The role of the pediatric hospitals is essential because children are the investment in future society. While the environment has an emotional impact in child’s behavior by influencing kid’s thoughts and feelings although they are more sensitive to environments compared with adults, Scanlon and Bauer emphasized that because kids are more dynamic than adults, more considerations should be included in healthcare for kids. Meanwhile improving kid’s patient experience didn’t receive the attention that it needs to make thoughtful progress. The patient experience is an essential component of improving the quality of healthcare (Patient Experience Network 2013, p.7).
There is a relationship between the quality of healthcare and consequent anxiety felt by patients, due to the generated feelings by unfamiliar faces, sounds, smells, and sights. (Norton Westwood 2012). When kids go in an unexperienced environment a feeling of fear and anxiety dominate them (Ekra and Gjengedal 2012, Festini et al 2008, Walker 2006, Coyne 2006). So kids shall be in an environment designed, furnished, and equipped to meet their needs to eliminate these feelings (European Association for Children in Hospital 2014). Hence, development considerations need to incorporate to planning, designing, and evaluation of environment. Bishop (2008) notes the importance of identifying kid’s perception in term of what role environment plays in their experience of healthcare. So a developmental theory can be beneficial for ‘understanding’ kid’s reactions and interactions with the environment.
According to NHS Estates (2004), the design of the environment is a vital element that plays a part of kids understanding of their surroundings, also a high-quality environment can increase the morale of patients (Alder Hey Children’s NHS Foundation Trust 2012, p.20). Additionally, kids psychological and physiological well-being have a significant contribution to the healing process (Eisen et al 2008), thus the physical environment can manipulate a reduction in stress and anxiety to reach a holistic healing procedure (Norton – Westwood 2012), Whereas Adverse physiological responses to the environment lead to higher blood pressure, heart rate, and muscle tension (Kreitzer 2013a, Bird 2007), all of which impede the healing process.
Many evidence in literature recommends that Sensory receptors are very important since through these receptors the total environment can experience. These senses: sight, touch, hearing, taste and smell work simultaneously to help children understand the environment. Understanding the dimensions and limitations of the senses help to construct the actually receptive environment that can support healing. The important factors that can impact environmental experiences can be changed or redesign to produce different effects, according to different needs these elements of design are Space, Form, Texture, Light, Colour, and Human Scale (Kreitzer 2013). In this study, the focus is on kids patient rooms because it is the most important components in the hospital, due to the time of hospitalization that patients spend inside it. Said (2007) promotes principles of design that include knowledge of kids perception, which can qualify children to have ‘better control over aspects of their environment such as privacy or social interaction, heat, light and noise’ (Alder Hey Children’s NHS Trust 2012, p.20).
For in-patient kids, the healing and curative benefits of sleep are very important (Herbert et al 2014), whereas sleeping can face a problem due to noise level which occurs from clinical activities, accordingly the stress of noise might effect in a kid feeling (Lambert et al 2013) and elevate infant blood pressure, decrease oxygen saturation, increase heart and respiration rate, and worsen sleep (Slevin et al. 2000; Zahr and de Traversay 1995) and for that reason it is very important to create a suitable environment that is conducive to sleep for all children in hospital. Quiet, comfortable, organized room and not too warm are Primary conditions for establishing patients room (McGrath n.d.).
Furthermore, investigation proper design strategies for providing individual bedrooms, removal of the noise resources, such as it is replacing noise equipment’s by quiet ones, and also the using of high-performance installation which avoid sound spread like ceiling tiles or panels, are considered extremely influential (Ulrich 2006). So, it is important that Sound is rated in a beginning of designing stages especially in a time for deciding key space should be considered in the early planning stages when deciding key space abutments of single rooms as well as departments. Contiguity of the quiet area with noisy areas, for instance, bed areas and playrooms, should not be near each other, should be kept away from. So, this can avoid costly sound isolations. Whereas the designers have a significant role in the selection of proper finishing, furnishing, fabrics, floor coverings and materials. And all of the elements in the interior can have an absorption and reflection sound. The study illustrates that environments with the importance of age proper design help children psychologically and effects on children’s emotional well-being, mental wellness and physical health (Norton-Westwood 2012). The transfer in a calmness place (home) to a complicated and busy space with many strange machines, noises, unfamiliar smells, and faces can be petrifying. So, playground space and other kid’s activity can help and improve children’s perception and understanding of hospital language, sounds, and sights (Haiat, Bar-Mor and Shochat 2003). Therefore, it is significant to have a place inwards for playing with games, graft works, toys, and books, or other activities. Playing is not only supply enjoyment unless it leads to an exploration and interaction with the environment (Armstrong and Aitken 2000). It can be positive for develops children’s social, cultural, emotional growth and physical. Moreover, the specific environment such as playing contributes to decreasing the stress and bother (Peterson 1989), as well as assist to manage with a hospital admission process (Delpo and Frick 1988).
