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| May 24 2009, 5:30 PM EDT (current) | Artchik | 110 words added, 1 word deleted |
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B By Pamela A. Johnson
This information has been compiled in an effort to help improve and provide standards for artwork plans in military and veterans administration hospitals and clinics. I have been a professional art consultant for over 20 years, working in large corporate environments and then focusing in more recent years in healthcare and government healthcare projects. I have had the unique and challenging opportunity to tour multiple military healthcare facilities while evaluating them for best fit solutions for artwork plans. Each project has had its own set of requirements and challenges, and has been on the surface very different, because each set of patients has been of varying ages, backgrounds and circumstances. Many designers do not consider the reality that military hospitals treat the children and family members of both active and retired personnel. Pediatric wards, mother baby units, senior living and psychiatric treatment areas require the same quality and dedication to art work design as their counterparts in the civilian world, but frequently seem to lack the same financial resources and purchasing avenues, and, in addition, experienced design personnel who can also navigate the contracting office. The nature of government contracting causes a great restriction of normal acquisition practices and creates the need for innovative ideas, as well as standards, to compensate these restrictions. Therefore, a new type of designer is required, one with the expertise and commitment to embrace both the challenges and restrictions of current procurement procedures, and within this frame work, utilize the best resources available to help enlisted, retired, and wounded war fighters and their families heal in comfort. The following are areas both practical and aesthetic, that will help justify attention to this often overlooked, under budgeted and underserviced part of a military healthcare environment.
Environment and Healing
The therapeutic environments movement has been built on the beliefs of patients, scientists, designers, clinicians and visionary hospital staff. Artwork is important element within this movement. Several decades ago, individuals with mutually supportive belief that the physical environment has a measurable impact on human behavior, physiology, psychology and sociology found each other and began sharing knowledge. A few ground-breaking hospitals were built or transformed and, eventually , a movement was born.(*1 ) This movement became known as the Planetree organization. The Planetree organization has always maintained that artwork is an important part of an overall effort to create a less institutional healthcare environment. In 1982, Roger Ulrich, an environmental psychologist who is currently director of Texas A&M University's Center for Health Systems and Design, published a ground-breaking study in the prestigious journal Science. His study into the effects of a view of nature from the room of gall bladder surgery patients showed the differences in length of stay, the use of powerful drugs and reports of patients' conditions in the record. This extraordinary study gave a boost to design professionals who had always believed the environment had an influence on patients, but had not known of methods to measure it.(*2) In 1990, Ulrich published "Theory of Supportive Design" which was built on the basis of the existing relevant research and the understanding that all known medical conditions were exacerbated by stress. The concept was for design to reduce stress on patients , visitors, staff and physicians wherever possible. The theory recognized categories of stress reducing elements impacted by design, such as social support, provision of choice, positive distraction and access to nature.(*3) Artwork design can play an important part in fulfilling the void for positive distraction during treatment and access to nature, even inside a hospital facility. Individuals receiving treatment can focus away from pain and stress with effective visual aids. The USAF has integrated Planetree concepts into remodeled wards at Wilford Hall Medical Center in San Antonio, Texas. Homelike family waiting areas, family counseling rooms and antepartum wards have all included specialized appropriate art plans. Highline Community Hospital in Seattle uses art therapy, reporting success in alleviating depression in patients. (*4) Children away from parents and home environments for extended periods, such as a pediatric oncology patients, must suffer great discomfort, with an additional layer of fear that they are in a strange, often sterile environment devoid of the familiar childhood images, activities and play areas they would experience at home and in school. Much can be done to alleviate and modify their care areas by placing the familiar and comforting childhood images of Disney and others, placing cheerful color on walls and areas for display of their own artistry. To their great credit, this void is often filled by the efforts of the medical staff; however, again, a small investment of special and easily cleanable artwork display areas and cleanable digital murals can go a long way to help a child forget they are sick and in a strange place away from family. Individuals receiving treatment can focus away from pain and stress with effective visual aids. Artwork as Wayfinding
The health care campus of the future will be a network of programs that must be planned for diverse populations, site locations, levels of care and sophisticated technological linkages. The one time asset expenses of an upgraded or comopletely replaced wayfinding system will pay back exponentially over time. Many of the military hospitals have extremely similar floorplans, and patients and family can become easily disoriented in the maze of white walls, floor after floor of standardized design lacking customization. Because of on going mobility demands, there is certainly a basis for this standardization. Years of ongoing facility expansion, too, have caused the maze like effect. To a battlefield weary soldier returning to visit a family member, newly rotated medical personnel trying to acclimate to a new hospital, or a patient receiving medication, the lack of distinctive wayfinding and artwork in many hospitals is frustrating and unnecessary. Many patients today are older people who are easily disoriented in a hospital setting, particularly those who have dementia. For instance, one of the greatest difficulties in treating individuals with Alzheimer's in an acute care setting is the fear and disorientation that can cause these patients to become disturbed, loud and sometimes combative.(*5) Artwork provides distinctive and easily readable and recognizable wayfinding, especially for individuals with reading challenges. Wall colors differentiating floors or clinical areas with a few distinctive and individual pieces of artwork would seem like a worthy investment to assist with quick identification of each floor. White on white may be a sophisticated color scheme for the young, but not for older eyes and persons with low vision. Contrasting wall and floor colors improve visibility for older eyes. (*6) Colorful artwork images provide lasting signposts for patients with disorientation or memory loss issues. In tandem with the signage plan, visual cues for easy recall shold also be adopted. This marriage of architectural design, engineering, interior design, wayfinding and furnishings is required to adequately prepare a comprehensive hospital campus wayfinding strategy. As the internal conditions for aesthetics, lighting, signage and related factors are studied, the following opportunities to improve these aesthetics should utilize artwork, sculpture, water features, awards, honors and benefactors walls. (*7)
Pride and Morale
I have never been more astonished than when I began accessing photography created by warfighters and staff photographers alike. The wealth of absolutely unique images taught me a great deal, educating me to the many worthy humanitarian efforts that go otherwise unpublicized and unknown by those outside the military arena. The pride of our war fighters in their work, and the great compassion they show the civilians they interact with while doing their duty, has evoked some of the most moving and beautiful images I have ever seen. Through the medium of digital images, and the efforts to catalog them, we are presented as never before with resources to create displays unlike any other time in history. Bird's eye views of the world through the eyes of war fighters are wealth of material to utilize to inspire pride, respect and courage through visual media. These images have been utilized with success in refractive surgery centers, clinical research areas and medical staff training areas where patients are youthful recruits undergoing elective surgery or where there are no patient being treated.
Staff Satisfaction and Retention
The most overlooked group of individuals studied for their artwork preferences seem to be the staff themselves. Most emphasis is placed on patient outcome rates. In recent years, efforts to recruit and retain high quality medical staff has become a priority. The opportunity to individualize personal office space has gained importance, as furnishings have become less private and more uniform. Interviewing and interacting with medical staff does not have to compromise design standards. An experienced artwork designer can engage staff with a controlled group of selections that will not compromise overall interior design ingegrity or function. In civilian hospitals, the average age of the nursing staff has risen to 47 years, doctors and other medical staff are older and more than 50 percent of the volunteer force helping in medical facilities are people over 65 according to the December 2002 issue of the AARP Bulletin. *(8) Data from Planetree model sites utilizing artwork have shown decreased length of stay, fewer medication errors, lower infection rates, increased staff retention and little significant difference in cost. Although staff in military hospitals may on average be of a younger age, there is little doubt that they are highly enthusiastic and interested in participating in the selection of artwork for their patient areas. Many years of interaction with them and the care and importance they have placed on assisting me with selections has provided me with evidence to conclude that they, as well as the patients, benefit psychologically from artwork images incorporated into their interior design. Artwork in patient rooms, treatment areas and on art carts add to the ambiance.
Evidence -based design for artwork plans
Evidence-based design operates on many levels. The simplest is personal experience. A designer does what he or she believes works based on personal experience as a human being in similar circumstances. The second is anecdotal reciprocity. A designer does what he or she heard works in multiple instances. The next level of evidence-based design involves a deeper understanding based upon serious and systematic evaluations of the interactions of humans within an environmental context.(*9) Ultimately, evidence-based artwork design needs to be informed by all four categories--personal experience (as in employing an experienced artwork designer experience in government hospital environments), anecdotal evidence, relevant research and pure science. Much in the direction of anecdotal evidence can easily be gathered. Over time, this can develop into relevant research and pure science.
