Doctor of Philosophy (PhD) / This study was conducted to increase our understanding of children and young people’s experience of a hospital environment and to identify the salient attributes of the physical environment in their experience. There were three specific aims: to describe children and young people’s experience of a hospital environment and identify what constitutes a supportive paediatric environment; to examine the role of the physical environment in patients’ feeling of well-being; and to highlight the capacity of participatory research with children and young people to inform evidence-based paediatric design. At this stage, there has been very little healthcare design research carried out with populations of children and young people. Well-being research with children and young people in paediatric environments that identifies the potential supportive attributes in this environment is also very limited. Historically research on children’s health and well-being has been dominated by a focus on the prevalence of disorders, problems and disabilities. More recently, in response to the change to health promotion, positive attributes have been included in well-being and satisfaction measures. At this stage, there are still many fewer positive measures. Within the body of literature that exists in healthcare, healthcare design research, and well-being research, there are only a small number of participatory studies that focus on children and young people’s experience of hospitalisation, and an even smaller number that include children and young people’s experience of hospital environments. The picture that is created by the research that exists is patchy. There is a need for a more holistic understanding of children and young people’s experience of hospitalisation and of hospital environments from their own perspectives. Based on these gaps in current knowledge, two research questions were developed. The first was concerned with describing children and young people’s experience of the sociophysical environment of a paediatric hospital. The second question was concerned with understanding the role of the physical environment in children and young people’s feeling of well-being in a hospital environment. In addressing these questions, the intention was to identify attributes within the hospital setting which collectively comprise a supportive environment for children and young people and which contribute to children and young people’s feeling of well-being in a paediatric setting. The current study was conducted as an exploratory qualitative case study and carried out at the Children’s Hospital at Westmead, in Sydney, Australia. Using participatory research techniques, the sequence of the study included two pilot studies and the main study. The focus was on understanding the experiences of longer-term patients of a paediatric hospital environment. In the main study 25 children and young people, aged between 9-18 years, who had been in hospital for at least a week completed semi-structured interviews in which they talked about their response to the environment of the hospital and their experience of hospitalisation. Data analysis was completed using a combination of concept mapping and thematic analysis techniques. Preliminary findings were used as the basis of a further member-checking task carried out with a further six children and young people before conclusions were reached. The findings reveal that children and young people’s experience of a paediatric setting involves a number of major areas of influence including their personal situation, their social experience, their interaction with the physical environment, opportunities and characteristics of the organisation, and the effect of time. The findings also reveal that children’s feeling of well-being within this experience is linked to their ability to feel comfortable in the environment, to maintain a positive state of mind, and to remain positively engaged with the experience and the environment. This research reveals a dynamic relationship between children and young people and a paediatric environment that children and young people actively manage and shape. It reveals some of the key considerations in children and young people’s experience of hospitalisation. It also reveals why these considerations are important and what role they play in patients’ experience and feeling of well-being. These findings provide the basis for further research and they have implications for future design and research practice in paediatric healthcare settings.

