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A B S T R A C T Evidence-based design strategies can improve stress-free environments in healthcare, by emphasizing strategic opportunities to influence the design of health facilities. Evidence-based design (EBD) as a tool for healthcare planning is a method that began in healthcare having a general purpose of providing evidence based medicine. It involved Gathering information and evidence and using this evidence to mold the environment which supports the programming stage in design problem-solving. The connection between the theories and use of findings in (EBD), have not been adequately revealed enough to be used as a tool in design. As such, several factors, or characteristics, evident in numerous studies about healing environment and (EBD), require categorization into tangible and non-tangible dimensions in order to apply them during the design process successfully. Among others, four distinct variable or factors summarized from the work of two researchers – Dilani (2001) and Ulrich (1991) have been selected to be tested in this research; (1) enhancement of social support, (2) stimulating design features, (3) flexibility and coherence (4) connection to nature, focusing on the hierarchy of the above mentioned attributes according to their relevance in application and outcomes. Two research questions served as a foundation for the investigation of attributes in healing environments: What critical attributes can be identified by healthcare staff related to Dilani and Ulrich’s research findings? Is a hierarchy of attributes perceived by healthcare staff? The aim of this research is to closely examine the factors of Psychosocial Supportive Design theory by Alan Dilani (2001) and Supportive design theory (SDT) by Roger Ulrich (1991) on the staff in Eastern Mediterranean university health centre. Questioners and site visit were used for data collection. SPSS was used to obtain percentages from data collected. The result of the study reveals a hierarchy of factors perceived by the staff that can promote supportive healing

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Evaluating Staff Perceptions of Supportive Healing Environment in Healthcare Facilities * Ph.D. Candidate PATRICK CHUKWUEMEKE UWAJEH1, Ph.D. Candidate IKENNA STEPHEN EZENNIA2 1 & 2 Department of Architecture, Eastern Mediterranean University, Famagusta, North Cyprus via Mersin10, Turkey 2Department of Architecture, Nnamdi Azikiwe University, Awka, PMB 5025, Anambra State, Nigeria Email: uwajehpatrick@gmail.com Email: is.ezennia@unizik.edu.ng A R T I C L E I N F O: Article history: Received 04 January 2018 Accepted 10 February 2018 Available online 15 June 2018 Keywords: Evidence-based design; Healing environment; Healthcare; Supportive design; Wellness; Health. A B S T R A C T Evidence-based design strategies can improve stress-free environments in healthcare, by emphasizing strategic opportunities to influence the design of health facilities. Evidence-based design (EBD) as a tool for healthcare planning is a method that began in healthcare having a general purpose of providing evidence based medicine. It involved Gathering information and evidence and using this evidence to mold the environment which supports the programming stage in design problem-solving. The connection between the theories and use of findings in (EBD), have not been adequately revealed enough to be used as a tool in design. As such, several factors, or characteristics, evident in numerous studies about healing environment and (EBD), require categorization into tangible and non-tangible dimensions in order to apply them during the design process successfully. Among others, four distinct variable or factors summarized from the work of two researchers – Dilani (2001) and Ulrich (1991) have been selected to be tested in this research; (1) enhancement of social support, (2) stimulating design features, (3) flexibility and coherence (4) connection to nature, focusing on the hierarchy of the above mentioned attributes according to their relevance in application and outcomes. Two research questions served as a foundation for the investigation of attributes in healing environments: What critical attributes can be identified by healthcare staff related to Dilani and Ulrich’s research findings? Is a hierarchy of attributes perceived by healthcare staff? The aim of this research is to closely examine the factors of Psychosocial Supportive Design theory by Alan Dilani (2001) and Supportive design theory (SDT) by Roger Ulrich (1991) on the staff in Eastern Mediterranean university health centre. Questioners and site visit were used for data collection. SPSS was used to obtain percentages from data collected. The result of the study reveals a hierarchy of factors perceived by the staff that can promote supportive healing. CONTEMPORARY URBAN AFFAIRS (2019), 3(1), 13-25. https://doi.org/10.25034/ijcua.2018.4678 www.ijcua.com Copyright © 2018 Contemporary Urban Affairs. All rights reserved. 