Healing Through Interactions

University of Chicago Pediatric Cardiology Healing through interaction By:Katie Abushanab

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Fostering interaction through a bold journey.

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Contents

Research

programming

07 08 10

Reseach Statement

Goals & Issues

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Observations & Reflections

22 24 30 34 38 42 46

Diagrammatic Analysis

Definitions Summary of Research Articles

Site Analysis Client & User Analysis

Schematic Design 60 Wayfinding Package 68

Schematic Design Proposal

Spatial Needs Preliminary Design Considerations

Code Issues

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Research Statement Known for its devotion to health, a hospital building must first be a healing, life-affirming space that plays an active role in guiding patients and their families as they return to health (Sprow, 2012).

Not limited to a healing space, a hospital is composed of various occupants, functions and criteria, creating challenges for all aspects to connect and work together. To advance in a holistic design approach one must address crucial issues that are restraining improved health and connection. These issues exist because healthcare is embracing a new reality of technology, research and evolving trends while healthcare design struggles to promptly advance.

There is a growing need for an improved healing environment through positive distractions, avenues of interaction, flexibility, and infection prevention. These aspects work together as the building blocks to an enhanced healthcare environment. The contribution of positive distractions to the healing environment is among the most common examples of evidence-based design theories that have been intuitively embraced in healthcare design (Ulrich, 1997). “The use of positive distractions has the ability to allow the individual to shift focus from negative foci within the health environment to the more restorative aspects of the non-medical world� (Shepley, 2006, p. S34). As a result, the course of one’s perceived medical experience is changed, which in turn, affects the staff and their interactions with the patients. Art is used as a positive distraction to help decease emotional stimulation and to provide balance in the environment. It has been noted that high sensation seekers prefer abstract work; however, representational work is used to reduce the intensity of the visual experience and obtain sensory control. (Shepley,2006).

Designing for the human factor can help healthcare organizations enhance the connections that are vital to successful outcomes and can help them achieve critical measures of success. These measures of success can be seen through advancement and openness of connection between processes and people. This can be accomplished by providing a more collaborative workplace that facilitates interactions among patients, families and clinicians.

(Steelcase). In recent years technology has rapidly changed the healthcare dynamic and will continue to do so. With this in mind, it is crucial to design for the future by developing flexible, modular and technology-driven solutions. The outcome for this design is to provide the users with a healthcare facility that contributes to their healing journey through the use of positive distractions, interactions, modularity and proper space planning. Focusing the design on human needs and a holistic approach will ensure healing through the environment, circulation, and interactions. This approach will make a powerful contribution to healthcare design as it is rooted in Evidence- based design and will reinforce and encourage design solutions based on holistic approach of interaction and connection.

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definitions Activates of Daily Living (ADL): An Index or scale which measures a patient’s degree of independence in bathing, dressing, dressing, using the toilet, eating, and moving from one place to another. (Glossary of Terms Commonly Used in Health Care) Acute Care: medical treatment rendered to individuals whose illnesses or health problems are of a sort-term or episodic nature.

Acute care facilities are those hospitals that mainly serve persons with short-term health problems. (Glossary of Terms Commonly Used in Health Care) Acute Disease: A disease that Is characterized by a single episode of relatively short durwation from which the patient returns to his/her normal or previous level of activity, while acute diseases are frequently distinguished from chronic diseases, there is no standard definition or distinction. (Glossary of Terms Commonly Used in Health Care) ADA Accessible Design: State and local government facilities, public accommodations, and commercial facilities that are designed to be easily accessible for individuals with disabilities. (ADA.gov.)

Adaptability: able to adjust oneself readily to different conditions. (Dictionary.com) Adverse event: An injury resulting from a medical intervention. (Glossary of Terms Commonly Used in Health Care) Antimicrobial: destroying or inhibiting the growth of microorganisms and especially pathogenic microorganisms. (Dictionary.com) Anxiety: distress or uneasiness of mind caused by fear of danger or misfortune. (Dictionary.com) Art: the quality, production, expression, or realm, according to aesthetic principles, of what is beautiful, appealing, or of more than ordinary significance. (Dictionary.com) Burnout : emotional and physical exhaustion resulting from a combination of exposure to environmental and internal stressors and inadequate coping and adaptive skills. In addition to signs of exhaustion, the person with burnout exhibits an increasingly negative attitude toward his or her job, low self-esteem, and personal devaluation. (Burnout) Cardiology: The study of the heart and its function in health and disease. (Dictionary.com)

Centralized Nursing Station: One central nursing station that serves all caregivers in the entire unit. (Morel) Computed tomography (CT or CAT scan): A non-invasive procedure that takes cross-sectional images of the brain or other internal organs; to detect any abnormalities that may not show up on an ordinary x-ray. (Health Topics) Congenital: Refers to conditions existing at birth. (Health Topics) Congenital heart defects A heart problem present at birth, caused by improper development of the heart during fetal developmet. (Health 8

Decentralized Nursing Station: Multiple nursing stations that are spread throughout the unit and outside of patient rooms. ( Morel) Echocardiography: A procedure that evaluates the structure and function of the heart by using sound waves recorded on an electronic sensor, which produces a moving picture of the heart and heart valves. (Health Topics) Electrocardiogram (ECG or EKG): A test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle stress. (Health Topics) HAI : Healthcare-associated infections are infections that patients acquire during the course of receiving treatment for other conditions within a healthcare setting. (HAI) Headwall Vs. Footwall: Prefabricated surface mounted or wall-recessed units used to organize the utility services (e.g., electrical, gas, vacuum) and devices at the head of the patient’s bed. (Headwall-systems-prefabricated) HIPAA: the federal Health Insurance Portability and Accountability Act of 1996. The primary goal of the law is to make it easier for people to keep health insurance, protect the confidentiality and security of healthcare information ad help the healthcare industry control administrative costs. (HIPAA) LEAN Design: Lean Design and Construction is a production management-based approach to project delivery -- a new way to design and build capital facilities (What is Lean Design & Construction) LOS -Length of Stay: A term defined by the NHS as the length of an inpatient episode of care, calculated from the day of admission to day of discharge, and based on the number of nights spent in hospital. Patients admitted and discharged on the same day have a length of stay of less than one day. (Length of stay) Magnetic Resonance Imaging (MRI): A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. (Health Topics) Medication Error: any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. (U.S. Food and Drug Administration) PICU : Pediatric intensive care unit - An area in a hospital specializing in the care of critically ill infants, children, and teeagers. (PICU) Positive Distraction: environmental feature that elicits positive feelings and holds attention without taxing or stressing the individual, thereby blocking worrisome thoughts.(Pati) Same-handed Rooms vs. Mirrored Patient Rooms: Same handed is when the headwalls do not share a wall. They are always positioned on the same side of the patient room. Mirrored patient rooms share wall that accommodates their headwalls, so they are reflections, backto- back mirror images of each other. (Watkins, N.)

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Summary of Articles Blumenfeld, J., BaRoss, C., & Dufner, S. (n.d.). High Performance Interiors Evidence-Based Design. Perkins Will Research Journal, 01.

02. 83-109.

Main Idea: There are trends enhancing modern high performance interior design such as collaborative spaces, modularity/flexibility, sustainability and daylighting. These aspects are specifically discussed in regards to healthcare, workplace and education design (p.1).

Key Points: How collaboration, modularity, flexibility sustainability and daylighting can improve the healthcare experience for the patients and staff.

Application: Collaboration: Unit configuration to reduce walking ad maintain continuity of patient information between staff.

Minimizing patient bed transfers. Private patient rooms leads to perceived improved communication between patients and caregivers.

Environments that allow for quality sleep and minimize stress Specific areas for conferencing and collaboration Decentralized stations Dedicated family areas in-patient care setting Creating moments of interaction for collaboration.

(Page 2) Modularity/ Flexibility: Creating patient rooms that are standardized.

Multifunctional rooms Incorporating procedures such as hand washing and preventing the spread of illness into the design.

Sustainability: Using materials with low off gassing Materials that absorb sound to provide a calmer experience for patients Daylight: Ensuring daylight in all patient rooms and for staff Considering a 24-hour design method for the staff with day and night shifts.

Article Summary: There are various applications for healthcare design that can lead to high performance interiors, some of which include collaborative spaces, modularity/ flexibility, sustainability and daylighting. These aspects play key roles in impacting efficient design.

Collaboration in the healthcare environment can be approached at various levels and can meet the needs of all users while enhancing positive effects. It is important to consider collaboration as a design factor when designing for patients. Collaboration can include communication patterns or providing an adequate amount of control to maintain privacy. When designing for the staff, collaboration can be implemented though breakout rooms or even a centralized workstation. According to the journal “Aspects of collaborative experiences lead to positive results through enhanced communication, social support and acoustical control (p. 2).

In addition, modularity and flexibility in healthcare design are major factors that need to be considered for future growth. According to Ulrich, ”The inpatient environment, specifically patient rooms should be private and acuity adaptable with standardized room design” (p. 4). There is an overall importance on human health; with this in mind there are specific procedures such as hand washing and prevention of spreading illnesses that should be addressed in the design (p. 4).

Continually, sustainability in the healthcare industry is an important factor to be considering. It is critical to be mindful of material selection and the effects they can have on patients and staff. It is important to always ask your self if the materials will promote an overall better experience. An example is considering design materials that trap sound and are acoustically absorptive – these materials reduce noise and allow for quality sleep for patients.

Furthermore, daylighting in healthcare design is a major factor that can directly influence the physical and emotional health, as well as behavior and performance of patients. There is research that shows specifically how exposure to natural light improves sleep and circadian rhythms (p. 8). In addition, “Edelstein emphasizes the need for healthcare to 24 hours design considerations for day and night shift caregivers (p. 8).”Overall, daylight is shown to provide positive effects on patients and staff and can be used as a positive distraction.

All in all, this article touched on various aspects that can enhance healthcare design and improve patient outcomes as well as the work environment for staff.

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Geboy, L. (n.d.). The evidence-based design wheel. Retrieved September 26, 2015, http://www.healthcaredesignmagazine.com/article/ evidence-based-design-wheel

Main Idea: Evidence based design is the main driver for developing the design wheel. The wheel demonstrates the best practices for a healing environment.

