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Introduction
An increase of research studies focuses on the physical as-
pects of the environment as an important dimension of caring
and quality of life, with the assumption that some of these
aspects may be built into the way the health care environ-
ment is designed. For example it is well known that orienta-
tion in the environment can be facilitated by way-finding cues,
symbols and proper lighting to enhance visibility (Ulrich, 2006)
as well as that environmental factors both can act as support
and hinder for adequate performance, interaction with family,
fellow-residents and staff, increase health, feeling of security
and safety. Adapting the environment to match the needs of the
user can therefore be considered as a non-pharmacological
treatment (Ulrich 2012).
The healthcare environment should contribute to residents’
health and wellbeing and a person-centred care (Gesler, Bell,
Curtis, Hubbard & Francis, 2004). Planning for new health-
care environments therefore claim a thorough analysis of the
resident-related objectives that are expected to be fulfilled and
the processes (care activities) and the space conditions that
are considered necessary to achieve the objectives (Curtis,
Gesler, Priebe & Francis, 2009; Vischer, 2008). By adopting this
approach it is easy to see that the analysis must be a shared
responsibility and be performed through collaborative planning
with stakeholders from healthcare, architecture, design and
building construction.
According to Lawton (2001) there are five general categories of
user needs:
Decreasing unwanted behaviour, increasing social
behaviour, increasing activity and increasing positive feelings and
decreasing negative feelings
. This is in line with studies demon-
strating an increase of social activities among older residents
as a result of an adapted environment that support function
and interaction between the elderly residents (Liebowitz et al.
1979) as well as studies showing an increase in well-being by
the implementation of a home-like design at dementia institu-
tions (Küller 1991) . Also an easy floor plan configuration and
the use of concrete signs and symbols have shown to act as a
supporting factor (Passini et al. 1998). Another environmental
intervention important in old age is the avoidance of glare due
to the often diminishing visual function following old age. Also
the restriction of using pastel colours in relation to low colour
contrast is highlighted since it is proposed that a more frequent
use of contrasting colours can facilitate orientation and func-
tioning in old age (Cannava 1998). As an example Passini et al.
(2000) conducted a way-finding test for old people with severe
cognitive decline where they could show that despite their
cognitive condition they were able to find their way around.
Critical features in the environment to support their orientation
seemed to be the implementation of environmental informa-
tion that was easy to interpret and identify and a great number
of reference points. Also avoidance of floor patterns and dark
lines that could increase anxiety showed to be important to
support orientation.
These studies are all examples of where the ability to interact
and perform actions is used as cut off variables. That means
that interaction and prevalence of adequate performance have
been accounted for as measures of the success of an environ-
mental intervention. An increased knowledge about the inter-
action between residents suffering from illness and their living
environment are crucial for planning, designing and evaluating
the quality of caring environments.
Adapting the environment to residents’ needs
A starting point in designing health care environments is to
take interest in the
preserved environmental perception instead
of perceptual decline
among the residents. This is in a way to
reconsider caring from a focus on risk factors for pathology to
a focus on health promoting issues. This approach, also named
the
salutogenic
way of caring (Antonovsky 1987), advocates that
the health of various degree, always present within the indi-
vidual, should be the focus of caring instead of the disease. In
other words, caring should put a stronger focus on what other
strategies beside medical actions that could promote health for
the resident. This interest on health and preserved functions
instead of disease and lost functions is also in line with the
concept of
empowerment and person-centred care
(Ekman et al
2011). By focusing on preserved function, and by implementing
this knowledge in the environment and care of the residents,
it is assumed that the persons opportunity to behave indepen-
dently increase.
Central concepts of nursing are the respect and dignity for the
person as a whole in his environment with the overall goal to
contribute to health and to support preserved functions. This
is expressed in many nursing theories e.g. in Orem’s (1995)
model of nursing which focuses on strategies to compensate
for the persons lack of self-care abilities. Central is that it is
the knowledge of how the resident perceives the environment
that is the starting point for environmental intervention (Wijk et
al. 2002).
The increase of research stressing the importance of envi-
ronmental design to promote quality of life, is an important
complement to the notion that competent cognitive functioning,
the ability to perform everyday activities and engage in mean-
ingful use of time has been found to be of immense importance
in the population at large (Ulrich 2012). But even though that
the knowledge base comprises of a variety of methods, still
regrettably few can serve as hard fact design directives.