Healing Environments

[Co-authored with Faye Brands] Attention to the role of art within healthcare is on the rise. Dutch hospitals are increasingly embracing the concept of the ‘healing environment’, which aims to create agreeable hospital surroundings for the well-being of employees and patients. The concept is being interpreted in diverse ways; irrespective of the specific outcome of this interpretation, the healing environment does have consequences for the healthcare facilities’ policies related to art. Research at a few Dutch hospitals has revealed that the more stringently the guidelines on the healing environment are followed, the more emphasis is placed on the medical-functional approach to art and the lesser attention is paid to the intrinsic value of art. Hospitals that reject the concept of the healing environment, however, also clearly demonstrate defining art in terms of making the surroundings agreeable to the patient. The healing environment therefore cannot serve as a new legitimation of autonomous artworks in existing hospital collections, but it is congruent with the recent attention given to the societal role of art.

Introduction. The influence of the environment on wellness, not only for patients themselves
but for all care-givers as well, refers to the humanisation principles of spaces of
care. Commencing with an analysis of existing paediatric hospices, the paper examines
design suggestions for prosthetic environments, considered as a fundamental component
in the healing process.
Methodology. A prosthetic environment can be created only through a specific knowledge
of the real needs of users. Therefore, some scholars have conducted research work
for defining the best practices for healing environments, supported by an assessment and
comparison of case studies. The methodology is based on two phases: the first is based
on interviews with experts in hospice design and management and the second, through
the application of a questionnaire to several users.
Discussion and Results. The output of the work is the achievement of a logical, sequential
and participatory broad-spectrum process in the design of health facilities in order to
cause a sustainable awareness in paediatric hospices.
Conclusion. Starting from the research work, it is necessary to define a scientific method
for implementing knowledge on health, psychological, perceptual and behavioural needs
to contribute towards proper planning for meeting the real requirements of users.

There are currently about 6 million -mainly older-people with dementia in 28 the European Union. With ageing, a number of sensory changes occur. Dementia 29 syndrome exacerbates the effects of these sensory changes and alters perception of 30 stimuli. People with dementia have an altered sensitivity for indoor environmental 31 conditions, which can induce problematic behaviour with burdensome symptoms to 32 both the person with dementia and the family carer. This paper, based on literature 33 review, provides an overview of the indoor environmental parameters, as well as the 34 integrated design and implementation of relevant building systems. The overview is 35 presented in relation to the intrinsic ageing of senses, the responses of older people 36 with dementia and the impact on other relevant stakeholders through the combined 37 use of the International Classification of Functioning, Disability and Health, and the 38 Model of Integrated Building Design. Results are presented as indicators of the basic 39 value, functional value and economic value, as well as a synthesis of building-related 40 solutions. Results can help designers and building services engineers to create optimal 41 environmental conditions inside the living environments for people with dementia, 42 and can be used to raise awareness among health care professionals about of the 43 influence of the indoor environment on behaviour of the person with dementia. 44 45

A assistência ao parto está em crise no Brasil. A redução da mortalidade materna e neonatal ainda é um desafio para os serviços de saúde e a sociedade como um todo. As altas taxas encontradas se configuram como uma violação dos Direitos Humanos de Mulheres e Crianças e um problema de gênero e saúde pública. A assistência médica prestada no interior dos hospitais, passa a produzir iatrogenias para a mulher em trabalho de parto, que tem experienciado um momento de violência e desrespeito à sua fisiologia. Através do entendimento dessa problemática, o presente trabalho sugere a Casa de Parto como uma ferramenta arquitetônica capaz de corroborar para a reconstrução de valores sociais e mudança de paradigma acerca do ato de parir e nascer como um ato fisiológico, desvinculado do ambiente hospitalar geralmente associado à insegurança e sofrimento. Utilizou-se como metodologia o estudo de pesquisas observacionais que levam em consideração a perspectiva das usuárias nesses estabelecimentos de saúde bem como visitas a duas unidades em funcionamento. É proposto um projeto arquitetônico de Centro de Parto Normal que contempla as principais necessidades de humanização do ambiente de nascer, sob o viés da percepção do ambiente pelos usuários e a influência deste no processo do parto. Palavras-Chave: arquitetura de ambientes de saúde; centro de parto normal; parto humanizado