Key Points: there are 12 key aspects that improve the healthcare experience.

1.Single patient rooms 2. Noise 3.Windows 4.Light 5.Access to nature 6.Positive Distractions 7.Furniture Arrangements 8.Air Quality 9.Flooring Materials 10.Wayfinding 11.Building Layout 12.Ergonomics Application: Designing plans with single patient rooms and adequate amount of space for family members to stay overnight.

Using materials that absorb noise and proper placement of spaces that require frequent maintenance and equipment.

Keeping in consideration the staff schedules and how that can affect patients during rest periods.

Allowing natural light through windows Using bright lights to maintain an upbeat atmosphere. – LEDs? Architectural lighting Creating a nature exhibit/nature themed space to provide positive distractions while enhancing the healing process.

Using Big Ass Fans as a sculptural element/ providing great air quality.

Using methods of wayfinding that is interactive and easily translated to all users of the space.

Floor/ ceiling methods of wayfinding – non traditional.

Article Summary: In this article we clearly understand the elements that create a successful healthcare environment through the design wheel. We are presented with factors that promote healing and are based on evidence-based design. The wheel is formed through researched design methods and studies that have proven effective in the healthcare environment. The elements that encompass the wheel include: Single patient rooms, noise, windows, light, nature, positive distractions furniture arrangements, air quality, flooring materials, way finding, building layout and ergonomics. These factors are used to drive design that is supportive for a healing environment and become a framework for EBD. Zborowsky, T., Bunker-Hellmich, L., Morelli, A., & O’neill, M. (2010). Centralized vs. Decentralized Nursing Stations: Effects on Nurses’ Functional Use of Space and Work Environment. HERD: Health Environments Research & Design Journal,03. 19-42.

Main Idea: To understand the effects of centralized and decentralized nursing stations.

Key Points: Decentralized nursing stations provide more visibility, less walking, more patient time while making staff feel more isolated.

Centralized stations provide means of collaboration, learning and a hub for interaction while they reduce patient time and cut costs.

Application: Finding a happy medium between the two stations through a hybrid. Using the decentralized model of workstations while incorporating rooms that allow for interaction and private conversations among staff.

Article Summary: This article focused on centralized and decentralized nursing stations and the effects on nurses and patients. It explains a study of exploratory design where data was collected on nurse’s health and work environment. From this study we understand the differences of centralized and decentralized and the impact it has on staff. Centralized stations provide a means of collaboration, learning and a hub

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for interaction. However, they reduce patient time while cutting costs. The decentralized model increases visibility and reduces walking while providing more patient time. The down side of this model is that nurses feel more isolated and there are fewer opportunities for staff interactions. In addition, we learned from this study that the stations also impact the patients. With decentralized stations, nurses are more inclined to have interactions in corridors, which can be a noise disturbance for the patients. With the decentralized model we eliminate a common area for connection and communication.

All in all, from this study we see both the pros and cons of each station and how they specifically impact patients and nurses. The results of this study proposed a hybrid model that includes decentralized station and centralized meeting spaces.

Pati, D., & Nanda, U. (2011). Influence of Positive Distractions on Children in Two Clinic Waiting Areas. HERD: Health Environments Research & Design Journal, 04. 03. 124-140.

Main Idea: Positive distractions for pediatric waiting areas have resulted in calm behavior and an overall enhanced healthcare experience.

Key Points: The research focused on two clinics to further understand the impact of positive distractions on behavior. With this, they have come to understand that in both clinics the presence of positive distractions was correlated with calm behavior.

Application: Using positive distractions such as art, architectural details, and monitors to contribute to calm behaviors.

Exhibit like design – using textures and forms as interactive distractions Technology as a distraction Article Summary: This study was based on the influence of positive distraction in waiting areas. This study was influenced by the idea that perceived waiting time and the experience during that time could be influenced by the physical environment. That in turn can affect the perceived amount of waiting time and the quality of the healthcare experience. To further understand how positive distractions can impact behavior and children and family members the study was created. This study uses five positive distraction methods to determine data.

The results of this study show that the positive distractions are correlated to increase in calm behavior. In addition, the use of positive distractions such as TV Monitors attracted more attention than interior elements. These positive distractions ultimately enhanced calmer behavior and enhanced the waiting experience.

Patient Rooms: A Positive Prognosis – Steelcase. (n.d.). Retrieved September 26, 2015. http://www.steelcase.com/insights/articles/ patient-rooms-a-positive-prognosis/ Main Idea: A focus on the needs of patient rooms and creating a human centered design approach. This approach enhances the healthcare experience for all users.

Key Points: The transition in patient rooms – more renovations Using research as a framework for improvement – “well-designed rooms often lead to increased patient satisfaction rates, fewer accidents, lower infection rates, shorter stays and even a decrease in pain medication.” (P. 3) Safety and wellbeing of all users – cleanable surfaces and designing to prevent injuries such as falls.

Multifunctional rooms for the staff, patient, and family and using up to date conveniences (technology) Providing opportunities for interactions Allowing control – methods can be through lighting, space design, customization of meals. Allowing the space to be about the users preferences.

Application: Controllable spaces – allowing patients to alter spaces based on preferences – heating and cooling, light, technology, usb outlets Allocating adequate space for families, patients and staff.

Storage for patients belonging, which are within reach Materials that are cleanable Creating a space for private conversations with family and doctors – hopeful environment Using technology and design features to encourage communication Installations that provide opportunities of interaction between patients and families.

Article Summary: In the article “Patient Rooms: A Positive Prognosis”, Steelcase focused its research on studies that prove the patients experiences in well designed rooms lead to improved health, in turn less occurrence of preventable accidents. In this article Steelcase points out that patient rooms serve as multifunctional spaces not only for the patients but the family and staff. With that in mind, the focus was drawn to creating a human centered model for patient rooms. The human centered model focuses on reducing injury and spread of illnesses, encouraging educational interactions though communication, designing to allow choice control and comfort in spaces and meeting all

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Reddez, P., & Pati, D. (n.d.). Does The Decentralized Nursing Model Deliver? Retrieved September 26, 2015. http://www. healthcaredesignmagazine.com/article/does-decentralized-nursing-model-deliver Main Idea: Understanding the concerns and successes of the decentralized nursing station.

Key Points: Decentralized stations have resulted in an increase with patient satisfaction Speedy response time Similarities of decentralized and centralized stations: sound levels, perception of work environment, self reported productivity and clinical outcome Issues associated with decentralized stations: Walking distances and less staff interaction Concerns of time spent in medication rooms – correlating with distance and interactions within closed corridors Application: Creating a hybrid between the centralized and decentralized station Staff meeting areas for interaction Positioning medication and equipment rooms near units to reduce walking distance Creating spaces with room clusters to reduce walking distances Article Summary: This article is an overview of the successes and concerns of decentralized nursing stations. The data acquired was based on six studies in which the expected positive outcomes of this model were contradicted. The expected positive outcomes include less walking time, more bedside time with patient, reduced stress and enhanced productivity. From the study we understand that decentralized stations do provide increased patient satisfaction along with more efficient response times. However, concerns with the decentralized station include less staff interactions, which in turn resulted in more time spent in medication rooms. An additional concern is increased walking distances. Overall, this articles pinpoint areas of concern in decentralized stations and seeks to find a balance.

Joseph, A. (n.d.). The Role of the Physical and Social Environment in Promoting Health, Safety, and Effectiveness in the Healthcare Workplace. The Center for Health Design, 1-19.

Main Idea: How the physical environment can affect all aspects of the experience. Specifically regarding the health and safety of patients and staff, the efficiency is staff and the overall experience.

Key Points: Addressing problems that cause illness among staff.

Need to redesign with a focus on ergonimcal principles to ensure safety and wellbeing of staff Holistic healthcare approach to healing Providing proper ventilation to reduce risk of infectious diseases Back injuries are common in this profession Night shift working conditions affect physical health Lower noise correlated with positive outcomes A lot of time is spent looking for materials, staff and walking Radial units show that nurses walk less Application: Height adjustable footstool, table and seating with ergonomical principles Incorporating lifting machinery to reduce manual lifting Placing sinks, sanitizer and hand washing station in rooms and outside Designing single patient rooms Softer floors Bright lights during night shift to regulate rhythms Using materials that absorb sound to reduce noise/stress Common or neutral spaces Rearranging furniture to promote interaction Control for patients and nurses Article Summary: This article helps us understand how the physical environment and social support are key factors in improving health, safety, effectiveness and satisfaction of the health care team. Some of the main components discussed include, addressing issues that cause illness among staff, reducing physical pain and injuries among staff, improving the night shift and increasing effective work and productivity. There are various solutions to enhancing the overall wellbeing of staff in the healthcare environment, these methods include and are not limited to ergonomical considerations, proving proper ventilation, decreasing noise levels to reduce stress and designing with the staff and families in mind. Using a holistic design approach can enhance the physical environment and work style of

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Evidence for Innovation (1st ed., pp. 2-24). (2008). Alexandria, VA: National Association of Children’s Hospitals and Related Institutions http://www.premiersafetyinstitute.org/wp-content/uploads/evidenceforinnovation-execsum-small.pdf.

Main Idea: Healthcare design is moving in a new direction because of the increase in hospital construction and new advances in technology through evidence based design. The main components of this article focus on evidence based design and the impact it can have in healthcare design for the future.

Key Points: Evidence -based design recommendations Improved outcomes in NICU Positive distractions Music therapy Special needs for families nursing units and patient rooms Patient safety Balance between privacy and intimacy Lessen stress for staff Standardization of rooms Green building features Application: Eliminating sources of loud noise and creating boundaries for talking Using materials (ceiling tiles) to absorb sound Noise reduction though distractions Single patient rooms with doors Using elements for healing such as color, carpet, music Play spaces Amenities Avoiding hazards such as bedrails, wires and equipment that could lead to injuries Spaces for communication Noise reduction Control over privacy – curtain & doors Nature/ gardens Attractiveness of space Way finding Natural light Article Summary: As technology is evolving so is the need for healthcare facilities that are based on solid research and evidence. In this article we are diving into the reasoning behind the shift in healthcare facilities and the importance of family and patient centered care. With this we uncover basic factors that can assist in creating a space to enhance the healthcare environment. These include positive distraction, patient safety, and noise reduction; lessening stress on staff, green building design, effects of natural light and gardens. These elements can all be used in conjunction with one another to improve the overall quality of the healthcare environment for patients, staff and families.

