RestorativeRecovery Spaces Renewal
Foreword Project Statement Facts DeďŹ nitions & Reactions Criteria Visual Studies Partnerships Design Theories Spatial Programming Restorative Techniques R.Space Archeworks Team Resources
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the designer and in conjunction with Archeworks. COPYRIGHT ÂŠ 2003 Kerl LaJeune/Archeworks CREATED, AND DESIGNED BY KERL LAJEUNE Editorial Assistance by Heidi Lubin Work generated by Archeworks Participants with Facilitators
03 05 07 13 15 19 33 37 46 49 58 62 64
Foreword There are 126,000 nursing positions currently unﬁlled in hospitals around the country.
--American Hospital Association
It is estimated that by 2020, there will be at least 400,000 fewer nurses available to provide care than will be needed. -- Journal of the American Medical Association And the problem isn’t just in the United States. According to the World Health Organization, health ofﬁcials in nations as diverse as Canada, Poland, and Chile report that qualiﬁed nurses are becoming harder and harder to ﬁnd. Given the magnitude of the nursing shortage - nurses are a critical link in patient care - many organizations have eagerly sought solutions that might positively impact this increasingly dire situation. Some typical recommendations are: “Reduce patient load. “Create interdisciplinary environments that stimulate interaction between and among health care professionals, patients and communities. “Create patient care models that encourage professional nurse autonomy and clinical decision-making. “Reposition nursing as a versatile profession where young people can learn science and technology, customer service, critical thinking and decision-making. “Implement and sustain a marketing effort that addresses the image of nursing and the recruitment of qualiﬁed students into the ﬁeld. Although each of these recommendations has the potential for strong impact it is surprising that little mention is made of retention and rarely are concrete action plans developed with this stated goal. It is in this context that we, the restorative spaces team, have sought to answer the question “how can the built environment support employee retention and improve staff morale? In our opinion, this is where good design can create the most value in a healthcare environment that is already strapped for funds.
Foreword Analysts advocate that the most effective way to create good design in the workplace is to begin with the work, then address the worker and, ﬁnally, the workplace. In our case, this posed a substantial challenge and we’ve done our best over the last eight months to stand in nurses’ shoes, understand their routines and engage with the complex and, often bureaucratic, world of healthcare. In that time we have struggled to recognize that there are many things related to this project that we cannot impact like shift assignment, wages, and stafﬁng levels. We have worked just as hard to deﬁne areas we might hope to change. And we have come to believe that design, of ﬁnancial policies, buildings, interiors, graphics, and gardens will be important to creating a positive outcome in an increasingly dire situation. The following booklet is illustrative of the meandering path we traveled, our successes and our failures.
by Heidi S. Lubin, History/Globolization 2002-03 Archeworks Participant
Restorative Spaces for Work, Health & Community In response to the alarming social need in the health services area, Archeworks will research the cause of the shortage of health professionals, identify design methods that will address the issues. Our goal will be to develop prototype restorative spaces that will improve staff morale and decrease staff turnover.
Restore Recover Renew
This project addresses the crisis in morale among hospital nurses. That crisis is manifested in widespread burnout and early retirement among individual nurses, contributing to a decline in quality of patient care and potentially leading to severe shortages of skilled, committed professionals within the healthcare sector. Restorative spaces (areas that promote renewal of energy, spirit, sense of life balance, and overall wellbeing) counteract job stresses and facilitate many forms of self-nurturance. Such self-nurturance is linked to higher individual morale and also to constructive activities to change the structural factors that cause low morale in the ﬁrst place. The principles of this project is to develop and consolidate current information about restorative-space design principles and speciﬁc design elements, using either a site speciﬁc health facility or a prototypical environment. The ultimate goal will involve several steps, including the creation and installation of restorative spaces at health care institutions; reﬁnement and supplementation of design concepts introduced and developed.
Nursing is demanding, exhausting, stressful work; those characteristics have serious consequences for individual nurses, for healthcare institutions, and for the overall delivery of health services. The human toll, on individual nurses, is summed up in a quotation from a recent Washigton Post story: It is terrible to go to work and feel that you are doing an inadequate job, especially with patients’ lives. Most nurses don’t mind working hard. Working impossible is another story. And the response from management is, “Do the best you can.” Well, when the best I can do is no longer good enough, this RN --like thousands before me -- will leave the bedside. Few statements could capture the essence of the nursing morale problem as well as that one -- the sense of personal and professional inadequacy; the disappearance of hope for positive change; the expectation of further disappointment; the alienation from organizational management.
