Reaserch thesis
Health - Architecture Tsiantou elena
This paper refers to the therapeutic environment and more specifically to the necessity of its presence in nursing facilities, such as hospitals, health centers, clinics, rehabilitation centers and nursing homes. In the first part of the first chapter are explained the concepts of health and healing. Then emphasis is put in the experience of hospitalization and the impact of this to patients and their companions. Extensive reference is made to one of the most important factors that arise during the visit of the majority of people in a hospital, stress. In the second part of the first chapter are explained the concepts of therapeutic architecture, sustainability and bioclimatic design often found in architecture industry nowadays. Last but very important for understanding the architecture of nursing facilities attempted analysis and explanation of the term evidence-based design. The second chapter emphasizes the need for the existence of certain elements of buildings that contribute to creating a safe environment that enhances wellness. More specifically are analyzed, suitable lighting, ventilation and acoustics of a hospital. The third chapter refers to some elements of interior architecture that in their turn take place indirectly in faster recovery of patients. These are the materials, colors and placement of art works within the premises of health institutions. The fourth and final chapter is about the contribution of nature in the treatment process and the need for therapeutic gardens of any kind (in some cases with special characteristics), in the building program of nursing centers. Before recording the conclusions, listed some examples of existing hospitals in different regions of the world, which meet the above criteria for the creation of therapeutic environment. Finally, in conclusion is referred the existing situation in our time on the value given to the specificity of the response of architecture in terms of health buildings, both in Greece and around the world and highlighted once again the unquestionable contribution of the environment, in psychology and wellbeing of the users.
C o n t e n t s
Introduction Health/Healing Hospital Stress Healing environment Sustainability Evidence-based design Lighting Ventilation Acoustics Materials Colors Art work Nature Examples Conclusions
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I n t r o d u c t i o n
Increasing number of scientific studies demonstrate the immediate and remarkable impact of the built environment of hospitals on the wellbeing and safety of patients and visitors but also on the efficiency and effectiveness of the staff and generally on the quality and cost of the services provided. As Socrates has pointed out, when the bodies are sick, souls are getting sicker. Medicine, perhaps drifted by the rapid technological advances, has placed more emphasis on the treatment of physical illness and less on the pain of the soul that accompanies it. This spirit has also affected healthcare facilities. Modern hospitals are not dealing holistically with the patient, providing only medical treatment, without taking into account that the psychological and social condition of the patient can contribute to the healing process. What do we define as healing architecture? By the term healing architecture we obviously do not refer to an architecture that is capable of healing, but we are looking for an architecture that will achieve a therapeutic contribution to the recovery process. A healing environment is the result of an enidence-based design that has shown measurable improvements in the physical and psychological levels of patients, staff, doctors and visitors. 2
Health / Healing Health is determined by the balance between environmental forces and individual behavior. Hippocrates Health is the state of complete harmony with the universe. Plato
It is likely that everyone has some negative memory of a hospital associated with a family illness.For most, the hospital represents the place where, apart from the birth of a baby, bad (or at least difficult) things are happening.
The hospital is commonly accepted as the most complex building project, in terms of architecture. In addition, as a spatial entity, as a model of organization it claims the fist place in terms of the complexity of activities, functions and organizational structures. It is a living organism that is constantly growing, with unpredictable future requirements, both functionally and technologically. Space psychology and user comfort are just as important as its technological infrastructure.
Ηealth is the achievement of best physical, mental and social well-being and not only the absence of distinct illness constantly in relation to the environment. World Health Organisation 3
H o s p i t a l
Stress
In the hospital we can distinguish three groups: • Patients are clearly the most important group because the hospital has been established and works exclusively for them. This group is under the greatest psychological pressure. • Staff spend much of their day and life in the hospital. They are the most permanent users of healthcare facilities, and so their satisfaction is as important as that of the patients. • The family of patients and visitors. They are closely attached to the patients and are naturally anxious and irritated. Patients with a high level of social support experience less stress and recover faster than those who do not have a support network from family and friends.
The experience of hospitalization is a source of psychological stress for most patients, regardless the nature of the illness. Patient stress level plays an important role in how receptive he or she is to treatment and how soon responds to it. Low sterss levels improve the results of treatment and accelerate the recovery process. Additional stress is caused by poorly designed natural environments. A proper design requires a natural environment that reduces stress: one that is psychologically supportive for patients and their families who are suffering from the stress of the illness, but also for the staff of healthcare facilities.
