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Table 2. ‘Clinical Conversations’ In the conversation with clinical staff, a similar process of looking at the requirements of the rooms was undertaken. Clinical staff were happy to engage in discussion, but only in formal meetings in their offices. Each discussion would last usually for one hour. Pattern of Activity: Clinical Conversations

Table 2 ‘Clinical Conversations’ In the conversation with clinical staff, a similar process of looking at the requirements of the rooms was undertaken. Clinical staff were happy to engage in discussion, but only in formal meetings in their offices. Each discussion would last usually for one hour. Pattern of Activity: Clinical Conversations

Related Figures (46)

Figure 1: Existing Quiet Room in Emergency Department (2014). Photo: Chris Fremantle The need for Quiet Rooms has emerged within hospital design and in NHS Greater Glasgow and Clyde (NHSGGC); this is the first generation of buildings in which these spaces are included as part of the Employer's Requirements. These spaces are used for a range of purposes of which the most important are conversations between clinical, nursing or spiritual care staff and patients’ relatives and carers. Previously these types of spaces have been created in older buildings as part of refurbishment programmes. For instance they exist in the Emergency Department and Critical Care Unit at Yorkhill Children's Hospital, Glasgow. Although located in clinical areas, these spaces are used for a range of non-clinical purposes of which the most important are the 'difficult’ or ‘challenging’ conversations. They are also used by relatives and carers waiting to have conversations with healthcare professionals. Waiting can be for significant lengths of time and is frequently a stressful experience. Whilst these rooms can be used for other purposes, e.g. staff meetings, their primary function is not best described as a 'meeting' room because of the emotional nature of the conversations that take place. It is also important to understand that the function goes beyond that of a waiting room, which is a holding space for something important that happens elsewhere.
Figure 1: Existing Quiet Room in Emergency Department (2014). Photo: Chris Fremantle The need for Quiet Rooms has emerged within hospital design and in NHS Greater Glasgow and Clyde (NHSGGC); this is the first generation of buildings in which these spaces are included as part of the Employer's Requirements. These spaces are used for a range of purposes of which the most important are conversations between clinical, nursing or spiritual care staff and patients’ relatives and carers. Previously these types of spaces have been created in older buildings as part of refurbishment programmes. For instance they exist in the Emergency Department and Critical Care Unit at Yorkhill Children's Hospital, Glasgow. Although located in clinical areas, these spaces are used for a range of non-clinical purposes of which the most important are the 'difficult’ or ‘challenging’ conversations. They are also used by relatives and carers waiting to have conversations with healthcare professionals. Waiting can be for significant lengths of time and is frequently a stressful experience. Whilst these rooms can be used for other purposes, e.g. staff meetings, their primary function is not best described as a 'meeting' room because of the emotional nature of the conversations that take place. It is also important to understand that the function goes beyond that of a waiting room, which is a holding space for something important that happens elsewhere.
Figure 2: Workshop at The Hidden Gardens 2013 selecting plant material. Photo: Alexander Hamilton. The characteristics of the institutional environment were discussed including the conservative and utilitarian character of furniture as well as the character of lighting: Strip lights were unanimously agreed to be too harsh and people felt wall lights should be used instead. Natural light was seen as essential, but where that wasn't available the idea of lightboxes with nature based imagery was supported. Participants commented that rooms should have a sofa as well as chairs. A sofa allows to people to sit together and someone can be comforted. It was also commented that in a difficult relationship it is important that everyone is at an equal height, so everyone is included. Another comment was that seating needed to accommodate the needs of different users and different levels of mobility. The tactile qualities of furniture were commented on. The afternoon session was devoted to a direct engagement with nature. In some workshops, a creative writer or a plant specialist were involved. The final approach was however similar, in which the workshop participants, walked around the garden and freely chose the leaf types and flower petals that spoke to them. Their selection of plant material was then taken back to the Yurt. The participants freely choose how the various leaf and petals should be arranged on a sheet of paper. The guidance, offered by the Lead Artist, was to let Nature Speak. Some participants, found the request difficult, a concern expressed was, “I am not an artist, | can’t make art.” The reassurance The afternoon session was devoted to a direct engagement with nature. In some workshops, a
Figure 2: Workshop at The Hidden Gardens 2013 selecting plant material. Photo: Alexander Hamilton. The characteristics of the institutional environment were discussed including the conservative and utilitarian character of furniture as well as the character of lighting: Strip lights were unanimously agreed to be too harsh and people felt wall lights should be used instead. Natural light was seen as essential, but where that wasn't available the idea of lightboxes with nature based imagery was supported. Participants commented that rooms should have a sofa as well as chairs. A sofa allows to people to sit together and someone can be comforted. It was also commented that in a difficult relationship it is important that everyone is at an equal height, so everyone is included. Another comment was that seating needed to accommodate the needs of different users and different levels of mobility. The tactile qualities of furniture were commented on. The afternoon session was devoted to a direct engagement with nature. In some workshops, a creative writer or a plant specialist were involved. The final approach was however similar, in which the workshop participants, walked around the garden and freely chose the leaf types and flower petals that spoke to them. Their selection of plant material was then taken back to the Yurt. The participants freely choose how the various leaf and petals should be arranged on a sheet of paper. The guidance, offered by the Lead Artist, was to let Nature Speak. Some participants, found the request difficult, a concern expressed was, “I am not an artist, | can’t make art.” The reassurance The afternoon session was devoted to a direct engagement with nature. In some workshops, a
Figure 3: Workshop at The Hidden Gardens 2013 arranging plant material. Photo: Alexander Hamilton is a passionate cook and is interested in both the healing and edible properties of herbs and plants Individuals chose plants for a range of reasons. One individual chose the fern as he said it reminded him of Christmas with his family. It also spoke to him because he saw it as ancient and powerful, growing on the planet whilst dinosaurs walked the earth. Another chose wild garlic. She is a passionate cook and is interested in both the healing and edible properties of herbs and plants.
