Objectives: This study reports on a postoccupancy evaluation (POE) of the Cognitive Empowerment Program (CEP), a purpose-built day program designed for individuals with mild cognitive impairment (MCI). It examines how the built environment is perceived to support or constrain social engagement (SE) among CEP members and their care partners, and organizational effectiveness (OE) for staff. Background: MCI affects SE and daily functioning, requiring environments that foster wellbeing. However, limited research has explored how purposefully designed facilities support individuals with MCI. Unlike traditional healthcare settings, the CEP was conceived as a living laboratory, enabling ongoing evaluation and refinement of environmental modifications to enhance user experiences. Methods: A mixed-methods approach included surveys and focus groups. In total, 11 staff members completed the survey and 12 participated in the focus group, while 22 members and care partners completed the survey and 54 participated in the focus groups. Quantitative data were analyzed using descriptive statistics, while qualitative data were examined through thematic analysis. Results: While the facility successfully promotes SE and OE, the study identified opportunities to enhance key environmental dimensions, including navigation, environmental comfort, social adaptability, resource accessibility, and privacy-sensitive collaboration to further support both SE and OE. Conclusion: The study introduces a framework that addresses key challenges in designing for people with MCI. These insights inform evidence-based strategies for enhancing healthcare spaces and highlight the value of iterative POE assessments in optimizing built environments for this population.
Despite therapeutic environments being increasingly recognized as health determinants for residents with cognitive decline in care facilities, empirical research examining their measurable outcomes objectively for residents remains limited. OBJECTIVES:This study explored the potential moderating effects of therapeutic environments in facilities, as assessed by the Environmental Audit Tool (EAT), on sleep quality of residents with either normal cognition or mild cognitive impairment (MCI). METHOD:A cross-sectional study involving 43 participants (32 cognitively normal and 11 with MCI) was conducted across nine residential care facilities. The cognitive status of participants was evaluated using the Mini-Mental State Examination, and objective sleep measures were obtained through validated actigraphy. Therapeutic environments were evaluated through sensitivity analysis using three a priori EAT total score thresholds: 48, 50, and 52. Comparisons were performed using the Mann-Whitney U test. RESULTS:Participants with MCI exhibited prolonged sleep onset latency, increased wake after sleep onset, and decreased sleep efficiency. The differences observed diminished as the total EAT score increased, and these disparities were largely absent at an EAT score of approximately 50. Residency conditions, including duration of stay, room occupancy, and perceived environmental noise, were significantly correlated with the EAT subscales of visual access, unnecessary stimuli, helpful stimuli, familiarity, privacy and community, and domestic activities. CONCLUSIONS:This study examined facility- and individual-level variations in therapeutic environments, highlighting sleep as a design-responsive metric for cognitive resilience, and emphasizing environmental factors such as safety, visual access, familiarity, acoustic control, sensory clarity, and surveillance-privacy balance to improve sleep in residents with MCI.
AimThis scoping review aims to provide insight into how various connections between indoor and outdoor environments in care buildings affect end-user experiences and use of space.BackgroundNumerous studies highlight the beneficial effects of outdoor interaction on end-users' physical and mental health and well-being. To move beyond this focus and fully understand and capture the width and depth of indoor-outdoor connections and end-user experiences thereof, it is essential to draw on research from multiple disciplines where relevant evidence is available.MethodsWe conducted a literature search across six databases to identify relevant studies. Eligibility criteria were specified a priori using the population, concept, and context framework. After full-text screening, 34 studies remained. In a first phase, the data were coded inductively without predefined categories; in a second phase, a thematic analysis was conducted to develop descriptive themes.ResultsOur findings revealed a combination of various connections and aspects of the built environment. Especially, visual and physical connections to outdoor spaces are prominent. Auditory, sociospatial, and outside-to-inside connections were identified less frequently. Aspects of the built environment are mostly related to features of windows, pathways, and doorways, while intermediate spaces were sporadically discussed.ConclusionsThis review provides an in-depth overview of the existing studies on indoor-outdoor connections in care buildings. We identify a gap in the literature: the lack of an umbrella term for the connection between indoor and outdoor spaces. We therefore propose the term indoor-outdoor nexus to unify these scattered concepts and improve the clarity and findability of research.
