HERD: Health Environments Research & Design Journal

Objective: This study aimed to document and empirically evaluate the physical environment strategies used by emergency departments (EDs) to address the challenges posed by the COVID-19 pandemic; and to develop recommendations for managing future crises. Background: Emergency departments made significant environmental modifications in responding to the COVID-19 pandemic but these modifications and the decision-making processes were seldomly studied. Methods: In this in-depth qualitative case study, a multidisciplinary research team conducted semistructured interviews with 11 professionals of various roles in environmental responses to the pandemic at a large urban ED in the U.S. Qualitative content analysis generated codes and code categories from the data as well as a conceptual framework. Design documents and photographic documentation were used to cross-check the interview data. Results: The ED faced challenges in making rapid changes with limited information and resources. Physical barriers separating patients, air filtration, airflow control, and alternative care spaces were key physical environmental strategies implemented. Among them, the physical separation of patients was perceived to be most effective, followed by air quality control measures. Interviewees recommended flexibility in building design (self-contained zones, negative pressure and air filtration in all patient rooms, pandemic mode of air ventilation system), and an all-inclusive bottom-up decision-making process. Concerns included ventilation, security, communication strategies, and workplace ergonomics. Conclusion: The physical environment constitutes an important part of ED pandemic response and the proactive preparation for future crises. Hospitals should consider the ED environment's role in pandemic response, including ventilation capability, security visibility, and functionality for staff.

Objective: This study aimed to examine the effect of a contextualized intervention program on the level of noises in the neonatal intensive care unit (NICU) in Konya, Turkey. Background: For the healthy development of preterm infants, NICUs should have noise levels within safe limits. Methods: A single-center, before-and-after study design was employed. Participants included one head nurse, four physicians, 42 nurses, six physician assistants, and 14 other staff members. The contextualized intervention program involved environmental modification, behavioral modification, and resource management. Sound level measurements were recorded at two-hour intervals over a week before the program's initiation, after the first cycle, and following the installation of central monitor screens. Data analysis utilized SPSS 25, employing percentile calculations, one-way analysis of variance, and Bonferroni tests. Results: The evaluations in the second level of NICU showed that the noise level recorded on weekday mornings and evenings was significantly lower for the third measurement compared to the first and second measurements. However, at the weekend the noise level recorded in the morning was higher in the second measurement than the first, with no significant difference found for the third measurement. The evaluations in the third level of NICU showed that on weekdays the noise level recorded in the third measurement was significantly lower than in the first and second measurements (p < .05). Conclusion: The implementation of a contextualized noise reduction program in our NICU led to significant improvements in noise levels, particularly during morning and evening shifts.

Background: Changing consumer attitudes toward the natural environment are reflected in an increase in demand for environmental design of private houses, which requires the definition of some general principles of such design, particularly graphic design. Purpose: The purpose of the study is to highlight and determine the fundamental features of the visual component of the ecological design of private houses. Objectives: Present the characteristics of the countries of the world in accordance with the application of eco-design and sponsorship of green construction; identify visual principles that characterize the ecological design of private houses. Methods: The study is based on mixed qualitative analysis. The authors of the study used statistical from statista.com concerning the number of LEED certified projects during 2018 to 2021. Statistical indicators of countries is used to select houses for research, an assessment of a group of experts of photo-interview methods is used to determine the main trends in visual environmental design. Results: It was possible to systematize the world experience in designing private homes using an ecological approach. They categorized the basic principles of visualization of functional-planning, technological and artistic-esthetic solutions in the interior design of a private residential building; compliance with appropriate esthetics; functional design solutions of the interior space, modularity, compactness, responsible and rational architecture; and interior design, preferably with the possibility of moving housing to another place in case of forced relocation. Conclusions: The results obtained can be used in the framework of theoretical and practical design of private residential buildings.

