International Journal of Scientific & Engineering Research, Volume 5, Issue 7, July-2014 990
ISSN 2229-5518
Essential Elements in Children Hospital Environment: Role of Perceived Affordances
Usman Bukar Wakawa1, Aminu Umar2, Elnafaty Abbas Said3 Abubakar Alkali Ibrahim4
1,2,3,4, PhD Students Department of Architecture, Universiti Teknologi Malaysia 81310 Skudai Johor angilibukar@yahoo.com
—————————— ——————————
Healthcare facilities were built to deliver care in line with norms and practices [1]. However, several research findings support the concept of the healthcare environment to have an impact on the health outcome of patients [2]. There are aspects of the physical healthcare environment that can have effects on the health outcomes of patients “ architectural features (e.g., spatial layout, room size), ambient features (e.g., lighting, odors), and interior design features (e.g., color, artwork, indoor plants). Interior design variables provide relatively easy and inexpen- sive opportunities to alter the atmosphere of healthcare envi- ronments” [3]. This may work especially with new facilities or those that exist and scheduled for renovation. The review from [2] explains that effects of interior design variables appear to be highly undecided, The knowledge of particular environ- mental stimuli and their i nf l u e nc e on health outcome may facilitate the needed changes in an environment. In addition, understanding the underlying processes causing these effects may help us in providing healthcare facilities to accommodate more interesting features like loose play items that can improve on health restoration.
For children, hospitalization is generally associated with feel- ings of fear, uncertainty, and anxiety [4]. These feelings of stress and anxiety may affect the healing process. Research shows for example, that such psychological stress impairs wound healing in patients [5]. With regard to the idea of heal- ing environments, aspects of the built healthcare environment
that can reduce this stress may therefore have beneficial ef- fects on health-related outcomes. Research on restorative envi- ronments suggests that certain environments are capable of promoting recovery from stress, such as natural settings that has certain restorative qualities [6]. Considering the potential healing properties of nature, exposing patients to natural ele- ments may be an effective way of reducing stress associated with hospitalization [3] However, most healthcare facilities are im- plemented and built with little or no features added that pa- tients can be exposed to reduce stress in patients and in turn aid their recovery [7]
As a result, humans have an innate tendency to pay attention and respond positively to natural elements [8]. This tendency to select natural elements to man-made objects may be the explanation of the stress-reducing effects of nature. It might thus be hypothesized that natural elements affect feelings of stress through the perceived attractiveness of an environ- ment. The purpose of this experiment was thus to inves- tigate whether the stress-reducing effects of loose play items occur because an environment with such items is per- ceived as being more of affordances to children. The theory that natural element in the environment is beneficial than man-made objects may be the elucidation of the stress-reducing effects of nature. It might thus be hypothesized that natural elements affect feelings of stress through the perceived affordance of an environment; the following hypotheses will be tested:
IJSER © 2014 http://www.ijser.org
International Journal of Scientific & Engineering Research, Volume 5, Issue 7, July-2014 991
ISSN 2229-5518
H1: The presence of loose play items in children hospital ward leads to reduced feelings of stress in patients.
H2: The perceived affordance of the hospital ward facilitates this relation between loose play items and stress.
This procedure has been shown to accurately simulate real environments, an experimental study using photos of (ward: with conventional loose items vs. ward with no conventional loose items) with (n=12) patients. They were presented with a pho- to of a hospital ward setting with conventional loose play items and other different settings that is generally used in Nigerian paediatric hospital context. The scenario described that participants in- volved have been hospitalized with symptoms of typhoid and malaria fever. In both conditions, participants were exposed to a photo of the two different hospitals setting where their behav- iors were observed for period of 3 days. Prior to the com- mencement of the study, a written consent was obtained from the hospital ethics committee and parents of the participants.
The descriptive content analysis of the photographic docu- mentation of two different scenarios that has shown that patient in the hospital room with images of conventional loose play items perceived less stress than participants in the hospital ward whose photographs indicate a similar conventional set- ting with no loose items. The analysis, with perceived stress as the dependent variable and the presence of conventional loose play items as the predictor, generated a significant perceived relationship with participants perceiving less stress with the images of conventional loose play items. Another analysis, with the mediator (conventional loose play items) as the dependent variable and the presence of loose play items as the predictor, showed that the presence of loose play items increased the perceived affordance significantly, subsequently; it was observed whether the relation between the presence of loose play items and perceived stress was mediated by the perceived affordances of the ward.
The present study aimed to gain an understanding of the primary guide on environment and its features that may influ- ence stress-reducing effects of natural elements such as con- ventional loose play item in the healthcare environment. Our results suggest that the abstract presence of loose play items in a hospital ward leads to a reduction of perceived stress in
patients. This finding supports the general notion that nature has stress-reducing properties [3,9]. Most importantly, the present results also demonstrate that these stress-reducing effects are mediated by the perceived affordances of the hos- pital ward. The presence of loose play items in a hospital ward leads to a higher perceived affordance of the cubicle and this, in turn, leads to reduced feelings of stress in pa- tients.
