Background: Health care settings are generally regarded as stress inducing environments. Stress can alter the immune response, impair wound healing and create a greater risk for asthma, diabetes, gastrointestinal disorder and myocardial infarction. Beginning in the 1980s and 1990s, there has been increasing interest in healing environments and evidence-based design concepts. Yet, there has been little progress developing healing environments and using evidence-based design for psychiatric inpatient units, a uniquely stressful environment. Psychiatric units today continue to use designs such as caged in outdoor patio areas that resemble facilities that incarcerate rather than facilities which reduce stress and facilitate healing. The purpose of this systematic literature review was to identify design features that are evidence-based which can be used to create an optimal inpatient psychiatric patient room by: (1) analyzing the research literature for evidence of architectural and design elements that could be used in the inpatient psychiatric care setting to reduce stress and improve the well-being; (2) identifying design elements that are consistent with accreditation and licensing standards for inpatient psychiatric units; and (3) designing a psychiatric inpatient room that has evidence-based elements to reduce stress and improve well-being. Methods: A systematic literature review was conducted to identify factors in the inpatient healthcare environment that support an optimal healing environment. The PICO question for this review was what design factors in the inpatient healthcare environment support an optimal healing environment? A search of five databases and a hand search of reference lists were conducted. The search included studies from 1980 to the present, original research conducted on inpatient units with adult patients that investigated an intervention with an outcome that promotes a healing environment. Experimental, quasi-experimental, non-experimental, systematic literature reviews and expert opinions were sought and evaluated using a scale to analyze scientific rigor and research quality. Results: A total of 6,874 articles were identified in the search. Seventy-six articles were eligible for full text screening. After review of the full text, 38 articles were determined to be eligible for evidence analysis. After removing 11 inadmissible articles due to poor quality, 27 articles were included in the final synthesis. The search found research on eight hospital design features which may support optimal healing environments: artwork (n = 7), building configuration (n = 2), finish materials (n = 7), interior details (n = 6), lighting (n = 11), nature and view (n = 8), noise (n = 10), room configuration (n = 6). More than 50% of the research on optimal healing environments used quasi-experimental and non-experimental designs with rare use of experimental research designs. Overall, the quality of the research on optimal healing environments is not high, but results were reasonably consistent across studies. Conclusions: Evidence suggests seven design features for healing inpatient psychiatric environments, including: (a) single rooms, (b) calm, naturalistic and domestic artwork or photographs, (c) east facing windows, (d) plants, (e) acoustic ceiling tiles, (f) patient rooms removed from noise producing unit areas and (g) a window view of nature. These seven recommendations were examined for consistency with existing Arizona statutes and industry standards for behavioral health care environments. Recommendations found to be inconsistent with these statutes and standards were modified to reach congruency with the statutes and guidelines, and then an evidence-based design of a psychiatric inpatient room design was formulated and is illustrated. Future research on interventions to create healing environments at the greatest scientific rigor is needed along with measurement techniques to quantify stress responses to the environment.

abstract: Healthcare is one of the most personal and complex services provided, and as such, designing healthcare environments is particularly challenging. In the last couple of decades, researchers have concentrated their efforts on exploring the elements of the hospital environment that affect patients' health and in finding ways to apply that knowledge in contemporary healthcare design. But despite the growing body of research, there is an element of utmost importance to healing environments that has not been studied very extensively: the patient experience. The interaction of patients with their environment shapes their personal experience, and inversely, focusing on designing experiences rather than services can inform the design of successful healing environments. This shift from designing services to designing experiences has deep implications in healthcare settings because of the stressful situations that patients have to go through; memorable experiences have a positive influence on a patient's emotional health because they help minimize stress and in healthcare environments this translates into improved outcomes. The concept of assembling experiences is not new, especially in the entertainment industry; it was, in fact, the underlying principle behind the creation of the first theme park more than fifty years ago: Disneyland. Today, Disney is an entertainment industry leader and their design concepts and practices have been perfected to achieve the Company's main purpose: to immerse Guests in a happy, unforgettable experience. This research study focuses on examining the principles used by Disney designers, or Imagineers, as they are called within the organization, to generate memorable experiences, and how those theories can be adopted and adapted by healthcare designers to create better healing environments. However, Disney's Imagineering is not the only approach considered in this research. A thorough analysis would not be complete without delving into the concept of experiential design as a design process and from an economical perspective, as well as without analyzing recent notions about the importance of authenticity in businesses and its implications on design. This study, therefore, suggests a new healing environment design model based on a comprehensive review of the literature related to three main design approaches: Disney Imagineering, experiential design and authenticity. / Dissertation/Thesis / M.S.D. Design 2012