Delivery care is in crisis in Brazil. The reduction of maternal and neonatal mortality is still a challenge for health services and society as a whole. The high rates are seen as a violation of women and children's human rights and a problem of gender and public health. The medical assistance provided within hospitals produces iatrogenic effects for women in labor, who have been experiencing a moment of violence and disrespect to their physiology. Through the understanding of this issue, this paper suggests the Birth Center as an architectural tool to improve the reconstruction of social values and paradigm shift about the act of giving birth as a physiological act, detached from the hospital usually associated with insecurity and suffering. Observational studies that consider user's perspective and site visits to two units in operation were used as methodology. A Birth Center architectural design is proposed, which considers the main needs of humanization in birth care place and the user's perspective in the parturition process.

Proses penyembuhan manusia adalah keseimbangan dari kondisi fisiologis dan psikologis seseorang. Untuk mendukung kondisi psikologis tersebut, maka diperlukan
lingkungan yang sehat dan nyaman, yang dapat memberikan suasana dan dampak positif terhadap proses penyembuhan pasien. Alam sebagai objek termudah yang dapat dicapai oleh panca indera memiliki peran besar terhadap proses penyembuhan manusia. Alam juga memiliki efek restoratif, seperti memberikan kontribusi bagi keadaan emosi positif, meningkatkan energi, dan menurunkan hormone stress. Dan
diharapkan melalui pemanfaatan objek alam tersebut, dapat diciptakan sebuah lingkungan atau suasana ruang yang dapat mendukung proses penyembuhan itu sendiri. Penerapan konsep ini merupakan desain lingkungan terapi yang memadukan unsur alam, indera, dan psikologi manusia yang menjadikan elemen interior sebagai stimulus dan indera manusia sebagai reseptor. Dampak dari penerapan konsep ini
adalah pengurangan waktu rawat, berkurangnya rasa stress dan tertekan, suasana pasien menjadi lebih tenang, dan membangkitkan harapan dan semangat pasien untuk segera sembuh.

Kata Kunci: Rumah Sakit Mata, Alam, Proses Penyembuhan,
Pasien

This document is the syllabus for a graduate seminar I am offering this fall in the Department of Architecture at Kansas State University. The tripartite "Deep Beauty" construct, which is defined in the paper, outlines a new paradigm for sustainable design that recognizes that only those buildings and landscapes which are truly beautiful and connect us functionally and meaningfully to the living world  are truly sustainable. The textbooks and readings listed in the syllabus constitute an essential bibliography for an approach to design that must become universally applied if we are to survive and transcend the crisis of sustainability. It is both a call to action and a roadmap for change.

In Syria, there are two dominant scholarly opinions on ritual self-flagellation, which rest on different understandings of health and healing, and which form the topic of the first part of this chapter. The second examines miracle stories and ritual practices, which are both symbolic and productive of healing and sustain the legitimacy of the shrine of Sayyida Zaynab. The chapter looks at how Twelver Shi'is in Syria prior to the Arab Spring responded to the ambiguities surrounding the female Shi'is saint Sayyida Zaynab. Proponents of self-flagellation draw on 'traditional' medicine and argue that self-flagellation derives from cupping and constitutes a miraculous healing practice. Donating blood focuses on the community-not on individual devotees and the question of sainthood. The transactional aspect of the relationship between saints and Shi'is is highlighted in the ritual of nidhr (making religious vows) and in the sponsorship of majalis 'aza'.

Evidence-based design strategies can improve stress-free environments in healthcare, by emphasizing strategic opportunities to influence the design of health facilities. Evidence-based design (EBD) as a tool for healthcare planning is a method that began in healthcare having a general-purpose of providing evidence-based medicine. It involved Gathering information and evidence and using this evidence to mould the environment which supports the programming stage in design problem-solving. The connection between the theories and use of findings in (EBD), have not been adequately revealed enough to be used as a tool in design. As such, several factors, or characteristics, evident in numerous studies about healing environment and (EBD), require categorization into tangible and non-tangible dimensions in order to apply them during the design process successfully. Two research questions served as a foundation for the investigation of attributes in healing environments: What critical attributes can be identified by healthcare staff related to Dilani and Ulrich’s research findings? Is a hierarchy of attributes perceived by healthcare staff? The aim of this research is to closely examine the factors of Psychosocial Supportive Design theory by Alan Dilani (2001) and Supportive design theory (SDT) by Roger Ulrich (1991) on the staff in Eastern Mediterranean university health centre. Questioners and site visit were used for data collection. SPSS was used to obtain percentages from data collected. The result of the study reveals a hierarchy of factors perceived by the staff that can promote supportive healing.