Figure 3: Workshop at The Hidden Gardens 2013 arranging plant material. Photo: Alexander Hamilton is a passionate cook and is interested in both the healing and edible properties of herbs and plants Individuals chose plants for a range of reasons. One individual chose the fern as he said it reminded him of Christmas with his family. It also spoke to him because he saw it as ancient and powerful, growing on the planet whilst dinosaurs walked the earth. Another chose wild garlic. She is a passionate cook and is interested in both the healing and edible properties of herbs and plants.
Figure 4: Workshop at Battlefield Primary School 2013 arranging plant material. Photo: Alexander Hamilton The participants then transferred the plant leafs and petals to paper prepared for making cyanotype images and placing them under glass; the pressed plant forms were exposed to sunlight. In the garden shed, within the grounds of The Hidden Gardens, a temporary photographic studio had been set up and the cyanotypes, or 'sun pictures,’ were then developed and hung to dry. At each stage, the workshop participants saw the process unfolding. From the cyanotype images and placing them under glass; the pressed plant forms were exposed to
Figure 4: Workshop at Battlefield Primary School 2013 arranging plant material. Photo: Alexander Hamilton The participants then transferred the plant leafs and petals to paper prepared for making cyanotype images and placing them under glass; the pressed plant forms were exposed to sunlight. In the garden shed, within the grounds of The Hidden Gardens, a temporary photographic studio had been set up and the cyanotypes, or 'sun pictures,’ were then developed and hung to dry. At each stage, the workshop participants saw the process unfolding. From the cyanotype images and placing them under glass; the pressed plant forms were exposed to
(web site for video clips of this process- www.designingfordignity.co.uk). selection of leafs, to making a picture, to creating a photogram and finally to seeing the result
(web site for video clips of this process- www.designingfordignity.co.uk). selection of leafs, to making a picture, to creating a photogram and finally to seeing the result
Figure 6: Workshop at The Hidden Gardens 2013 completed cyanotypes. Photo: Alexander Hamilton. At the end of day workshop all the cyanotypes were viewed by participants and further discussion was held on the how the images would be used, in the furniture and other design requirements. The Lead Artist explained that the cyanotypes would drive the design process and be used to bring nature back into the clinical environment. The platform for these images would be fabric to be used on the furniture and wallpapers to be used within the clinical rooms. The challenge was to engage and direct these visual outcomes towards the complex arrangements that control the delivery of design within clinical spaces. In return for their engagement the commitment was made to keep participants informed anc return regularly to The Hidden Gardens to present the results of the design development process.
Figure 6: Workshop at The Hidden Gardens 2013 completed cyanotypes. Photo: Alexander Hamilton. At the end of day workshop all the cyanotypes were viewed by participants and further discussion was held on the how the images would be used, in the furniture and other design requirements. The Lead Artist explained that the cyanotypes would drive the design process and be used to bring nature back into the clinical environment. The platform for these images would be fabric to be used on the furniture and wallpapers to be used within the clinical rooms. The challenge was to engage and direct these visual outcomes towards the complex arrangements that control the delivery of design within clinical spaces. In return for their engagement the commitment was made to keep participants informed anc return regularly to The Hidden Gardens to present the results of the design development process.
Figure 7: Initial development from cyanotype to design for fabric and wallpaper 2014.
Figure 7: Initial development from cyanotype to design for fabric and wallpaper 2014.
Figure 8: Fully developed fabric design alternatives 2014.
Figure 8: Fully developed fabric design alternatives 2014.
Figure 9: Visualisations of fabrics applied to furniture for Quiet Rooms 2014.
Figure 9: Visualisations of fabrics applied to furniture for Quiet Rooms 2014.