Health Care Industry What What What What What
can the built environment do in order to support employee retention and improve staff morale? are the critical issues and problems revolving around providers and patients? are the components of routine like shift assignments, wages, and stafďŹ ng levels make an impact? are the challenges that can or cannot be controlled? are the characteristics that can have serious consequences for providers and healthcare institutions?
Restore Recover Renew
StafďŹ ng Shortage
Report ties nursing shortage to deaths:
Surgical patients face higher risks of death and injury from infections and other preventable complications if nurses workloads exceed four patients per shiftâ€Ś
- Chicago Tribune, 10-26-2002
In a typical 300 bed facility,
occur each day. - Study: Archives of Internal Medicine
There are roughly 21,000
fewer nursing students today than in 1995. - American Association of Colleges of Nursing
90% of long term care organizations,
lack sufďŹ cient nurse stafďŹ ng to provide even the most basic of care. - Centers for Medicare and Medicaid Services
70.5% of nurses,
suffer from chronic effects of stress and overwork.
On average, nurses work 8 1/2 weeks of overtime per year. - Service Employees International Union (SEIU) Over 30 minutes of every taken up by paperwork. - NBBJ: Symposium on Health Care Design 10-4-2002
minutes of care is
Quality of Care
Nationwide, at least 50 medical facilities required a surgical nurse to take a shift in the last ďŹ ve years.
- Department of Health and Human Services
12 or more patients on
59.4% of nurses
are concerned about a disabling back injury - Recent ANA Health and Safety Survey 2002
Costs due to back injuries resulting
from nurses lifting patients: Treatment per nurse: $25,000 Lift-enabling beds: $16,500 - Hill-Rom/Bureau of Labor and Statistics
Deﬁnitions & Reactions Team Reaction
What did the phrase “Restorative space” mean? What would be considered restorative? The premise of this project is that, in the United States, issues of heavy workload, low morale and quality of care are affecting staff turnover. Design is not typically involved in a solution to these problems. But we believe there is an opportunity for design to have a profound effect.
Restore Recover Renew
(ri stor’e tiv)
Restoring Health, consciousness, etc.
Another deﬁnition of restorative is based upon research initiated by Dr. Patricia Novick who found that there are speciﬁc positive and biological responses to simple matters of self-care such as proper eating and deep breathing. She also found that there can be a restorative biological response to color, sound and other external factors. After site visits, panel discussions, research and site observations we have augmented that deﬁnition by introducing design as an interactive method. We’ve been thinking about introducing restorative elements into everyday routine, all the while mindful of the fact that different people ﬁnd different things restorative. “Architects restore themselves drinking a cold Pint at the Bar”
Brad Lynch/Kerl LaJeune, Facilitators
There is growing use within organizations for restorative spaces (i.e. healthcare, education, corporate, not-forproﬁt, community based) to aid individual self-nurturance, and increasing attention to the complex design elements that maximize the effectiveness of such spaces. “Studies have shown that restorative spaces have a therapeutic value for patients”
Create and implement micro concepts that impact the environments, products and spaces utilized by health care professionals. Understanding that health spaces are inherently inert and adaptable, emphasis will investigate to empower individual characteristics to assist in the development of group interaction through physical spaces. Conditions, causes, affects, analysis and research represent criteria that inform a grouping of elements, (E.S.P., Environment - Space - Product), that are related to conditions and/or acts that are restorative.
Restore Recover Renew
Micro Concepts.01 Health Economics: - Managed care, Nursing classiﬁcation. Case Study: - Gathered research of environments. - Interviews, site visits, etc.. Trends: - Industry facts or health norms relevant to serve as factual references of comparison. · Health ﬁeld, in/out patients, Level of care, age differentials, baby boom eras and affects, global changes and effects, existing research related to the profession.