Needed: A Veterans Artwork Project
Veterans present a different and more complex set of challenges to the artwork designer. Many veterans suffering from post traumatic stress disorder and other psychological disorders are disturbed by images that evoke memories of the trauma they have suffered, however well meaning; even images of national monuments can leave them distressed or emotionally disconnected. Much more research needs to be gathered regarding their reactions to ascertain imagery they consider positive, attractive, reassuring and comforting, as they will comprise a vast majority of long term Veteran's Administration patients in the future. Patients with both mild and traumatic brain injuries will be commonplace, and immediate actions to gather evidence-based design regarding artwork images for their health care environments is overdue. Any health crisis is stressful, but we rely upon our brain to help us cope and survive these crises, and when our brain is injured and we are unable to express our helplessness and inability to communicate, our journey to survival takes another turn altogether. As with senior living environments, images and sounds that are reassuring and comforting to a patient who is disoriented and stressed, can be of great comfort, calming a patient, and thereby assisting care takers and clinical staff. Perhaps a first step toward developing such a program would be a simple anonymous multiple choice questionnaire offered to current patients of exisiting VA facilities. This questionnaire could provide a focused and realistic database of preferences from which a practical design program could be initiated. Programs that engage warfighters and veterans in positive expressions via artwork could also be incorporated in small, revolving gallery exhibits that are already used in some hospitals. The parallels between-evidence based art work design and evidence-based medicine make the development of therapeutic environments an area of interest. This exciting trend looks to be a positive and important direction for the health care field, and is beginning to confirm what most art plan designers have always believed - that positive artwork images help both the mind and the body heal.
References:
*1. From "Therapeutic environments" by Fancis M. Pitts, OAA, AIA, FACHA & Dirk Hamilton, FAIA, FAC HA
*2. From "Therapeutic environments" by Fancis M. Pitts, OAA, AIA, FACHA & Dirk Hamilton, FAIA, FAC HA
*3. From "Planetree: Changing the Way We Think About Patients" by Nancy Moore
*4. From "Therapeutic environments" by Fancis M. Pitts, OAA, AIA, FACHA & Dirk Hamilton, FAIA, FAC HA
*5. From " Accomodating the aged" by Elizabeth C. Brawley, IIDA, AAHID, CID *6. From "Accomodating the aged " by Elizabeth C. Brawley, IIDA, AAHID, CID
*7.*6. From "Traffic/Report/Advice on improving a hospital wayfinding system" by James G. Easter Jr., FAAMA
*7. From "Accomodating the aged" by Elizabeth C. Brawley, IIDA, AAHID, CID
*8. From "Therapeutic environments" by Fancis M. Pitts, OAA, AIA, FACHA & Dirk Hamilton, FAIA, FAC HA
Update: 05/23/09
We are now currently preparing the above mentioned questionnaire an have arranged for a test group. I will publish the findings of this initial research as soon as it is completed.
I have also recently been assisted in finding information that the Veterans Administration has an art exhibition and contest annually, and I am in the process of interviewing staff and participants in this program to gather their personal experiences and opinions as to how this program could be integrated into the design process of military and government hospital facilities and clinics. Thank you to Vicki Berrios, interior designer, and Patti Kaufman, recreational therapist, at the CTVA.
y By Pamela A. Johnson This information has been compiled in an effort to help improve and provide standards for artwork plans in military and veterans administration hospitals and clinics. I have been a professional art consultant for over 20 years, working in large corporate environments and then focusing in more recent years in healthcare and government healthcare projects. I have had the unique and challenging opportunity to tour multiple military healthcare facilities while evaluating them for best fit solutions for artwork plans. Each project has had its own set of requirements and challenges, and has been on the surface very different, because each set of patients has been of varying ages, backgrounds and circumstances. Many designers do not consider the reality that military hospitals treat the children and family members of both active and retired personnel. Pediatric wards, mother baby units, senior living and psychiatric treatment areas require the same quality and dedication to art work design as their counterparts in the civilian world, but frequently seem to lack the same financial resources and purchasing avenues, and, in addition, experienced design personnel who can also navigate the contracting office. The nature of government contracting causes a great restriction of normal acquisition practices and creates the need for innovative ideas, as well as standards, to compensate these restrictions. Therefore, a new type of designer is required, one with the expertise and commitment to embrace both the challenges and restrictions of current procurement procedures, and within this frame work, utilize the best resources available to help enlisted, retired, and wounded war fighters and their families heal in comfort. The following are areas both practical and aesthetic, that will help justify attention to this often overlooked, under budgeted and underserviced part of a military healthcare environment. Environment and Healing The therapeutic environments movement has been built on the beliefs of patients, scientists, designers, clinicians and visionary hospital staff. Artwork is important element within this movement. Several decades ago, individuals with mutually supportive belief that the physical environment has a measurable impact on human behavior, physiology, psychology and sociology found each other and began sharing knowledge. A few ground-breaking hospitals were built or transformed and, eventually , a movement was born.(*1 ) This movement became known as the Planetree organization. The Planetree organization has always maintained that artwork is an important part of an overall effort to create a less institutional healthcare environment. In 1982, Roger Ulrich, an environmental psychologist who is currently director of Texas A&M University's Center for Health Systems and Design, published a ground-breaking study in the prestigious journal Science. His study into the effects of a view of nature from the room of gall bladder surgery patients showed the differences in length of stay, the use of powerful drugs and reports of patients' conditions in the record. This extraordinary study gave a boost to design professionals who had always believed the environment had an influence on patients, but had not known of methods to measure it.(*2) In 1990, Ulrich published "Theory of Supportive Design" which was built on the basis of the existing relevant research and the understanding that all known medical conditions were exacerbated by stress. The concept was for design to reduce stress on patients , visitors, staff and physicians wherever possible. The theory recognized categories of stress reducing elements impacted by design, such as social support, provision of choice, positive distraction and access to nature.(*3) Artwork design can play an important part in fulfilling the void for positive distraction during treatment and access to nature, even inside a hospital facility. Individuals receiving treatment can focus away from pain and stress with effective visual aids. The USAF has integrated Planetree concepts into remodeled wards at Wilford Hall Medical Center in San Antonio, Texas. Homelike family waiting areas, family counseling rooms and antepartum wards have all included specialized appropriate art plans. Highline Community Hospital in Seattle uses art therapy, reporting success in alleviating depression in patients. (*4) Children away from parents and home environments for extended periods, such as a pediatric oncology patients, must suffer great discomfort, with an additional layer of fear that they are in a strange, often sterile environment devoid of the familiar childhood images, activities and play areas they would experience at home and in school. Much can be done to alleviate and modify their care areas by placing the familiar and comforting childhood images of Disney and others, placing cheerful color on walls and areas for display of their own artistry. To their great credit, this void is often filled by the efforts of the medical staff; however, again, a small investment of special and easily cleanable artwork display areas and cleanable digital murals can go a long way to help a child forget they are sick and in a strange place away from family. Individuals receiving treatment can focus away from pain and stress with effective visual aids. Artwork as Wayfinding The health care campus of the future will be a network of programs that must be planned for diverse populations, site locations, levels of care and sophisticated technological linkages. The one time asset expenses of an upgraded or comopletely replaced wayfinding system will pay back exponentially over time. Many of the military hospitals have extremely similar floorplans, and patients and family can become easily disoriented in the maze of white walls, floor after floor of standardized design lacking customization. Because of on going mobility demands, there is certainly a basis for this standardization. Years of ongoing facility expansion, too, have caused the maze like effect. To a battlefield weary soldier returning to visit a family member, newly rotated medical personnel trying to acclimate to a new hospital, or a patient receiving medication, the lack of distinctive wayfinding and artwork in many hospitals is frustrating and unnecessary. Many patients today are older people who are easily disoriented in a hospital setting, particularly those who have dementia. For instance, one of the greatest difficulties in treating individuals with Alzheimer's in an acute care setting is the fear and disorientation that can cause these patients to become disturbed, loud and sometimes combative.