Considering Behavioral Health. (2012). Retrieved September 26, 2015. http://www.hermanmiller.com/research/research-summaries/ considering-behavioral-health.html Main Idea: Designing with a holistic approach to meet the needs of behavioral health units.

Key Points: moving away from institutional, clinical designs to a more residential design Plant Tree Philosophy to promote a holistic approach to healing Considering the mental, emotional social, physical and spiritual aspects of healing Safety as a first design concern The VA design guide Rooting design in hope, healing and recovery Healthcare facilities affects the way patients view the care, the staff and themselves VA Ann Arbor Healthcare System – case study Application: open floor plan Create lines of sight into group and open areas Windows to allow light to pass through unit Fresh design – transformative

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Article Summary: Considering behavioral health is a key aspect in the design of healthcare facilities. The main aspects discussed in this article include the laws and awareness on facilities and the new trends that are enforcing holistic design approaches. Specifically discussed are the issues in healthcare design, such as increased patient loads, diversity in patient conditions and complexity of treatments. To resolve some of these issues and design with a more holistic approach designers have used methods such as focusing on the aesthetic of the space. With this, I am referring to creating spaces for healing by designing more residential like environments rather than institutional.

In addition, the plant tree design philosophy is a new vision used in designing mental health facilities (page4). This philosophy places a large emphasis on design approached that are home like and avoid the institution look. These spaces are patient centered and provide healing, familiarity and a sense of being valued (page 4). As a whole, this article touched on aspects of concern I healthcare and provided various design solutions.

Bosch, P. (2015, February 24). How Do We Design for More Holistic Healthcare Practices? Retrieved September 26, 2015. http://blog. perkinswill.com/how-do-we-design-for-more-holistic-healthcare-practices/ Main Idea: Addressing means of designing for the progressive culture of healthcare facilities.

Key Points: Health care as a team based discipline Creating a hospital with integrated functions and where all needs can be met in one space Workplace methods – adaptability and collaborative spaces Taking into consideration caregivers needs Holistic and humanistic approach Application: Moveable walls to allow for multifunctional spaces Transformative potentials Expandable rooms Waiting areas to outdoors Article Summary: The main points discussed in this article revolves around the notion of developing holistic design and using methods that will adapt for the progressive future of healthcare. In this we learn that in order to design for all we must consider all – including the staff. Using innovative methods of transforming the workplace creates a better environment for healing and problem solving. In addition, methods of natural systems we discussed to help decreases stress in the workplace. The goal of this article was to encourage designers to being thinking about spaces for the future and as human- centered as possible. It is crucial to design not only for the patient but also for the other users of this space.

Sound Practices: Noise Control in the Healthcare Environment. (2006). Retrieved September 26, 2015. http://www.hermanmiller.com/ MarketFacingTech/hmc/research_summaries/pdfs/wp_Sound_Practices.pdf Main Idea: Noise control. Understanding where noise is coming from and how to solve the issue.

Key Points: Noise is a problem and has increased over past 50 years Human speech – communication devices Noise as “abuse” on patients Sound levels have negative outcome on patients – physical and psychological Noise interferes with staff effectiveness Negative distraction of staff performance/ nursing errors Application: Sound masking – adding noise Replacing /repair equipment Placement of nurse stations Using materials to absorb sound Slow shutting cabinets

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Article Summary: Noise is an issue that has affected the healthcare for many years now. Its causes come from machines, staff, materials and the built environment itself. Noise levels have proven to be harmful to patients and staff, leading to negative physical and psychological outcome. In addition, sound has a negative effect on staff, causing errors in medication and procedures along with risking patient privacy.

As a result of this issue, many solutions were proposed such as using barriers like doors and windows insure privacy. In addition, simply fixing or replacing squeaky equipment can help create a quiet environment. Additional methods include using padded materials to avoid loud clamoring. Adding noise is another method used to control noise – it is called sound masking. An interesting technology, which allows individual patient and caregivers access to control sound masking devices. This can also be customized for specific situations.

Using natural sounds can also aid in creating a more soothing and healing environment.

Overall, this article touched on noise issues and how resolves them with healing in mind.

Cranmer, K., & Davenport, L. (2013). Quiet Time in a Pediatric Medical/Surgical Setting. Journal of Pediatric Nursing, 28. 04,400-405.

Main Idea: Determining if a scheduled quiet time would reduce noise level and decrease staff fatigue.

Key Points: Descriptive correlation study: relationships between quiet times and parent fatigue Parents fatigue level decrease with quiet time Staff fatigues level decease Application: Designing with noise in mind Space planning – desiring noisy areas away from patient rooms Choosing sound absorbent materials Softer equipment Article Summary: Hospitals are known for being noisy areas. The noise comes from materials, staff, equipment and many more avenues. In this study, the objective was to determine if a set quiet time in a pediatric medical–surgical setting would decrease fatigue for parents and staff.

With this objective, two phases of a study were developed. In the first there was no quiet time in regular routine. In phase 2, a quiet time was implemented for 8 weeks.

The findings from this study show that parent and staff fatigue decreased during phase 2.

All in all, we understand that sound is a major factor in causing fatigue in the hospital and design solutions are available to decrease the issue.

Campagnol, G., & Shepley, M. (2014). Positive Distraction and the Rehabilitation Hospitals of Joao Filgueiras Lima. HERD: Health Environments Research & Design Journal, 08.01, 199-227.

Main Idea: The use of positive distractions and their impact on the environment.

Key Points: Positive distractions for recovery from stress in patients, visitors and staff Art Access to Nature Presence of Daylight Social Interactions Application: Cleanable materials – fabrics, counters, walls, ect.

Less aggressive spaces – camouflage large medical equipment Daylight- use of large windows – bring into hallways Natural ventilation Beds that allow for total mobility Artwork created by patients – creating a connection to space Terraces – biophilia – area of relief Gardens Large open social spaces Creating experience through art and architecture – curvilinear walls

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Article Summary: As a summary, this article focuses on positive distractions in many forms and the best way to incorporate these into the design. To begin, art as a positive distraction is discussed along with the two focuses: appropriateness of various genres and subject matter (page 3.) It was noted that contemporary art is not always the best fit for hospital settings because of its ambiguous nature and can be visually aggressive (p. 3).

Other positive distractions discussed include nature and presence of daylight. The Basophilic Hypothesis, Attention Restoration Theory (ART), has reported the healing aspects of nature theories have become guiding frameworks. “According to Kellert and Wilson (1993) the need to affiliate is biological, part of our evolutionary development, linked to genetic fitness, increases fulfillment, and instills an appreciation for the promotion of care and protection of nature. The presence of daylight is closely related to access to nature, as daylight is a manifestation of the outdoors. Additionally daylight is a continually changing component of the environment, thereby adding interest to the environmental experience.�(p. 3). In addition, creating social spaces of collaboration and interaction can be a positive distraction for all users. Researchers believe that social interaction contributes to a therapeutic environment (p. 4). All in all, positive distractions were the main theme of this article along with the best and most effective ways of incorporating them.

St. Joseph Mercy Hospital. (n.d.). Retrieved September 26, 2015. http://www.bigassfans.com/case-studies/st-joseph-mercy-hospital/ Key Points: Designers chose biophilic design to reduce stress in hospital Simulating outdoors Conditioned heat rising to ceiling in winter Application: Using Big Ass Fans for efficiency and aesthetic Reducing energy costs through destratification.

Article Summary: This case study is based on the St. Joseph Mercy Hospital in Ann Arbor, Michigan. The design of the lobby was based on biophilic design and creating a space that was healing and calming to users. With that, the design incorporates natural elements such as trees and a skylight. With these design choices come issues, which include alack of overhead ductwork. This causes a concern when trying to create cool summers while pushing heat down in the winter. The design solution for this issue was using two Big Ass fans – the element. These silent fans mix warm air in the winter and create a breeze in the warmer months. This movement replicates natural air movement in the summer, almost as if the users are outdoors. In addition, the fans help reduce the hospitals energy costs and overall add to the sustainable design approach.

Big Ass Fas will reduce energy costs

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Observations and reflections As a part of large Evidence - based design study at the University of Kentucky Chandler Hospital, I served sixteen hours of post-occupancy observations. In the sixteen hours I observed solely in the telemetry unit on the 8th floor. The hours spent in telemetry were crucial to my understanding and empathy for healthcare design. From these observations I began to understand the scope of work and the everyday work patterns of the clinicians. As a result of my time in telemetry I began to acquire a healthcare vocabulary and become familiar with the equipment, materials and how the space is used. Those observations informed my understanding and have helped guide my design as a holistic approach to human needs.

Through my time in telemetry I began to understand the issues and personal preferences of the staff. There is a large complaint about walking distances becoming longer as a result of the decentralized nursing station. However, from my observations the time spent in the patient’s room was extended due to proximity of the nurse’s station, as well as a speedy response time to a patient call. In addition, I noticed the communication patterns throughout the space. The main form of socialization was based around the clerk’s desk and nurse’s stations. Many conversations were held outside of a patient’s door and were within reach of disturbing the patients. In addition, another finding was based on the chair selections for the nurse’s station; the chairs did not allow for the users feet to touch the ground, which was a large discomfort for the nurses. As a result, many brought in personal step stools to resolve their issue. An additional take away was the need for patient interaction. During a specific observation time there was a patient who enjoyed roaming the hallways for socialization. Talking with whoever and whenever he had the chance. I found this very interesting because there were not very many common areas in which he could socialize with staff, patients, and family other than the hallway.

As a result of my observation, I plan to utilize specific findings in my work. This includes creating hallways that are large enough for socialization, staff rotations, maintenance and the various users of the space. Also, creating visibility into patient rooms for staff discernment. Also, I plan to use a hybrid between the centralized and decentralized nursing station. I found great benefits of having the station in close proximity to patient room; however, I also observed that there was an increase in noise around patient rooms as well as a limited ability for staff to interact as a part of their wellbeing. I plan to utilize decentralized stations and incorporate a nurse hub for interactions and variety in work modes. Continually, I plan to ensure the most daylight into the space along with well-designed lighting for sundown.