Conclusions
Conclusions
Figure 2: Mood Diary Record Sheet Figure 1: The Stress Sensor has made to them in terms of contributing to the self-monitoring of stress for self-management. The group has gone through a journey in the last year. The group participated in a research project as co-researchers to pilot a stress sensor device (worn as a watch) in September 2012 (the sensor seeks to measure stress level of an individual through contact between the device and the skin) in Sheffield Hallam University’s ACES (Faculty of Arts, Computing, Engineering and sciences) faculty. The aim was to develop confidence and competency, build organisational skills, develop knowledge and understanding about ethical issues on conducting and participating in research, examine if a level of engagement with the stress sensor project will enable the development of knowledge and understanding of stress, measure what difference engagement with the project has made to them in terms of contributing to the self-monitoring of stress for self-management. knowledge and understanding about ethical issues on conducting and participating in research,
Figure 2: Mood Diary Record Sheet Figure 1: The Stress Sensor has made to them in terms of contributing to the self-monitoring of stress for self-management. The group has gone through a journey in the last year. The group participated in a research project as co-researchers to pilot a stress sensor device (worn as a watch) in September 2012 (the sensor seeks to measure stress level of an individual through contact between the device and the skin) in Sheffield Hallam University’s ACES (Faculty of Arts, Computing, Engineering and sciences) faculty. The aim was to develop confidence and competency, build organisational skills, develop knowledge and understanding about ethical issues on conducting and participating in research, examine if a level of engagement with the stress sensor project will enable the development of knowledge and understanding of stress, measure what difference engagement with the project has made to them in terms of contributing to the self-monitoring of stress for self-management. knowledge and understanding about ethical issues on conducting and participating in research,
The stress sensor (figure 1) with electro-dermal reads stresses level when people with autism are stressed and relaxed. The study was to investigate if the device was able to record stress experienced by physical symptoms of activity and temperature. The group members maintained a mood diary (figure 2) recording events including how stressed they felt at that particular time. The data collected by sensor were then analysed by matching them with the diary sheet to determine whether the stress sensor can identify periods when the individual was highly stressed. Figures 3 and 4 illustrates different level of stress at different time. mood diary (figure 2) recording events including how stressed they felt at that particular time. The At present, the group is working on PebblePad, an online portfolio with two main components: Pebble+ and ATLAS. Pebble+ is the personal learning space where personal resources like achievements and accomplishments, CV and records of personal learning can be kept. On the other hand, ATLAS is the community space where the group can communicate with each other; share their ideas with others through blogs. At present, the group is working on PebblePad, an online portfolio with two main components:
The stress sensor (figure 1) with electro-dermal reads stresses level when people with autism are stressed and relaxed. The study was to investigate if the device was able to record stress experienced by physical symptoms of activity and temperature. The group members maintained a mood diary (figure 2) recording events including how stressed they felt at that particular time. The data collected by sensor were then analysed by matching them with the diary sheet to determine whether the stress sensor can identify periods when the individual was highly stressed. Figures 3 and 4 illustrates different level of stress at different time. mood diary (figure 2) recording events including how stressed they felt at that particular time. The At present, the group is working on PebblePad, an online portfolio with two main components: Pebble+ and ATLAS. Pebble+ is the personal learning space where personal resources like achievements and accomplishments, CV and records of personal learning can be kept. On the other hand, ATLAS is the community space where the group can communicate with each other; share their ideas with others through blogs. At present, the group is working on PebblePad, an online portfolio with two main components:
Proceedings of the Second European Conference on Design 4 Health 2013, 3 - 5 July 2013, Sheffield UK ISBN: 978-1-84387-373-0
Proceedings of the Second European Conference on Design 4 Health 2013, 3 - 5 July 2013, Sheffield UK ISBN: 978-1-84387-373-0
Figure 1: Examples of Jakob’s research investigating sensory experiences through the experimental use of light and colour, projected imagery, textiles and space. (Images © A Jakob)
Figure 1: Examples of Jakob’s research investigating sensory experiences through the experimental use of light and colour, projected imagery, textiles and space. (Images © A Jakob)
The MSE concept originated in 1966, when American psychologists Cleland and Clark set up several Sensory Rooms they referred to collectively as a ‘Sensory Cafeteria’ (Cleland, Clark, 1966). Following on from this the first ‘Snoezelen’ (the term derived from the two Dutch words ‘snuffelen’ and ‘soezen’ - the equivalents for English ‘sniffing’ and ‘dozing’) was subsequently developed by Dutch therapists Jan Hulsegge and Ad Verheul in the 1970s for adults with severe learning disabilities (Hulsegge, Verheul, 1987). The MSE concept has since been adopted worldwide coming to the UK approximately 30 years ago where it was embraced as a leisure driven activity with a focus on enablement (Hulsegge, Verheul, 1987). Figure 2: MSE examples: Snoezelen room for people with severe cognitive disabilities in De Hartenberg Centre, Netherlands (© A Verheul); Multisensory Room by ROMPA, one of the leading suppliers of MSE equipment (Source: online, last accessed 12/12/2013, http://www.rompa.com/multisensory-environments- rooms); MSE for older people in The Mount Hospital Leeds (Source: online, last accessed 12/12/2013, http://www.communitycare.co.uk/blogs/mental-health/2010/02/multisensory-snoezelen-room-fo/)
The MSE concept originated in 1966, when American psychologists Cleland and Clark set up several Sensory Rooms they referred to collectively as a ‘Sensory Cafeteria’ (Cleland, Clark, 1966). Following on from this the first ‘Snoezelen’ (the term derived from the two Dutch words ‘snuffelen’ and ‘soezen’ - the equivalents for English ‘sniffing’ and ‘dozing’) was subsequently developed by Dutch therapists Jan Hulsegge and Ad Verheul in the 1970s for adults with severe learning disabilities (Hulsegge, Verheul, 1987). The MSE concept has since been adopted worldwide coming to the UK approximately 30 years ago where it was embraced as a leisure driven activity with a focus on enablement (Hulsegge, Verheul, 1987). Figure 2: MSE examples: Snoezelen room for people with severe cognitive disabilities in De Hartenberg Centre, Netherlands (© A Verheul); Multisensory Room by ROMPA, one of the leading suppliers of MSE equipment (Source: online, last accessed 12/12/2013, http://www.rompa.com/multisensory-environments- rooms); MSE for older people in The Mount Hospital Leeds (Source: online, last accessed 12/12/2013, http://www.communitycare.co.uk/blogs/mental-health/2010/02/multisensory-snoezelen-room-fo/)
Figure 3: Existing MSE facilities / Sensory Rooms in some of the care homes visited experience. The furniture did not offer an alternative seating position; the vestibular sense was neglected completely. Furthermore, interviews with staff revealed that few had been trained in how a sensory approach should be applied. Almost all of staff interviewed were not satisfied with the MSE equipment or MSE items available through suppliers. Staff felt overwhelmed and uninspired by the suppliers’ catalogue and the researchers experienced a sense of helplessness amongst some of the staff.