(*5) Artwork provides distinctive and easily readable and recognizable wayfinding, especially for individuals with reading challenges. Wall colors differentiating floors or clinical areas with a few distinctive and individual pieces of artwork would seem like a worthy investment to assist with quick identification of each floor. White on white may be a sophisticated color scheme for the young, but not for older eyes and persons with low vision. Contrasting wall and floor colors improve visibility for older eyes. (*6) Colorful artwork images provide lasting signposts for patients with disorientation or memory loss issues. In tandem with the signage plan, visual cues for easy recall shold also be adopted. This marriage of architectural design, engineering, interior design, wayfinding and furnishings is required to adequately prepare a comprehensive hospital campus wayfinding strategy. As the internal conditions for aesthetics, lighting, signage and related factors are studied, the following opportunities to improve these aesthetics should utilize artwork, sculpture, water features, awards, honors and benefactors walls. (*7) Pride and Morale I have never been more astonished than when I began accessing photography created by warfighters and staff photographers alike. The wealth of absolutely unique images taught me a great deal, educating me to the many worthy humanitarian efforts that go otherwise unpublicized and unknown by those outside the military arena. The pride of our war fighters in their work, and the great compassion they show the civilians they interact with while doing their duty, has evoked some of the most moving and beautiful images I have ever seen. Through the medium of digital images, and the efforts to catalog them, we are presented as never before with resources to create displays unlike any other time in history. Bird's eye views of the world through the eyes of war fighters are wealth of material to utilize to inspire pride, respect and courage through visual media. These images have been utilized with success in refractive surgery centers, clinical research areas and medical staff training areas where patients are youthful recruits undergoing elective surgery or where there are no patient being treated. Staff Satisfaction and Retention The most overlooked group of individuals studied for their artwork preferences seem to be the staff themselves. Most emphasis is placed on patient outcome rates. In recent years, efforts to recruit and retain high quality medical staff has become a priority. The opportunity to individualize personal office space has gained importance, as furnishings have become less private and more uniform. Interviewing and interacting with medical staff does not have to compromise design standards. An experienced artwork designer can engage staff with a controlled group of selections that will not compromise overall interior design ingegrity or function. In civilian hospitals, the average age of the nursing staff has risen to 47 years, doctors and other medical staff are older and more than 50 percent of the volunteer force helping in medical facilities are people over 65 according to the December 2002 issue of the AARP Bulletin. *(8) Data from Planetree model sites utilizing artwork have shown decreased length of stay, fewer medication errors, lower infection rates, increased staff retention and little significant difference in cost. Although staff in military hospitals may on average be of a younger age, there is little doubt that they are highly enthusiastic and interested in participating in the selection of artwork for their patient areas. Many years of interaction with them and the care and importance they have placed on assisting me with selections has provided me with evidence to conclude that they, as well as the patients, benefit psychologically from artwork images incorporated into their interior design. Artwork in patient rooms, treatment areas and on art carts add to the ambiance. Evidence -based design for artwork plans Evidence-based design operates on many levels. The simplest is personal experience. A designer does what he or she believes works based on personal experience as a human being in similar circumstances. The second is anecdotal reciprocity. A designer does what he or she heard works in multiple instances. The next level of evidence-based design involves a deeper understanding based upon serious and systematic evaluations of the interactions of humans within an environmental context.(*9) Ultimately, evidence-based artwork design needs to be informed by all four categories--personal experience (as in employing an experienced artwork designer experience in government hospital environments), anecdotal evidence, relevant research and pure science. Much in the direction of anecdotal evidence can easily be gathered. Over time, this can develop into relevant research and pure science. Needed: A Veterans Artwork Project Veterans present a different and more complex set of challenges to the artwork designer. Many veterans suffering from post traumatic stress disorder and other psychological disorders are disturbed by images that evoke memories of the trauma they have suffered, however well meaning; even images of national monuments can leave them distressed or emotionally disconnected. Much more research needs to be gathered regarding their reactions to ascertain imagery they consider positive, attractive, reassuring and comforting, as they will comprise a vast majority of long term Veteran's Administration patients in the future. Patients with both mild and traumatic brain injuries will be commonplace, and immediate actions to gather evidence-based design regarding artwork images for their health care environments is overdue. Any health crisis is stressful, but we rely upon our brain to help us cope and survive these crises, and when our brain is injured and we are unable to express our helplessness and inability to communicate, our journey to survival takes another turn altogether. As with senior living environments, images and sounds that are reassuring and comforting to a patient who is disoriented and stressed, can be of great comfort, calming a patient, and thereby assisting care takers and clinical staff. Perhaps a first step toward developing such a program would be a simple anonymous multiple choice questionnaire offered to current patients of exisiting VA facilities. This questionnaire could provide a focused and realistic database of preferences from which a practical design program could be initiated. Programs that engage warfighters and veterans in positive expressions via artwork could also be incorporated in small, revolving gallery exhibits that are already used in some hospitals. The parallels between-evidence based art work design and evidence-based medicine make the development of therapeutic environments an area of interest. This exciting trend looks to be a positive and important direction for the health care field, and is beginning to confirm what most art plan designers have always believed - that positive artwork images help both the mind and the body heal. References: *1. From "Therapeutic environments" by Fancis M. Pitts, OAA, AIA, FACHA & Dirk Hamilton, FAIA, FAC HA *2. From "Therapeutic environments" by Fancis M. Pitts, OAA, AIA, FACHA & Dirk Hamilton, FAIA, FAC HA *3. From "Planetree: Changing the Way We Think About Patients" by Nancy Moore *4. From "Therapeutic environments" by Fancis M. Pitts, OAA, AIA, FACHA & Dirk Hamilton, FAIA, FAC HA *5. From " Accomodating the aged" by Elizabeth C. Brawley, IIDA, AAHID, CID *6. From "Accomodating the aged " by Elizabeth C. Brawley, IIDA, AAHID, CID *7. From "Traffic/Report/Advice on improving a hospital wayfinding system" by James G. Easter Jr., FAAMA *7. From "Accomodating the aged" by Elizabeth C. Brawley, IIDA, AAHID, CID *8. From "Therapeutic environments" by Fancis M. Pitts, OAA, AIA, FACHA & Dirk Hamilton, FAIA, FAC HA Pamela A. Johnson This information has been compiled in an effort to help improve and provide standards for artwork plans in military and veterans administration hospitals and clinics. I have been a professional art consultant for over 20 years, working in large corporate environments and then focusing in more recent years in healthcare and government healthcare projects. I have had the unique and challenging opportunity to tour multiple military healthcare facilities while evaluating them for best fit solutions for artwork plans. Each project has had its own set of requirements and challenges, and has been on the surface very different, because each set of patients has been of varying ages, backgrounds and circumstances. Many designers do not consider the reality that military hospitals treat the children and family members of both active and retired personnel. Pediatric wards, mother baby units, senior living and psychiatric treatment areas require the same quality and dedication to art work design as their counterparts in the civilian world, but frequently seem to lack the same financial resources and purchasing avenues, and, in addition, experienced design personnel who can also navigate the contracting office. The nature of government contracting causes a great restriction of normal acquisition practices and creates the need for innovative ideas, as well as standards, to compensate these restrictions. Therefore, a new type of designer is required, one with the expertise and commitment to embrace both the challenges and restrictions of current procurement procedures, and within this frame work, utilize the best resources available to help enlisted, retired, and wounded war fighters and their families heal in comfort. The following are areas both practical and aesthetic, that will help justify attention to this often overlooked, under budgeted and underserviced part of a military healthcare environment. Environment and Healing The therapeutic environments movement has been built on the beliefs of patients, scientists, designers, clinicians and visionary hospital staff. Artwork is important element within this movement. Several decades ago, individuals with mutually supportive belief that the physical environment has a measurable impact on human behavior, physiology, psychology and sociology found each other and began sharing knowledge. A few ground-breaking hospitals were built or transformed and, eventually , a movement was born.(*1 ) This movement became known as the Planetree organization. The Planetree organization has always maintained that artwork is an important part of an overall effort to create a less institutional healthcare environment. In 1982, Roger Ulrich, an environmental psychologist who is currently director of Texas A&M University's Center for Health Systems and Design, published a ground-breaking study in the prestigious journal Science. His study into the effects of a view of nature from the room of gall bladder surgery patients showed the differences in length of stay, the use of powerful drugs and reports of patients' conditions in the record. This extraordinary study gave a boost to design professionals who had always believed the environment had an influence on patients, but had not known of methods to measure it.(*2) In 1990, Ulrich published "Theory of Supportive Design" which was built on the basis of the existing relevant research and the understanding that all known medical conditions were exacerbated by stress. The concept was for design to reduce stress on patients , visitors, staff and physicians wherever possible. The theory recognized categories of stress reducing elements impacted by design, such as social support, provision of choice, positive distraction and access to nature.