Objectives: Chinese classical gardens, designated as a vital world cultural heritage, embody a lasting legacy transcending generation. Despite the cultural importance of these gardens, a notable research gap exists in deciphering the nuanced emotional and physiological responses triggered by individual elements within classical garden landscapes. Our research question aims to uncover the specific emotional and physiological impacts of key garden elements—plants, architecture, waterscape, and rockery—on visitors, with a particular focus on the Humble Administrator's Garden. These elements serve as the primary subjects for video capture at four sites. Study Design: A within-subject design experiment was used. Methods: Videos were recorded at these sites, encompassing visual, auditory, and tactile elements. Ninety-five participants watched these videos in an indoor setting. While viewing, we measured participants’ physiological responses, including heart rate variability, skin conductance, and skin temperature, will be monitored alongside subjective assessments obtained through self-reported questionnaires such as the Emotional Perception Scale and State-Trait Anxiety Scale. Results: Findings suggest that while all landscape types evoke positive emotions, natural elements exert a more profound influence. Additionally, the Large Rockery emerges as a focal point, indicating enhanced emotional relaxation through auditory and tactile stimuli, particularly among younger individuals. Conclusions: This research contributes to the broader understanding of how classical gardens impact human emotions and well-being, offering insights that can inform future landscape design and promote mental health in diverse cultural contexts.

Objective: The purpose of this study is to investigate if there is a physiological stress response to the visual and auditory characteristics of waterscapes. Background: Biophilic research suggests that the presence of water can reduce stress, reduce blood pressure, and increase circulation. However, water has largely been omitted from healthcare design due to concerns of cost, maintenance, waterborne pathogens, and contamination. Existing research has not yet provided a design methodology to incorporate the healing effects of water without the potential diseases, contamination, and maintenance issues associated with physical water. Given the current technological capabilities, the isolation of the auditory and visual sensory stimuli has potential to re-introduce the healing benefits of water into healthcare design. Methods: Participants were either exposed to a slow-moving or fast-moving waterscape for 20 minutes. Pre- and post-anxiety were measured using the State Trait Anxiety Scale in an online Qualtrics survey (118 participants) and through a salivary cortisol biomarker (in which 26 participants also partook). Results: The overall results demonstrate that the utilization of digital blue space was effective in reducing stress. There was no significant difference between the lake or waterfall environment in both salivary cortisol and state-trait anxiety measures. However, it is suggested that the slow and fast-moving waterscapes may be beneficial in different settings. Conclusion: Design recommendations are made regarding potential biophilic design in healthcare facilities. The utilization of sensory waterscapes can also provide a cost affordable, non-pharmacological, alternative for anxiety mitigation for patients and staff undergoing high-stress situations.

Aim: This qualitative study aimed to explore needs and wishes of older adults concerning their perceived need for contact with outdoor environments at residential care facilities (RCFs) and what implications it has for theory and practice. Background: There is increased awareness of the importance of health-promoting everyday environments for persons with special needs. Therefore, it is important to include the experiences of older adults at RCFs in research. Methods: Twelve older adults from three Swedish RCFs participated in semistructured walking interviews. Results: Two categories were identified concerning the needs and wishes of older adults for contact with outdoor environments. The first category, Outdoor environments as part of everyday life, describes aspects of normality linked to outdoor stays at RCFs. The second category, Getting outdoors in practice, describes supportive and hindering aspects of outdoor stays, as well as accessibility regarding different body positions and access to personal support. Conclusion: It was found in this study that the needs and wishes of older adults are important to consider to increase their opportunities for outdoor stays. Their needs and wishes could also be included in briefs and programs for the design and planning of new construction or refurbishment of RCFs. The results of the study can serve as the basis for further discussions concerning older adults’ outdoor stays and the accessibility of outdoor environments. Further, the results are intended to facilitate practical knowledge that is useful for care workers and managers at RCFs and to support decision makers, property developers, architects, and planners.

Aim: This study aims to shift views away from negative perceptions towards aging by exploring the following research question: How are the multiple levels of the gerotranscendence theory influenced by the sustainable behavior and attitude toward the biophilic design of older adults? Background: Improving perceptions of aging is vital for positively impacting both the biological and societal aspects of the global aging phenomenon. Methods: The study utilized a mixed-method design. Initially, 300 older Turkish adults completed self-reported measures including the Gerotranscendence Scale (GS), Pro-environmental Behavior (PB), Environmental Identity Scale (EID), Biophilic Design Importance Level (BDI), and Inclusion of Nature in the Self Scale (INS). Subsequently, the second phase involved diary logs from 30 participants who volunteered during the initial phase. Results: Results indicated that a higher importance level placed on biophilic design was linked to a greater inclusion of nature in the self. Moreover, a stronger interest in nature correlated positively with the gerotranscendence experience. Conclusions: The results bring significant attention to biophilic design, especially its relevance in supporting sustainable environmental behaviors and positive aging.

