As the global population of people with dementia is projected to reach 139 million by 2050, there is a growing focus on strategies supporting their Health and Care Outcomes (HCOs), one of which is dementia-friendly design in healthcare facilities. The built environment of healthcare facilities plays a key role in dementia care. To design healthcare facilities that better align with the HCOs for people with dementia, it is beneficial to assess the effects of Architectural Variables (AVs) on HCOs. The more extensive the consideration of AVs’ effects in design, the greater the capacity to achieve alignment between the built environment and HCOs. For this purpose, this PhD thesis develops a new assessment software which assesses the effects of AVs on HCOs more effectively, shifting from traditional and manual assessment tools in architecture towards systematic and digital approaches. Its development is guided by a methodology that addresses correspondingly three main challenges in previous assessment tools including lack of standard set of AVs and HCOs with widespread consensus, limitation in the holistic and systematic coverage of their interactions in the assessment calculations, and application difficulties of assessment tools. Firstly, this thesis creates a new set of AVs and HCOs through terminology analysis and introduces a new structure of classification for allocating and positioning the AVs and HCOs. In the terminology analysis, AVs and HCOs were extracted from a source of Evidence-Based Design (EBD) studies, then through frequency analysis and statistical tests, representative terms with the most potential for consensus were identified. For the structure of classification, a new structure was developed for AVs and HCOs based on both theoretical and practical investigation approaches to meet a set of fundamental classification criteria. Secondly, Model-Based Systems Engineering (MBSE), a subset of Systems Engineering, is utilized to model the interactions between AVs and HCOs. This approach enables the consideration of all different types of interactions between AVs and HCOs. It considers both direct interactions (AV-HCO) and indirect interactions, such as AV-HCO-HCO (an AV affects an HCO, which in turn affects another HCO) and AV-AV-HCO (an AV affects another AV, which then affects an HCO). Through systematic modeling with MBSE, a logical model has been developed that automates assessment calculations. Thirdly, the application difficulties of the previous assessment tools are addressed through considerations in the software features and capabilities. Namely, the logical model obtained in the second step is integrated into the computational engine of the software to support it as a calculative engine without any need for manual intervention by users. Users can enter the specifications of the facilities supposed to be assessed through AVs in the software, then the assessment is carried out through data exchange between the computational engine and its logical model on the backend. The results of the assessment are displayed online through quantitative and qualitative analysis. Users are informed about how many negative or positive effects each HCO receives from which AVs. It also provides root cause analysis through the impact chains of direct and indirect interactions to clarify why an effect, whether positive or negative, occurs. The total result for all of the HCOs is also available. Currently, the software conducts the assessment based on 396 interactions between AVs and HCOs, extracted from a source of previous studies. However, the model obtained through implementing MBSE is so developed that new findings could be added into the model and subsequently automatically into the software, along with all relevant assessment calculations. This makes the software dynamic and adaptable to new findings. Moreover, the software was implemented in two real-world case assessments in Cambridge, UK. Additionally, expert feedback was gathered through a series of feedback sessions.:Table of content SUMMARY OF THESIS KURZFASSUNG TABLE OF CONTENT GLOSSARY INTRODUCTION CHAPTER 1.BUILT ENVIRONMENT AND HUMAN OUTCOMES 1.1. Introduction to built environment and human outcomes 1.1.1. Definition of built environment and human outcomes 1.1.2. The impact of built environment on human outcomes, with a focus on older occupants 1.2. Theories linking the built environment and human outcomes 1.2.1. Overview of theories linking built environment and human outcomes 1.2.2. Environmental gerontology 1.3. EBD: An approach to design for the theories linking built environment and human outcomes 1.3.1. Role of EBD in healthcare facility design 1.3.2. Role of EBD in environmental gerontology CHAPTER 2.DEMENTIA-FRIENDLY DESIGN IN NURSING HOMES 2.1. Understanding dementia: Definition to consequences 2.2. The built environment of people with dementia 2.3. Definition and history of dementia-friendly design 2.4. Effects of dementia-friendly design on people with dementia 2.5. Principles of dementia-friendly design in nursing homes CHAPTER 3.ASSESSMENT TOOLS IN DEMENTIA-FRIENDLY DESIGN 3.1. Role of assessment tools in dementia-friendly design 3.2. Overview of previous assessment tools 3.3. Analyzing the previous assessment tools CHAPTER 4.RESEARCH DESIGN AND METHODOLOGY 4.1. Research gap, objectives, and questions 4.2. Scope and boundaries 4.3. Methodology CHAPTER 5.TERMINOLOGY ANALYSIS FOR CONSISTENCY 5.1. Extraction of terminology through concept-based approach 5.1.1. Conducting content analysis of source studies 5.1.2. Application