Micro Concepts.02 Conceptual ideas: - Thoughts and relevant ideas generated in similar or tangential areas of the health profession. - Theoretical, practical, pragmatic, Environment prototypes, individual vs. group Physical characteristics: - Exploration of effects of health professionals within their environments while assessing personal needs. - Spatial needs, human comfort, content, biological needs (i.e. smoking, nutrition, bowel movement, air, sound, sensual perceptions, etc.) Design: - Ideas to be implemented from gathered research using architectural or design principles. - Built, Unbuilt, prototypical, Theoretical ideas not created and/or implemented, restorative spaces
Micro Concepts.03 Spatial conditions: - Conditions speciﬁc to spaces and their use in clinics and hospitals. - Areas of Focus: Clinic’s, Hospitals and other related zones Behavioral: - Understanding characteristics and patterns of behavior within clinics and hospitals though interaction between the various groups of people. · Groups: Patients, Nurses, Visitors Statistical Data: - Information gathered from sources researched to analyze. - Investigate causes, effects and conditions
Visual Studies Visual Studies
HIERARCHY - Segregation: Gender, Social Class, Race, Education, Private vs. Public, Rural vs. Urban, respect. GROUP INTERACTION - Communication, Nurses to each other / Nurses vs. Doctors, Self empowerment. QUALITY OF CARE - Teamwork: Communication (email or voice), Errors: equipment vs diagnosis, Collaborative Care. TECHNOLOGICAL ADVANCES - Electronic or interactive support for providers: pda’s, High Res. displays, video simulations. ENVIRONMENT - Location of ﬂoors & layout, Nurse Stations, Personal vs Public Environments, Physical space. RESTORATIVE TECHNIQUES - Humor and behavioral characteristics, Indoor Air Quality, Passage of Time for patients/nurses. DESIGN APPROACHES - Health Care speciﬁc, IAQ’s, Sick Building Syndrome, Natural approaches, material usage, layout. STAFF TURN-OVER - Statistical Data, Lack of entry into the profession. ROUTINE - Daily Routines and Interruptions, Individual (Nurses), Actual Data: Visits, Interviews, Focus Groups.
In an effort to consolidate and continue criteria development, the group generated a more specialized listing of issues related to health care. Individual research and data was gathered and presented for further assessment and discussion. The collage process translated the written and gathered research into visually represented ideas that could develop further into conceptual physical studies.
“Photomontage can say much more than the proverbial thousand words. Among the great inventions of the twentieth century, and still in its swaddling clothes, photomontage provides opportunities that have yet to be fully exploited. Photomontage is illustration by association, by juxtaposition, by subtlety. It collapses time and pulls extraneous elements together - an ideal instrument for storytelling and for the visualization of complex ideas. --- Paul Rand, graphic designer
â€œAmongst the arsenal of thinking methods, the process of collage making, though pervasive, occupies a disruptive position by using trash and deadness to form beauty. Collage is part of everyoneâ€™s experience and, however well it is understood, it seems to refer to a group of ephemeral things brought together by a logic that disturbs or negates, the status of the individual elements. --- Ben Nicholson, Studio Professor of Architecture at Illinois Institute of Technology in Chicago
The goal of this exercise was to compile a graphic representational assemblage of personal imagery, related to the health care issues, that due to research will communicate perceptions of space, serve as a critique and investigative research for the studio. The two dimensional drawings are composed of a collection of pieces arranged in a composition that become both reasonable and distressing. The work is based on previously created architectural, cinematic, landscape or sculptural compositions found in publications and other sources. All of the images were gathered from existing sources. They intrigue, becoming provocative and represent ideals of exceptionally imaginative spaces, exciting zones, crevices and interstitial spaces that are architecturally insightful.
Health care has become, a collective activity, but healthcare is not yet organized to support collective practice
Currently, the design of clinical environments contributes to nurseâ€™s frustrations.
Credentialism, Gender, and Race are still lingering at the roots of many stafďŹ ng issues.
Quality of Care
Increases in teamwork and the use of collaborative care models prevent errors.
Personal interaction and relationships are critical factors in reducing stress for a â€œhappyâ€? workforce.
Individuals ought to have the opportunity to engage in restorative activities individually and collectively.
Monotony and heavy workloads burden staff.
Clinical environments are often lacking of visual ties to cultural characteristics of the population.
Many hospitals are using technology to create efďŹ ciency, though with limited concerns for application.
Common practice incorporates light, color, texture, sound and temperature.
