Literature review final submission

GROUP 4

Literature Review: Final Submission Tatiana Acosta, Thayse Darzi, Elisabet Lyon & Esperanza Muino Florida International University Spring, 2016

Department of Interior Architecture IND 5937 Special Topics April 29, 2016 Instructor: Professor Philip Abbott 1

GROUP 4 TABLE OF CONTENTS

INTRODUCTION Background

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Research Questions

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Purpose Statement of Literature Review

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Statement of Significance

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LITERATURE REVIEW Holistic Medicine Definition & philosophy

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Holistic medicine alternatives treatments & techniques

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Reiki

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Yoga

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Tai chi

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Meditation

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Acupuncture

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Chiropractic

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Massage therapy

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Homeopathy

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Aromatherapy

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Holistic medicine vs conventional medicine and healthcare Stress, Health & Well-being

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Symptoms, signs, and causes

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Holistic methods and techniques used to manage stress

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Sustainability Definition and facts

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Procedural Sustainability

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Regenerative Sustainability Guidelines and principles

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Sustainable design

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Regulations

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GROUP 4 Sustainability vs holistic healthcare

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Principles of sustainable design & relationship to stress

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Lifestyle, productivity, & personal relationships Lifestyle balance & holistic approaches

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How lifestyle, productivity, & personal relationships are related to you wellbeing Lifestyle changes and stress Characteristics of healthy lifestyle

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Designing a holistic center healthcare environments Characteristics of a holistic center care facilities and its benefits

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Stress patients’ perceptions and feelings toward holistic

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healthcare facilities User’s expectations and needs

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Designing features and spaces that contribute relaxing and stress-free environments

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A Holistic healthcare model

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CONCLUSION

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REFERENCE LIST

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APPENDIX Literature Review Outline

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Reading List

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Annotated Bibliography

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GROUP 4 INTRODUCTION Background Can holistic medicine techniques control, enhance, and cure patients’ stress? Are the sustainable principles being applied in the holistic healthcare environments intended to improve productivity and relationships in patients’ lifestyle? This paper aims to provide the reader with information and review of literature to potentially enable an understanding of the roles of interior designers in the design of holistic sustainable healthcare. It also examines how stress can be treated using holistic care, the importance of the integration of sustainable principles in the development of holistic centers, and how the user’s experience might enhance their health, sense of well-being, life-style, productivity, and personal relationships.

This literature review follows a framework that will guide the reader throughout, beginning with an understanding of holistic philosophy. It is followed by the study of stress and how it can be treated using holistic treatment and how these treatments can enhance patients’ health. It concludes on how the interior designers are integrating sustainable principles in this design. The literature review will help define holistic healthcare in the built environment, its characteristics, and the stress related to patient interactions within the space. In addition, this paper provides the audience with the definition, relationship, facts about stress, sustainable healthcare and productivity, and lifestyle & personal relationships.

According to the American Holistic Medicine Association (Skinner, 2013), the main objective of holistic medicine is to achieve optimal health and to differentiate it from the orthodox allopathic medicine that is a system in which medical doctors and other healthcare professionals (such as nurses, pharmacists, and therapists) treat symptoms and diseases using drugs, radiation, or surgery (Skinner, 2013). The difference is that holistic medicine treats the patient “integrally”, while traditional orthodox medicine focuses more on specific diseases. The term “integral” refers to the evaluation and treatment of the patient in general. Holistic medicine aims to comprehensively assess the human being in the physical, mental, and emotional components in order to contribute to the conservation and regain health when it has been affected by an endogenous (produced within or caused by factors within the organism) or exogenous (developed or originating outside the organism, as exogenous disease) condition (Skinner, P. 2013). These conditions are treated in the same way and are equally important when making decisions for a 4

GROUP 4 treatment. Integrative medicine is a way of understanding human health from the points of view of the individual, family and community, and then considers the biological, psychological, and social aspects. Holistic medicine integrates the knowledge of conventional medicine with those of complementary medicine, which some studies have been shown to be very effective. The purpose of a comprehensive examination on a holistic practice is to treat the problem from its root and find its true cause. According to AHMA holistic medicine’s philosophy (2015), its purpose is to optimize health by maintaining a balance between body, mind, spirit, and emotion, thus the patient's health can function effectively.

Stress is often described as a feeling of being overwhelmed, worried or run-down. Stress can affect people of all ages, genders and circumstances and can lead to both physical and psychological health issues (Avey, 2003). According to the American Psychological Association (APA), stress is any uncomfortable emotional experience accompanied by predictable biochemical, physiological and behavioral changes (Beil, & Hanes, 2013). The APA states that stress can be beneficial at times, producing a boost that provides the drive and energy to help people get through situations like exams or work deadlines. The APA also states that an extreme amount of stress can have health consequences and adversely affect the immune, cardiovascular, neuroendocrine and central nervous systems. They state that people who do not manage stress well can have headaches, stomach pain, sleeping problems, illness, and depression. According to King and Hegadoren (2006), stress can affect all aspects of human experiences, including food intake and digestion, exercise, learning, motivation, attention, work, mood, sleep and social relationships. They indicate that some people use holistic techniques to release tension and to counteract the ill effects of stress. The authors state that some holistic techniques often combine relaxation, breathing and focused attention on pleasing thoughts and images to calm the mind and the body. Robinson, Chesters , and Cooper (2007) state that mind and body practices, such as meditation, yoga, acupuncture, chiropractic care, homeopathy, massage therapy and naturopathy, are also considered holistic techniques. According to the American Institute of Stress, stress can be managed by the implementation of holistic treatment (Selye, H. 2014). A holistic approach to care must encompass the biological, as well as the psychological and social aspects of being human. Stress is a circumstance that lends itself well to an integrative science approach (King, L., & Hegadoren, M. 2006).

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GROUP 4 Sustainable design seeks to reduce the negative impacts on the environment, and the health and comfort of building occupants, thereby improving building performance (Guenther, R. 2006).

The basic objectives of sustainability are to reduce consumption of non-renewable resources, minimize waste, and create healthy, productive environments (Guenther, R. 2006). Sustainability is explained with many definitions by different authors. Guenther, (2006) emphasizes that sustainable design is based on indoor environmental quality, safety, stress control and increase of productivity in both healing and caregiving. She states that healthcare and sustainability go hand in hand. Guenther further states that idea of implementing sustainable design in healthcare is to reduce and eliminate all forms of contamination in medical practices, improving the quality of care to users and the safety of health workers with the utmost respect of the social and natural environment where they are located. Sustainable architecture reflects a proposal of great value to healthcare (Guenther, R. 2006).

The perception of stress related to time management and the pressures of modern life in the Western nations has increased the public interest to the belief that one’s lifestyle can be balanced (Christiansen, H., & Matuska, M. 2006). Apparent imbalanced conditions such as exhaustion, workaholism, insomnia, obesity, and circadian desynchronosis are universal and have been linked to adverse health consequences. Modern stress research recognized the negative health impact of stressful life circumstances and the importance of lifestyle patterns to both physical and mental health (Christiansen, H., & Matuska, M. 2006).

The Literature Review will address the following questions: Central Research Question: How does the interior design of a holistic care center support the treatment process, in order to have a positive impact on patients who suffer from high stress levels in relation to their health, sense of well-being, life style, productivity, and personal relationships as well as the implementation of sustainability on the interior design?

Sub-questions: 1. Holistic Center and Procedures What is the philosophy of holistic medicine, and how can its treatments be used to help patients with high stress levels?

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GROUP 4 2. Stress, Health & Well-being What causes stress, how does it affect people’s health and when does stress becomes a problem or an illness and what are some methods used to help people manage stress?

3. Sustainability Does applying the principles of sustainable design benefit patients with high stress levels, and have a positive impact on behavior?

4. Productivity, lifestyle & personal relationships How can people improve productivity and relationships in their lifestyle, and how does behavior, ethics, lifestyle and holistic approaches influence these relationships?

Purpose of the Literature Review: The overall purpose of this literature review was to explore and develop an understanding of a holistic medical approach on human health, well-being, life style, productivity, and personal relationships as well as sustainability effects on health care design. This literature review was conducted by a series of questions that combined generated a central question.

Significance of the Literature Review: Through the study and connections of these four concepts, holistic medicine, stress, sustainable design and lifestyle, we as interior designers could offer the patients that suffer stress sustainable design solutions of holistic centers that can provide treatments to control stress. They could do so while at the same time providing an interaction in harmony with the natural environment that can help to improve patient’s productivity, lifestyle & personal relationships.

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GROUP 4 LITERATURE REVIEW 1. Holistic Medicine (Acosta) 1.1 Definition & philosophy According to Gordon, (1982) holistic medicine is a type of alternative therapy that helps treat people who have serious illnesses. It is important to understand that a holistic approach is used to find cures that traditional medicine cannot. He states that holistic medicine can help people feel better since there is use of herbal medicine. Many people use holistic medicine because it heals them emotionally, physically and spiritually. According to Gordon, (2008) holistic medicine can be used for fatigue or health related problems. He states that the body is more respondent to holistic medicine since it does not involve drugs or chemical stimulants that affect the body. According to Skinner, (2013) the philosophy behind holistic medicine is that it is based ancient techniques used by Chinese practitioners. He states that holistic medicine can improve the immune system and its purpose is to channel energy back to the body so that there is a balance of harmony. It is effective in helping people with stress and depression. Some of the major holistic therapies are herbal medicine and psychotherapy.

1.2 Holistic medicine alternatives, treatments & techniques According to the articles: Health care and consumer choice: Medical and alternative therapies, Kelner, M., & Wellman, B. (1997) and How one woman overcame the pressures in her life? Tianuru, M. & Gitre, L. (1996): 

Patients who use alternative medicine feel better once they find a practitioner that discovers their diseases.

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People more than ever are relying on alternative medicine because it gives them better options that hospitals cannot provide.

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Yoga, meditation, acupuncture, massage therapy, vitamins and herbs are some of the holistic medicine alternatives.

According to the American Holistic Medicine Association (AHMA) (2012), these are some holistic alternatives and their definitions:

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GROUP 4 1.2.1 Reiki According to AHMA, (2012) reiki is a Japanese technique that is used to reduce stress. It originates from Japan and is known to heal people from many diseases. It is important to understand that Reiki comes from two words. Rei signifies “God’s wisdom or the higher power�. Ki means life force energy. It is important to understand that it is a spiritual healing art that has benefitted many people. People use Reiki as an alternative therapy to combat stress and daily pressure. Reiki promotes free and continuous energy. It has been effective in healing people with migraines, muscular spasms and sports injuries. It is beneficial to people because it is safe and natural.

1.2.2 Yoga According to AHMA, (2012) yoga is an ancient art form that is based in being in harmony with the body, mind and soul. Yoga is beneficial to people because it improves body movement and posture. Many people enjoy the health benefits that yoga provides. It is an art form that improves the respiratory, circulatory and digestive systems. Yoga helps people improve their posture too. People who practice yoga are always feeling better and live longer. Many people practice yoga to breathe better and develop better immune systems. People practice yoga outdoors and indoors. It is better to practice yoga outdoors since the body and mind are focused on the natural setting.

1.2.3 Taichi According to AHMA, (2012) taichi is a Chinese exercise that uses slow body movements to achieve a state of pure relaxation of the body and mind. Its purpose is to improve physical and mental relaxation. Tai chi was initially a martial art that started in China but eventually became a great exercise technique that people practice. Tai chi helps people with their posture and joints. It is a Chinese exercise system that uses slow, smooth body movements to achieve a state of relaxation of both body and mind. In China it is practiced outdoors and students are taught to use standing meditation.

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1.2.4 Meditation According to Sibinga, & Kemper, (2010) meditation is an art form that was developed by people to maintain focus when most needed. They explain that meditation is done by taking deep breaths, closing one’s eyes and focusing on something good. People who meditate have been able to live happier lives.

Meditation helps people reduce stress and enhance personal and spiritual growth Avey, H. (2003). People who practice meditation have a sense of fulfilment and enjoy better health benefits that regular people Avey, H. (2003).

1.2.5 Acupuncture According to Gordon, (1982) acupuncture is one of the main forms of treatment in traditional Chinese medicine. It is a very popular because it uses sharp needles that are placed inside specific body points to reduce stress. He states that acupuncture eliminates certain health conditions such as back pain and muscular aches. He explains that acupuncture targets specific pressure points in the body and helps promote overall better health. We believe it is an alternative medicine for many people who are finding ways to eliminate anxiety and depression. In addition, it helps people who have back injuries and improve posture. According to Gordon, (1982) acupuncture is generally a very safe procedure. If a patient is in doubt about a medical condition, more than one physician should be consulted. In addition, a patient should always feel comfortable and confident that their acupuncturist is knowledgeable and properly trained.

1.2.6 Chiropractic According to AHMA, (2012) chiropractic is a Greek word that means done by the hand. It is done to align the spine and make sure the skeletal system is working with the nervous system. Chiropractors are very important because they help people who have spinal problems. People use their hands with force and move the vertebrae so that it is aligned with the head. It is important to reduce back pain and use chiropractors to reduce spinal problems. Chiropractors 10

GROUP 4 have been able to cure people that have been involved in car accidents. A chiropractor does a spinal adjustment by manipulating the entire. This creates a popping noise that is carefully done without damaging any joints.

1.2.7 Massage Therapy According to Kelner, & Wellman, (1997) massage therapy is the done through a series of hand techniques that target soft tissues and muscles. They explain that massage therapy is done to reduce the swelling of the soft tissues. It improves blood circulation and improves movement in the muscles. Massage therapy is done to reduce muscle spasms and increase ease of movement on the body.

Massage therapy is done to reduce back pain and increase quicker healing of damaged tissues and ligaments (Kelner, M., & Wellman, B. 1997).

1.2.8 Homeopathy According to Skinner, (2013) homeopathy is an alternative medicine that is used to provide benefits for people who have allergies and stress disorders. It is a philosophy that relates to how the body can heal itself. It originated in Germany about 200 years ago and its theory is based that a highly diluted substance can be used to cure a disease by using many doses. It primarily is used to reduce anxiety, cardiovascular disease and other infections (Skinner, P. 2013).

1.2.9 Aromatherapy According to Tang, & Tse, (2014) aromatherapy is the therapeutic use of plantderived, aromatic essential oils to promote physical and psychological wellbeing. They state that the use of oils to reduce inflammation is important to reduce stress and muscle aches. They explain that aromatherapy uses essential oils that are plant based to improve circulation and reduce muscle pain.

Aromatherapy is used to treat infections and respiratory illnesses.

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GROUP 4 1.3 Holistic medicine vs conventional medicine and healthcare Gavin (2013) states that holistic medicine is becoming more popular every day because it uses less chemicals that are harmful to the body. The author indicates that it uses natural ingredients such as plants and organic materials that are sustainable. He also feels that the harmful effects of conventional medicine are being exposed by many organic companies.

Conventional medicine uses synthetic treatments to address physical symptoms. Holistic medicine is better for the body since it uses natural treatments to find illnesses. It is important to know that physical ailments can be cured through holistic medicine rather than prescribing drugs (Gavin, A. J. 2013).

“Conventional thought is that holism involves an acknowledgement that mind, body and various social systems are deeply interconnected and need to be considered as one – as the sum of their parts.” (Gavin, 2013, p.107)

2. Stress, Health & Well-being (Lyon) “Stress is a mental state that can cause severe negative emotional and physical consequences.”

(Weiss, 2003, p. 24) According to Weiss Stress is a condition that affects the happiness of people and prevents them from experience life greatest pleasures. It is linked with the immune system of the body and when this is attacked, the human body becomes much more vulnerable to get seriously ill. Weiss found in a study that in United States, five of the leading causes of death are linked to stress. In presence of stress, it is very important for people to find inner peace and work towards the physically and emotional healing that will allow self-love and appreciation of life.

2.1 Symptoms, signs, and causes Lately, the modern world has become very busy. Weiss stated that people are immersed in daily activities; technology provides too much information not allowing people to shutdown anymore. “As the world becomes more complex, we become more stressed.” (Weiss, 2003, p. 3) Many situations in life cause stress. Events such as the death of a family member or a close friend, being present in an accident, suffering from an illness, losing a job, going through a divorce or a breakup, having legal problems, financial problems, loneliness, being victim of crime, becoming a parent, balancing job and home responsibilities, having frequently deadlines or unhealthy competition at work or at school, problems with fertility 12

GROUP 4 and other traumatic events are common situation that many people go through in life and are the primarily causes of stress.

Chronic stress can inflict on the human body. According with the authors, signs and symptoms of stress can be divided in categories such as: psychological, physical and behavioral. Psychological symptoms include: forgetfulness, fears and anxieties, depression irritability, worrying, impaired concentration, low self-esteem, anger, guilt, suspicion, getting easily frustrated, loss of motivation. Physical symptoms are found to include: headaches, sweating, difficulty breathing, tremors, increase blood pressure, heart rate, hyperventilation, insomnia, obesity, skin disorders, muscle tightness, tension, heartburn, acid stomach, osteoporosis and fatigue. Lastly, behavioral symptoms involve: impulsivity, overeating, aggressive behavior, increase use or resumption of alcohol, drugs or tobacco; excessive caffeine intake, overeating, relationship conflicts, withdrawal from responsibility, avoidance of people or places; social isolation and decreased activity. People experiencing these symptoms, suffer from high stress levels. If stress is controlled early, people’s body and mind can return to their normal state of function. .

2.2 Holistic methods and techniques used to manage stress Authors stated that there are many methods that go by hand with holistic medicine. These methods and techniques include: meditation, acupuncture, chiropractic, massage therapy, homeopathy, aromatherapy, vitamins and herbs and disciplines such as yoga, reiki and tai chi.

All of these methods are considered to heal people from stress and will give them the disciplines for them to find inner peace and a healthy lifestyle, which is the purpose and desire of people suffering from stress conditions.

3. Sustainability (Muino) 3.1 Definition and facts According to the Leadership in Energy and Environmental Design (LEED) (2000), sustainability in architecture and interior design is defined as the design that seeks to minimize the negative environmental impact of buildings by efficiency and moderation in the use of materials, energy, and development space. Sustainable architecture uses a conscious approach to energy and ecological conservation in the design of the built environment.

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GROUP 4 According to Guenther (2006), sustainability has been called the most powerful force to impact the construction field in more than a decade, and the speed with which it is moving may well the defining trend of this century. Some building professionals are affirming that the tipping point is the commercial office market sector (Guenther, 2006). In our opinion healthcare may not be far behind.

3.2 Procedural Sustainability Sustainability preserves species and engages the complex systems and reconciliation of three variables: ecological, economic, and social without depleting the natural resources (Pettigrew, Maeseneer, Anderson, Essuman, Kidd, & Haines, 2015). They state that in depth, the ecological variables include; waste management, species preservation, energy savings, and water use and reuse. According to these authors, the economic variables are different in each country, city or community but there is always a generalized idea of the global economic status. In addition, they state that the social variables are the most important because are directly related to the people and how they might react to changes.

According to Robinson and Cole (2014) sustainability could be differentiate as regenerative sustainability and procedural sustainability. They explained that regenerative sustainability engages the living world with creative partnership between nature and human activity based on strategies of adaptation, resilience and regeneration. On the other hand, the authors found that procedural sustainability argues about the separation of culture from nature and fact from value driving the society to a sustainability crisis that might lead to human exploitation and domination. They state that as designers, we should take in consideration the regenerative sustainability to develop spaces that promotes integration of culture and natural elements that could last longer and regenerates the social environment.

3.3 Regenerative Sustainability 3.3.1 Guidelines and principles The principles of sustainability or green practices are directly related to how the humans manage the resources more efficiently.

These resources are: energy, materials, ecosystems, air, water and land. (ASID, 2015). For instance, a building could be consider sustainable if utilize forms of 14

GROUP 4 energy preservation, use of natural breeze for ventilation, use local materials that don’t emit VOCs, recycle and reuse waste water, and have a good waste management etc. (Cottrell, 2014) A more detailed guideline list is provide by LEED v4 for building design and construction 2015 that includes requirements such as: 

An interdisciplinary design and decision making during the design process.

-Professionals form different fields efficiently working together as a team to improve the design and construction process.

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Site conditions that integrates access shading, exterior lighting and landscape.

-Site analysis and integration of the natural environment to the built environment.

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Massing and orientation for energy saving and renewal energy opportunities.

-Orientation of the building taking advantage of natural light and sun light.

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Basic envelope attributes with glazing characteristics and window operability.

-Light and ventilation penetration control.

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Lighting levels that assess interior surfaces reflectance values.

-Lighting levels control to possible energy saving and users interior environmental control.

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Thermal comfort ranges.

-Thermal control according to the exterior temperature and time of the year.

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Reduce of plug and process load needs through programmatic solutions.

-Utilization of lightweight materials.

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Programmatic and operational solutions that asses multifunctioning spaces.

-Easy circulation allowance avoiding unnecessary partition walls.

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Indoor and outdoor water demand.

-Water use reduction and possible recycle.

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Supplies sources management 15

GROUP 4 -Waste management.

3.3.2 Sustainable Design Sustainable design is based on indoor environmental quality, safety, stress control and increase of productivity in both healing and caregiving (Guenther, R. 2006).

For all designers, it is important to become knowledgeable about how to apply sustainability in their design.

It is a concern that interior designers should have in the need of creating healthy environments for the community, a “green” or “sustainable” design is part of the code of their professional ethic (Nussbaumer, L. 2004). Many designers do not have education about sustainability and their lack of information about material or furnishing (synthetic textile, carpets…) selection becomes a problem when designing spaces for sick people. Many materials may contain VOCs (“compounds that vaporize (become a gas) at room temperature.”) This compounds greatly influence the indoor air quality of a space, thus, people with respiratory problems can be severely affected. It is easy for people to be surrounded by environments containing poor air quality and with VOCs. This can be presented in their workplace, residency, office, and in healthcare environments of course (Nussbaumer, L. 2004).

3.3.3 Regulations Sustainable design and construction practices are evolving and growing. Therefore, professionals use regulation systems and assessments to evaluate their design.

Guidelines, regulations and assessments are proposed by different organizations all around the world to rate the levels of sustainability in regards of life cycle cost, energy systems design, performance evaluation, indoor environmental assessments and operation optimization.

There are five rating systems: BREEAM, Building Research Establishment’s Environmental Assessment Method, CASBEE, Comprehensive Assessment System for Building Environmental Efficiency, GBtool, Green Globes™ U.S and LEED, Leadership in Energy and Environmental Design (Fowler and Rauch, 2006). As outlined by the authors: 16

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BREEAM, Building Research Establishment’s Environmental Assessment Method.

This rating system is used in United Kingdom but not in USA. It cannot be use to rate all type of projects and is accessible for licensed professionals only. Is update every year.

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CASBEE, Comprehensive Assessment System for Building Environmental Efficiency.

This rating system is develop by the Japanese market and is not recognize in USA. However, CASBEE could potentially be apply in USA because it offers environmental evaluation data. This systems requires documentation sustainable design achievements by licensed architects.

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GBtool.

Is an international system that has been used to evaluate U.S buildings for the Green Building Challenge. This system could be use to rate the building and the building’s maintenance applications. This systems use qualitative and quantitative tools to evaluate building performance. This rating system requires greater technical expertise than other rating systems.

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Green Globes™ U.S. This rating system was adapted from Green Globes Canada in 2004 and is the newest rating system. This system address mayor renovations, tenant build-out and operations and maintenance applications. Is working toward getting an official ANSI standard consideration. Only four buildings have obtained Green Globes rating and 63 buildings have registered to be consider.

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LEED, Leadership in Energy and Environmental Design.

Is currently the main rating system in United States market and is being expanded to multiple markets worldwide.

LEED follows different rating steps that include technical development, pilot testing, public comment period, approval by council membership and then release for public use. The documentation to quantify sustainable design measures is provide by trained assessors. There is more than 400 U.S 17

GROUP 4 buildings that have received LEED ratings and more than 3,400 are in the process to possible certification. Green design must meet certain requirements to be LEED certified. It is important to reduce energy when using lighting and ventilation in enclosed spaces (Wood, C., Wang, C., Abdul-Rahman, H., & Abdul-Nasir, S. 2015).

According to the US Green Building Council, LEED 2009 for Healthcare Green Building Rating System is a set of performance standards for certifying health care facilities. The intent is to promote healthful, durable, affordable, and environmentally sound practices in building design and construction.

Prerequisites and credits in the LEED 2009 for Healthcare address 7 topics: 

Sustainable Sites (SS)

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Water Efficiency (WE)

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Energy and Atmosphere (EA)

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Materials and Resources (MR)

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Indoor Environmental Quality (IEQ)

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Innovation in Design (ID)

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Regional Priority (RP)

LEED for Healthcare was written primarily for inpatient and outpatient care facilities and licensed long-term care facilities. The rating system may also be used for medical offices, assisted living facilities and medical education and research centers.

LEED for Healthcare addresses design and construction activities for both new buildings and major renovations of existing buildings. A major renovation involves major HVAC renovation, significant envelope modifications, and major interior rehabilitation. For a major renovation of an existing building, LEED for Healthcare is the appropriate rating system. If the project scope does not involve significant design and construction activities and focuses more on operations and maintenance activities, LEED for Existing Buildings: Operations & Maintenance is more appropriate because it addresses operational and maintenance issues of working buildings.

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GROUP 4 3.4 Sustainability vs healthcare According to Guenther (2006), healthcare and sustainability go hand in hand. Thanks to scientific progress, we try to combat some diseases more effectively than before, but we cause more side effects on health and the environment. Therefore, it is necessary to apply the precautionary principles or prevention methods and substitute hazardous substances with safer for health and environmentally friendly alternatives (Guenther, R. 2006). Given the prevailing economic criteria we have to clarify that health budgets are to be regarded as an investment and not an expense. The cost doesn’t have to be an excuse to paralyze the activity but a permanent stimulus to research, develop and promote technically feasible and economically reasonable alternatives (Guenther, R. 2006). Basically, the idea is to reduce and eliminate all forms of contamination in medical practices, improving the quality of care users and the safety of health workers with the utmost respect of the social and natural environment where they are located.