Although human beings continuously learn through their experiences and impressions, the most important years in determining all actions and decisions which will be made in life, are during childhood. In designing spaces for children, their perception of the built environment and interaction with their surroundings needs to be understood in terms of the influence that elements of architecture and the landscape have on their sensorial and motoric actions as well as social activities. FEEL + LEARN + HEAL, the subject of this dissertation, is a centre for childhood development and an ambulatory clinic, which will demonstrate how built environments enhance perceptual experience by means of sensory stimulation and healing environments. The study area is located on the urban edge, north east of Pretoria's Central Business District and forms a gateway into the city at a large intersection, where Boom, Soutpansberg, Dr. Savage and du Toit Street intersect. / Dissertation MArch(Prof)--University of Pretoria, 2012. / Architecture / MArch(Prof) / Unrestricted

La presente tesis desarrolla la creación y el diseño de un Centro de Salud Mental orientado a la prevención, tratamiento y control de trastornos mentales leves en el distrito de San Juan de Lurigancho, aplicando la teoría de la Neuroarquitectura y Entornos Curativos. Este proyecto tiene como objetivo, en trabajar la creación de una serie de lineamientos en base a como los aspectos perceptuales de los espacios en el diseño arquitectónico pueden contribuir a la recuperación de los pacientes, facilitando así la creación de una arquitectura sanadora. / This thesis develops the creation and design of a Mental Health Center aimed at the prevention, treatment and control of slight mental disorders in the district of San Juan de Lurigancho, applying the theory of Neuroarchitecture and Curative Environments. This project aims to work on the creation of a series of guidelines based on how the perceptual aspects of spaces in architectural design can contribute to the recovery of patients and facilitating the creation of a healing architecture. / Tesis

La présente étude concerne le rôle de l’aménagement intérieur dans les centres de santé, dans une perspective thérapeutique. Il s’agit d’une recherche théorique exploratoire. Le cadre théorique à l’intérieur duquel elle s’effectue comprend la Biopolitique de Michel Foucault, du Sens de cohérence d’Aaron Antonovsky, ainsi que de La théorie des environnements reconstituants de Kaplan & Kaplan. Chacune de ces approches vise à mieux saisir le problème de la thérapeutique dans son rapport avec la santé, ainsi qu’à dégager des éléments permettant d’enrichir et d’apporter un regard autre sur le thème à l’étude, à savoir, celui des environnements thérapeutiques. C’est ainsi que nous proposons six concepts que sont l’exclusion/l’isolement, le pouvoir, les interactions sociales, le soutien social, le plaisir et la réflexion. Une étude de cas effectuée au Centre de réadaptation Estrie vise à vérifier leur validité. Cet établissement, qui fait partie du Réseau de la santé et des services sociaux du Québec, est également un membre désigné du Réseau Planetree, dont la mission est vouée au développement de pratiques gestionnaires respectueuses de la dimension humaine dans les centres de santé. La qualité de l’environnement physique étant l’une des dix composantes du modèle promu par cette organisation, l’analyse, en vue de la validation ou du rejet des concepts issus du cadre théorique, concerne leur articulation dans le concret. Nous retenons des quatre concepts que sont les interactions sociales, le soutien social, le plaisir et la réflexion, qu’ils sont valides, et rejetons l’exclusion/isolement et le pouvoir. Des propositions de remplacement pour ces deux derniers sont soumises, soit, les limites/l’’intimité et l’emprise. La principale piste de sujet de recherches futures est le développement de la notion « d’accueil », où l’aménagement intérieur joue, à ce titre, un rôle dans les milieux de santé. / The present study considers the role of interior design in health centers in a therapeutic way. It is a theoretical exploratory research. The framework within which it is performed comprises the Biopolitics of Michel Foucault, the Sense of Coherence of Aaron Antonovsky, and the Restorative Environments from Kaplan & Kaplan. Each of these approaches is to provide a better understanding of the therapeutic question in its relation to health, and to identify elements to further enrich and to give another view on the thematic issue – that is, Healing Environments. We suggest six concepts: exclusion/isolation, power, social interactions, social support, pleasure and reflection. A case study aimed at examining their validity is carried out in the Centre de réadaptation Estrie. This facility, part of the Réseau de la santé et des services sociaux du Québec, is also a designated member of Planetree, whose mission is devoted to the development of management practices respectful of the human dimension in the health care environment. The quality of the physical environment being one of the ten key components of the model promoted by this organisation, the analysis, in view of the validation or the rejection of the concepts drawn from the theoretical framework, concerns the concrete forms given to these concepts. Hence, we retain: social interactions, social support, pleasure and reflection, and reject exclusion/isolation and power. Alternative proposals for these last two concepts are submitted: limits/privacy and empowerment. The principal suggestion for future research is the development of the notion of “welcome”, where interior design plays, as such, a role in health care environments.

