b1600v10_4_sec004.htm

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Fig 4.17: “Maneuvering clearances at recessed doors and gates.”................................................................................................................................................................................................................................95 Reprinted and retrieved from http://publicecodes.cyberregs.com/st/fl/st/b1600v10/st_fl_st_b1600v10_4_sec004.htm Fig. 5: Nosara Map........................................................................................................................................................................................................................................................................................................95 Reprinted and retrieved from http://www.nicoyapeninsula.com/nosara/nosara.php.

Fig. 5.1: Red eye tree frog..............................................................................................................................................................................................................................................................................................97 Reprinted and retrieved from http://www.duiops.net/seresvivos/galeria/ranassapos/Animals%20Frogs_Red-Eyed%20Treefrog,%20Costa%20Rica.jpg Fig. 5.2: Closeup of an Eukalyptus tree.........................................................................................................................................................................................................................................................................98 Reprinted and retrieved from https://www.flickr.com/photos/offshorecbr/5483018843/ Fig. 5.3: Image of papaya’s fruit...................................................................................................................................................................................................................................................................................98 Reprinted and retrieved from http://www.gettyimages.com/detail/photo/papayas-in-market-royalty-free-image/130905923 Fig. 5.4: Sustainable architecture of Costa Rica...........................................................................................................................................................................................................................................................98 Reprinted and retrieved from http://www.designboom.com/architecture/benjamin-garcia-saxe-elevates-casa-flotanta-above-the-trees-01-31-2014/ Fig. 5.5: View of volcano in Costa Rica.........................................................................................................................................................................................................................................................................99 Reprinted and retrieved from http://www.ticotimes.net/2012/07/17/crater-area-access-to-rincon-de-la-vieja-volcano-closed-to-visitors Fig. 5.6: Pathway made of logs.....................................................................................................................................................................................................................................................................................99 Reprinted and retrieved from http://www.pinterest.com/pin/286893438733059130/ Fig. 5.7: View of a pacific coast beach..........................................................................................................................................................................................................................................................................99 Reprinted and retrieved from http://www.flickr.com/photos/jotpe/8062346864/in/photostream/ Fig. 5.8: Woman practicing yoga exposed to nature....................................................................................................................................................................................................................................................99 Reprinted and retrieved from http://www.pinterest.com/pin/199565827211409783/ Fig. 5.9-5.14: These images show the progress work of the concept/materiality model of this project...................................................................................................................................................................103 Fig. 5.15: Lobby of the building, main desk and children friendly zone..................................................................................................................................................................................................................120 Fig. 5.16: View of the lounge and waiting area adjacent to the lobby........................................................................................................................................................................................................................120 Fig. 5.17: The lobby of the inpatient center...............................................................................................................................................................................................................................................................121 Fig. 5.18: The water feature behind the elevator........................................................................................................................................................................................................................................................121 Fig. 5.19-5.23: Different views of the stair design....................................................................................................................................................................................................................................................122 Fig. 5.24: Lounge located in the inpatient center......................................................................................................................................................................................................................................................124 Fig. 5.25: The elevations of the patient room.............................................................................................................................................................................................................................................................126 Fig. 5.26-5.28: Different perspective views of the patient room..............................................................................................................................................................................................................................128 Fig. 5.29: View of the office hallway in the outpatient center.....................................................................................................................................................................................................................................129 Fig. 5.30: View of the cafe bistro located in the outpatient center. This cafe offers small plates and snacks but its main purpose is to provide the users with a place where to escape for a little bit to have a chat and rest...............................................................................................................................................................................................................................................................................................................................130 Fig. 5.31: The dining area, located on the second floor of the inpatient center, provides the patients and their family with a place where to escape from the rooms to have some family time........................131 Fig. 5.32: The gift shop in the outpatient center, was created to sell products that are organic and pro health, not only for the patients but also for the visitors and staff.........................................................132 Fig. 5.33-5.34: Materials Board................................................................................................................................................................................................................................................................................134 Fig. 5.35: Some of the materials used for the project.................................................................................................................................................................................................................................................136

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ACKNOWLEDGEMENTS

help towards finishing the job.

This thesis project was a challenge as both a student and a future professional of the field.

It was a great opportunity of knowledge gathering and discovery of the health care field and specifically of the physical therapy department. It was also a growing experience as both a person and a designer, giving that I had to work closely with real professionals from both the interior design field and the health care department.

I thank the many friends who collaborated with ideas and advices as if they were real designers; the friends who shared food and drinks; the friends who stayed awake on sleepless nights trying to finish the work and giving moral support and the much needed laughs to make it through the night. Those friends that shared the same years and experiences and that with no doubt will be missed but admired on their new paths and journeys.

This project could not have been accomplished without the help of the professors from the three courses: Special Topics with Jacqui Failer, Programming with Katie Rothfield, and the thesis with Phillip Abbott and Katie Rothfield. These professors offered their knowledge, advise and expertise to guide each one of us through this journey.

Also, I would like to express my deepest gratitude to Claudia Machado, a current designer at RTKL Associates Inc.; who mentored me and helped me with important decisions on the space planning, design ideas, and materials selection for the design. She not only offered her expertise but also her support and words of ecouragement that were of great 149

I could not leave behind the support of my family, who were there for me even in the hardest moments; but specially I would like to thanks Giuliano Ricci, who besides moral support and designer advice, has helped me with the logistics and organization of this book.

I have to recognize that a designer can be great, but it becomes greater with the help of a team that is there in every step of the way, helping with decision making and the developement of the project.

CARMEN FERRER I am a 24 years old, cuban american girl. I started studying Interior Design in Miami Dade College and after achieving my AA in 2011, I transferred to the School of Architecture at Florida International University. I followed their Accelerated Masters program in Interior Architecture for three years. Finally, in 2014, I graduated with a masters degree in Interior architecture.

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Florida International University, College of Architecture + Arts School of Architecture, Interior Architecture, Class of 2014 Thesis Title: Pura Vida Student: Carmen Ferrer Professors: Phillip Abbott & Katie Rothfield Mentor: Claudia Machado