LIBRARY OF THE
UNIVERSITY OF ILLINOIS
no. 3G I '5*75
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Digitized by the Internet Archive
in 2010 with funding from
University of Illinois Urbana-Champaign
Council of Planning Librarians exchange bibliography
USER/ENVIRONMENT INTERFACE IN HEALTH CARE SYSTEMS
Uriel Cohen, Assistant Professor
School of Architecture
University of Wisconsin — Milwaukee
Mrs. Mary Vance, Editor
Post Office Box 229
Monticello, Illinois 61856
THE LIBRARY OF THE
JAN 2 4 1973
UNIVERSITY OF ILLINOIS
COUNCIL OF PLMNING LIBPJiRIiUIS Szchsnge Bibliography #367
US"j;R/EI\n/IROiIMJi«IT IOT^;;IFAC3 EI IEaLTH Ciuli SYST.aiS
Uriel Cohen, Assistant Profer.sor
School of Architecture
University of Visconsin-Iulxraukee
This publication was facilitated in part by the TTork of the
Architectural Team/Coronary Care Project, directed by Professor
Colin Clipson and Professor Joseph IJehrer, Department of Arclii-
tecture. University of liichigan.
3.1 The Patients
TIZIT 1. 1. Iripact of Illness and Hospitalization
2. Sub-Populations in Crisis and HospitcJ.ization ^
3. Social/Psychological Factors in Health Care
3.2 Personnel 10
U. Social/Psychological Factors in Specialized
U.l Intensive Care Units H
li.2 Coronary Cere Units H
5* Behavioral Concepts « Issues Related to the
Health Care iinvironment 13
PART II. 6. Human Factors I6
7. Research and Design ilethodology 1°
8. Spatial Design and Physical Organization
8.1 General 20
8.2 Nursing Units 20
8.3 Patient's Environment 21
9. Plaiming ajid Design of Health Ctre Systems
9.1 General 22
9.2 Specialized Units 23
9.3 Environmental Control eind Support 21;
(Contents continued) 2. GPL Sxchrnge ELbliography //367
10, Bibliographies 26
Part one deals mostly with the human-behavioral aspects of
the care environment j part two contains selected items in applied
areas, and includes mor.tly reference data, Methods and techniques,
case studies, etc. in planning and design of health care systems
The Expanding Role of "jnyironmental Design
Psjrcho- social elements in the diagnosis and treatment of dis-
eases are nox'f considered essential aspects of the total patient
Modern medicine recognizes that the treatment process is af-
fected by such factors as the social and psychological environ-
ments of the patient, uhich are in turn affected also by the phy-
sical and orgamzational structure of the health care system.
In designing environments for health care as well as other
building types - the planners traditionally addressed themselves
to the functional aspects oj? human performance and needs, e.g.
optimal floor plan of nursing unit, the design criterion being
number and duration of nurses trips j or optimal lighting intensity
and distribution, the criterion being human task performance. In
both cases, as vrell as a multitude of similar situations, design-
ers concentrated on factors that lent themselves to quantitative
methods of identification, analysis and evaluation, e.g. monetary
cost, time, temperature, etc.
Factors such as human psychological stress, adaptation, sub-
jective comfort and preferences were usually relegated to a lower
priority order in the design process, if considered at all.
lath the groxjing knowledge of environmental psychology and
relented disciplines, their methods and findings irdght be applied
to the design process: the effects of the physical environment
on the users vjill be better understood, consequently developing
the ability to design, regulate, and control the care environment
for optimal benefit.
