The mindset behind palliative architecture is to strengthen the bond between the architecture and the palliative effect granted on the given site. The mantra is; 'when you care for a room, it cares back'. The design criteria's is defined as five aspects that intersect and influence each other.
– FUNCTION
– ATMOSPHERE
– NATURE
– PRIVACY AND RELATIONS
– LIGHT, SOUND, AIR AND TEMPERATURE
In a broader perspective palliative architecture is not limited to traditional treatment facilities, but applies for several types of architecture that facilitates human beings.
Designing a hospice
In the aspect of treatment facilities, Palliative architecture is commonly integrated in the design of a hospice, nursing home, cancer center etc. When specifically designing a hospice, emphasis is put on creating a palliative setup that follows the strict criteria's necessary when dealing with patients in a terminal stage.
The concept In general strives to give people comfort they yearn for, and for the patients and relatives to feel well cared for, to be unburdened and unburdening, and to find some sense of closure and peace. It is important to think of patients in the terminal stage of life as living and to treat them accordingly. A hospice should leave room for personal preference and aim to relief both patients, relatives and staff in their during their stay and daily routines.
FUNCTION covers a list of the necessary elements that successfully needs to ensemble in order to carry out daily routines in an effective matter. Way-finding is essential when designing the floor plan. Simple floorplan solutions, with 90 degree corners, landmarks and universally understandable graphic to ease navigation. All elements that help patients, relatives and staff to quickly reach their desired destination, and as a result minimize stress related to navigation. Accessibility is another key word when laying out the floor plan. Many patient often need the assistance of either a wheel chair or a bed in order to navigate through the complex. In case of patients dying, coffin transport, is also a necessary element to include when designing doors, access roads, access area etc. The possibility to call for aid in cases of emergency needs to be integrated in the design. Do to the typical state of a hospice patient, emergency buttons needs be reachable from the bed. Life at a hospice goes by the mantra; 'live life until you die'. That means hospice design should be able to accompany a variety of arrangements such as music arrangements, birthdays, holidays or saying goodbye in the event of a patient dying. Meanwhile the hospice needs to fulfill the needs of the relatives and the staff as well. The many different events demand a certain amount of adaptability from the design. Placement of functions is crucial in order to accomplish an effective work flow. Depending on the relation and special needs of a specific function, it can be placed in a busy, isolated, noisy, quite, private or public area, etc. with the options of exploiting the synergy effect between different functions.
ATMOSPHERE is an important parameter in order for the patients to keep their sense of identity and self-knowledge. It is key to downplay the clinical expression, and aim to create a homely atmosphere. One way to achieve this is to allow the patients bring personal belongings and integrate clinical equipment into the design in an anonymous matter. The main focus of hospice design is to create a place that supports the palliative effort and to accommodate quality of life in the terminal stage. In order to do so, it is of great importance to understand that affliction can come in both physical, mental, social and existential character. The idiom of the design should include recognizability. In that context the choice of materials, lighting, art, social space, furniture and the view, is all of great importance. Another significant aspect is the design of the arrival area, as it sets the stage for the first impression for patients and visitors. When deciding on the d''cor expression, tests show, that the level of comfortability dramatically effects how people perceive other people. The more comfortable, the better perception. The level of comfortability, self-knowledge and sense of identity is increased by creating a homely atmosphere. Most patients at a hospice is depending on the use of a wheelchair or a bed, and there for the design of the individual units and common areas, should take the patients field of view into consideration. Daily routines as making dinner, walking the dog and other daily activities also effect the mood and wellbeing of patients and relatives.
A hospice often sets the stage for saying goodbye to member of the family. A palliative hospice unit therefor needs a room that offers space for reflection, religious and spiritual thoughts. The d''cor of this function should carefully take the modern multiethnic society into consideration.
NATURE as a design principle includes everything from a wild forest or a lake, to a simple picture of the nature in common areas. Series of test show that visual and physical contact with nature have a significant effect on pain and stress relief as well as minimizing the chance of depression. Nature has a positive effect on both patient, relative and staff, and helps to maintain a connection to life outside of the hospice. The more integrated the outdoor area is to hospice unit, the more it is used. The outdoor area should aim to stimulate the senses of it user, who in this case often is bedridden or in a wheelchair. A scenario that calls for a sensory gardens that's relies on fragrance, sounds, wind or raises beds that stimulates patients with a limited field of view. The establishment of a playground would also serve to increase the mood of the patients, relatives and staff, as the sound and view of joyful kids playing is appreciated.
PRIVACY AND REALATIONS between patients, relatives and staff is very different from case to case. The options to choose whether the individual or group want to be social or private is critical when designing the floorplan of a hospice. Test shows that a solution with private wards and private bathroom accompanied by a separate room for relatives, is highly appreciated by both patients, relatives and staff. It allows for privacy, withdrawal, tranquility, etc. and relatives tend to stay longer and participate more intensely in the daily care of the patient when they have the hospice facilitate a more comfortable stay. Further tests point towards avoiding an open plan structure, and aim for a circular layout instead. Both patients, relatives and staff highlight the feeling of increased safety, security, overview, company and recreation do the enhanced visual overview and intuitive understanding of a circular plan structure. A close relation between the patient units and staff functions also contributes to an increased feeling of safety and security.
LIGHT ' SOUND ' AIR ' TEMPERATURE all falls under the category commonly known as the indoor climate. This design principle focus on how the individual factors effects the user in relation to the experienced level of stress, anxiety and discomfort. Common for all parameters is that a certain level of individual adaptability is needed in order to accommodate the user. Individual adjustments of the indoor climate require some degree of understanding the mechanisms behind regulating temperature, shading, light level and air quality etc. Light have a positive effect on the user's general level of satisfaction, ability to navigate, sleep, mental disorders, depression, delirium, pain, stress as well as the risk of mistake during medical treatment. Tests prove that the amount of daylight a given patient is exposed to during the day, has a direct influence on the sleep quality. The higher amount of daylight, the better sleep quality. An important note on this, is that the amount of light must be adjusted according to the daily rhythm of the patient. Light in general should also be understood as a tool for setting the correct atmosphere for changing scenarios. It can vary from an intense light source during medical treatment, to the dim lighting of a candle in the scenario saying goodbye to a family member. Sound is also an important element as it have the ability to either heal or be disturbing. Music, wind blowing through the treetops, birds singing or the sound of running water etc. all seems to have a positive effect on both the patients, relatives and staff, when it comes to stress, distraction, pain, calmness and the amount of readmissions. Noise from technical equipment, staff, relatives and other patients on the other hand, have quite the opposite effect and pushes the course of treatment in a negative direction. The acoustic ability and sound proofing of a patients unit, also effects the patients and relative's experience of privacy, which in some scenarios makes the patient retain important information from the staff. Air quality is especially important in a hospice do to changing scenarios of a patient in the terminal stage of life, varying from a minor feeling of nausea to the stage of necrosis. In the other end of the spectrum, the fragrance of a specific flower, might just be what takes the patient a trip down memory lane, and thereby adds quality to the life of the patient. Hygiene is another important aspect that's needs to be taking in to consideration, and therefor a hospice needs the ventilation system that can adapt to different scenarios, while adding a minimum of noise to the patient units. Lack of influence on the room temperature leads to discomfort for the patients and relatives, and further more adds to the feeling of disempowerment. Some extent of individual control on the indoor climate is recommended.
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