Essentially, in this regard, light and color are the most important features of healthcare environments they are the two keys aspects of sight that have a physical effect on the patients overall well-being. Firstly, colour design can lead to more stimulating environments, which will be of benefit to all users, colour can make the hospital appear less frightful and this can be promoted through the use of appropriate art (Paintings in Hospitals 2015a, Lankston et al 2010) which can increase pain tolerance and a reduction in anxiety (Lankston et al 2010). Color design can play a part in the healing process and add to a sense of well-being. Color is also associated with child-friendly atmospheres. For instance, kids have a particular requirement for color design scheme, pre-school kids focus on color rather than “form”. According to past studies, Orange, pink and red, in this order of preference, are the favorite colors for pre-school kids. In term of color, they found that kids showed positive emotions to bright colors and negative emotions for dark colors. Kids of different ages are inspired by different colors and pattern combinations:
• Infants affected by complex patterns.
• Toddlers respond to real objects and bold colors.
• Older kids and teenagers generally prefer a neutral background.
As an example, the saturated yellows color harm the REM activity in sleep, although green can make a child with cancer feel nauseous. “Clinicians’ experiences at the Bristol Children’s Hospital have shown that purple can have the same nauseous effects”. Red can have powerful relations with blood for some kids. A color is an influential tool, at the same time it should be carefully specified for each particular kid’s age.
Secondly, Lighting (both natural and artificial) is a particularly powerful element in the design. It effective in patient body and control it. The quality of lighting in patients rooms affect patient’s emotion and the medical state of them; it also can lead to more stimulating environments and can support well-being (Antonakaki, 2009). The quality of natural or non-natural light has an essential impact on patients healing processes and it has effect in reducing the length of stay for in-patients in hospital. On the other hand it is important to notice that many kids may be receiving phototropic drugs which make them more sensitive for light .while kids related to outdoor environment, the advantage of full-spectrum lighting from the sun are: shorter reaction times, improved motor skills, better visual acuity, vitamin D synthesis, less physiological fatigue, and general better-quality performance.
According to (Lambert et al 2014), the main design principle is to enable the transmission of natural light in patient rooms and construct windows with views of nature for promoting a healing environment and reach calm (Alder Hey Children’s NHS Foundation Trust 2015a, Norton-Westwood 2012). Also, designers should develop ceilings with high levels of light reflectance to support daylight penetrate into the room (Anonymous 2011, p.19) and developing a light scheme to promote a high-quality image and a restful environment. Luminaries shouldn’t be organized on ceilings directly above patients, the light should be designed to reflect off walls and ceilings due to the fact that kids usually have very reflective skin.
According to this study, promoting better healthcare design requires cooperation between the world of medicine and architecture. To conclude, the factors that influence a healing environment are safety, sound, colour, artwork, interactive art, lighting, outdoor view, furnishing, and the atmosphere. Playing outside positively impacts the communication between children and the society. Nature and gardens can effectively develop kid’s emotion, decrease their pain, and produce a healing effect. In addition, outdoor view, natural sunlight, pastel colours, therapeutic sounds, and communication with family members can lead to a healing environment and they are essential to kid’s immediate well-being.
As a conclusion, improving healthcare environments can facilitate patients to relax, and reduce the stress, thus improving doctor-patient relations, improving healthcare quality, and decreasing costs. It is difficult to know the needs of the future but with the help of technology the creation of enjoyable, healing environments and therefore create a better quality in kid’s hospital facilities. Innovative materials, new design aspects, and fresh ideas will hopefully help children as much as possible so that the feelings of pain fear and isolation during hospitalization process won’t be the dominant ones. It is hoped that the findings and recommendations from this study will provide designers with a better understanding of design elements and help them to create better environments for patient kids.