Evidence-based design (EBD) has significantly advanced healthcare environments by utilizing empirical research to improve outcomes related to safety, efficiency, and satisfaction. Its success in addressing issues with ethical implications, such as privacy and infection control, inevitably raises the question of its sufficiency in creating a fully ethical environment. This article critically examines the ethical scope of EBD within the UK context, arguing that its empirical methodology encounters significant limitations. Specifically, its predominant focus on quantitative metrics-medical, financial, and satisfaction-based-fails to adequately address the inherent dignity of nonautonomous patients and complex ethical tradeoffs where principles like justice or safety may not align with user contentment. An analysis of professional codes and NHS guidelines reveals they are insufficient to bridge this gap, being either too narrow in scope or too generalized. Consequently, this article proposes the integration of a complementary, principled ethical framework. It highlights the potential of Martha Nussbaum's Capabilities Approach to complement EBD's empirical strengths by providing a robust, dignity-oriented model for navigating areas where quantitative evidence is lacking. Ultimately, bridging EBD's rigor with such an ethical lens offers a promising path toward creating healthcare environments that are not only effective but also profoundly respectful of fundamental patient rights.
ObjectiveThis study examined perspectives of rehabilitation professionals and environmental designers to identify benefits, challenges, and design considerations for outdoor therapy spaces.BackgroundThe therapeutic potential of nature-based environments has gained recognition among researchers, healthcare practitioners, and designers, highlighting an opportunity to leverage outdoor environments in physical and occupational therapy. However, our understanding of the benefits, challenges, and considerations for implementation remains limited.MethodsThis exploratory qualitative study used thematic analysis of in-depth semistructured interviews following Braun and Clarke's six-phase framework. Interviews were conducted remotely with a purposive sample of 23 rehabilitation professionals (physical therapists, occupational therapists, horticultural therapists, and medical staff) and design practitioners (landscape architects, architects, and planners) involved in outdoor rehabilitation.ResultsFive primary themes were identified related to benefits, challenges, and design considerations: holistic health impact, real-world activities as therapy, the control-choice paradox, hazards and discomforts, and logistical and management barriers. Two distinct spatial typologies emerged: publicly owned, dispersed sites and privately owned, centralized sites. Nineteen environmental features were identified as high priority, with terrain variety (91%), environmental variety and choice (87%), and graduated challenge (70%) most frequently cited. Rehabilitation professionals emphasized practical concerns and therapeutic functionality, while designers prioritized sensory diversity and spatial arrangement.ConclusionOutdoor rehabilitation environments offer holistic health benefits and real-world therapeutic opportunities but require careful planning to address logistical barriers and environmental challenges. Successful implementation depends on early engagement of therapists and the establishment of supportive organizational cultures. Cross-disciplinary collaboration between therapists and designers is essential.
Objectives: This article aims to provide a resource on operating theater design by examining current design standards implemented for this department in Türkiye. It is also aimed to present various suggestions for solutions by revealing the extent to which these standards are implemented in hospitals, their widespread applicability levels, and the positive/negative situations encountered. Background: Operating theaters should be meticulously planned to provide a sterile environment. Although planning principles have undergone profound changes, when the current literature is examined, it is seen that a sufficient number of comprehensive studies on the subject have not yet been conducted. Methods: To create a perspective on how these standards are addressed in the projects of the hospitals and what kind of results are achieved in practice, the operating theaters of three hospitals, which were constructed based on the design standards published by the Ministry of Health, are comparatively examined. Results: This study reveals that the applications implemented within the framework of the new design standards have significantly contributed to the control of the sterility level of the space, together with the implementation of new spatial zoning principles and the addition of new units. Conclusions: The findings express that it is necessary to make scenarios and plans that consider possible problems encountered in design and construction processes when creating standards. Future studies can shed light on the applicability of the relevant design standards and the difficulties encountered.
BackgroundThe COVID-19 pandemic created unprecedented operational challenges (such as surge-capacity demands and infection-control requirements) that disturbed the equilibrium of healthcare work systems worldwide. Physical environments can play a pivotal role in mitigating or exacerbating these challenges.PurposeThis article aims to strengthen healthcare-system resilience in future pandemics by synthesizing the findings of existing literature to identify environmental factors that supported or hindered healthcare work systems during the COVID-19 pandemic.MethodsWe conducted a systematic search of the CINAHL, MEDLINE, PubMed, and ScienceDirect databases and complemented this search with handsearching. We included studies if they addressed the COVID-19 pandemic, focused on physical healthcare environments, and were published in English in peer-reviewed journals. With a focus on environmental influences, we deductively coded the findings using components of the Systems Engineering Initiative for Patient Safety (SEIPS) model.ResultsForty-two studies met the inclusion criteria. The analysis revealed six major operational challenges: (1) surge capacity, (2) infection control, (3) increased risk of errors, (4) rethinking of care models, (5) financial losses, and (6) the pandemic's adverse psychological impacts on staff and patients. The article documents environmental factors that influenced either the overall healthcare work system or its individual components during the COVID-19 pandemic. We identified three overarching roles for these environmental factors: they served as barriers, solutions, or facilitators.ConclusionsUsing the SEIPS framework can enable well-orchestrated pandemic-response planning by guiding the creation of design strategies that will strengthen resilience, flexibility, and safety in future health crises.