Aim: The objective of this study was to develop a comprehensive multidimensional framework by identifying the key drivers and components associated with the health of older people in healing environments, and to apply this framework in high-density city block spaces, creating opportunities for aging in place. Background: Effective theoretical and practical research frameworks are necessary to determine how to best support older adults in high-density city areas as they face aging-related challenges. Methods: The methodological approach involved bibliometric analysis (SciMAT) and systematic literature review of approximately 4446 articles related to rehabilitation settings and older adults. The review focused on literature that developed concepts and research frameworks and provided an empirical foundation. Results: The review identified four types of drivers for a healing environment for older individuals in high-density city blocks (HEOI-HCBs): self-environment, interpersonal, physical, and informational environments. These drivers were linked to eight desirable outcomes: initiative acquisition, shared vision, trust, empathy, integrity, systematicity, networking, and perceived usefulness. Conclusion: The drivers and outcomes formed the HEOI-HCBs framework, each representing a distinct dimension of the HEOI-HCBs concept. This study and the resulting framework facilitate the application and understanding of healing environments.

Background: The end-of-life experience is significantly influenced by the surrounding environment, emphasizing the importance of exploring built environmental factors in palliative care, especially for pediatric patients. As the majority of end-of-life individuals are elderly or adults, most studies have focused on the environment for this demographic. However, it is essential to recognize that children and adolescents may have distinct needs in this regard. Aim: This narrative review aims to explore the impact of the built environment on pediatric end-of-life patients in inpatient units within palliative care settings. Method: A comprehensive search was conducted across four key databases (PubMed, MEDLINE, PsycINFO, and CINAHL) to identify relevant articles. The screening process commenced with an initial assessment of article titles and abstracts, followed by a thorough examination of full-text studies that met the inclusion criteria. Data synthesis involved thematic analysis facilitated by NVIVO software and informed by the findings extracted from selected literature. Results: The review identified 22 studies meeting inclusion criteria, revealing key insights into environmental considerations in pediatric palliative care. Four themes emerged, highlighting the significance of activities and play environments, accommodation spaces for patients, supportive spaces for families, and outdoor and green spaces. Conclusions: Acknowledging limited research on architectural aspects and reliance on family and staff perspectives, future studies should prioritize understanding pediatric patients’ perspectives, particularly adolescents. The study underscores the importance of enhancing environmental design in pediatric palliative care to meet the unique needs of patients and their families.

Purpose: To present the social network analysis-based approach used to create a new workspace layout for three hospital services as part of a campus expansion at a large tertiary care public hospital. Objective: To analyze the relationships among service members across four healthcare resilience abilities (monitor, anticipate, respond, and learn) and utilize network metrics to indicate the suitability of a shared workspace layout for the services. Background: The hospital expanded by 70%, providing space for relocating key services—the rapid response team, medical on-call team, and nursing supervision. Initial observations suggested a shared workspace layout based on anecdotal evidence. Method: Stakeholders have reached a consensus on a three-stage process to assess the suitability of a shared workspace layout for these services: first, collecting data on social interactions with a focus on resilience abilities; second, presenting layout alternatives based on sociograms; and third, evaluating these alternatives and devising a strategy for allocating personnel to shifts based on a resilience score derived from social network metrics. Case Study: The examination of social network metrics allowed identifying key individuals contributing to the overall resilience of the three services. Sociograms provided visual representations of how these individuals were spatially distributed within the shared layout. Discussion: The process was designed to shape a resilient layout and incorporated initial data, preferences, and constraints into layout proposals. Additionally, it utilized a resilience score from existing literature to formulate a strategy for staff allocation to shifts, ensuring consistent collective resilience ability across all shifts.