Indoor environment has a potential impact on health by influencing behaviors, actions, and interactions of patients and their families as well as the health providers. The motto of health professionals since Hippocrates “First, do no harm” seems to be not widely followed in recent times. Unhealthy buildings can cause a lot of illnesses to occupants. Sick building syndrome (SBS) is a poorly understood phenomenon where people have a range of symptoms related to a certain building and there is no specific identifiable cause. The effect of poor indoor environmental quality (IEQ) is not only on physical health of the building occupants, but also on their psychological health. Through extensive review, the paper addresses different factors, which affect both physical and psychological health of occupants in healing environments. These factors are divided into two main categories; (a) spatial factors, which include the architecture design of the space, views of nature and nature images, in...

Da qualche anno il dibattito che si è intrecciato tra l'architettura e le discipline antropologiche ha preso di mira lo spazio-tempo della post-modernità» così scrive Ida Farè nella sua riflessione sulla dimensione contemporanea dell'istituzione ospedaliera 1 e prosegue: «i riferimenti abituali e tradizionali di piazza, casa, via, giardino, quartiere, che costituiscono l'idea di uno spazio famigliare e antropologico sono come trasmutati in un diverso ordine, vengono attraversati dai segni del globale […] Si vive in una condizione di spazio plurale.». L'autrice perviene alla considerazione che in questo scenario metropolitano anche l'istituzione antropologica per eccellenza, l'ospedale appunto 2 , risenta della connotazione di nonluogo 3 almeno per quanto concerne una serie di caratteri abitativi di cui, in questi stessi luoghi, si fa specifica esperienza: attraversabilità semantica, ibridazione pubblico/privato, intermezzo sospeso tra spazio del sé e spazio relazionale, identità "parzialmente e temporaneamente connotata" dall'intorno. Oltre il testo citato, la letteratura specifica (sia nelle discipline del progetto che in quelle antropologiche, v. bibliografia) propone una serie di riflessioni teoriche lega-1 Farè,I. 2002. "Il sistema della cura" in Marsicano, S. (a cura di) 2002. Abitare la cura: riflessioni sull'architettura istituzionale. Milano: Franco Angeli. Pag.27 2 sempre la stessa Farè lo descrive così: «Il luogo della malattia è antico e antropologico, non partecipa alle categorie della surmodernità che hanno a che fare con quell'eccesso di spazio e di tempo e con quel mutamento di scala che caratterizza il non-edificio.» cfr. Farè,I. 2002. "Il sistema della cura" in op.cit. Pag.29 3 come teorizzato da Marc Augé, ma declinato nello specifico caso anche dalle definizioni di Laura Balbo e Massimo Ilardi.

