'Humanizing' healthcare environments: architecture, art and design in modern hospitals

Expectation, emotion and the built environment: experiences of occupying hospital spaces as a loved one nears the end of life

Following a 3-year long research project that gathered 146 views, including those of palliative care patients, family members, medical staff, administrators, architects and government representatives, this paper explores the hypothesis that motivated this work; a hunch that the built environment affects us most during times of intense vulnerability. Of these 146 people, only a small handful could provide insight relative to the experience of occupying hospital spaces as a loved one nears the end of life. This article honours these stories and discusses them in relation to my own observations and experiences. The article is thus part observation, part participant interview, part autoethnography. Findings already published from the broader study have spoken to the importance of fresh air, access to nature, spaces for spending time with family, as well as alone, and ensuring people feel comfortable to enact rituals of home within the hospital. Yet the accounts discussed here are different. They speak to the subtle ways that hospital environments communicate when emotions are raw, and people are at their most exhausted. They speak to the ways that aesthetics are felt; and make evident that notions of homeliness must encompass far more at the end of life. A sense of welcome is not a nicety but a need, as is comfort, and what might be termed 'imaginative respite'-the idea that the built environment might somehow alleviate the focus on an unbearable reality. These accounts speak to the difficulty of navigating grief, and a hopeful expectation that the built environment might somehow soften the edges of this experience. In focusing on these stories, this article contributes a deeper understanding of what is really at stake when we design for palliative care.

Hospital Environment and Medical Sociology: User-Centered Environmental Sociology Model Based on a Systematic Review

PURPOSE

This study investigates the relationship between environmental quality and medical sociology in hospitals and suggests a conceptual framework for understanding their interrelation.

BACKGROUND

Despite the importance of environmental properties in the sociological approach to users' health and the role of medical sociology research in the design of hospital environments, few studies have been conducted in the field of hospital environments and medical sociology interrelation. Therefore, this article attempts to fill this gap in our knowledge.

METHODS

A systematic review was carried out in five databases (Scopus, Web of Science, Google Scholar, MEDLINE, and ScienceDirect) based on PRISMA guidelines to survey how environmental quality and medical sociology factors are related in the medical/environmental sociology research and the hospital design.

RESULTS

The search yielded the final 17 potentially relevant articles after finding 3,840 records, screening 1,295 nonduplicate articles, and reviewing 158 full-text articles. The findings revealed that four main aspects of medical sociology (physical-biological, psychological, social, and economic) and hospital environmental quality (physical, social, and psychological dimensions) influence users' health and disease status. The hospital environment includes various social issues in medical sociology (like interactions, behavior patterns, lifestyle, work motivation, and culture). The physical and psychosocial factors of the hospital environment (such as spatial configuration, aesthetics, scale, privacy, and collective spaces) are associated with psychosocial aspects of medical sociology (like social class, behavior patterns, culture, and lifestyle).

CONCLUSION

Environmental features and psychosocial issues should be considered to improve users' health and experience in hospitals and to create a user-centered health-promoting environment.

Parents' and nurses' affective perception of a pictorial intervention in a pediatric hospital environment: Quasi-experimental design pre-post-testing

BACKGROUND/AIM

The humanization of the hospital environment of pediatric departments represents an area of research and intervention on improving the quality of life for hospitalized patients, but also that one of relatives and health professionals. The aim of the study was to test, in a sample of nurses and hospitalized children's parents, whether the pictorial intervention impacted the perceptions of affective qualities of hospital environment.

METHODS

This quasi-experimental design study investigated the effects of a pictorial humanization intervention which consisted of some naturalistic and colorful illustrations in the corridor of two pediatric wards of an Italian hospital. A total of 425 parents of hospitalized children and 80 nurses were asked to complete the Italian version of the "Scale of measurement of the affective qualities of places" in two different moments: 1) before the pictorial intervention and 2) three months after its implementation.

RESULTS

For all participants (parents and nurses), results showed a significant effect of pictorial intervention with the four positive dimensions investigated (Relaxing, Exciting, Pleasant, and Stimulating) reporting higher scores after being performed it, and with the four negative dimensions (Distressing, Gloomy, Unpleasant, Sleepy) showing lower scores.

CONCLUSIONS

Data suggest that the pictorial intervention could be particularly useful to create more welcoming hospital environments, reducing distress levels from hospitalized patients, but also of relatives and healthcare professionals.

IMPLICATIONS TO PRACTICE

Pictorial interventions improve the emotional atmosphere in pediatric healthcare settings. Integrating visual elements related to care and healing enhances user experience, creating a more welcoming environment.