(*3) Artwork design can play an important part in fulfilling the void for positive distraction during treatment and access to nature, even inside a hospital facility. Individuals receiving treatment can focus away from pain and stress with effective visual aids. The USAF has integrated Planetree concepts into remodeled wards at Wilford Hall Medical Center in San Antonio, Texas. Homelike family waiting areas, family counseling rooms and antepartum wards have all included specialized appropriate art plans. Highline Community Hospital in Seattle uses art therapy, reporting success in alleviating depression in patients. (*4) Children away from parents and home environments for extended periods, such as a pediatric oncology patients, must suffer great discomfort, with an additional layer of fear that they are in a strange, often sterile environment devoid of the familiar childhood images, activities and play areas they would experience at home and in school. Much can be done to alleviate and modify their care areas by placing the familiar and comforting childhood images of Disney and others, placing cheerful color on walls and areas for display of their own artistry. To their great credit, this void is often filled by the efforts of the medical staff; however, again, a small investment of special and easily cleanable artwork display areas and cleanable digital murals can go a long way to help a child forget they are sick and in a strange place away from family. Individuals receiving treatment can focus away from pain and stress with effective visual aids. Artwork as Wayfinding The health care campus of the future will be a network of programs that must be planned for diverse populations, site locations, levels of care and sophisticated technological linkages. The one time asset expenses of an upgraded or comopletely replaced wayfinding system will pay back exponentially over time. Many of the military hospitals have extremely similar floorplans, and patients and family can become easily disoriented in the maze of white walls, floor after floor of standardized design lacking customization. Because of on going mobility demands, there is certainly a basis for this standardization. Years of ongoing facility expansion, too, have caused the maze like effect. To a battlefield weary soldier returning to visit a family member, newly rotated medical personnel trying to acclimate to a new hospital, or a patient receiving medication, the lack of distinctive wayfinding and artwork in many hospitals is frustrating and unnecessary. Many patients today are older people who are easily disoriented in a hospital setting, particularly those who have dementia. For instance, one of the greatest difficulties in treating individuals with Alzheimer's in an acute care setting is the fear and disorientation that can cause these patients to become disturbed, loud and sometimes combative.(*5) Artwork provides distinctive and easily readable and recognizable wayfinding, especially for individuals with reading challenges. Wall colors differentiating floors or clinical areas with a few distinctive and individual pieces of artwork would seem like a worthy investment to assist with quick identification of each floor. White on white may be a sophisticated color scheme for the young, but not for older eyes and persons with low vision. Contrasting wall and floor colors improve visibility for older eyes. (*6) Colorful artwork images provide lasting signposts for patients with disorientation or memory loss issues. In tandem with the signage plan, visual cues for easy recall shold also be adopted. This marriage of architectural design, engineering, interior design, wayfinding and furnishings is required to adequately prepare a comprehensive hospital campus wayfinding strategy. As the internal conditions for aesthetics, lighting, signage and related factors are studied, the following opportunities to improve these aesthetics should utilize artwork, sculpture, water features, awards, honors and benefactors walls. (*7) Pride and Morale I have never been more astonished than when I began accessing photography created by warfighters and staff photographers alike. The wealth of absolutely unique images taught me a great deal, educating me to the many worthy humanitarian efforts that go otherwise unpublicized and unknown by those outside the military arena. The pride of our war fighters in their work, and the great compassion they show the civilians they interact with while doing their duty, has evoked some of the most moving and beautiful images I have ever seen. Through the medium of digital images, and the efforts to catalog them, we are presented as never before with resources to create displays unlike any other time in history. Bird's eye views of the world through the eyes of war fighters are wealth of material to utilize to inspire pride, respect and courage through visual media. These images have been utilized with success in refractive surgery centers, clinical research areas and medical staff training areas where patients are youthful recruits undergoing elective surgery or where there are no patient being treated. Staff Satisfaction and Retention The most overlooked group of individuals studied for their artwork preferences seem to be the staff themselves. Most emphasis is placed on patient outcome rates. In recent years, efforts to recruit and retain high quality medical staff has become a priority. The opportunity to individualize personal office space has gained importance, as furnishings have become less private and more uniform. Interviewing and interacting with medical staff does not have to compromise design standards. An experienced artwork designer can engage staff with a controlled group of selections that will not compromise overall interior design ingegrity or function. In civilian hospitals, the average age of the nursing staff has risen to 47 years, doctors and other medical staff are older and more than 50 percent of the volunteer force helping in medical facilities are people over 65 according to the December 2002 issue of the AARP Bulletin. *(8) Data from Planetree model sites utilizing artwork have shown decreased length of stay, fewer medication errors, lower infection rates, increased staff retention and little significant difference in cost. Although staff in military hospitals may on average be of a younger age, there is little doubt that they are highly enthusiastic and interested in participating in the selection of artwork for their patient areas. Many years of interaction with them and the care and importance they have placed on assisting me with selections has provided me with evidence to conclude that they, as well as the patients, benefit psychologically from artwork images incorporated into their interior design. Artwork in patient rooms, treatment areas and on art carts add to the ambiance. Evidence -based design for artwork plans Evidence-based design operates on many levels. The simplest is personal experience. A designer does what he or she believes works based on personal experience as a human being in similar circumstances. The second is anecdotal reciprocity. A designer does what he or she heard works in multiple instances. The next level of evidence-based design involves a deeper understanding based upon serious and systematic evaluations of the interactions of humans within an environmental context.(*9) Ultimately, evidence-based artwork design needs to be informed by all four categories--personal experience (as in employing an experienced artwork designer experience in government hospital environments), anecdotal evidence, relevant research and pure science. Much in the direction of anecdotal evidence can easily be gathered. Over time, this can develop into relevant research and pure science. Needed: A Veterans Artwork Project Veterans present a different and more complex set of challenges to the artwork designer. Many veterans suffering from post traumatic stress disorder and other psychological disorders are disturbed by images that evoke memories of the trauma they have suffered, however well meaning; even images of national monuments can leave them distressed or emotionally disconnected. Much more research needs to be gathered regarding their reactions to ascertain imagery they consider positive, attractive, reassuring and comforting, as they will comprise a vast majority of long term Veteran's Administration patients in the future. Patients with both mild and traumatic brain injuries will be commonplace, and immediate actions to gather evidence-based design regarding artwork images for their health care environments is overdue. Any health crisis is stressful, but we rely upon our brain to help us cope and survive these crises, and when our brain is injured and we are unable to express our helplessness and inability to communicate, our journey to survival takes another turn altogether. As with senior living environments, images and sounds that are reassuring and comforting to a patient who is disoriented and stressed, can be of great comfort, calming a patient, and thereby assisting care takers and clinical staff. Perhaps a first step toward developing such a program would be a simple anonymous multiple choice questionnaire offered to current patients of exisiting VA facilities. This questionnaire could provide a focused and realistic database of preferences from which a practical design program could be initiated. Programs that engage warfighters and veterans in positive expressions via artwork could also be incorporated in small, revolving gallery exhibits that are already used in some hospitals. The parallels between-evidence based art work design and evidence-based medicine make the development of therapeutic environments an area of interest. This exciting trend looks to be a positive and important direction for the health care field, and is beginning to confirm what most art plan designers have always believed - that positive artwork images help both the mind and the body heal. References: *1. From "Therapeutic environments" by Fancis M. Pitts, OAA, AIA, FACHA & Dirk Hamilton, FAIA, FAC HA *2. From "Therapeutic environments" by Fancis M. Pitts, OAA, AIA, FACHA & Dirk Hamilton, FAIA, FAC HA *3. From "Planetree: Changing the Way We Think About Patients" by Nancy Moore *4. From "Therapeutic environments" by Fancis M. Pitts, OAA, AIA, FACHA & Dirk Hamilton, FAIA, FAC HA *5. From " Accomodating the aged" by Elizabeth C. Brawley, IIDA, AAHID, CID *6. From "Accomodating the aged " by Elizabeth C. Brawley, IIDA, AAHID, CID *7. From "Traffic/Report/Advice on improving a hospital wayfinding system" by James G. Easter Jr., FAAMA *7. From "Accomodating the aged" by Elizabeth C. Brawley, IIDA, AAHID, CID *8. From "Therapeutic environments" by Fancis M. Pitts, OAA, AIA, FACHA & Dirk Hamilton, FAIA, FAC HA
This information has been compiled in an effort to help improve and provide standards for artwork plans in military and veterans administration hospitals and clinics. I have been a professional art consultant for over 20 years, working in large corporate environments and then focusing in more recent years in healthcare and government healthcare projects. I have had the unique and challenging opportunity to tour multiple military healthcare facilities while evaluating them for best fit solutions for artwork plans. Each project has had its own set of requirements and challenges, and has been on the surface very different, because each set of patients has been of varying ages, backgrounds and circumstances. Many designers do not consider the reality that military hospitals treat the children and family members of both active and retired personnel. Pediatric wards, mother baby units, senior living and psychiatric treatment areas require the same quality and dedication to art work design as their counterparts in the civilian world, but frequently seem to lack the same financial resources and purchasing avenues, and, in addition, experienced design personnel who can also navigate the contracting office. The nature of government contracting causes a great restriction of normal acquisition practices and creates the need for innovative ideas, as well as standards, to compensate these restrictions. Therefore, a new type of designer is required, one with the expertise and commitment to embrace both the challenges and restrictions of current procurement procedures, and within this frame work, utilize the best resources available to help enlisted, retired, and wounded war fighters and their families heal in comfort. The following are areas both practical and aesthetic, that will help justify attention to this often overlooked, under budgeted and underserviced part of a military healthcare environment.