of a concept-based approach 5.2. Dataset generation of the extracted terminologies 5.3. Frequency analysis and statistical tests 5.3.1. Frequency analysis and chi-square test of the concepts for AVs 5.3.2. Frequency analysis and chi-square test of the concepts for HCOs 5.4. Selection of representative terms 5.5. Scenarios for establishing comprehensive standardized terminology Chapter 6. DEVELOPMENT OF CLASSIFICATION STRUCTURE 6.1. Development of the classification structure 6.1.1. Expected efficacies and importance of the classification structure 6.1.2. Criteria for the development of classification structure 6.1.3. Nature of classification criteria 6.1.4. Investigation approaches 6.1.5. Creating the structure of classifications for AVs and HCOs 6.2. Allocation of AVs and HCOs to their corresponding classifications 6.3. Extraction of the interactions between AVs and HCOs 6.4. Considerations for interactions between AVs and HCOs CHAPTER 7.IMPLEMENTING MODEL-BASED SYSTEMS ENGINEERING 7.1. The role and benefits of MBSE in the assessment software 7.2. Introduction to the Model-Based Systems Engineering (MBSE) 7.2.1. The foundation of MBSE: Systems Engineering (SE) 7.2.2. The core principles of MBSE 7.3. Implementing MBSE 7.3.1. Operational analysis phase 7.3.2. System analysis phase 7.3.3. Logical architecture phase 7.3.4. Physical architecture phase CHAPTER 8.DEVELOPMENT OF WEB-BASED ASSESSMENT SOFTWARE AND ITS IMPLEMENTATION IN PRACTICE 8.1. Overview of the software structure 8.2. Technical structure and key technologies 8.3. Key features and functionalities 8.3.1. Accessibility 8.3.2. Registration 8.3.3. Management of assessment cases 8.3.4. Creation of a new assessment case 8.3.5. Design assessment questionnaire 8.3.6. Displaying the assessment results 8.4. Considerations for interactions in the assessment software 8.4.1. Reliability awareness 8.4.2. Reflection of AV-HCO direct vs. indirect distinctions 8.4.3. Clarification of conflicts in studies’ findings 8.5. Case analysis 8.5.1. On-site assessment and data collection for AVs’ specifications 8.5.2. Assessment results of case analysis 8.5.3. Comparative analysis 8.6. Experts’ feedback 8.6.1. Selection of participants 8.6.2. Content of the feedback sessions 8.6.3. Feedback session process and outcomes CHAPTER 9.DISCUSSION AND CONCLUSION 9.1. Thesis implications for dementia-friendly design assessment 9.1.1. Standardization and organization of AVs and HCOs 9.1.2. Systematic consideration of interactions 9.1.3. Application capabilities 9.2. Limitations 9.2.1. Scope of interactions and benchmarking 9.2.2. Limitation in qualitative nature of EBD findings 9.2.3. Practical application and validation 9.2.4. Standardization of terminology 9.2.5. Stakeholder interplay 9.3. Future directions 9.3.1. Expanding scope of interactions 9.3.2. Expanding practical application and user feedback 9.3.3. Extending standardization of terminology 9.3.4. Region-specific versions of the assessment software 9.4. Conclusion APPENDICES TABLE OF TABLES TABLE OF FIGURES DECLARATION REFERENCES / Bis zum Jahr 2050 wird die Weltbevölkerung voraussichtlich 139 Millionen Menschen mit Demenz erreichen. Infolgedessen liegt der Schwerpunkt zunehmend auf Lösungen zur Unterstützung ihrer Gesundheits- und Pflegeergebnisse (HCOs), zu denen auch die demenzfreundliche Gestaltung von Gesundheitseinrichtungen gehört. Um Gesundheitseinrichtungen zu gestalten, die besser mit den HCOs von Menschen mit Demenz übereinstimmen, ist es notwendig, die Auswirkungen von architektonischen Variablen (AVs) auf HCOs gründlich zu bewerten. Je umfassender die Berücksichtigung der Effekte von AVs im Design ist, desto größer ist die Fähigkeit, eine Übereinstimmung zwischen der gebauten Umgebung und den HCOs zu erreichen. Zu diesem Zweck wird in dieser Dissertation eine neue softwaregesteuerte Bewertungslösung entwickelt, mit der die Auswirkungen von AVs auf HCOs effektiver bewertet werden können, indem von traditionellen und manuellen Instrumenten auf digitale Lösungen umgestellt wird. Die Entwicklung wird von einer Methodik geleitet, die drei Hauptprobleme in früheren Bewertungsinstrumenten behandelt, darunter das Fehlen eines Standardsets von AVs und HCOs mit weitreichendem Konsens, Einschränkungen in der umfassenden und systematischen Abdeckung ihrer Interaktionen in den Bewertungsberechnungen sowie Anwendungsprobleme von Bewertungsinstrumenten. Erstens wird in dieser Arbeit durch eine Terminologieanalyse ein neues Set von AVs und HCOs erstellt und eine neue Klassifikationsstruktur für die Zuordnung und Positionierung der AVs und HCOs eingeführt. Bei der Terminologieanalyse wurden AVs und HCOs aus einer Quelle von Evidence-Based Design (EBD) Studien extrahiert, dann durch statistische und Häufigkeitsanalysen repräsentative Begriffe mit dem größten Konsenspotenzial ermittelt. Für die Struktur der Klassifizierung wurde eine neue Struktur für AVs und HCOs entwickelt, die sowohl auf theoretischen als auch auf praktischen Untersuchungsansätzen basiert, um eine Reihe von grundlegenden Klassifizierungskriterien zu erfüllen. Zweitens wird das modellbasierte System-Engineering (MBSE), ein Teilbereich des Systems-Engineering, zur Modellierung der Interaktionen zwischen AVs und HCOs eingesetzt. Dieser Ansatz ermöglicht die Berücksichtigung aller verschiedenen Arten von Interaktionen zwischen AVs und HCOs. Es berücksichtigt sowohl direkte Interaktionen (AV-HCO) als auch indirekte Interaktionen wie AV-HCO-HCO (ein AV beeinflusst ein HCO, das wiederum ein anderes HCO beeinflusst) und AV-AV-HCO (ein AV