Staff reductions, budget cuts, and future staff shortfalls have increased turnover.
Health care has to be a collective activity but there is no existing framework to support this.
Partnerships In an effort to engage with the Chicago community, Archeworks froms partnerships to ensure that students are confronted by reallife, real-world, real-time situations. As part of this study, many institutions were consulted as partners to further research as site speciďŹ c facilities working towards solutions with the goal of developing products.
Advocate Bethany Hospital Rehabilitation Institute of Chicago Community Health
The restorative spaces team approached selected test sites with the goal of acquiring research information via interviews, video documentation, and observations. The site-based data was used to generate client speciďŹ c proposals and prototypical models for implementation within the larger healthcare system.
Restore Recover Renew
Advocate Bethany Hospital is an acute care community-based hospital in Chicago’s West Loop. The facility is part of the Advocate system serving a diverse metropolitan community. The patient population served is 67% African-American, 29% Hispanic, and 4% other. Over 67,000 people a year receive care via the inpatient and outpatient units of this comprehensive facility. Bethany’s philosophy is, and we quote “grounded in principles of human ecology, faith, and community-based health care. These principles arise from an understanding of the human being as a whole person in light of their relationship to God, themselves, their families and the society in which they live.” We observed that this philosophy is lived out in day to day activities; the chaplain’s prayer can be heard over the PA system everyday at 9am and 9pm.
Some of Bethany’s priorities related to space and design included the following: -- Reconceptualizing the nurse’s station to address trafﬁc ﬂow, workspace, and relaxation needs -- Conceiving a “refresh and rejuvenate center” for nurses -- Develop strategies to control sound ﬂow pursuant to the needs of hospitals for increasing information conﬁdentiality -- Create interactive spaces for communication amongst hospital staff, patients, and their families -- Address nurses needs for physical and mental therapy, with particular focus on exercise and dietary control Our liaison with Bethany Hospital has been helping to facilitate further research and interactive design development that will hopefully lead to a tangible product and/or space tailored to the needs and concerns of the facility and its providers.
The Rehabilitation Institute of Chicago The RIC offers different levels of care, including inpatient, day rehabilitation, and outpatients services, according to the special needs of each patient. At all levels of treatment, specialists from many disciplines are brought together to help patients progress. Each team is lead by a physiatrist, a physician who specializes in physical medicine and rehabilitation. Other members of the team could include rehabilitation nurses, pediatric-certiďŹ ed nurses, physical and occupational therapists, speech/language pathologists, psychologists, chaplains, social workers, rehabilitation engineers, recreation therapists, vocational counselors and respiratory specialists and many other health professionals. Through a collaborative approach, each team focuses on helping patients meet their individual goals, and get back to life.
Rehab Institute of Chicago
R.I.C. Staff People come from all over the world to work at RIC and comprise the extraordinary staff who are dedicated to helping patients rebuild their bodies and their lives. Their staff includes board-certiďŹ ed physiatrists (rehabilitation physicians), rehabilitation nurses, physical and occupational therapists, speech-language pathologists, psychologists, chaplains, social workers, rehabilitation engineers, therapeutic recreation specialists, vocational therapists and respiratory specialists.
Community Health Center - â€œA Free clinic serving the uninsuredâ€? Located on the far west side of Chicago Avenue within the hearth of the Latino community, this facility has been providing free healthcare to uninsured patients only for a few years. The staff is made up of volunteer providers from area Chicago hospitals and clinics that rotate on a two year cycle, twice a month for a four hour period. The center divides its working shift of the volunteers into sessions that become manageable for staff, providers and patients. They are funded by private patrons honoring their goals for the facility to focus on outpatient services with very little research initiatives. 65% of the patients are of Spanish and Polish heritage.
Restore Recover Renew
We believe that good design can provide the most value added. Time was spent on the project, analyzing what “good design”, in the context of the healthcare industry, could be. Our focused audience was primarily healthcare providers. We spoke with nurses, doctors, and healthcare administrators. Visits were organized to numerous sites including The Rehabilitation Institute of Chicago (the designed/the afﬂuent), the old Cook County Hospital (the under-resourced), Advocate Bethany Hospital (the private community hospital), and Community Health, (a free clinic near Humboldt Park).