Aspects that I would change of the current design include lighting, wayfinding, welcome desk, and areas for respite and private conversation. I found that the lighting was very dim in the hallways, making it difficult to stay focused and alert. In addition, the hallways all looked the same so it was easy to get lost in the space. I feel that the wayfinding could have been stronger and used certain cues to assist spatial understanding. In addition to helping users navigate the space, I feel that there should be a central desk upon exiting the elevator to greet the users and assist with their needs, ultimately creating a less stressful environment. Lastly, I believe that the space should incorporate a hub for social interactions and additional rooms of respite and privacy for communicating personal information.

All in all, the observations informed my understanding of healthcare design as well as influencing specific design solutions. The hours spent in telemetry we invaluable in this process. They have given me a first hand experience of the lives of the patients and staff and can guide my decisions based on their space.

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Mapping

Time sheet 19

Progra 20

amming 21

Project goals and issues captivate positive distractions Captivating users by providing positive distractions through nature, technology and art. Allowing the users to interact and shift their attention to an enjoyable activity.

-Providing a variety of distractions,

Fortify Infection prevention- Reducing HAI Space plan systematic to increase efficiency while reducing mistakes.

-Circulation -Natural ventilation

allowing users a sense of choice

-Fans to move air

-Incorporating a feeling of hospitatlity

-Windows in all rooms

-Providing means of waiting time -

-Cleanable materials

encouraging self directed interactions -Providing resources for personal technology -Wayfinding as a distraction -Creating a safe and comfortable environment that reduces stress

Natural light and techology

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Cleanable surfaces

Involve

modify

opportunities for interaction Creating opportunities for interaction and connection to aid emotional wellbeing and communication.

adaptability of spaces -Creating adaptable spaces for multiuse, control and future additions.

-Desiging with controllable LED lighting -Creating a hybrid decentralized nursing station to provide space for socialization -Utilizing technology as a form of communication for patients and staff -Creating interactive common areas for patients -Incorporating writable wall surface in patient rooms to encourage creativity and communication

-Using moveable walls – DIRTTwritable surfaces Using moveable, flexible furniture - Providing control in patient rooms though storage, light, and technology -Utilizing multiuse facilities, such as a standard operating room, classroom, lounge -Providing a choice in patient room

materials (bedding, lamps, plants) -Using high quality acoustics

Common areas for all users

Moveable walls

23

Site Analysis Transportation Chicago, otherwise known as the windy city is one which experiences cold winters, warm summers, and frequent short fluctuations in temperature, humidity, and cloudiness. Our site is located at the University of Chicago's Medical Center on Payne Drive and Midway Plaisance on the 8th floor of the new construction building. Below is an overview on transportation and site views.

Bikes

Divy bike rental: Closest Docks: Ellis Ave & 58th ST Ellis Ave & 60th St

24

The Loop and CTA buses

Closest Transit station: Green Line : Cottage Grove Distance: .05 Mile from Payne Drive &Midway Plaisance

Site

o'hare international airport

Closest Transit station: Blue Line -Cottage Grove & 55th Street Total travel time from Payne Drive &Midway Plaisance to O’Hare International airport :1 hour and 40 minutes

25

Cottage grove ave

Bus Stop

Payne Drive

Buses 2&4 Cottage Grove/ 60th/ 63rd

N

SITE

26

Midway plaisance

Fountain of time

E 58 th Street

S Maryland Drive Buses 2&4 Navy Pier / Illinois Center

Medical Campus

Island / U E 59 th Street60th/Stony Chicago Hospitals Buses170 & 192

midway Plaisance

University of chicago medical center

Midway plaisance park

27

SUn Study It is crucial in the design process to understand the relationship between the sun and the building. This relationship effects the design considerations and helps ensure the most purposeful layout for maximum sunlight in the space. The study below is based on our site and the suns orientation at the start of the season and at various times throughout the say.With this, we understand that we will need to design patient rooms against the south wall to ensure maximum sunlight.

sunrise

Autumnal Equinox: September 22

Vernal Equinox: March 20

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noon

sunset

Winter Solstice: December 21

Summer Solstice: June 21

29

Demographics Chicago, IL : race

Understanding demographics of the location is vital to the design. It ensures that the design is catered to the specific body of individuals. The following information was retrieved from the United States Census Bureau.

45%

5.5%

white .5%

28.9%

Asian

American Indian and Alaska Native

39.9% African American

Hispanic or Latino

31.7% White alone, not Hispanic or Latino

Population

Chicago 2,722,389 Illinois 12,880,580

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persons under 5 years

6.9% Persons under 18 years

23.1% 10.3% Persons 65years and over

33.3 minutes of travel time to work

31

Client and user analysis

The University of Chicago’s mission is to provide a transformative education that enables individuals to challenge conventional thinking in pursuit of original ideas.

The University of Chicago is passionate about their groundbreaking research and the commitment to free and open inquiry. They foster an environment that encourages research that will impact the world and they way they understand it.

The University of Chicago has a commitment to enrich and invest in their community through neighborhood initiatives, local benefits, and partnerships to heighten society and make a difference.

Motto: Crescat scientia; vita excolatur

Goals: Facilitate personal and intellectual development of students outside the classroom.

Support the basic academic and personal needs of students.

“Let knowledge grow from more to more; and so be human life enriched.”

Create and sustain a vibrant campus community for faculty, students and staff.

Encourage the free and open expression of ideas.

The Unvieristy of Chicago Medicine Comer Children’s Hospital - Cardiac Care Center for Care and Discovery Comprehensive Cancer Center Kovler Diabetes Center Urban Health Initiative Bucksbaum Institute for Clinical Excellence MacLean Center for Clinical Medical Ethics

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Patients 0-18years Infants Toddlers Adolescence

There are various reasons why a patient may be at the cardiology unit. These include, surgery, pre and post procedure appointments, check ups, studies, and the journey to recovery.

Visitors Family Friends Delivery Celebrities

There are various types of visitors who occupy the halls of a pediatric unit. The majority is family who is a vital component in the healing process. However, there are the occasional celebrity visitors who pop in to cheer up a patient or family - using interaction as a form of healing.

Clinicians Doctors Surgeons Nurses Anesthesiologist Nurse practitioner Physical therapists Respiratory therapists

Clinicians are one the key components of this unit.

They are supporters throughout the healing process.

They provide medical assistance, information and guidance while developing relationships through interactions with the patients. They are accessible throughout every step in the journey to ensure the best medical care.

Staff Maintenance Administration Food service Support Custodial Reception Security Transport

The staff also plays a key role in keeping the unit functioning. They provide medical documents, food, clean materials, security, transportation and major administrative work to keep the unit running smoothly.

33

Spatial needs

Understanding spatial needs is an important aspect in the design process.

It provides a framework for the uses and equipment needed for each space.

In addition, it ensures an adequate amount of space for each activity and influences successful space planning.

The charts list the various spaces, quantity, and square footage, users activities and equipment.

34

Primary Area

Quantity

Circulation

SF/Unit

Net SF

20%

4400

Patient Rooms

18

375 +/-

6750

Patient Bathrooms

18

50

900

Meds Room

2

100

200

Supply Room

2

100

200

Clean Utility Rooms

2

100

200

Decentralized Workstations

18

10

180

Reception and Waiting Area

1

580

580

2

80

160

SF/Unit

Net SF

Nourishment Station

Comments

Interactive common area Total Square Footage: 13,570

Secondary Quantity

Area Resident’s Workroom

1

300

300

Centralized Workstations

2

200

400

Play Area

1

165

165

Staff Restroom

4

55

220

Portable Equipment

4

50

200

Family Respite Area

1

400

400

Housekeeping Closet

2

50

100

Rec/ Rehab Room

2

200

400

Consultation/Quiet Room

2

80

160

Teen Lounge Area

1

165

165

Hub Rooms

2

100 +/-

200

Storage

2

100

200

Washing area

6

15

90

SF/Unit

Net SF

1

400

400

Classroom/Conference Room 1

250

250

Patient Care Managers Office 1

150

150

Unit Director Office

1

150

150

Support Offices

4

80 +/-

320

Comments

Interactive area

Total Square Footage: 3,000

Administrative Area Staff Break Room

Quantity

Comments 15 Lockers

Total Square Footage: 1,270

Final Square Footage: 17,840

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Spatial needs equipment Ultrasound System Height:53 inches Width:25 inches Depth:46 inches Weight:477 lbs

EKG Machine 10� LCD screen

Height:315mm Width: 255mm Depth 427 mm

Heart-Lung Bypass Machine Height:46 3/4 inches Width:22 1/4 inches Length:40 1/4 inches

Vital Signs Monitor Weight:6 3/4 inches (Width:8 1/2 inches Depth:3 inches Weight:3 kg

Defibrillator Height:8 inches Width:10 1/2 inches Depth:12 1/2 Inches

Sleeper Height:34 inches Width:31 1/2 inches Depth:81 1/2 inches

Office Chairs Height:39 1/4 inches Width:22 3/8 inches Depth:21 inches

Sink Height:25 inches Width:20 inches Length:27 inches

Desktop Computer Height:17 inches Width:25 inches Depth:8 inches Weight:21 pounds

ECMO Machine

Patient Chairs Height:46 5/16 inches Width:31 5/8 inches Depth:31 1/4 inches

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Crash Cart Height:57 inches Width:51 1/2 inches Depth:24 1/8 inches

activites Patients

Sleeping Eating Research Walking Playing Reading Surgery Recovery Bathing Restroom Therapy Extra circular Worship Travel within unit

Staff

Walking Talking Charting Communicating Restroom Eating Assisting patients Interacting with patients Retrieving supplies Cleaning Administrative work

Visitors

Sleeping Eating Walking Playing Reading Writing Worship Travel Room up keeps

37

preliminary deisgn considerations Lighting

“

Exposure to daylight at the right time of day also suppresses our melatonin, leading to more restful sleep in the evening. From treatment of depression to alleviating workplace stress, daylight in particular is a convenient means to positively impact human health.