beeinflusst ein anderes AV, das wiederum ein HCO beeinflusst). Durch systematische Modellierung mit MBSE wurde ein logisches Modell entwickelt, das die Bewertungsberechnungen automatisiert. Drittens werden die Anwendungsprobleme der vorherigen Bewertungsinstrumente durch Überlegungen zu den Softwarefunktionen und -fähigkeiten behandelt. Insbesondere wird das im zweiten Schritt erhaltene logische Modell in den Berechnungsmotor der Software integriert, um es als einen rechnerischen Motor zu unterstützen, ohne dass Benutzer manuell eingreifen müssen. Benutzer können die Spezifikationen der Einrichtungen, die durch AVs der Software bewertet werden sollen, eingeben, und die Bewertung erfolgt durch den Datenaustausch zwischen dem Berechnungsmotor und seinem logischen Modell auf dem Backend. Die Ergebnisse der Bewertung werden online durch quantitative und qualitative Analysen angezeigt. Benutzer werden darüber informiert, wie viele negative oder positive Auswirkungen jede HCO von welchen AVs erhält. Es bietet auch Ursachenanalyse, um zu klären, warum ein Effekt, sei er positiv oder negativ, auftritt. Das Gesamtergebnis für alle HCOs ist ebenfalls verfügbar. Aktuell führt die Software die Bewertung auf der Grundlage von 396 Interaktionen zwischen AVs und HCOs durch, die aus einer Quelle früherer Studien extrahiert wurden. Das durch die Implementierung von MBSE erhaltene Modell ist jedoch so entwickelt, dass neue Erkenntnisse problemlos in das Modell und anschließend automatisch in die Software und alle relevanten Bewertungsberechnungen integriert werden können. Dies macht die Software dynamisch und anpassungsfähig für neue Erkenntnisse. Darüber hinaus wurde die Software in zwei realen Fallbewertungen in Cambridge, Großbritannien, implementiert. Zusätzlich wurde durch eine Reihe von Feedback-Sitzungen Expertenfeedback gesammelt.:Table of content SUMMARY OF THESIS KURZFASSUNG TABLE OF CONTENT GLOSSARY INTRODUCTION CHAPTER 1.BUILT ENVIRONMENT AND HUMAN OUTCOMES 1.1. Introduction to built environment and human outcomes 1.1.1. Definition of built environment and human outcomes 1.1.2. The impact of built environment on human outcomes, with a focus on older occupants 1.2. Theories linking the built environment and human outcomes 1.2.1. Overview of theories linking built environment and human outcomes 1.2.2. Environmental gerontology 1.3. EBD: An approach to design for the theories linking built environment and human outcomes 1.3.1. Role of EBD in healthcare facility design 1.3.2. Role of EBD in environmental gerontology CHAPTER 2.DEMENTIA-FRIENDLY DESIGN IN NURSING HOMES 2.1. Understanding dementia: Definition to consequences 2.2. The built environment of people with dementia 2.3. Definition and history of dementia-friendly design 2.4. Effects of dementia-friendly design on people with dementia 2.5. Principles of dementia-friendly design in nursing homes CHAPTER 3.ASSESSMENT TOOLS IN DEMENTIA-FRIENDLY DESIGN 3.1. Role of assessment tools in dementia-friendly design 3.2. Overview of previous assessment tools 3.3. Analyzing the previous assessment tools CHAPTER 4.RESEARCH DESIGN AND METHODOLOGY 4.1. Research gap, objectives, and questions 4.2. Scope and boundaries 4.3. Methodology CHAPTER 5.TERMINOLOGY ANALYSIS FOR CONSISTENCY 5.1. Extraction of terminology through concept-based approach 5.1.1. Conducting content analysis of source studies 5.1.2. Application of a concept-based approach 5.2. Dataset generation of the extracted terminologies 5.3. Frequency analysis and statistical tests 5.3.1. Frequency analysis and chi-square test of the concepts for AVs 5.3.2. Frequency analysis and chi-square test of the concepts for HCOs 5.4. Selection of representative terms 5.5. Scenarios for establishing comprehensive standardized terminology Chapter 6. DEVELOPMENT OF CLASSIFICATION STRUCTURE 6.1. Development of the classification structure 6.1.1. Expected efficacies and importance of the classification structure 6.1.2. Criteria for the development of classification structure 6.1.3. Nature of classification criteria 6.1.4. Investigation approaches 6.1.5. Creating the structure of classifications for AVs and HCOs 6.2. Allocation of AVs and HCOs to their corresponding classifications 6.3. Extraction of the interactions between AVs and HCOs 6.4. Considerations for interactions between AVs and HCOs CHAPTER 7.IMPLEMENTING MODEL-BASED SYSTEMS ENGINEERING 7.1. The role and benefits of MBSE in the assessment software 7.2. Introduction to the Model-Based Systems Engineering (MBSE) 7.2.1. The foundation of MBSE: Systems Engineering (SE) 7.2.2. The core principles of MBSE 7.3. Implementing MBSE 7.3.1. Operational analysis phase 7.3.2. System analysis phase 7.3.3. Logical architecture phase 7.3.4. Physical architecture phase CHAPTER 8.DEVELOPMENT OF WEB-BASED ASSESSMENT SOFTWARE AND ITS IMPLEMENTATION IN PRACTICE 8.1. Overview of the software structure 8.2. Technical structure and key technologies 8.3. Key features and functionalities 8.3.1. Accessibility 8.3.2. Registration 8.3.3. Management of assessment cases 8.3.4. Creation of a new assessment case 8.3.5. Design assessment questionnaire 8.3.6. Displaying the assessment results 8.4. Considerations for interactions in the assessment software 8.4.1. Reliability awareness 8.4.2. Reflection of AV-HCO direct vs. indirect distinctions 8.4.3. Clarification of conflicts in studies’ findings 8.5. Case analysis 8.5.1. On-site assessment and data collection for AVs’ specifications 8.5.2. Assessment results of case analysis 8.5.3. Comparative analysis 8.6. Experts’ feedback 8.6.1. Selection