As professional designers, we are looking for hospitals to become leaders and role models for healthier life styles, where sustainability is a great ally. This can be done by simple basics: Providing organic food, recycling waste and eliminating the poor handling of materials.

Green buildings and world of healthcare have a common mission: to protect and promote health. We cannot have healthy people if we do not have clean air, water and soil. For more than 70 years, our healthcare system has been frozen in time by a massive industrial design that has little to do with health. Then we can transform this 20th century industrial healthcare model into a system that rather than delivers sick care goes to a one that builds actual health.

3.5 Principles of sustainable design & relationship to stress According to Coskun, Zimmerman, & Erbug, (2015), the social benefits of sustainable design are related to improvements in the quality of life, health, and well-being. These benefits can be realized at different levels – buildings, the community, and society in general. At a building level, research on the human benefits of sustainable design has centered on three primary topics: health, comfort, and satisfaction. Although these outcomes are clearly interrelated, they have different scholarly roots and employ different methodologies. Health issues are the domain of epidemiologists and public health professionals. Comfort is studied by researchers with expertise in building science and physiology, while well-being and 19

GROUP 4 psychosocial processes are studied by environmental and experimental psychologists (Coskun, A., Zimmerman, J., & Erbug, C. 2015).

Stress is a physiological factor that affects many people and causes many physical and emotional impacts on everyday life. It is important to understand the relationship between stress and our natural environment. In addition, it is important to determine how natural and sustainable settings can be helpful in finding ways to alleviate stress. Urban natural environments and sustainable built environments influence a person’s well- being. It is important to understand that exposure to natural and sustainable environments can help reduce stress in someone (Beil, K., & Hanes, D. 2013).

The building environment can have both negative and positive impacts on the occupants' quality of life. Negative impacts include illness, absenteeism, fatigue, discomfort, stress, and distractions resulting from poor indoor air quality, thermal conditioning, lighting, and specific aspects of interior space design (e.g., materials selections, furnishings, and personnel densities). Reducing these problems through sustainable design often improves health and performance. Improved indoor air quality and increased personal control of temperatures and ventilation have strong positive effects. In addition to reducing risks and discomforts, buildings should also contain features and attributes that create positive psychological and social experiences. Although less research has been done on health-promoting environments, emerging evidence shows that certain sustainable building features, including increased personal control over indoor environmental conditions, access to daylight and views, and connection to nature, are likely to generate positive states of well- being and health (Beil, K., & Hanes, D. 2013).

4. Lifestyle, productivity, & personal relationships (Darzi) 4.1 Lifestyle balance & holistic approaches According to Christiansen and Matuska (2006), The importance of a healthy, balanced lifestyle is widely encouraged within developed nations, where it is commonly perceived that the demands of modern living often exceed people’s ability to cope with them. There are a few factors that can affect a balanced lifestyle, such as, the use of time, life roles, need of satisfaction, biological rhythms, and influence on behavior, but the main one is personal conditions, so the best way of pursue a balanced lifestyle is the holistic model of wellness concept that motivates 20

GROUP 4 people to change their activity level, exercising more, diet, creating a healthier eating habit, and behavior changes. Meyer (1922) states that the only way to attain balance in all this is actual doing, actual practice, a program of wholesome living as the basis of wholesome feeling and thinking and fancy and interests.

According to Gieck and Olsen (2007), Promotion of holistic wellness has been associated with improvements in psychological functioning, and the concept has been used to enhance prevention and treatment of physical disorders. Creating programs that brings the concept and involve people with the main purpose of maintenance and development of a healthier and balanced lifestyle may approach an innovative concept for the Holistic Center. By engaging people with those programs, creating a bonded relationship between specialists and participants, encourages the idea of maintenance and motivates them to develop more and more their balanced lifestyle.

4.2 How lifestyle, productivity, & personal relationships are related to you wellbeing.

Wellbeing is a great and pleasing condition of life, an accomplishment of great health, happiness, and life realizations. Achieving wellbeing in our lives should be our main goal, to be able to do that we need to change our lifestyle. Why lifestyle? Simple, changing our lifestyle, taking small and manageable steps, such as adding different activities on our daily bases, changing our eating methods, taking care of our health and body, relate ourselves with different people, socialize, respect each other, spend time with nature, meditate, and others, will help increase productivity and by doing all that achieve wellbeing. Small adjustments in our lives can provide a great benefit to our quality of life.

Lifestyle factors can be potent in determining both physical and mental health. According to Khaw (2008), in modern affluent societies, the diseases exacting the greatest mortality and morbidity— such as cardiovascular disorders, obesity, diabetes, and cancer—are now strongly determined by lifestyle. Differences in just four lifestyle factors—smoking, physical activity, alcohol intake, and diet—exert a major impact on mortality, and “even small differences in lifestyle can make a major difference in health status”.

Micthell and Ozminkowski (2013) states that it is very important to educate ourselves that lifestyle is the key-factor to have a successful well-being in life; changing lifestyle is the start, by doing that consequently other sections of our lives, such as productivity and personal 21

GROUP 4 relationships will have better progress and growth. Health promote programs typically provide services that educate consumers about their health care system and stay on track with their health improvement goals.

4.3 Lifestyle changes and stress According to McMorris, Tomporowski, and Audiffren (2009), by changing your lifestyle, the benefits can offer significant therapeutic advantages for patients, therapists, and society.

Therapeutic Lifestyle Changes (TLC) can be used alone or adjunctively and are often accessible and affordable. Deslandes (2009) states that TLCs offer significant secondary benefits to patients, such as improvements in physical health, self-esteem, and quality of life. Furthermore, Hamer and Chida (2009) state that some TLCs—for example, exercise, diet, and meditation— may also be neuroprotective and reduce the risk of subsequent age-related cognitive losses and corresponding neural shrinkage. Didonna (2009) states that many TLCs—such as meditation, relaxation, recreation, and time in nature—are enjoyable and may therefore become healthy selfsustaining habits. According to Christiansen and Matuska (2006), lifestyle changes also must be considered when thinking about stress in our lives, lifestyle patterns encourage satisfactory adaptation to the stresses of everyday life; many skillful strategies for stress management are now available, ranging from lifestyle changes to psychotherapy to self-management skills.

There are some benefits within lifestyle changes: According to Khaw and Ornish (2008), exercise offers physical benefits that extend over multiple body systems. It reduces the risk of multiple disorders, including cancer, and is therapeutic for physical disorders ranging from cardiovascular diseases to diabetes to prostate cancer. It also helps with stress release, when exercising; we release bad substances of our body by sweating.

Christiansen and Matuska state that major dietary component must be considered: food selection.

Choosing vegetable and fruits helps adults keep a healthy diet, maintain a great body, preserve mental functions, and reduces indicators of affective disorders.

According to Berman, Jonides, and Kaplan (2008), a therapy that had no known side effects, was readily available, and could improve your cognitive functioning at zero cost. Such a therapy has been known to philosophers, writers, and laypeople alike: interacting with nature. Many have

22

GROUP 4 suspected that nature can promote improved cognitive functioning and overall well-being, and these effects have recently been documented.

According to Fowler and Christakis (2008), rich relationships reduce health risks ranging from the common cold to stroke, mortality, and multiple psychopathologies. On the positive side, good relationships are associated with enhanced happiness, quality of life, resilience, cognitive capacity, and perhaps even wisdom. When you have a great relationship with others, is easier to deal with any kind of problem and avoid stress, because you will know how to talk, act and react towards another person. There are a few factors that can help you create a great relationship with others, such as, respect, be sympathetic, have integrity and conviction, be fair, be helpful, solve problems, follow rules, listen to others, respect their privacy, be open minded, and others.

By relaxing, meditating, having a spiritual or religious involvement, and the use of massaging techniques, helps you to manage stress, anxiety, panic, and insomnia.

4.4 Characteristics of healthy lifestyle A healthy balanced lifestyle will make you feel better with yourself mentally and physically and will promote a longer life. The best way to create it is eating healthy in a balanced diet that will give you enough nutrients for your health, practice regular exercises, such as, walking outside or in a trade mill, ride a bike, jog, stretch, and others, keep a great weight or a weight that is reasonable to your type of body and high, and minimizes daily stresses. An active lifestyle will increase your health by keeping the heart muscle in shape, increasing blood flow, will reduce hearts diseases, blood pressure, and stress, and will promote a great feeling of well-being and gives you a better social life. Things to avoid in order of keeping a healthy lifestyle will be smoke, eat unhealthy food, and drinking alcohol regularly.

5. Designing a holistic center healthcare environments 5.1 Characteristics of a holistic center care facilities and its benefits Healthcare facilities in general encompass a wide range of types, from traditional to alternative or holistic medicine, from small and relatively simple medical clinics to large, complex, and costly, teaching and research hospitals.

A holistic care facility conveys a message to patients, visitors, volunteers, vendors, and staff.

This facility also communicates a torrent of clues about the organization and the holistic care 23

GROUP 4 being provided there. We think the clues start at the approach to the facility, the drop-off area, the parking lots, and the street signs. Ideally, that message is one that conveys welcoming, caring, comfort, and compassion, commitment to patient well-being and safety, where stress is relieved, refuge is provided, respect is reciprocated, competence is symbolized, and way-finding is facilitated. Like a hospital, a holistic center should be designed with the same care and dedication.

Sustainability must be a consideration for the design of our holistic healthcare facility. Many sustainable design features can be incorporated into the holistic healthcare facility design, including daylighting, energy and water conservation, nontoxic materials and finishes, and sustainable operations and maintenance.

A holistic center is designed based on the holistic philosophy, understanding health as a state of harmony between body, mind and spirit. Therefore, the design is intended to cover the needs that may occur in each of these areas, away from the traditional view of treating the person in a single plane.

According to the American Holistic Health Association, holistic health supports reaching higher levels of wellness as well as preventing illness. People enjoy the vitality and wellbeing that results from their positive lifestyle changes, and are motivated to continue this process throughout their lives.

5.2 Stress patients’ perceptions and feelings toward holistic healthcare facilities Stress can be cured or controlled by holistic medicine (Tianuru, M. & Gitre, L. 1996).

According to some studies (Kelner, M., & Wellman, B. 1997), patients have become more responsible with their own health; they have become more aware of the benefits of using holistic medicine. Prevention is a key factor that enables people to increase their overall health. People more than ever are relying on holistic medicine because it gives them better options that hospitals cannot provide. Holistic medicine is important because it can help people find cures that a regular physician cannot prescribe. Physical and emotional health is important for people that seek help in holistic treatments.

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GROUP 4 5.2.1 User’s expectations and needs As a designer, we know that the most important part of the design process is fulfill user needs.

Holistic approaches toward healthcare are an important factor to live an overall better life. Physicians are now looking for better ways to combine traditional and holistic healthcare in a way, which can improve better healthcare in people. It is important to understand that holism is a new form of treatment that is starting to become popular among many physicians. Many practitioners have been able to treat patients through holistic therapies and agree that holism has changed the way people perceive healthcare.

It is important to address new methodologies and create conceptual design frameworks that can support individual treatments. People are becoming aware that holistic medicine is a better way to seek attention their medical needs. Holism has always been linked to healing (Gordon, J. S., Md. 1982). Holistic medicine is increasingly becoming popular in mainstream society since it is a healthier alternative than going to a regular physician’s office.

5.3 Designing features and spaces that contribute relaxing and stress-free environments.

Healing environments often integrate nature to help de-stress patients. Nature can be a beautiful distraction or have physiological benefits. Either way, nature is important because it has been proven to reduce pain and subsequent stress (Gavin, A. J. 2013).

By incorporating technology, we can extract features from nature in a more conscious manner. As designers bring architecture together with nature, they can align environments with human natural biorhythms. For example, lighting properties could more closely resemble those found in natural sunlight. For better understanding, we can give an example of healing gardens that are full of life and appeal to all of the human senses. Color, sound, smell, touch and sometimes-even taste are embedded into garden designs. Healing gardens are places where people can find strength, both physically and mentally.

Sometimes certain healing garden characteristics can be found within healing architectural spaces. Water features, circulation pathways or social gathering areas are elements that each may have in common. From healing gardens, we learn that by reaching out to the senses, design can greatly impact human well-being. The key is to appeal to human senses.

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GROUP 4 Sustainable architectural features are also helping to make architectural environments more pleasant and comfortable. Interest is in spending less energy while maintaining optimal comfort conditions (Guenther, R. 2006).

Unfortunately, many hospital environments are still overfilled with technology and interior design that is clunky, noisy and visually too sterile and intimidating. Patient experience in such places dampens the senses and makes patients heal in spite of their surroundings.

Currently; however, there is an ongoing push to make such environments more humane, comforting and natural. Attention to color or organic textures, for example, are proving to significantly impact occupant or patient mood (Gavin, A. J. 2013).

5.3 A Holistic healthcare model According to the American Holistic Health Association, holistic health is based on the law of nature that a whole is made up of interdependent parts. The earth is made up of systems, such as air, land, water, plants and animals. If life is to be sustained, they cannot be separated, for what is happening to one is also felt by all of the other systems. In the same way, an individual is a whole made up of interdependent parts, which are the physical, mental, emotional, and spiritual. Holistic health is an ongoing process; as a lifestyle, it includes a personal commitment to be moving toward the right end of the wellness continuum. No matter what their current status of health, people can improve their level of well-being. Even when there are temporary setbacks, movement is always headed toward wellness.

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GROUP 4 CONCLUSION This literature review presents information that supports the idea of designing a holistic care center and the treatment process, in order to have a positive impact on patients who suffer from high stress levels in relation to their health, sense of well-being, life style, productivity, and personal relationships as well as the implementation of sustainability on the interior design.

Through the extensive literature review conducted, valuable information was collected that allows us to increase our knowledge on how to design a psychological supportive and healing environment to benefit patients who suffer from high stress levels. Holistic health includes not only treating or curing specific symptoms, but also supports promoting the overall health and well-being of individuals, families and communities. It recognizes that for some individuals and families, the experience of illness and pain may relate to spiritual concerns and that those concerns may manifest as physical or emotional symptoms. Holistic health approaches address not only curing or treating a specific physical ailment, but also ensure that support and comfort are provided to the individual and his or her family and community.

Implementing sustainable practices in a holistic center has economic factors that overtime can improve the financial status. Through sustainable practices, the holistic center can have ideas such as energy and water conservation, and waste management. If all the ideas and discussion are implemented, then the holistic center should be successful based on not only research but the experience that will be promoted. Levels of productivity and benefits in health all can be determined in scientific form, but why not implement it as an everyday setting? This is why one should design a sustainable holistic center that will inform, educate, and bring awareness to the environment and all the methods of sustainability that can be implemented in its patients and potentially in the community that surrounds it.

Concluding and with the help of this literature review, we believe that to create a holistic center with therapeutic environments, all members of the design team—medical planner, architect, engineer, interior designer, site and landscape designer,—are responsible for using the power of design to find solutions that will affect the patients and staff in positive ways, throughout the facility; from the parking lot, approach, and entry, to the public spaces, and clinical spaces.

Following are some specific design criteria that we consider should be used when designing a Holistic Care Center:

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GROUP 4 Reducing or Eliminating Environmental Stressors 

Artwork and aesthetics can enhance the soothing and calming qualities of a space.



Adequate space should be provided in public areas and care rooms to avoid crowding.



Perceived waiting time can be mitigated by positive distractions.



Visual and noise privacy.



Wayfinding; the built environment should provide clear visual cues to orient patients and families, and guide them to their destination and return. Landscaping, building elements, daylight, color, texture, and pattern should all give cues, as well as artwork and signage.



Maintain good indoor air quality; 100% outside air where climatic conditions allow.



Color, while subjective, can be a design factor in reducing environmental stress when understood and used in the context of the color preferences of a project-specific population.

Providing Positive Distraction 

Views of nature, from care rooms, and wherever possible in lobby, waiting, and other areas.



Access to nature, healing gardens.



Meditation rooms, and meditation gardens.



Artwork depicting nature, including back-lighted photographs of nature.



Music; live piano in public area, recorded music in care rooms when programmed specifically to create a healing environment.



Mild physical exercise; corridors, public spaces, and gardens that invite walking when appropriate.



Pets and other activities or elements that allow for a sense of stimulation that help nurture a patient's sense of positive well-being.

Giving a Sense of Control 

Give the patient as much privacy and control over it, as is consistent with the need for nursing supervision.



Give the patient control over the immediate environment; i.e., radio, TV, reading light.



Provide mini-medical library and computer terminals so patients can research their conditions and treatments.

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GROUP 4 

Choice of lighting; patients and staff can benefit from personal dimming controls.



Choice of artwork.



Volume and programming control of televisions in waiting areas.



Storage area for patient belongings.

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GROUP 4 REFERENCE LIST: Anderko, L. (2013). Greening the ‘proclamation for change’ healing through sustainable healthcare environments. The American journal of nursing, 113(4), 52-59.

Avey, H. (2003). Health care providers' training, perceptions, and practices regarding stress and health outcomes. Journal of the National Medical Association, 95(9), 833-845.

Beil, K., & Hanes, D. (2013). The influence of urban natural and built environments on physiological and psychological measures of stress— A pilot study. International Journal of Environmental Research and Public Health IJERPH, 10(4), 1250-1267.

Christiansen, C. H., & Matuska, K. M. (2006). Lifestyle balance: A review of concepts and research. Journal of Occupational Science, 13(1), 49-61.

Coskun, A., Zimmerman, J., & Erbug, C. (2015). Promoting sustainability through behavior change: A review. Design Studies, 41, 183-204.

Gavin, A. J. (2013). Creating the right therapy vibe: Relational performances in holistic medicine. Social Science & Medicine, 83, 99-109.

Gieck, D. J., & Olsen, S. (2007). Holistic wellness as a means to developing a lifestyle approach to health behavior among college students. Journal of American College Health, 56(1), 29-35.

Gordon, J. S., Md. (1982). Holistic Medicine: Advances and shortcomings. The Western Journal of Medicine, 546-551.

Gordon, S. (2008). Review of Whole person healthcare: Humanizing healthcare (vol. 1); Whole person healthcare: Psychology, spirituality, & health (vol. 2) and Whole person healthcare: The arts & health (vol. 3). The Humanistic Psychologist, 36(3-4), 357-373.

Guenther, R. (2006). Healthy Environments. Contract, 48(10), 46.

Guenther, R. (2015). Building health. Architecture Boston, 18(4), 32-35.

Johanson, M., Larsson, U. S., Säljö, R., & Svärdsudd, K. (1996). Addressing life style in primary health care. Social Science & Medicine, 43(3), 389-400.

Jones, M. C., Wells, M., Gao, C., Cassidy, B., & Davie, J. (2011). Work stress and well-being in oncology settings: A multidisciplinary study of health care professionals. PsychoOncology, 22(1), 46-53.

30

GROUP 4 Keim, S., Klärner, A., & Bernardi, L. (2013). Tie strength and family formation: Which personal relationships are influential? Personal Relationships, 20(3), 462-478 Kelner, M., & Wellman, B. (1997). Health care and consumer choice: Medical and alternative therapies. Social Science & Medicine, 45(2), 203-212.

King, S. L., & Hegadoren, K. M. (2006). An integrative science approach: Value added in stress research. Nurs Health Sci Nursing and Health Sciences, 8(2), 114-119.

Lewis, D., Paterson, M., Beckerman, S., & Sandilands, C. (2001). Attitudes toward integration of complementary and alternative medicine with hospital-based care. The Journal of Alternative and Complementary Medicine, 7(6), 681-688.

Manwani, D. (2014). Effective workplace relationships and better productivity. International Journal of Organizational Behaviour & Management Perspectives, 3(1), 763-765.

McClafferty, H. (2011). Complementary, Holistic, and Integrative Medicine: Mind-Body Medicine. Pediatrics in Review, 32(5), 201-203.

Pettigrew, L. M., Maeseneer, J. D., Anderson, M. P., Essuman, A., Kidd, M. R., & Haines, A. (2015). Primary health care and the sustainable development goals. The Lancet, 386(10009), 2119-2121.

Pronk, N. (2012). An optimal lifestyle metric: Four simple behaviors that affect health, cost, and productivity. Health & Fitness Journal, 16(3), 39-43.

Ramirez, B., West, D. J., & Costell, M. M. (2013). Development of a culture of sustainability in health care organizations. Journal of Health Organization and Management J of Health Org and Mgt, 27(5), 665-672.

Reilly, P. M., Buchanan, T. M., Vafides, C., Breakey, S., & Dykes, P. (2014). Auricular Acupuncture to Relieve Health Care Workers’ Stress and Anxiety. Dimensions of Critical Care Nursing, 33(3), 151-159.

Robinson, A., Chesters, J., & Cooper, S. (2007). People's choice: Complementary and alternative medicine modalities. Complementary Health Practice Review,12(2), 99-119.

Robroek, S. J., Lenthe, F. J., & Burdorf, A. (2012). The role of lifestyle, health, and work in educational inequalities in sick leave and productivity loss at work. Int Arch Occup Environ Health International Archives of Occupational and Environmental Health, 86(6), 619-627.

31

GROUP 4 Sibinga, E. M., & Kemper, K. J. (2010). Complementary, holistic, and integrative medicine: Meditation practices for pediatric health. Pediatrics in Review, 31(12), 91-103.

Skinner, P. (2013). Holistic Medicine. Gale Encyclopedia of Alternative Medicine, (4th ed.) (pp.1162-1166). Detroit: Gale.

Tang, S. K., & Tse, M. Y. (2014). Aromatherapy: Does it help to relieve pain, depression, anxiety, and stress in community-dwelling older persons? BioMed Research International, 2014, 1-12.

Tham, R., Humphreys, J., Kinsman, L., Buykx, P., Asaid, A., Tuohey, K., & Riley, K. (2010).

Evaluating the impact of sustainable comprehensive primary health care on rural health. Australian Journal of Rural Health, 18(4), 166-172.

Tianuru, M. & Gitre, L. (1996).Get the Stress Out!: How one woman overcame the pressures in her Life – A holistic path that you, too, can take’, Essence, 26 (11).p.26 Van Scheppingen, A. R. (2014). Motivations for health and their associations with lifestyle, work style, health, vitality, and employee productivity. Journal of Occupational and Environmental Medicine, 56(5), 540-546.

VanWormer, J. J. (2011). Stress and workplace productivity loss in the heart of new ulm project.

Journal of occupational and environmental medicine, 53(10), 1106-1109.

Walsh, R. (2011). Lifestyle and mental health. American Psychologist, 66(7), 579-592.

Ventegodt, S., Kandel, I., Neikrug, S., & Merrick, J. (2005). Clinical Holistic Medicine: The Existential Crisis—Life Crisis, Stress, and Burnout. The Scientific World JOURNAL, 5, 300-312.

Wood, L. C., Wang, C., Abdul-Rahman, H., & Abdul-Nasir, N. S. (2015). Green hospital design: Integrating quality function deployment and end-user demands. Journal of Cleaner Production, 112, 903-913.

32

GROUP 4 APPENDIX Literature Review Outline 1. INTRODUCTION 1.1 Background 1.2 Research Question 1.3 Purpose Statement of Literature Review 1.4 Statement of Significance 2. LITERATURE REVIEW 2.1 Holistic Medicine 2.1.1 Definition & philosophy 2.1.2 Holistic medicine alternatives, treatments & techniques 1. Reiki 2. Yoga 3. Taichi 4. Meditation 5. Acupuncture 6. Chiropractic 7. Massage Therapy 8. Homeopathy 9. Aromatherapy 2.1.3 Holistic medicine vs conventional medicine and healthcare 2.2 Stress, Health & Well-being 2.2.1 Symptoms, signs, and causes 2.2.2 Holistic methods and techniques used to manage stress 2.3. Sustainability 2.3.1 Definition and facts 2.3.2 Procedural Sustainability 2.3.3 Regenerative Sustainability 2.3.3.1 Guidelines and principles 2.3.3.2 Sustainable Design 2.3.3.3 Regulations 33

GROUP 4 2.3.4 Sustainability vs healthcare 2.3.5 Principles of sustainable design & relationship to stress 2.4. Lifestyle, productivity, & personal relationships 2.4.1 Lifestyle balance & holistic approaches 2.4.2 How lifestyle, productivity, & personal relationships are related to you wellbeing.

2.4.3 Lifestyle changes and stress 2.4.4 Characteristics of healthy lifestyle 2.5. Designing a holistic center healthcare environments 2.5.1

Characteristics of a holistic center care facilities and its benefits

2.5.2

Stress patients’ perceptions and feelings toward holistic healthcare facilities 2.5.2.1 User’s expectations and needs

2.5.3

Designing features and spaces that contribute relaxing and stress-free environments.

2.5.4

A Holistic healthcare model

3. CONCLUSION

34

GROUP 4 READING LIST 1. Holistic Center and Procedures What is the philosophy of holistic medicine, and how can its treatments be used to help patients with high stress levels?

Gavin, A. J. (2013). Creating the right therapy vibe: Relational performances in holistic medicine. Social Science & Medicine, 83, 99-109.

Gordon, J. S., Md. (1982). Holistic Medicine: Advances and shortcomings. The Western Journal of Medicine, 546-551.

Gordon, S. (2008). Review of Whole person healthcare: Humanizing healthcare (vol. 1); Whole person healthcare: Psychology, spirituality, & health (vol. 2) and Whole person healthcare: The arts & health (vol. 3). The Humanistic Psychologist, 36(3-4), 357-373.

Kelner, M., & Wellman, B. (1997). Health care and consumer choice: Medical and alternative therapies. Social Science & Medicine, 45(2), 203-212.

Lewis, D., Paterson, M., Beckerman, S., & Sandilands, C. (2001). Attitudes toward integration of complementary and alternative medicine with hospital-based care. The Journal of Alternative and Complementary Medicine, 7(6), 681-688.

McClafferty, H. (2011). Complementary, Holistic, and Integrative Medicine: Mind-Body Medicine. Pediatrics in Review, 32(5), 201-203.

Robinson, A., Chesters, J., & Cooper, S. (2007). People's choice: Complementary and alternative medicine modalities. Complementary Health Practice Review,12(2), 99-119.