“

(The Link Between Light and Health)

Natural light through windows and curtain walls is a key aspect in the healing process. It promotes positive distractions, allows control in space and it allows staff the opportunity to connect with the natural environment during a 12 hour shift.

LED wall sconces, lamps, dimmable options in occupant spaces provide choices and control.

This promotes adaptability and changes the perception of the space to a more hospitality like environment.

Ceiling coves are a pleasing design method to create form and light while softening the space. It captivates users while acting as a calming and therapeutic design element.

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Color

“ Bold hues accelerate

heart rate and energize patients upon awakening from surgery (Tisch, 2008)

Orange: Energy, balance, warmth, enthusiasm, vitality Yellow: Joy, optimism, happiness

Reds: Power, energy, passion, desire, speed, strength

The interaction of color and their relationships to one another influenced the color scheme selected. Research has shown that analogous color schemes, with variety of hues are preferred among children (Tisch,2008).

With this as a contributing factor, the design will incorporate different color sets in specific environments to reinforce positive distractions, healing, energy and a sense of wonder.

The colors will be used in sets to support the analogous study, however, at a holistic view, the overall design will demonstrate how colors come full circle and interact. The color sets will serve as complementary colors to a more neutral palette of whites, greys and hints of wood.

Blues: Peace, harmony, unity, trust

39

“

preliminary deisgn considerations Materials

FilzFelt Hanging panels serves as acoustical solutions and creates space division for private interactions.

Knoll: Accent Backed in Sky wallcovering with stain repellant finish.

Shaw Carpet Collection: Color Form, Color Frame allows interaction of colors providing movement in the space.

Knoll: Durand in Safflower textile

Steelcase Finish: Clear Maple

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Knoll: Jot in Hot Spot drapery

Furnishings The Steelcase Regard lounge seating collections is a great system for the waiting area. This modular system provides the perfect balance of privacy, technology and interaction to make the waiting time more meaningful.

The DIRTT wall system for patient rooms provides opportunities for patient comfort and staff efficiency. The system allows for total personalization, storage, writing surfaces and more. Ultimately, providing flexible solutions for communication, personalization and space.

The Steelcase Sync Desk system is the perfect solution for the nurse’s station. It provides a hybrid between centralized and decentralized station while designing for the future. The system is modular and allows for multiple configuration in new and excising locations. In addition, it provides clear line of sight views to patients while nurses are preforming different activities such as collaboration, focused tasks, teaching and learning, and quick social exchanges.

41

diagrammatic analysis

The diagrammatic analysis provides vital information on spatial needs such as adjacencies, criteria and access to spaces.

This information helps reinforce successful space planning and guides the design to a human centered and holistic approach.

42

An adjacency matrix is used to determine what spaces need to be next to each other, and which do not. It is a useful diagram that influences space planning.

Circulation Patient Rooms Patient Bathrooms Meds Room Supply Room Family Respite Area Workstations Reception and Waiting Area Play Area Resident's Workroom Clean Utility Rooms Soiled Utility Room Staff Restroom Portable Equipment Storage Nourishment Station Housekeeping Closet Rec/ Rehab Room Consultation/Quiet Room Teen Lounge Area Hub Rooms Storage Washing area

Key Direct Relation

Staff Break Room Classroom/Conference Room

Close

Patient Care Managers Office

Neutral

Unit Director Office

No Contact

Support Offices

43

Diagrammatic analysis

Circulation

Patient Rooms Patient Bathrooms Meds Room Supply Room Family Respite Area Workstations Reception and Waiting Area Play Area Resident's Workroom Clean Utility Rooms Soiled Utility Room Staff Restroom Portable Equipment Storage Nourishment Station Housekeeping Closet Rec/ Rehab Room Consultation/Quiet Room Teen Lounge Area Hub Rooms Storage Washing area Staff Break Room Classroom/Conference Room Patient Care Managers Office Unit Director Office Support Offices 44

Needed

Indifferent

Not Needed

N at u Va ral ri L Vi ed igh ew Li t g Vi In ht ew Pa Ou tie t St nt af U s Vi f Us e su e Ac al P ou riv H stic acy ar s a An h C l tim le Se icr anin cu ob g Po rity ial si Fl tive ex D ib is le tra F u ct rn ion itu s re

A criteria matrix is used to determine the needs for each space. The matrix is a helpful tool to create an efficient space.

An access diagram is used to determine privacy and security needs in relation to the spaces. This is an essential aspect of the design process because it focuses on the health, safety and wellbeing of users in the space.

Patient Access

Staff Access

Play Area Teen Lounge

Rec/Rehab Room Consultation/ Quiet Room Offices Hub Rooms Family Respite Area Patient Rooms Circulation

Meds Room Supply Room Workstations Resident’s Workroom Clean Utility Room Soiled Utility Room Portable Equipment Storage Nourishment Station Housekeeping Closet Washing area Staff Break Room Classroom/Conference Room

Visitor Access

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code issues ADA Specifications

1.4 Design Standards for the Disabled The Americans with Disabilities Act (ADA) became law in 1990. This law extends comprehensive civil rights protection to individuals with disabilities. Under Titles II and III of the ADA, public, private, and public service hospitals and other health care facilities will need to comply with the Accessibility Guidelines for Buildings and Facilities (ADAAG) for alterations and new construction. The Uniform Federal Accessibility Standards (UFAS) also provides criteria for the disabled. Implementation of UFAS and ADAAG for federal facilities is handled in the following ways: â– Compliance with UFAS â– Compliance with ADAAG â– Compliance with a combination of UFAS and ADAAG using the most stringent criteria Individual federal agencies will provide direction on applicable criteria to be used for the design of federal facilities.

Also available for use in providing quality design for the disabled is the American National Standards Institute (ANSI) A117.1 American National Standard for Accessible and Usable Buildings and Facilities.

State and local standards for accessibility and usability may be more stringent than ADA, UFAS, or ANSI A117.1. Designers and owners, therefore, must assume responsibility for verification of all applicable requirements.

It shall be recognized, however, that the users of hos- pitals and health care facilities often have very differ- ent accessibility needs from the typical adult individual with disabilities addressed by the model standards and guidelines mentioned above.

Hospital patients, and especially nursing facility residents, due to their stature, reach, and strength characteristics, typically require the assistance of caregivers during transfer maneuvers. Many prescriptive requirements of model accessibility standards place both older per- sons and caregivers at greater risk of injury than do facilities that would be considered noncompliant.

Flexibility may be permitted for the use of assistive configurations that provide considerations for transfer assistance.

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Signage and Finishes

*8.14 General Standards for Details and Finishes Resident facilities require features that encourage ambulation of long-term residents. Signage and wayfinding features shall be provided to aid self- ambulating residents and avoid confusing or disorienting them. Potential hazards to residents, such as sharp corners, slippery floors, loose carpets, and hot surfaces should be avoided.

Renovations shall not diminish the level of compli- ance with these standards below that which existed prior to the renovation. However, features in excess of those for new constructions are not require 8.15 Finishes 8.15.A. Cubicle curtains and draperies shall be noncombustible or flameretardant as prescribed in both the large and small scale tests in NFPA 701.

8.15.B. Materials provided by the facility for finishes and furnishings, including mattresses and upholstery, shall comply with NFPA 101.

8.15.C. Floor materials shall be readily cleanable and appropri- ate for the location. Floors in areas used for food preparation and assembly shall be water-resistant. Floor surfaces, including tile joints, shall be resistant to food acids. In all areas subject to frequent wet-cleaning methods, floor materials shall not be physically affected by germicidal cleaning solutions. Floors subject to traffic while wet (such as shower and bath areas, kitchens, and similar work areas) shall have a slip-resistant surface. Carpet and padding in resident areas shall be glued down or stretched taut and free of loose edges or wrinkles that might create hazards or interfere with the operation of wheelchairs, walkers, wheeled carts, etc.

8.15.D. Wall bases in areas subject to routine wet cleaning shall be coved and tightly sealed.

8.15.E. Wall finishes shall be washable and, if near plumbing fixtures, shall be smooth and moisture-resistant. Finish, trim, walls, and floor constructions in dietary and food storage areas shall be free from rodent and insect harboring spaces.

8.15.F. Floor and wall openings for pipes, ducts, and conduits shall be tightly sealed to resist fire and smoke and to minimize entry of pests. Joints of structural elements shall be similarly sealed.

8.15.G. The finishes of all exposed ceilings and ceiling structures in resident rooms and staff work areas shall be readily cleanable with routine housekeeping equipment. Finished ceilings shall be provided in dietary and other areas where dust fallout might create a problem.

8.15.H. Directional and identification signage shall comply with ADA guidelines.

47

code issues Lighting and Material

8.32 Electrical Standards 8.32.A. General 8.32.A1. All material and equipment, including con- ductors, controls, and signaling devices, shall be installed to provide a complete electrical system in accordance with NFPA 70 and NFPA 99.

8.32.A2. All electrical installations and systems shall be tested to verify that the equipment has been installed and that it operates as designed.

8.32.A3. Electrical systems for nursing facilities shall comply with applicable sections of NFPA 70.

8.32.A4. Lighting shall be engineered to the specific application. *a. The Illuminating Engineering Society of North America (IES) has developed recommended mini- mum lighting levels for nursing facilities. *b. Approaches to buildings and parking lots, and all occupied spaces within buildings shall have fixtures for lighting.

Consideration shall be given to contrast in lighting levels. *c. Resident rooms shall have general lighting and night lighting. A reading light shall be provided for each resident. Reading light controls shall be readily accessible to residents. At least one night light fixture in each resident room shall be controlled at the room entrance. All light controls in resident areas shall be quiet operating. d. Resident unit corridors shall have general illumination with provisions for reducing light levels at night.