of participants 8.6.2. Content of the feedback sessions 8.6.3. Feedback session process and outcomes CHAPTER 9.DISCUSSION AND CONCLUSION 9.1. Thesis implications for dementia-friendly design assessment 9.1.1. Standardization and organization of AVs and HCOs 9.1.2. Systematic consideration of interactions 9.1.3. Application capabilities 9.2. Limitations 9.2.1. Scope of interactions and benchmarking 9.2.2. Limitation in qualitative nature of EBD findings 9.2.3. Practical application and validation 9.2.4. Standardization of terminology 9.2.5. Stakeholder interplay 9.3. Future directions 9.3.1. Expanding scope of interactions 9.3.2. Expanding practical application and user feedback 9.3.3. Extending standardization of terminology 9.3.4. Region-specific versions of the assessment software 9.4. Conclusion APPENDICES TABLE OF TABLES TABLE OF FIGURES DECLARATION REFERENCES

The awareness regarding important aspects of how to plan and design healthcare environments is something that is constantly progressing. Even though these environments can be seen as complex, the knowledge and understanding of its many different users is often taken into consideration in today’s planning. Several studies have shown positive effects on the visual performance among the hospital staff but also positive effects regarding visual comfort that facilitates recovery and well-being among patients. However, when planning lighting in healthcare environments today, the focus often lies on providing good lighting qualities regarding the visual performance of the hospital staff and the patients are, by that, not taken in consideration to the same level of extent. Therefore this study was focused on analyzing if certain demands could be set on lighting in a nursing room, to improve the experience of visual comfort, from a patient perspective, while using two different lighting scenarios. The thesis has been conducted using an already approved and widely used method Evidence based design (EBD) through a literature study, a pre-study, and an experiment. This to evaluate and develop an innovative design to facilitate visual comfort from a patient's perspective. The visual parameters that the experiment has been focusing on are glare, luminance, contrasts, shadows, lighting principles, and the perception of objects. These parameters have been evaluated from a sitting, standing and lying position in two different lighting scenarios, developed from the hypothesis, without access to daylight. A healthcare environment has a number of different users, that all use the facilities in different ways. Therefore it was important that the innovative design, constructed for the experiment, did not compromise the visual comfort or need of light for the other users. A questionnaire was created, based on the visual parameters, to help answer the research questions. The experiment had a total of 30 participants, where each participant answered the questionnaire six times, one for each position and a total of three times in each lighting scenario.   The results were compiled and the mean values were analyzed to evaluate differences and similarities between the two lighting scenarios and between the positions. The results of the experiment show that there are certain demands that can be set on the artificial lighting in a nursing room, and it also shows that it is of great importance to plan for a various lighting environment since it can enhance the experience of visual comfort. Despite this, it is important for a lighting designer to carefully analyze and evaluate the patient's need for light in the specific ward that is being designed. To achieve a sustainable lighting solution it is important to remember that all the sustainability factors, such as the social, economic and environmental factors, are equally important to create a sustainable development. / Medvetenheten gällande viktiga aspekter av hur man planerar och utformar vårdmiljöer är något som ständigt ökar. Trots att dessa miljöer kan ses som komplexa, tas ofta kunskap och förståelse i beaktning för miljöernas många olika användare vid dagens planering. Flera studier har visat positiva effekter på visuell prestanda hos sjukhuspersonalen, men även positiva effekter gällande visuell komfort som påskyndar återhämtning och ökar välbefinnande bland patienter. När belysningsplanering idag utförs i vårdmiljöer ligger fokuset ofta på att tillgodose ljuskvaliteter med avseende för sjukhuspersonalens visuella prestanda och patienterna beaktas därmed inte i samma omfattning. Därför har denna studie fokuserats på att analysera om vissa krav kan ställas på artificiell belysning i ett vårdrum, för att förbättra upplevelsen av visuell komfort utifrån en patients perspektiv, vid utvärdering  av två olika belysningsscenarion. Studien har genomförts med hjälp av en redan beprövad och allmänt använd metod Evidensbaserad design (EBD), genom en litteraturstudie, en förstudie och ett experiment. Detta för att utvärdera och utveckla en innovativ design med fokus på att underlätta visuell komfort från patientens perspektiv. De visuella parametrar som experimentet har fokuserat på är bländning, luminans, kontraster, skuggor, olika belysningsprinciper samt uppfattningen av objekt. Dessa parametrar har utvärderats från en sittande, stående och liggande position, vid två olika belysningsscenarion med enbart artificiell belysning, utvecklad utifrån hypotesen. I en vårdmiljö vistas ett antal olika användare som alla använder anläggningarna på olika sätt. Det ansågs därför viktigt att den innovativa designen, som