Figure 3: Existing MSE facilities / Sensory Rooms in some of the care homes visited experience. The furniture did not offer an alternative seating position; the vestibular sense was neglected completely. Furthermore, interviews with staff revealed that few had been trained in how a sensory approach should be applied. Almost all of staff interviewed were not satisfied with the MSE equipment or MSE items available through suppliers. Staff felt overwhelmed and uninspired by the suppliers’ catalogue and the researchers experienced a sense of helplessness amongst some of the staff.
the primary level of the injury. (The Back Up Trust) A person with an incomplete injury may be able to move one limb more than another, may be able to feel parts of the body that cannot be moved, or may have more functioning on one side of the body than the other. With the advances in acute treatment of SCI, incomplete injuries are becoming more common. SCI injuries are split into four regions depending on which vertebra they affect; cervical, thoracic, lumbar and Sacral. Each will affect different areas of the body (See figure 1) For the individual, SCI can affect bladder, bowels, temperature, sleeping, diet, balance, trunk stability, sexual function, regulation of blood pressure, the ability to sweat and can cause pressure sores. Thanks to modern medicine, life expectancy for people with SCI is near normal. This is positive news, but the long-term demands on medical and chinnort racoiircec are hiigqa | Once medically stable, inpatient rehabilitation for people with SCI is predominately Physiotherapy (focussing on muscles and movement) and can involve splinting, stretching, standing frames, improving circulation for example) and Occupational Therapy (that focuses on meaningful activity) and can involve practising daily life activities such as car transfers, toileting, computer work, brushing or shaving). However, inpatient SCI patients can struggle with boredom and monotony, which can reinforce depression (Campbell, 2011).
the primary level of the injury. (The Back Up Trust) A person with an incomplete injury may be able to move one limb more than another, may be able to feel parts of the body that cannot be moved, or may have more functioning on one side of the body than the other. With the advances in acute treatment of SCI, incomplete injuries are becoming more common. SCI injuries are split into four regions depending on which vertebra they affect; cervical, thoracic, lumbar and Sacral. Each will affect different areas of the body (See figure 1) For the individual, SCI can affect bladder, bowels, temperature, sleeping, diet, balance, trunk stability, sexual function, regulation of blood pressure, the ability to sweat and can cause pressure sores. Thanks to modern medicine, life expectancy for people with SCI is near normal. This is positive news, but the long-term demands on medical and chinnort racoiircec are hiigqa | Once medically stable, inpatient rehabilitation for people with SCI is predominately Physiotherapy (focussing on muscles and movement) and can involve splinting, stretching, standing frames, improving circulation for example) and Occupational Therapy (that focuses on meaningful activity) and can involve practising daily life activities such as car transfers, toileting, computer work, brushing or shaving). However, inpatient SCI patients can struggle with boredom and monotony, which can reinforce depression (Campbell, 2011).
Figure 2: A participant exploring the unit thinking about its sounds, textures, barriers etc
Figure 2: A participant exploring the unit thinking about its sounds, textures, barriers etc
Figure 3: Design Activity Proceedings of the Second European Conference on Design 4 Health 2013, 3 - 5 July 2013, Sheffield UK ISBN: 978-1-84387-373-0
Figure 3: Design Activity Proceedings of the Second European Conference on Design 4 Health 2013, 3 - 5 July 2013, Sheffield UK ISBN: 978-1-84387-373-0
Figure 4: A team of students and participants on the marshmallow challenge. The students accompanying the project team became an invaluable resource acting with, on- behalf of and under instruction from the participants as and when required and hence enabling participants of all functional capability to engage with all activities in some way (see figure 4). Proceedings of the Second European Conference on Design 4 Health 2013, 3 - 5 July 2013, Sheffield UK ISBN: 978-1-84387-373-0
Figure 4: A team of students and participants on the marshmallow challenge. The students accompanying the project team became an invaluable resource acting with, on- behalf of and under instruction from the participants as and when required and hence enabling participants of all functional capability to engage with all activities in some way (see figure 4). Proceedings of the Second European Conference on Design 4 Health 2013, 3 - 5 July 2013, Sheffield UK ISBN: 978-1-84387-373-0
Figure 1: A simplified version of the ‘Patient Pathway’ used by QENSIU. What is survivor's rehabilitation journey, how is this described and who describes this? If one examines the way the patient ‘pathway’ through rehabilitation is currently described, this is largely from the clinical perspective of functional rehabilitation. Figure 1 provides a simplified version of the model of the ‘Patient Pathway’ used by QENSIU. The total extent to which SCI is understood as a life-changing event begins to sink home when one also views the ‘Goal Planning Checklist’ used by QENSIU which helps the SCI survivor, working with their Key Worker, to ‘assess and identify what you need to know, what you are able to do, and what you still have to learn or achieve’. This 18-page checklist is used to discuss, assess and record progress in relearning the management of such areas as: e.g., eating, dressing and undressing, grooming, and personal hygiene; skin, bladder, physical and psychological sexual issues; bowel and chest; joints - to prevent contractures; management of autonomic dysreflexia; issues surrounding mobility such as bed, transfers, wheelchair, ambulation, and driving; new equipment and assistive aids - wheelchair, cushion, standing frame, upper limb splints, and orthosis; one’s accommodation - house, placements; social issues - social work, social activity, personal assistants, district nursing services; schooling; and employment. The checklist reveals just how complex the problem of simultaneous functional management of the many aspects of SCI is. However, the survivor's experience of this journey is essential to understand as a context for this research. The SCI patient's ‘voice’ is noticeably absent from the literature, revealed in only a small number of studies, such as in Dickson et a/ (2011, 2012) who discuss survivors’ and their carers’ lived experiences of SCI, and survivors’ difficulties in adjusting to home and community life following discharge. In contrast to the busy, supportive community of individuals in QENSIU with following discharge. In contrast to the busy, supportive community of individuals in QENSIU witt