3. CPl ::!;xchange Bibliography //367
1. Impact Ox Illness 1 Hospitalization
Hospitalization due to acute illness is described as: "A
process accoiripajiied by a sudden and drastic change in the life
pattern, characterized by the substitution of a more or less self-
regulated active e:dLstence, by an enforced passi-s/ity occurring in
a subjective state of suffereing and ill healthj it is a strange,
friendleso and aseptic smelling enviroP-iiisnt, i-fhere bodily functions,
habitually exercised in discreet privacy, are noxr exposed to the
indignity of open-season inspection, xiith a concomitant dislocation
of economic, domestic, social and se:aial patterns." (Simpson, 1969)
The association of hospitalisation mth acute illness, the
hospital bein^ the last resort after other means have failed, is
still a popialar concept. It permeEtes the tliinlcLng of the commun-
ity and the individual patient, and results in regarding hospita-
lization lath misgiving and apprehension.
The patient is subjected to examinations aaid tests, the pur-
pose of XiTliich he does not always vinderstand, even if it is being
explained. He is reluctant to ask questions, either because he is
afraid of the ansifers, or hesitates to bother the busy personnel^
knoT'ledge of results often leave him vlth the need to malce inter-
pretations of Tiliich he is not crpable.
Despite the use of sedatives and tranquilizers to combat
physical pain and discomfort, intrusive dsvices such as IV needles
in the arm, prolonged bad stay in one posture and other physical
discomforts iiiipinge on the patient's state of mind.
The patient has to give up his personal control on important
as well as siriiple functions: i/hat, when and hou to eatj keeping
x-jindox'S open, closed or shaded^ sitting, Ijdng, or getting upj
these and other minutia. of everyday living are no longer determin-
ed by the patient and Iiis preferences j most of the routine activ-
ities are done by others for lum, and the enforced dependence, a-
long lath the physical demcnds of his illness, increase his feel-
ings of helplessness.
The phenomenon of patient "childlike" behavior and submis-
sion is a typical transformation that most patients experience to
some extent. It is both a defense mechanism and social convention
to facilitate the drastic change in norms. Hov;ever, frequently
tliis teiTiporary transform.ation deteriorates into regression, xath
all the attended adverse outcomes.
Being faced xdth unaccustomed routines and schedules, the
patient has to make emotional and social adjustments to new ways
of life. Loss of autonomy'" is accompanied also by breach of soc-
ial norms regarding privacy, communication, and other behavioral
k. CPL 3xchsiige Bibliography #367
These factors are usually recognized, ajid so is the realiza-
tion that their cxuaulative affect can create a significant stress.
Hoxiever, very seldora are these factors acknoiiedged by the
designers of the patients oaviromaent, vho could, and should, in-
tervene to effectively mininiizs stress.
Abram, H.S. "Psychological Responses to Illness and Hospitaliza-
tion," Psycho somatic s , 10:2l8-2U, Jxily-August 1969.
Barnes, Elizabeth. People in Hospitals . ¥.e\r York: liacmillan
and Co., Ltd., 1961.
Colman, Arthur D. "Territoriality in lian: A Conparison of Be-
havior in Horae and Hospital," imerican Journal of Orthopsy -
chiatry, 38:36U-8, 1968.
Duff, P.O. and A.B. Ilollingshead. Sickness and Society . New Tork:
Harper Sz Rot:, 1968.
Earickson, jlobert. The Spatial Behavior of Hospital Patients.
Chicago: University of Chicago, Department of Geography,
JanLs, I.L. and H. Leventhal. "Psychological Aspects of Physical
Illness and Hospital Care," Methods of Treatment , p. I36C-
liing, Joan M. "Denial.", American Journal of Nursing , 66:5:1010-
1013, Kay 1966.
Lev, P. and M.S. Spelman. Corjnuni eating vath the Patient . London:
Staple Press, 1967.
Lsyy, Roland. "The Immobilized Petient and His Psychological Uell-
Being," Postgraduate Medicine , 1:0:1:73-77, July 1 966.
Wecl, i..F. "ileflections on Psychological Distance as a Function
of Length of Hospitalization," Psychol Rep , 26:ii6, February
Rubinstein, D. "Family Therapy," Progress in Neurological Psy -
ciatry, 2li:U2U-l435, 1969.