Orientador: Leandro Silva Medrano / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Civil, Arquitetura e Urbanismo / Made available in DSpace on 2018-08-10T16:17:10Z (GMT). No. of bitstreams: 1 Mendes_AnaCarolinaPotier_M.pdf: 11110490 bytes, checksum: 5e512348563255bb23ffc98000aedcd0 (MD5) Previous issue date: 2007 / Resumo: A maior competitividade do mercado de assistência à saúde, o avanço das ciências médicas e as constantes necessidades de incorporação de novas tecnologias e de aprimoramento de instalações físicas têm levado hospitais a buscarem meios de organizar e direcionar suas ações e investimentos. Entretanto, em grande parte dessas estruturas encontram-se situações de obsolescência, improvisação e dificuldade de atualização espacial, causadas, entre outros motivos, pela falta de planejamento da área física. Nesse sentido, o plano diretor destaca-se como importante instrumento de direcionamento de ações por ser o elo de ligação entre o planejamento estratégico e a arquitetura do empreendimento. Assim, o objetivo da pesquisa é reunir conceitos e informações sobre a elaboração de planos diretores físicos hospitalares, com foco na abordagem metodológica em função da elevada complexidade que envolve o tema. A primeira parte do trabalho apresenta uma revisão bibliográfica que descreve a importância do planejamento físico hospitalar e o papel do arquiteto nesse processo, influenciado pela característica intrínseca dos hospitais que é a complexidade. São apresentados métodos e exemplos de planos diretores tanto nacionais quanto estrangeiros. Na segunda parte da pesquisa são analisados princípios e métodos utilizados por três arquitetos brasileiros no processo de elaboração de planos diretores hospitalares, relacionando-os com a revisão bibliográfica. Também é estudado o currículo de cada um dos arquitetos com o intuito de caracterizar parte da produção dos planos no país. Em síntese, a dissertação tem como intenção contribuir para o aprimoramento do trabalho de arquitetos, engenheiros e consultores que atuam no setor de saúde, e levar ao conhecimento de gestores, proprietários, órgãos públicos e outros o conceito e a importância de um plano diretor físico hospitalar / Abstract: The increasing healthcare market competitiveness, the evolution in medical sciences, the constant necessities of new technology incorporation and of improvement in infrastructure have lead hospitals to search for ways of organizing and guiding their actions and investments. However, situations of obsolescence, improvisations and difficulties in updates are found in most of these buildings, caused, among other things, by the lack of area planning. From this master plan comes an important instrument of guiding the actions, once it links the strategic planning and the architecture of the establishment. Thus, the objective of this research work is to gather information and concepts about hospital master plans, through a methodological approach due to the high complexity involved. The first part of the work refers to the bibliographical review which describes the importance of hospital area planning and the role of the architect in this process, which is influenced by complexity, an intrinsic characteristic of hospitals. Methods and examples of plans are presented, both national and international ones. In the second part of the work, principles and methods on master planning used by three Brazilian architects are analyzed, relating them to the bibliographical review. It also analyzed the résumé of each architect in order to characterize part of the production of plans in the country. In this sense, it is expected to achieve the main objective of the research, besides contributing to the work of architects, engineers and consultants of the health system, and bringing knowledge to managers, owners, public institutions and others, about the importance of a hospital master plan / Mestrado / Arquitetura e Construção / Mestre em Engenharia Civil

The thesis focuses on analysis and design of a special hospital bed designed for the department of anesthesiology and resuscitation. The design was based on the rules set by the ČSN EN 60601-2-52 norm. The bed is adjusted for the use at the department of anesthesiology and resuscitation not only with its look but also with its functions. The design emphasizes the ergonomics of the bed, safety and the needs of the patient as well as of the staff and also an easy maintenance of the bed. Some of the main innovative elements are: basal stimulation system placed directly in the bed, used colors, more infusion-rack holders or a headboard fixed to the construction of the bed if not needed. The bed was designed especially to provide more comfort to the patient.

Information visualization aims at creating visually concrete representations of big and abstract data. Research shows that the subject has good potential when it comes to conveying information within many various sectors. However, there is a scarce range of research defining a design space for information visualization tools with the aim of trying to convey clear and true information that is completely understandable for many different target groups with varying educational background, cognitive state, etc. To explore the gap of such design and the potential that information visualization has towards it, a study was conducted to gather the experience of healthcare practitioners with various experience of examining and presenting results to patients with a certain condition. To gather their opinions and thoughts, semi-structured interviews were used and from the results, four defined design aspects emerged. These four emerged design aspects have potential to work as a base when designing a future design concept.

Patient falls are the most commonly reported "adverse events" in hospitals, according to studies conducted in the U.S. and elsewhere. The rate of falls is not high (2.3 to 7 falls per 1,000 patient days), but about a third of falls result in injuries or even death, and these preventable events drive up the cost of healthcare and, clearly, are harmful outcomes for the patients involved. This study of a private hospital, Dublin Methodist Hospital, in Dublin, Ohio analyzes data about patient falls and the facility's floor plans and design features and makes direct connections between hospital design and patient falls. This particular hospital, which was relatively recently constructed, offered particular advantages in investigating unit-layout-related environmental factors because of the very uniform configuration of its rooms, which greatly narrowed down the variables under study. This thesis investigated data about patients who had suffered falls as well as patients with similar characteristics (e.g., age, gender, and diagnosis) who did not suffer falls. This case-control study design helps limit differences between patients. Then patient data was correlated to the location of the fall and environmental characteristics of the locations, analyzed in terms of their layout and floor plan. A key part of this analysis was the development of tools to measure the visibility of the patient's head and body to nurses, the relative accessibility of the patient, the distance from the patient's room to the medication area, and the location of the bathroom in patient rooms (many falls apparently occur during travel to and from these areas). From the analysis of all this data there emerged a snapshot of the specific rooms in the hospital being analyzed where there was an elevated risk of a patient falling. While this finding is useful for the administrators of that particular facility, the study also developed a number of generally applicable conclusions. The most striking conclusion was that, for a number of reasons, patients whose heads were not visible from caregivers working from their seats in nurses' stations and/or from corridors had a higher risk of falling, in part because staff were unable to intervene in situations where a fall appeared likely to occur. This was also the case with accessibility; patients less accessible within a unit had a higher risk of falling. The implications for hospital design are clear: design inpatient floors to maximize a visible access to patients (especially their heads) from seats in nurses' stations and corridors.