1. Introduction 1.1. Definition of scientific terms Supportive Healing environment: a term which defines a physical setting and administrative culture that helps patients and families cope with the stresses caused by illness, physical therapy, the healing process, and sometimes, with the demise of family and friends in healthcare buildings. The implication of this concept is that, the physical healthcare environment can make a difference in recovery time for patients with specific critical and prolonged health conditions (Stichler, 2001). Supportive design theory (SDT): a theory designed by Roger Ulrich (1991) that explores the various ways to utilize the built environment to minimize stress and stress causative factors, by providing a sense of control, access to social support and access to positive distractions to users in the physical surroundings (Ulrich, 2000). Psychosocially supportive design (PSD): a theory designed by Alan Dilani (2001) that supports the healing environment from a standpoint of psychological manageability, and general wellbeing (Dilani, 2009). Salutogenesis: is a term coined by a professor of medical sociology Aaron Antonovsky (1996), to define an approach aiming on factors that support human health and well-being, rather than on factors that cause disease. More specifically, the "salutogenic model" is concerned with the relationship between health, stress, and coping (https://en.wikipedia.org). Wellness factor: This refers to components of the built physical environment that affects the quality of human life and emotional status. They include, physical, emotional, spiritual, intellectual, occupational, and social wellness. Evidence-based design (EBD): this is a design approach which involves the collection of facts and evidence based data to achieve design goals. It is prominently applied in healthcare sectors, but has gradually gained recognition in other fields and building typologies. Evidence-based medicine (EBM): is an approach to medical practice intended to elevate decision-making by stressing the use of evidence from well designed and conducted research. Although all medicine based on science has some degree of empirical support, EBM goes further, classifying evidence by its epistemologic strength and requiring that only the strongest types (coming from meta-analyses, systematic reviews, and randomized controlled trials) can yield strong recommendations, while weaker types (such as from case-control studies) can yield only weak recommendations (https://en.wikipedia.org). 1.2. Background of Study People visiting healthcare facilities general expect a suitable and supportive healing environment. Hospitals have evolved from an institutional feel to a warm and welcoming environment. The makeup of such environments is, the careful integration of physical, social and psychological factors proven to have positive evidence based effects on health outcomes (Molzahn, 2007). In accordance with Mroczek, et al. (2005), who supports the theory, that there is a need for a continuous empirical analysis, focused on the identification of more definite and advanced factors that improves wellness in patients, family members and visitors in healthcare facilities, as proposed by Ulrich, should be strengthened by the observation of evidence oriented knowledge in existing healthcare buildings, with emphasis on design solutions that improves stress and perceived health outcomes. 1.3. The value of Evidence-based design (EBD) as a tool for healthcare planning Designers are faced with the increasing task of integrating cultural diversity, psychological and socio-spatial considerations by the application of EBD in both interior and exterior context of buildings. The rigors of accessing valid EBD information for design purpose remain one of the main challenges, thus the development of suitable empirical methods towards achieving scientific results is a prerequisite in dealing with design challenges related to supportive healing environments. More so, recognizing and categorizing key influential factors of perceived care and wellbeing would provide ample guidance to designers in their design solutions (Molzahn, 2007). According to Dilani (2001), a properly designed physical environment improves health of mind and wellness, while a poorly designed environment promotes frustration and other health related problems which cumulate into illness in humans. As such, the need for these factors to be clearly defined in healthcare design is sacrosanct in order to become adoptable design tools for the therapeutic process. 1.3.1. Assumptions Dilani (2001) and Ulrich (1991) agree that there are substantial and abstract impacts of physical environments measured by different variables in certain environments in their research, which might pose a challenging to other settings, or situations.

Perspectives

Evaluating Staff Perceptions of Supportive Healing Environment in Healthcare Facilities * Ph.D. Candidate PATRICK CHUKWUEMEKE UWAJEH1, Ph.D. Candidate IKENNA STEPHEN EZENNIA2 1 & 2 Department of Architecture, Eastern Mediterranean University, Famagusta, North Cyprus via Mersin10, Turkey 2Department of Architecture, Nnamdi Azikiwe University, Awka, PMB 5025, Anambra State, Nigeria Email: uwajehpatrick@gmail.com Email: is.ezennia@unizik.edu.ng A R T I C L E I N F O: Article history: Received 04 January 2018 Accepted 10 February 2018 Available online 15 June 2018 Keywords: Evidence-based design; Healing environment; Healthcare; Supportive design; Wellness; Health. A B S T R A C T Evidence-based design strategies can improve stress-free environments in healthcare, by emphasizing strategic opportunities to influence the design of health facilities. Evidence-based design (EBD) as a tool for healthcare planning is a method that began in healthcare having a general purpose of providing evidence based medicine. It involved Gathering information and evidence and using this evidence to mold the environment which supports the programming stage in design problem-solving. The connection between the theories and use of findings in (EBD), have not been adequately revealed enough to be used as a tool in design. As such, several factors, or characteristics, evident in numerous studies about healing environment and (EBD), require categorization into tangible and non-tangible dimensions in order to apply them during the design process successfully. Among others, four distinct variable or factors summarized from the work of two researchers – Dilani (2001) and Ulrich (1991) have been selected to be tested in this research; (1) enhancement of social support, (2) stimulating design features, (3) flexibility and coherence (4) connection to nature, focusing on the hierarchy of the above