Simpson, I. "HumaJis and Hospitals," Medical Journal of /'ustralia ,
1:17:833-9, Apill 26, 1969.
Skipper, James K. and Tlobert C. Leonard. Social Interaction aiid
Patient Care . Philadelphia: J.B. Lippincott Conpany, 1965.
5. CPL Exchange Bibliography 7','367
Susman, Harvin et al. The l.'alkin^ Pat ient. Cleveland: IJestern
Reser\'e University Press, 1967.
Taylor, Carol. "Sociological Sheep Sheailn,-^;, " Nursing Forum , 1:
79-100, Spring 1962.
Tolor A. and M.S. Donnon. "Psychological Distance as a Function
01 Length of Hospitalization," Psychol Rep , 2^:Q^l-$, Decem-
Weissman, R. et al. "Role Disorders in Extended Hospitalization,"
Hospital Adinini strati on, "'inter 1967, 52-5'9.
6. CPL Exchange Bibliogrs.phi'" i!'367
2. Subpopuletions in Crisis ^ Hospitalization
\J3 need a constEnt reminder that humcH nature is variable.
Individuality - the qualities that distinguish one person from
another - defy typology and universal prescriptions for coiimcn
problems. Understanding of the potential range (rather than
"average") of human responses and needs due to individual differ-
ences, is an essential requirement for optimal problem solving.
Often it is not feasible to design environments that viill accom-
modate specific user needs, since many environments are designed
for short term use of variety of users, like the patient area in
a nursing unit.
Yet, knoirledge and appreciation of the ranges of users'
needs, mil enable the designer to provide open options and enough
variability in the environment to satisfy a larger spectrum of
IJitliin societies, some groups - or sub-populations - possess
some common characteristics irliich are not shared lath the whole
society or other societies. These characteristics are largely
influenced by c\altural and developmental factors. The uays in
which individuals tliink, believe, and act depend largely on the
culture and society in wliich they dwell. It is ivithin these soc-
ietal boundaries that group life and subsequent interpersonal re-
lationships are structured.
Developmental factors create a different set of sub-popula-
tions: the very young, the very old, the handicapped, and others,
all perceive and conceive the social and physical environment in
/Jdrich, C.K. "Personality Factors and Mortality in the Reloca-
tion of the Aged," Gerontologis t, Vol. U, 1961;, pp. 92-3.
Aldrich, C.K. "J''.elocation of the Aged and Disabled: A liortality
Study," Journal of the ^jierlcan Geriatrics Society, 11:185-
/iltnan, Irwin and \J.\). Ha.j.'-bhorn. "The Effects of Social Isola-
tion and Group Composition on Performance," Human Relations ,
Bayes, Kenneth (ed.) Desi.'^ting for the Handicapped . I Montreal:
Society of Emotionally Disturbed Cliildren, 1971.
Carp, Frances H. "The Elderly and Levels of ..daptation to Chan-
ged Surroundings," Spatial Behavior of Older People , L.A.
Past al an and D.H. Carson (eds.)". University of liichigan
Press, 1970, pp. 162-82.
7. CPL Sxchange Bibliography #36?
Cotler, S.R. "How to Keep the Handicapped to Keep Moving," Modern
Nursing Home , October 1967, p. 96.
Curtis, B.H. "A Survey of Forty-3ight Children's Hospitals:
Factors Shaping a Broader Concept of Children's Orthopedics,"
J. Bone Joint Surg , kkA'.39Q-hl.$, 1962.
Haller, J. iilex, James L. Tslbert and Robert H. Dombro (eds.)
The Hospitalized Child and His Family . Johns Hopkins Univ-
ersity Press, 1967.
Leibman, Miriam. "The Effects of Sex and Race Norms on Personal
Space," Environment and Behavior , 2:2C8-1;6, September 1970.
Liebermsn, Morton i: . "Factors in Environmental Change," in Pat -
terns of Living and Housing of Middle Aged and Older People .