Toward Restorative Hospital Environment: Nature and Art in Finnish Hospitals

This study explores the integration of nature and art in recent hospital construction projects in Finland, focusing on public hospitals. Interviews with 15 stakeholders, including hospital executives, workers, designers, artists, and architects, reveal the value placed on nature and nature-themed art in hospital settings. The research question presented was: How nature and art are incorporated in Finnish hospitals in order to achieve a restorative hospital environment? Findings highlight themes that appeared in different hospitals: (1) the desired atmosphere, (2) nature and multisensory experiences, (3) social support, and (4) sense of connection and belonging. Bringing nature inside the hospital, whether through natural elements or artworks, emerges as a promising approach. Despite positive outcomes, challenges such as cost and maintenance persist, indicating the need for further research to optimize these initiatives. Overall, incorporating nature and art in hospitals has the potential to enhance healing and well-being for patients, families, and healthcare workers.

Intersections of the arts and art therapies in the humanization of care in hospitals: Experiences from the music therapy service of the University Hospital Fundación Santa Fe de Bogotá, Colombia

Humanization of care is becoming an increasingly important aspect in providing high-quality health services and the arts are more and more implemented to support and foster humanization and person-centered care efforts. Musical experiences are one of the most frequently encountered art forms in medical settings. Music therapy as a healthcare profession has a decades-long tradition in hospitals, both in inpatient and outpatient areas. However, while studies regarding the effectiveness of music therapy are on the forefront of clinical research, little attention has been paid to the profession's inherent opportunities to assist the hospitals' strategies in terms of humanization of care. Yet, the musical experiences in music therapy are especially versatile in supporting healthcare users from a holistic perspective, contributing to a more compassionate, personalized, and humanized environment. In this article, the basic pillars of humanized and person-centered care will be outlined, followed by examples of seven intersections in which the music therapy service of the University Hospital Fundación Santa Fe de Bogotá aligns with its Humanized and Compassionate Care Model. The aim of this article is to stimulate the discussion on music therapy not only as a profession that provides safe and effective treatment, but also as a therapeutic art experience that can add value for hospitals on their path toward a more humanized care culture.

Smile InTM Totems in Radiotherapy: Patients’ Satisfaction with Limited Equipment and COVID-19

Background: We report a mono-institutional experience regarding patient-perceived quality regarding the Chieti Radiotherapy Department, through RAMSI (Radiotherapy Amica Mia—SmileINTM(SI)—My Friend RadiotherapySI) project, in critical scenarios of limited equipment and COVID-19. Material and methods: Patient-reported experience measures (PREMs) were assessed as follows: Patient-centric welcome perception (PCWP), Comfort, Professional skills and Punctuality. Patients could give anonymous feedback using HappyOrNot technology through four totems located in strategic areas within the center. An internal benchmark was obtained using the feedback received after a preliminary observation period. The SI Experience Index was collected, analyzed and compared. Weekly and monthly reports were generated. Results: From February 2019 to February 2022, 8924 patients accessed the department; 17,464 daily treatments were recorded and 5830 points of feedback were collected: 896, 1267, 1125 and 2542 for PCWP, Comfort, Professional skills and Punctuality, respectively. A LINAC decommissioning period was analyzed, with decreases in the SI-Index score and Smile-IN approved percentage and an improvement after this period. Additionally, the COVID-19 pandemic was analyzed with a mild evaluations decrease for PREM’s Welcome, Comfort and Punctuality (Δ-value: −9%, −3% and −4%, respectively), while Professional skills were always optimal. Conclusion: The RAMSI project was effective for assessing treatment quality perception, allowing for improving clinical procedures with corrective actions. The RAMSI project is ongoing.

Potential Space in Hospitals: Insight From a Health Psychologist

OBJECTIVE

Humanization is a challenge for the future of healthcare. Architecture may play a major role in designing spaces that enhance communication and help the patient to maintain mental health during physical illness. Health psychologists struggle to find adequate space for taking care of their patients. There is an urgent need to better define how relational space, defined here as potential, can be guaranteed in everyday hospital psychological consultations.

BACKGROUND

The author relates to his work as a health psychologist and psychotherapist in a consultation-liaison psychiatry (CLP) service operating in a general hospital in Lugano (Switzerland).

METHODS

An autoethnographic method is applied through calling on childhood memories on architecture and analyzing insights regarding the healthcare space in everyday work as a psychologist. Photographs and drawings are employed as evocative material.