Skinner, P. (2013). Holistic Medicine. Gale Encyclopedia of Alternative Medicine, (4th ed.) (pp.1162-1166). Detroit: Gale.

Tianuru, M. & Gitre, L. (1996).Get the Stress Out!: How one woman overcame the pressures in her Life – A holistic path that you, too, can take’, Essence, 26 (11).p.26

2. Stress, Health, Well-being What causes stress, how does it affect people’s health and when does stress becomes a problem or an illness and what are some methods used to help people manage stress?

Avey, H. (2003). Health care providers' training, perceptions, and practices regarding stress and health outcomes. Journal of the National Medical Association, 95(9), 833-845.

35

GROUP 4 Beil, K., & Hanes, D. (2013). The influence of urban natural and built environments on physiological and psychological measures of stress— A pilot study. International Journal of Environmental Research and Public Health IJERPH, 10(4), 1250-1267.

Jones, M. C., Wells, M., Gao, C., Cassidy, B., & Davie, J. (2011). Work stress and well-being in oncology settings: A multidisciplinary study of health care professionals. PsychoOncology, 22(1), 46-53.

King, S. L., & Hegadoren, K. M. (2006). An integrative science approach: Value added in stress research. Nurs Health Sci Nursing and Health Sciences, 8(2), 114-119.

Reilly, P. M., Buchanan, T. M., Vafides, C., Breakey, S., & Dykes, P. (2014). Auricular Acupuncture to Relieve Health Care Workers’ Stress and Anxiety. Dimensions of Critical Care Nursing, 33(3), 151-159.

Sibinga, E. M., & Kemper, K. J. (2010). Complementary, holistic, and integrative medicine: Meditation practices for pediatric health. Pediatrics in Review, 31(12), 91-103.

Tang, S. K., & Tse, M. Y. (2014). Aromatherapy: Does it help to relieve pain, depression, anxiety, and stress in community-dwelling older persons? BioMed Research International, 2014, 1-12.

Ventegodt, S., Kandel, I., Neikrug, S., & Merrick, J. (2005). Clinical Holistic Medicine: The Existential Crisis—Life Crisis, Stress, and Burnout. The Scientific World JOURNAL, 5, 300-312.

3. Sustainability Does applying the principles of sustainable design benefit patients with high stress levels, and have a positive impact on behavior?

Anderko, L. (2013). Greening the ‘proclamation for change’ healing through sustainable healthcare environments. The American journal of nursing, 113(4), 52-59.

Coskun, A., Zimmerman, J., & Erbug, C. (2015). Promoting sustainability through behavior change: A review. Design Studies, 41, 183-204.

Guenther, R. (2006). Healthy Environments. Contract, 48(10), 46.

Guenther, R. (2015). Building health. Architecture Boston, 18(4), 32-35.

36

GROUP 4 Pettigrew, L. M., Maeseneer, J. D., Anderson, M. P., Essuman, A., Kidd, M. R., & Haines, A. (2015). Primary health care and the sustainable development goals. The Lancet, 386(10009), 2119-2121.

Ramirez, B., West, D. J., & Costell, M. M. (2013). Development of a culture of sustainability in health care organizations. Journal of Health Organization and Management J of Health Org and Mgt, 27(5), 665-672.

Tham, R., Humphreys, J., Kinsman, L., Buykx, P., Asaid, A., Tuohey, K., & Riley, K. (2010).

Evaluating the impact of sustainable comprehensive primary health care on rural health. Australian Journal of Rural Health, 18(4), 166-172.

Wood, L. C., Wang, C., Abdul-Rahman, H., & Abdul-Nasir, N. S. (2015). Green hospital design: Integrating quality function deployment and end-user demands. Journal of Cleaner Production, 112, 903-913.

4. Productivity, life style and personal relationships How can people improve productivity and relationships in their lifestyle, and how does behavior, ethics, lifestyle and holistic approaches influence these relationships?

Christiansen, C. H., & Matuska, K. M. (2006). Lifestyle balance: A review of concepts and research. Journal of Occupational Science, 13(1), 49-61.

Gieck, D. J., & Olsen, S. (2007). Holistic wellness as a means to developing a lifestyle approach to health behavior among college students. Journal of American College Health, 56(1), 29-35.

Guenther, R. (2015). Building Health. Architecture Boston, 18(4), 32-35.

Johanson, M., Larsson, U. S., Säljö, R., & Svärdsudd, K. (1996). Addressing life style in primary health care. Social Science & Medicine, 43(3), 389-400.

Keim, S., Klärner, A., & Bernardi, L. (2013). Tie strength and family formation: Which personal relationships are influential? Personal Relationships, 20(3), 462-478 Manwani, D. (2014). Effective workplace relationships and better productivity. International Journal of Organizational Behaviour & Management Perspectives, 3(1), 763-765.

Pronk, N. (2012). An optimal lifestyle metric: Four simple behaviors that affect health, cost, and productivity. Health & Fitness Journal, 16(3), 39-43.

37

GROUP 4 Robroek, S. J., Lenthe, F. J., & Burdorf, A. (2012). The role of lifestyle, health, and work in educational inequalities in sick leave and productivity loss at work. Int Arch Occup Environ Health International Archives of Occupational and Environmental Health, 86(6), 619-627.

Van Scheppingen, A. R. (2014). Motivations for health and their associations with lifestyle, work style, health, vitality, and employee productivity. Journal of Occupational and Environmental Medicine, 56(5), 540-546.

VanWormer, J. J. (2011). Stress and workplace productivity loss in the heart of new ulm project.

Journal of occupational and environmental medicine, 53(10), 1106-1109.

Walsh, R. (2011). Lifestyle and mental health. American Psychologist, 66(7), 579-592.

38

GROUP 4 ANNOTATED BIBLIOGRAPHY (Lyon) Sub-question 1: What is the philosophy of holistic medicine, and how can its treatments be used to help patients with high stress levels?

Skinner, P. (2013). Holistic Medicine. Gale Encyclopedia of Alternative Medicine, (4th ed.) (pp.1162-1166). Detroit: Gale.

Author’ Credentials: American Holistic Medicine Association.

Intended Audience: Healthcare professionals, conventional hospitals, holistic centers, scholarly researchers and the public.

Objective reasoning: This article is based on knowledge and credentials of a group of health professionals very well trained in the holistic concept. Their goal is to help transform conventional healthcare into a more holistic model.

Coverage: Holistic therapies, alternative medicine, conventional medicine and healthcare.

Writing Style: Formal

Summary of methodology: According with the author, “holistic medicine is a term used to describe therapies that attempt to treat the patient as a whole person.” (p.1162) Its main objective is to achieve optimal health, exanimating at an individual’s overall mental, spiritual, physical and emotional well being, before start to treat them. Holistic medicine differentiates from the orthodox allopathic medicine.

One of the differences between these two is that holistic medicine treats the patient “integrally”, while traditional medicine focuses more on specific diseases. The “integral” term refers to the evaluation and treatment of the patient in general. Many diseases and disorders can be treated holistically. The principle of holistic medicine is that individuals’ body, mind, spirit and emotions are in balance or in equilibrium, in this way the patient's health function effectively.

When an individual seeks comprehensive treatment for a particular disease or condition, other health problems without direct treatment improved due to the improved performance of the immune system, which is one of the objectives of holistic medicine. The purpose of holistic treatments is to treat the problem from its root and finding its true cause. This medicine focuses on people’s immune system, specifically in patients with particular diseases. This term is considered as an “imbalance in the body’s system” with the intention to improve other health problems.

39

GROUP 4 Although holistic medicine was discovered before the fourth century, it was in the 70s when it began to be recognized, when the Westerners began looking for alternative medicines. According to this article, Socrates was one of the pioneers in holistic medicine. He thought that treating just one part of our body would not have good result. Modern medicine has great advances and new discoveries, but the big difference with holistic medicine, is that modern medicine does not produce optimal health. Treatments in modern medicine are designed only to attack the disease without examining the entire human system. According to the authors, holistic medicine also helps control stress, but patients are responsible for this. They must learn to control their own body and be their own doctor. The good news is that holistic medicine teaches us how to learn to do this.

Findings 

The basis of holistic medicine is to understand the human being as a unit consisting of body, mind and spirit.



In holistic medicine, treatments are performed both modern and traditional.



Holistic medicine focuses on seeking a patient’s treatment and not on his or her condition or disease.



Holistic medicine is defined as a complementary or alternative therapy, which is based mainly on natural healing powers.



From the point of view of holistic medicine it is thought that each body is able to naturally heal a disease by itself.



Holistic medicine treats physical and psychological conditions. The psychological part deals with problems like stress, sleep problems, anxiety, depression or anxiety.

Quotations: “Treating one part of the body only would not have good result.” (p.1162) “An imbalance in the body’s system” (p.1162)

Relationship and potential application to the typology decision This article will help us understand the philosophy of holistic medicine and the principle of its practices, as designers of a holistic center, it is important to understand and to study the concepts and purpose of the project in order to design towards the right need and start evaluating the future program.

40

GROUP 4 (Lyon) Sub-question 1: What is the philosophy of holistic medicine, and how can its treatments be used to help patients with high stress levels?

Tianuru, M. & Gitre, L. (1996).Get the Stress Out!: How one woman overcame the pressures in her life – A holistic path that you, too, can take’, Essence, 26 (11).p.26

Intended Audience: Healthcare professionals, conventional hospitals, holistic centers, scholarly researchers and public.

Objective reasoning: This article is based on a personal true story of the author’s life experience, explaining changes in her life through the use of holistic medicine.

Coverage: Holistic therapies, alternative medicine, conventional medicine and healthcare.

Writing Style: Formal

Summary of methodology: This article relates the author’s experience on how a person named Maisha Tianuru suffered from high levels of stress. It also explains how following holistic medicine treatments helped her to heal.

Maisha felt that stress was consuming her life. Everything in her life, both personal and professional, was falling apart. Tianuru began to seek help through conventional medicine with doctors that did not really address the root of the problem, but instead, just focused on the treatment of the superficial disturbance without ever asking about her lifestyle or pressures that she could be under.

When she found out that stress was one of the main culprits of her whole illness, she began doing researches. She began to investigate alternatives to conventional medicine. However, it was not until she attended a health fair that she started heading on the road to wellness. She also became more self-aware that she needed to help herself with methods that allowed her to have control of her health through natural means.

She began by joining yoga groups, doing meditation, taking vitamins and herbs, going to acupuncture and even getting massage therapy. She changed her eating habits and began cleansing her system with a better nutritional diet. After trying these life-changing steps, she also started attending workshops that deal with holistic medicine. Having made all of these

41

GROUP 4 integrations into her new habits, Maisha began to enjoy a rejuvenated life, filled with the pleasures of a natural balance.

Tianuru now feels so enthusiastic and thankful for her new lifestyle. Because of these reasons, she decided to embark in a fully devoted career towards helping others find the true meaning of their illness, so that they may find true meaning in their lives. Tianuru became a naturopathic doctor. Thanks to the holistic medicine, her “days are essentially stress-free” and Misha Tiamuru has found peace and a life purpose.

Findings 

Stress can be cured or controlled by holistic medicine.



Yoga, meditation, acupuncture, massage therapy, vitamins and herbs are some of the holistic medicine alternatives.



Holistic medicine and its alternatives can help improve patients’ lifestyles.



Holistic medicine focuses on seek patient’s treatment and not on his condition or disease.

Relationship and potential application to the typology decision This article would help us as designers to start growing ideas of the different disciplines that holistic treatments can provide, such as yoga, meditation, acupuncture, massage therapy and herbs shop. Also, it would give us an idea of the target that would frequently visit the center and the reason of interests of why they could reach this alternative discipline.

42

GROUP 4 (Muino) Sub-question 1: What is the philosophy of holistic medicine, and how can its treatments be used to help patients with high stress levels?

Lewis, D., Paterson, M., Beckerman, S., & Sandilands, C. (2001). Attitudes toward integration of complementary and alternative medicine with hospital-based care. The Journal of Alternative and Complementary Medicine, 7(6), 681-688.

Author’s Credentials: This is a group of healthcare professionals dedicated to the study and research of alternative medicine and its integration with conventional medicine.

David Lewis, PhD Father Sean O'Sullivan Research Centre, Hamilton, Hamilton, Ontario, Canada Michael Paterson, MSc Department of Family Medicine, St. Joseph's Healthcare, Hamilton, Ontario, Canada Susan Beckerman, RN, MHSc, CHE Trillium Health Centre, Mississaugua, Ontario, Canada Charlene Sandilands, RN, BSc (N), MPA Trillium Health Centre, Mississaugua, Ontario, Canada Intended Audience: Healthcare professional, conventional hospitals, holistic centers and scholarly researchers.

Objective reasoning: This article is a study based on a mail survey in Ontario, Canada for which the objective was to characterize a group of people who have used, expect to use, or are opposed to the use of holistic therapies, in a conventional medical setting.

Coverage: Holistic therapies, alternative medicine, conventional medicine and healthcare.

Writing Style: Statistical and comparison, formal.

Summary of methodology: This article is based on a study through a mail survey applied to a group of residents at the Hamilton-Wentworth hospital in Ontario Canada.

According to the study, over one third of American has used “uncommon” care. By comparison with other studies (Eisenberg et al., 1993) (Berger, 1990; Millar, 1997) the reasons cited for this interest included awareness that traditional medicine focused on prevention is limited, costly or inefficient, or that it is strict and out of touch with patients’ values and beliefs about the essence 43

GROUP 4 of health. According to these researches and MEDLINE (bibliographic database of life sciences and biomedical information), some physicians use holistic techniques in their own practices as a complimentary procedure. MEDLINE also found no less than 766 randomized controlled trials of various holistic interventions between 1989 and 1997.

The purpose of this study was: 

To determine the proportion of Hamilton hospital residents who have used or will use holistic therapies in the future.



Analyze what and why some holistic therapies were and were not used.



Identify predictors of prior and future use of holistic therapy.



Characterized those who might be opposed to the use of holistic therapies in conventional hospitals.

Methods used for the study: This study was based on a mail survey conducted between March and June 1998 in HamiltonWentworth, Ontario. The group frame was a simple random sample of listed residential telephone subscribers.

The questionnaire asked about individuals self-perceived health status. It was followed by a group of questions regarding prior use of conventional and holistic health services and therapies, preventive health behaviors, health problems for which they used holistic therapies, opinions regarding the effectiveness of holistic treatments and likelihood of using holistic healthcare if it were available at a local hospital. There were sociodemographic questions related to age, gender, religion, ethnicity, employment, level of education and income. Twenty-five typical holistic therapies were listed, selected from the directory of New Choices in Natural Healing in MEDLINE and individuals were asked to indicate how often each was used in the previous year.

Those subjects who reported using any holistic therapy were categorized as “prior users.” Those who indicated that they would very likely use any holistic therapy were named “intended users.”

The ones that agreed with the term holistic medicine but stated that these kind of therapies should not been placed in a hospital were defined as “opposed”.

Based on a previous study the researcher estimated 35% of Hamilton-Wentworth area residents would report having used at least one holistic treatment in the previous year, so a minimum of 350 usable questionnaires were needed to detect the 35% proportion.

44

GROUP 4 

900 questionnaires were mailed.



240 (27%) were returned because of incorrect address, relocation or deaths.



660 questionnaires remained.



37% of respondents used at least one holistic therapy in the previous year (Table 2 pp.

684).

Findings: About of use of holistic therapies: 

Many used holistic therapies for general health and wellness. Use was most often for treatment than for prevention.



Most commonly, holistic therapy use was for fatigue, arthritis, muscle or back pain and emotional problems related with stress. (Table 3 pp. 684)



30% and 20% saw a chiropractor or use a massage therapist respectively, more than five times in the previous year.

About attitudes toward holistic therapy and its use in traditional hospitals: 

33% stated that were “very” or “some-what” likely to use a holistic treatment in the future.



Around 50% stated that they planned never to use a holistic therapy treatment (Table 4 pp. 685) because of lack of information, ineffectiveness and cost.



About 40% of respondents agreed that they would only use holistic therapies with the advice of a physician.



Roughly, 13% of individuals were opposed to holistic therapy. 5% of this group believes that hospitals using holistic health care practitioners are “unsafe”.

About factors associated with use of holistic therapy and objection to its use in hospitals (Table 6 pp. 686): Respondents’ prior use of holistic treatment was somewhat associated with: 

A younger age (less than or equal to 50 years old)



Post-secondary education.



Health problems that limit every day activities (i.e. walking and climbing stairs).



Being employed.

45

GROUP 4 

Very religious.

General results: 

44% would use holistic therapy in the future.



45% had used a holistic therapy at least once in the past year.



Lower income households (less than $40.000) self-rated as excellent or very good health were independently associated with negative attitude toward use of holistic treatment use in hospitals.



The proportion of Hamilton residents who used a holistic treatment in the previous year is similar to the United States as a whole (34%; see Eisenberg et al., 1993; Paramore, 1997) but lower than Australia (49%, see MacLennan et al, 1996).



In 1990, the most frequently used alternative therapies in the United States were relaxation techniques both chiropractic and massage (Eisenberg et al., 1993).



The most prevalent conditions treated in this study were fatigue, arthritis, muscle or back pain and emotional problems (stress).



Chiropractic, massage and herbal therapy were the most prevalent treatments in Hamilton. 20% reported at least one chiropractic treatment in the previous year; versus 15% in the US (Eisenberg et al., 1993).



In Hamilton, the five factors that were independently associated with residents’ prior use of holistic treatment were age, education, functional capacity, strength of religion and relative preference for holism.



According to the study, lack of information was perceived to be the major barrier to future use of holistic therapies.

Relationship and potential application to the typology decision As a designer, we know that the most important part of the design process is fulfill user needs.

This article provides us with information about the characteristics of a group of patients on the use of holistic treatments. Also, analyzes what and why some holistic therapies were and were not used. This information will help us in making decisions when designing the spaces that promote the most prevalent treatments. The results about social class, gender and desired social

46

GROUP 4 interaction study that the authors analyzed from their references would help us to specify the qualitative characteristics of the different spaces in the Holistic Center.

Quotations: “Most respondents would accept integration of holistic techniques into hospitals; therapies would be more acceptable if there were clear evidence of their efficacy”. (p.681) “Lack of information, availability and cost were perceived to be the major barriers to the future use of holistic therapies” (p.687)

47

GROUP 4 (Acosta) Sub Question 1: What is the philosophy of holistic medicine, and how can its treatments be used to help patients with high stress levels?

Kelner, M., & Wellman, B. (1997). Health care and consumer choice: Medical and alternative therapies. Social Science & Medicine, 45(2), 203-212.

Author’s Credentials: Institute for Human Development. Life Course and Aging, University of Toronto Intended Audience: Professional Healthcare, Physicians and Healthcare Providers Objective Reasoning: This article is an author’s opinion on the choice that a consumer can make on alternative medicine. It deciphers the complex issues that a consumer has to go through to find alternative therapies. The goal is to help people understand the different options that exist in the medical field.

Coverage: Healthcare, Physicians, Alternative therapies Writing Style: Formal

Summary of methodology A study was done to understand the factors that influence these decisions. There was a method that was done by using five different practitioners which use alternative medicine. Then many people were interviewed in person regarding their health problems and how they used health care services.

The results were that people make choices based on referrals to a particular practitioner, knowledge of available services, and a convenient location. A study revealed that chiropractic patients chose alternative therapy because of referrals from other patients

Findings: 

This article talks about the choices that people have when they chose their own medical procedures. Goldstein states that spread of New Age conceptions emphasize the unity of body, mind and spirit.



He then talks about how attitudes encourage people to make their own assessment of their overall health.



According to the article, people seek different types of practitioners such as chiropractors and Chinese doctors to find solutions to their problems.

48

GROUP 4 

It shows that referrals are the main reason for choosing a particular practitioner for patients of acupuncture and chiropractor.



Sometimes locations matters as well since people prefer not to travel long distances to get proper treatment. In addition, it is important to understand the ability for people to pay for their services since incomes vary between all types of consumers.



Sharma points out that personal recommendations from friends and family members help people choose specific practitioners.



Patients who use alternative medicine feel better once they find a practitioner that discovers their diseases.



The article explains how patients have become more responsible with their own health.

People have become more aware of the benefits of using alternative medicine.



It is important to have a holistic lifestyle and understand the benefits that it can create for everyone.



People more than ever are relying on alternative medicine because it gives them better options that hospitals cannot provide. People have different views on alternative medicine since they have strong beliefs.



People who use alternative medicine have serious health issues.



Prevention is a key factor that enables people to increase their overall health



Alternative medicine is important because it can help people find cures that a regular physician cannot prescribe



Physical and emotional health are important for people that seek help in alternative treatments

Relationship and potential application to typology decision:

The typology relates to the article selected because it gives importance to medical and alternative therapies that exist for consumers. The primary concerns are the medical attention that a consumer needs and how the design process can help benefit someone who is looking for a better alternative.

The responsibility of an interior architect is to further improve interior spaces that can contribute to an overall better experience for people who select alternative therapies as a medical choice.

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GROUP 4 Quotations: “By educating yourself regarding health and well-being, your body, what’s going on in your, and different health related issues, you can make the most appropriate decisions about your own health care” (p.204)

50

GROUP 4 (Muino) Sub-question 1: What is the philosophy of holistic medicine, and how can its treatments be used to help patients with high stress levels?

Gordon, S. (2008). Review of Whole person healthcare: Humanizing healthcare (vol. 1); Whole person healthcare: Psychology, spirituality, & health (vol. 2) and Whole person healthcare: The arts & health (vol. 3). The Humanistic Psychologist, 36(3-4), 357-373.

Author’s Credentials: Susan Gordon: Susan Gordon has a doctorate in philosophy of psychology, the history and mind body medicine from Research Center, San Francisco, CA and Say Brook Graduate School.

Her research combines reproductive endocrinology, existential-phenomenological psychology and cognitive neuroscience. Her interests span depth psychology, Asian thought, neurophenomenology, and the politics of 21st century healthcare. Susan is an adjunct professor of personality, biological and developmental psychology and the research director of Southbury Clinic for Traditional Medicines at National University, La Jolla, CA. Intended Audience: Healthcare professionals, nurses, college-level students, researchers, public health and patients.

Objective reasoning: This work presents a vision of healthcare for the future that honors the integrated person—mind, body, and spirit. The three volumes bring out the expertise of over 80 editors and contributors, who explore integrative methods and integrated person programs. Each has experience in some perspective of whole person health care.

Coverage: Complementary and alternative medicine, humanistic psychology & spirituality Writing Style: Analytic, conceptual, informative & formal.

Summary of methodology: This paper shows an analysis of the book Whole person healthcare by David Spiegel, M.D. of Stanford University, and Dean Ornish, M.D. of University of California. The book introduces three volumes, which introduce how Western and non-Western healing practices—including QiGong, meditation, yoga, music, art, and dance therapy—are being incorporated with contemporary Western medicine and psychology in hospitals and in contemporary healthcare facilities. Breaking research on this growing area is featured, as are perceptions by healthcare professionals who say the new studies are helping patients, and also helping professionals restore 51

GROUP 4 their ancient role as healers. Each focused, constructive and functional chapter includes a Tool Kit for Change, compiling major treatment points from a particular perspective. Examples of treatment protocols, funded programs, and training templates are included. Prevention and lifestyle are addressed, as are cures. This work presents a vision of health care for the future that honors the integrative person—mind, body, and spirit. All three volumes combined express the knowledge of many contributors that all explore these unique approaches and programs. Each has experience in some aspect of integrative person health care. Each volume demonstrates the utilization of mind-body-spirit therapies in a variety of contexts and settings.

Volume 1, humanizing healthcare: The first volume presents the challenges of prevalent health concerns and health behaviors, lays the foundation for the practice of integrative therapies, and gives guides for practitioners in whole person health care.

Volume 2, psychology, spiritually and health: The second volume focuses on implication in illness; the part of the psychological, cognitive, and spiritual aspects of health; and the partnering of healthcare institutions with resorts, spas, and residential communities.

Volume 3, the arts and health: The third and final volume introduces the history and ritual in healing and practices of art. Each chapter wraps up with a Tool Kit for Change from participant, professional, and overall contexts. Although other works on holistic care are available, none provides the comprehensive scope of this set. Referenced and extensively researched, it includes helpful graphs, tables and figures.

Findings: 

Whole Person Healthcare should influence all health professionals concerned with the research and application of integrative approaches, patients searching to empower themselves, and health care policy makers.



Readers can use this book to acquire new skills.



The book will prompt practitioners to pay attention to the integrative person, which in turn should result in better care.



Integrative Medicine may be more suitable for libraries with smaller budgets.



Examples of funded programs, training templates, and treatment protocols are included.

Prevention and lifestyle are addressed, as are cures.

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GROUP 4 

In this set of books, experts from over the country, at the forefront in their fields, define how, how extensively, and why healthcare is changing to consolidate complementary practices, from QiGong, meditation and yoga, to music, art, and dance therapy.



The new approaches are not only helping patients heal, but also helping professionals restore their ancient roles as healers of body, mind, and spirit.

Relationship and potential application to the typology decision The information in this article will be help us to understand a new vision of healthcare related to the integrated person—mind, body, and spirit. These approaches will help us to better understand meditation, yoga, music, art, and dance therapy among other therapies and how they are being incorporated with contemporary Western medicine and psychology in hospitals and in contemporary healthcare facilities.