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Healing environment The common understanding of the “hospital” environment is that of a complex, institutional and inhospitable environment that intensifies negative emotions and causes stress. The primary role of a healing environment is to help reduce patients’ stress levels and consequently to improve the outcome of their treatment or recovery process. The basic criteria of an effective healing environment are: • has variety and novelty elements in architectural design • to reduce any kind of stress factor in the environment • to facilitate medical services, • to satisfy the five senses as well as spiritual needs, • to introduce socio-cultural and environmental activities • to enable the patient to express his or hers diversity and to feel personal comfort and dignity. Factors that have to be taken into account in creating a healing environment: • Place of residence for families • Noise adjustment • Air quality • Thermal comfort • Privacy • Lighting • Communication • View to nature • Colour • Texture
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S u s t a i n a b i l i t y
Evidence- based design Evidence-Based Design or EBD is a field of study that emphasizes to the use of evidence that influences the design process. Makes decisions based on the best available research information from previous project evaluations. It provides data on what works and what does not fit the design of the building for its qualitative use, it brings experience to the planning process to support imagination, judgment and appreciation. Empirisism replaces philosophy. Most of the scientific evidence available to architects about how the built environment affects human behavior come from the study of environmental psychology. However, bibliography from the fields of medicine, nursing, management, engineering, industrial design, technology, psychology, sociology, anthropology, natural sciences and economics can be used.
Bioclimatic is the sector of architecture that takes into account the imperatives of ecology and sustainability. The results of the bioclimatic design, especially when is approached properly, are the creation of a building friendly to the environment, but mainly to the human being, offering comfort conditions capable of providing with a healthy and pleasant living. Modern people spend more than 80% of their lives indoors or in general built-up spaces, which makes the effects of inappropriate indoor environments particularly serious.
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Lighting
Light is the most important environmental input, after food, in controlling bodily function.
Daylight exposure levels are those that have an impact on mental well-being. Exposure to light is vital to humans and has noticeably beneficial effects on patients, such as pain, depression, stress reduction, hospitalization time. It is able to accelerate and enhance the treatment, helping to the production of the right hormones and vitamins.
Richard Wurtman Lighting in an interior space must satisfy three functions: • to ensure the safety of users in indoor spaces • to facilitate the conduct of visual work • to help create a suitable visual environment
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V e n t i l a t i o n
Acoustics
Noise is one of the most harmful environmental stressors. Several studies have shown that noise deteriorates the effects of patients, for example, increases blood pressure, heartbeats, the need for painkillers by lowering the personal pain limit and keeps the mind excited so the patient can not rest or sleep.
The main reason for ventilation is to dilute and remove indoor pollutants in order to protect the occupants and the contents of the building, as well as to provide a comfortable indoor environment for the occupants.
Research suggests that the most effective overall strategy to achieve a quiet hospital is to emphasize to the proper design of the natural environment instead of trying to change the behavior of the staff and the organization’s culture.
Many studies have shown that hospital air quality and ventilation (air changes per hour, filter type, airflow direction and air pressure) strongly influence the concentration levels of airborne pathogens and therefore strongly affect the rates of infections .
In contrast to noise, several studies in patient groups have shown that pleasant music, especially when it is controlled, can reduce anxiety or stress and helps some patients recover.
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Materials The user touches the components of space, feels the climate and shapes his emotional state, often unconsciously. Materials can affect comfort and many other actions. Materiality has a direct impact on the general feeling of the environment. Wood is human-friendly as people respond positively to it. It offers a warmth in the space, making it open and welcoming. There are indications that soft materials such as carpet are more acceptable by patients, in contrary to hard or glossy materials such as vinyl or linoleum floors. “Green” construction materials with no toxic components and low gas leak can contribute to faster recovery. The lightness of a room, the interior color and decoration, have strong influences on people’s feelings. Movement of interest, feelings of alertness, even happiness can be caused or suspended. Factors that influence the design approach: • Utility of materials • Their mechanical and physical properties • Life time • Their cost • Their ecological footprint
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Colors
It is the color that stimulates. It can lead to an increase in blood pressure and breathing. Red light is said to reduce the pain of rheumatism and arthritis. It dilates the blood vessels and produces heat in the tissues.
It is excellent for nerves, brain and invigoration.
It has anticonvulsive effect.
Doctors and psychologists agree that anything that can affect the psychology and mind of a person can also affect his or her physical condition. That is something that colors do. Specific color combinations have the potential to change the user’s spatial perception and mood.
It is soothing and refreshing. It creates a sense of security because it is associated with nature.