Figure 1: A simplified version of the ‘Patient Pathway’ used by QENSIU. What is survivor's rehabilitation journey, how is this described and who describes this? If one examines the way the patient ‘pathway’ through rehabilitation is currently described, this is largely from the clinical perspective of functional rehabilitation. Figure 1 provides a simplified version of the model of the ‘Patient Pathway’ used by QENSIU. The total extent to which SCI is understood as a life-changing event begins to sink home when one also views the ‘Goal Planning Checklist’ used by QENSIU which helps the SCI survivor, working with their Key Worker, to ‘assess and identify what you need to know, what you are able to do, and what you still have to learn or achieve’. This 18-page checklist is used to discuss, assess and record progress in relearning the management of such areas as: e.g., eating, dressing and undressing, grooming, and personal hygiene; skin, bladder, physical and psychological sexual issues; bowel and chest; joints - to prevent contractures; management of autonomic dysreflexia; issues surrounding mobility such as bed, transfers, wheelchair, ambulation, and driving; new equipment and assistive aids - wheelchair, cushion, standing frame, upper limb splints, and orthosis; one’s accommodation - house, placements; social issues - social work, social activity, personal assistants, district nursing services; schooling; and employment. The checklist reveals just how complex the problem of simultaneous functional management of the many aspects of SCI is. However, the survivor's experience of this journey is essential to understand as a context for this research. The SCI patient's ‘voice’ is noticeably absent from the literature, revealed in only a small number of studies, such as in Dickson et a/ (2011, 2012) who discuss survivors’ and their carers’ lived experiences of SCI, and survivors’ difficulties in adjusting to home and community life following discharge. In contrast to the busy, supportive community of individuals in QENSIU with following discharge. In contrast to the busy, supportive community of individuals in QENSIU witt
Figure 2: A speculative working model constructed by the author from Dickson et al (2011, 2012) and Lawton (2009) to reveal the contrast between the two key ‘biographical disruptions’ and some of the potential emotional issues arising.
Figure 2: A speculative working model constructed by the author from Dickson et al (2011, 2012) and Lawton (2009) to reveal the contrast between the two key ‘biographical disruptions’ and some of the potential emotional issues arising.
Figure 3: Healthcare staff at QENSIU viewing SCI survivors’ critiques of the shopping experience status quo. Still from film, 'Design and Rehabilitation’, Dir. Claire Levy © 2012. Discussion
Figure 3: Healthcare staff at QENSIU viewing SCI survivors’ critiques of the shopping experience status quo. Still from film, 'Design and Rehabilitation’, Dir. Claire Levy © 2012. Discussion
system of corridors that connects waiting areas with exam and consultation rooms (fig.2). The second difference is that in Hospital A the clinics are co-located and have a shared work area - the ‘Knowledge Centre’ while in Hospital B clinics are separated and do not have shared facilities. Therefore, in Hospital A caregivers are brought together with each other and are separated from patients while in Hospital B caregivers are separated from each other but brought together with patients. Figure 1: Hospital A — patients waiting area and reception; the Knowledge Centre;
system of corridors that connects waiting areas with exam and consultation rooms (fig.2). The second difference is that in Hospital A the clinics are co-located and have a shared work area - the ‘Knowledge Centre’ while in Hospital B clinics are separated and do not have shared facilities. Therefore, in Hospital A caregivers are brought together with each other and are separated from patients while in Hospital B caregivers are separated from each other but brought together with patients. Figure 1: Hospital A — patients waiting area and reception; the Knowledge Centre;
Figure 2: Hospital B - patients waiting area and reception; a corridor;
Figure 2: Hospital B - patients waiting area and reception; a corridor;
1Exam rooms; © Corridor; Waiting area; © Reception; ® Workspaces; ™ Meeting rooms; ™@ Breakout areas; lM Quiet rooms i Staircases & lifts; M Supply, storage, clean utilities; ---Clinic area;---Knowledge centre; Figure 3a and b: Floor plan of Surgery in Hospital A and B
1Exam rooms; © Corridor; Waiting area; © Reception; ® Workspaces; ™ Meeting rooms; ™@ Breakout areas; lM Quiet rooms i Staircases & lifts; M Supply, storage, clean utilities; ---Clinic area;---Knowledge centre; Figure 3a and b: Floor plan of Surgery in Hospital A and B
Figure 4a and b: Axial maps of Surgery in Hospital A and B Observations were conducted by following six different caregivers each day for ten working days in each hospital (two days dedicated to each clinic). In total 128 members of staff were observed (64 physicians, 33 nurses and 31 clerks), each for a period of 1.5-2 hours during examination hours. Sequences of activities and locations, durations and types of activities were digitally recorded. Pre- programmed PDAs (Personal Digital Assistants) were used for the data collection. Differences in time spent in certain activities and locations between the two hospitals were analysed.
Figure 4a and b: Axial maps of Surgery in Hospital A and B Observations were conducted by following six different caregivers each day for ten working days in each hospital (two days dedicated to each clinic). In total 128 members of staff were observed (64 physicians, 33 nurses and 31 clerks), each for a period of 1.5-2 hours during examination hours. Sequences of activities and locations, durations and types of activities were digitally recorded. Pre- programmed PDAs (Personal Digital Assistants) were used for the data collection. Differences in time spent in certain activities and locations between the two hospitals were analysed.