However, the general knowledge by which contact with nature may reduce feelings of stress had never been empirically studied in Nigerian context. This experiment showed that the stress- reducing effects of nature are caused by the perceived affordance of the hospital ward. This result would mean that, by basically making the environment more playful, the environments can contribute to the health of patients. Since children generally prefer loose play items, the use of loose play items in healthcare interi- ors thus seems a straightforward and effective way to promote the patients' recovery.
The bound of contention here will be that the findings of such an experiment cannot be translated into actual healthcare set- tings. There is evidence available, though, that photograph can accurately simulate real environments and such studies show results similar to field experiments [10]. Moreover, if exposure to an imaginary hospitalization and a photo of a hospital ward with play is already capable of generating such a clear effect, this may be very promising for actual exposure of hospitalized patients to indoor loose play items. Furthermore, even if these effects only seemed in f airness to real healthcare settings, such a simple and low-cost mediation may well be highly cost-effective.
Looking at the positive effect of features in the environment that can influence healing of patients, children wellbeing has become really important in hospital setting. As such, this study confirms the stress-reducing properties of loose elements in the built healthcare environment. Although, most studies were not scientifically proven, it sheds light on the underlying features causing this stress- reduction. This experiment indicates that the stress-reducing effects of nature interventions to children in the built healthcare environment are the result of a higher level of perceived affordances of such environments.
The authors wish to thank UTM and TETFUND for their sup- port in the course of this research work.
IJSER © 2014 http://www.ijser.org
International Journal of Scientific & Engineering Research, Volume 5, Issue 7, July-2014 992
ISSN 2229-5518
[1] S. A. Sherman, J. W. Varni, R. S. Ulrich, and V. L. Malcarne, ‘Post- occupancy evaluation of healing gardens in a pediatric cancer cen- ter’, Landsc. Urban Plan. vol. 73, no. 2–3, pp. 167–183, Oct. 2005.
[2] K. Dijkstra, M. Pieterse, and A. Pruyn, ‘Physical environmental stimuli that turn healthcare facilities into healing environments through psychologically mediated effects: systematic review’, J. Adv. Nurs., vol. 56, no. 2, pp. 166–181, Oct. 2006.
[3] M. E. P. K Dijkstra, ‘Stress-reducing effects of indoor plants in the built healthcare environment: the mediating role of perceived at- tractiveness.’ Prev. Med., vol. 47, no. 3, pp. 279–83, 2008.
[4] M. E. Wilson, M. E. Megel, L. Enenbach, and K. L. Carlson, ‘The Voices of Children: Stories About Hospitalization’, J. Pediatr. Health Care, vol. 24, no. 2, pp. 95–102, Mar. 2010.
[5] M. P. White, S. Pahl, K. Ashbullby, S. Herbert, and M. H. Depledge,
‘Feelings of restoration from recent nature visits’, J. Environ. Psy- chol., vol. 35, pp. 40–51, Sep. 2013.
[6] F. Monti, F. Agostini, S. Dellabartola, E. Neri, L. Bozicevic, and M.
Pocecco, ‘Pictorial intervention in a pediatric hospital environment: Effects on parental affective perception of the unit’, J. Environ. Psy- chol., vol. 32, no. 3, pp. 216–224, Sep. 2012.
[7] D. A. Harrison, K. Patel, E. Nixon, J. Soar, G. B. Smith, C. Gwin- nutt, J. P. Nolan, and K. M. Rowan, ‘Development and validation
of risk models to predict outcomes following in-hospital cardiac ar- rest attended by a hospital-based resuscitation team’, Resuscitation, vol. 85, no. 8, pp. 993–1000, Aug. 2014.
[8] Y. Joye and A. van den Berg, ‘Is love for green in our genes? A criti- cal analysis of evolutionary assumptions in restorative environ- ments research’, URBAN FOR. URBAN GREEN, VOL. 10, NO. 4, PP.
261–268, JAN. 2011.
[9] M. Gelkopf, I. Hasson-Ohayon, M. Bikman, and S. Kravetz, ‘Na ture adventure rehabilitation for combat-related posttraumatic chronic stress disorder: A randomized control trial’, Psychiatry Res., vol. 209, no. 3, pp. 485–493, Oct. 2013.
[10] A. Toet and M. G. van Schaik, ‘Effects of signals of disorder on fear of crime in real and virtual environments’, J. Environ. Psychol., vol.
32, no. 3, pp. 260–276, Sep. 2012.
IJSER © 2014 http://www.ijser.org