U.S. Department of Health, Education, and Velfare, 1965, Pub-
lic Health Service Publication No. Iii96.
Lindsley, Ogden R. "Geriatric Behavioral Prosthetics," in NetJ
Thoughts on Old Age , Robert Kastenbaura (ed.). New York:
Springer Publishing Co., 196ii, pp. I4I-6O.
Meff, IJalter S. and Samual s,. Weiss. "Psychological Aspects of
Disability," Handbook of Clinical Psychology . New York;
McGraw-Hill Book Co., Inc., 1965.
Mellist, Ivan. Planning Buildings for Handicapped Children .
London, England: Crosby Lockviood and Son, Ltd., 1970.
Nuffield Foundation. Children in Hospital; Studies in Planning .
London: Oxford University Press, 1963.
Pastalan, Leon A. and Daniel H. Carson. Spatial Behavior of Old -
er People . Institute of Gerontology, University of Mchigan
and Wa^Tie State University, 1970.
Rapoport, Amos and Newton Watson. "Cultural Variability in Phy-
sical Standards," Transactions of the Bartlett Society , 6;6l-
Riley, M.l,'. (ed.) Aging and Society . NevT York; Russell Sage
Torrens, P.R. and D.G. Yedvab. "Emergency Room Treatment Varies
with Make-Up of Local Pop\ilation," Hospital Topics , Ui:71,
U.S. Senate Proceedings. A Barrier Free Environment for the Eld -
erly and the Handicapped . Hearings of the Special Committee
on Aging, U.S. Senate, 92 Congress, October I8, 1971.
8. CPL £ix:chc.ngo Bibliography #367
3. Social/Psychological Factors in the Health Cere Snvironnient
Rapid advances in our knowledge and understanding of physio-
logical mechanisms and causes of disease, and of medical treatment
procedures, have caused a relative neglect of the consideration
given to the psycho-social aspects of illness, especially in hos-
With the great influx of technology and related human activi-
ties in the health care environment, the need to not lose sight of
patients as people is even greater. ¥0 longer is the cure of the
human organism and tissue the only care objective j the restora-
tion of a person to the optimal mental and physical level, compa-
tible idth the status of his organism requires consideration of
psychological trauma as well as the physiological one.
Functional activities of health care personnel were tradi-
tionally a major determinant of physical design and organization.
However, as in the patient's case, staff socio-psychological needs
are ill defined and thus rarely accommodated.
Bailey, R. "Needed; Optimum- Social Design Criteria," Modern
Hospital , 106:101-3, March I966.
Beahrs, O.H. "Patient Care in the Hospital of Tomorrow," Indus -
trial Medical Surgery , 37:609-l5, ..ugust 1968.
Bloom, B.L., E.M. Lang and H. Goldberg. "Factors Associated with
Accuracy of Prediction of Posthospitalization Adjustment,"
Journal of Abnormal Psychology , 7Si2'.2h3-2h9', October 1970.
BroTr/n, Lucile ilsther. Newer Dimensions of Patient Care , Part I.
New York: Russell Sage Foundation, 1961.
Broiime, I.Ij. and T.P. Hackett. "Em.otional Reaction to the Threat
of Impending Death," Irish Journal of Medical Science , Series
6, No U96, p. 177-187, April 1967.
Field, Minna. Patients are People . New York: Columbia Univer-
sity Press, 1967.
Folta, Jeannette R. and Edith S. Eck. A Sociological Framework
for Patient Care . New York: John V'iley and Sons, Inc., I966,
GeliJicks, L.E. "Design Can Brainwash the Chronic Care Patient,"
Modern Hospital , 102, March I96U, pp. IO6-II.
Glass, David, et al. "Psychic Cost of Adaptation to an Environ-
mental Stressor," Journal of Personality and Social Psycho -
loe.v. 12:200-10, July 1969.
