Executive Summary of Key Concepts

Anjali Joseph, Matthew H.E.M Browning, Shan Jiang

Immersive Virtual Environments (IVEs) consist of synthetic sensory information that surround the user with a continuous stream of stimuli. IVEs provide an innovative but underutilized way to conduct environmental design research because of the ability to manipulate specific features of the environment while holding others constant. This ability makes IVEs ideal for conducting experimental studies as well as for systematically evaluating alternative design configurations during the design process. Ecological validity, which defines the extent to which a participant’s responses in VR resembles their responses in the real world is a key consideration while using IVEs for environmental design research studies. Related to this are issues around visual realism, behavioral realism, and contextual realism. While considering the use of IVEs for environmental design research, the research questions and study designs play a critical role in IVE selection and ecological validity. The research study framework provided in this paper is accompanied by a workflow that operationalizes the creation and use of IVEs in research. IVE use for environmental design research should remain deliberate and thoughtful to ensure the research workflow always matches the research question(s).

Rita Rodrigues, Rita Coelho, João Manuel R.S. Tavares

This article provides an analysis of quantitative data collected through questionnaires applied at three Portuguese hospitals. The data collected covers the evaluations and perceptions of users regarding the signs at these institutions. An analysis was made to understand the most common problems referring to the signage systems of these hospitals. The results showed that the users evaluated the signage as good; however, they made many suggestions for improvements, including on signs that they had initially evaluated as good. The reviewed literature and some of the concepts presented here are useful to set the basis of similar studies and the current results are a major contribution to increase the amount of available literature on the topic. Furthermore, this analysis is useful for stakeholders involved in the process of design of signage systems for healthcare institutions in order to understand and overcome the common problems identified in the current systems.

Lisa Lim, Ruth Kanfer, Robert J. Stroebel, Craig M. Zimring

Communication and teamwork among healthcare professionals are critical for patient care. Staff members need to coordinate patient care, check clinic progress, train students or new staff members, and handle interruptions, which all require privacy from patients. This study investigated communication patterns of staff members in relation to visual exposure levels to patients by empirically studying four team-based primary care clinics where privacy levels of the team rooms varied. The study found that staff members preferred talking in team areas and did not prefer talking at visually exposed areas. Furthermore, there was a lack of agreement between staff members’ preferences toward where they have patient-related communication at visually exposed team areas. The findings of this study emphasize the importance of careful attention to visual interfaces between staff members and patients, especially how to open the team areas to patients and where to visually expose to patients in clinics. Team areas or other staff work areas where frequent and significant staff communication needs to occur privately from patients should not be visually exposed to patients.

Mahshid Jalalianhosseini, Kara N. Freihoefer, Nancy Doyle, Amanda Simpson

The growing number of patients with cancer diagnosis calls for a more efficient design of cancer infusion centers that promote staff engagement and concentration, as well as patient privacy. This empirical research compares nurses’ workflow and nurses’ and patients’ satisfactions of two different layouts of infusion centers and fills a knowledge-gap related to the impact of infusion center design. One of the centers in the study has a traditional open bay design and the other has semi-private bays.

Comparison of data indicated no significant difference in the time spent by nurses in different areas, duration of activities and number of visits to different rooms among the two centers, although nurses and patients had different satisfaction levels which can be explained by layout qualities. This study presents evidence that can be used in the design of infusion centers and help with prediction of workflow and satisfaction in these settings.

David Brodsky and Mardelle Shepley

Social interaction frequency is a crucial factor for evaluating self-perceived quality of life for individuals in long-term care. This mixed-methods study explores the impact of building configuration on social interaction between staff and residents in acquired brain injury specific long-term care facilities. The social and affective behaviors of residents and staff in one open configuration and one corridor configuration facility outside of Boston, MA were compared using behavioral observation and staff and resident questionnaires. Staff rated the hallway configuration facility as more effective in promoting social interaction while there were no differences between residents’ perceptions of the two physical environments. However, residents in the open configuration facility had more interactions with staff and exhibited positive affect for longer durations. The differences in the findings of each data collection method are discussed and used to make design recommendations to improve social interaction frequency in similarly specialized facilities.