Esta pesquisa aborda o ambiente da sala de exames de Ressonância Magnética (RM), um dos principais exames de diagnóstico médico por imagem. A partir de um estudo de caso, usuários internos (funcionários) e usuários externos (pacientes) de um Estabelecimento Assistencial de Saúde (EAS) expressaram suas percepções acerca da experiência com o referido exame por meio de entrevista e questionários formulados com o apoio da avaliação pós-ocupação (APO). Observou-se que as mulheres são as principais desistentes na realização dos exames, alegando claustrofobia. Também foi observado que o próprio aparelho de RM causa emoções contraditórias nos pacientes, ora despertando medo, ora, satisfação. Fica claro que o ambiente é fator de influência das emoções e que os dados coletados nessa pesquisa serão norteadores para projetos futuros, como, por exemplo, uma proposta de design do ambiente de exames com foco na humanização e com intenções de melhorar a experiência dos examinados com o procedimento. / This research addresses the MRI examination room environment (MRI), which is considered one of the main medical imaging tests. Using a case study methodology, both internal users (employees) and external users (patients) were interviewed and were asked to express their perceptions regarding the experience with the procedure. The interview and questionnaires were based on the framework of postoccupancy evaluation (POE). It was observed that women are the main dropouts in MRI scans, claiming claustrophobia. It was also observed that the scanner itself is likely to evoke mixed emotions in patients, sometimes arousing fear and sometimes arousing satisfaction. This study makes it clear that the environment is a key factor in shaping emotions and that the data collected in this survey will serve as a guide for future projects, such as a proposal for design focusing on environmental humanization that aims at improving the experience with this medical procedure.

Esta pesquisa aborda o ambiente da sala de exames de Ressonância Magnética (RM), um dos principais exames de diagnóstico médico por imagem. A partir de um estudo de caso, usuários internos (funcionários) e usuários externos (pacientes) de um Estabelecimento Assistencial de Saúde (EAS) expressaram suas percepções acerca da experiência com o referido exame por meio de entrevista e questionários formulados com o apoio da avaliação pós-ocupação (APO). Observou-se que as mulheres são as principais desistentes na realização dos exames, alegando claustrofobia. Também foi observado que o próprio aparelho de RM causa emoções contraditórias nos pacientes, ora despertando medo, ora, satisfação. Fica claro que o ambiente é fator de influência das emoções e que os dados coletados nessa pesquisa serão norteadores para projetos futuros, como, por exemplo, uma proposta de design do ambiente de exames com foco na humanização e com intenções de melhorar a experiência dos examinados com o procedimento. / This research addresses the MRI examination room environment (MRI), which is considered one of the main medical imaging tests. Using a case study methodology, both internal users (employees) and external users (patients) were interviewed and were asked to express their perceptions regarding the experience with the procedure. The interview and questionnaires were based on the framework of postoccupancy evaluation (POE). It was observed that women are the main dropouts in MRI scans, claiming claustrophobia. It was also observed that the scanner itself is likely to evoke mixed emotions in patients, sometimes arousing fear and sometimes arousing satisfaction. This study makes it clear that the environment is a key factor in shaping emotions and that the data collected in this survey will serve as a guide for future projects, such as a proposal for design focusing on environmental humanization that aims at improving the experience with this medical procedure.