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Graham, L.E. and E.M. Conley. "Evaluation of Anxiety and Fear in
Adult Surgical Patients," Mursing Research , 20:2:133-122,
March- April 1971.
Hawxhurst, D. and H. VJalzer. "Patients Helping Patients," Mental
Hygiene . 5U: 3: 370-373, July 1970.
Hewitt, P.B. "Subjective Follow-Up of Patients from a Surgical
Intensive Therapy V/ard," British Medical Journa l, ii:669-673,
December 12, 1970.
'dyde, R. Experiencing the Patie nt's Day; A Manual for Psychia -
tric Hospital Personnel. Wew York: G.P. Putnam's Sons,
195^: — — \
Mumford, Emily. Sociology in Hospital Care . Keu York: Harper &
Rot: Publishers, 1967.
Osmond, H. "Design Must Meet" Patient's Human Needs," Modern Hos -
pital , 106:98-100, March 1966.
Rosengren, 'Ailliam R. and Mark Lefton. Hospitals and Patients.
Kew York! Atherton Press, 1969, p. 219.
Senescu, R. "The Problem of Establishing Communication i-.dth the
Seriously 111 Patient," Me^^^ York Academy of Science Annals ,
l6U:696-706, December 19, 1969.
Sivadon, P. "Space as Experienced: Therapeutic Inplications,"
in Environmental Psycholog.y , H.M. Proshansky, et al. (eds.)
Holt, Rinehart and I'inston, Inc., 1970, pp. U09-I4I9.
Sommer, R. "Implications for Patient IJell -Being in Hospital De-
sign," Hospitals; J..A.H..ri ., U0:71-U, .^ril 16, I966.
Tey, R. and M.S. Spellman. Communicating xath the Patient . St.
Louis: Wanen H. Green, Inc., 1967.
Thompson, John D. and Robert J. Pelletier. "Privacy vs. Effici-
ency in the Inpatient Unit," Hospitals, J.A.H.A. , 36:^3-7,
August 16, 1962.
Ward, Anthony. "Notes on Therapeutic Environment," Emerging Met -
hods in :J:nvironmental Design and Planning , Gary T. Moore
(ed. ). D.M.G. 1st International Conference, Cambridge., Mass-
achusetts, J-une 1968, pp. 2I1.7-69.
VJilliams, i?.L. "a Social System Model Applied to a Rehabilitation
Program for Institutionalized Patients," Journal of Rehabil -
itation . 36:20-23, July- August 1970.
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3.2 P^aSOMB L
Crook, J. "User ileeds of Pctients and rlurses in Clinical Monitor-
ing," Postgraduate Hedical Journal , U6:37li-7, June 15^70.
Currie, F.II. "The Psychological Aspects of Patient Nursing,"
yaather Van e, 38:11-6, February 1965.
George, iiary. "The Transferring Phenomena Influences on Nurse
and Patient," Hospital Hanagement , 10U:92, October 1967 •
Hackett, T. and N.H, Casssm. "Sources of Tension for the CCU
Nurse," /unerican Journal of Nursing , August 1972.
Kornfield, D.S., T. liexvrell and D. iiomrou, "Psychological Hazards
of the Intensive Care Unit; Nurse Care Aspects," I-Mrsing
Clinics of North America , 3:lji|l-U7, March I968.
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Location Dependencies in a Behavior of Staff and Patients,"
J. Archea, et al. (ed.), Sdra Two . Proceedings of the 2nd
A^nnual Environmental Design Research Association Conference,
Pittsburgh, October 1970.
Robinson, Alice h'. "Professional Conflict in the ICU/CCU, " R.il .,
Kay 1972, pp. ItO-U5.
Rosenberg, S.D. "Hospital Culture as Collective Defense," Psy -
chiatry , 33:21-35, February 1970.
