While scientific studies and EBD are still in relative early exploration, there are elements of the way a space is designed that is effective in having calming and restorative effects. Einstein stated that “there is nothing in the understanding which did not previously exist in the feeling” (From and Lundin, 2009, pp234), demonstrating that adopting a greater ‘spiritual aesthetic which engenders hope, contentment and peace’ (Haggard and Hosking, 1999, pp169), could form healing environments.
Hospital entrances are the first impression the patient receives of the hospital experience. In web article, Can Architecture Heal, Mathiesen discusses ‘crossing the harsh line that typically defines a hospital entrance’ (Mathiesen, 2013). Due to our perception of spaces having the ability to produce nerve chemicals that negatively impact the immune system, and thus prevent us to heal efficiently (Sternberg, 2009, pp13), it is important that entrances are unintimidating. Commenting on Nord Architect’s Centre for Cancer and Recovery, Mathiesen describes the glass entrance as a ‘central hub’ whereby other spaces are clearly visible (Mathiesen, 2013), forming a comforting aesthetic.
Hospitals typically provide waiting rooms for patients prior to appointment or treatment. As spaces with high use, where patients often spend a considerable duration of time waiting for a healthcare professional, it is identified as important to alter the potentially negative perception of care quality within the waiting room environment (Arneill and Devlin, 2002). In addition to aesthetics such as comfortable seating and the presence of artwork as visual distraction (Arneill and Devlin, 2002), a sense of flexibility and adaptability in the waiting room has the ability to allow the patient to divert attention away from the health concern (Arneill and Devlin, 2002).
Poor wayfinding has been known to prohibit efficient application of staff hours, and incidentally the time attributed to patient healing. In one USA based study, ‘4,500 hours of clinical time a year’ was wasted (Maddox, 2014) as a result of staff giving directions. Represented commonly through signage, wayfinding can be attractively integrated in floor prints, colour injection and the manipulated form of space to channel users (Farr, 2015). Whilst vital that navigation permits ease of use, if hospitals can seek a balance between a diverse interior for exploration that maintains mental stimulation, with uncomplicated spaces that prioritise patient comfort, then the space will be more therapeutic (Maddox, 2014).
The structure and form of a space impacts both how we use it and our emotional interpretation. Regarding spatial typology, lower ceiling heights or I N - W A L L 'N I C H E S' infer intimate spaces in contrast to large, open voids whose volume indicates a public purpose (From and Lundin, 2009, pp52). Breaking linear spaces by including
C U R V E D F O R M S , in walls or seating, has been linked to ‘comfort and beauty’ (Steemers, 2016). Exemplifying this aesthetic is Aberdeen’s Maggie Centre for cancer patients, featuring a cutaway egg shaped exterior, described by Jencks as ‘enveloping, comforting and cuddling’ (Jencks, 2014). In consideration, form and structure is subjective therefore V A R Y I N G S P A T I A L F O R M can be interpreted differently by each patient, and not necessarily have a positive impact.
The introduction of recreational and social zones for supporting both physical and mental health needed for recovery could appear as yoga and meditation spaces, gardens and art therapy rooms (Farr, 2015). These spaces are known to promote ‘self-confidence which can lead to restorative effects’ (Ivarsson, 2010, pp152-153). Jencks exemplifies this in his neologism, ‘kitchenism’ (Jencks, 2014), to term the centrally located kitchens native to Maggie Centres that become relatable, sociable and comforting. Delivering a similar impact are homely aesthetics, emerging architecturally as ceilings imitating the roof peaks or the exposure of roof trusses, evoking a sense of normality and avoiding ‘institutionalisation’ (From and Lundin, 2009, pp45).
Introducing outdoor elements through natural materials such as solid wood flooring and stone (From and Lundin, 2009, pp51) relates to the positive impact of nature on patients. Light diffusing materials, glass partitions and windows benefit hospitals by being hygienic materials that additionally provide a balance between seclusion and openness (From and Lundin, 2009, pp48). In further regards to materials, literal healthy and non-toxic options exist, such as ‘carpets and paints that clean the air by collecting dust particles in their fabric structure’ (Nickl and Nickl-Weller, 2013, pp157).