La présente étude concerne le rôle de l’aménagement intérieur dans les centres de santé, dans une perspective thérapeutique. Il s’agit d’une recherche théorique exploratoire. Le cadre théorique à l’intérieur duquel elle s’effectue comprend la Biopolitique de Michel Foucault, du Sens de cohérence d’Aaron Antonovsky, ainsi que de La théorie des environnements reconstituants de Kaplan & Kaplan. Chacune de ces approches vise à mieux saisir le problème de la thérapeutique dans son rapport avec la santé, ainsi qu’à dégager des éléments permettant d’enrichir et d’apporter un regard autre sur le thème à l’étude, à savoir, celui des environnements thérapeutiques. C’est ainsi que nous proposons six concepts que sont l’exclusion/l’isolement, le pouvoir, les interactions sociales, le soutien social, le plaisir et la réflexion. Une étude de cas effectuée au Centre de réadaptation Estrie vise à vérifier leur validité. Cet établissement, qui fait partie du Réseau de la santé et des services sociaux du Québec, est également un membre désigné du Réseau Planetree, dont la mission est vouée au développement de pratiques gestionnaires respectueuses de la dimension humaine dans les centres de santé. La qualité de l’environnement physique étant l’une des dix composantes du modèle promu par cette organisation, l’analyse, en vue de la validation ou du rejet des concepts issus du cadre théorique, concerne leur articulation dans le concret. Nous retenons des quatre concepts que sont les interactions sociales, le soutien social, le plaisir et la réflexion, qu’ils sont valides, et rejetons l’exclusion/isolement et le pouvoir. Des propositions de remplacement pour ces deux derniers sont soumises, soit, les limites/l’’intimité et l’emprise. La principale piste de sujet de recherches futures est le développement de la notion « d’accueil », où l’aménagement intérieur joue, à ce titre, un rôle dans les milieux de santé. / The present study considers the role of interior design in health centers in a therapeutic way. It is a theoretical exploratory research. The framework within which it is performed comprises the Biopolitics of Michel Foucault, the Sense of Coherence of Aaron Antonovsky, and the Restorative Environments from Kaplan & Kaplan. Each of these approaches is to provide a better understanding of the therapeutic question in its relation to health, and to identify elements to further enrich and to give another view on the thematic issue – that is, Healing Environments. We suggest six concepts: exclusion/isolation, power, social interactions, social support, pleasure and reflection. A case study aimed at examining their validity is carried out in the Centre de réadaptation Estrie. This facility, part of the Réseau de la santé et des services sociaux du Québec, is also a designated member of Planetree, whose mission is devoted to the development of management practices respectful of the human dimension in the health care environment. The quality of the physical environment being one of the ten key components of the model promoted by this organisation, the analysis, in view of the validation or the rejection of the concepts drawn from the theoretical framework, concerns the concrete forms given to these concepts. Hence, we retain: social interactions, social support, pleasure and reflection, and reject exclusion/isolation and power. Alternative proposals for these last two concepts are submitted: limits/privacy and empowerment. The principal suggestion for future research is the development of the notion of “welcome”, where interior design plays, as such, a role in health care environments.