Endorsements: "Whole Person Healthcare is a glimpse into the future of healing. It is a magnificent effort, bringing together authorities who have made landmark contributions in fashioning a form of healthcare that honors all we are--body, mind, spirit. These volumes demand our attention, because no other approach to healing deserves to be called scientific or humane."—Larry Dossey, M.D., author of The Extraordinary Healing Power of Ordinary Things

"This three-volume set is a complete and useful guide to empowering the learner to provide whole person care. The authors and editors have done an excellent job taking an often gray subject and applying expertise to make it useful and practical. The work will help us prepare for the health care of the future, which will be whole person and healing oriented."—David Rakel, M.D., Director, UW Integrative Medicine, University of Wisconsin Medical School

"This ground-breaking collection edited by Ilene Serlin brings to full realization a remarkable new phase in the reunion of mind, body, and spirit."—Alan Combs, author of The Radiance of Being

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GROUP 4 "These volumes provide a thoughtful and comprehensive overview of what we now know about the ways our thoughts and feelings, the world we live in, and the way we approach it, can contribute to the progression of the illnesses that beset us. Its distinguished contributors also show us how we can use music, art, dance and, even more important, the creative power of our imagination and the blessings of spirituality, to improve our health and enhance our lives."— James S. Gordon, M.D., Chair, White House Commission on Complementary and Alternative Medicine Policy (WHCCAMP), Director, The Center for Mind-Body Medicine

54

GROUP 4 (Darzi) Sub-question 1: What is the philosophy of holistic medicine, and how can its treatments be used to help patients with high stress levels?

Gavin, A. J. (2013). Creating the right therapy vibe: Relational performances in holistic medicine. Social Science & Medicine, 83, 99-109.

Author’s Credentials: Professor Gavin J. Andrews worked on the chair of the Department of Health, Aging and Society. He has a BA Honors in Geography, a Ph.D. in Medical Geography and a Thesis in Private residential and nursing care for older people. He also has a great number of articles and journals published.

Intended Audience: This article is for therapists, and designers.

Objective reasoning: The author is trying to explain how important is creating the right therapy vibe in an interior space by understanding how holistic medicine works, how the procedures, and how the body and objects or material things work together. With over sixty references methods and findings this article has a great support. By breaking down this article into topics the authors explained well how the mind and body can work well if the space that the holistic medicine will be practiced is well designed. This is a fact based article.

Coverage: Holistic wellness, health, and interior design.

Writing Style: Formal

Summary of Methodology The author researched about the holistic medicine and how it is the practice between the therapists and patients. Then used methods to describe embodied happenings in the space and time, and through it define details of the practice and how the space can affect the therapy or how people feel, and how a well interior design can help with the healing process.

The methodology used was observing different therapists, asking them questions, and taking notes about what they said and what was observed. Things to be observed were how the therapies worked, such as if was a massage, a relaxing music section, a mental healing, selfunderstanding, and others therapies; understand how objects may or may not affect the patients, and the interior design of each space can give a different perspective to patients and even therapists once they walk in those spaces.

55

GROUP 4 Findings: 

Holistic therapy can be worked through physical spaces and imaginal spaces.



Materials items and people come from different times, places and therapies what can occur as an interactive outcome, spacing and timing.



Create a ‘moment’ or ‘momentum’ feeling when patients and therapists walk in to a space. For example placing an interior design feature that can create a ’moment‘, such as a wall with waterfall fixture and rocks, that can bring natural feeling, and with the sound of the water falling can bring relaxation.



The use of warm colors can capacitate a healing process.



The use of natural fibers, such as linens is great for the bodywork.



Décor of a calming nature will bring more sympathy in the soul that comes from the core.



Create desired practice environment, which means thinking about how the body and its appropriate positions are important.

Relationship and potential application to the typology decision: This article explains how is important is the interior design to help with the holistic medicine process. In fact, there are different techniques used in holistic medicine that as interior designers we must take into consideration, such as, space planning, for example: how can we incorporate privacy in a classroom for yoga? Another important factor would be the objects placement, where would we place all objects used for the holistic medicine practice? Music has also an important whole, some of the practices use music to help on the relaxation, so how would we design a space where we can separate different type of music without the clients listen two different types at the same time, or how should we separate the music from the quiet space.

Those are some factors that after reading this article should be considered.

Quotations: “Conventional thought is that holism involves an acknowledgement that mind, body and various social systems are deeply interconnected and need to be considered as one – as the sum of their parts.” (p.107)

56

GROUP 4 (Acosta) Sub Question 1: What is the philosophy of holistic medicine, and how can its treatments be used to help patients with high stress levels?

Gordon, J. S., Md. (1982). Holistic Medicine: Advances and shortcomings. The Western Journal of Medicine, 546-551.

Author’ Credentials: James Gordon Medical Doctor. Advances and Shortcomings. National Institute of Mental Health. Washington DC. Intended Audience: Medical Providers, Holistic practitioners, Alternative Medicine Objective Reasoning: This article tries to explain how holistic medicine is a better approach than traditional healthcare. The holistic approach is a method which helps people with problems that regular health practitioners cannot solve. It helps explain the relationship that a doctor and patient have in the medical office.

Coverage: Holistic Health, Philosophy and Medical Writing Style: Informative

Summary of Methodology This article talks about how holistic medicine has become an alternative to conservative health care and how it is changing people’s attitude toward society. It focuses on the holistic approach that people take when it comes to using the health care system. The rapid rise of the holistic system is important because it involves a more spiritual and psychological healing than other types of medicine. It is important because it involves the use of therapeutic approaches that ease stress in people. The review explains the main differences between alternative medicine and private health care. It talks about how patients are diagnosed with different illnesses. The article gives an explanation on how holistic practitioners are learning various techniques to help people live better lives and reduce overall stress levels.

Findings: 

The article showed how holistic approaches toward health care are an important factor to live an overall better life.



Physicians are now looking for better ways to combine traditional and alternative health care in a way which can improve better health care in people.

57

GROUP 4 

Many practitioners have been able to treat patients by use of acupuncture and massage therapy. The traditions of ancient healing are important since they help in the healing process of many patients.



It is important to understand that holism is a new form of treatment that is starting to become popular among many physicians.



It is important to evaluate how a holistic perspective toward health care can help people live better lives.



According to the American Holistic Medical Association, seminars and retreats have become increasingly popular since they support humanistic medicine.



It is important to address new methodologies and create conceptual frameworks that can support individual treatments. People are becoming aware that alternative medicine is a better way to seek attention their medical needs. Holism has always been linked to healing.



According to the article, a young asthmatic adolescent may be treated in a group that runs several miles a day, while other may be treated by family therapy.



The article revealed how taking standardized tests which focus on social adjustments help show patients their habits, attitudes, and expectations on how they live, think and work.



Another finding was how physicians have studied other cultures to get an understanding of how acupuncture influences holistic elements.



Many physicians agree that holism has changed the way people perceive healthcare.



Another method holistic practitioners have used is to focus their work through public advocacy and public education programs.



In the meantime, there is strong support to start holistic medicine and wellness programs through a variety of socioeconomic groups.



Holistic medicine is increasingly becoming popular in mainstream society since it is a healthier alternative than going to a regular physician’s office.

Relationship and potential application to typology decision: The article relates to the typology selected because it focuses on the holistic approach that traditional medicine does not provide. The main concerns are to find ways to improve on the lack of alternative programs that exist when people seek treatment for various ailments. One of the main responsibilities of the interior architect is to develop a strategic plan by using sustainable 58

GROUP 4 materials in hospitals that are usually under developed. It is important to recognize the interior decoration and find ways to improve the overall medical experience for patients.

Quotations: “Holistic medicine includes the promotion of heath and the prevention of disease and emphasizes the role of education in the process.� (p.548)

59

GROUP 4 (Muino) Sub-question 1: What is the philosophy of holistic medicine, and how can its treatments be used to help patients with high stress levels?

Robinson, A., Chesters, J., & Cooper, S. (2007). People's choice: Complementary and alternative medicine modalities. Complementary Health Practice Review,12(2), 99-119.

Author’s Credentials: Anske Robinson: Dr Anske Robinson undertakes graduate and postgraduate education at the Monash University School of Rural Health, Department of Rural and Indigenous Health (MUDRIH). Her areas of teaching are health research methods, health care for communities, Indigenous Health, and health, knowledge and society. She has a Doctor of Philosophy (PhD), graduating in 2007. Her PhD, completed at Monash University, explored the use of complementary medicine within a diversity of communities. Supervision of HDR students is also part of her teaching role. She has over 30 publications and is engaged in research projects and collaborations focusing on the scholarship of learning and teaching research methods, healthy ageing, care giving for older adults and the use of complementary medicines and its diversity.

Current graduate research supervision areas include medical education, healthy ageing, culture and well-being, and complementary medicine.

Janice Chesters: Janice has broadened her career beyond her PhD interest in rural mental health research to investigate rural workforce issues, theoretical and applied medical education, Indigenous health, rural health in general and health and medical sociology. Janice’s teaching and publications have been able to highlight the complexity and diversity of rural places, and to move beyond a paralyzing negativity about rural health to recommend better ways of working with rural people and delivering better rural health services. Janice is currently Associate Professor and Deputy Director at the Monash University Department of Rural and Indigenous Health in Moe Victoria.

Simon Cooper: Associate Professor Simon Cooper, PhD, Med BA., RGN.FHEA is a registered nurse with a management degree, a Master’s in education and PhD in resuscitation leadership.

He has worked in critical care departments, as a Resuscitation Officer, Head of Education for an ambulance service, and in academia in the UK. Since 2008, he has been at Monash University, Australia where he is currently Head of the School of Nursing at Berwick Campus, Melbourne.

His academic interests focus upon the first hour of emergency care, leadership, teamwork, 60

GROUP 4 education and clinical simulation. He has extensive experience in curricula design and innovative teaching approaches in research methods, clinical skills and assessment methods.

Intended Audience: Healthcare professionals, nurses, students, researchers, and patients.

Objective reasoning: The objective of this study is to describe and discuss the diversity of complementary and alternative medicine (CAM) use in communities. This article details not only on the respondents’ overall complementary and alternative medicine use but goes on to describe the analysis of the usage of 23 individual CAM modalities as well as the beliefs, concerns, and characteristic of the CAM users.

Coverage: Complementary and alternative medicine, health care behavior and healthcare beliefs.

Writing Style: Research, conceptual, informative & formal.

Summary of methodology: A mailed survey was used to obtain data on the modalities used and the beliefs, concerns and characteristics of the respondents that influence their complementary and alternative medicine use. The mailed survey was chosen for the data collection method as the questionnaire was lengthy, and this format gave respondents ample time to consider their responses. Seven localities –two metropolitan and five rural- in Victoria, Australia were selected to provide geographic and socioeconomic diversity. The two metropolitan localities were coded as Portelli, a locale of high socioeconomic status, and Bluette, a locale of low socioeconomic status. From each locality, 200 people were selected using an electronic telephone directory. 1,308 surveys were mailed. Respondents completed and returned 459 surveys –response rate of 40%.

Another 11.76% were returned undelivered. There were no responses from 695 people; 14 people called or sent a note with an apology for not responding and another 5 people returned the survey in the reply paid envelopes but did not respond any questions. The sociodemographic characteristic of the respondents were as follows: 68% female; 29% university educated, 19% technical for future education; 31% earned below $25.000, 29% earned $25,000 to $50,000, and 34% earned $50,000+ per year; 22%were between the ages of 18 and 39, 44% to 59 years of age and 32% were more than 60 years old. From the overseas born respondents, 10% were from the United Kingdom, New Zealand, Canada, and the United States, 4% from Eastern Europe and 2% from Asia.

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GROUP 4 The dependent variables in the questionnaire were the complimentary or alternative modalities used. Twenty-two individual modalities not usually provided in conventional medical practices were included. Information about use or likelihood of use was requested for the following: aromatherapy, acupuncture, chiropractic, Bowen therapy, chelation therapy, homeopathy, magnet therapy, herbalist, kinesiology, osteopathy, massage therapy, naturopathy, meditation, reflexology, Reiki, shiatsu, prayer, spiritual healing, traditional Chinese medicine, tai chi and yoga. Scales were developed for seven concepts encompassing beliefs in what we have called holistic health care. These concepts were labeled as holistic healthcare beliefs as they cover beliefs about the role of nature and science in healthcare as well as individual, societal, and healthcare provider responsibilities. Six other scales were developed to explore characteristics considered to be more or less prominent in rural people: indifference, resilience, social capital, spiritualism healthy nutrition and stress. These characteristics were thought to be more prevalent in rural people because of findings from research on rural society and popular myths about rural people (Dade-Smith, 2004),. The respondents were asked to rate from a level of 1 (strongly disagree) to 7 (strongly agree) their responses to each of the statements.

Findings: 

52% of the respondents indicate that they were current users of a complementary and alternative medicine modality.



Lifetime use of at least one complementary and alternative medicine modality was 85%, whereas another 6% who had not used any modalities that they would probably use one or more CAM modalities in the future.



Only 9% of the respondents reported that they were not interested in using complementary alternative medicine.



More than half of the respondents (58%) had used three or more modalities.



Chiropractic and massage therapy were the modalities with the highest reported lifetime use.



Some form of herbal, vitamins or mineral supplements and prayers were also popular.



Aromatherapy, naturopathy, meditation and acupuncture were the next most popular modalities. They were used in similar amount (25% to 30%).

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GROUP 4 

Only three modalities-hypnotherapy, chelation, and shiatsu- were used by less than 10% of respondents.



The holistic healthcare beliefs of the Natural Remedy users were very strong.



Women were much more likely to use the Natural Remedy and Wellness modalities than men.



The two younger age groups, (18-39 & 40 -59) used a much wider range of modalities than the 60+ age group.



Higher levels of education were strongly associated with the use of many complementary and alternative medicine modalities. Overall, the users of the Natural Remedy and Wellness modalities were much more likely to have higher levels of education.



Respondents with the highest income ($50,000) were significantly more likely to use only one modality (homeopathy) than the mid-income group ($25,000 to $50,000).

However, they were significantly more likely to use half of the modalities than the lowest income group (under $25,000). There was no pattern in the results to indicate that cost was a major factor in the differences.



The study explores the relationship between complementary and alternative medicine usage and characteristics commonly associated with rural people. There is a little research available on the relationship between these characteristics and healthcare behavior.



The respondents indicated that complementary alternative medicine modalities were often used because of a healthcare problem. The Natural Remedy modalities of homeopathy, naturopathy, and herbalism were often chosen for chronic health problems, such as headaches and migraines, women’s health problems of fertility and hormone imbalance, or mental health problems of stress anxiety, and depression.



Many of the respondents indicated that they used complementary alternative medicine for wellness or well-being issues. In this instance, they mostly used one of the wellness modalities. Modalities such aromatherapy, yoga and meditation were chosen.

Research limitations/implications: One limitation of this study is that the 40% responses rate is not fully representative of the localities surveyed.

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GROUP 4 Conclusions: This study concludes that the respondent’s decisions were not about whether to use complementary alternative medicine but about which modality to use. The study provides and understanding of the way in which people take individual responsibility for their healthcare through choosing a complementary alternative medicine modality that they believe meets their healthcare needs and is in accord with their beliefs and values. The researchers conclude that there is a need for practitioners of conventional medicine to move on from the notion of complementary alternative medicine as a generic concept and understand the beliefs, values, information and healthcare knowledge that lead people to use different modalities.

Relationship and potential application to the typology decision: This study made a research about complementary alternative medicine and provides and understanding of the way in which people take individual responsibility for their healthcare through choosing a complementary alternative medicine modality that they believe meets their healthcare needs and is in accord with their beliefs and values. This information will help us to understand the possible users of our Holistic Center and what are the procedures or techniques that they prefer according to the condition type.

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GROUP 4 (Acosta) Sub-question 2: What causes stress, how does it affect people’s health and when does stress becomes a problem or an illness and what are some methods used to help people manage stress?

Beil, K., & Hanes, D. (2013). The Influence of Urban Natural and Built Environments on Physiological and Psychological Measures of Stress— A Pilot Study. International Journal of Environmental Research and Public Health, 10(4), 1250-1267 Author’ Credentials: Associate Professor, School of Research and Graduate Studies, National College of Natural Medicine, Portland, OR Intended Audience: Adults within the age range of 20-61 Objective reasoning: This article studied the various stress levels that occur in adults when exposed to different environmental settings. It shows how the natural environment affects people’s moods, thought processes and their overall general health.

Coverage: Environmental Health, Stress, Physiological–Physiology Writing Style: Formal style

Summary of methodology: A study was performed to evaluate the way stress affects people. Salivary analysis helps measure the way the body responds to life’s daily stressors. People tend to have different levels of stress when they are subject to problems. It is important to determine how natural settings can be helpful in finding ways to alleviate stress. There have been various methods to describe how stress plays a vital role in everyday lives. For example, experimental designs were conducted where certain participants were asked to not use any electronic devices for a certain period of time. At the same time the participants were taken to environmental settings and told to sit down and look at their surroundings without communicating with anyone. The settings were divided into four categories: very natural, very built, mostly natural and mostly built. Then they were evaluated using a variety of methods. One of the methods used was the Perceived Stress Scale which measures a person’s response to stress that happens within a certain time period. Everyone had about the same stress levels when they arrived at the setting. The most important setting was the very natural setting because it allowed for researchers to gather valuable data between other settings. The results were alarming because people who lived in mostly built had high cortisol levels. On the other hand, 65

GROUP 4 natural urban environments are important to recognize since they create a more sustainable form of living. Also, the studies revealed that women and men respond to their natural environments differently. It looks like men can handle stress better in the mostly built environment. It details that women are most likely to handle situations better in a relaxed natural setting because they feel more comfortable. It is important to understand that sustainability in urban design can help improve personal relationships, health and a better standard of living for many people. It is important to learn the various factors that affect stress levels such as noise, physical surroundings, temperature, and memories of certain events to get a clear understanding of why people react different under stress.

Statistical findings reveal that stress changes after 20 minutes exposure to environmental settings: Setting

Gender

Very Natural

Male

-0.88

Female

-1.26

Male

-0.33

Female

-0.48

Male

-0.60

Mostly Natural

Mostly Built

Female

Very Built

Stress levels

0.89

Male

-0.02

Female

-0.47

This table shows the various stress levels that occur when people are subject to different environmental settings. It shows that there is gender differences between men and women when it comes to stress levels.

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GROUP 4 Findings: 

According to the article, urban natural environments and built environments influence a person’s well- being. It is important to understand that exposure to natural environments can help reduce stress in someone.



Urban design is important because rising populations are continuing to grow and there is a need for a better lifestyle. As an urban designer it is important to understand the relationship between building spaces and an emphasis on the population’s health.



It is essential to create natural green spaces that will allow for a better lifestyle within a community.



Stress is a factor that affects many people and causes many physical and emotional impacts on everyday life. It is important to understand the relationship between stress and our natural environment.



All participants were subject to a saliva test after their environmental exposure



The study revealed that cortisol levels increased when people were shown the very built environment



Very Natural Setting was seen as beneficial to people’s overall health



The most significant stress levels occur between the very natural and the mostly built settings



Gender differences have different outcomes in relation urban design



Variables such as the collection of salivary data provided detailed analysis of how stress levels occurred.

Relationship and potential application to typology decision: The article relates to the typology because it shows how people react to different natural environments. The primary concern this article addresses is to show how certain places affect people’s stress levels. The article gives many details of how designers can add natural light to their own spaces or interior settings. Research has shown that high levels of stress can gave negative effects on our health. As a group we have made the decision that our typology will focus on reducing stress levels in the urban environment. The responsibility of the interior architects is to design places that create a comfortable and inspiring working environment for many people.

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GROUP 4 Quotations: “ Conducting an experimental field study introduces the potential for exposure to non-extraneous variables, preventing attribution of study findings to the dependent variable and making it impossible analyze the validity of stress” (p.11,48).

“The gender differences in outcome measures support previous evidence suggesting women and men respond to environmental settings differently” (p.44-46).

Conclusion: The article was very informative because it shows the different stress levels that exist in environment. It is important to understand how urban design can influence sustainability and the ways it can impact the lives of people. This article has inspired me to become more environmental conscious when designing an urban setting.

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GROUP 4 (Acosta) Sub-questions 2: What causes stress, how does it affect people’s health and when does stress becomes a problem or an illness and what are some methods used to help people manage stress.

Jones, M. C., Wells, M., Gao, C., Cassidy, B., & Davie, J. (2011). Work stress and well-being in oncology settings: A multidisciplinary study of health care professionals. PsychoOncology, 22(1), 46-53.

Author’s Credentials: School of Nursing and Midwifery. Alliance of Self Care Research.

University of Dundee Intended Audience: Health care Providers and Physicians Objective Reasoning: This studied the relationship of work stress and emotional distress that occurs in health care professional settings. It talks about how oncology workers are suffering from severe stress levels and what can be done to reduce the workload. The article is based on research that was done on employees to figure out what triggers various stress levels in their daily routines.

Coverage: Health care, Oncology Practitioners.

Writing Style: Formal

Summary of methodology A study was done to predict how people react to certain stressors that occur in the workplace.

According to the article, 85 staff members gave their responses in regards to work stress and job satisfaction. Work stress management in a hospital is important because it helps stop medical errors and malpractice that can result in litigation and legal issues for hospitals. There is a demand for people who work with cancer patients. It important to train people who can specialize in grief counseling and bereavement. The study of the oncology staff showed that older people tend to have lower satisfaction in their jobs. In addition, it shows that females score higher on self -report measures.

Findings: 

The article talks about the differences between perceptions of work, environment emotional distress and job satisfaction that occurred in a group of oncology staff.

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GROUP 4 

Jones states occupational stress occurs when people place too much emphasis on work and do not live a balanced life. This occurs in many places where there are no support groups that help staff members cope with the stress of daily life.



It is important to find out what triggers such emotional distress in employees. There are many factors such as job satisfaction, vacation time, and personal development which help reduce stress in the workplace. It is important to understand how the work environment affects people’s stress levels.



The article explains that there is a strong relationship between emotional distress and satisfaction. The article tries to show how the oncology staff responded to emotional demands that led to an overall lower job satisfaction rate.



There are certain characteristics that occur when people have stress at work. These could be a loss of appetite, rudeness, poor performance and job dissatisfaction. These factors occur in medical office practitioners that specialize in oncology.



There was a strong link between sickness and emotional distress in an oncology office. It showed that people who called out sick had very little support from other people.



Many participants did not report missing many days at work.



Sick days were used for work related stress



The study found out that many people thought about leaving their employer.



Support staff were on hand to deal with stress related issues.



There needs to be an improvement in communication in all levels of an organization

Relationship and potential application to typology decision: The article relates to the typology selected because health care professionals need to find ways to avoid burnout on the workplace and live a more balanced life that can benefit their health. The needs and wellness of the employees is the main concern since there is a lack of productivity that may occur when people are not happy in the workplace. The responsibility of the interior architect is to improve the working conditions by designing places that create a relaxed atmosphere. This can be achieved by using natural light or making the work environment more sustainable.

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GROUP 4 Quotations: “There is a need for additional research to develop and evaluate effective interventions to limit work environment stressors and reduce emotional distress at work�. (p.16)

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GROUP 4 (Muino) Sub-question 2: What causes stress, how does it affect people’s health and when does stress becomes a problem or an illness and what are some methods used to help people manage stress?

King, S. L., & Hegadoren, K. M. (2006). An integrative science approach: Value added in stress research. Nurs Health Sci Nursing and Health Sciences, 8(2), 114-119.

Author’s Credentials: Shirley L. King: Graduated as a registered nurse (RN) from Lowell General Hospital in 1955.

She attended Providence-Barrington Bible College in 1956.

Kathy M. Hegadoren: Dr Kathy Hegadoren is a professor in the Faculty of Nursing and holds a Canada research chair in Stress Disorders in Women. She has been involved in mental health in the Edmonton region for more than 30 years. Most of her clinical background involved inpatient psychiatric programs. She has also worked as a mental health consultant for Alberta Health. Her academic background includes an MSc in Neurochemistry, a PhD in Medical Sciences from the University of Alberta and a Postdoctoral Fellowship in molecular pharmacology.

Intended Audience: Mental health professionals, nurses, students, researchers, and teachers.

Objective reasoning: This article is a comprehensive discussion or approach of all stress theories, strategies, measurements and stress related problems. Specific examples are incorporated for illustrative purposes.

Coverage: Health, integrative, nursing, research, stress.

Writing Style: Informative, statistical research and comparison, formal.

Summary of methodology: This article is a comprehensive discussion or approach, made by a group of nurses on the theories, strategies, and measurements of stress related problems. The purpose of this approach is to understand stress, providing a new direction for nursing research and to be a requisite for delivering responsible, safe and holistic nursing care. Specific examples are incorporated for illustrative purposes.

This article is based on the analysis and discussion of the theories related to stress. The analysis begins with some definitions and concepts related to integrative science, stress as a phenomenon of interest to nursing, and some cognitive and physiological approaches to understand stress.

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GROUP 4 By integrative science, the authors mean the “intellectual strategies that scientist employ to spam disciplinary or knowledge barriers so as to more fully study and understand human phenomena.”

They suggest that stress is a circumstance that lends itself well to an integrative science approach. Stress as it relates to illness has been studied by a variety of disciplines with differing research traditions. Two research traditions, cognitive and physiological, were discussed as an example of how two different traditions contribute importantly, but differently to the understanding of the relationship between stress and illness. The discussion included the importance of integrating the knowledge about stress derived through research by multiple disciplines for a more complete and holistic understanding of stress and its effects on human health and well-being.

The authors explained that cognitive approaches to understand stress focus primarily on the role of emotional responses, appraisal and coping strategies in determining vulnerability to help problems (Cohen et al., 1997), According to the authors, physiological approaches to understanding stress focus on the activation of biological stress systems in responses internal stimuli or environmental threats. The primary pathway on physiological approaches linking stress to illness involves hormonal, immune and neuronal systems (Cohen et al., 1997).

Findings: 

Stress can affect all aspects of human experiences, including food intake and digestion, exercise, learning, motivation, attention, work, mood, sleep and social relationships.



Preventing or attenuating the potentially adverse effects of stress on health is a critical challenge.



Because of their role, Nurses can identify people who are at increased risk of stressrelated health problems and helping them to avoid or reduce the potentially negative consequences.



Interpersonal interactions, new events, caffeine intake, time of day or year, personality, psychiatric disorders and mood are factors that can potentially influence stress responses.



The primary pathway that links stress to illness from the cognitive perspective is having poor resources to manage the current stress and can lead to helplessness and

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GROUP 4 hopelessness, as well as to poor health increasing smoking, alcohol or substance use, poor diet, lack of exercise and disturbed sleep (Cohen et al.1997). 