The application of colour in hospitals is subjective and being significantly linked to mood and emotion (Lehman, N/D), colour sub-consciously influences how people use space and address stress. An experiment conducted at the Architectural Digest Home Design Show, NYC (2006), consisted of hosting a social event in three equal rooms (Sternberg, 2009, pp42). Each room adopted either red, blue or yellow paint; and attendees were monitored on variables such as heartrate and behaviour (Sternberg, 2009, pp42). Blue was perceived as the most soothing, whilst red and yellow were stimulating (Sternberg, 2009, pp42). The introduction of appropriate colour to hospital design could avoid the often clinical, neutral hospital aesthetic, and promote the sought after normality (From and Lundin, 2009, pp191).
Despite not being architectural factors, indoor environmental parameters influence the hospital experience. The most habitable spaces must provide patients with access to a sufficient amount of daylight (Steemers, 2016).
Natural light has the power to ‘banish claustrophobia and lighten mood’ (Haggard and Hosking, 1999, pp98) and variable conditions should be available such as ‘light that is from above, the side, direct, diffused, adjustable by shutters, louvres and blinds’ (Steemers, 2016). Poor, glaring or florescent artificial lighting, and over which the patient might have no control, has been identified as a stressor (Smith and Watkins, 2016).
Acoustically, human traffic and medical equipment in a hospital environment contribute to loud noise levels. The WHO studied five UK intensive care units, discovering noise levels consistently exceeded the average of 35 dB (Darbyshire and Young, 2013). Excessive noise has a negative impact on stress levels and sleep needed to recover. Noise reduction approaches include acoustical treatment of walls and inclusion of materials such as soft furnishings and flooring in addition to adequate separation of patient and staff orientated zones (Smith and Watkins, 2016).
The optimisation of natural ventilation is a necessity in creating healthy buildings. Louvre instalments and ventilation techniques such as ‘stack and cross’ exemplify methods to exploit and sustain natural ventilation (Steemers, 2016). Material considerations could help retain warmth of certain spaces, such as social and familial zones, for instance heavyweight cushioning on seating areas for thermal absorption (Steemers, 2016).
A sense of control over indoor conditions, such as being able to adjust lighting, temperature, have outdoor access and involvement in social or recreational therapy seemingly offers a sense of importance to the patient and instils a caring environment. Lena Walther, Director of Planning at the Sahlgrenska University Hospital, claims a ‘lack of independent control has proved to entail many negative effects, including depression, helplessness and impaired cognitive achievement capacity’ (From and Lundin, 2009, p25), suggesting its potential to reduce patient recovery rates. While patient independence is beneficial, it is questionable as to the extent of control given.
The natural environment supports well-being of patients, with outdoor views providing ‘stabilising points of reference’ (Sternberg, 2009, pp128). The inclusion of courtyards and gardens, or large windows are methods of increasing the connection between indoor and outdoor environments, providing escapism. Professor of Landscape Architecture at the University of California, Clare Marcus, emphasises “Spending time interacting with nature in a well-designed garden won’t cure your cancer or heal a badly burned leg. But there is good evidence it can reduce your levels of pain and stress—and, by doing that, boost your immune system in ways that allow your own body and other treatments to help you heal” (Franklin, 2012).
A R C H I T E C T U R A L + E N V I R O N M E N T A L F E A T U R E S
F O R T H E R A P E U T I C + ' H E A L I N G ' S P A C E S
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W A Y F I N D I N G + N A V I G A T I O N
S T R U C T U R E + F O R M
S O C I A L , R E C R E A T I O N A L , G R O U P T H E R A P Y
V I E W S A N D A C C E S S T O N A T U R E
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I N D O O R E N V I R O N M E N T
A C O U S T I C S A N D N O I S E R E D U C T I O N
V E N T I L A T I O N A N D T E M P E R A T U R E
C O N T R O L A N D I N D E P E N D E N C E
H O V E R O V E R M E
HAYLEY MARCROFT
INTERIOR ARCHITECTURE | NTU
N0495471
It is advised that hospital artwork be selected or commissioned with care (Heathcote and Jencks, 2010, pp29); art is subjective and emotional response varies depending on the viewer (Ulrich, 1992, pp25). Ulrich conducted several art based studies, finding that artwork theming ‘therapeutic landscapes’ (Evans, et al., 2009, pp716) left patients feeling happier and with increased concentration (Ulrich, 1992, pp25).
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