8.32.A5. Receptacles (convenience outlets) a. Each resident room shall have duplex-grounded receptacles. There shall be one at each side of the head of each bed and one on every other wall. Receptacles may be omitted from exterior walls where construction makes installation impractical. b. Duplex-grounded receptacles for general use shall be installed approximately 50 feet (15.24 meters) apart in all corridors and within 25 feet (7.62 meters) of corridor ends. c. Electrical receptacle coverplates or electrical receptacles supplied from the emergency system shall be distinctively colored or marked for identification. If color is used for identification purposes, the same color should be used throughout the facility. d. Ground-fault-interrupters shall comply with NFPA 70. A8.32.A4a. The reader should refer to the IES Lighting Handbook and Lighting for Health Care Facilities for additional information.

A8.32.A4.b. Excessive differences in lighting levels should be avoided in transition areas between parking lots, building entrances and lobbies or corridors, in transition zones between driveways and parking garages, etc. As the eye ages, pupils become smaller and less elastic, making visual adaptation to dark spaces slower. Upon entering a space with a considerably lower lighting level, elderly residents may need to stop or move to one side until their eyes adapt to excessive lighting changes.

Elderly pedestrians may need several minutes to adjust to significant changes in brightness when entering a building from a sunlit walkway or terrace.

Consideration should be given to increasing both indoor and outdoor illumination levels in such transition spaces to avoid excessive differences between electric lighting levels and natural daytime and nighttime illumination levels. In addition, it is very helpful for pedestrians to have conveniently located places to wait, giving them time to adjust their eyes to different lighting environments. Seating areas off busy lobbies or corridors can minimize the potential for accidents by giving them the extra time they need.

Care should be taken to minimize extremes of brightness within spaces and in transitions between spaces. Excessive brightness contrast from widows or lighting systems can disorient residents.

A8.32.A4a. The reader should refer to the IES Lighting Handbook and Lighting for Health Care Facilities for additional information.

7.32.D4. Operating and delivery rooms shall have general lighting in addition to special lighting units pro- vided at surgical and obstetrical tables. General lighting and special lighting shall be on separate circuits.

48

Lighting and Material

7.32.D5. Nursing unit corridors shall have general illumination with provisions for reducing light levels at night.

7.32.D6. Light intensity for staff and patient needs should generally comply with health care guidelines set forth in the IES publication. Consideration should be given to controlling intensity and/or wavelength to prevent harm to the patient’s eyes (i.e., retina damage to premature infants and cataracts due to ultraviolet light).

Many procedures are available to satisfy lighting requirements, but the design should consider light quality as well as quantity for effectiveness and effi- ciency. While light levels in the IES publication are referenced herein, those publications include other useful guidance and recommendations which the designer is encouraged to follow.

7.32.D7. Consideration should be given to the special needs of the elderly. Excessive contrast in lighting levels that makes effective sight adaptation difficult should be minimized.

7.32.D8. A portable or fixed examination light shall be provided for examination, treatment, and trauma rooms.

7.32.D9. Light intensity of required emergency lighting shall generally comply with the IES recommendations. Egress and exit lighting shall comply with NFPA 101.

7.32.D. Lighting 7.32.D1. The Illuminating Engineering Society of North America (IES) has developed recommended lighting levels for health care facilities. The reader should refer to the IES Handbook.

7.32.D2. Approaches to buildings and parking lots, and all occupied spaces within buildings shall have fixtures that can be illuminated as necessary.

7.32.D3. Patient rooms shall have general lighting and night lighting. A reading light shall be provided for each patient. Reading light controls shall be accessible to the patient(s) without the patient having to get out of bed. Incandescent and halogen light sources that produce heat shall be avoided to prevent burns to the patient and/or bed linen. The light source should be covered by a diffuser or lens.

7.29.D. Interior Finishes Interior finishing materials shall comply with the flame-spread limitations and the smoke-production limitations indicated in NFPA 101. This does not apply to minor quantities of wood or other trim (see NFPA 101) or to wall covering less than four mil thick applied over a noncombustible base.

7.29.E. Insulation Materials Building insulation materials, unless sealed on all sides and edges with noncombustible material, shall have a flame spread rating of 25 or less and a smoke- developed rating of 150 or less when tested in accor- dance with NFPA 255.

10.24 Details and Finishes Patients in a rehabilitation facility will be disabled to differing degrees. Therefore, high standards of safety for the occupants shall be provided to minimize accidents. All details and finishes for renovation projects as well as for new construction shall comply with the following requirements insofar as they affect patient services: 10.24.A. Details 10.24.A1. Compartmentation, exits, automatic extinguishing systems, and other details relating to fire prevention and fire protection in inpatient rehabilita- tion facilities shall comply with requirements listed in NFPA 101. In freestanding outpatient rehabilitation facilities, details relating to exits and fire safety shall comply with the appropriate occupancy chapter of NFPA 101 and the requirements outlined herein.

10.24.A2. Items such as drinking fountains, telephone booths, vending machines, and portable equipment shall not restrict corridor traffic or reduce the corridor width below the required minimum.

49

code issues lighting and material

10.24.A3. Rooms containing bathtubs, sitz baths, showers, and water closets subject to patient use shall be equipped with doors and hardware that will per- mit access from the outside in an emergency. When such rooms have only one opening or are small, the doors shall open outward or be otherwise designed to open without pressing against a patient who may have collapsed within the room.

10.24.A4. Minimum width of all doors to rooms needing access for beds shall be 3 feet 8 inches (1.12 meters). Doors to rooms requiring access for stretch- ers and doors to patient toilet rooms and other rooms needing access for wheelchairs shall have a minimum width of 2 feet 10 inches (.86 meter). Where the functional program states that the sleeping facility will be for residential use (and therefore not subject to in-bed patient transport), patient room doors may be 3 feet (0.91 meter) wide, if approved by the local authority having jurisdiction.

10.24.A5. Doors between corridors and rooms or those leading into spaces subject to occupancy, except elevator doors, shall be swing-type. Openings to showers, baths, patient toilets, and other small, wet- type areas not subject to fire hazard are exempt from this requirement.

10.24.A6. Doors, except those to spaces such as small closets not subject to occupancy, shall not swing into corridors in a manner that obstructs traffic flow or reduces the required corridor width.

10.24.A7. Windows shall be designed to prevent accidental falls when open, or shall be provided with security screens where deemed necessary by the functional program.

10.24.A8. Windows and outer doors that may be frequently left open shall be provided with insect screens.

10.24.A9. Patient rooms intended for 24-hour occu- pancy shall have windows that operate without the use of tools and shall have sills not more than 3 feet (0.91 meter) above the floor.

10.24.A10. Doors, sidelights, borrowed lights, and win- dows glazed to within 18 inches (457.2 millimeters) of the floor shall be constructed of safety glass, wired glass, or plastic glazing material that resists breaking or creates no dangerous cutting edges when broken. Similar mate- rials shall be used in wall openings of playrooms and exercise rooms. Safety glass or plastic glazing material shall be used for shower doors and bath enclosures.

10.24.A11. Linen and refuse chutes shall comply with NFPA 101.

10.24.A12. Thresholds and expansion joint covers shall be flush with the floor surface to facilitate use of wheelchairs and carts in new facilities.

10.24.A13. Grab bars shall be provided at all patient toilets, bathtubs, showers, and sitz baths. The bars shall have 1-1/2 inches (38.1 millimeters) clearance to walls and shall be sufficiently anchored to sustain a concentrated load of 250 pounds (113.4 kilograms). Special consideration shall be given to shower curtain rods which may be momentarily used for support.

10.24.A14. Recessed soap dishes shall be provided in showers and bathrooms.

10.24.A15. Handrails shall be provided on both sides of corridors used by patients. A clear distance of 1- 1/2 inches (38.1 millimeters) shall be provided between the handrail and the wall, and the top of the rail shall be about 32 inches (812.8 millimeters) above the floor, except for special care areas such as those serving children.

10.24.A16. Ends of handrails and grab bars shall be constructed to prevent snagging the clothes of patients.

10.24.A17. Location and arrangement of handwash- ing stations shall permit proper use and operation. Particular care should be given to clearance required for blade-type operating handles. Lavatories intended for use by disabled patients shall be installed to per- mit wheelchairs to slide under them.

10.24.A18. Mirrors shall be arranged for convenient use by wheelchair patients as well as by patients in a standing position.

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Building Component

7.30 Special Systems 7.30.A. General 7.30.A1. Prior to acceptance of the facility, all special systems shall be tested and operated to demonstrate to the owner or his designated representative that the installation and performance of these systems con- form to design intent. Test results shall be documented for maintenance files.

7.30.A2. Upon completion of the special systems equipment installation contract, the owner shall be furnished with a complete set of manufacturers’ operating, maintenance, and preventive maintenance instructions, a parts lists, and complete procurement information including equipment numbers and descriptions. Operating staff persons shall also be provided with instructions for proper operation of systems and equipment. Required information shall include all safety or code ratings as needed.

7.30.A3. Insulation shall be provided surrounding special system equipment to conserve energy, protect personnel, and reduce noise.

7.30.B. Elevators All hospitals having patient facilities (such as bed- rooms, dining rooms, or recreation areas) or critical services (such as operating, delivery, diagnostic, or therapeutic) located on other than the grade-level entrance floor shall have electric or hydraulic elevators.

Installation and testing of elevators shall comply with ANSI/ASME A17.1 for new construction and ANSI/ASME A17.3 for existing facilities. (See ASCE 7-93 for seismic design and control systems requirements for elevators.)

7.30.B1. In the absence of an engineered traffic study the following guidelines for number of eleva- tors shall apply: a. At least one hospital-type elevator shall be installed when 1 to 59 patient beds are located on any floor other than the main entrance floor. b. At least two hospital-type elevators shall be installed when 60 to 200 patient beds are located on floors other than the main entrance floor, or where the major inpatient services are located on a floor other than those containing patient beds. (Elevator service may be reduced for those floors providing only partial inpatient services.) c. At least three hospital-type elevators shall be installed where 201 to 350 patient beds are located on floors other than the main entrance floor, or where the major inpatient services are located on a 66 floor other than those containing patient beds. (Elevator service may be reduced for those floors that provide only partial inpatient services.) d. For hospitals with more than 350 beds, the number of elevators shall be determined from a study of the hospital plan and the expected vertical transportation requirements. *7.30.B2. Hospital-type elevator cars shall have inside dimensions that accommodate a patient bed with attendants. Cars shall be at least 5 feet 8 inches (1.73 meters) wide by 9 feet (2.74 meters) deep. Car doors shall have a clear opening of not less than 4 feet (1.22 meters) wide and 7 feet (2.13 meters) high. In renovations, existing elevators that can accommodate patient beds used in the facility will not be required to be increased in size.