Rosenblatt, Deniel. "Physical Plant, Staff L'orale and Informal
Ideolo^es in Mental Hospitals," Spaticl Behavior of Older
People, L.A. Pastalan and D. Carson (edvS.) Institute of
Gerontology, University of Michigan, 1970.
Rosengren, Uilliau R. and Spencer Devault. "The Sociology of
Time and Space in an Obstetrical Hospital," Environmental
Psychology, H.M. Proshanskj'-, et al. (ed. ) Holt, PJ.nehai't
and Uinston, Inc., 1970, pp. U39-52.
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k. Social/Psychologicsl Fc.ctors in Specialized Units
Intensive care iinits are by definition the raost coinplex en-
■vironments mtliin the health care system. In the recovery room,
ICU, coronary care unit, burn unit, etc., the patients are in
sone stage 6f ■critical illnessj the physical environment is de-
signed to facilitate life support procedures and the appropriate
systems. The latter are taking the form of monitoring devices,
oxygen tents, mres, electrodes, defibrillators intravenous tubesj
sone are literaJ-ly impinging upon the patient, iihile other ele-
ments are suggestive of the critical nature of the environraent.
The overwhelming impact of these units on their users present an
added, or intensified dimension for consideration in the design
of an optimal environiiient for health care.
U.l INTEHSIV5 CiJiS UIIITS
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U.2 CORONi-i^Y CA1I3 UNITS
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5. Behsvioral Concepts Ic Issues Relgted to the Heslth Csre
Plaruiers end designers of the health cere environment are
becoming increasingly avjare of the significance of the behavioral
aspects of man's relationsliip vdth his environment. I'ith the
groTO-ng Icnoxijledge and interest in the application of environment-
al psychology, the potential for optimizing the therapeutic as-
pects of the health care environment increases. The understand-
ing of the basic concepts and issues is essential to all those
involved in the planning, design and administration of the health
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8.2 NURSING UNITS
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9.2 SPECIALIZED UNITS
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9.3 ENVIllOI'lIISlIT.^L COiflROL iJTD SUPPORT SYSTEMS
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ruary 16, 1962.
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26. GPL i^lxchengs Bibliography #36?
U.3. Department of H.S.IJ. Biblio.Traphy on Design and Constructio n
Ox Health Care F£.ciliti3S . Public Ileelth Service, 1J71.
Council of Planning librarians, ^'cchange Bibliographies;
•;r82 Housing -Health Relationsliips, 1?6?.
;;i02 Periodicals for the Health Planner, 1969.
ivll7 Coriiraunity Mental Health Planning, 1970,
#123 Behavior and Environment, 1970.
i;a68 Health Planning, 1971.
7/233 Health Planning Applications of Operation Research and
System Analysis, 1971.
i;'-235 mnvironinental and Spatial Behavior, 1971.
#255 The Ergonomics of Environmental Design and Activity
lianrgement for the Aging, 1972.
#'265 Health Systems and Health Planning in International
#285 Intei'ior Ergonomics, 1972.
#•288 The Psychology and Physiology of Light and Color, 1972.
Some related information ctoring and retreiving systems:
3mithsoiU.an Institution. Sc ience Information S:cchange , lOCO Jef-
ferson Drive, '.ashing-ton, D.C. 20560.
U.S. Department of Commerce, jlationcl Technical Iiiformation Ser -
vice (IITIS) Springfield, Virginia 22151
U.S. Dopai'tment of H.:".U. MEDLARS (iledical Literature /Jialj'-sis
and Retrieval System). National Library of liedicine, 8600
P.ockville Pike, Bethesda, Maryland 2001U.
27. CPL Exchange Bibliography //367
CCUirciL OF PLmTiHIIG- LIBRiaTIxalS acchange Bibliography ,,-'36?
US^yEITglROHIEI'lT II^TgRFAC3 III ICiiLTH CiJE SIST^IS
Additional copies available from:
Council of Planning librarians
Post Office Box 22?
rionticello, Illinois 6l656