Esta pesquisa aborda o ambiente da sala de exames de Ressonância Magnética (RM), um dos principais exames de diagnóstico médico por imagem. A partir de um estudo de caso, usuários internos (funcionários) e usuários externos (pacientes) de um Estabelecimento Assistencial de Saúde (EAS) expressaram suas percepções acerca da experiência com o referido exame por meio de entrevista e questionários formulados com o apoio da avaliação pós-ocupação (APO). Observou-se que as mulheres são as principais desistentes na realização dos exames, alegando claustrofobia. Também foi observado que o próprio aparelho de RM causa emoções contraditórias nos pacientes, ora despertando medo, ora, satisfação. Fica claro que o ambiente é fator de influência das emoções e que os dados coletados nessa pesquisa serão norteadores para projetos futuros, como, por exemplo, uma proposta de design do ambiente de exames com foco na humanização e com intenções de melhorar a experiência dos examinados com o procedimento. / This research addresses the MRI examination room environment (MRI), which is considered one of the main medical imaging tests. Using a case study methodology, both internal users (employees) and external users (patients) were interviewed and were asked to express their perceptions regarding the experience with the procedure. The interview and questionnaires were based on the framework of postoccupancy evaluation (POE). It was observed that women are the main dropouts in MRI scans, claiming claustrophobia. It was also observed that the scanner itself is likely to evoke mixed emotions in patients, sometimes arousing fear and sometimes arousing satisfaction. This study makes it clear that the environment is a key factor in shaping emotions and that the data collected in this survey will serve as a guide for future projects, such as a proposal for design focusing on environmental humanization that aims at improving the experience with this medical procedure.

A presente pesquisa busca demonstrar, por meio da Avaliação Pós-Ocupação (APO) funcional, os procedimentos mais adequados para alimentar processos de projeto arquitetônico para centros de diagnóstico por imagem em unidades autônomas, visando colaborar com a elaboração de programas de necessidades mais próximos das necessidades efetivas dos usuários de edifícios complexos dessa natureza. Está centrada na ênfase à flexibilidade do edifício e à funcionalidade da compartimentação dos seus ambientes. Os centros de diagnóstico representam um setor em expansão, apresentam alta rotatividade de equipamentos, sempre de última geração, com uma dinâmica de adaptação espacial acelerada, requerendo revisões e ampliações constantes. São, pela própria natureza, promotores do reuso de edifícios, uma vez que a maioria se encontra em casas adaptadas. Via de regra, estão localizados em grandes centros urbanos. A metodologia da Avaliação Pós-Ocupação (APO) funcional foi aplicada no decorrer do uso em dois centros de diagnóstico por imagem na cidade de Campinas, São Paulo, uma vez que a detecção de problemas após a ocupação é imprescindível como insumo para futuras ampliações e adaptações inerentes à realidade das unidades de diagnóstico em geral. Os estabelecimentos foram estudados dos pontos de vista do seu projeto, construção e uso. Observou-se de que forma ocorre o uso dos ambientes pelos seus usuários, levando-se em conta seus aspectos positivos e aspectos a serem melhorados. As bases teóricas da pesquisa abordaram temas relativos a estudos de caso constantes na literatura, o estudo das normas brasileiras pertinentes, bem como o estudo de um importante centro de radiologia referencial situado na cidade de São Paulo, um benchmark na área de diagnóstico por imagem. Os resultados da pesquisa demonstraram que as abordagens teóricas e práticas são complementares. Dentre os resultados obtidos, é possível considerar que o estudo dos fluxos de usuários, a aplicação dos grupos focais e as observações comportamentais dos usuários podem contribuir em diversos temas na elaboração dos projetos de centros de diagnóstico por imagem e ser adotados para a gestão da qualidade desse tipo de ambiente da saúde. / The present research intends to show, through the Functional Post-Occupancy Evaluation, the most suitable procedures to feed the architectural design processes for imaging centers of diagnosis in autonomous units, aiming at to collaborate with the development of architectural programming to meet user requirements of complex buildings of such nature. It focused on the building flexibility and in the functionality of the environment share. The centers of diagnosis represent a growing industry, present a high last generation equipment turnover, with a dynamics of speed up environment adjustment, requiring constant reviews and enlargements. They are, by nature, promoters of buildings reuse, once most of them are adapted houses and are generally located in large urban centers. The Functional Post-Occupancy Evaluation methodology was applied during the use of two centers of diagnosis in Campinas city, at São Paulo state, as the detection of post occupation problems is essential for future adaptations and extensions inherent to diagnostic units reality in general. The sites were studied in terms of its architectural design and its use. It was noted how is the use of environments by their users, taking into account its positive aspects and the aspects to be improved. The theoretical bases of the research approached themes are related to case studies in the literature, the study of Brazilian standards and the study of a major referential center of radiology located at the city of São Paulo, a benchmark in the field of diagnosis by image. The survey results showed that the theoretical and practical approaches are complementary. Among the results, it can be considered that the study of the flow of users, the application of focus groups and the observations of user behavior can help on several issues in the development of designs for the imaging centers of diagnosis and are used to manage the quality of this type of health environment.