konstruerats för experimentet, inte påverkade den visuella komfort eller behovet av ljus för övriga användare. Ett frågeformulär skapades, baserat på de visuella parametrarna, för att besvara frågeställningen. Experimentet hade totalt 30 deltagare, där varje deltagare besvarade frågeformuläret sex gånger, ett formulär per position och totalt tre gånger vid varje ljusscenario. Resultaten sammanställdes och medelvärden analyserades för att utvärdera skillnader och likheter mellan de två belysningsscenarierna samt mellan positionerna. Resultaten av experimentet visar att det finns särskilda krav att ställa på den artificiella belysningen i ett vårdrum. Resultatet visar även att det är av stor betydelse att planera in en varierad ljusmiljö då det kan förbättra upplevelsen av den visuella komforten. Utöver detta är det även viktigt för en ljusdesigner att noggrant analysera och utvärdera patientens behov av ljuset i den specifika avdelningen som utformas. För att uppnå en hållbar belysningslösning är det viktigt att ha i åtanke att alla hållbarhetsfaktorer, såsom de sociala, ekonomiska och ekologiska, är lika viktiga att ta hänsyn till för att skapa en hållbar utveckling.

Bakgrund: Evidensbaserad Design (EBD) är en process som har utvecklats för att säkerställa att beslut om planering och utformning av vårdmiljön bygger på trovärdig forskning med målet att skapa bästa möjliga resultat för personal, patienter och närstående. Vårdmiljöforskning visar att en välplanerad och genomtänkt fysisk vårdmiljö spelar en viktig roll för patientsäkerhet, patientnöjdhet och arbetstillfredsställelse hos personalen. Inom begreppsramen för EBD ingår den visuella miljön som en variation av den fysiska miljön. Det finns redan mycket forskning som undersöker olika aspekter av den visuella miljön inom vården, men det finns dock lite forskning som beskriver åtgärder som syftar till att förbättra vårdmiljön på en akutmottagning.   Syfte: Att beskriva personalens upplevelse av den visuella miljön på akutmottagningen.   Metod: En kvalitativ induktiv intervjustudie genomfördes vid två akutmottagningar i södra Sverige. Femton (n = 15) intervjuer med legitimerade sjuksköterskor, undersköterskor och läkare utfördes. Intervjuerna analyserades med hjälp av innehållsanalys. Resultat: Personalen vid akutmottagningen upplevde att en balanserad visuell miljö främjar välbefinnande. Balansen består av en integration av klinisk funktionalitet och estetiska intryck. Den visuella miljön kan distrahera på olika sätt, vilket skapar en avledning från stressiga upplevelser. Det kan också uppmuntra nyfikenhet och reflektion. Aspekter av den visuella miljön kan emellertid vara distraherande på ett provocerande sätt vilket i sin tur kan ökar stress. En balanserad visuell miljön skapar atmosfär för vårdande. Den visuella miljön har en stimulerande känslomässig inverkan som kan vara både positiv och negativ samt stimulera delaktighet och dialog.   Slutsats: Att skapa en balanserad visuell miljö på akutmottagningen kräver en helhetssyn som inkludera funktionella och personliga perspektiv. Man kan dra slutsatsen att en balanserad visuell miljö i slutändan kan förbättra atmosfären på akutmottagningen och därmed bidra till en stödjande miljö som främjar en känsla av välbefinnande hos personal, patienter och närstående. / Background: Evidence-based Design (EBD) is a process that has been developed to ensure that decisions on planning and design of the healthcare environment are based on credible research with the goal of creating the best possible outcomes for staff, patients and next-of kin. Research on health care design shows that a well-planned and thought out physical environment plays an important role in patient safety, patient satisfaction and job satisfaction for the staff.  Within the conceptual framework of EBD, the visual environment is included as a variation of the physical environment. There is a substantial amount of research that examines different aspects of the visual environment within healthcare, there is however little research describing interventions aimed at improving the healthcare environment in an emergency department (ED). Purpose: To describe the staff experiences of the visual environment at an ED. Method: A qualitative inductive interview study was conducted at two emergency departments in southern Sweden.  Fifteen (n=15) interviews including registered nurses, assistant nurses and emergency physicians were conducted. The interviews were analyzed using content analysis. Result: The staff at the emergency department experienced that a balanced visual environment promotes well-being. The balance consists of an integration between clinical functionality and aesthetic impressions. The visual environment can be distracting in various ways, creating a diversion from stressful experiences. It can also encourage curiosity and reflection. Aspects of the visual environment can however be equally distracting in a provocative manner, reinforcing stress. The visual environment has a stimulating emotional impact that can be both positive and negative as well as stimulating participation and dialogue. A balanced visuell environment creates an atmosphere which supports caring. Conclusion: Creating a balanced visual environment in the emergency requires a holistic approach incorporating practical and personal perspectives. It can be concluded that providing a balanced visual environment can ultimately improve the atmosphere of the emergency department and thereby promote a sense of well-being in staff, patients and next-of kin.