Nurses might have insufficient knowledge to provide truly holistic care, particularly for the serious ill.



A holistic approach to care must encompass the biological, as well as the psychological and social aspects of being human.

Conclusion: Complex health problems and experiences can be better understood from integrative science perspective. Stress and its relationship to illness is one example of a phenomenon that can be understood more fully from integrative perspective. An integrated approach to understanding health-related stress is imperative for safe, responsible and holistic nursing practice.

Relationship and potential application to the typology decision This article would be used as a support of the design ideas that we would use in the development of the “Holistic Center”. We would considered the nursing research and opinions about the approach of all stress theories, strategies, measurements and stress related problems. Nurses can identify people who are at increased risk of stress-related health problems and help them to avoid or reduce the potentially negative consequences. Therefore, we would also considered the nurse experts suggestions and recommendation.

Quotations: “Cognitive and Physiological frameworks and research traditions have contributed much to our understanding of stress and how stress influence health and disease processes” (p.115)

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GROUP 4 (Lyon) Sub-question 2: What causes stress, how does it affect people’s health and when does stress becomes a problem or an illness and what are some methods used to help people manage stress?

McClafferty, H. (2011). Complementary, Holistic, and Integrative Medicine: Mind-Body Medicine. Pediatrics in Review, 32(5), 201-203.

Author’s Credentials: Assistant Director of the Fellowship, Arizona Center for Integrative Medicine, University of Arizona Health Sciences Center, Phoenix, AZ. Intended Audience: Healthcare professional, conventional hospitals, holistic centers, parents, pediatricians and scholarly researchers.

Objective reasoning: The author states the different modalities within the Min-Body Medicine that can help children from stress and chronic conditions. Also, the article explains the encouragement that exits towards pediatricians to consider this type of medicine in their future practice.

Coverage: Holistic therapies, alternative medicine, conventional medicine and healthcare.

Healthcare design and pediatric practices.

Writing Style: Formal.

Summary: Children can be affected by stress and chronic conditions, such as migraine, abdominal pain, cancer, anxiety, asthma, arthritis, and dysfunctional voiding. According with McClafferty, there are several effective treatments within the Mind-Body Medicine that can help to achieve a state of calm and reduce these conditions. The author has found that this type of medicine should be integrated in pediatric care, encouraging children to become active practitioners of these alternative therapies. Furthermore, this medicine has no risk and its treatments are cost-effective.

There are different modalities which pediatrics has taken into practice in order to support evidence of the treatment’s benefits. Among these are: biofeedback, hypnosis, guided imagery, mindfulness, music therapy, and yoga. These therapies have similarities, they all can treat diseases such as: “chronic pain, anxiety and stress, dysfunctional voiding, constipation and encopresis, sleep disorders, habit disorders, attention-deficit/hyperactivity disorder (ADHD), asthma, obesity, diabetes, inflammatory bowel disease, irritable bowel syndrome, and cancer.” (p. 201) 75

GROUP 4 Between the modalities, there is Biofeedback. According with the author’s research, it is the most used therapy for pain management since it is painless and uses child-friendly tools, games and pleasing graphics that allow children to obtain self-regulation skills in the process.

McClafferty states that this method is very successful also in children that suffer from ADHD. Another method is Hypnosis. It is defined by the author as “an altered state of consciousness, usually involving relaxation, in which a person develops heightened concentration on a particular idea or image for the purpose of maximizing potential in one or more areas.” (p.202) This method involves imagery guidance, which is very friendly for children of the ages between 2 and 3 years, due to their wide imagination and fantasy.

Other methods such as Music Therapy and Mindfulness have also succeeded in managing chronic pain, anxiety and depression.

Yoga therapy is another treatment within the Mind-Body medicine. McClafferty based the concept of yoga as “bringing together mind, body, and spirit.” This discipline helps to reduce stress and improve fitness and flexibility; it is a successful method, which improves mental health.

In conclusion, Mind-Body medicine can have important implications in the future if pediatrics keeps considering and integrating these alternative therapies in their practices, giving the patients the opportunity to provide to their patients a drug-free, cost-effective treatment and a new lifestyle.

Findings: 

Mind-Body treatments can benefit children of all ages from chronic conditions.



Mind-Body therapies can be use as alternative medicine when conventional treatments have adverse effects.



Once learned the discipline of yoga, children can be able to reduce asthma, ADHD symptoms and chronic pain.



Hypnosis method has been shown to be very successful in the results of pain treatments and anxiety reduction.



Particularly, the music therapy brings positives effects on the emotional process and immune systems.



Mind-Body Medicine may have an important pediatric implication in the future.

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GROUP 4 

Educational and training programs have been developed in the field of Mind-Body medicine.

Quotations: “Chronic pain, anxiety and stress, dysfunctional voiding, constipation and encopresis, sleep disorders, habit disorders, attention-deficit/hyperactivity disorder (ADHD), asthma, obesity, diabetes, inflammatory bowel disease, irritable bowel syndrome, and cancer.” (p.201) “An altered state of consciousness, usually involving relaxation, in which a person develops heightened concentration on a particular idea or image for the purpose of maximizing potential in one or more areas.” (p.202)

Relationship and potential application to the typology decision Stress is present not only in adults but also in children and youth. This article would help us to understand the purpose of why people reach out holistic center when they are going through critic conditions, in this case, stress. Also, the information provided in the article would give us an idea of another caring target interested in be treated with holistic medicine. As designers we can also consider the integration of areas for children, integrating in the program spaces for activities such as music therapy, yoga and others.

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GROUP 4 (Acosta) Sub-questions 2: What causes stress, how does it affect people’s health and when does stress become a problem or an illness and what are some methods used to help people manage stress?

Ventegodt, S., Kandel, I., Neikrug, S., & Merrick, J. (2005). Clinical Holistic Medicine: The Existential Crisis—Life Crisis, Stress, and Burnout. The Scientific World JOURNAL, 5, 300-312.

Author’s Credentials: Soren Ventegodt and Joav Merrick. Nordic School of Holistic Health and Quality of Life Research Center. Copenhagen, Denmark Intended Audience: Psychologists, Medical Providers, Patients Objective Reasoning: This article explains the different factors that occur when dealing with stress and how people go through life crises by seeking help from others. It talks about how stress and burnout affect people in the workplace. The article seeks to understand the different factors that lead to stress and difficulties in life.

Coverage: Holistic Health, Quality of life Writing Style: informative

Summary of Methodology: This article talks about how people deal with burnout and stress at the workplace .It explains how people cope with stress and what they do to avoid burnout. It talks about how certain life events such as trauma and near death; experiences impact a person’s emotional and physical well-being.

It talks about how people react to painful events and what they learn from the process of emotional healing. It is important to find resources that create hope, belief and understanding of negative attitudes and beliefs that influence our everyday lives. The article gives us a deep understanding of how learning from painful experiences can lead us to become better human beings. It is important to take responsibility and seek help when problems become an issue. The article goes on to explain how people had traumatic events and how they were able to overcome their problems.

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GROUP 4 Findings: 

The article gives an explanation on how improving one’s life perspective can help dealing with anxiety and what symptoms may occur because it. For instance, when facing pain it is important to not avoid the problem and make sure you get treatment.



The article talks about existential pain and how it hurts people who never overcome it.

We can chose to behave a certain way and find solutions that can help us grow out of our negative habits.



The article shows how a 26-year-old female would develop chronic stress because she was not able to let go of certain habits. For instance, she was overwhelmed because she would constantly think about her job and not be able to let go.



Her remedy was too write down all her thoughts about the job and physically let go of the job after she was done. This is a classic example of how patients claim to have stress when they really do not have any.



For many people stress cannot be treated since it manifests itself in many different ways.

One important factor is for the patient to better understand himself better and straighten out their life.



Another important finding was how people deal with life crises. Some people cannot fully recover from the loss of a loved one, a physical or mental illness that can cause severe trauma.



Everyone that experiences this type of issue needs help to move on. It is important to not suppress any feeling and make sure to express how one really feels inside.



Another mysterious ailment that affects people is burnout. This occurs when someone goes to a job everyday with no sense of interest. This occurs when certain activities become routine and people feel unfulfilled by certain experiences that may occur.



A 42-year-old female has not had sex in many years and really cannot understand herself.

One of the best practices for this is to feel your inner emotions without changing anything.



The main thing is to have a sense of fulfillment in life and try to rejuvenate yourself by looking for new friends.

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GROUP 4 Relationship and potential application to typology decision:

The typology relates to the article selected because holistic medicine serves the purpose of finding a cure for various ailments that may occur to someone in particular. The primary concern is to create solutions that can enhance the way people feel when they are going through a life crisis. As an interior architect it is important to understand why a holistic approach is a better alternative to treatment than regular treatment to prevent stressful situations. The main responsibility of an architect is to understand ways to reduce life crisis stress and burnout in a holistic clinic.

Quotations: “Burnout is basically a consequence of a loss of interest in what one is doing due to the lack of intellectual stimulation, growth and development�. (p.308)

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GROUP 4 (Darzi) Sub-question 2: What causes stress, how does it affect people’s health and when does stress becomes a problem or an illness and what are some methods used to help people manage stress?

Avey, H. (2003). Health care providers' training, perceptions, and practices regarding stress and health outcomes. Journal of the National Medical Association, 95(9), 833-845.

Author’s Credentials: Holly Avey has a bachelor’s degree in creative writing from university of Arizona, a PhD from the University of Georgia and a Master’s in Public Health from the University of Michigan.

Intended Audience: This article is for professionals in healthcare.

Objective reasoning: This article is about how important it is to know how stress affect your healthy, and how professionals should learn more about how to inform their patients about stress management, relaxation, prevention, etc.; because through stress other health problems might develop. This article is based on research Writing Style: Formal

Summary of Methodology The author is trying to explain how stress has been considered one of the most important causes of healthcare provider visits, and how experts should be able to deal and deliver feedbacks to their patients has been a problem, because or they don’t see how stress is an important factor, or they don’t have a background on about how experts didn’t deal with stress well, the author used a methodology of finding participants that were internal medicine residents and through a survey that measured the stress counseling practices of providers and the level of training in stress management, mind/body medicine, and/or psychoneuroimmunology, acquire some answers towards why they couldn’t or did not know how to deal with that subject matter. Also, another evaluation that was provided from the same survey was personal practice of stress management techniques.

As a conclusion the author mention that now the experts have conscience and are aware of how it is important controlling stress for the patients’ health.

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GROUP 4 Findings: 

The mind and body cannot be considerate distinct entities without collaborating effects.



Relaxation and its physiological effects which are called “relaxation responses” backup the tendencies of stress and diseases caused by it.



Relationship between stress management and the improvement of other chronical diseases are important for stress prevention.



Psychological stress can regulate several characteristics of the cellular immune system.



Stress has been related with infectious diseases.

Relationship and potential application to the typology decision The relationship between this research article and healthcare typology is how to design an interior environment that can provide professionals a way to counsel their patients or help them changing their behaviors to prevent stress. All professionals must know how is important for them to encourage a patient to relax and distress. This research article provide some information, such as, a lot of professionals in healthcare barely take care of patients that suffer from stress, because of the lack of training, perceptions, and practices regarding stress and health outcomes in a primary care setting, so a great way to apply this research is to create some spaces that can help patients develop a lifestyle change and help them control their stress level.

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GROUP 4 (Lyon) Sub-question 2: What causes stress, how does it affect people’s health and when does stress becomes a problem or an illness and what are some methods used to help people manage stress?

Tang, S. K., & Tse, M. Y. (2014). Aromatherapy: Does It Help to Relieve Pain, Depression, Anxiety, and Stress in Community-Dwelling Older Persons? BioMed Research International, 2014, 1-12.

Author’s Credentials: Shuk Kwan Tang: Department of Orthopaedics & Traumatology, United Christian Hospital, Kowloon, Hong Kong.

M. Y. Mimi Tse: School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong Intended Audience: Healthcare professional, seniors, conventional hospitals, holistic centers and scholarly researchers.

Objective reasoning: Aromatherapy is a nonpharmacological method that helps older people with problems of depression, stress, pain and anxiety.

Coverage: Holistic therapies, alternative medicine, conventional medicine and healthcare.

Writing Style: Formal.

Summary of methodology: A very common feature among seniors is the feeling of pain. Pain brings several issues to many older people affecting them in all levels: physically, psychologically, socially, and spiritually and all of these levels lead to serious problems, such as depression, anxiety, stress, and functional status. Pain education programs can help seniors with their discomfort. Most likely, older people will approach pharmacological and nonpharmacological methods to manage their pain, however, some of them with no pain education, will not consider the second option, rather they tend to practice self-strategies for pain relief. According with the authors, in the western society, aromatherapy has been used to treat medical and health problems. This practice consists in the use of essential oils to bring back balance and restore well-being. Other researches have demonstrated the effectiveness of this method in reducing pain in people from all ages. They

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GROUP 4 stated that there is a relation between pain and the olfactory pathways in humans and that with the inhalation of a pleasant aroma, pain intensity can be reduced. This article is based on a study aiming to exanimate the effects of aromatherapy in older people suffering from chronic pain, depression, anxiety and stress.

The study consisted in examine a total of 82 participants from a local community in Hong Kong.

People from the study were 65 years and older and were able to communicate and understand.

Two different groups were developed; the intervention group (44 participants) and the control group (38 participants). All of the participants, women and men, suffer from pain mainly from knees and back. They also suffer from depression, anxiety and stress. Essential oils, such as lavender and bergamot (oils that are considered antidepressant and relaxant) were selected for the purpose of the study. Also massage, hot pads and analgesic balm or oils were the first top choices of nonpharmacological method. The intervention group received more education and information about aromatherapy program unlike the control group.

Findings: 

Aromatherapy implications can have positive results in reducing pain, depression, anxiety and stress in older people.



By inhaling pleasant aromas the intensity of pain can be reduced, since pain and the olfactory pathways in humans are related.



Pain generates stress and causes serious problems in older persons, affecting them physically, psychologically, socially, and spiritually.



The use of aromatherapy as a holistic approach, treating people as a whole.



After the introduction of aromatherapy treatment, the pain from the participants in both groups decreased and the use of nonpharmacological interventions increased. The intervention group responded positively to the effectiveness perception of nonpharmacological intervention, increasing from 84% to 100% and it also lowed the levels of anxiety, stress and depression within the participants. Due to the lack information of pain management from the control group, results from the study showed that psychological distress increased within.



Authors stated “the findings were consistent with those of previous studies, namely, that the inadequate pain management of older persons results in decreased enjoyment of life, 84

GROUP 4 and pain management programs can decrease pain- related distress”. (p.7) 

It was found that pleasant aromas could bring a positive mood to a person. In the study, seniors’ mood was “lifted after inhaling the essential oils and aromatic spray, resulting in decreased depression, anxiety, and stress.” (p.7)



Aromatherapy treatments are successful in decreasing feelings of depression, stress levels, chronic pain and anxiety. Older people sometimes prefer the use of nonpharmacological intervention since they have fewer side effects, unlike analgesics.



Aromatherapy can help to maintain the psychological health of older people.

Quotations: “The findings were consistent with those of previous studies, namely, that the inadequate pain management of older persons results in decreased enjoyment of life, and pain management programs can decrease pain- related distress”. (p.7) “Lifted after inhaling the essential oils and aromatic spray, resulting in decreased depression, anxiety, and stress.” (p.7) Relationship and potential application to the typology decision Another treatment that is listed as alternative medicine and that is very important to treat stress in patients is the aromatherapy. It is now known that the results of aromatherapy can offer a change in human’s health. The information provided in the article would help us to develop areas in the program of the project, in this case, the aromatherapy areas that would treat patients. Also, it is useful to understand another target that the center could have, which is older people suffering from chronic pain, stress, depression, and other conditions.

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GROUP 4 (Lyon) Sub-question 2: What causes stress, how does it affect people’s health and when does stress becomes a problem or an illness and what are some methods used to help people manage stress?

Sibinga, E. M., & Kemper, K. J. (2010). Complementary, Holistic, and Integrative Medicine: Meditation Practices for Pediatric Health. Pediatrics in Review, 31(12), 91-103.

Author’s Credentials: Erica M.S. Sibinga: Assistant Professor, Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md.
 Kathi J. Kemper: Caryl J. Guth Chair for Holistic and Integrative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC. Intended Audience: Healthcare professional, pediatrics, educational institutions, holistic centers and scholarly researchers.

Objective reasoning: To demonstrate the benefits within the most commonly used meditation practices in order to help pediatrician patients by the use of evidence-based information.

Coverage: Holistic therapies, pediatrics, alternative medicine, conventional medicine and healthcare. Healthcare.

Writing Style: Formal.

Summary of methodology: The authors support the study that shows the benefits of meditation in the well-being of children and youth. Sibinga and Kemper indicate in their research three different cases of parents with children suffering from chronic conditions and who are looking for alternative solutions to help them. According with the authors, meditation promotes health and wellbeing. In this article, they explain three different types of meditation, which can be implemented in order to improve the lifestyle of children and youth. Among these are: the concentration on a word, thought, sensation or image, mindfulness and movement-based meditation. The first type of meditation offers a sound or mantra, which is taken as a focus of attention. Authors stated that is recommended to 86

GROUP 4 practice this meditation 15 to 20 minutes per day over a period of 4 months. For children, it is beneficial for behavioral problems, school infractions and absenteeism. Secondly, mindfulness meditation improves physical, behavioral, cognitive and psychological outcomes. The last type of meditation is the movement-based meditation. Yoga and Tai Chi are practices associated with this meditation. For children, yoga is also a positive option that can help them with asthma, eating disorders and irritable bowel syndrome. Tai chi is another practice, which according to the authors, is associated with well-being, calmness and relaxation. It improves mood and quality of life, also improves sense of interconnection with other people and with nature.

Findings: 

Integrate meditation as an approach into pediatric practices.



Meditation is an alternative treatment that promotes health and wellbeing.



Meditation can help children and youth with physical and mental problems.



Authors suggest that meditation bring variety of physical benefits to people suffering from “pain, fatigue, hypertension, asthma, autoimmune disorders, epilepsy, irritable bowel syndrome, and premenstrual and menopausal symptoms” (p.93) and also mental benefits, including decrease of stress, anxiety, depression, obsessive-compulsive thoughts, substance abuse and aggressiveness.



By practicing sound or mantra meditation, blood pressure problems can be reduce.



In a study was found that senior students from high school lower their levels of tiredness, aches and pain by practicing mindfulness meditation. They also increase feelings of calmness, emotion regulation, relaxation and self-acceptance.



The benefits of yoga include “greater physical fitness and strength, better mood, lower stress and anxiety, better attention and behavior, and better verbal and spatial memory and visual perception.” (p.95)



Studies show that yoga help children suffering from obesity. Children that practice yoga have less food preoccupation and eating disorder that those who never practice the discipline before.



The study of Sibinga and Kemper supports the evidence that meditation is a successful practice for children and youth, which should be taken in consideration for those patients suffering from chronic conditions.

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GROUP 4 

Meditation is a safe alternative that brings a variety of approaches that can ensemble different needs, values and preferences.

Quotations: “Pain, fatigue, hypertension, asthma, autoimmune disorders, epilepsy, irritable bowel syndrome, and premenstrual and menopausal symptoms” (p.93) “Greater physical fitness and strength, better mood, lower stress and anxiety, better attention and behavior, and better verbal and spatial memory and visual perception.” (p.95) Relationship and potential application to the typology decision It was learned in the article that meditation is an alternative treatment that promotes health and wellbeing. As designers of a holistic center, the article provides information about meditation practices for children that are useful for the program at the moment of selecting the activities that would be performed inside or outside the holist center. When thinking about a quite space, there are many ideas that we can think as designers, either a quite interior space to meditate or a garden to relax and listening to the nature. The information about other practices for children such as yoga and tai chi, would give us another opportunity to evaluate the space and the integration of different areas for the various activities.

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GROUP 4 (Lyon) Sub-question 2: What causes stress, how does it affect people’s health and when does stress becomes a problem or an illness and what are some methods used to help people manage stress?

Reilly, P. M., Buchanan, T. M., Vafides, C., Breakey, S., & Dykes, P. (2014). Auricular Acupuncture to Relieve Health Care Workers’ Stress and Anxiety. Dimensions of Critical Care Nursing, 33(3), 151-159.

Author’s Credentials: Teresa M. Buchanan, MBA, RN: Project manager. She has a Health care setting focus on program development and project management. Teresa is now supporting the “Integrative Care Program at Brigham and Women’s Hospital in Boston, Massachusetts.

Carol Vafides, MAc, Lic Ac: Graduated in New England School of Acupuncture with a master’s degree in Acupuncture. Before, she has studied medical Qi Gong at the Oriental Culture Institute of Boston.

Patricia M. Reilly, MSN, RN: Director of Caring and Healing Modalities at Brigham and Women’s Hospital in Boston, Massachusetts. Her interest focuses in healing environments for patients and staff.

Suellen Breakey, PhD, RN: She has a background in critical care nursing and is an Assistant professor in the School of Nursing at Massachusetts General Hospital Institute of Health Professions in Charlestown, Massachusetts.

Patricia Dykes, PhD, RN: She is an assistant professor at Harvard Medical School and a senior nurse scientist and program director for research in the Center for Patient Safety Research and Practice and the Center for Nursing Excellence at Brigham and Women’s Hospital and assistant professor at Harvard Medical School.

Intended Audience: Care nurse, nurse educator, nurse manager, nurse practirioner, clinical nurse specialist, researcher, healthcare professional, conventional hospitals, holistic centers and scholarly researchers.

Objective reasoning: The use of auricular acupuncture in health care providers in order to reduce stress-related anxiety and allow them to develop caring relationships with patients.

Coverage: Holistic therapies, Nursing, alternative medicine, conventional medicine and healthcare.

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GROUP 4 Writing Style: Formal.

Summary of methodology: The authors saw the need of studying the idea of integrating auricular acupuncture in health care providers suffering from chronic conditions generated by the caring relationship between them and patients with critical conditions. This is the syndrome of “burnout”, explained by the authors as when the health care providers start to care and to develop relationship with patients. This action brings physical, psychological, and spiritual problems to the health care providers, creating chronic stress of having to deal with the patient’s problems and needs until the person has nothing left to give. Burnout can turn in physical exhaustion, anger, paranoia, poor selfesteem, susceptibility to illness and substance abuse. The authors found that it is important for health care providers to create good relationship with patients in order to obtain a healing environment. These relationships can be based in love, awareness and compassion. Caring relationships help patients to improve physical comfort and healing. However, the process of creating these caring relationships, bring the providers bad health conditions that affect not only them, but also the organization. Burnout relates to stress, and the authors found that one of the more stressful professions among health care providers is nursing and also the highest rates of burnout are found in areas of neurology, emergency departments, hospice nurses, oncology and intensive care units.

Findings: 

Auricular acupuncture can help with stress and anxiety



The treatment only requires a qualified acupuncturist and a peaceful and quite space so it can be a successful. An aspect that should be taking into consideration for other organizations setting.



“Health care providers are exposed to the trauma, suffering and pain of patients” (p.157) and should take into consideration alternative solutions to prevent stress and other mental, emotional and physical disorders.



Auricular acupuncture is an effective solution in reducing stress and anxiety. Wang and Kain examined the effect of auricular acupuncture on the reduction of anxiety in healthy volunteers with similar baseline anxiety levels and environmental stress. They got 90

GROUP 4 positive results in the effectiveness of the treatment, obtaining patients less anxious after 30 minutes and 24 hours from the intervention. 

The present study consisted in 76 participants where only 37 of them completed the intervention. There were primarily women from the nurse discipline. The intervention consisted of 5 auricular acupuncture sessions administered by a licensed acupuncturist over a 16-week period. Each of the session had a length of 25 minutes. The results were significant in the reduction of anxiety and burnout. The movement of each measure is consistent with a reduction in provider stress and anxiety and supports the hypothesis that auricular acupuncture is an effective strategy in mitigating the risks of caregiving.



The auricular acupuncture treatment was not only successful due to the positive effects of the acupuncture, but also because it allow the patients to interact within each-other, shared experience of community and understand that all of them are in the same stress situation that is associated with caregiving. “The experience of having acupuncture provided by a welcoming, accepting, and compassionate caregiver in and of itself can be healing for the health care provider.” (p.156)



The authors found out with their results that auricular acupuncture is helpful and it is a great strategy for reducing stress and anxiety.

Quotations: “The experience of having acupuncture provided by a welcoming, accepting, and compassionate caregiver in and of itself can be healing for the health care provider.” (p.156) “Health care providers are exposed to the trauma, suffering and pain of patients” (p.157) Relationship and potential application to the typology decision It was learned through this article that inside holistic medicine, acupuncture is another treatment that plays an important role, since it helps with reducing stress, anxiety, and other mental, emotional and physical disorders. It is interesting for us as designers to know about the functions of this alternative medicine. The treatment only requires a qualified acupuncturist and a peaceful and quite space so it can be successful, this aspect should be taking into consideration at the time of programing and thinking about organization settings.

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GROUP 4 (Lyon) Sub-question 2: What causes stress, how does it affect people’s health and when does stress becomes a problem or an illness and what are some methods used to help people manage stress?

Weiss, B. L. (2003). Eliminating stress, finding inner peace. Carlsbad, CA: Hay House.

Author’s Credentials: Brian L. Weiss, M.D.: He is the America’s leading authority on past-life regression therapy.

Graduated from Yale School of Medicine and Columbia University. Conductor of national and international seminars and author of many books.

Intended Audience: researcher, healthcare professional, conventional hospitals, holistic centers and scholarly researchers.

Objective reasoning: Author intended to give information that will help individuals with their emotional and spiritual wellbeing.

Coverage: Holistic therapies, nursing, alternative medicine, conventional medicine and healthcare.

Writing Style: Formal.