Environment and Healing
The therapeutic environments movement has been built on the beliefs of patients, scientists, designers, clinicians and visionary hospital staff. Artwork is important element within this movement. Several decades ago, individuals with mutually supportive belief that the physical environment has a measurable impact on human behavior, physiology, psychology and sociology found each other and began sharing knowledge. A few ground-breaking hospitals were built or transformed and, eventually , a movement was born.(*1 ) This movement became known as the Planetree organization. The Planetree organization has always maintained that artwork is an important part of an overall effort to create a less institutional healthcare environment. In 1982, Roger Ulrich, an environmental psychologist who is currently director of Texas A&M University's Center for Health Systems and Design, published a ground-breaking study in the prestigious journal Science. His study into the effects of a view of nature from the room of gall bladder surgery patients showed the differences in length of stay, the use of powerful drugs and reports of patients' conditions in the record. This extraordinary study gave a boost to design professionals who had always believed the environment had an influence on patients, but had not known of methods to measure it.(*2) In 1990, Ulrich published "Theory of Supportive Design" which was built on the basis of the existing relevant research and the understanding that all known medical conditions were exacerbated by stress. The concept was for design to reduce stress on patients , visitors, staff and physicians wherever possible. The theory recognized categories of stress reducing elements impacted by design, such as social support, provision of choice, positive distraction and access to nature.(*3) Artwork design can play an important part in fulfilling the void for positive distraction during treatment and access to nature, even inside a hospital facility. Individuals receiving treatment can focus away from pain and stress with effective visual aids. The USAF has integrated Planetree concepts into remodeled wards at Wilford Hall Medical Center in San Antonio, Texas. Homelike family waiting areas, family counseling rooms and antepartum wards have all included specialized appropriate art plans. Highline Community Hospital in Seattle uses art therapy, reporting success in alleviating depression in patients. (*4) Children away from parents and home environments for extended periods, such as a pediatric oncology patients, must suffer great discomfort, with an additional layer of fear that they are in a strange, often sterile environment devoid of the familiar childhood images, activities and play areas they would experience at home and in school. Much can be done to alleviate and modify their care areas by placing the familiar and comforting childhood images of Disney and others, placing cheerful color on walls and areas for display of their own artistry. To their great credit, this void is often filled by the efforts of the medical staff; however, again, a small investment of special and easily cleanable artwork display areas and cleanable digital murals can go a long way to help a child forget they are sick and in a strange place away from family. Individuals receiving treatment can focus away from pain and stress with effective visual aids. Artwork as Wayfinding
The health care campus of the future will be a network of programs that must be planned for diverse populations, site locations, levels of care and sophisticated technological linkages. The one time asset expenses of an upgraded or comopletely replaced wayfinding system will pay back exponentially over time. Many of the military hospitals have extremely similar floorplans, and patients and family can become easily disoriented in the maze of white walls, floor after floor of standardized design lacking customization. Because of on going mobility demands, there is certainly a basis for this standardization. Years of ongoing facility expansion, too, have caused the maze like effect. To a battlefield weary soldier returning to visit a family member, newly rotated medical personnel trying to acclimate to a new hospital, or a patient receiving medication, the lack of distinctive wayfinding and artwork in many hospitals is frustrating and unnecessary. Many patients today are older people who are easily disoriented in a hospital setting, particularly those who have dementia. For instance, one of the greatest difficulties in treating individuals with Alzheimer's in an acute care setting is the fear and disorientation that can cause these patients to become disturbed, loud and sometimes combative.(*5) Artwork provides distinctive and easily readable and recognizable wayfinding, especially for individuals with reading challenges. Wall colors differentiating floors or clinical areas with a few distinctive and individual pieces of artwork would seem like a worthy investment to assist with quick identification of each floor. White on white may be a sophisticated color scheme for the young, but not for older eyes and persons with low vision. Contrasting wall and floor colors improve visibility for older eyes. (*6) Colorful artwork images provide lasting signposts for patients with disorientation or memory loss issues. In tandem with the signage plan, visual cues for easy recall shold also be adopted. This marriage of architectural design, engineering, interior design, wayfinding and furnishings is required to adequately prepare a comprehensive hospital campus wayfinding strategy. As the internal conditions for aesthetics, lighting, signage and related factors are studied, the following opportunities to improve these aesthetics should utilize artwork, sculpture, water features, awards, honors and benefactors walls. (*7)
Pride and Morale
I have never been more astonished than when I began accessing photography created by warfighters and staff photographers alike. The wealth of absolutely unique images taught me a great deal, educating me to the many worthy humanitarian efforts that go otherwise unpublicized and unknown by those outside the military arena. The pride of our war fighters in their work, and the great compassion they show the civilians they interact with while doing their duty, has evoked some of the most moving and beautiful images I have ever seen. Through the medium of digital images, and the efforts to catalog them, we are presented as never before with resources to create displays unlike any other time in history. Bird's eye views of the world through the eyes of war fighters are wealth of material to utilize to inspire pride, respect and courage through visual media. These images have been utilized with success in refractive surgery centers, clinical research areas and medical staff training areas where patients are youthful recruits undergoing elective surgery or where there are no patient being treated.
Staff Satisfaction and Retention
The most overlooked group of individuals studied for their artwork preferences seem to be the staff themselves. Most emphasis is placed on patient outcome rates. In recent years, efforts to recruit and retain high quality medical staff has become a priority. The opportunity to individualize personal office space has gained importance, as furnishings have become less private and more uniform. Interviewing and interacting with medical staff does not have to compromise design standards. An experienced artwork designer can engage staff with a controlled group of selections that will not compromise overall interior design ingegrity or function. In civilian hospitals, the average age of the nursing staff has risen to 47 years, doctors and other medical staff are older and more than 50 percent of the volunteer force helping in medical facilities are people over 65 according to the December 2002 issue of the AARP Bulletin. *(8) Data from Planetree model sites utilizing artwork have shown decreased length of stay, fewer medication errors, lower infection rates, increased staff retention and little significant difference in cost. Although staff in military hospitals may on average be of a younger age, there is little doubt that they are highly enthusiastic and interested in participating in the selection of artwork for their patient areas. Many years of interaction with them and the care and importance they have placed on assisting me with selections has provided me with evidence to conclude that they, as well as the patients, benefit psychologically from artwork images incorporated into their interior design. Artwork in patient rooms, treatment areas and on art carts add to the ambiance.
Evidence -based design for artwork plans
Evidence-based design operates on many levels. The simplest is personal experience. A designer does what he or she believes works based on personal experience as a human being in similar circumstances. The second is anecdotal reciprocity. A designer does what he or she heard works in multiple instances. The next level of evidence-based design involves a deeper understanding based upon serious and systematic evaluations of the interactions of humans within an environmental context.(*9) Ultimately, evidence-based artwork design needs to be informed by all four categories--personal experience (as in employing an experienced artwork designer experience in government hospital environments), anecdotal evidence, relevant research and pure science. Much in the direction of anecdotal evidence can easily be gathered. Over time, this can develop into relevant research and pure science.