Sustainability One change that we are observing in the healthcare industry is the increasing importance of green design. Healthcare has a huge and often negative impact on the environment. For example: “The healthcare industry generates approximately 2.4 million tons of medical waste, annually.” “Medical incinerators are one of the largest sources of dioxin (a known carcinogen) emissions in the U.S.” “And, perhaps most disturbingly, some of the chemicals that are routinely used in the manufacture of medical supplies have been found to leach into the bloodstream causing, in the case of DEHP which is used in IV bags, adverse effects to the male reproductive system.” Not suprisingly, people in healthcare were alarmed to learn that hospitals were making people sick. And, in response, many are turning to embrace the tenets of green design. Currently, The School of Nursing at the University of Texas in Houston is being built with 50 percent recycled materials, 50 percent sustainably harvested wood, a roof planted with trees, and no PVC piping. The U.S. Green Building Council has begun discussions about guidelines for health care facilities. And, perhaps most exciting, large healthcare management organizations, like Kaiser Permanente, which has 8.4 million members, are starting to phase out the use of PVCs and other chemicals. Sustainability, is undoubtedly a strong design concept to work with in our research and development.
Adaptability Another industry trend is related to the continual need for adaptability. Although healthcare is often slow to change, once the evidence is substantial (or captures media attention), change can happen very rapidly; witness the move away from PVCs and medical incineration. Further, technology evolves so quickly that weâ€™ve heard more than one story about designers who will specify a given product for a project and, by the time construction is complete, the product is out of date. We think that simple, streamlined, and in some cases, modular, design will be an asset to this industry.
- Responsive to changing technology. - Multiplicity of use - Allow for Expansion - Flexibility of Patient Care - Modulation/Shared Functions
Care Team Another trend in health care can be illustrated by looking at sustainability from a medical perspective. When the FDA found out that DEHP, the chemical in the IV bags, was dangerous to the male reproductive system they cautioned against its use in procedures on young men and boys, but also in pregnant women. It’s interesting because it reﬂects a certain expansive or holistic sensitivity to life cycles that hasn’t always been accepted. This holistic approach to care is prevalent in an emerging model known as integrative medicine. Many of you have heard about the increasing use of “alternative therapies” from yoga to homeopathy. Integrative medicine takes this one step further as it seeks to take a whole person approach to medical treatment. For example, in the conventional medical model, if you were diagnosed with a cancerous tumor, your treatment plan would be centered around the tumor. Integrative medicine, on the other hand, seeks to shift our focus to a holistic understanding of patient needs. In this context, practitioners will want to evaluate, along with your tumor: how are you feeling, what do you eat, do you have a strong social network, how is your mental health, and how can improvements in those areas of your life positively impact your physical health? Healthcare is thus delivered by a team of professionals that seeks to support the individual overtly and by modeling healthy behavior. Even the building, in this case, should model and support health.
Care Team If care is provided by a team then the space needs to be reorganized to support collective practice. Incidentally, in rural settings, nursing retention is better in part because nurses have more adjacencies within such teams to make decisions and direct care.
Clinic as Citizen As outpatient procedures become more common and hospital visits become fewer and shorter, satellite clinics will become more numerous and more central to the provision of care. If these clinics are to model healthy behavior they ought to offer services to the community that extend beyond a doctor’s visit. In other words, the clinic doesn’t have to be a place that you only visit when you’re “sick.”
Macro Concepts.03-04 -
Strength in wellness notions of group interaction Restorative exterior environment Centralized health care team Nucleus concept of treatment
Clinic as Citizen
Privacy / Shared Spaces This concept stems from an emerging tension in healthcare. Pursuant to recent legislation that aims to protect privacy requirements related to the conﬁdentiality of patient information have grown much more stringent. For instance, ﬁnes may be imposed if someone down the hall overhears a conversation about someone else. That said, as we mentioned earlier, there is a growing consensus that community and social interaction are important for good health. So, as designers we are striving to create spaces that will protect privacy and simultaneously create opportunities for patient interaction.
Macro Concepts.05 -
Breakdown of Barrier use Fewer classiﬁcation of enclosure Sequential spaces from interior/exterior Re-imagination of privacy Private space with opportunity for public
Restore Recover Renew
The diagrams focused on particularities of program, adjacencies, circulation and modular capacity.