Note: Additional elevators installed for visitors and material handling may be smaller than noted above, within restrictions set by standards for disabled access.

7.30.B3. Elevators shall be equipped with a two way automatic level-maintaining device with an accuracy of Âą 1/4 inch (Âą 6.4 millimeters) 7.30.B4. Each elevator, except those for material handling, shall be equipped with an independent keyed switch for staff use for bypassing all landing button calls and responding to car button calls only.

7.30.B5. Elevator call buttons and controls shall not be activated by heat or smoke. Light beams, if used for operating door reopening devices without touch, shall be used in combination with door edge safety devices and shall be interconnected with a system of smoke detectors. This is so that the light control feature will be overridden or disengaged should it encounter smoke at any landing.

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code issues Building Component 7.30.B6. Field inspections and tests shall be made and the owner shall be furnished with written certification stating that the installation meets the requirements set forth in this section as well as all applicable safety regulations and codes. .31 Mechanical Standards 7.31.A. General 7.31.A1. The mechanical system should be designed for overall efficiency and appropriate life cycle cost. Details for cost effective implementation of design features are interrelated and too numerous (as well as too basic) to list individually. Recognized engineering procedures shall be followed for the most economical and effective results.

A well-designed system can generally achieve energy efficiency at minimal additional cost and simultaneously provide improved patient comfort. Different geographic areas may have climatic and use conditions that favor one system over another in terms of overall cost and efficiency. In no case shall patient care or safety be sacrificed for conservation.

Mechanical, electrical, and HVAC equipment may be located either internally, externally, or in separate buildings.

7.31.A2. Remodeling and work in existing facilities may present special problems. As practicality and funding permit, existing insulation, weather stripping, etc., should be brought up to standard for maximum economy and efficiency.

Consideration shall be given to additional work that may be needed to achieve this.

7.31.A3. Facility design consideration shall include site, building mass, orientation, configuration, fenestration, and other features relative to passive and active energy systems.

7.31.A4. Insofar as practical, the facility should include provisions for recovery of waste cooling and heating energy (ventilation, exhaust, water and steam discharge, cooling towers, incinerators, etc.).

7.31.A5. Facility design consideration shall include recognized energy-saving mechanisms such as variable-airvolume systems, load shedding, programmed controls for unoccupied periods (nights and week- ends, etc.) and use of natural ventilation, site and climatic conditions permitting. Systems with excessive installation and/or maintenance costs that negate long-range energy savings should be avoided.

7.31.A6. Air-handling systems shall be designed with an economizer cycle where appropriate to use utside air. (Use of mechanically circulated outside air does not reduce need for filtration.)

It may be practical in many areas to reduce or shut down mechanical ventilation during appropriate climatic and patient-care conditions and to use open windows for ventilation.

7.31.A7. Mechanical equipment, ductwork, and piping shall be mounted on vibration isolators as required to prevent unacceptable structureborne vibration.

7.31.A8. Supply and return mains and risers for cooling, heating, and steam systems shall be equipped with valves to isolate the various sections of each system. Each piece of equipment shall have valves at the supply and return ends.

7.31.B. Thermal and Acoustical Insulation 7.31.B1. Insulation within the building shall be provided to conserve energy, protect personnel, prevent vapor condensation, and reduce noise.

7.31.B2. Insulation on cold surfaces shall include an exterior vapor barrier. (Material that will not absorb or transmit moisture will not require a separate vapor barrier.)

7.31.B3. Insulation, including finishes and adhesives on the exterior surfaces of ducts, piping, and equipment, shall have a flame-spread rating of 25 or less and a smoke-developed rating of 50 or less as determined by an independent testing laboratory in accordance with NFPA 255.

7.31.B4. If duct lining is used, it shall be coated and sealed, and shall meet ASTM C1071. These linings (including coatings, adhesives, and exterior surface insulation on pipes and ducts in spaces used as air supply plenums) shall have a flame-spread rating of 25 or less and a smoke developed rating of 50 or less, as determined by an independent testing laboratory in accordance with NFPA 255. If existing lined ductwork is reworked in a renovation project, the liner seams and punctures shall be resealed.

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Building Component 7.31.B5. Duct linings exposed to air movement shall not be used in ducts serving operating rooms, delivery rooms, LDR rooms, nurseries, protective environment rooms, and critical care units. This requirement shall not apply to mixing boxes and acoustical traps that have special coverings over such lining.

7.31.B6. Existing accessible insulation within areas of facilities to be modernized shall be inspected, repaired, and/or replaced, as appropriate.

7.31.B7. Duct lining shall not be installed within 15 feet (4.57 meters) downstream of humidifiers.

7.31.C. Steam and Hot Water Systems 7.31.C1. Boilers shall have the capacity, based upon the net ratings published by the Hydronics Institute or another acceptable national standard, to supply the normal heating, hot water, and steam requirements of all systems and equipment. Their number and arrangement shall accommodate facility needs despite the breakdown or routine maintenance of any one boiler. The capacity of the remaining boiler(s) shall be sufficient to provide hot water service for clinical, dietary, and patient use; steam for sterilization and dietary purposes; and heating for operating, delivery, birthing, labor, recovery, intensive care, nursery, and general patient rooms.

7.31.C2. Boiler accessories including feed pumps, heat-circulating pumps, condensate return pumps, fuel oil pumps, and waste heat boilers shall be con- nected and installed to provide both normal and standby service.

7.31.D. Air Conditioning, Heating, and Ventilation Systems 7.31.D1. All rooms and areas in the facility used for patient care shall have provisions for ventilation. The ventilation rates shown in Table 7.2 shall be used only as minimum standards; they do not preclude the use of higher, more appropriate rates. Though natural window ventilation for nonsensitive areas and patient rooms may be employed, weather per- mitting, availability of mechanical ventilation should be considered for use in interior areas and during periods of temperature extremes. Fans serving exhaust systems shall be located at the discharge end and shall be readily serviceable. Air supply and exhaust in rooms for which no minimum total air change rate is noted may vary down to zero in response to room load. For rooms listed in Table 7.2, where VAV systems are used, minimum total air change shall be within limits noted. Temperature control shall also comply with these standards. To maintain asepsis control, airflow supply and exhaust should generally be controlled to ensure movement of air from “clean” to “less clean” areas, especially in critical areas. The ventilation systems shall be designed and balanced according to the requirements shown in Table 7.2 and in the applicable notes.

7.31.D2. Exhaust systems may be combined to enhance the efficiency of recovery devices required for energy conservation. Local exhaust systems shall be used whenever possible in place of dilution ventilation to reduce exposure to hazardous gases, vapors, fumes, or mists. Airborne infection isolation rooms shall not be served by exhaust systems incorporating a heat wheel. *7.31.D3. Fresh air intakes shall be located at least 25 feet (7.62 meters) from exhaust outlets of ventilating systems, combustion equipment stacks, medical surgical vacuum systems, plumbing vents, or areas that may collect vehicular exhaust or other noxious fumes. (Prevailing winds and/or proximity to other structures may require greater clearances.) Plumbing and vacuum vents that terminate at a level above the top of the air intake may be located as close as 10 feet (3.05 meters). The bottom of outdoor air intakes serving central systems shall be as high as practical, but at least 6 feet (1.83 meters) above ground level, or, if installed above the roof, 3 feet (0.91 meter) above roof level. Exhaust outlets from areas that may be contam- inated shall be above roof level and arranged to minimize recirculation of exhaust air into the building.

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code issues Building Component *7.31.D4. In new construction and major renovation work, air supply for operating and delivery rooms shall be from ceiling outlets near the center of the work area. Return air shall be near the floor level. Each operating and delivery room shall have at least two return air inlets located as remotely from each other as practical. (Design should consider turbulence and other factors of air movement to minimize fall of particulates onto sterile surfaces.)

Where extraordinary procedures, such as organ transplants, justify special designs, installation shall properly meet performance needs as determined by applicable standards. These special designs should be reviewed on a case-bycase basis. Temperature shall be individually controlled for each operating and delivery room. .30.B Elevators 8.30.B1. All buildings having resident use areas on more than one floor shall have electric or hydraulic elevator(s).

Installation and testing of elevators shall comply with ANSI/ASME A17.1 (for new construction) or ANSI/ASME 17.3 (for existing buildings). (See ASCE 7-93 for seismic design and control sys- tems requirements for elevators.) a. Engineered traffic studies are recommended, but in their absence the following guidelines for minimum number of elevators shall apply (Note: these standards may be inadequate for moving large numbers of people in a short time; adjustments should be made as appropriate): b. At least one elevator sized to accommodate a bed, gurney, and/or medical carts and wheelchair users shall be installed where residents are housed on any floor other than the main entrance floor. c. When 60 to 200 residents are housed on floors other than the main entrance floor, at least two elevators, one of which shall be of the hospital type, shall be installed. d. When 201 to 350 residents are housed on floors other than main entrance floor, at least three elevators, one of which shall be of the hospital type, shall be installed. e. For facilities with more than 350 residents housed above the main entrance floor, the number of elevators shall be determined from a facility plan study and from the estimated vertical transportation requirements. f. When the nursing facility is part of a general hos- pital, elevators may be shared and the standards of Section 7.30 shall apply.

8.30.B2. Cars of hospital-type elevators shall have inside dimensions that accommodate a resident bed with attendants. The clear inside dimension of such cars shall be at least 5 feet (1.52 meters) wide by 7 feet 6 inches (2.29 meters) deep. Car doors shall have a clear opening of not less than 3 feet 8 inches (1.12 meters). Other elevators required for passenger service shall be constructed to accommodate wheelchairs.

8.30.B3. Elevators shall be equipped with an automatic two-way leveling device with an accuracy of Âą1/4 inch (7 millimeters).

8.30.B4. Elevators shall have handrails on all sides without entrance door(s).