Needed: A Veterans Artwork Project
Veterans present a different and more complex set of challenges to the artwork designer. Many veterans suffering from post traumatic stress disorder and other psychological disorders are disturbed by images that evoke memories of the trauma they have suffered, however well meaning; even images of national monuments can leave them distressed or emotionally disconnected. Much more research needs to be gathered regarding their reactions to ascertain imagery they consider positive, attractive, reassuring and comforting, as they will comprise a vast majority of long term Veteran's Administration patients in the future. Patients with both mild and traumatic brain injuries will be commonplace, and immediate actions to gather evidence-based design regarding artwork images for their health care environments is overdue. Any health crisis is stressful, but we rely upon our brain to help us cope and survive these crises, and when our brain is injured and we are unable to express our helplessness and inability to communicate, our journey to survival takes another turn altogether. As with senior living environments, images and sounds that are reassuring and comforting to a patient who is disoriented and stressed, can be of great comfort, calming a patient, and thereby assisting care takers and clinical staff. Perhaps a first step toward developing such a program would be a simple anonymous multiple choice questionnaire offered to current patients of exisiting VA facilities. This questionnaire could provide a focused and realistic database of preferences from which a practical design program could be initiated. Programs that engage warfighters and veterans in positive expressions via artwork could also be incorporated in small, revolving gallery exhibits that are already used in some hospitals. The parallels between-evidence based art work design and evidence-based medicine make the development of therapeutic environments an area of interest. This exciting trend looks to be a positive and important direction for the health care field, and is beginning to confirm what most art plan designers have always believed - that positive artwork images help both the mind and the body heal.
References:
*1. From "Therapeutic environments" by Fancis M. Pitts, OAA, AIA, FACHA & Dirk Hamilton, FAIA, FAC HA
*2. From "Therapeutic environments" by Fancis M. Pitts, OAA, AIA, FACHA & Dirk Hamilton, FAIA, FAC HA
*3. From "Planetree: Changing the Way We Think About Patients" by Nancy Moore
*4. From "Therapeutic environments" by Fancis M. Pitts, OAA, AIA, FACHA & Dirk Hamilton, FAIA, FAC HA
*5. From " Accomodating the aged" by Elizabeth C. Brawley, IIDA, AAHID, CID *6. From "Accomodating the aged " by Elizabeth C. Brawley, IIDA, AAHID, CID
*7.*6. From "Traffic/Report/Advice on improving a hospital wayfinding system" by James G. Easter Jr., FAAMA
*7. From "Accomodating the aged" by Elizabeth C. Brawley, IIDA, AAHID, CID
*8. From "Therapeutic environments" by Fancis M. Pitts, OAA, AIA, FACHA & Dirk Hamilton, FAIA, FAC HA
Update: 05/23/09
We are now currently preparing the above mentioned questionnaire an have arranged for a test group. I will publish the findings of this initial research as soon as it is completed.
I have also recently been assisted in finding information that the Veterans Administration has an art exhibition and contest annually, and I am in the process of interviewing staff and participants in this program to gather their personal experiences and opinions as to how this program could be integrated into the design process of military and government hospital facilities and clinics. Thank you to Vicki Berrios, interior designer, and Patti Kaufman, recreational therapist, at the CTVA.
y By Pamela A. Johnson This information has been compiled in an effort to help improve and provide standards for artwork plans in military and veterans administration hospitals and clinics. I have been a professional art consultant for over 20 years, working in large corporate environments and then focusing in more recent years in healthcare and government healthcare projects. I have had the unique and challenging opportunity to tour multiple military healthcare facilities while evaluating them for best fit solutions for artwork plans. Each project has had its own set of requirements and challenges, and has been on the surface very different, because each set of patients has been of varying ages, backgrounds and circumstances. Many designers do not consider the reality that military hospitals treat the children and family members of both active and retired personnel. Pediatric wards, mother baby units, senior living and psychiatric treatment areas require the same quality and dedication to art work design as their counterparts in the civilian world, but frequently seem to lack the same financial resources and purchasing avenues, and, in addition, experienced design personnel who can also navigate the contracting office. The nature of government contracting causes a great restriction of normal acquisition practices and creates the need for innovative ideas, as well as standards, to compensate these restrictions. Therefore, a new type of designer is required, one with the expertise and commitment to embrace both the challenges and restrictions of current procurement procedures, and within this frame work, utilize the best resources available to help enlisted, retired, and wounded war fighters and their families heal in comfort. The following are areas both practical and aesthetic, that will help justify attention to this often overlooked, under budgeted and underserviced part of a military healthcare environment. Environment and Healing The therapeutic environments movement has been built on the beliefs of patients, scientists, designers, clinicians and visionary hospital staff. Artwork is important element within this movement. Several decades ago, individuals with mutually supportive belief that the physical environment has a measurable impact on human behavior, physiology, psychology and sociology found each other and began sharing knowledge. A few ground-breaking hospitals were built or transformed and, eventually , a movement was born.(*1 ) This movement became known as the Planetree organization. The Planetree organization has always maintained that artwork is an important part of an overall effort to create a less institutional healthcare environment. In 1982, Roger Ulrich, an environmental psychologist who is currently director of Texas A&M University's Center for Health Systems and Design, published a ground-breaking study in the prestigious journal Science. His study into the effects of a view of nature from the room of gall bladder surgery patients showed the differences in length of stay, the use of powerful drugs and reports of patients' conditions in the record. This extraordinary study gave a boost to design professionals who had always believed the environment had an influence on patients, but had not known of methods to measure it.(*2) In 1990, Ulrich published "Theory of Supportive Design" which was built on the basis of the existing relevant research and the understanding that all known medical conditions were exacerbated by stress. The concept was for design to reduce stress on patients , visitors, staff and physicians wherever possible. The theory recognized categories of stress reducing elements impacted by design, such as social support, provision of choice, positive distraction and access to nature.(*3) Artwork design can play an important part in fulfilling the void for positive distraction during treatment and access to nature, even inside a hospital facility. Individuals receiving treatment can focus away from pain and stress with effective visual aids. The USAF has integrated Planetree concepts into remodeled wards at Wilford Hall Medical Center in San Antonio, Texas. Homelike family waiting areas, family counseling rooms and antepartum wards have all included specialized appropriate art plans. Highline Community Hospital in Seattle uses art therapy, reporting success in alleviating depression in patients. (*4) Children away from parents and home environments for extended periods, such as a pediatric oncology patients, must suffer great discomfort, with an additional layer of fear that they are in a strange, often sterile environment devoid of the familiar childhood images, activities and play areas they would experience at home and in school. Much can be done to alleviate and modify their care areas by placing the familiar and comforting childhood images of Disney and others, placing cheerful color on walls and areas for display of their own artistry. To their great credit, this void is often filled by the efforts of the medical staff; however, again, a small investment of special and easily cleanable artwork display areas and cleanable digital murals can go a long way to help a child forget they are sick and in a strange place away from family. Individuals receiving treatment can focus away from pain and stress with effective visual aids. Artwork as Wayfinding The health care campus of the future will be a network of programs that must be planned for diverse populations, site locations, levels of care and sophisticated technological linkages. The one time asset expenses of an upgraded or comopletely replaced wayfinding system will pay back exponentially over time. Many of the military hospitals have extremely similar floorplans, and patients and family can become easily disoriented in the maze of white walls, floor after floor of standardized design lacking customization. Because of on going mobility demands, there is certainly a basis for this standardization. Years of ongoing facility expansion, too, have caused the maze like effect. To a battlefield weary soldier returning to visit a family member, newly rotated medical personnel trying to acclimate to a new hospital, or a patient receiving medication, the lack of distinctive wayfinding and artwork in many hospitals is frustrating and unnecessary. Many patients today are older people who are easily disoriented in a hospital setting, particularly those who have dementia. For instance, one of the greatest difficulties in treating individuals with Alzheimer's in an acute care setting is the fear and disorientation that can cause these patients to become disturbed, loud and sometimes combative.