In recognition of the fact that redesigning an entire hospital was beyond the scope of this project we created a series of spatial studies to express design solutions that would usually be implemented throughout the architecture of an entire building.
Clinical Program (1st ﬂoor diagram) A similar diagram we explored involves the relationship of provider and community with, again, a distinct sector for staff and for the public with shared spaces in between. (2nd ﬂoor diagram) The ‘Provider Space’ addresses the concept of a care team, or a centralized hub for all clinical staff that promotes interaction and clinical efﬁciency. The provider space on the second ﬂoor, which acts as the connection between patient zones, is the specialized care team zone wherein all clinical activities (such as lab work, administration ofﬁces, and hub stations) would be located. Given our initial focus was speciﬁcally geared towards improving the working conditions for nursing, we have chosen to further develop these provider spaces.
Prototypical Clinic To help explain our concepts we began by deﬁning a related clinical program with a focus on the particularities of the program, such as adjacency of spaces and circulation. In this study, the clinical space is separated into a public sector for the community & a private sector for the clinic, anchored by shared circulation. When the question of ‘what is restorative’ was asked to the many nurses we’ve encountered, many saw the need for more private space and others saw it as the need for more public interaction with fellow workers & the surrounding community… (1st ﬂoor diagram) We felt the program should provide spaces that do allow more personalized clinical areas but also spaces that foster community & staff interaction, such as a soda fountain/pharmacy and an educational, or outreach, area.
Restorative Techniques Restorative Techniques
The plan concepts addresses spatial relationships, orientation, size and location as well as the important aspect of providing better care with the conscious goal of restorative techniques for both patients and providers.
Restore Recover Renew
Given that the aforementioned issues we are addressing are applicable to many healthcare settings, we decided to develop our ideas in a prototypical manner rather than pursuing a site-speciďŹ c route.
One of the design tools we have developed to address the research theories such as care team and privacy/shared spaces are a series of spatial relationships, which illustrate how a deďŹ ned program could be actualized.
DESIGN IDEAS - [Conceptual Development]
Modular Wall Storage Upon numerous site visits to various hospitals, we noticed the typical nurses’ station was primarily used for nurse check-in and administrative duties. Carts containing medicine were placed in any available corridor space, not usually accessible to the nurse station. We also noticed there seemed to be no specialized area for charting - hospital staff would ﬁll out paperwork on any available shelf or worktop. This system offers a more efﬁcient use of the provider space with charting space, medical storage, and ﬂip-down workspaces as part of the movable wall system.
Interactive Wall This concept is based on ideas generated where a design option was devised to become an interactive wall that would tie together clinical duties within a space, including workspaces and deďŹ ned meeting areas. This wall would act as a ribbon winding throughout a corridor, punctured with openings for natural light. From that came a similar idea of a modular wall system that would be located in the central provider space.
Lifting Device In a response to nurses concerns about personal injury while lifting patients. We created a patient lifting device that moves the patient directly from the wheelchair to the bed by creating joinery that transforms the wheelchair into a gurney. Given that hospital stays these days are mainly for the extremely itll, a high proportion of patients are osentibly immobile. And ,although the cost of a lifting device is far cheaper than teh cost to provide medical care to an injured nurse, many report that lifting devices are frequently unavailable or inconveniently placed. So why not build lifting capacity into one of the most commonly used tools to aid patient movement, the wheelchair. This product is a cross between a typical ofďŹ ce chair, a wheelchair and a gurney that can de developed with the use of hydraulics
Existing marketed equipment in the industry are available to patients and hospitals primarily as an overhead pendulum seating arrangement suspended from ceiling tracks or an option for a mobile lever arm for patient transfer. The obstacle of fear for the majority of older patients, raises the question for the need of suspension devices especially when bed stricken.
Therapy Module One design element is the therapy module designed to provide a private, contained environment in which a nurse can relax, rejuvenate, and recover from the day’s activities. The module is ﬂexible in space because it is collapsible and mobile. Along this concept could be the creation of a set of universal symbols that will serve as reminders to engage in health, wellness, and social interaction. They may include such topics as eating, hydrating, taking a deep breath, and characteristics unique to a health facility. These symbols would be displayed within the primary trafﬁc areas like the corridor, eating zones, nurse’s station etc..