Sheng-Wen Su, Shwn-Jen Lee, Mei-Wun Tsai, Hong-Ji Luo

The planning and design of new adult day care centers (ADCCs) affect service users and workflow in several subsequent years. This study explored managers’ opinions on planning and design of location, building type, spatial layout, and interior design of ADCCs. The ADCC managers assigned different weightings to each factor regarding the selection of locations and building types, and provided critical opinions on the planning and design of ADCC spatial layout and interior design. The managers deemed support and attitudes from local residents and authorities as their first two critical location selection criteria. In terms of their opinions on the conditions of building type, those that prioritized the products and technologies of facility design were deemed the most critical, followed by those that valued daylight quality. The results of this study organized the obtained opinions of actual administrators of ADCCs to provide a reference for operational topics.

Robert G. Davis, Lindsay J McCunn, Andrea Wilkerson, Sarah Safranek

Lighting systems in patient rooms must balance energy efficiency concerns with the holistic needs of patients, families, and medical caregivers. This paper reports questionnaire responses from 138 nurses working in medical-surgical units in four hospitals, with three of the hospitals having traditional lighting systems and the other hospital having a more contemporary lighting system. The results add to a growing evidence base on the effects of lighting on nurses’ job performance, job satisfaction, and overall perceptions of the environment, and provide evidence that innovative lighting approaches and technologies are worth considering as an investment by hospital administrators looking to improve employees’ and patients’ perceptions of the patient room environment. This knowledge is intended to help facility designers and managers incorporate nurses’ perspectives in their decisions, as well as to inform technologists and engineers developing future generations of lighting systems for patient rooms. These future systems will utilize solid-state lighting technologies, such as LEDs, and will provide new opportunities for adapting the intensity, distribution, and spectrum of light to better satisfy the holistic needs of patients and caregivers at different times of day or night.

Gijs Hesselink, Merlijn Smits, Mariël Doedens, Sharon Nijenhuis, Denise Van Bavel, Harry Van Goor, Tom Van de Belt

In the past, studies have confirmed that the hospital environment of a patient affects recovery after surgery and could shorten length of stay. Yet, we have not enough insights into the needs of patients with respect to their environment, nor in how these needs are being met. For that reason, this study aimed to gain an understanding of the needs of postoperative patients during their stay. We conducted a qualitative study with 21 patients in a Dutch university hospital. Patients filled in context-mapping exercises (they kept diaries and took photos) and were interviewed afterwards. All the data were analyzed.

Three themes emerge with respect to patients’ environmental needs. First, patients want a sense of control over their treatment, ambient features, privacy, nutrition and help requests. Second, patients need positive distractions from the personalized bedroom, connection with the external environment and activities. Third, patients value good relationships with professionals, peers and relatives.

Needs fulfillment of patients could be improved by practical adjustments to the environment of the patient, and considering individual preferences and changing needs during the recovery process.

Ann Sloan Devlin, Alaina Anderson, Sarah Hession-Kunz, Margaret Kelly, Lilly Noble, Amy Zou

Art positively affects patients’ responses to healthcare environments (e.g., Ulrich & Gilpin, 2003). Representational art is generally favored (e.g., Hathorn & Nanda, 2008; Lankston, Cusack, Fremantle, & Isles, 2010; Ulrich, 1999). Much is known about the recommended content of art, but less about whether the size of the art displayed affects patients’ perceptions of quality of care. The current research examined effects of the presence and size of a representational image (color photograph of a scenic landscape) on a series of dependent variables (e.g., positive distraction, anxiety, perceptions of the clinic, perceptions of the healthcare provider, perceptions of quality of care), using 4 images (blank wall, small, medium, large). How long patients waited to see the physician (10 vs. 45 minutes) was also considered. Significant effects emerged for Size on Positive Distraction, Perceptions of the Clinic, Perceptions of Physician Competence, and 4 Quality of Care variables. Time showed significant effects for Spaciousness, Anxiety, Perceptions of the Clinic, Perceptions of Physician Competence, and the 4 Quality of Care variables. Overall, larger images were judged more positively; waiting longer was negatively rated. Recommendations for the size of art on display are considered.

Michelle Maura Shannon, Susanna Elisabet Nordin, Julie Bernhardt, Marie Lena Elf

Researchers are faced with multiple, varied theories when they plan studies of the design of adult healthcare environments. Theories are structured descriptions of physical design features, how they might interact with each other, and then how these design features might interact with adult behaviors to produce optimal health and wellbeing.