Summary of methodology: The way that people are living their life in this modern era is simple stressful. According to Weiss, nowadays, individuals have easy access to information about news of tragedies and disasters. Families have broken down as businesses relocate and travel time have become shorter. Too many information exposed to people daily, we have technology that never sleeps and it is always by people’s hands. There is no time for people to shutdown anymore. “As the world becomes more complex, we become more stressed.” (p.3) Weiss states that stress affects people mentally and physically. Our minds can be affected by feelings of worry, fear and concern. On the other hand, our bodies are affected by secreting stress hormones and chemicals.

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GROUP 4 The author defines stress as “any activation of the HPA axis, which means almost any stimulus, such as fear or pain that disturbs or interferes with the normal physiological equilibrium of the individual.” (p.9) Weiss also noted that stress bring many reactions to our body. It can increase secretions of chemicals and hormones in our organism. Heart rhythms start to accelerate, blood pressure increase to serious levels and stomach acids erode. In many cases people feel depress, miserable and hopeless affecting their personal relationships.

“Stress prevents you from experiencing life’s many pleasures.” Finding inner peace and eliminating stress is an important step to be healed. There are no doubts that stress kills. It affects your level of happiness; it depresses your immune system and allows chronic illness to overwhelm you, causing disabilities, pain and even death. Stress is a mental state that can cause severe negative emotional and physical consequences. By adjusting our understanding and attitudes and by learning relaxation techniques, people can eliminate stress.

Findings: 

Stress occurs when we react physically and psychologically to the possibility of change in our environment.



Stress is our physiological and psychological response to the daily events happening in our lives.



If stress is have short duration, it can be considered as positive events, bringing good results because our bodies and minds become more focus, alert engaged and energetic.

After going through a moment of stress, eventually in a short period of time, we clear our bodies of the stress hormones and return to our normal state. However, if the stress continues, those beneficial results are contradictory.



Five of the leading causes of death in United States are linked to stress. It affects the immune system and when this happens, the body becomes much more vulnerable to diseases. In addition, the immune system plays a major role in impending cancer cells to reproduce. If it does not work fine, we more susceptible to cancer and its spread.



Chronic stress impairs fertility, since it affects the reproductive system



Stress respects no particular race, nationality, sex or religion.



Many studies linked chronic stress with depression that leads to suicide attempts.

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GROUP 4 

Illnesses such as anxiety, shock, guilt and depression, often occur as a result of posttraumatic stress disorders.



In a research study, among crime victims with posttraumatic stress, 41 percent experienced sexual dysfunction, 82 percent manifested depression, 27 percent revealed obsessive-compulsive symptoms, and 18 percent suffered from phobias.



The Prevention Magazine survey from 1996 found that 75 percent of the Americans are undergo great stress at least once a week and 33 percent report having the same feelings more than twice a week.



A consensus of research studies estimates that 75 to 90 percent of all visits to primary care physicians are stress related problems.



78 percent of Americans define their jobs to be stressful.



Stress costs American industries $300 billion annually approximately.



For many years, doctors have prescribed anti-anxiety drugs, especially benzodiazepines for symptoms of anxiety or insomnia. These drugs, which mainly differ in the length of their stay in the body, often produce side effects such as drowsiness, decreased energy, dry mouth, constipation, problems with coordination, and mental confusion.



All medicines cause side effects that need to be monitored.



Traditional treatments such as individual or group psychotherapy have always been useful in alleviating symptoms of stress.



Individual or group psychotherapy are considered traditional treatments that are useful in relieving stress.



Weiss found that combining medication, particularly anti-depressants, with meditation, stress reduction practices and self-relaxation, patients recover faster than with drugs alone.

Quotations: “As the world becomes more complex, we become more stressed.” (p.3) “Any activation of the HPA axis, which means almost any stimulus, such as fear or pain, that disturbs or interferes with the normal physiological equilibrium of the individual.” (p.9)

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GROUP 4 Relationship and potential application to the typology decision This article would help us to be informed about what the stress is, what are its causes and how can be controlled. Being stress one of the most leading causes of death in United States, would thrill us as designers to design a Holistic center that can help people to survive from this condition. Areas of stress reduction such as meditation would become an important space for the center’s settings.

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GROUP 4 (Muino) Sub-question 3: Does applying the principles of sustainable design benefit patients with high stress levels, and have a positive impact on behavior?

Guenther, R. (2006). Healthy environments. Contract, 48(10), 46.

Author’s Credentials: Architect & Principal of Perkins+Will and Senior Advisor to Health Care. FAIA, LEED AP. New York Sustainable Healthcare Design Leader.

Intended Audience: Professional healthcare architects, firms and owners.

Objective reasoning: This article is an author’s personal opinion, based on her knowledge and credentials. Her goal is to persuade and inform her audience through some thoughts about sustainability and healthcare.

Coverage: Healthcare, Sustainable Architecture, Sustainability Classification and Health and Environmentally Friendly Design Alternatives.

Writing Style: Formal

Summary & findings: This article is the opinion of an expert in sustainable healthcare design. Robin Guenther is a long-time advocate for healthier healing environments and recently in 2014 she spoke at TEDMED about this topic.

She explains that in the last decade sustainable design has grown very rapidly and that in the next five years we will see how it will be put on the commercial market list. She affirms that healthcare did not remain far behind.

Guenther states that sustainable design is based on indoor environmental quality, safety, stress control and increase of productivity in both healing and caregiving.

She classifies commitment to sustainability at three levels. The first level is based on minimum compliance with environmental regulations at local, state and national levels.

This level is characterized by undertaking green building projects only until they are forced to do so by pressures and legislative policy initiatives.

The second level is characterized by going beyond compliance with the measures that save money. The organization at this level may lack the internal structure necessary to bring about change, decision, support or requirements and leadership.

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GROUP 4 The third level is known for the strong link between the environment and health and to work beyond compliance and monetary savings with a long-term plan that aims to reduce the environmental impact. The groups that belong to level three are involved in the design and sustainable construction largely because their primary mission is to serve the community. For this group, design strategies and construction are more than saving energy. Its goal is primarily connected to health and basic human values.

For her, sustainable architecture reflects a proposal of great value to healthcare. These levels of sustainability classification made her question the purpose of sustainability in the health system. “Is the healthcare system treating diseases or is it promoting it? Does it produce sickness and prevent health? Is it a complicated situation that can be resolved, and if so, how?”(46) According to the author, the aim of this paper is to raise awareness and to try to find a response in the design of more humane healthcare architecture, helping us to understand that buildings are not only just another project. At the community level, in this era of chronic disease we are looking for hospitals to become leaders and role models for healthier life styles, where sustainability is a great ally. She suggests that this can be done by providing such things as organic food (that is more nutritious and free of steroids) and antibiotics. But also by looking to recycle waste and, better yet, eliminating the source from which it originates which eventually will eliminate the poor handling of materials that always end up in the local landfill.

According to Guenther’s point of view, Healthcare and sustainability go hand in hand. She adds that thanks to scientific progress, we try to combat some diseases more effectively than before, but we cause more side effects on health and the environment. Therefore, it is necessary to apply the precautionary principles or prevention methods and substitute hazardous substances with safer for health and environmentally friendly alternatives. Given the prevailing economic criteria we have to clarify that health budgets are to be regarded as an investment and not an expense. The cost doesn’t have to be an excuse to paralyze the activity but a permanent stimulus to research, develop and promote technically feasible and economically reasonable alternatives. Basically, the idea is to reduce and eliminate all forms of contamination in medical practices, improving the quality of care users and the safety of health workers with the utmost respect of the social and natural environment where they are located.

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GROUP 4 Findings: 

Sustainable design is based on indoor environmental quality, safety, stress control and increase of productivity in both healing and caregiving.



Commitment to sustainability classification: Level one: Minimum compliance with environmental regulations at local, state and national levels.

Level two: Goes beyond compliance with the measures that save money.

Level three: Strong link between the environment and health. Long-term plan that intend to reduce the environmental impact.



Sustainable architecture reflects a proposal of great value to healthcare.



We are looking for hospitals to become leaders and role models for healthier life styles, where sustainability is a great ally. This can be done by: Providing organic food.

Recycling waste.

Eliminating the poor handling of materials.



Prevention methods can be replacing hazardous substances by safer for health and environmentally friendly alternatives.



The cost does not have to be an excuse.



The idea is to reduce and eliminate all forms of contamination in medical practices, improving the quality of care users and the safety of health workers with the utmost respect of the social and natural environment where they are located.

Relationship and potential application to the typology decision: According to the author, sustainable design is based on indoor environmental quality, safety, stress control and increase of productivity in both healing and caregiving. I think this is one of the articles than is going to provide us with a very valuable information to use when designing our Holistic Center. This information is giving us the different alternatives and ideas of sustainable design and the important relationship to healthcare. In addition, this information will help us to raise awareness and to try to find a response in the design of more humane healthcare architecture.

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GROUP 4 Quotations: “Incorporating sustainable construction into the healthcare sector is providing to be a formidable task� (p.46)

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GROUP 4 (Muino) Sub-question 3: Does applying the principles of sustainable design benefit patients with high stress levels, and have a positive impact on behavior?

Guenther, R. (2015). Building health. Architecture Boston, 18(4), 32-35.

Author’s Credentials: Co-author of Sustainable healthcare architecture. Architect & Principal of Perkins+Will and Senior advisor to health care. FAIA, LEED AP. New York Sustainable healthcare design leader.

Intended Audience: Professional healthcare architects, scholarly researchers.

Objective reasoning: This article is an author’s personal opinion, based on her knowledge on sustainable healthcare. She compares and contrasts some examples of sustainable healthcare constructions based on restorative architecture.

Coverage: Healthcare, Sustainability, Restorative Design and Cradle to Cradle.

Writing Style: Statistical and comparison, formal.

Summary of methodology: In this particular article, she emphasizes the idea that green buildings and world of healthcare have a common mission: to protect and promote health. She says that we cannot have healthy people if we don’t have clean air, water and soil. She explains that for more than 70 years our healthcare system has been frozen in time by a massive industrial design that has little to do with health. Then she affirms that we can transform this 20th century industrial healthcare model into a system that rather than delivers sick care goes to a one that builds actual health.

She continues her article by analyzing and contrasting some examples of healthcare constructions. Some of them according to JAMA (the Journal of American Medical Association) that have hazardous potential and some that actually changed this system, giving us solutions that stop making us sick.

Section: Findings: 

The Texas Medical Center in downtown Houston a 1.5 square miles institution with 7,000 beds and 106,000 employees that is one of the largest in the world. It generates 217 million tons of carbon dioxide in to the environment every year.

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GROUP 4 

Swedish Medical Center in Issaquah, Washington. Its operations are the lowest energy-consuming in the country- a 60 percent below industry average. As a result of building design optimization and energy systems.



Kiowa County Memorial Hospital in Greensburg, Kansas, is the first carbon-neutral hospital in the country using wind instead of fossil fuel.



Gundersen Health System in La Crosse, Wisconsin. This system generates more renewable energy than it consumes becoming the first energy-independent health system.



The Center for Discovery in Harris, New York, -which Guenther works with. It was the first LEED-certified ambulatory healthcare clinic in US. In this particular case she came to the conclusion that people have so many health issues in their lives and we don’t know what the causes of these problems are. So why would we want to expose these people to bad indoor qualities by being surrounded by chemicals?

At the end of the article she came to the conclusion that some healthcare systems have the purpose of building health by being carbon free, changing the market for healthy materials and partnering with their communities. Restoration in healthcare architecture doesn’t have to be expensive or too radical, it’s just common sense. “We can transform healthcare by building health.”(p.35)

Relationship and potential application to the typology decision: The information in this article provides us with a framework of several examples of sustainable healthcare construction. It is a great addition to our literature review and can be helpful when planning our holistic healthcare design. Some of the buildings have hazardous potential and some others actually changed the system, giving us solutions that can stop making us sick.

Quotations: “A health system shall cause neither human nor ecological harm” (p.33) “Restorative design means moving from solutions that degrade health and the environment to solutions that do no harm and heal some of the harm we’ve already done” (p.34) “We can transform healthcare by building health” (p.35)

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GROUP 4 (Muino) Sub-question 3: Does applying the principles of sustainable design benefit patients with high stress levels, and have a positive impact on behavior?

Coskun, A., Zimmerman, J., & Erbug, C. (2015). Promoting sustainability through behavior change: A review. Design Studies, 41, 183-204.

Author’s Credentials: Aykut Coskun: Department of Media and Visual Arts, Koc University, Rumelifeneri Yolu, Sariyer, Istanbul, Turkey.

John Zimmerman: School of Design, Carnegie Mellon University, Pittsburgh, PA. Cigdem Erbug: Department of Industrial Design, Middle East Technical University, Dumlupinar Bulv. Universiteler Mah. Ankara, Turkey Intended Audience: Design research community, Interior designers, Architects and Users.

Objective reasoning: This article is a literature review to help advance the growing research in promoting more sustainable behaviors through the design of new products and services.

Coverage: Design research, User behavior and Design for behavior change Writing Style: Informative, statistical and comparison, formal.

Summary of methodology: This journal presents findings from seventy peer-reviewed design research articles on sustainability through behavior change. It focuses absolutely on sustainability; as it is an important and developing area of concern for design research, and significant work now exists to make a review possible and beneficial. This review pushes forward the work on sustainability and behavior change by characterizing the ongoing state of design research and exposing crucial gaps that future research should address.

Method: To be included in this study, the articles had to be published in a design journal or conference.

The study started with peer review design journals and design conferences, looking at work published between January 2000 and June 2014. All articles had a focus on design, sustainable design and persuasive technology. Seventy design research papers published were found.

(Table1 pp.185) 102

GROUP 4 Articles were sorted according to methodological approach for the analysis: Conceptual Studies: Frameworks, Guidelines, Toolkits and Research gaps Empirical studies / formative field studies: Exploring opportunities for behavior change, proposing a design element based on identified opportunities, evaluating this element in the field of commercial behavior-changing products and experiments and evaluating the effectiveness of behavior-changing techniques.

The design process proposed by Selvefors, Pedersen, and Rahe (2011) were used. This model employs a generic, three-stage, product development process consisting of exploration, generation and evaluation. The authors formulated this process for designing sustainable behaviors.

Previous review studies: Findings were explaining by previous review studies: 

Lilley, Lofthouse, & Bhamra (2005). Sociology, behavioral psychology and sustainability.



Tang & Bhamra (2012). Feedbacks, rewards, steering and intelligent products.



Froehlich, Findlater, and Landay (2010). Environmental psychology and research activities within Human-Computer Interaction (HCI).



Yun, Scupelli, Aziz and Loftness (2013). Techniques for environmental psychology, social psychology and behavior science. Including advice, communication, engagement and control.



Pierce and Paulos (2012). Discussion of previous research displaying consumption data and investigation of domestic environments, encouraging conservation behavior.



Brynjarsdottir et al. (2012). Critical review of persuasive technology and sustainability in Human-Computer Interaction.



Boks (2012). A review of design research on sustainable behavior, discussing the lack of common terminology facilitating research progress despite the abundance of design techniques.

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GROUP 4 Review findings: 

Ordering the articles by year showed a growing interest in behavior change and sustainability, 82% of the papers appeared with the last five years.



Two main categories were identified according to their methodology. Forty-six studies were empirical and twenty-four studies were conceptual. Fourteen empirical studies focused on exploring and identifying opportunities for behavior change.



Sixteen studies were identified as proposing an element and evaluating its impact on behavior change though field studies.



Seven studies evaluated a commercial product meant to promote sustainable behavior either by giving it to the users and observing their interactions or by observing people who already own such a product.



Two studies evaluated the effectiveness of different feedback types in promoting sustainable behaviors through lab experiments.



Nine of the conceptual studies proposed various behavior change strategies designers can use to promote sustainable behavior, and offered frameworks categorizing these strategies along different dimensions.

Exploration: Looking across these studies no systematic processes employed were founded by researches to select a target behavior. Most of the papers never discussed the rationale for selecting a behavior.

Conclusion: 

Designing sustainable products efficient in energy and resource consumption is not always sufficient to reduce environmental impacts due to unintended user behavior.



User behavior is influential on environmental impact. Changing behavior through design could contribute to great environmental benefits.



The research on promoting sustainable behaviors through design has a very ambitious and relevant design goal for achieving a sustainable society.



Design researchers have produced a substantial amount of work that made valuable contributions promoting sustainability through behavior.

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GROUP 4 

There are still several gaps in the current investigation that can help researches advance this growing field further. In this literature review, these gaps were identified and recommendations for future research to facilitate this process were made.

Relationship and potential application to the typology decision: The review of this article showed that there has been a growing interest in exploring the potential of design in promoting sustainable behaviors. The work on this topic illustrated that this idea is very important for the design research community in terms of having impact on environmental problems that we face today. This information can be beneficial and helpful when designing our holistic center.

Quotations: “We conducted a review on design for behavior change and sustainability” (p.183) “We characterized the current research, identified gaps and made recommendations for future work” (p.184) “To advance this field further we should prioritize promising areas of impact with the potential of having greater environmental benefits” (p.198) “It should identify behavior change strategies that have the most profound and lasting impact” (p.198)

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GROUP 4 (Acosta) Sub Question 3: Does applying the principles of sustainable design benefit patients with high stress levels, and have a positive impact on behavior?

Wood, L. C., Wang, C., Abdul-Rahman, H., & Abdul-Nasir, N. S. (2015). Green hospital design: Integrating quality function deployment and end-user demands. Journal of Cleaner Production, 112, 903-913.

Author’s credentials: Faculty of Business and Law, LEED .The University of Auckland Intended Audience: Architects, Sustainable hospital designers, Construction builders Objective Reasoning: The article talks about the rapid growth of sustainable materials in the construction of green places. It emphasizes the importance of QFD tools that are used to build hospitals. It explains the quality function deployment concept that is used when building hospitals with green materials.

Coverage: Healthcare, Construction Design, Sustainable healthcare design leaders, Architects Writing style: Formal

Summary of methodology: Green design must meet certain requirements to be LEED certified. It is important to reduce energy when using lighting and ventilation in enclosed spaces. The article gives specific examples on how problems can occur when dealing with engineers and designers of green spaces. The article explains the use of specific qualities that are based on energy efficiency, innovation, materials and resources. There was research that involved a series of questionnaires which were given out a group of chosen participants. The groups involved in the study were medical, hospital staff, patients and visitors as well. This study was done to find out the factors that could affect a green hospital design. It is important for the hospital to meet customer’s needs in order to improve the overall experience of the facility. In order to achieve these results a questionnaire was made to capture the importance of 18 demand quality factors over six categories. Some of the categories that were included were energy efficiency, indoor quality, water efficiency and innovation.

Designers are in charge of creating places that have quality function deployment which is a concept that is widely used in the construction industry with an emphasis on identifying the key factors when designing a green hospital. For example, the Construction Industry development board of Malaysia talked about the environmental and sustainability problems that the construction industry 106

GROUP 4 faces. Green designers have found that natural lighting is important to reduce energy costs. It is important to use solar energy and insulation on buildings. These features help in the cooling of the exterior design and increase ventilation. According the designers, it important to see through the lens of the customer, since they are the reason demand for green spaces has increased. It is important that the designer use the green design elements when starting such an important project.

Findings: 

This article addresses the importance of using green design in construction by integrating sustainable materials in hospitals.



Han states that sustainability and green building commitment improve financial performance and market differentiation.



The green design is becoming a trend in the construction of hospitals and other retail spaces. It is important to understand that green design can reap financial benefits for many people.



The green principles focus on the use of water resources, solar energy improved ventilation and the use of sustainable materials.



The House of Quality identified customer needs and essential design requirements



The results show that visitors, medical staff and patients have higher demands in relation to the importance of factors than hospital workers do



Gender plays a vital role since women prefer building orientation and natural ventilation



Safety is during an emergency because it allows for an easy exit out of the hospital



It is important to maximize natural light and enhance pedestrian walkways



Deadlines were not met at times since priorities were not established at the time of initializing the project



Quality elements indicate that design characteristics need to have features that make



sustainable materials effective

Relationship and potential application to typology decision The article relates to the typology selected because it gives importance to the design of green hospitals and how they can benefit patients and practitioners. The main concerns as an interior designer is to integrate quality controls that meet consumer demand. The interior architect needs 107

GROUP 4 to understand how to create a sustainable environment for employees and analyze the environmental impact that can occur when not using sustainable materials in a hospital.

Quotations: “Customers only express what they want and this is usually not easily quantifiable and makes little sense to designers� (p.56)

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GROUP 4 (Acosta) Sub Question 3: Does applying the principles of sustainable design benefit patients with high stress levels, and have a positive impact on behavior?

Pettigrew, L. M., Maeseneer, J. D., Anderson, M. P., Essuman, A., Kidd, M. R., & Haines, A. (2015). Primary health care and the sustainable development goals. The Lancet, 386(10009), 2119-2121.

Author’s Credentials: Department of Health Services Research and Policy (LMP) Faculty of Public Health and Policy.

Intended Audience: Developmental communities, Physicians, Primary health care providers Objective Reasoning: This article talks about how primary care is the most important issue in countries that have emerging economies. The author’s goal is to address the factors that influence heath care issues in countries that have low income benefits.

Coverage: Healthcare providers, Environmental protection agencies, Investors in New markets, Sustainable.

Writing Style: Formal

Summary of methodology It important to understand the benefits of a universal health care system. First, it alleviates the financial pressure of health care providers to give medical attention to low income communities.

It can help create jobs in the medical sector and at the same time help in the construction of new medical facilities. Health care officials need to find an economic platform that supports the primary health care system. It is important to develop sustainable goals when it comes to implementing strategies that enhance a country’s health care system. The article addresses the issues that occur when people do not receive proper healthcare. It leads to poverty and socioeconomic problems such as hunger and homelessness.

Findings: 

The article gives a great explanation on how sustainable developmental goals were established by the United Nations to promote health awareness in children.

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GROUP 4 

The author states that health care is important for sustainability in many countries. The importance of sustainable developmental goals is important because it fights against poverty, hunger and inspires individuals to find new ways to live fruitful lives.



Pettigrew states that the density, distribution, and performance of the healthcare workforce will allow for national resources to be used on infrastructure needed in order to provide adequate service to those in need.



It is important to have funding in place to build healthcare offices where physicians can help children who do not have enough money to see a private doctor.



There has been a strong backing by global corporations to push for a universal health care system but getting investors to fund projects has been quite worrisome.



It seems that universal health coverage is a pipe dream for many since it needs heavy support from government officials.



The Universal Health care initiative is important for the development of sustainable goals.

Pettigrew states that health-financing indicators need to track government expenditures and provide information on the economic accessibility of primary care services.



National governments need to be aggressive in implementing strategic progress towards providing primary health care that will achieve sustainable developmental goals.



Some countries need to establish effective economic and political policies that will allow for international efforts to fund a universal health care system.



The Gates foundation and the World Bank Group have launched a campaign to promote the Primary Health Care Performance Initiative.



It is important to establish a connection with physicians who are willing to support and push for new reform on universal health care.



The first step in creating universal health care is to have strong public health policies that are in place with social, economic and political platforms.

Relationship and potential application to typology decision: The article relates to the typology because it relates to the importance of having primary health coverage in low income countries. The main concern is to find ways to increase health coverage by using government grants and charitable organizations that contribute to a better quality of life.

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GROUP 4 As an interior architect it is important to find ways to develop a universal health care system that uses facilities with an emphasis on sustainable development.

Quotations: “ Work force 2030 ,will be important in shaping how primary health care develops in the next 15 years and providing the backbone for the successful launch of the universal health care system� (p.2120)

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GROUP 4 (Muino) Sub-question 3: Does applying the principles of sustainable design benefit patients with high stress levels, and have a positive impact on behavior?

Ramirez, B., West, D. J., & Costell, M. M. (2013). Development of a culture of sustainability in health care organizations. Journal of Health Organization and Management J of Health Org and Mgt, 27(5), 665-672.

Author’s Credentials: Bernardo Ramirez: Associate Professor, Director Global Initiatives, Executive MSHSA Health Management and Informatics, International Committee. Employed since August 2007 on the Department of health management and informatics at University of Central Florida.

Daniel J. West: Dr. West is the Chairman and Professor in the Department of Health Administration and Human Resources, University of Scranton. He teaches in the Graduate School and The University of Scranton and has specialized in international health care, globalization, multiculturalism, and diversity management. He holds a Professor in Public Health appointment at Trnava University, Slovakia and a Visiting Professor appointment at the University of Matej Bel in Slovakia.

Michael M. Costell: Dr. West is President and Chief Executive Officer of HTC Consulting Group, Inc. He currently serves on the Board of Directors for the Commission on Accreditation of Healthcare Management (CAHME). He is a Certified Healthcare Consultant with the American Association of Healthcare Consultants, and board certified in healthcare management by the American College of Healthcare Executives. He is a dedicated and hardworking teacher, consultant and scholar who has achieved success and is recognized for his accomplishments in international healthcare projects and activities in Central Europe and Eurasia.

Intended Audience: Healthcare professionals, nurses, students, researchers, and organizations.

Objective reasoning: This paper examines the concept of sustainability in health care organizations and the key managerial competencies and change management strategies needed to implant a culture of sustainability. Competencies and management development strategies needed to engrain this corporate culture of sustainability are analyzed in this paper.

Coverage: Sustainability, change management, accountable care organizations, managerial competencies, management education, change management & health care.

Writing Style: Conceptual, formal.

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GROUP 4 Summary of methodology: This document is based on the experience of the authors as healthcare executives and educators developing managerial competencies with integrative and international groups of executives in the last 25 years, using direct observations, interviews, discussions and bibliographic documentation. Sustainability of healthcare institutions with the holistic suggestion seen in this paper is an inventive and sensible approach to quality improvement that merits further development.

The authors examine the key managerial competencies and change management strategies needed to enclose a culture of decisive sustainability in healthcare organizations. Teaching and mentoring approaches are presented to promote the participation between educators and practitioners to progressively promote these competencies, enhance the governmental potential of health services, and work towards sustained healthier communities. Finally, this paper explains how sustainability areas embedded on the managerial culture impact resource allocation and accountability strategies in healthcare organizations.