IntroductionWards with a radial layout, where rooms are configured around a central nursing station, allow better patient monitoring by nursing staff than where rooms are along a corridor.PurposeWe took advantage of the design of our hospital, with three quarters of rooms in a radial layout and the remainder located on corridors to compare falls surveillance and outcomes between patients in a radial room and those in a corridor room.MethodsThis is a retrospective observational study of falls occurring using anonymized data from fall incident reports.ResultsThere were 166 falls over the 15-month study period, 124 among patients in radial rooms and 42 in patients in corridor rooms. Fallers in the radial location beds were significantly older, more likely to be women and had a higher baseline falls risk. The falls/1000 bed days were 3.7 (95% CI 2.6-5.1) in the radial and 3.4 (95% CI 2.4-4.8) in the corridor areas (P = 0.73). Falls in radial room patients were more likely to be witnessed than in corridor room patients (27 (21.8%) versus 3 (7.1%); odds ratio (OR) 3.6 (95% confidence interval (CI) 1.0-12.6), P = 0.04). There was no significant difference between injury rates for fallers in the radial rooms (24 (19.4%)) and in the corridor rooms (11 (26.2%)) (P = -0.34).ConclusionA radial configuration of beds around the nursing station improves falls surveillance with a significantly higher proportion of witnessed falls compared with when rooms are arranged along a corridor.
Objectives This systematic review synthesizes empirical evidence on core urban design dimensions that affect clinical mental health outcomes and examines how environmental exposures mediate or moderate these relationships. Background Urban design has increasingly been recognized as a determinant of psychological well-being, yet a standardized framework to evaluate its mental health impact remains underdeveloped. Methods Following PRISMA 2020 guidelines, we systematically reviewed 19 quantitative empirical studies published through January 2025, examining relationships between outdoor urban design features and validated clinical mental health indicators across four major databases. Results Findings reveal that urban design influences clinical mental health outcomes (depression, anxiety, stress, cognitive decline) through two objective spatial scales: street-level features (imageability, enclosure, human scale, complexity) and neighborhood environments (land use mix, density, green infrastructure). Environmental exposures (traffic, noise, air pollution) operate as perceptual and experiential mechanisms that mediate or moderate the mental health effects of these spatial design features. Conclusions We propose an integrated three-domain conceptual framework distinguishing objective spatial design scales from subjective exposure mechanisms. This framework provides evidence-based guidance for urban planners and policymakers toward creating mentally healthier urban environments.
Purpose This study examines how operating room (OR) staff in Australia are engaged in OR design planning and how their professional experience shapes participation, safety considerations, and design priorities. Background The design of OR environments influences safety, efficiency, and workflow. Yet design processes are complex, requiring regulatory compliance, technical expertise, and integration of end-user perspectives. Methods A sequential exploratory mixed methods design was used. Phase one involved qualitative interviews with OR staff and design professionals ( n = 16) to explore experiences of design processes and perceptions of safety. Phase two involved a national cross-sectional survey ( n = 418) to assess broader patterns of engagement and role-based differences in safety and design priorities. Results Mixed methods integration showed that OR design in Australia is shaped by systemic and professional barriers, including fragmented communication, limited interdisciplinary engagement, and hierarchical decision-making. OR staff reported inconsistent or minimal involvement, while designers reported challenges embedding participatory approaches within project constraints. OR staff prioritized safety, ergonomics, and workflow efficiency, while designers focused more on regulatory and technical elements. Access to support, spatial layout, and ergonomic considerations emerged as top safety-related design features. Conclusions OR environments are shaped by the interaction of clinical, architectural, and institutional priorities, yet design processes often lack inclusive, safety-focused collaboration. Strengthening participatory mechanisms that integrate clinical expertise with technical and regulatory demands may improve the relevance and safety of surgical built environments. These findings can inform future policy, standards, and design frameworks to support more collaborative OR planning.