8.30.C. Waste Processing Service Facilities shall be provided for sanitary storage and treatment or disposal of waste and recyclables using techniques and capacities acceptable to the appropri- ate health and environmental authorities.

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The codes were taken from the Guidelines for design and Construction of Hospital and Healthcare Facilities. codes are essential in the design process because they ensure health, safety and wellbeing of the occupants of the space. These codes will be used to guide the design process. “Guidelines for Design and Construction of Hospital and Healthcare Facilities.� 2001.

Accessed October 2, 2015.

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bibliography ADA.gov. (n.d.). Retrieved September 27, 2015.

Blumenfeld, J., BaRoss, C., & Dufner, S. (n.d.). Transcending Project Type - Principles for High Performance Interior Design. Perkins Will Research Journal, 01.0201.02, 83-109.

Bosch, P. (2015, February 24). How Do We Design for More Holistic Healthcare Practices? Retrieved September 26, 2015.

Burnout. (n.d.) Farlex Partner Medical Dictionary. (2012). Retrieved September 27 2015 Campagnol, G., & Shepley, M. (2014). Positive Distraction and the Rehabilitation Hospitals of Joao Filgueiras Lima.

HERD: Health Environments Research & Design Journal, 08.01, 199-227.

Considering Behavioral Health. (2012). Retrieved September 26, 2015.http://www.hermanmiller.com/research/researchsummaries/considering-behavioral-health.html Cranmer, K., & Davenport, L. (2013). Quiet Time in a Pediatric Medical/Surgical Setting. Journal of Pediatric Nursing, 28.

04 400- 405.

Dictionary.com. (n.d.). Retrieved September 27, 2015.

Evidence for Innovation (1st ed., pp. 2-24). (2008). Alexandria, VA: National Association of Children’s Hospitals and Related Institutions. http://www.premiersafetyinstitute.org/wp-content/uploads/evidenceforinnovationexecsum-small.pdf.

Geboy, L. (n.d.). The evidence-based design wheel. Retrieved September 26, 2015.

Glossary of Terms Commonly Used in Health Care. (2004). Retrieved September 27, 2015.

“Guidelines for Design and Construction of Hospital and Healthcare Facilities.” 2001. Accessed October 2, 2015.

HAI. (n.d.). Retrieved September 27, 2015.

Headwall-systems-prefabricated. (n.d.). Retrieved September 27, 2015.

Health Topics. (n.d.). Retrieved September 27, 2015.

HIPPA. (n.d.) English-Spanish/Spanish-English Medical Dictionary. (2006). Retrieved September 27 2015 Joseph, A. (n.d.). The Role of the Physical and Social Environment in Promoting Health, Safety, and Effectiveness in the Healthcare Workplace. The Center for Health Design, 1-19. length of stay. (n.d.) Mosby’s Medical Dictionary, 8th edition. (2009). Retrieved September 27 2015 Morel, A., Bunker-Hellmich, L., & Zborowsky, T. (n.d.). Centralized vs. Decentralized Nursing Stations. Retrieved September 27, 2015.

Pati, D., & Nanda, U. (2011). Influence of Positive Distractions on Children in Two Clinic Waiting Areas. HERD: Health Environments Research & Design Journal, 04. 03. 124-140.

Patient Rooms: A Positive Prognosis – Steelcase. (n.d.). Retrieved September 26, 2015. from http://www.steelcase.com/insights/articles/patient-rooms-a-positive-prognosis/ 56

Reddez, P., & Pati, D. (n.d.). Does The Decentralized Nursing Model Deliver? Retrieved September 26, 2015. http://www.health caredesignmagazine.com/article/does-decentralized-nursing-model-deliver Shepley, M. (2006). The role of positive distraction in neonatal intensive care unit settings. Journal of Perinatology, 26, S34–S37.

Sound Practices: Noise Control in the Healthcare Environment. (2006). Retrieved September 26, 2015.

Sprow, R. Perkins Eastman White Papers. Planning Hospitals of the Future. 2012, 1–24.

St. Joseph Mercy Hospital. (n.d.). Retrieved September 26, 2015. . http://www.bigassfans.com/case-studies/st-joseph-mercy-hos pital/ Steelcase. Time for Change: New Solutions for Healthcare Places. (n.d.).

Strategies for Leadership: Patient- and Family-Centered Care. (n.d.). Retrieved September 27, 2015.

The Link Between Light and Health | NBBJ. (n.d.). Retrieved November 30, 2015, from http://www.nbbj.com/ideas/2013/3/19/let-t here-be-ligh Tisch, C. (2008). Advances in Healthcare Design. Retrieved October 1, 2015.

Ulrich, R. S. (1997). Pre-symposium workshop: A theory of supportive design for healthcare facilities. Journal of Health care Design, 9, 3–7.

U.S. Food and Drug Administration. (n.d.). Retrieved September 27, 2015.

Watkins, N., Kennedy, M., Ducharme, M., & Padula, C. (n.d.). Same-Handed and Mirrored Unit Configurations.

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What is Lean Design & Construction. (n.d.). Retrieved September 27, 2015.

Zborowsky, T., Bunker-Hellmich, L., Morelli, A., & O’neill, M. (2010). Centralized vs. Decentralized Nursing Stations: Effects on Nurses’ Functional Use of Space and Work Environment. HERD: Health Environments Research & Design Journal,03. 19-42.

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Sche Des 58

ematic sign 59

wayfinding

Wayfinding is a key component to a users first impression of a space. When designed well, users can move within the space easily, comfortably and without confusion.

The design language of the wayfinding package mimics the branding and space.

The use of symbols and colors are the main tools for wayfinding.

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color scheme “Bold hues accelerate heart rate and energize patients upon awakening from surgery�

(Tisch, 2008)

Rooms 800-807

Rooms 808-815

Rooms 816-822

The interaction of color and their relationships to one another influenced the color scheme selected.

Research has shown that analogous color schemes, with variety of hues are preferred among children (Tisch, 2008). With this as a contributing factor, the design will incorporate the three color sets to differentiate zones of patient rooms. This concept will reinforce positive distractions, healing, energy and exploration through wayfinding.

The color sets will be used as an accent to the neutral palette of woods, greys and white and will serve as visual cues for wayfinding.

At a holistic view, the accent colors will be zone specific and come full circle throughout the unit while the public spaces will incorperate a color combination.

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Inspiration

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Signage The pediatric cardiology unit will focus its wayfinding on creating interactions and meaningful moments within the space. Signage will coordinate with color zones and will use symbols as visual cues of wayfinding. In addition, art and prints will be utilized to create a fun and easily navigable space.

Symbol Index

Toilets Toilets men women

Meds Room

Supply Room

Family Respite

Play Area

Elevator Information

Phone

Overhead signage will be made out of plexiglass and will incorporate icons and colors specific to each zone.

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Reception/ Registration

Waiting Area Resident Inpatient Workroom Rooms

Teen Lounge

Overhead signage

Vending

Rehab Room

Quiet Room Classroom/ Administrative Conference Offices

Washing Station

Surgery

Nurse’s Station

Cardiology Staff Nourishment Breakroom Station

Elevator

Vending

08

Waiting Area

Information

Inpatient Rooms

800 800

G. Fisher

Patient room.

Patient room signage will be made out of plexiglass with interactive features. The signage provides simple solutions for changing data through its adjustable name insert. In addition, the signage is ADA compliant and utilizes braille.

Overhead Patient Room.

Overhead patient room signage will be located above the patient’s door for quick wayfinding. This signage will be made out of plexiglass and is easily cleanable.

In addition, the signage will coordinate with the color zone of the patient’s room.

800

Doors.

Teen Lounge

824 824

The door signage will be made out of plexiglass and provides an understandable method of wayfinding. The use of icons allows users to quickly determine level of access.

08 pediatric Cardiology Directory

Directory.

Information

The directory will be placed near the elevator for wayfinding convenience. This tool will guide users to proper locations and will reinforce interaction through guided tools such as icons, pathways and color zoning.

Restrooms Registrstion Inpatient Rooms 816-822

Surgery Inpatient 800-807 808-815

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Material application Wayfinding through pathways Mondo rubber flooring will be utilized to create a whimsical and interactive pathway of wayfinding. The paths will be color coordinated according to zone and will interact throughout the space as they connect at transition points.

Interactive magnetic wall covering

08 Elevator

Vending

08 Rooms 808-815

pediatric Cardiology Directory Information Restrooms Registrstion Inpatient Rooms 816-822

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Surgery Inpatient Rooms 800-807

08

Waiting Area

Film overlay Film will be utilized on glass surfaces as a form of wayfinding and to create a sense of privacy. The film will also function as a positive distraction when applied as a graphic cue.

Textiles and graphic wall coverings: Textiles and graphic wall coverings will be used through the color zones to provide color and vibrancy while serving as visual cues. All textiles and wallcoverings are antimicrobial and bleach cleanable. In addition, some wallcoverings will be used as interactive pieces by providing opportunities for interactions.

Art Local art will be placed through out each color zone as a form of wayfinding and to reinforce exploration and vibrancy.

Martin Creed 800

800 800

G. Fisher

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Alexander Calder

Schematic Design Proposal

The schematic design proposal was the first attempt at space planning, designing and understanding the space.

The following includes bubble diagrams, blocking diagrams and sections.

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Bubble diagrams help us understand the proper spatial relationships and inform the rest of space planning. Utilizing the adjacency matrix and the criteria matrix help determine space relationships.

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bubble diagrams

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Blocking Diagrams

Building upon the bubble diagrams, blocking diagrams allow us to determine how much space should be allocated for each area. Utilizing the clients space needs and the design codes, we are able to determine the correct amount of space for the design.

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Patient Zone

Staff Zone

Staff Zone

Public Zone

Patient Zone

Staff Zone

Staff Zone

Public Zone 73

Preliminary Sections Blue Zone Color Study

Nurse’s Station

Teen Lounge

74

Play Area

Sleeper Sofa

Seating Area

Restroom

Patient Room

Family Respite

orange Zone Color Study

Nurse’s Station

Teen Lounge

Play Area

Sleeper Sofa

Seating Area

Restroom

Patient Room

Family Respite

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University of Kentucky School of Interiors ID421: Fall 2015 Healthcare Studio Katie Abushanab

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