Reconsidered Corridors Charting tables should be abundant, near the patient and in the nurses station, and should provide at least a stool or bench for nurses to sit. They could even ďŹ‚ip up from the wall. Message boards could be used to share information and provide a medium for nurses and patients to personalize their space. Washing stations should be equipped with water fountains and even message boards for nurses to leave fun comics or articles to read over the course of the shift. After all, they wash their hands 25 times a day or more. A mobile unit, ceiling mounted or otherwise could positively impact circulation within teh space and ease the ďŹ‚ow of supplies.
Sound Control This technique addresses the issue of sound control. Pursuant to recent legislation hospitals are re-evaluating the ﬂow of sound within the building in order to preserve conﬁdentiality. We seek to capitalize on this opportunity to create ﬂexible interactive spaces that could be used for conversations between and among hospital staff, patients and their families in the patient’s room, the corridor, or a combination of the two. Already on the market that also adds beneﬁt are powerful invisible air barriers created by air curtains playing a key role in climate control and energy cost reduction programs by enhancing comfort in building interiors and preventing the ﬂow of dust, sound, odors, fumes, wind, and even outside air into heated and air conditioned areas.
Nurses’s Station Nurses’ stations were originally created to control trafﬁc. These days, however, nurses aim not to limit the ﬂow of people within the space but rather to facilitate interaction. Simple changes like lowering sight lines can have a big impact. In an effort to reduce congestion some activities could be developed throughout the corridor; charting tables, for example, could be placed throughout the corridor and ﬂip down from the wall. Further, nurses have asked that we reorganize the ﬂow of paperwork and create more work space. Given the stop and go nature of the work, nurses stations should also provide a restful area for social interaction and downtime. One way of achieving this is to decentralize work activities from the nurses station to dead corridor spaces.
Refresh Center One technique is a restorative suite that includes a refresh center and locker-room, an interactive center space with tables to eat that will be equipped with a way to return patient calls, and a private room with convertible spaces for rest, relaxation, internet access, TV, and other needs. At one of our test sites, the team was particularly concerned by the current working conditions of nurses on a common ďŹ‚oor and their lack of public and private space. Another approach aims to address the fact that we have repeatedly heard nurses ask for things like â€œmore plantsâ€? or more control over lighting. We suggest that more attention be paid to the interrelationship of light, temperature, sound, texture, and color. Improvements in these areas have reduced absenteeism, increased labor productivity, and created a sense of community.
R.Space Restorative Prototype
Restore Recover Renew
The prototypical model constructed is a design response creating physical space to be shared by a group of health providers (i.e. nurses) that can be experienced individually or collectively. The private atmosphere that it provides include some of these following elements; writing surface, personal storage, sleeping area, display shelving, ambient lighting, soft and rich materials to create a concentrative and restful space.
“Different people ﬁnd different things restorative”
A.00 Plan Drawing.
A.01 Vertical cross-section of the space along with selected construction details.
01 Under Construction Hard at work, some of the Archeworks participants are showing a bit of humor while gathering materials for the R.Space construction.
02 Under Construction Progressive shots of the partially completed sofďŹ t assembly along with the supporting walls containing the wall storage.
Under Construction The translucency of the space is comprised by primarily open surfaces to the top, sides and back of the room. The construction of the ribbed wooden supports are shown that will carry the horizontal ribbed components of translucent material are taking form.
In the U.S. there are currently 126,000 unﬁlled nursing positions. Thus, we sought to improve nursing retention by creating a restorative environment that would ﬂex according to the myriad needs of a diverse staff. Our design work was based on user research and quantiﬁed data research by a professional team of consultants studying the impact of the environment on retention. Our prototype includes design elements known to promote positive, biologically measurable response in the body such as color and light. We also focused on rejuvenative activities such as rest, concentrated work, and social interaction; the size of the space is designed as a comfortable enclosure for one or many. Materials were chosen to counteract the impersonal character of most hospital environments. Cabinets were constructed in modular units to create the opportunity for customization within the space; we envision that each ﬂoor of nurses could tailor the environment to their collective needs and desires. This tangible idea creates and promotes a general work environment that fosters retention. Indeed, consensus building processes alone are often helpful in building community and creating an environment of retention.