(*5) Artwork provides distinctive and easily readable and recognizable wayfinding, especially for individuals with reading challenges. Wall colors differentiating floors or clinical areas with a few distinctive and individual pieces of artwork would seem like a worthy investment to assist with quick identification of each floor. White on white may be a sophisticated color scheme for the young, but not for older eyes and persons with low vision. Contrasting wall and floor colors improve visibility for older eyes. (*6) Colorful artwork images provide lasting signposts for patients with disorientation or memory loss issues. In tandem with the signage plan, visual cues for easy recall shold also be adopted. This marriage of architectural design, engineering, interior design, wayfinding and furnishings is required to adequately prepare a comprehensive hospital campus wayfinding strategy. As the internal conditions for aesthetics, lighting, signage and related factors are studied, the following opportunities to improve these aesthetics should utilize artwork, sculpture, water features, awards, honors and benefactors walls. (*7) Pride and Morale I have never been more astonished than when I began accessing photography created by warfighters and staff photographers alike. The wealth of absolutely unique images taught me a great deal, educating me to the many worthy humanitarian efforts that go otherwise unpublicized and unknown by those outside the military arena. The pride of our war fighters in their work, and the great compassion they show the civilians they interact with while doing their duty, has evoked some of the most moving and beautiful images I have ever seen. Through the medium of digital images, and the efforts to catalog them, we are presented as never before with resources to create displays unlike any other time in history. Bird's eye views of the world through the eyes of war fighters are wealth of material to utilize to inspire pride, respect and courage through visual media. These images have been utilized with success in refractive surgery centers, clinical research areas and medical staff training areas where patients are youthful recruits undergoing elective surgery or where there are no patient being treated. Staff Satisfaction and Retention The most overlooked group of individuals studied for their artwork preferences seem to be the staff themselves. Most emphasis is placed on patient outcome rates. In recent years, efforts to recruit and retain high quality medical staff has become a priority. The opportunity to individualize personal office space has gained importance, as furnishings have become less private and more uniform. Interviewing and interacting with medical staff does not have to compromise design standards. An experienced artwork designer can engage staff with a controlled group of selections that will not compromise overall interior design ingegrity or function. In civilian hospitals, the average age of the nursing staff has risen to 47 years, doctors and other medical staff are older and more than 50 percent of the volunteer force helping in medical facilities are people over 65 according to the December 2002 issue of the AARP Bulletin. *(8) Data from Planetree model sites utilizing artwork have shown decreased length of stay, fewer medication errors, lower infection rates, increased staff retention and little significant difference in cost. Although staff in military hospitals may on average be of a younger age, there is little doubt that they are highly enthusiastic and interested in participating in the selection of artwork for their patient areas. Many years of interaction with them and the care and importance they have placed on assisting me with selections has provided me with evidence to conclude that they, as well as the patients, benefit psychologically from artwork images incorporated into their interior design. Artwork in patient rooms, treatment areas and on art carts add to the ambiance. Evidence -based design for artwork plans Evidence-based design operates on many levels. The simplest is personal experience. A designer does what he or she believes works based on personal experience as a human being in similar circumstances. The second is anecdotal reciprocity. A designer does what he or she heard works in multiple instances. The next level of evidence-based design involves a deeper understanding based upon serious and systematic evaluations of the interactions of humans within an environmental context.(*9) Ultimately, evidence-based artwork design needs to be informed by all four categories--personal experience (as in employing an experienced artwork designer experience in government hospital environments), anecdotal evidence, relevant research and pure science. Much in the direction of anecdotal evidence can easily be gathered. Over time, this can develop into relevant research and pure science. Needed: A Veterans Artwork Project Veterans present a different and more complex set of challenges to the artwork designer. Many veterans suffering from post traumatic stress disorder and other psychological disorders are disturbed by images that evoke memories of the trauma they have suffered, however well meaning; even images of national monuments can leave them distressed or emotionally disconnected. Much more research needs to be gathered regarding their reactions to ascertain imagery they consider positive, attractive, reassuring and comforting, as they will comprise a vast majority of long term Veteran's Administration patients in the future. Patients with both mild and traumatic brain injuries will be commonplace, and immediate actions to gather evidence-based design regarding artwork images for their health care environments is overdue. Any health crisis is stressful, but we rely upon our brain to help us cope and survive these crises, and when our brain is injured and we are unable to express our helplessness and inability to communicate, our journey to survival takes another turn altogether. As with senior living environments, images and sounds that are reassuring and comforting to a patient who is disoriented and stressed, can be of great comfort, calming a patient, and thereby assisting care takers and clinical staff. Perhaps a first step toward developing such a program would be a simple anonymous multiple choice questionnaire offered to current patients of exisiting VA facilities. This questionnaire could provide a focused and realistic database of preferences from which a practical design program could be initiated. Programs that engage warfighters and veterans in positive expressions via artwork could also be incorporated in small, revolving gallery exhibits that are already used in some hospitals. The parallels between-evidence based art work design and evidence-based medicine make the development of therapeutic environments an area of interest. This exciting trend looks to be a positive and important direction for the health care field, and is beginning to confirm what most art plan designers have always believed - that positive artwork images help both the mind and the body heal. References: *1. From "Therapeutic environments" by Fancis M. Pitts, OAA, AIA, FACHA & Dirk Hamilton, FAIA, FAC HA *2. From "Therapeutic environments" by Fancis M. Pitts, OAA, AIA, FACHA & Dirk Hamilton, FAIA, FAC HA *3. From "Planetree: Changing the Way We Think About Patients" by Nancy Moore *4. From "Therapeutic environments" by Fancis M. Pitts, OAA, AIA, FACHA & Dirk Hamilton, FAIA, FAC HA *5. From " Accomodating the aged" by Elizabeth C. Brawley, IIDA, AAHID, CID *6. From "Accomodating the aged " by Elizabeth C. Brawley, IIDA, AAHID, CID *7. From "Traffic/Report/Advice on improving a hospital wayfinding system" by James G. Easter Jr., FAAMA *7. From "Accomodating the aged" by Elizabeth C. Brawley, IIDA, AAHID, CID *8. From "Therapeutic environments" by Fancis M. Pitts, OAA, AIA, FACHA & Dirk Hamilton, FAIA, FAC HA Pamela A. Johnson This information has been compiled in an effort to help improve and provide standards for artwork plans in military and veterans administration hospitals and clinics. I have been a professional art consultant for over 20 years, working in large corporate environments and then focusing in more recent years in healthcare and government healthcare projects. I have had the unique and challenging opportunity to tour multiple military healthcare facilities while evaluating them for best fit solutions for artwork plans. Each project has had its own set of requirements and challenges, and has been on the surface very different, because each set of patients has been of varying ages, backgrounds and circumstances. Many designers do not consider the reality that military hospitals treat the children and family members of both active and retired personnel. Pediatric wards, mother baby units, senior living and psychiatric treatment areas require the same quality and dedication to art work design as their counterparts in the civilian world, but frequently seem to lack the same financial resources and purchasing avenues, and, in addition, experienced design personnel who can also navigate the contracting office. The nature of government contracting causes a great restriction of normal acquisition practices and creates the need for innovative ideas, as well as standards, to compensate these restrictions. Therefore, a new type of designer is required, one with the expertise and commitment to embrace both the challenges and restrictions of current procurement procedures, and within this frame work, utilize the best resources available to help enlisted, retired, and wounded war fighters and their families heal in comfort. The following are areas both practical and aesthetic, that will help justify attention to this often overlooked, under budgeted and underserviced part of a military healthcare environment. Environment and Healing The therapeutic environments movement has been built on the beliefs of patients, scientists, designers, clinicians and visionary hospital staff. Artwork is important element within this movement. Several decades ago, individuals with mutually supportive belief that the physical environment has a measurable impact on human behavior, physiology, psychology and sociology found each other and began sharing knowledge. A few ground-breaking hospitals were built or transformed and, eventually , a movement was born.(*1 ) This movement became known as the Planetree organization. The Planetree organization has always maintained that artwork is an important part of an overall effort to create a less institutional healthcare environment. In 1982, Roger Ulrich, an environmental psychologist who is currently director of Texas A&M University's Center for Health Systems and Design, published a ground-breaking study in the prestigious journal Science. His study into the effects of a view of nature from the room of gall bladder surgery patients showed the differences in length of stay, the use of powerful drugs and reports of patients' conditions in the record. This extraordinary study gave a boost to design professionals who had always believed the environment had an influence on patients, but had not known of methods to measure it.(*2) In 1990, Ulrich published "Theory of Supportive Design" which was built on the basis of the existing relevant research and the understanding that all known medical conditions were exacerbated by stress. The concept was for design to reduce stress on patients , visitors, staff and physicians wherever possible. The theory recognized categories of stress reducing elements impacted by design, such as social support, provision of choice, positive distraction and access to nature.