To facilitate this study the authors propose Rusinko’s (2010) holistic matrix framework. This matrix helps academics organize their thoughts on programs, curriculum, content, applied learning, residency and internship opportunities, levels of competencies, and mechanisms of learning.

Findings: 

With a holistic framework for sustainability, healthcare administrators can implement methods for multidisciplinary teams to respond to the constant change, fine-tune procedures and successfully manage quality of care.



Supervisors can mentor students and provide in-service training experiences that integrate knowledge, skills and abilities.



Healthcare organizations around the world are under stakeholders’ tension to provide high quality, cost-effective, reachable and sustainable service.



Professional organizations and healthcare providers can cooperate with college graduate health management education programs to prepare qualify managers in all the dimensions of sustainability.

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GROUP 4 

The newly designated liable care organizations represent an opportunity for managers to address the need for sustainability.

Research limitations/implications: Additional experimental research needs to be conducted on these integral innovative subjects.

Conclusions: This thesis analyzed specific competencies and certain models and strategies that managers can use to encourage change in the organization and the communities they serve. In order to institute a managerial culture of sustainability in healthcare organizations, managers need to look at all the aspects of sustainability, as well as the competencies and changes management strategies required to do.

Healthcare amendments in US and all over the world will continue evaluating the sustainability framework with increased request for quality and cost effective services, the allotment of limited resources, the unpredictable environment, the power/professional dynamics and the reductions of the relative numbers of appropriated skilled staff to meet the populations’ demands.

Challenges outside of this circle of influence, like natural disasters having to do with the change in climate and competition from emerging economies, will also easily place pressure on the efficiency of the healthcare system.

Relationship and potential application to the typology decision: This paper examines the concept of sustainability in health care organizations and the key managerial competencies and change management strategies needed to implant a culture of sustainability. This information can give us a better understanding on how sustainability is evaluated on the healthcare system and how the healthcare organizations, government and the community are working together to implement a quality and cost effective service.

Quotations: “Care organizations represent an excellent and timely opportunity for managers to apply the sustainability framework to analyze the relationship of key elements such as cost/financial

114

GROUP 4 issues, quality of care, partnership support, community engagement, strong governance, and policy regulations.� (p.670)

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GROUP 4 (Darzi) Sub-question 3: Does applying the principles of sustainable design benefit patients with high stress levels, and have a positive impact on behavior?

Anderko, L. (2013). Greening the ‘proclamation for change’ healing through sustainable healthcare environments. The American journal of nursing, 113(4), 52-59.

Author’s Credentials: Laura Anderko has a bachelor’s degree in Nursing from University of Illinois at Chicago, a master’s degree in Nursing (Specialty, Community Health) from Northern Illinois University and a Ph.D. in Public Health from University of Illinois at Chicago.

Intended Audience: This article is for Healthcare and architects.

Objective reasoning: The author is trying to explain how sustainable practice plays an important whole in Healthcare. By applying sustainability in healthcare design, it can have as a result an improved health, less stress, and an improved work environment as well as a healthier interior design for patients. This article has 36 references that cover four principles, such as, adopt sustainable and human centered designs, promote the use of environmentally preferable purchasing, create healing environments, and ensure and manage interdisciplinary sustainability efforts. Those principles will help to create a greater and greener environment for healthcare.

Coverage: Healthcare, sustainable practice and interior design.

Writing Style: Formal Summary of Methodology The author researched about sustainable practices in healthcare and how it can have a positive effect on the patients and employee’s health, communities and environment as a whole. The main goal of this article is to influence the construction and interior design of healthcare clinics, hospitals, nursing homes, decrease stress from work, and generate better safety and care quality by improving the nurse work environments.

As a result of this sustainability practice process was the Proclamation for Change, in other words, a set of four principles as mentioned before that support the change by focusing on centering patients design. By using the Proclamation for Change health care became more environmentally sustainable and was able to encourage a better health, healing, and had a great encouragement on the healthy public policy.

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GROUP 4 Findings: 

Incorporating green building materials is a way to adopt a sustainable and humancentered design.



Encourage vendor partnerships and make sure that suppliers reveal comprehensive hazard data on their products.



Focus on the use of cleaner air on the interiors.



More use of natural light increases the healing process, a way to do that is make bigger windows, and using interior lighting that simulates natural lighting.



Reduce the buildup of latex allergens in the ceiling tiles.



Do not use flooring materials that has PVC.



More single bedrooms are better than multi-bed rooms.



The use of acoustics is also great for creating privacy.



Use of healthier food by planting vegetables in the facilities can increase patient’s health.

Relationship and potential application to the typology decision: This article is very important to our typology decision since it is about how the environment has a great influence on human health. The potential application of this article in health care is providing ways in which the interior design and any activity inside of the space can have a positive effect to people’s health (patients and employees). To accomplish that, is important to take into consideration the provision of pure air and water, efficient drainage, keep the space clean and lighting.

Quotations: “Features such as single-patient rooms, improved unit layout, and easily accessible workstations can help reduce patient falls, health case associated infections, and medication errors while improving patient, worker and community safety.”(p.54)

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GROUP 4 (Acosta) Sub Question 3: Does applying the principles of sustainable design benefit patients with high stress levels, and have a positive impact on behavior?

Tham, R., Humphreys, J., Kinsman, L., Buykx, P., Asaid, A., Tuohey, K., & Riley, K. (2010).

Evaluating the impact of sustainable comprehensive primary health care on rural health. Australian Journal of Rural Health, 18(4), 166-172.

Author’s Credentials: Dr. Rachel Tham. Monash University School of Rural Health. Victoria, Australia.

Intended Audience: Primary health care providers, Physicians Objective Reasoning: The article’s main objective is to initiate a conceptual framework for monitoring the relationship between health services and health outcomes in rural Australia. The article talks about how rural communities are being ignored by health officials in Australia.

Coverage: Health Service Evaluation, Sustainability and Rural Healthcare Writing style: Informative

Summary of Methodology: The article talks about how health services in Australia play a vital role in rural communities. It gives emphasis to sustainable primary health care services and how they provide the foundation for quality health care services. It talks about the increased demand for health care services and how resources are sometimes scare for the funding of healthcare centers. Also, it explains how there is no organizational projects that are trying to improve the quality of health services. The article talks about how healthcare services are divided into three important sections, which are service performance, sustainability and service activities. Sustainability is important factor for rural communities since it provides better treatments and facilities that provide quality healthcare.

The article states that certain communities will have difficulties getting healthcare services because of financial constraints. This uncertainty creates a problem when rural communities are trying to get quality healthcare from their providers. It is important to deliver the right services to people in rural areas since it would be a logistical issue for families to travel to urban areas to get healthcare services.

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GROUP 4 Findings: 

The article provided a study that was conducted by the Elmore Primary Health Service.



Since rural areas provide a perfect setting to gain insight into how rural, communities benefit from health care services.



Its main objectives are to study the health services and see how sustainability can impact health care services.



It wanted to know how to measure the effect on patterns of health service outcomes on residents and how much medical attention are they getting from their healthcare provider.



The results of the assessment provided Elmore with valuable data such as the organizational structure and processes that take place when there are changes in certain health risk behaviors.



One of the important indicators that were found is that providing high quality health services in rural areas make service design and structure a complicated problem. There really is not a practical solution that can cater to the needs of all rural residents since health service needs will vary between communities.



The study will help monitor aspects such as physical facilities and equipment that may be needed to help start an effective health facility in a rural area.



The study allowed for the changes that could improve the quality of life for people who live in a rural community.



The study allowed for a better understanding on how health services can provide a better quality of life for rural communities.

Relationship and potential application to typology decision: The article relates to the typology selected because it talks about how people who live in rural Australia have difficulty in receiving health care from medical providers. The primary concern as an interior architect is to build sustainable outposts that will facilitate a smoother transition for medical providers coming to rural parts of Australia. This will be beneficial for people since it cuts distances to receive medical care. The responsibility of an interior architect is to implement a plan to build sustainable facilities that can provide healthcare services to people in rural areas.

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GROUP 4 Quotations: “Comprehensive health service evaluation is necessary to monitor the effectiveness of services in delivering care that targets the changing health needs and service utilization behavior of a rural populations� (p.167)

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GROUP 4 (Lyon) Sub-question 3: Does applying the principles of sustainable design benefit patients with high stress levels, and have a positive impact on behavior?

Nussbaumer, L. L. (2004). Multiple Chemical Sensitivity (MCS): The Controversy and Relation to Interior Design. Journal of Interior Design, 30(1), 51-65.

Author’s Credentials: Linda L. Nussbaumer: PhD, ASID, IDEC. Linda is an Interior Designer in Minnesota; she works as a professor of interior design at South Dakota State University (SDSU).

Intended Audience: Interior designers, conventional hospitals, physicians, care nurse, interior designers educators, healthcare professional, hospitals, scholarly researches.

Objective reasoning: The purpose of this article is to analyze the multiple definitions of Multiple Chemical Sensitivity (MCS) in relation to the Indoor Air Quality (IAQ) and to understand its condition and symptoms. Implications were presented to give solutions for designers to apply in their work, towards MCS. Coverage: Interior design, sustainability practices, medicine and healthcare.

Writing Style: Formal.

Summary of methodology: For all designers, it is important to become knowledgeable about how to apply sustainability in their design. This article explains how the syndrome of multiple chemical sensitivity, can affect people’s life. In a study, poor indoor air quality (IAQ) was identified as the main source when people were experience health problems or illness, and this illness was identified as MCS. Many definitions were developed for multiple chemical sensitivity, (MCS) however, the most common term was defined as “a chronic condition with symptoms that recur reproducibly in response to low levels of exposure to multiple unrelated chemicals [and the conditions] improve[s] or resolve[s] when incitants are removed [and that] recurring...symptoms occur in multiple organ systems” (p.54) Even though MCS is considered an illness and phenomenon, some physicians believe that it is a psychological condition. According with Linda, a person with this syndrome will experience the following symptoms: “chest pain, depression, difficulty remembering, 121

GROUP 4 dizziness, fatigue, headache, inability to concentrate, nausea, and aches and pains in muscles and joints.” (p.55) Linda discussed the concern that interior designers should have in the need of creating healthy environments for the community. According with the author, a “green” or “sustainable” design is part of the code of their professional ethic. Many designers do not have education about sustainability and their lack of information about material or furnishing (synthetic textile, carpets…) selection becomes a problem when designing spaces for people who has MCS syndrome. Many materials may contain VOCs (“compounds that vaporize (become a gas) at room temperature.”) This compounds greatly influence the indoor air quality of a space, thus, people with the syndrome can be severely affected. It is easy for people to be surrounded by environments containing poor air quality and with VOCs. This can be presented in their workplace, residency, office, and others.

In the year of 2002, 1,570 individuals participated in a study made in the south side of United States. These individuals reported hypersensitivity to common chemical products and showed the following symptom reactions: -

Headache (88.4%)

-

Burning eyes (76.8%)

-

Stomach distress/ nausea (55.1%)

-

Dizziness (46.4%)

-

Loss of mental concentration (31.9%)

-

Muscle pain (30.4%)

-

Loss of consciousness (7.2%)

-

Asthma or similar breathing problems (59.4%)

Also, in this study, chemical products and substances were evaluated, such as: cleaning products (82.6%), tobacco smoke (82.6%), perfume (81.2%), pesticides (81.2%), and car exhaust (72.5%).

MCS syndrome generates a synergistic reaction within the body. Conclusions of the study indicated that individuals with MCS “experience a synergistic reactions to chemicals.” Also, it was concluded that individuals with the syndrome exposed to chemicals, not only become 122

GROUP 4 sensitive to one chemical but to many of them.

Even though, researches and studies about the symptoms and reactions of MCS exit, there are many theories that imply that MCS is “particularly difficult to diagnose.” Linda stated that the American College of Physicians believes “MCS condition is purely psychological” thus, many physicians will not treat patients in this condition. However, Linda showed how other organizations demonstrated the opposite, with MCS being “a very real physical illness.” Other studies have shown that MCS is most seen in female patients between 30 and 40 years old. Other studies estimated 25 percent to 33 percent of the population holds MCS. In other studies the syndrome affects only 15 percent of the population. In regards demographic studies, several indicated that MCS affect people regardless of individual’s social background, race or economic background. However, other stated that MCS tend to occur more frequently among people with higher education levels and incomes.

Solutions such as minimize the exposure to chemicals and to ventilate interior spaces that are exposed to chemicals in an adequately manner, are also been discussed as treatments and preventive solutions for MCS. Poor interior air quality possibly produces MCS syndrome, which along Linda’s research, it becomes a serious condition when not paying attention to it. Thus, Linda stated that it is important for interior designers to create sustainable spaces, free of chemicals, taking in consideration that people are indoors 90 percent of their time. For this, designers need to be well educated about sustainable practices. She indicated that sometimes, green products do not necessarily have to be safe and healthy. A person that is not well informed about this topic can also turn into bad consequences.

Findings: 

Poor indoor air quality was identified as the main source of multiple chemical sensitivity (MCS) syndromes.



There is a need within the designer’s community in creating sustainable environments where individuals can be safe and healthy.



It is important for designers to be educated about sustainable practices.

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GROUP 4 

Designers must be knowledgeable about MCS causes and symptoms to avoid the use of chemical and toxic products that will affect individuals in an interior space.



It is important for designers to provide healthy environments, taking in consideration that people are indoors 90 percent of the time.



Materials that produce high levels of VOCs are very dangerous and exposed to many individuals daily.



Theories indicate that MCS can be a psychological according with many doctors but it can also be a physical illness.



MCS can be controlled with the reduction of chemicals in products and with adequately ventilated systems in a room exposed with chemicals.



Studies found that MCS can be present in female patients between 30 and 40 years old.



MCS occur more frequently among people with higher education levels and incomes.

Quotations: “A chronic condition with symptoms that recur reproducibly in response to low levels of exposure to multiple unrelated chemicals [and the conditions] improve[s] or resolve[s] when incitants are removed [and that] recurring...symptoms occur in multiple organ systems” (p.54) “Chest pain, depression, difficulty remembering, dizziness, fatigue, headache, inability to concentrate, nausea, and aches and pains in muscles and joints.” (p.55) Relationship and potential application to the typology decision As designers, this article helps us to understand the importance of being knowledgeable about sustainable design. It would help us to design a Holistic Center, which could be characterized by offering a healthy environment for the patients. Sustainability would be part of out professional ethic and ideas of green environment would be considered in the design of the space

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GROUP 4 (Darzi) Sub-question 4: How can people improve productivity and relationships in their lifestyle, and how behavior, ethics, lifestyle, and holistic approaches influence these relationships?

Pronk, N. (2012). An optimal lifestyle metric: Four simple behaviors that affect health, cost, and productivity. Health & Fitness Journal, 16(3), 39-43.

Author’s credential: Nico Pronk is a vice president of the Health Management and Health Science Officer at HealthParters in Minneapolis, MN. He has a Ph.D., FACSM and FAWHP. At HealthPartners Research Foundation, Nico works as a senior researcher and investigator.

Dr. Pronk works at the Harvard University School of Public Health as an adjunct professor, and there he teaches and conducts research in worker health protection and promotion.

At the International Association for Worksite Health Promotion, Nico Pronk is the current president.

Intended Audience: This article is addressed for students but also could be relevant for practitioners and could be considered as an informational type of article.

Objective reasoning: The author is trying to explain the importance of the use of an Optimal Lifestyle Metric as a way of life that improves health factors, benefits productivity, and lower costs towards a work environment. To support this research the authors acquired references from 15 sources and developed topics with objective definitions and experimental analyses in order to accomplish the study and provide enough information.

Coverage: This Journal is related to the topic Sustainable Holistic Medical Center, and helped answer the question about how lifestyle can help with productivity and give you a healthier condition.

Writing Style: Formal

Summary of Methodology The Author is trying to inform about four behaviors that can improve health and productivity and reduce cost, to accomplish that he created a profile of all the different possibilities that exist and can relate to the adherence of the individual behaviors and of the optimal lifestyle metric gatherings. To accomplish it, the author needed to create an overview of all possibilities, and gather some data, he did it and analyzed more than 500,000 employees from a workspace who 125

GROUP 4 had completed a health assessment as part of their worksite health promotion program and the data results, helped with the OLM criteria understanding.. There were some other studies, such as, using OLM for health outcomes, OLM for emotional health concerns, OLM for cost outcomes, and OLM for productivity outcomes.

Findings: 

Communicating the importance of OLM.



Showing that is simple the participants take action on OLM, that they can pick one behavior at time to start to change, first they can choose to do something that they think they might enjoy, and then add others until they get use to the new lifestyle.



Explaining that the adherence of OLM will help on their productivity, and lower their health costs.



Highlight main actions that help on the engagement of OLM behaviors.



The authors concluded based on the data from the methodology presented, higher levels of adherence to OLM are associated with better health status, fewer new cases of chronic disease, fewer health care costs, and better productivity. The results seem to appear within 18 months to 2 years.

Relationship and potential application to the typology decision: The information that this article provides help to understand how beneficial is a lifestyle for a better production, but also as a principle of practice of a holistic medicine in the healthcare. Also as designers we would provide a technique to express in a sustainable way and make the patients acquire the lifestyle change concept working on a different design by using a “subliminal method”, making them understand how it is important without being thrown on their faces, such as use of images that can inspire them.

Quotations: “Optimal lifestyle metric (OLM) can be created that represents simultaneous adherence to multiple positive health behaviors” (pag.39)

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GROUP 4 “Health promotion programs present an excellent opportunity to increase adherence to OLM and thereby reduce the burden of chronic disease, reduce health care costs, and increase productivity.” (pag. 39) “Whatever behaviors you are not adhering to currently, pick one you think you can do and would enjoy doing, and add it to the mix of behaviors you already are engaged in on a daily basis.” (pag.42-43)”

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GROUP 4 (Darzi) Sub-question 4: How can people improve productivity and relationships in their lifestyle, and how behavior, ethics, lifestyle, and holistic approaches influence these relationships?

Gieck, D. J., & Olsen, S. (2007). Holistic wellness as a means to developing a lifestyle approach to health behavior among college students. Journal of American College Health, 56(1), 29-35.

Author’s Credentials: Joseph Gieck is the former chief athletic trainer and director of sports medicine at the University of Virginia, he works there since 1962.

Joe Gieck brought his cowboy style to Charlottesville and the University of Virginia in 1962, figuring he wouldn’t stick around long. Gieck was honored at the 21st annual Multiple Sclerosis Society’s Dinner of Champions.

Gieck was involved with MS since the beginning when he first starts working at the University of Virginia, he worked with a professor that was affected by the disease.

Sara Olsen went to Dartmouth College and received an MBA and MASW degrees from UC Berkeley and the University of Chicago. Olsen is a co-founder of the Global Social Venture Competition. Sara also holds professorships at Hult International Business School and the Monterey Institute of International Studies, since 2001 Sara worked straight with more than 7900 people and teaches management & impact accounting and she has led the design of customized systems that nowadays expose the impact of over $9Bn in 70+ countries and many industries including sustainable agriculture, reforestation, green technology, housing, education, community economic development and maternal and child health.

Intended Audience: This article is for academics students and professors, and participants.

Objective reasoning: Both authors are trying to explain the importance of a holistic model of wellness can influence the lifestyle of college students and promote a better health. With 26 references and using different methods this research had a great initial support, but it was mostly among woman, because all the men’s gave up during the analysis, so they need a further study.

By using the question “how to develop a lifestyle approach to health maintenance behavior, which could significantly reduce rates of morbidity and mortality?” (Giek & Olsen) the authors came up with different methods to explain how it can happen. They used two different group’s men’s and women.

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GROUP 4 Coverage: Holistic wellness, health, and lifestyle.

Writing Style: Informal, needs more information.

Summary of Methodology The authors researched about limited discussions of how to create programs that can encourage lifestyle approach to health behavior. In their research they found Hettle’s model approaches of wellness that had six different dimensions about health behavior, such as, physical, emotional, spiritual, social, occupational, and intellectual wellness. By adapting Hettler’s model for their study, the authors had as a goal the achievement balance through domains of wellness.

To start, the authors examined the first effects of adding a holistic wellness in an eleven week walking program. By this first step, the results were increased levels of cardiorespiratory fitness, reducing of body fat, better metabolic rate, better mood, less depression and anxiety.

After this previous test, they elaborated more follow ups, using daily logs to record the steps of all participants during that eleven week program. The authors collected more data by using different measurements, analyses, and viewing the results.

They concluded that those experiments were a pilot investigation that helped prove that a holistic wellness lifestyle does help in woman health results, but they need a deeper study.

Findings: 

Adherence of exercise activity will create a better lifestyle.



Increase of resistance training, walking behavior, and self-efficacy help understand the principles of a holistic wellness.



Promote lifestyle approach to increase a better health behavior.



Develop programs to bring others the knowledge of holistic wellness.

Relationship and potential application to the typology decision: This journal was more about giving us the knowledge of lifestyle and how it can affect our lives if used for health matters. With the information provided, it helped us understanding about how a holistic wellness can help our health, and made us think about how we could design a space that invites people to come in and change their lifestyle and keep the new lifestyle. How would we be able to invite people in and help them to change their lifestyle? Maybe throughout using 129

GROUP 4 windows that people that pass by the area can see the work provided inside of the holistic center, but the patients inside can’t see what is happening on the outside (so they don’t get distract from their treatment). Of course the same treatments would have to be provided on other spaces that don’t have those windows, especially because not all patients would like to be seen from the outside of the building.

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GROUP 4 (Acosta) Sub-question 4: What are the factors that help build healthy relationships and how do behavior, ethics, lifestyle and holistic approaches influence these relationships?

Keim, S., Klärner, A., & Bernardi, L. (2013). Tie strength and family formation: Which personal relationships are influential? Personal Relationships, 20(3), 462-478 Author’ Credentials: Department of Sociology and Demography Rostock Germany. Institut des Sciences Sociales

Intended Audience: Adults within the ages of 25 and 35 who have completed formal education.

Objective reasoning: This article is based on a series of interviews that showed how personal relationships have a major effect on the decisions that people make when deciding to have kids.

It talks about the social influences that impact the formation of new families and the strong ties to other groups of individuals.

Coverage: Personal Relationships, Social Influences, Education.

Writing Style: Formal style

Summary of methodology: The article wants to address the affect the formation of young adults’ childbearing opinions. In order to get an understanding of how the research was going to be conducted a mixed method design was done to collect information on the participants. The research started by interviewing people who finished college and focus on the changes that happen when people postpone childbirth and do not have kids. Most of the people who postpone having children have completed their bachelor’s or master’s degrees. They tend to forgo having children due to the fact it may cause a financial burden.

This Table shows the following types of people and their relative age group

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STATISTICS OF DIFFERENT PARTICIPANT

Number of Respondents

50 respondents

Gender

28 women and 22 men

Median Age

30 years

Parity

31 childless

16 one child 3 two children Partnership Status

11 single

6 living apart 8 cohabiting 25 married

Education

13 secondary diploma

11 high school diploma 18 university diploma 8 currently studying

The analysis revealed that researchers found that people discovered their own views based on other persons’ ideas, plans, intentions, behavior and experiences. For the people who had children the study revealed that social influence was a key indicator on how they felt about having children and making a strong relationship with their families. The most important aspect for people wanting to have kids is the trust they have in their partner. It is important to recognize that one’s own upbringing will influence views on family formation. In addition, many participants experienced social pressure. They felt emotional pressure from their own parents. Many parents were sometimes seen sad because their children were sometimes single well into their mid-thirties.

The following are some of the factors that influence people when forming a family 1. Parental advice was important when deciding to form a family nucleus 2. The support of siblings and cousins provide emotional and communication experiences 132

GROUP 4 3. Being close to friends is a strong indicator of social influence that can lead an easier transition when forming a family.

4. Findings: 

The article talks about the complicated relationships that parents have with their children.



It explains the factors that influence personal relationships, such as cultural and religious patterns.



Social influence is important because it shows how people behave in society. According to Flap, “The concept of social support highlights how individuals are affected in their beliefs, ideas and behavior by the resources to which they have access” (469).



Family ties are an important factor since they help in social interactions between parents and children.



It is often recognized that families that have strong bonds have better social interactions with others.



It is important to understand the differences between emotional and social influences that occur in personal relationships.



Individuals are influenced in their attitudes, intentions, and behaviors by the resources in which they access



Learning can occur through communication but also through observing other people’s behavior



The study revealed that relatives, siblings and friends have strong ties to one another



Social learning provides emotional support and advice for parents



Acquaintances have decided not to form families since they prefer to have financial freedom



Some people decided to not have children because they did not have social support from their inner circle

Relationship and potential application to typology decision: The article relates to the typology selected because it shows how personal relationships influence the formation of families. There are various reason why young couples are postponing on starting a family. The main concern is to find the socioeconomic reasons why couples are feeling pressure

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GROUP 4 to start their own families. As an architect it is important to focus on a strategy that uses quality materials in a sustainable environment where people can have a better quality of life.

Quotations: “All respondents indicated relatives were important in terms of emotional closeness, intimacy, and trust (466)”.

“All partners and children as well as more than 80% of the parents, siblings and closest friends were considered strong ties (467)”.

Conclusion The article was very informative and helped me understand the different relationships that exist when forming strong ties to family. It showed that people have different views on how to form a family and why socio-economic factors influence the development of strong relationships.

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GROUP 4 (Muino) Sub-question 4: How can people improve productivity and relationships in their lifestyle, and how behavior, ethics, lifestyle and holistic approaches influence these relationships?

Walsh, R. (2011). Lifestyle and mental health. American Psychologist, 66(7), 579-592.

Author’s Credentials: Roger Walsh, M.D., Ph.D. DHL. Graduated from Australia’s Queensland University with degrees in psychology, physiology, neuroscience, and medicine, and then came to the United States as a Fulbright Scholar. He is now at the University of California at Irvine where he is professor of psychiatry, philosophy, and anthropology, as well as a professor in the religious studies program.

Intended Audience: Mental health professionals, students, researchers, and teachers.