04 Project Description
05 Exterior Corner view This shows the ambient lighting quality of the transluscent panels for the resting area and the rich natural wood material for the construction.
06 Front Entry Entrance to the restorative space showing the cabinetry doors closed with a display shelf for use by providers positioned within a public corridor environment. The privacy of the room utilizes a sliding wood door to minimize space.
07 Interior view The restorative space showing the various techniques and environmental capabilities possible by providers.
08 Rear Exterior View Detail of transluscent panels washed with ambient lighting.
Archeworks Team Faculty/Facilitators
Kerl LaJeune, Architect/Professor Brad Lynch, Architect
Jennifer Baker – Interior Design/Photography John Jeffery – Architecture, London Heidi Lubin – History/Globalization Kari Viste - Architecture
Richard Lewis – Architecture, London Taylor Lies – Economics/Mathematics Todd James - Architecture Eric Matthews - Architecture Teneca Williams - Architecture Melissa Matthei - Architecture
Advocate Bethany Hospital North Side Community Health Resource Facility - Community Health Clinic Archeworks was founded in 1994 by designer Eva L. Maddox and architect Stanley Tigerman. Even though their practices are extremely different, they were drawn together by their common belief that creative people can and should support design in the context of social cause. The school develops and provides alternative design education solutions through a multidisciplinary process. www.archeworks.org
.....Chicago Illinois .....Leicester, U.K.
.....Chicago Illinois .....Leicester, U.K. .....Tuskegee, Alabama
Dr. Patricia Novick, Ph.D., D. Min., “Quality Life training” Connie Stuetzer, LCSW, ACSW, BCD, “Creative Solutions/Therapy” Dr Suzanne Gordon, Author and journalist. Eva Maddox, Branded Environments, Eva Maddox Associates Laura Michalski, Dir. of clinical relations, Northside Community Health Donna King, Illinois Masonic Hospital June Crayton, V.P. Patient Services, Bethany Hospital. Saundra Thompkins Searcy, V.P. of Operations, Bethany Hospital Roosevelt Gallion, Head of Nursing Education, Bethany Hospital. Sara Marberry, Dir. of Communications, Center for Health and Design Dr Gordon Schiff, Dir. Clinical Quality Research, Dept. of Medicine, C.C.H. Steve Liska, Principal, Liska & Associates, Inc. Mardge Cohen, Dir. of Women’s Research, The Core Center, C.C.H.
www.archeworks.org www.jcaho.org www.metropolismag.com www.healthweb.org www.healthdesign.org www.hcaredesign.com www.npsf.org www.nurses.com RestorativeSpace@yahoo.com :Web www.RestorativeSpaces.com :Email
Thanks For the many years that I have taught at the University of Illinois at Chicago in the school of architecture, this experience was by far the most challenging; mentally and physically. While numerous opportunities were apparent in developing ideas within a multi-disciplinary setting, this process however quickly became an unnerving and arduous task than originally expected. The participants working as a team with their diverse backgrounds, and in most cases not of design origin, required methods to conceptualize and evaluate the design processâ€™ that became extremely foreign my standard practice. While the subject matter was interesting and unfamiliar to my ďŹ eld of study, the investigation was handled with rigor and critical analysis like no other. The yield by the participants to generate the built construct serving as the design response was the product of seemingly endless weeks of research, of which the result is absolutely remarkable. I applaud their hard work and persistence on this project. I was amazed at the level of certainty that I have come to expect from working with individuals of the design profession, was so often taken for granted prior to my short tenure at Archeworks. My now skewed vision has been renewed with great vitality to understand the advantages of collaboration with others from different disciplines. I had the wonderful opportunity to collaborate with both founders of Archeworks on this project and I thank them for their insights, guidance and trusted belief of my talents to lead the charge with 10 eager students. Working with my colleague and Facilitator, Brad Lynch, whom quickly became a great friend, was truly a very interesting experience. Special thanks to Heidi Lubin for her continued and very, very persistent inquiries of my design methodologies, and I hope that she also enjoyed our thoughtful exchanges. ----Kerl LaJeune 2002-03 Archeworks Facilitator UIC Adjunct Associate Professor
RestorativeRecovery Spaces Renewal
Responding to the alarming social need in the health services area, Archeworks will initiate work to learn the cause of the shortage of heal...