Our multi-disciplinary scoping review team broadly mapped these theories, described them, described the research studies using them, and summarized how such theories are used. Despite finding that eight theories were used in the research process, five of these were used more explicitly than others in research. We have provided an educational compendium to assist researchers in their choice of the most relevant theory to situate future research activity.

Shan Jiang

This study aimed to validate and extend evidence on positive distractions and play opportunities in the design of a pediatric healthcare environment, translate existing evidence into design suggestions, and identify research gaps in this realm. A four-phased literature review method was employed in the study, including literature search, literature screening and selection, literature appraisal, and thematic analysis and in-depth discussion. Eventually, 27 peer-reviewed publications were categorized into six themes of positive distractions: art and environmental aesthetics, spatial arrangement and atrium, considerations of socialization patterns, play and interactive technologies, sound and lighting interventions, and access to nature. This study indicated that positive distractions in pediatric healthcare environment provide a series of health benefits for patients, including improved behavioral and emotional well-being, reduced stress and anxiety, enhanced healthcare experience and satisfaction, and facilitated medical procedures and recovery. This study also identified the following research gaps in pediatric healthcare facilities: environmental design to promote the engagement between pediatric patients and healing garden features, the implementation of various play programs in properly designed public spaces, spatial design to encourage socialization through play, as well as to accommodate interactive technology as positive distractions.

Christina Nilsson, Helle Wijk, Lina Höglund, Helen Sjöblom, Eva Hessman, Marie Berg

The physical healthcare environment has positive and negative effects on health and wellbeing, but the effects of the environment where labor and birth take place have only been sparingly studied. We therefore conducted a systematic literature review to summarize and analyze published research on how birthing room design influences physical and emotional health outcomes in women and their babies during labor and birth. A search in 10 databases from their inception dates resulted in an analysis of 15 studies presenting qualitative and quantitative data from six countries on four continents. When birthing room designs showing physical and emotional influence on birthing women and their babies were grouped together, four physical themes emerged as important: 1) means of distraction, comfort and relaxation; 2) raising the birthing room temperature; 3) features of familiarity; and 4) diminishing a technocratic environment. The review demonstrates that there is only limited evidence regarding birthing room design that promotes the health of women and babies, particularly in hospital-based labor units. Globally, many women give birth in hospital environments, although evidence of how such environments affect their health is lacking. There is an urgent need for more research in this field.

Joslin Rae Clouse, B. Jeanneane Wood-Nartker, Franklyn Alexander Rice

The goal of this study was to synthesize current research to develop guidelines that can be incorporated into one vocational center. An effective environment can positively impact people with autism as it enhances their ability to learn and work towards the development of job and life skills that lead to more independent living. One plan of the center highlights the Americans with Disabilities Act (ADA) guidelines, which meet the physical needs of people using the center (Search ADA.gov., n.d.). A second plan reinforces how the guidelines for people with autism provide a more universal solution for all people. Better design solutions allow teachers to address students’ hypo- and hyper-sensitivity needs to meet children where they are at to minimize the impact of over- or under-stimulation. This can enhance their socialization skills, ability to interact with others, and develop overall communication skills for interacting within the community. As far as the broader community, this work will inform designers/architects on environmental characteristics that enhance students’ feelings of control and contribute to their well-being by bringing them to a place of regulation that will naturally enhance their overall development (Gaines et al., 2016). In the process toward supporting their independence, this will be a win-win.

Liwei Zhu, Shanshan Zhang, Zhipeng Lu

In modern society, it becomes a responsibility of healthcare architects to realize the design of “benefit for patients.” The goal of healthcare environment design and research is also gradual from a basic level of ensuring the physiological safety of patients to achieving a higher level of respecting patients and helping realize their self-realization. However, how to express respect to patients in the healthcare environment is ambiguous. In order to break through the limitation of architectural specialty, we propose to introduce biomedical ethics. Under this major premise, the article will discuss from the perspective of respect for autonomy. The article combines Beauchamp and Childress’s discussion of autonomy with other relevant research results and it is organized in the three practical themes under this principle: (1) patient decision-making, (2) autonomous action, and (3) social relationship and interaction. The effects of the environment are discussed in terms of the three conditions to promote patient autonomy: (1) respecting the patient’s intention, (2) building and supporting the patient’s capacity of autonomy, and (3) avoiding physical limitations or controlling influences.