Figure 5a and b: Importance of different activities and suitability of the spatial layout for Hospital A and B. In Hospital B caregivers are much more segregated by the partitioning of the traditional corridor- offices layout. During exam hours, caregivers spend only 46% of their time in teamwork areas and corridors (with a comparable 24% spent in examinations), so that in effect caregivers are not as openly available for communication and interaction as in Hospital A. While a similar amount of time of the working day (during exam hours) is dedicated to communication with 22% of time spent talking to caregivers in the same clinic and 0.2% to external caregivers, average conversation length is 1 minute and 21 seconds, i.e. twice as long as in Hospital A. This means each instance of communication lasts longer and is therefore in all likelihood more planned and less spontaneous. offices layout. During exam hours, caregivers spend only 46% of their time in teamwork areas and
Figure 5a and b: Importance of different activities and suitability of the spatial layout for Hospital A and B. In Hospital B caregivers are much more segregated by the partitioning of the traditional corridor- offices layout. During exam hours, caregivers spend only 46% of their time in teamwork areas and corridors (with a comparable 24% spent in examinations), so that in effect caregivers are not as openly available for communication and interaction as in Hospital A. While a similar amount of time of the working day (during exam hours) is dedicated to communication with 22% of time spent talking to caregivers in the same clinic and 0.2% to external caregivers, average conversation length is 1 minute and 21 seconds, i.e. twice as long as in Hospital A. This means each instance of communication lasts longer and is therefore in all likelihood more planned and less spontaneous. offices layout. During exam hours, caregivers spend only 46% of their time in teamwork areas and
Figure 6a and b: Percentage of time spent in various locations by physicians, nurses and clerks in Hospital A and B; To summarise, the caregiver-caregiver interface in Hospital B is characterised by longer and more programmed conversations focusing on relationships within rather than across clinics, and within rather than across professions. Higher spatial distances and the overall configuration contribute to lower ratings of satisfaction with the building. To summarise, the caregiver-caregiver interface in Hospital B is characterised by longer and more
Figure 6a and b: Percentage of time spent in various locations by physicians, nurses and clerks in Hospital A and B; To summarise, the caregiver-caregiver interface in Hospital B is characterised by longer and more programmed conversations focusing on relationships within rather than across clinics, and within rather than across professions. Higher spatial distances and the overall configuration contribute to lower ratings of satisfaction with the building. To summarise, the caregiver-caregiver interface in Hospital B is characterised by longer and more
Fig. 1: The analysed facilities: three Lighea non-hospital residential facilities
Fig. 1: The analysed facilities: three Lighea non-hospital residential facilities
(dimensions, materials, colors, furniture, etc.) were shown on a floor plan. Then, the use of the spaces was analysed in detail: how and where patients were most likely to spend their time in relation to their different needs, the interaction between patients, staff and spaces. After the collection of information, drawings were made on the plan marking the positions of the people at intervals of 15/30 minutes, by distinguishing between staff and patients and posture that they had adopted, such as standing, sitting or lying down (Fig. 2). To respect the privacy of patients, it was not always possible to get in all the rooms. Figure 2: Use of the spaces: - time and manner - people interaction Short films Thanks to the help of “Centro Sperimentale di Cinematografia” of Milan, the researcher had three graduating students creating three short films (Fig. 3) about patients’ life and the interaction among themselves and the environment they live in. In the first short film, the director has inverted the rules of the "institutional documentary" asking a patient to interview the researchers (Tadiello, 2011). In the second, the director has led six of the involved patients to a theatre to rebuild their "inner spaces" within the empty space of the stage (Maralla, 2011). In the third, the director has used the three residences of Lighea as a set, with the involvement of nine patients, with the aim of shooting scenes of real life, the everyday experience of rehabilitation (Donzella, 2011).
(dimensions, materials, colors, furniture, etc.) were shown on a floor plan. Then, the use of the spaces was analysed in detail: how and where patients were most likely to spend their time in relation to their different needs, the interaction between patients, staff and spaces. After the collection of information, drawings were made on the plan marking the positions of the people at intervals of 15/30 minutes, by distinguishing between staff and patients and posture that they had adopted, such as standing, sitting or lying down (Fig. 2). To respect the privacy of patients, it was not always possible to get in all the rooms. Figure 2: Use of the spaces: - time and manner - people interaction Short films Thanks to the help of “Centro Sperimentale di Cinematografia” of Milan, the researcher had three graduating students creating three short films (Fig. 3) about patients’ life and the interaction among themselves and the environment they live in. In the first short film, the director has inverted the rules of the "institutional documentary" asking a patient to interview the researchers (Tadiello, 2011). In the second, the director has led six of the involved patients to a theatre to rebuild their "inner spaces" within the empty space of the stage (Maralla, 2011). In the third, the director has used the three residences of Lighea as a set, with the involvement of nine patients, with the aim of shooting scenes of real life, the everyday experience of rehabilitation (Donzella, 2011).
Figure 3: Images from the short films, CSC, 2011 Findings The findings about the needs, problems and expectations of patients were collected, starting from their direct statements (their preliminary documents, informal talks during the various stages of research, interviews, etc.).
Figure 3: Images from the short films, CSC, 2011 Findings The findings about the needs, problems and expectations of patients were collected, starting from their direct statements (their preliminary documents, informal talks during the various stages of research, interviews, etc.).
1. Integration and openness within the inhabited territory — to facilitate the relationship with the surrounding environment (Fig. 4); Fig. 4: Accordance with “Integration to the inhabited territory ”. 2. Non-labelling environment — avoiding the risk of stigmatization and isolation
1. Integration and openness within the inhabited territory — to facilitate the relationship with the surrounding environment (Fig. 4); Fig. 4: Accordance with “Integration to the inhabited territory ”. 2. Non-labelling environment — avoiding the risk of stigmatization and isolation
Fig. 5: Accordance with “Activities’ friendly “.