Objective reasoning: This article is an author’s research study on how to enhance physical, psychological, social and spiritual wellbeing. Based on his own knowledge and other studies, he explores the many implications of contemporary lifestyles and Therapeutic Lifestyle Changes (TLCs) for individuals, society and health professionals.

Coverage: Lifestyle, Therapeutic lifestyle changes, mental health, psychopathology, cognitive capacities.

Writing Style: Informative, statistical and comparison, formal.

Summary of methodology: In the hectic world in which we live, where we find it hard to make changes in our routine, and often simply do what we "are used to do” all our life, the small adjustments in our lives can deliver a huge benefit to our quality of life. That is what Roger Walsh, professor of psychiatry and human behavior at the University of California, Irvine, discovered in this study conducted in 2010 and published in 2011 in the journal "American Psychologist" of the American Psychological Association.

This article, outlines eight major lifestyle factors that are woefully under-appreciated in the field of mental health, despite overwhelming evidence of their psychological (and physical and social) benefits. In his investigation, the author found that changes in the lifestyle of people are as useful as conventional medicine when it comes to improving mental health and quality of life.

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GROUP 4 Findings: Walsh conducted this study with the help and review of previous research. He studied the effects, effectiveness, principles, advantages and challenges involved in the implementation of Therapeutic Lifestyle Changes (TLCs), and the economic, institutional, and professional forces that hinder their use.

These are the nine adjustments we can make in our lives that Walsh found in his study, that allow us to have better mental health and improved quality of life. These are: 

Exercise improves the sense of well-being, memory loss in older and increases the formation of neurons in the brain. (580)



Eating fruits and vegetables helps maintain cognitive functions in adults and reduces symptoms of affective disorders. (581-582)



Spending time in nature improves cognitive function and wellness. (583)



Cultivating good relationships even reduces the risk of catching a cold in addition to reduce several mental illnesses. (584)



Recreation and fun times cut down the barriers we put in front of others. (585)



Relaxing and managing stress helps to treat anxiety, panic and insomnia.



Meditating improves empathy and emotional stability, reduce stress and fatigue. (585586)



Involving in spiritual or religious way that focuses on love and forgiveness promotes well-being and reduces anxiety. (587)



Altruistic contributions increase generosity and joy and can benefit mental health and perhaps even extend life. (588)

According to Walsh, the key is to be able to persevere in these settings and not expect them to operate overnight, but gradually go feeling the change.

Relationship and potential application to the typology decision: According to the findings in this research study, for our design we can take into account some of the adjustments that we can make in our lives allowing us to have better mental health and improved quality of life. Some features of these adjustments will give us an idea when designing spaces, such as in the case of doing exercises, spending time in nature, relaxing and meditating.

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GROUP 4 Quotations: “Lifestyle factors can be potent in determining both physical and mental health” (p.579) “Exercise offers physical benefits that extend over multiple body systems” (p.580) “Two major dietary components must be considered: food selection and supplements” (p.581) “For thousands of years, wise people have recommended nature as a source of healing and wisdom” (p.583) “Chronic stressors can exact a major toll across multiple organ systems and levels” (p.585) “Religious and spiritual concerns are vitally important to most people and most patients” (p.586) “There is nothing selfish about enjoying yourself. In fact, as wise people have long said and psychologists have since discovered, happiness makes people less self-focused and more altruistic” (p.587)

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GROUP 4 (Acosta) Sub question 4: How can people improve productivity and relationships in their lifestyle, and how behavior, ethics, lifestyle and holistic approaches influence these relationships?

Johanson, M., Larsson, U. S., Säljö, R., & Svärdsudd, K. (1996). Addressing life style in primary health care. Social Science & Medicine, 43(3), 389-400.

Author’s Credentials: Department of Communication Studies Intended Audience: Professional Health Care advocates Objective reasoning: This article is an author’s research on how physicians and patients interact with one another during a consultation. It explores how a patient and physician talk about their daily life choices during a visit.

Coverage: Healthcare, Lifestyles.

Writing Style: Formal.

Summary of methodology: The article explains how each person has different types of lifestyles. According to the article, the physicians would interrogate their patients by asking them a series of questions, such as if they would smoke cigarettes. Then the physician would ask the patient how they feel about eating healthy food and coffee. Also, the patient would talk about family and it would affect their workplace performance. The analysis revealed that when physicians spoke to their patients they would come across daily life topics and find ways to improve their lifestyle. Another important aspect is that the consultations would involve a series of discussions that would improve a person’s lifestyle. When a patient visits a family center it is important to get a general idea on why they engage in a deep conversation with their physicians. Giddens states that life style takes on a vital role for people who have different types of daily activities. During a medical encounter it is important to analyze the different types of dialogues that may occur when a physician talks patient.

For example, some physicians started to talk about drugs and physical exercise. Many patients would talk about the uncertainty of their symptoms and how a type of lifestyle would change their outlook toward certain topics.

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GROUP 4 Findings: 

The article speaks about the importance of life style in primary care. According to Korsch and Negrete, since 1972 there have been more than 800 consultations that doctor using different medical terminology which confused patients.



The article explains the difficult task occurs when physicians and patients have different views on certain medical topics.



This article explains how patients and physicians deal with lifestyle patterns. It is important to recognize the personal relationships that exist between a physician and his patient during a consultation.



People who have different lifestyles which allow them to live a different life.



Physicians have different conversations with their patients regarding their general well being



Modern medicine and primary health care are essential for a person’s development



Results are based upon the fact that physicians talk to their patients about different aspects of life

Relationship and potential application to typology decision: The article relates to the typology selected because it focuses on the relationship that a patient and a doctor have with each other. The primary concerns are to develop places where patients feel comfortable in an environment where they can talk to their practitioners without worrying about an intrusion of privacy. As an interior architect it is important to focus creating a quality facility that values the care of its patients. It is important to focus on sustainability to produce places that are comfortable.

Quotations “Living in a ‘risk society’ implies living with a calculative attitude to the open responsibilities of action, positive and negative, as individuals we are confronted in a continuous way in our contemporary social existence” (p.28)

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GROUP 4 (Darzi) Sub-question 4: How can people improve productivity and relationships in their lifestyle, and how behavior, ethics, lifestyle, and holistic approaches influence these relationships?

Robroek, S. J. W. (2013). The role of lifestyle, health, and work in educational inequalities in sick and productivity loss at work. International archives of occupational and environmental health, 86(6), 619-627.

Author’s Credentials: Suzan, graduated with a master’s degree of Science in a health care major in 2005, then worked on her PhD in 2007, and then got another master’s degree in health sciences, specialization epidemiology in 2010. Right now she is a researcher for a postdoctoral.

Intended Audience: This article is addressed to professional firms and their employees, it also relevant for practitioners and could be considered as an informational type of article.

Objective reasoning: This article has forty-two references that the author discussed throughout it, in addition with her personal judgement and knowledge as well as the methods and its results.

Her objective was to inform the audience over some methods about the role of lifestyle, health and work.

Coverage: Healthcare and Commercial Offices.

Writing Style: Formal

Summary of Methodology The author is trying to explain how lifestyle, health, and work can or cannot affect employees in their productivity and sickness at work. To support this research the authors acquired references from 42 sources and separated into topics, such as: productivity loss at work, sick leave, individual characteristics, lifestyle factors, health indicators and work related factors, with the explanations and experimental analyses in order to accomplish the study and provide some facts or information that could add on previous and future studies.

Conditions at work and lifestyle did not have influence to the link between education and productivity at work, but it did partway explain the association between education (poor education) and sick leave.

To insure all information, a questionnaire method with one year experience and following responses were used in this article, a great amount of employees (915 participants) were gathered 140

GROUP 4 to accomplish these tests. And the results proved that a healthier lifestyle does not change a lot in productivity, but it did decrease the sick leave number at the work environment.

Findings: 

Lifestyle factors, health and conditions at work could play a role in educational inequalities, productivity loss at work and sick leave.



Design successful interventions to increase education, productivity and decrease sick leave.



Investigations that address behavioral aspects as well as work-related and lifestyle factors.

Relationship and potential application to the typology decision Based on the information provided on this article is important to consider how education can inform and help changing life style. Even though the typology is healthcare, education can be used in a way to educate patients about health improvements. A way to do that is the use of signs and TV screams that serves as guidance. Signs could be interesting, with figures, or use of different colors, TV’s could be recessed in the walls interacting with a wall fixture or paint.

Quotations: “Work-related and lifestyle-related factors did attenuate the association between low education and sick leave, but did not influence the association between educational level and productivity loss at work.” (p. 626)

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GROUP 4 (Darzi) Sub-question 4: How can people improve productivity and relationships in their lifestyle, and how behavior, ethics, lifestyle, and holistic approaches influence these relationships?

Guenther, R. (2015). Building Health. Architecture Boston, 18(4), 32-35.

Author’s Credentials: Rebecca has a PhD from University of Sydney, a Master Degree of Business Stud (Management Consultancy) from University College, Dublin – Ireland and a Graduate Certificate of Tertiary Teaching from University of Newcastle.

Intended Audience: Healthcare, businesses, employees, people in general that would like to increase or learn more about their productivity and health.

Objective reasoning: This article has twenty-two references that the author used in it, in addition the author made a study using methods and responses to assure the main purpose of this article, such as, inform the reader how a healthier lifestyle can improve their productivity as well as save money to the participant’s employers.

Coverage: Healthcare, Productivity, and Lifestyle.

Writing Style: Informational and formal.

Summary of Methodology: This article emphasizes the idea of a health promotion programs that can educate participants about their health conditions and how can they treat it, as well as create a better lifestyle and stay on track with their health improvement goals.

The main purpose of working with the participants of these programs services besides of educating them, were also to inform people about how they can increase their health, reduce medical costs, and have a better productivity in a work environment.

To make the study accurate, the participants had to complete two surveys, one before the initial date program and another one after completing the program six to eighteen months. These surveys were the main source of information that helped with the conclusion that when an employee have a health coach, health advocate, or nurse that helps him or her makes improvements in health and lifestyle, he or she can have more production on their daily work.

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Findings: 

Plan a wellness and disease management interventions evaluating the current study, and how the methods used had an impact on employee’s productivity in a working space.



Create a summary about the reduction in lost work time between the participants and how successfully they improved their health and lifestyle.



Have a discussion about the implications and calculate the economic benefits an employee will have with those health programs promotion.

Relationship and potential application to the typology decision: This article can be applied in our typology of a holistic center by creating spaces that can be divided into different treatment sections, where patients can be guided easily and be treated.

Therefore, space planning is a huge hole in this case. Also the designer can design a space but he/she need to consider the patient’s needs and solutions to help on their health problems, to do that in this case, the designer need to understand what this article explained about different health programs and how it can help changing lifestyle and productivity and throughout that come with a design solution. Factors such as space planning, interior guidance, color treatment, lighting, staff and patients interaction are all part of the design solution.

Quotations: “In an effort to control costs and improve health, employers seek solutions that improve employee health habits and increase the appropriateness or coordination of their health care--these may also lead to a more productive workforce” (p.1142)

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GROUP 4 (Darzi) Sub-question 4: How can people improve productivity and relationships in their lifestyle, and how behavior, ethics, lifestyle, and holistic approaches influence these relationships?

VanWormer, J. J. (2011). Stress and workplace productivity loss in the heart of new ulm project.

Journal of occupational and environmental medicine, 53(10), 1106-1109.

Author’s Credentials: Dr. VanWormer is a behavioral epidemiologist with interests in primary prevention and risk factor control in cardiovascular disease, with particular attention to community level surveillance and lifestyle interventions. Currently, he works as an investigator member of the HMO Research Network and Marshfield Clinic. He is also the site Principal Investigator and steering committee representative for the NHLBI-funded Cardiovascular Research Network. He is a Senior Program Evaluator at HealthPartners and continues to serve as a Scientific Advisory Board member of the Heart of New Ulm Project and an investigator member of the Institute for Clinical and Translational Research.

Intended Audience: This article is addressed to people that would like to improve their lifestyle and/or suffer from stress. It is also for employees and business.

Objective reasoning: This article has twenty-nine references that helped the author with his findings and methods throughout it.

His objective was to inform the audience about the impact of stress in combination with lifestyle factors and the workplace productivity.

Coverage: Healthcare, Stress, and Lifestyle.

Writing Style: Formal

Summary of Methodology The author is trying to explain that a poor health status can prejudice on people’s productivity in the work environment. He mentions some of the risk factors that influence the workplace productivity, such as diabetes, hypertension, or hyperlipidemia, lifestyle factors, obesity, tobacco use, and surprisingly from researches he found out that stress also has effect on the low productivity.

When thinking on there are a lot of studies that supports worksite wellness programs that focus on weight loss, physical activities, better nutrition and other healthy issues, but this specific 144

GROUP 4 study has an overall aim to focus on stress management and how it can help people to improve their productivity.

To support this research the authors acquired references from 29 sources and analyze over 2823 adults results after they participate on the Heart of New ULM (HONU) Project, that was designed to reduce the attack rate of myocardial infarctions in the New Ulm, Minnesota, area. In other words, the HONU project was created to help decrease stress levels.

As a conclusion the author found out that as more physical activity people do and a better lifestyle they have less stress they have and as a result better productivity in a work space.

Findings: 

Understand previous researches on stress in a workplace and productivity.



Understand the interaction between physical activities and different stress levels.



Workplace wellness programs along with physical activities and how to increase productivity for workers that suffer high level of stress.

Relationship and potential application to the typology decision: Based on the typology Holistic Center, these findings will control the environmental factors before they become a problem that can generate stress. It helped us to realize how counseling is important to help understand how stress plays a big hole in people’s life if not taken care of.

Quotations: “Higher stress generally predicted greater productivity loss.” (p.1106) “More activity was associated with less productivity loss, perhaps indicating that individuals cope by exercising more and working less.” (p.1106)

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GROUP 4 (Darzi) Sub-question 4: How can people improve productivity and relationships in their lifestyle, and how behavior, ethics, lifestyle, and holistic approaches influence these relationships?

Van Scheppingen, A. R. (2014). Motivations for health and their associations with lifestyle, work style, health, vitality, and employee productivity. Journal of occupational and environmental medicine, 56(5), 540-546.

Author’s Credentials: Arjella R. Van Scheppingen has a TS Social, Behavioral Sciences, and Developmental Psychology.

Intended Audience: This article is for professional firms, such as business and their employees.

Objective reasoning: This article is about applying a healthy lifestyle and a work style behavior towards employees can help with their productivity within the firm.

Coverage: Business productivity and healthy lifestyle.

Writing Style: Formal

Summary of Methodology The author is trying to explain how the use of a healthier lifestyle work style behavior (the response that employees have to work difficulties in different surroundings) can be a positive weight to the business towards employee’s health and productivity. To be able to prove that, the methodology used was intensify the discussion on how valuable is health and vitality, followed by healthy activities, such as the firm providing free fruits, lunch walking, physical activities, and others, and the use of an online questionnaire to follow-up the results.

All employees were examined in two different sections, first was lifestyle and work style, which smoking and alcohol intake, healthy dietary habits, relaxation and balanced work style were taken as consideration. Second was perceived health, vitality at work, and productivity, which perceived health, vitality at work, absenteeism and presentism were taken as consideration.

By the end, a total of 629 employees followed the whole methodology and the conclusion was that more men’s were open to a healthier lifestyle than women.

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GROUP 4 Findings: 

How to engage employees of a certain company in healthy lifestyle behavior, by using lifestyle programs.



Provide different programs such as physical activity, healthy dietary habits, relaxation, balanced work style and smoking and alcohol intake.



Make follow-ups with the programs, to ensure employees how those changes can provide them a better health and more productivity.



Take as consideration use of outdoors for the activities.



Require a social environment where employees are able to freely choose different activities, sense themselves competent to perform the activity, and experience the environment.

Relationship and potential application to the typology decision: Based on this article and its findings, the information given is great to facilitate the idea of incorporating different activities that can change life style and health eating into the interior design concept. The typology is healthcare, but the procedures used into a holistic center can definitely change someone’s concept of lifestyle, so how can we make an interesting interior design that help with this main healthy lifestyle concept? By designing an interior with different activities spaces and also an opening and functional area for interaction and socialization, where people can tell about their experiences to others, or where can have mix events that teaches others about lifestyle, such as professionals guests speakers. Also have an eating area, that have it only has healthier food, encouraging people to eat healthier.

Quotations: “Investing in health and vitality at work, in particular through internalization of the value of health, is likely to make sense from a business perspective. This knowledge is important, because companies need to understand the relevance of health promotion to improve their business, in order for them to invest in it.” (p.544)

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GROUP 4 (Muino) Sub-question 4: How can people improve productivity and relationships in their lifestyle, and how behavior, ethics, lifestyle and holistic approaches influence these relationships?

Christiansen, C. H., & Matuska, K. M. (2006). Lifestyle balance: A review of concepts and research. Journal of Occupational Science, 13(1), 49-61.

Author’s Credentials: Charles H. Christiansen: Dr. Charles Christiansen was the Executive Director of the American Occupational Therapy Foundation in March 2008. He was the Vice President for Health Sciences at the University of Minnesota in Rochester and the founding director of the Center for Health Programs. From 1993-2006, Dr. Christiansen was the dean of the University of Texas in the area of medicine.

Previously, he was a professor and director of the School of Rehabilitation Sciences at the University of British Columbia. Dr. Christiansen’s academic career has spanned over three decades. His research interests include understanding human activities and lifestyle patterns, and their relationship to subjective well-being, resilience, health and quality of life.

Kathleen M. Matuska: She is a professor of Occupational Therapy at St Catherine University.

Her studies are based on life balance and fatigue management. Her research interests include lifestyle patterns and their relationship to humans’ well-being. Matuska also studies lifestyle adaptations to chronic illness, particularly in persons with Multiple Sclerosis.

Intended Audience: Healthcare professionals, nurses, students, researchers, and organizations.

Objective reasoning: This research has focused on the study of patterns of healthy lifestyle. In this paper, the concept of balance lifestyle of the early history is explained, continuing with the mental hygiene movement of the early twentieth century and extending to the present. This research identifies the opportunities for scientists and occupational therapists, and suggests that future studies should be connected with existing research through a common bond; for example, the identification of work patterns that reduce stress. This study stressed the importance of these studies to guide and promote health, prevent diseases and take decisions of social policy necessary for the health of the population in the 21st century.

Coverage: Lifestyle balance, activity patterns, health promotion, stress, time-use, role and resiliency.

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GROUP 4 Writing Style: Research, conceptual, informative & formal.

Summary of methodology: The perception of stress related to time management and the pressures of modern life in Western nations has increased the public interest to the belief that lifestyle can be balanced. Apparent imbalance conditions such as exhaustion, workaholism, insomnia, obesity, and circadian desynchronosis are universal and have been linked to adverse health consequences.

This study begins by tracing the origins of the concept of lifestyle balance, starting with the ancient philosophers and continuing with the efforts of the United States of America and linking these concepts to modern research on adaptation to stress. Continuing that is the review and critique of the limited research that is directly related to the balance of lifestyle in the areas of use of time, role theory, theories of psychological need, and chronobiology. Then, personal and environmental conditions that put people at risk of imbalances in the lifestyle and concepts of literature that reflect such imbalances are identified. Finally, they tried to identify the conceptual bridges from existing research, arguing that further understanding of the patterns of healthy lifestyle is essential for public health efforts towards preventing disease, promoting health must be effective, and that social policy has to be well informed.

The literature selected for this review included papers published in scholarly journals over the past 25 years. The literature searches were performed using the following keywords: Balance, activity patterns, lifestyle, health, life satisfaction, resiliency, quality of life, time roles, use, wellbeing and work/life balance.

The researches use definition to trace the history of the concept of lifestyle balance and to describe and analyze approaches that have been taken by researchers interested in the same or closely related constructs.

Some of these concepts are: Historical Beliefs about Beneficial Ways of Living: A common theme across the ages has been that well-being and enjoyment can be promoted by patterns of activity that reflect a satisfactory relationship with self, others and the surroundings.

Lifestyle Balance and the Mental Hygiene Movement: Modern stress research recognized the negative health impact of stressful life circumstances and the importance of lifestyle patterns to both physical and mental health.

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GROUP 4 The Relation between Concepts of Lifestyle Balance and Modern Stress Research: Identifying lifestyle patterns that enable people to manage the needs of everyday life more successfully and therefore promote health, prevent illness, and enhance perceived well-being by lowering stress was the central idea in Adolf Meyer’s psychobiological perspective and is an implicit canon underlying much of the research on behavior and health that has been dealt with during the past century.

Relationship between Lifestyle Balance and Quality of Life: The elements of a balanced lifestyle can be identified; it is considered that people can learn to live their daily lives in ways that reduce stress and foster health and well-being.

Findings: 

Four concepts to understanding lifestyle balance have been reviewed in this research.

These concepts include: the use of time, life roles, need of satisfaction, biological rhythms and their influence on behavior.



Each of these points of views involves the human occupation examined from different perspectives, and each approach has linked the health and welfare of certain lifestyle patterns.



Lifestyle patterns encourage satisfactory adaptation to the stresses of everyday life; whether through time use, role balance, need fulfillment or circadian regularity.

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A convincing argument for the importance of lifestyle research can be found in the Global Burden of Disease Study (Jobst, Shostak & Whitehouse, 1999; Murray & Lopez, 1996), which projects that the majority of the conditions that will consume worldwide health conditions in the year 2020 can be directly or indirectly related to lifestyle.

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Disorders, like chronic obstructive pulmonary disease, cardiovascular disease and motor vehicle crashes are directly related to unhealthy or unsafe lifestyle habits.

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Disorders like substance abuse, unipolar major depression, and self-inflicted injury (suicide), can be portrayed by life circumstances that are not perceived by the individuals affected to be meaningful, enjoyable or worthy of engagement.

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These methods support the idea of promoting healthy balanced lives, yet clearly link the commitment of societies and communities to support individuals in the formidable tasks associated with lifestyle changes.

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GROUP 4 

The efforts at prevention often consist of addressing specific behaviors in order to reduce injury, disease and disability; for example, efforts to reduce the incidence of heart disease through diet and exercise (World Health Organization, 1986).

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The attention is placed on preventing specific problems, rather than on promoting an overall pattern of living that leads to physical, emotional, social and spiritual wellbeing.

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Occupational science and occupational therapy are in a particular position to leverage their close relationship and understanding of human occupation and health to advance efforts in health, social policy and intervention.

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The occupational science and occupational therapy can promote alliances between scientists and practitioners in other areas to encourage partnerships in translational research, perhaps by taking advantage and understanding how the characteristics of balanced lifestyles can lead to a reduction in stress-related disease.

Relationship and potential application to the typology decision: This study stressed the importance of lifestyle balance and quality of life to guide and promote health, prevent diseases and take decisions of social policy necessary for the health of the population. This information is very important and can be helpful when designing our Holistic Center. We found that there is a direct relationship between the balance in lifestyle and better control of stress. In addition, that lifestyle balance and quality of life can be improved using holistic techniques.

Quotations: “Nearly half of U.S. workers report that their jobs interfere some or a lot with their personal lives, and nearly three quarters of working mothers and fathers feel they do not have enough time to spend with their children (Bond, Galinsky, & Swanberg, 1998)”. (p. 50) “Time use must be viewed as an important dimension of lifestyle balance, since knowledge of how people spend their time provides useful insights into the nature and frequency of their occupations” (p. 52)

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GROUP 4 “Lifestyle imbalance may be experienced as anxiety, as fatigue or drowsiness resulting from insufficient sleep, or as the nagging perception that one has too little rest or leisure time, or insufficient time for meaningful socialization with family and friends� (p. 56)

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GROUP 4 (Darzi) Sub-question 4: How can people improve productivity and relationships in their lifestyle, and how behavior, ethics, lifestyle, and holistic approaches influence these relationships?

Manwani, D. (2014). Effective workplace relationships and better productivity. International Journal of Organizational Behaviour & Management Perspectives, 3(1), 763-765.

Author’s Credentials: Dr. Manwani has Practice Specialty in Pediatrics - HematologyOncology (Cancer), a medical education in B.J. Medical College, and Residency in B.J. Medical College, North Shore University Hospital – Manhasset.

Intended Audience: This article is for workspace, employees and managers.

Objective reasoning: This article is about relationships in a workspace, how training people to hear to their voices, meet their needs and cultivate different cultures can be effective and beneficial towards their relationships with others and their productivity.

Writing Style: Formal

Summary of Methodology The author is trying to explain how important it is to have a great relationship in a workplace, because it is there where people develop further relationship, make friends, and spend most of their time. These relationships are very substantial in terms of how employees’ productivity may be affected. It actually can enhance productivity if everyone feels good and comfortable with each other in the work environment.

To achieve the main goal of building an ambient where employees and employers have successful relationships, and with that increase productivity, people need to feel their work as something they can enjoy rather than their duty.

This article has no methodology, but it has important explanations on how people can improve their relationships and with that achieves better productivity.

Findings: 

Create a space where people enjoy to work

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. Great relationships need: 1. Integrity and conviction 153

GROUP 4 2. Mutual Interaction 3. Fairness 4. Problem resolving 5. Be Emphatic 6. Follow rules 7. Accept people flaws and yours as well.

8. Stop Intervention 9. Listen to others, by paying attention to what they say.

10. Understand by maintaining the right distance.

11. Be Open Minded, finking outside of the box.

12. Greet others, by saying good morning, good afternoon, special occasions.

13. Appreciate what others do.

14. Help when necessary.

Relationship and potential application to the typology decision: Based on the findings this article is very important when thinking about designing an interior for healthcare. The information gathered is great in terms of professional relationships. To be successful in an interior for employees and clientele there are a lot of factors that should be taken as concern, the most important of them is relationships, so how can we great an environment that helps people interact with each other, but also at the same time respects their privacy?

Organization and design is the key, so to accomplish that the interior designer has to create an interior that is well-organized, respects hierarchy, each space respect other spaces, and people can find easily everything they want in the space.

Quotations: “Effective workplace relationships are vital to an organization in various aspects. It helps in employee retention, enhancing productivity, maintenance of good culture, having happy employees resulting happy customers, and finally with all these aspects having more profits and revenue.� (p.765)

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