(*3) Artwork design can play an important part in fulfilling the void for positive distraction during treatment and access to nature, even inside a hospital facility. Individuals receiving treatment can focus away from pain and stress with effective visual aids. The USAF has integrated Planetree concepts into remodeled wards at Wilford Hall Medical Center in San Antonio, Texas. Homelike family waiting areas, family counseling rooms and antepartum wards have all included specialized appropriate art plans. Highline Community Hospital in Seattle uses art therapy, reporting success in alleviating depression in patients. (*4) Children away from parents and home environments for extended periods, such as a pediatric oncology patients, must suffer great discomfort, with an additional layer of fear that they are in a strange, often sterile environment devoid of the familiar childhood images, activities and play areas they would experience at home and in school. Much can be done to alleviate and modify their care areas by placing the familiar and comforting childhood images of Disney and others, placing cheerful color on walls and areas for display of their own artistry. To their great credit, this void is often filled by the efforts of the medical staff; however, again, a small investment of special and easily cleanable artwork display areas and cleanable digital murals can go a long way to help a child forget they are sick and in a strange place away from family. Individuals receiving treatment can focus away from pain and stress with effective visual aids. Artwork as Wayfinding The health care campus of the future will be a network of programs that must be planned for diverse populations, site locations, levels of care and sophisticated technological linkages. The one time asset expenses of an upgraded or comopletely replaced wayfinding system will pay back exponentially over time. Many of the military hospitals have extremely similar floorplans, and patients and family can become easily disoriented in the maze of white walls, floor after floor of standardized design lacking customization. Because of on going mobility demands, there is certainly a basis for this standardization. Years of ongoing facility expansion, too, have caused the maze like effect. To a battlefield weary soldier returning to visit a family member, newly rotated medical personnel trying to acclimate to a new hospital, or a patient receiving medication, the lack of distinctive wayfinding and artwork in many hospitals is frustrating and unnecessary. Many patients today are older people who are easily disoriented in a hospital setting, particularly those who have dementia. For instance, one of the greatest difficulties in treating individuals with Alzheimer's in an acute care setting is the fear and disorientation that can cause these patients to become disturbed, loud and sometimes combative.(*5) Artwork provides distinctive and easily readable and recognizable wayfinding, especially for individuals with reading challenges. Wall colors differentiating floors or clinical areas with a few distinctive and individual pieces of artwork would seem like a worthy investment to assist with quick identification of each floor. White on white may be a sophisticated color scheme for the young, but not for older eyes and persons with low vision. Contrasting wall and floor colors improve visibility for older eyes. (*6) Colorful artwork images provide lasting signposts for patients with disorientation or memory loss issues. In tandem with the signage plan, visual cues for easy recall shold also be adopted. This marriage of architectural design, engineering, interior design, wayfinding and furnishings is required to adequately prepare a comprehensive hospital campus wayfinding strategy. As the internal conditions for aesthetics, lighting, signage and related factors are studied, the following opportunities to improve these aesthetics should utilize artwork, sculpture, water features, awards, honors and benefactors walls. (*7) Pride and Morale I have never been more astonished than when I began accessing photography created by warfighters and staff photographers alike. The wealth of absolutely unique images taught me a great deal, educating me to the many worthy humanitarian efforts that go otherwise unpublicized and unknown by those outside the military arena. The pride of our war fighters in their work, and the great compassion they show the civilians they interact with while doing their duty, has evoked some of the most moving and beautiful images I have ever seen. Through the medium of digital images, and the efforts to catalog them, we are presented as never before with resources to create displays unlike any other time in history. Bird's eye views of the world through the eyes of war fighters are wealth of material to utilize to inspire pride, respect and courage through visual media. These images have been utilized with success in refractive surgery centers, clinical research areas and medical staff training areas where patients are youthful recruits undergoing elective surgery or where there are no patient being treated. Staff Satisfaction and Retention The most overlooked group of individuals studied for their artwork preferences seem to be the staff themselves. Most emphasis is placed on patient outcome rates. In recent years, efforts to recruit and retain high quality medical staff has become a priority. The opportunity to individualize personal office space has gained importance, as furnishings have become less private and more uniform. Interviewing and interacting with medical staff does not have to compromise design standards. An experienced artwork designer can engage staff with a controlled group of selections that will not compromise overall interior design ingegrity or function. In civilian hospitals, the average age of the nursing staff has risen to 47 years, doctors and other medical staff are older and more than 50 percent of the volunteer force helping in medical facilities are people over 65 according to the December 2002 issue of the AARP Bulletin. *(8) Data from Planetree model sites utilizing artwork have shown decreased length of stay, fewer medication errors, lower infection rates, increased staff retention and little significant difference in cost. Although staff in military hospitals may on average be of a younger age, there is little doubt that they are highly enthusiastic and interested in participating in the selection of artwork for their patient areas. Many years of interaction with them and the care and importance they have placed on assisting me with selections has provided me with evidence to conclude that they, as well as the patients, benefit psychologically from artwork images incorporated into their interior design. Artwork in patient rooms, treatment areas and on art carts add to the ambiance. Evidence -based design for artwork plans Evidence-based design operates on many levels. The simplest is personal experience. A designer does what he or she believes works based on personal experience as a human being in similar circumstances. The second is anecdotal reciprocity. A designer does what he or she heard works in multiple instances. The next level of evidence-based design involves a deeper understanding based upon serious and systematic evaluations of the interactions of humans within an environmental context.(*9) Ultimately, evidence-based artwork design needs to be informed by all four categories--personal experience (as in employing an experienced artwork designer experience in government hospital environments), anecdotal evidence, relevant research and pure science. Much in the direction of anecdotal evidence can easily be gathered. Over time, this can develop into relevant research and pure science. Needed: A Veterans Artwork Project Veterans present a different and more complex set of challenges to the artwork designer. Many veterans suffering from post traumatic stress disorder and other psychological disorders are disturbed by images that evoke memories of the trauma they have suffered, however well meaning; even images of national monuments can leave them distressed or emotionally disconnected. Much more research needs to be gathered regarding their reactions to ascertain imagery they consider positive, attractive, reassuring and comforting, as they will comprise a vast majority of long term Veteran's Administration patients in the future. Patients with both mild and traumatic brain injuries will be commonplace, and immediate actions to gather evidence-based design regarding artwork images for their health care environments is overdue. Any health crisis is stressful, but we rely upon our brain to help us cope and survive these crises, and when our brain is injured and we are unable to express our helplessness and inability to communicate, our journey to survival takes another turn altogether. As with senior living environments, images and sounds that are reassuring and comforting to a patient who is disoriented and stressed, can be of great comfort, calming a patient, and thereby assisting care takers and clinical staff. Perhaps a first step toward developing such a program would be a simple anonymous multiple choice questionnaire offered to current patients of exisiting VA facilities. This questionnaire could provide a focused and realistic database of preferences from which a practical design program could be initiated. Programs that engage warfighters and veterans in positive expressions via artwork could also be incorporated in small, revolving gallery exhibits that are already used in some hospitals. The parallels between-evidence based art work design and evidence-based medicine make the development of therapeutic environments an area of interest. This exciting trend looks to be a positive and important direction for the health care field, and is beginning to confirm what most art plan designers have always believed - that positive artwork images help both the mind and the body heal. References: *1. From "Therapeutic environments" by Fancis M. Pitts, OAA, AIA, FACHA & Dirk Hamilton, FAIA, FAC HA *2. From "Therapeutic environments" by Fancis M. Pitts, OAA, AIA, FACHA & Dirk Hamilton, FAIA, FAC HA *3. From "Planetree: Changing the Way We Think About Patients" by Nancy Moore *4. From "Therapeutic environments" by Fancis M. Pitts, OAA, AIA, FACHA & Dirk Hamilton, FAIA, FAC HA *5. From " Accomodating the aged" by Elizabeth C. Brawley, IIDA, AAHID, CID *6. From "Accomodating the aged " by Elizabeth C. Brawley, IIDA, AAHID, CID *7. From "Traffic/Report/Advice on improving a hospital wayfinding system" by James G. Easter Jr., FAAMA *7. From "Accomodating the aged" by Elizabeth C. Brawley, IIDA, AAHID, CID *8. From "Therapeutic environments" by Fancis M. Pitts, OAA, AIA, FACHA & Dirk Hamilton, FAIA, FAC HA