Fig. 5: Accordance with “Activities’ friendly “.
7. Environment with background elements — to allow the perception of time (Fig.6) Fig. 6: Accordance with “Environment with background elements”. 8. Friendly and rich of stimulus — to promote daily tasks and leisure activity
7. Environment with background elements — to allow the perception of time (Fig.6) Fig. 6: Accordance with “Environment with background elements”. 8. Friendly and rich of stimulus — to promote daily tasks and leisure activity
Several studies discussed the mental restoration process and the effects of restorative environments mainly the exposure to natural faunas on psychological well-being (Berto, 2005). Research suggests that visual interaction with natural plants and gardens facilitates recovery after psychological stress (Hinds and Sparks, 2008) (Herzog, Black, Fountaine, & Knotts 1997; Herzog, Chen, & Primeau, 2002; Kaplan, 1995; Kaplan R., 2001; Purcell, Peron, & Berto, 2001; Tennessen & Cimprich, 1995; Ulrich, 1984; Ulrich et al, 1991; Berto, 2005). When discussing the design of outpatient clinics, several experimental and EBD studies showed that the view of nature is much correlated with reducing pain, depression, fatigue and stress (Berto, 2005) (Ulrich et a/, 2008) (Aries et al, 2010). Other EBD studies demonstrated that the viewing and the direct contact of natural plants in the workplace reduce staff stress and fatigue, as well, increase the level of staff satisfaction in their working environment (Lundin, 2012) (Ulrich et al, 2008). Therefore, natural plants should be an essential part of the outpatient clinics design strategy (Ananth, 2008). For example, the architect might consider green planted facades, green roofs and interior green walls in the design of the outpatient-clinical buildings. Figure 1: Natural plants and design strategies°® Large Windows (windows become doors concept)
Several studies discussed the mental restoration process and the effects of restorative environments mainly the exposure to natural faunas on psychological well-being (Berto, 2005). Research suggests that visual interaction with natural plants and gardens facilitates recovery after psychological stress (Hinds and Sparks, 2008) (Herzog, Black, Fountaine, & Knotts 1997; Herzog, Chen, & Primeau, 2002; Kaplan, 1995; Kaplan R., 2001; Purcell, Peron, & Berto, 2001; Tennessen & Cimprich, 1995; Ulrich, 1984; Ulrich et al, 1991; Berto, 2005). When discussing the design of outpatient clinics, several experimental and EBD studies showed that the view of nature is much correlated with reducing pain, depression, fatigue and stress (Berto, 2005) (Ulrich et a/, 2008) (Aries et al, 2010). Other EBD studies demonstrated that the viewing and the direct contact of natural plants in the workplace reduce staff stress and fatigue, as well, increase the level of staff satisfaction in their working environment (Lundin, 2012) (Ulrich et al, 2008). Therefore, natural plants should be an essential part of the outpatient clinics design strategy (Ananth, 2008). For example, the architect might consider green planted facades, green roofs and interior green walls in the design of the outpatient-clinical buildings. Figure 1: Natural plants and design strategies°® Large Windows (windows become doors concept)
Figure 1: Canter’s ‘Room Interference Protocol (Canter, 1977) To investigate the potential effect of stigma, a method was appropriated from environmental psychology: the “room inference protocol” method by David Canter (1977). This method was utilised to determine the differences of perception that a change in room had on the model. Proceedings of the Second European Conference on Design 4 Health 2013, 3 - 5 July 2013, Sheffield UK ISBN: 978-1-84387-373-0
Figure 1: Canter’s ‘Room Interference Protocol (Canter, 1977) To investigate the potential effect of stigma, a method was appropriated from environmental psychology: the “room inference protocol” method by David Canter (1977). This method was utilised to determine the differences of perception that a change in room had on the model. Proceedings of the Second European Conference on Design 4 Health 2013, 3 - 5 July 2013, Sheffield UK ISBN: 978-1-84387-373-0
Figure 2. Image used in Dunn & Searle’s (2010) research, demonstrating a vast disparity of appearance between images. The stimuli presented in this study have a strong visual contrast - even between the same vehicles with a different driver. Within these four images, differences in lighting, position of the model, position of the camera, facial expression and background are evident. This ‘pollution’ of the image can lead to compromised survey data, especially when considering the aim of this study was to measure the attractiveness of the model, based upon which car they are sitting in. One particularly striking difference is the window in the ‘affordable’ car — in the female image, the window has been raised, with the camera flash being reflected towards the viewer. In the male image, the window is down, showing the viewer more of the male model’s clothing, and also over-exposing his face. A study by Lindgaard et. al (2006) suggests that we form a like/dislike opinion of visual stimuli within five hundred milliseconds (500ms), therefore it is of paramount importance that the visuals be tightly controlled to avoid this form of pollution. position of the camera, facial expression and background are evident. This ‘pollution’ of the image
Figure 2. Image used in Dunn & Searle’s (2010) research, demonstrating a vast disparity of appearance between images. The stimuli presented in this study have a strong visual contrast - even between the same vehicles with a different driver. Within these four images, differences in lighting, position of the model, position of the camera, facial expression and background are evident. This ‘pollution’ of the image can lead to compromised survey data, especially when considering the aim of this study was to measure the attractiveness of the model, based upon which car they are sitting in. One particularly striking difference is the window in the ‘affordable’ car — in the female image, the window has been raised, with the camera flash being reflected towards the viewer. In the male image, the window is down, showing the viewer more of the male model’s clothing, and also over-exposing his face. A study by Lindgaard et. al (2006) suggests that we form a like/dislike opinion of visual stimuli within five hundred milliseconds (500ms), therefore it is of paramount importance that the visuals be tightly controlled to avoid this form of pollution. position of the camera, facial expression and background are evident. This ‘pollution’ of the image