University libraries struggle to keep up with rapidly changing technology and the associated change in teaching strategy. Most administrators and librarians are often not trained to assess space needs and struggle to reassign library spaces for non-traditional library use. As such, they often embark on expensive and time-consuming feasibility studies, using (typically) hard-earned monies to complete the research or to pilot a new space. What academic research library administrators and staff lack is an analysis tool for discovering and planning needed renovations and improvements in aging library facilities. The purpose of this research project was to determine how students use library spaces for learning in this new high-tech, hands-on education experience (i.e. synthesis of previous research); develop a tool that can be used by library staff to self-analyze existing academic library spaces, identifying areas that could be improved for student benefit (e.g. provide a checklist of potential learning spaces that institutions should carefully consider adding to their facilities); and provide some examples/case studies of potential facility improvements. The end result is a hierarchical self-analysis tool that merges space options, Abraham Maslow's Hierarchy of Needs, and an example of library-user personas. It also provides some general cost guidelines, helpful construction tips, and a synthesis of exploratory questions related to strategy and space. The tool uses evidence-based design to facilitate important conversations, provide an organized checklist of various considerations, and be a quick reference for library administrators and facility managers as they navigate the world of twenty-first century pedagogy and student learning.

Rehabilitation clinics remain until this day a greatly unexplored topic from the perspective of architectural design. Stroke is the most common condition that is treated in neurological rehabilitation clinics in Germany and it is a disease that causes the most complex disability. Since stroke numbers are expected to constantly grow in the future, there is a definite need for understanding the stroke survivors’ spatial needs and for accommodating them in the built environment in a way that supports their recovery process and their life after rehabilitation. This PhD thesis aims at contributing to this wide knowledge gap and at introducing new research directions focusing on the relationship between stroke patients’ and the rehabilitation built environments. Rehabilitation clinics were chosen as the research setting for this study as the environments that stroke survivors encounter after the hospital stay and where they undergo a challenging rehabilitation process with the goal of returning home to their normal lives. This rehabilitation process involves living in rehabilitation clinics for a certain period and attending various types of therapies led by a multidisciplinary team, with multiple therapies per day, every day of the week. This type of intensive therapy is important for stroke patients since the greatest amount of functional recovery can be expected in the first 3 to 6 months after the stroke onset. German neurological rehabilitation clinics are commonly transformed from other functions or newly built without evidence-based knowledge about the spatial needs of their patients. This practice creates barriers in the built environment for patients, likely hindering their recovery process and negatively influencing their psychological well-being. These barriers can most directly influence and hinder patients’ mobility within the clinic. Mobility, as the main goal of stroke rehabilitation, is often not well-supported in the built environment of rehabilitation clinics. This study, therefore, focuses on identifying barriers and facilitators to mobility in rehabilitation clinics and their architectural properties and the different experiences of patients with different mobility levels. Three empirical research methods were used to investigate the relationship between the stroke inpatients’ mobility and the built environment of rehabilitation clinics: patient shadowing, patient questionnaire and staff questionnaire. These three methods were the elements of Post-occupancy evaluation (POE) applied in seven German neurological rehabilitation clinics over the period between September 2016 and May 2018. The results show that the built environment of rehabilitation clinics hinders patients’ mobility in five main aspects: challenging wayfinding, long distances, insufficient dimensions of corridors, floor surfaces and physical obstacles. It was also found that mobility facilitators are greatly lacking. Stroke patients with the lower levels of mobility, and especially patients using a wheelchair, were found the most vulnerable to the identified barriers. Patients were also greatly inactive during their time in the clinic since 50% of the day was spent in patient rooms. They also expressed a wish for a greater variety of common spaces within the clinic. The absence of motivating spaces was likely to be another important reason for patients’ inactivity, besides the avoidance of various barriers. The architectural properties of the identified barriers