Objectives This study develops and applies a Delphi-informed environmental audit framework to examine spatial responsiveness in community-based day centers for older adults. Background Daytime socialization spaces play an important role in supporting mobility, orientation, and psychosocial well-being in later life. Although international frameworks such as WHO Age-Friendly Cities, Universal Design, and NICE provide environmental guidance, structured evaluation tools for non-clinical community settings remain limited. Methods A three-round Delphi process involving experts in architecture, interior design, and gerontology refined an 18-item checklist organized into three macro domains and five subdomains addressing accessibility, environmental quality, safety, and supportive spatial features. The framework was applied to eight municipally operated day centers in Turkey. Group comparisons were conducted using non-parametric statistical tests, and visual-comparative synthesis incorporated photographic documentation. Results Item-level differences were identified in selected safety-critical and perceptual dimensions, including flooring safety, color contrast, and handrail provision ( p < 0.05). No significant differences were observed in total checklist scores, suggesting comparable baseline performance across facility types. Configurational analysis indicated greater spatial compactness and clearer entrance articulation in Type 1 centers, whereas more fragmented layouts in Type 2 centers may increase orientation demands. Conclusions Findings suggest that spatial responsiveness in community day centers extends beyond basic accessibility compliance to the coherent integration of sensory, safety-related, and circulation cues. Given the limited sample size and single-city context, results should be interpreted as exploratory. The Delphi-informed framework demonstrates practical applicability; however, broader multi-site validation and integration of user-reported outcomes are needed to strengthen generalizability.
Aim: This review aims to identify empirical studies that examine the relationship between physical environment features and the occurrence of interruptions in healthcare settings. Background: Studies have shown that interruptions are a significant cause of errors, which are a primary contributor to adverse events that can result in severe injury or even death. Built environmental factors contribute to these interruptions, yet comprehensive studies examining how environmental variables impact interruption frequency remain scarce. Therefore, it is essential to consider how the physical environment exacerbates or alleviates disruptions to enhance patient safety. Method: A scoping review following PRISMA guidelines analyzed 33 empirical studies from medical, nursing, engineering, and architectural design fields. Data were extracted regarding study design, setting, participants, environmental variables, and outcomes related to interruptions. Result: The findings indicate that physical environment features influencing interruptions include no-interruption zones, signage, medication room configurations, physical barriers, workstation layouts, and traffic-related factors. However, inconsistencies in how interruption-related terms are defined across studies make comparisons challenging. The reviewed studies cover a variety of healthcare settings—including medical units, operating rooms, emergency departments, and intensive care units—and involve participants such as nurses, physicians, pharmacists, patients, and support staff. Conclusion: This review concludes that significant gaps remain in understanding how physical environment features impact interruptions. Future research should systematically examine physical environment features across healthcare settings to enhance safety, optimize workflow, and reduce errors.
The physical environment of inpatient wards plays a critical role in supporting rest and care delivery. In palliative care, environmental conditions such as sound, lighting, and temperature directly influence patient comfort, circadian rhythms, and staff performance. However, few studies have quantitatively assessed these factors in functioning palliative care units (PCUs).ObjectivesTo evaluate the spatial and environmental performance of an acute PCU through sensor-based monitoring of acoustic exposure, light levels, and temperature.MethodA postoccupancy evaluation approach was employed to assess conditions within inpatient rooms. Environmental loggers recorded data continuously at 1-min intervals across two 1-month periods. Parameters included sound levels (Lmax, Leq, Lmin in A-weighted decibels) to reflect perceived loudness, lighting (lux), and temperature (°C). Measurements were benchmarked against World Health Organization and Australian guidelines for sleep-supportive healthcare environments. Data were collected from both single- and multibed rooms in a metropolitan tertiary hospital PCU.ResultsSound levels frequently exceeded recommended thresholds. Nighttime averages reached 54 dB(A), while daytime LAeq exceeded 60 dB(A), with minimal day-night variation (<6 dB), indicating sustained exposure. Lighting data showed repeated nighttime spikes above 20 lux and insufficient daytime illumination for circadian regulation. Temperature exhibited minimal diurnal variation (<2°C), falling short of conditions known to support sleep.ConclusionEnvironmental monitoring revealed persistent deviations from sleep-supportive conditions. These stressors likely impact both patient well-being and staff performance. Findings underscore the need for evidence-based design strategies and translational research that position the built environment as an active contributor to holistic care. In palliative contexts, architectural design should enable rather than simply contain clinical practice.