It reduces nervous enthusiasm and can be both sedative and stimulating. In its action in the human body, it reduces blood pressure and heart rate.
People surrounded by vivid and bright colors enjoy better physical condition and peace of mind than those surrounded by dark and dull colors. The variety of colors is psychologically more beneficial. A monochromatic scene throughout the whole building can be perceived as a institutional. 10
Art work The arts can contribute to creating a more peaceful, calming and protective environment. In hospitals, art therapy can help relieve patients from their pain, enable them to see the beauty around them and encourage them to feel that it worths fighting for life. According to studies, healing arts contribute to the faster recovery of the patient by helping him or her to cope as well as possible with the hospital experience. Their role is to transfer positive energy and a sense of comfort in spaces, which are usually experienced as places with high emotional tension, even temporarily.
It is obvious that any work of art is not suitable for the recovery environment. Abstract art, when it is characterized by violent features with sharp and harsh lines, has a negative effect on some groups of patients.
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Nature Nature is beneficial for the body and mind. It plays an important role in psychological nourishment, distracts and relieves pain. Nature through sensory stimuli influences the spiritual balance of the individual. A growing volume of research links nature exposure with improved medical results. There are several ways in which patients, visitors and hospital staff can connect with nature: • View of nature from a window or pictures hung on the walls, • Visit a natural environment, such as a garden or a nearby park, • Contact with indoor plants or flowers
Where does a patient chooses to go when he or she is stressed? Τηε 95% of respondents showed a positive change in their mood having spent some time outdoors, and less intense feelings of anxiety and stress So gardens at health facilities are the most important and essential way of dealing with stress.
A garden: • Helps patients to recruit their own internal healing sources • It provides an environment where staff can conduct physical therapy with patients • It provides staff with a necessary respite from work-related stress • It provides a relaxing environment for patient-visitor interaction away from the hospital • It creates opportunities for physical movement and activity 12
Examples Location:
Lisbon, Portugal
Architect:
Charles Correa Associates
Year:
2010
Research Center for neurosciences, vision problems and cancer.
The facilities are divided into 3 units • Unit A is the four-storey building. Diagnostic and therapeutic areas occupy the two lowest levels, while the top two floors are dedicated to research laboratories. A tropical garden that is developed inside the building is accessible to patients and staff. • Unit B is a smaller structure that houses the restaurant, the exhibition area, and an amphitheater at the entrance level and at the top level the conference center, along with the offices of the institution connected through an elegant glass bridge with the research laboratories . • Unit C, the third element key of the complex, is basically an outdoor amphitheater in front of the river for public performances and community events. The 3 units that form the project are designed to create a long 125-meter path that leads diagonally to the open sea.
The project is an excellent example of an holistic approach to sustainability. An attempt has been made to use nature, water, the sky and the presence of the tropical garden as a treatment for patients. A high-tech building management system allows the integration of many different environmental control solutions. 13
Location:
Chicago, United States
Architect:
Perkins+Will
Year:
2012
Hospital with 386 beds, diagnosis and treatment facilities.
The building consists of a rectangular base of seven levels, containing new diagnostic and therapeutic facilities, and is completed by a curved five-level tower where patients’ rooms are located. At the junction of the new and old hospital there is an entrance booth whose roof is shaped to provide a garden to patients and staff. Skylines that act as sculptural elements of the garden provide natural light at the lower part. The architectural design relys on the time people spend on going from one place to another, but also on patient safety. Maximizes the amount of wall surface and number of windows, allowing daylight to enter the rooms, and view from every patient room. The innovations that are being developed in the building include: • The butterfly shape, which gives the nursing staff a clear field of visibility for the patients’ rooms • The quality of air circulation • Single rooms designed with separate zones for the patient, family and staff. Patients’ rooms have a single design so that doctors and nurses find the same equipment in the same place to ensure that no precious time is lost in an emergency. 14
C o n c l u s i o n s The shaped environment affects to a large extent the well-being of humans. Particularly in the case of healthcare facilities, where a patient is in his or hers most sensitive and vulnerable version, the environment has an even greater impact, so it must be therapeutic, supportive and focus on the person. Architects have the most important role in designing the future healthcare facilities, while guaranteeing quality care in the hospital environment. Since developments in medical and medical technology have changed so quickly the general context of hospitals and the operation of patients’ rooms, the guidelines should be continuously reviewed so that the developer and designer can confirm their validity. The healing environment has large margins to contribute to energy saving and sustainable design.
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