and facilitators were used to develop a catalogue of architectural design guidelines that present a new model for rehabilitation buildings: the transitional model. The given recommendations are based on the obtained study results and the experience of living in rehabilitation clinics and observing their daily life for 14 weeks. The catalogue of guidelines is intended for architects, medical professionals and others included in the process of planning a rehabilitation clinic. The main goal is to provide directly applicable evidence-based recommendations for mobility supporting clinics and to facilitate the dialogue between different professions involved in the planning process. / Rehabilitationskliniken sind bis heute ein aus architektonischer Sicht wenig erforschtes Thema. Schlaganfall ist die häufigste Erkrankung, die in neurologischen Rehabilitationskliniken in Deutschland behandelt wird und die die komplexeste Beeinträchtigung verursacht. Da zu erwarten ist, dass die Anzahl der Schlaganfälle in Zukunft stetig zunimmt, müssen die räumlichen Bedürfnisse der Schlaganfallpatienten unbedingt begriffen und in der gebauten Umgebung so untergebracht werden, dass ihr Genesungsprozess und ihr Leben nach der Rehabilitation unterstützt werden. Diese Dissertation zielt darauf ab, zu dieser breiten Wissenslücke beizutragen und neue Forschungsrichtungen einzuführen, die sich auf die Beziehung zwischen Schlaganfallpatienten und der rehabilitierten Umgebung konzentrieren. Rehabilitationskliniken wurden als Forschungsumgebung für diese Studie ausgewählt, da sie nach dem Krankenhausaufenthalt von Schlaganfallpatienten heimgesucht werden und sich dort einem herausfordernden Rehabilitationsprozess unterziehen, um zu ihrem normalen Leben zurückzukehren. Dieser Behandlungsprozess beinhaltet das Leben in Rehabilitationskliniken für einen bestimmten Zeitraum und die Teilnahme an verschiedenen Arten von Therapien, die von einem multidisziplinären Team mit mehreren Therapien pro Tag an jedem Tag der Woche durchgeführt werden. Diese intensive Therapieform ist wichtig für Schlaganfallpatienten, da in den ersten 3 bis 6 Monaten nach dem Schlaganfall mit der größten Wiederherstellung der Funktion gerechnet werden kann. Deutsche neurologische Rehabilitationskliniken werden häufig von anderen Funktionen umgestaltet oder ohne evidenzbasiertes Wissen über die räumlichen Bedürfnisse ihrer Patienten neu errichtet. Dieses Vorgehen schafft Barrieren in der gebauten Umgebung für Patienten, die wahrscheinlich ihren Genesungsprozess behindern und ihr psychisches Wohlbefinden negativ beeinflussen. Diese Barrieren behindern auch die Mobilität der Patienten in der Klinik. Mobilität als Hauptziel der Schlaganfallrehabilitation wird in der bebauten Umgebung von Rehabilitationskliniken häufig nicht gut unterstützt. Diese Studie konzentriert sich daher auf die Identifizierung von Barrieren, die Erleichterungen für die Mobilität in Rehabilitationskliniken und deren architektonischen Eigenschaften, sowie auf die unterschiedlichen Erfahrungen von Patienten mit unterschiedlichen Mobilitätsniveaus. Drei empirische Forschungsmethoden wurden verwendet, um den Zusammenhang zwischen der Mobilität von Schlaganfallpatienten und der gebauten Umgebung von Rehabilitationskliniken zu untersuchen: Patienten-Shadowing, Patientenfragebogen und Mitarbeiterfragebogen. Diese drei Methoden waren die Elemente der Post Occupancy Evaluation (POE), die in sieben deutschen neurologischen Rehabilitationskliniken im Zeitraum von September 2016 bis Mai 2018 angewendet wurden. Die Ergebnisse zeigen, dass die bebaute Umgebung von Rehabilitationskliniken die Mobilität der Patienten in fünf Hauptaspekten behindert: Herausfordernde Orientierung, große Entfernungen, unzureichende Abmessungen der Korridore, Bodenflächen und physische Hindernisse, sowie ein Mangel an Unterstützungselemente der Mobilität. Schlaganfallpatienten mit eingeschränkter Mobilität und insbesondere Patienten, die einen Rollstuhl benutzen, waren am anfälligsten für die festgestellten Hindernisse. Die Patienten waren auch während ihrer Zeit in der Klinik sehr inaktiv, da 50% des Tages in Patientenzimmern verbracht wurden. Die Patienten wünschten sich mehr Abwechslung in den Gemeinschaftsräumen der Klinik. Das Fehlen von motivationsfördernde Bereiche ist wahrscheinlich ein weiterer wichtiger Grund für die Inaktivität der Patienten, neben der Vermeidung verschiedener Hindernisse. Die architektonischen Eigenschaften der identifizierten Barrieren und Unterstützungselemente wurden verwendet, um einen Katalog von Empfehlungen für die architektonische Gestaltung zu entwickeln, in dem ein neues Modell für Rehabilitationseinrichtungen vorgestellt wird: das Übergangsmodell. Die gegebenen Empfehlungen basieren auf den erhaltenen Studienergebnissen und der Erfahrung der Beobachtung der Abläufe in Rehabilitationskliniken für 14 Wochen. Der Empefehlungskatalog richtet sich an Architekten, Mediziner und andere Personen, die an der Planung einer Rehabilitationsklinik beteiligt sind. Hauptziel ist es, direkt anwendbare evidenzbasierte Empfehlungen für mobilitätsunterstützende Kliniken bereitzustellen und den Dialog zwischen verschiedenen am Planungsprozess beteiligten Berufen zu erleichtern.