RESULTS

Autoethnographical data show that building interiors can be a metaphor for an inner dimension. Spaces can be perceived as depersonalized in hospital. Through psychoanalytical theory, it is argued that space becomes ideal for CLP if it can ensure the continuity of the patient's self during hospitalization. Proximity, confidentiality, and privacy are healthcare design requirements to be considered for favoring potential space and psychological intervention.

CONCLUSION

Fostering potential space represents an outstanding challenge for the hospital of tomorrow in order to humanize healthcare spaces and promote a person-centered approach.

Lighting the Patient Room of the Future: Evaluating Different Lighting Conditions for Performing Typical Nursing Tasks

PURPOSE

This study explores how aspects of lighting in patient rooms are experienced and evaluated by nurses while performing simulated work under various lighting conditions. The lighting conditions studied represent design standards consistent with different environments of care-traditional, contemporary, and future.

BACKGROUND

Recent advances in lighting research and technology create opportunities to use lighting in hospital rooms to improve everyday experience and provide researchers with opportunities to explore a new set of research questions about the effects of lighting on patients, guests, and staff. This study focuses on the experience of nurses delivering simulated patient care.

METHOD

Perceptions of each of the 13 lighting conditions were evaluated by nurses using rating scales for difficulty of task completion, comfort, intensity, appropriateness of the lighting color, and naturalness of the lighting during the task. The nurses' ratings were analyzed alongside qualitative reflections to provide insight into their responses.

RESULTS

Significant differences were found for several a priori hypotheses. Interesting findings provide insight into lighting to support circadian synchronization, lighting at night, the distribution of light in the patient room and the use of multiple lighting zones, and the use of colored lighting.

CONCLUSION

The results of this study provide insight into potential benefits and concerns of these new features for patient room lighting systems and reveal gaps in the existing evidence base that can inform future investigations.

One Team's Experience with Integrating Flexible Visitation in the Medical Intensive Care Unit

Integration of flexible visitation into a large health system requires concentrated effort. Evaluating impact on patient, family, and staff outcomes is important to facilitate changes and ensure visiting policy success. The medical intensive care unit staff participated in a collaborative quality improvement effort to encourage flexible visitation. The integration of flexible visitation spanned an 18-month period, timed to accompany a transition to a new setting with rooms designed to support visitor presence. This article details these efforts, outcomes, and important gaps for future work evaluating integration of flexible visitation in critical care.

Using Evidence to Design Cancer Care Facilities

The nuts and bolts of planning and designing cancer care facilities—the physical space, the social systems, the clinical and nonclinical workflows, and all of the patient-facing services—directly influence the quality of clinical care and the overall patient experience. Cancer facilities should be conceived and constructed on the basis of evidence-based design thinking and implementation, complemented by input from key stakeholders such as patients, families, and clinicians. Specifically, facilities should be designed to improve the patient experience, offer options for urgent care, maximize infection control, support and streamline the work of multidisciplinary teams, integrate research and teaching, incorporate palliative care, and look beyond mere diagnosis and treatment to patient wellness—all tailored to each cancer center’s patient population and logistical and financial constraints. From conception to completion to iterative reevaluation, motivated institutions can learn to make their own facilities reflect the excellence in cancer care that they aim to deliver to patients.

Nurses' Satisfaction With Patient Room Lighting Conditions: A Study of Nurses in Four Hospitals With Differences in the Environment of Care

PURPOSE

The present study aims to contribute to current knowledge about nurses' perceived importance of lighting in patient rooms and to compare these perceptions across different ages, work shifts, (day and night), and environments of care (traditional and contemporary).

BACKGROUND

Creating an environment of care in patient rooms that successfully balances energy efficiency concerns with the holistic needs of patients, families, and caregivers poses a major challenge for future lighting systems. This study adds to a growing evidence base on the effects of lighting on nurses' job performance, job satisfaction, and overall perceptions of the environment.

METHOD

Survey responses from 138 participants working in medical-surgical units in four hospitals were analyzed using a mixed-methods approach, with three of the hospitals having lighting systems characterized as providing a traditional environment of care (TEC) and the other hospital having lighting systems characterized as providing a contemporary environment of care (CEC).

RESULTS

No significant differences were found based on age or work shift, but several significant differences were found between participants working in the hospital with a CEC and those working in hospitals with a TEC. Participants from the hospital with a CEC lighting system consistently reported higher lighting quality, fewer patient complaints, and less need for supplemental lighting than the participants from the three hospitals with TEC lighting systems.

CONCLUSION

The results of this study provide evidence that innovative lighting approaches and technologies are worth considering as an investment by hospital administrators looking to improve perceptions of the patient room environment.