Figure 3. Image used in Rick and Schweitzer’s (2010) study, demonstrating a tighter overall composition. The aim of this study was to assess the perceived intelligence of the model, based upon the beverage displayed in front of her. While the investigators demonstrated a far better model than Dunne & Searle, the image still suffers from pollution — namely the coaster underneath the beer in the second image. This has the potential to ‘highlight’ the alcoholic beverage and draw attention to it, while the non-alcoholic beverage is unadorned. Utilising digital means, this could be rectified post-hoc, delivering a more accurate and controlled stimuli, which can in turn lead to a more accurate result. The aim of this study was to assess the perceived intelligence of the model, based upon the
Figure 3. Image used in Rick and Schweitzer’s (2010) study, demonstrating a tighter overall composition. The aim of this study was to assess the perceived intelligence of the model, based upon the beverage displayed in front of her. While the investigators demonstrated a far better model than Dunne & Searle, the image still suffers from pollution — namely the coaster underneath the beer in the second image. This has the potential to ‘highlight’ the alcoholic beverage and draw attention to it, while the non-alcoholic beverage is unadorned. Utilising digital means, this could be rectified post-hoc, delivering a more accurate and controlled stimuli, which can in turn lead to a more accurate result. The aim of this study was to assess the perceived intelligence of the model, based upon the
Figure 4. Image detailing the design process for the female stimuli (Renda, 2013) The revised method builds upon the work of Canter, Rick & Schweitzer and Dunne & Searle, and its application within the use of cutlery design is novel.
Figure 4. Image detailing the design process for the female stimuli (Renda, 2013) The revised method builds upon the work of Canter, Rick & Schweitzer and Dunne & Searle, and its application within the use of cutlery design is novel.
In this author's study, an entirely digital approach was utilised, primarily using Adobe Photoshop to generate the final stimuli. Photographs of models and scenes were sourced from iStockPhoto and Dreamstime - two leading stock photography websites. As the study was primarily investigating the perception of middle-aged men and women of average appearance and income, details such as jewellery, makeup, height and weight were modified or removed using various tools within the application. The background of the stimuli was also modified; the models (initially only the female) were cut out of their original background and placed upon a series of three scenes — a home, a fine dining restaurant and a café. Levels of blur were also adjusted to reduce visual pollution and focus on the model and the cutlery. Through further investigation within the literature, it was decided to focus upon the home environment. Proceedings of the Second European Conference on Design 4 Health 2013, 3 - 5 July 2013, Sheffield UK ISBN: 978-1-84387-373-0 and Dreamstime - two leading stock photography websites. As the study was primarily
In this author's study, an entirely digital approach was utilised, primarily using Adobe Photoshop to generate the final stimuli. Photographs of models and scenes were sourced from iStockPhoto and Dreamstime - two leading stock photography websites. As the study was primarily investigating the perception of middle-aged men and women of average appearance and income, details such as jewellery, makeup, height and weight were modified or removed using various tools within the application. The background of the stimuli was also modified; the models (initially only the female) were cut out of their original background and placed upon a series of three scenes — a home, a fine dining restaurant and a café. Levels of blur were also adjusted to reduce visual pollution and focus on the model and the cutlery. Through further investigation within the literature, it was decided to focus upon the home environment. Proceedings of the Second European Conference on Design 4 Health 2013, 3 - 5 July 2013, Sheffield UK ISBN: 978-1-84387-373-0 and Dreamstime - two leading stock photography websites. As the study was primarily
Figure 5. Images used in the pilot survey A pilot survey was undertaken, with the results indicating an average level of attractiveness and age of the model, however the pilot survey indicated that the ‘expensive’ cutlery (the David Mellor set) did not register as such. By utilising digital as opposed to analogue image manipulation, the investigators were able to modify and appropriately position the stimuli (replacing it with a more traditional looking piece of silverware, which tested well) and ensuring that the scene was as tightly controlled as possible. One of the added benefits of this system was the speed; i.e. modifications can be done at any point of the day, irrespective of a model, site or product being available.
Figure 5. Images used in the pilot survey A pilot survey was undertaken, with the results indicating an average level of attractiveness and age of the model, however the pilot survey indicated that the ‘expensive’ cutlery (the David Mellor set) did not register as such. By utilising digital as opposed to analogue image manipulation, the investigators were able to modify and appropriately position the stimuli (replacing it with a more traditional looking piece of silverware, which tested well) and ensuring that the scene was as tightly controlled as possible. One of the added benefits of this system was the speed; i.e. modifications can be done at any point of the day, irrespective of a model, site or product being available.
Figure 6. Final female stimuli Another key advantage of this method was the ability to modify facial expression; the male model used in the stimuli was smiling; this was digitally altered to ensure that his expression matched the female model as closely as possible, ensuring neutrality in the data gathering. This is demonstrated across the following images: Another key advantage of this method was the ability to modify facial expression; the male mode
Figure 6. Final female stimuli Another key advantage of this method was the ability to modify facial expression; the male model used in the stimuli was smiling; this was digitally altered to ensure that his expression matched the female model as closely as possible, ensuring neutrality in the data gathering. This is demonstrated across the following images: Another key advantage of this method was the ability to modify facial expression; the male mode
Figure 6. Male stimuli, demonstrating modification of facial expression
Figure 6. Male stimuli, demonstrating modification of facial expression
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Space SyntaxEvidence Based Design
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