A presente pesquisa busca demonstrar, por meio da Avaliação Pós-Ocupação (APO) funcional, os procedimentos mais adequados para alimentar processos de projeto arquitetônico para centros de diagnóstico por imagem em unidades autônomas, visando colaborar com a elaboração de programas de necessidades mais próximos das necessidades efetivas dos usuários de edifícios complexos dessa natureza. Está centrada na ênfase à flexibilidade do edifício e à funcionalidade da compartimentação dos seus ambientes. Os centros de diagnóstico representam um setor em expansão, apresentam alta rotatividade de equipamentos, sempre de última geração, com uma dinâmica de adaptação espacial acelerada, requerendo revisões e ampliações constantes. São, pela própria natureza, promotores do reuso de edifícios, uma vez que a maioria se encontra em casas adaptadas. Via de regra, estão localizados em grandes centros urbanos. A metodologia da Avaliação Pós-Ocupação (APO) funcional foi aplicada no decorrer do uso em dois centros de diagnóstico por imagem na cidade de Campinas, São Paulo, uma vez que a detecção de problemas após a ocupação é imprescindível como insumo para futuras ampliações e adaptações inerentes à realidade das unidades de diagnóstico em geral. Os estabelecimentos foram estudados dos pontos de vista do seu projeto, construção e uso. Observou-se de que forma ocorre o uso dos ambientes pelos seus usuários, levando-se em conta seus aspectos positivos e aspectos a serem melhorados. As bases teóricas da pesquisa abordaram temas relativos a estudos de caso constantes na literatura, o estudo das normas brasileiras pertinentes, bem como o estudo de um importante centro de radiologia referencial situado na cidade de São Paulo, um benchmark na área de diagnóstico por imagem. Os resultados da pesquisa demonstraram que as abordagens teóricas e práticas são complementares. Dentre os resultados obtidos, é possível considerar que o estudo dos fluxos de usuários, a aplicação dos grupos focais e as observações comportamentais dos usuários podem contribuir em diversos temas na elaboração dos projetos de centros de diagnóstico por imagem e ser adotados para a gestão da qualidade desse tipo de ambiente da saúde. / The present research intends to show, through the Functional Post-Occupancy Evaluation, the most suitable procedures to feed the architectural design processes for imaging centers of diagnosis in autonomous units, aiming at to collaborate with the development of architectural programming to meet user requirements of complex buildings of such nature. It focused on the building flexibility and in the functionality of the environment share. The centers of diagnosis represent a growing industry, present a high last generation equipment turnover, with a dynamics of speed up environment adjustment, requiring constant reviews and enlargements. They are, by nature, promoters of buildings reuse, once most of them are adapted houses and are generally located in large urban centers. The Functional Post-Occupancy Evaluation methodology was applied during the use of two centers of diagnosis in Campinas city, at São Paulo state, as the detection of post occupation problems is essential for future adaptations and extensions inherent to diagnostic units reality in general. The sites were studied in terms of its architectural design and its use. It was noted how is the use of environments by their users, taking into account its positive aspects and the aspects to be improved. The theoretical bases of the research approached themes are related to case studies in the literature, the study of Brazilian standards and the study of a major referential center of radiology located at the city of São Paulo, a benchmark in the field of diagnosis by image. The survey results showed that the theoretical and practical approaches are complementary. Among the results, it can be considered that the study of the flow of users, the application of focus groups and the observations of user behavior can help on several issues in the development of designs for the imaging centers of diagnosis and are used to manage the quality of this type of health environment.