ObjectiveThis study explores the perspectives of birthing persons (BP) from historically underrepresented communities (HUCs), their support persons (SP), and Free-Standing Birth Centers' (FSBCs) birthing staff (BS) providing maternal care to these communities to understand how FSBC's physical environment influences culturally sensitive maternal care experiences within these settings.BackgroundIn the USA, birthing persons from underrepresented communities have disparate maternal care experiences and outcomes. Studies show that FSBCs, which follow the midwifery model, provide culturally sensitive care for birthing persons from underrepresented communities. However, few studies have explored these community members' perspectives of the physical environment of the FSBC settings they experience.MethodsIn-depth semistructured interviews with 28 BPs, SPs, and BSs from HUCs were thematically analyzed using a deductive-inductive approach to derive the participants' perception (three themes), "care experience" (11 themes), the physical environment at three spatial levels (community, facility, and room level) where these themes were addressed, and their corresponding design elements.ResultsThe physical environment was described positively in most quotations (82%), with "care experience" themes such as autonomy, support, and comfort most frequently discussed across the community, facility, and room level. At the community level, the travel distance and time taken to reach the FSBC were discussed, whereas family and social support spaces and the spatial organization and layout were frequently mentioned at the facility and room level.ConclusionsThe emerging design elements can help inform the physical environment of future maternal care settings to promote a culturally sensitive maternal care experience for people from HUCs.
Background/ObjectivesThis study explores how individuals form first impressions when encountering a hospital lobby in the United States. It examines the roles of emotional responses and decision-making during brief environmental exposure, focusing on how sensory cues and emotional reactions shape visitor judgments.MethodsAs part of a larger mixed-methods project, this paper presents findings from the quantitative phase. Data were collected between June 2023 and February 2024 from participants visiting a hospital lobby in West Texas. Participants were randomly assigned to either a 5-min or unlimited exposure condition. Three newly developed self-report scales measured environmental perceptions, emotional responses, and first impression judgments. Due to non-normal data distribution, nonparametric analyses (Spearman's rho, Mann-Whitney U) were conducted. Age and gender were also analyzed.ResultsParticipants formed first impressions rapidly, often within 5 min. Emotional responses significantly influenced the relationship between environmental perceptions and judgments. Negative emotions, such as nervousness, fear, and distress, had a stronger influence on first impressions than positive emotions. No significant differences were found between exposure durations or across age and gender. Sensory and visual cues were critical in shaping emotional reactions and first impressions.ConclusionsFirst impressions in hospital lobbies are formed quickly and are strongly shaped by the physical environment and emotional responses. Reducing negative emotional triggers such as confusion, poor signage, or unwelcoming interactions is more effective than incorporating positive features. Visitors rely on brief, "thin-slice" cues to evaluate and emotionally respond to a space, making initial moments of experience crucial for forming first impressions.
ObjectivesThis study examines how the rural physical environment-including spatial environment and leisure facilities-relates to the mental health of rural older adults in China, and explores group differences.BackgroundEvidence on the impact of rural environments on elderly mental health is limited, despite growing attention to this issue.MethodsUsing 2020 CLASS data, structural equation modeling in Mplus analyzed the pathways linking rural space and recreational facilities to mental health and compared group differences.ResultsBoth the rural spatial environment and recreational facilities are positively associated with the mental health of rural older adults, with differences in magnitude and mechanism. Recreational facilities show a stronger association than the spatial environment. The spatial environment is mainly related to mental health through a direct pathway, whereas the association between recreational facilities and mental health is partially mediated by physical exercise, with the direct effect remaining dominant. Group analyses indicate that physical exercise plays a greater mediating role among older adults aged 60-74, while among those aged ≥75, the association is primarily direct and more pronounced. Partial mediation through physical exercise is observed only in northern and more developed rural areas.ConclusionsThe study underscores the vital role of rural leisure facilities in enhancing elderly mental health, particularly those aged ≥75. Improving rural spatial design and developing diverse, age-friendly leisure facilities can promote well-being and provide evidence-based guidance for policies supporting rural revitalization and elderly quality of life.
ObjectivesThis study investigates the relationship between universal design (UD) attributes, autonomy, and the psychological wellbeing of older adults with disabilities. The goal is to provide evidence-based design guide for aging-in-place, prioritizing UD elements that promote autonomy and psychological wellbeing.MethodA total of 165 older adults participated in the online survey. Using structural equation modeling, the latent factors of UD were identified for the kitchen, bathroom, and general areas within home environments.ResultsResults revealed that bathroom UD features, including walk-in bathtubs, curb-less showers, shower seats, and grab bars, significantly predicted autonomy, whereas kitchen and general UD features did not. Additionally, autonomy was positively associated with psychological wellbeing and fully mediated the relationship between UD features and wellbeing.ConclusionImplications for aging-in-place design are provided, emphasizing the importance of prioritizing functionally essential design factors in residential planning and remodeling for older adults with disabilities.