mentioned attributes according to their relevance in application and outcomes. Two research questions served as a foundation for the investigation of attributes in healing environments: What critical attributes can be identified by healthcare staff related to Dilani and Ulrich’s research findings? Is a hierarchy of attributes perceived by healthcare staff? The aim of this research is to closely examine the factors of Psychosocial Supportive Design theory by Alan Dilani (2001) and Supportive design theory (SDT) by Roger Ulrich (1991) on the staff in Eastern Mediterranean university health centre. Questioners and site visit were used for data collection. SPSS was used to obtain percentages from data collected. The result of the study reveals a hierarchy of factors perceived by the staff that can promote supportive healing. CONTEMPORARY URBAN AFFAIRS (2019), 3(1), 13-25. https://doi.org/10.25034/ijcua.2018.4678 www.ijcua.com Copyright © 2018 Contemporary Urban Affairs. All rights reserved. 1. Introduction 1.1. Definition of scientific terms Supportive Healing environment: a term which defines a physical setting and administrative culture that helps patients and families cope with the stresses caused by illness, physical therapy, the healing process, and sometimes, with the demise of family and friends in healthcare buildings. The implication of this concept is that, the physical healthcare environment can make a difference in recovery time for patients with specific critical and prolonged health conditions (Stichler, 2001). Supportive design theory (SDT): a theory designed by Roger Ulrich (1991) that explores the various ways to utilize the built environment to minimize stress and stress causative factors, by providing a sense of control, access to social support and access to positive distractions to users in the physical surroundings (Ulrich, 2000). Psychosocially supportive design (PSD): a theory designed by Alan Dilani (2001) that supports the healing environment from a standpoint of psychological manageability, and general wellbeing (Dilani, 2009). Salutogenesis: is a term coined by a professor of medical sociology Aaron Antonovsky (1996), to define an approach aiming on factors that support human health and well-being, rather than on factors that cause disease. More specifically, the "salutogenic model" is concerned with the relationship between health, stress, and coping (https://en.wikipedia.org). Wellness factor: This refers to components of the built physical environment that affects the quality of human life and emotional status. They include, physical, emotional, spiritual, intellectual, occupational, and social wellness. Evidence-based design (EBD): this is a design approach which involves the collection of facts and evidence based data to achieve design goals. It is prominently applied in healthcare sectors, but has gradually gained recognition in other fields and building typologies. Evidence-based medicine (EBM): is an approach to medical practice intended to elevate decision-making by stressing the use of evidence from well designed and conducted research. Although all medicine based on science has some degree of empirical support, EBM goes further, classifying evidence by its epistemologic strength and requiring that only the strongest types (coming from meta-analyses, systematic reviews, and randomized controlled trials) can yield strong recommendations, while weaker types (such as from case-control studies) can yield only weak recommendations (https://en.wikipedia.org). 1.2. Background of Study People visiting healthcare facilities general expect a suitable and supportive healing environment. Hospitals have evolved from an institutional feel to a warm and welcoming environment. The makeup of such environments is, the careful integration of physical, social and psychological factors proven to have positive evidence based effects on health outcomes (Molzahn, 2007). In accordance with Mroczek, et al. (2005), who supports the theory, that there is a need for a continuous empirical analysis, focused on the identification of more definite and advanced factors that improves wellness in patients, family members and visitors in healthcare facilities, as proposed by Ulrich, should be strengthened by the observation of evidence oriented knowledge in existing healthcare buildings, with emphasis on design solutions that improves stress and perceived health outcomes. 1.3. The value of Evidence-based design (EBD) as a tool for healthcare planning Designers are faced with the increasing task of integrating cultural diversity, psychological and socio-spatial considerations by the application of EBD in both interior and exterior context of buildings. The rigors of accessing valid EBD information for design purpose remain one of the main challenges, thus the development of suitable empirical methods towards achieving scientific results is a prerequisite in dealing with design challenges related to supportive healing environments. More so, recognizing and categorizing key influential factors of perceived care and wellbeing would provide ample guidance to designers in their design solutions (Molzahn, 2007). According to Dilani (2001), a properly designed physical environment improves health of mind and wellness, while a poorly designed environment promotes frustration and other health related problems which cumulate into illness in humans. As such, the need for these factors to be clearly defined in healthcare design is sacrosanct in order to become adoptable design tools for the therapeutic process. 1.3.1. Assumptions Dilani (2001) and Ulrich (1991) agree that there are substantial and abstract impacts of physical environments measured by different variables in certain environments in their research, which might pose a challenging to other settings, or situations.

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