Being in an environment, which causes stress, anxiety and uncertainty, are some of the elements, which have an influence on the well-being of human beings. Health care providers, health care receivers and health care workers all universally agree upon the fact that the aforementioned elements are undesirable and that there exists a relationship between certain factors of the environment and its influence on patients' well-being. Several researchers such as Sakallaris, Macallister, Voss, Smith, & Jonas (2015), Ulrich et al. (2006) and Van den Berg (2005) agree that well-being depends upon individual perspectives and that there exists a positive 'symbiotic' relationship between physical factors within the environment and non-physical factors (namely the social and psychological factors). The central objective of this study focused on determining to what extent physical factors, psychological and social factors of the current design of hospital healing environments of Surinamese hospital wards influence the self-perception of patient well-being. To identify the determining factors and the extent to which they could have influence on the self-perception of a patients' well-being, a quantitative study approach was used. The measuring instrument utilized for measuring well-being of patients was the WHO-5 Well-Being Index Scale as it has been proved to be a good measurement tool for measuring well-being among patients. The study of what the influencing factors of the healing environment on our well-being is, is still an ongoing debate amongst researchers. Therefore, the focus of this study was towards identifying the factors which arose out of the literature and which proposes a relationship between the physical and social and psychological factors and the influence on in-patients self perceived well-being. Through literature review, 28 variables (factors) where chosen and 14 dimensions have been identified for the Hospital Healing Environment (HHE). The dimensions have been separated into physical factors and social and psychological factors. The results from the collected data from the respondents (n=401) reveal that for the physical factors only the dimensions of PF-Scent [Beta:.116, p < .05] and PF-Service [Beta: .179, p < 0.05] revealed enough statistical significant evidence as being a positive influence on Self-Perceived Patient Well Being (SPPWB). The research also found that for sec psychological factors, the dimension of PsF-Privacy and Safety [Beta: .114. p < .05] and for sec social factors, the dimension of SF-Service [Beta:.1173. p< .05] revealed enough statistical significant evidence as being a positive influence on Self-Perceived Patient Well-Being (SPPWB). It is also revealed that Length of Stay (LOS) both moderates the relationship between physical, psychological and social factors positively and no moderation could be found for Type of Room/Hospital Room Classification (ToR/HRC). Also no mediating effect has been found for social and psychological factors on the relationship between physical factors and patient self-perceived well-being. As hospitals of the 21st century strategically are gradually moving more towards becoming patient-centered institutions, than the results and recommendations derived from this study has implications for the application of Evidence Based Design for future hospitals. This study recommends that certain strategic policies should be undertaken by the management of hospitals regarding the redesign or creation of a Healing Environment for a Hospital.

Our understanding and experience of the built environment are primarily shaped by multi-sensory and emotional modes of exchange with space. Meaningful interaction with environmental stimuli and processing of multi-sensory information are vital for physical and psychological well-being. Yet, due to increased urban densification, hybridization and intensification, our contemporary cities are often either sensory overwhelming or sensory depleting.

The premise is that in order to trigger suggestive and positive relationships between space and users, all segments of urban developments would need to acquire an active role of healing. Consequently, the objective of this paper is to discuss the capacities of contemporary shopping spaces to overcome the mere consumption motifs and to acquire a health-supportive role, in spite of their manipulative design and “quasi-publicness”. Shopping malls have become influential model for various urban developments (including healthcare) and are tightly knitted into the everyday environment of many dense Asian cities, such as Singapore, Hong Kong or Tokyo. In these cities, they may arguably be seen as perpetual laboratories of “positive stress” (positive distractions). Qualitative approach employed consists of discourse analysis of health and space related theories and a comparative case study analysis of consumption spaces in Singapore (and Belgrade, Serbia). The case study analysis combines spatial explorations, first-person observations, participatory photo-journeys, multi-sensory mapping, interviews and on-site questionnaires.

Key findings show that consumption space users tend to seek positive stimulation. The richness and arrangement of overall sensory information available in space (visual and spatial complexity, tactile, auditory, olfactory and gustatory) considerably shape users’ subjective perception of and emotional response to shopping environments. The presence of nature, micro-climate, way-finding, access, safety and hygiene, but also subjective bodily and mental self-awareness, crowd and shared identity, social activities and phantasmagorical experiences, are perceived as important ingredients of “healing places” and as “stress fighters” within high-density urban contexts.

Submitted to the International Society of traumatic Stress Studies in 1998, this was a paper delivered on an UN-constructed healing environment for Post Traumatic Stress Disorder for a high school in the middle of the Robert Taylor Homes on the South-side of Chicago

Evidence-based design strategies can improve stress-free environments in healthcare, by emphasizing strategic opportunities to influence the design of health facilities. Evidence-based design (EBD) as a tool for healthcare planning is a method that began in healthcare having a general-purpose of providing evidence-based medicine. It involved Gathering information and evidence and using this evidence to mould the environment which supports the programming stage in design problem-solving. The connection between the theories and use of findings in (EBD), have not been adequately revealed enough to be used as a tool in design. As such, several factors, or characteristics, evident in numerous studies about healing environment and (EBD), require categorization into tangible and non-tangible dimensions in order to apply them during the design process successfully. Two research questions served as a foundation for the investigation of attributes in healing environments: What critical attrib...