ABSTRACT



Millions of US aging individuals are at risk for mild cognitive impairment (MCI), the early stage of Alzheimer's disease (Ad). Ad is progressive; there is no clinical cure to date. Certain drugs treat symptoms yet fog memory. Memory activity is critical to strengthen cognition. The Phoenix Art Museum (PAM) and Banner Alzheimer's Institute (BAI) founded the Arts Engagement Program (AEP), a non-clinical, specialized arts program for adults with (MCI) and their caregiver. The museum environment is thought to enhance communication and raise self-esteem in certain MCI individuals. The interior surroundings may spurn memory enhancement. Scholarship to substantiate this theory is minimal; therefore, further studies are required. Empirical literature regarding design elements researched specific types of memory impairment was employed. The hypotheses that design elements of the museum's infrastructure and design elements from art themes enhance memory, and the results of these findings when applied to other environments enhance memory emerged. An experience-based study was performed. Semi-structured interviews noting design elements of both infrastructure and art were conducted after each of nine AEP sessions with volunteers from 8 dyads, a term used by the PAM as one caregiver and one MCI individual. The presiding docent was later interviewed. Volunteer interviews with dyads and docents was coded and ranked. Overlapping themes that tallied five or higher were considered significant due the low sample size. Results showed that neither group considered infrastructure design elements or art theme design elements a contributor to memory enhancement. The hypotheses proved null. Both groups expressed pleasure in experiencing the PAM’s environment. Keywords: MCI, infrastructure, art themes.

Healthcare is one of the most personal and complex services provided, and as such, designing healthcare environments is particularly challenging. In the last couple of decades, researchers have concentrated their efforts on exploring the elements of the hospital environment that affect patients' health and in finding ways to apply that knowledge in contemporary healthcare design. But despite the growing body of research, there is an element of utmost importance to healing environments that has not been studied very extensively: the patient experience. The interaction of patients with their environment shapes their personal experience, and inversely, focusing on designing experiences rather than services can inform the design of successful healing environments. This shift from designing services to designing experiences has deep implications in healthcare settings because of the stressful situations that patients have to go through; memorable experiences have a positive influence on a patient's emotional health because they help minimize stress and in healthcare environments this translates into improved outcomes. The concept of assembling experiences is not new, especially in the entertainment industry; it was, in fact, the underlying principle behind the creation of the first theme park more than fifty years ago: Disneyland. Today, Disney is an entertainment industry leader and their design concepts and practices have been perfected to achieve the Company's main purpose: to immerse Guests in a happy, unforgettable experience. This research study focuses on examining the principles used by Disney designers, or Imagineers, as they are called within the organization, to generate memorable experiences, and how those theories can be adopted and adapted by healthcare designers to create better healing environments. However, Disney's Imagineering is not the only approach considered in this research. A thorough analysis would not be complete without delving into the concept of experiential design as a design process and from an economical perspective, as well as without analyzing recent notions about the importance of authenticity in businesses and its implications on design. This study, therefore, suggests a new healing environment design model based on a comprehensive review of the literature related to three main design approaches: Disney Imagineering, experiential design and authenticity.

ABSTRACT Nursing physical fatigue is a critical issue that may lead to degradation of care delivery and ultimately result in medical errors. This issue is equally relevant due to the looming shortage of nurses, which has been linked to the physical demands and potential occupational hazards intrinsic to the profession; as well as to the graying of the nursing workforce who experiences gradual loss of strength and agility that accompanies aging as time in the career advances. In a hospital Emergency Department, the level of nursing physical fatigue can potentially reach its threshold in light of challenging workloads, scope of job assignments and demanding schedules. While in other safety-sensitive industries such as aviation and nuclear plants, similar concerns have been the object of systematic research and addressed with consequent regulations, just recently, the healthcare sector has been engaged in further investigations. This study proposed to explore the linkage between Emergency Department design-layout and nursing physical fatigue. It was expected that further understanding on this relationship would support evidence-based design propositions linking nursing wellness, job satisfaction, and performance to a higher quality of care and improved patient safety levels. To this end, data collection was performed during four weeks in a community-based hospital. A convenience sample of twenty-four eligible nurses was invited to participate in this two-part study. The first section consisted of the completion of a self-administered questionnaire, which assessed nurses' perception of the impact of working conditions on nursing physical fatigue. The second section included the monitoring, through the use of accelerometers, of nurses' actual activity intensity levels during three consecutive shifts. Among other findings, data demonstrated that nurses perceive several attributes or components of the built environment as potential contributors to physical fatigue. In addition, various operational practices and organizational protocols were linked to physical fatigue. Contrary to nurses' perception of physical fatigue, their actual physical activity levels fell mostly between sedentary or light intensity ranges. This paradox offers the opportunity for design interventions that, in alignment with operational practices and organizational protocols will enhance nurses' performance and improve nurses' retention.

The goal of this research was to contribute to the understanding of how the physical design of Intensive Care Unit (ICU) environments may be improved to enhance nursing communication, and in turn, the quality and safety of patient outcomes. This study was guided by two research questions: (1) What are the major characteristics of nurse communication in a hybrid ICU nurse station design? (2) What are the factors in the built environment that enhance or hinder nurse communication in a hybrid ICU nurse station design? The research design was exploratory and qualitative. Observations were conducted in two ICUs with hybrid nurse station layouts. Participant observation was used to systematically observe and document nurse communication and the physical attributes of the ICU nurse work environment that affect communication. Literature, observations, and information regarding staffing and design about the selected ICUs were analyzed for the generation of concepts and the exploration of significant themes. Results show that nurse interactions with other staff members varied within the different zones of the ICU pod. A biaxial map illustrates four key types of core nurse communication interactions: At ease, On guard, In motion, and On the edge. The quadrants representing barriers to nurse communication are On guard and On the edge, and included interactions with other staff members in the pod. The quadrants representing facilitators to nurse communication are At ease and In motion. The hybrid nurse station layout supported nurse-nurse communication, but not communication interactions with other staff members present on the pod. The results provide a broad understanding of how nurse communication is affected by the environment in which nurses work, and allows for the emergence of design opportunities to enhance nurse communication.