Submitted by Maicon Juliano Schmidt (maicons) on 2015-05-08T19:40:28Z No. of bitstreams: 1 Mirela Rosa.pdf: 33214432 bytes, checksum: 6b8afee33b9a338a882f4914815741d2 (MD5) / Made available in DSpace on 2015-05-08T19:40:28Z (GMT). No. of bitstreams: 1 Mirela Rosa.pdf: 33214432 bytes, checksum: 6b8afee33b9a338a882f4914815741d2 (MD5) Previous issue date: 2013-01-31 / Nenhuma / O Design de Serviços é constituído de uma metodologia que utiliza um conjunto de ferramentas que permitem projetar soluções para melhorar a percepção dos usuários sobre os serviços, que podem ser aplicadas em diversas áreas e contextos. Conforme a complexidade de cada setor, se torna necessário considerar abordagens de projeto que tornariam os resultados desta metodologia mais eficazes e mensuráveis, como é o caso da Saúde. Alguns autores que vêm pesquisando a aplicação neste setor, sugerem uma possível integração do Design baseado em evidências (DBE) e do Design baseado em experiências (DBEx) para viabilizar que um projeto orientado pelo usuário seja implementado em larga escala. Em busca da investigação sobre a lógica de evidências, foi estudada uma ferramenta utilizada no setor de serviços chamada Mecanismo da Função Produção (MFP), que prevê a quantificação das perdas dos processos. O presente estudo teve como contexto o Intensivismo Adulto (CTI) de um hospital privado em Porto Alegre e aplicou um caso em Design de Serviços com a lógica das evidências através da ferramenta MFP, para o desenvolvimento de uma abordagem integrada. Foi utilizado o método de pesquisa-ação com a descrição de todo o processo de projeto e dos resultados obtidos. A partir das análises pode-se constatar que (i) o olhar das evidências contribui para replicações dos resultados do projeto em casos futuros, (ii) o MFP pode ser um argumento para justificar a realização de um projeto em Design e (iii) para a integração das experiências com as evidências no setor hospitalar, pode-se gerenciar o projeto de modo a destinar um tempo maior para o diagnóstico e para a implementação. / Service Design consists of a methodology that uses a set of tools to create solutions to improve users perception on services, which can be applied in many fields and contexts. As the complexity of each field, it is necessary to consider approaches that would make results of this methodology more effective and measurable, such as health sector. Some authors have been research application of Service Design in this sector, and suggest a possible integration of evidence-based design (EBD) and experience-based design (ExBD) to enable a user-oriented design on a large scale implementation. In search on the logic of evidence, we studied a tool used in service sector called Mechanism of the Production Function, that provides quantification of loss processes. The present study was context in Intensive Care Unit (ICU) of a private hospital in Porto Alegre and applied a case of Service Design with the logic of the evidence through MFP tool for the development of an integrated approach. We used the method of action research with the description of the whole design process and results. From the analysis it was found that (i) the look of the evidence contributes to replication of project outcomes in future cases, (ii) MFP is an argument supporting the realization of a Design project and (iii) to integrate experiences with evidence in the hospital sector, we can manage the project in order to devote more time to the diagnosis and implementation.

This practicum focuses on developing a deeper knowledge about stress and our external environments. It is directed towards the profession of Landscape Architecture, and healthcare facilities including professionals. It outlines critical information about stress: how stress affects people’s physical, emotional, mental health and well-being, and how landscape architects are able to mitigate different types of stress through the design and use of our exterior environments, offering respite and healing in times of great need. Stress reveals and manifests itself in numerous ways. It has become a major problem within our society, much bigger than people care to acknowledge or believe. Landscape Architects have the ability to help people reflect upon the stress that they are under by creating spaces that inevitably sooth their ‘selves’. Through the profession and subsequent work of Landscape Architects the awareness of stress can be addressed, helping bring respite and relieve tension and stress, whether large or small, which is extremely critical in today’s society. Through the use of gardens and exterior spaces designed with stress-relief in mind, we will be able to decrease hospital stays, drug use and the overall amount of money used by medical institutions and governments, while decreasing the progression and succession of illness and diseases related to and accentuated or propagated by, or due to stress. Through this document I will discuss ideas and theories that influence and/or are pertinent to Landscape Architecture and stress, as well as natural elements that should be taken into consideration when starting to design or when planning a design that will be situated within medical institutions and healthcare facilities, but not limited to, and including any other exterior environment (such as a backyard). It will also outline design elements which emphasize appropriate ways to design these spaces and places responsibly and sensitively. By understanding how people respond to stress, Landscape Architects may be able to design appropriate, beautiful spaces. Initially this practicum was directed towards designing beautiful, meaningful gardens for the sick and/or dying, as well as for the families, visitors, and employees within healthcare settings. It has evolved, to include how our brains and bodies are physiologically affected by spaces and places that we encounter, and how these spaces either reduce or increase stress responses within us, therefore, increasing or decreasing our ability to heal, be healthy, and feel well. Stress is a major condition that is often “down-played”, ignored, or not understood within society. It is in fact a very serious condition / illness that has the ability to dictate the outcome of our physical and mental performances, and especially our health and well-being. Landscape Architects have the ability and responsibility to contribute positively to people’s bodily reactions to spaces: exterior and interior.

Projektets syfte är att försöka utröna hur en visionär psykiatri skulle kunna se ut i framtiden. Jag frågade mig om man som arkitekt kan komma med en vision som är en lösning på psykiatrins problem. Hur gör man för att maximera de läkande faktorerna så att patienter återhämtar sig så fort och fullständigt som möjligt? Projektet är också ett försök att förmänskliga en av de stora insitutioner vi är beroende av i samhället och har resulterat i en bok i ämnet och ett designprojekt.