Psychology in Cancer Hospital

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    PSYCHOLOGY IN CANCER HOSPITAL

    A discussion on built environment

    SEMINAR

    REPORT

    SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE

    AWARD OF THE DEGREE OF BACHELOR OF ARCHITECTURE

    HIMANSHU TRIPATHI 2008BARC033

    TENTH SEMESTER, April.12

    DEPARTMENT OF ARCHITECTURE

    SCHOOL OF PLANNING AND ARCHITECTURE, BHOPAL

    April -2013

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    CERTIFICATE

    Certified that the thesis entitled PSYCHOLOGY IN CANCER HOSPITAL" submitted by

    Himanshu Tripathi in partial fulfilment for the award of the degree of Bachelor of Architecture at

    the School of Planning and Architecture, Bhopal (deemed to be a university), is a record of the

    student's own work carried out by him under my supervision and guidance. The matter embodied

    in this thesis work, other than that acknowledged as reference, has not been submitted for the

    award of any degree or diploma.

    ---------------------------------- ---------------------------------

    Thesis Guide Dr. Savita Raje

    (Sukanta Mujumdar) Head of Department

    School of Planning and Architecture School of Planning and Architecture,

    Bhopal Bhopal

    Himanshu Tripathi, 5th Year Architecture, 2008BARC033

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    ACKNOWLEDGEMENT

    I would like to acknowledge and extend my heartfelt gratitude to the following persons who have

    made the completion of this report possible:

    Our H.O.D. Dr. Sanjeev Singh ,for his vital encouragement and for giving this subject. Dr Sukanta

    Mujumdar, my Mentor , for his understanding, advice, guidance and support. Dr Rachna Khare

    and Ar Arti Grover, subject coordinator for the constant support and much needed motivation. I

    would also like to extend my sincere gratitude to all faculty members and Staff for assisting in the

    collection of the topics for the chapters.

    Most especially to my family and friends.

    Finally, to God, who made all things possible.

    Himanshu Tripathi 20008BARC033

    School of Planning and Architecture

    Bhopal.

    April - 2012

    Himanshu Tripathi, 5th Year Architecture, 2008BARC033

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    INDEX

    Table of Content Page No.

    Cover page

    Certificate

    Acknowkedgement

    Introduction

    Relationship of topic with thesis (advance objective)

    1. Psychological effects of hospitalization

    2. Departmental components of hospitals

    3. Landscape, garden and space between buildings

    4. Interior features

    5. Case Study

    a. Dharamshila cancer hospital, New Delhi

    b. Jawaharlal Nehru cancer hospital and research centre

    6. The designers role

    7. Inference

    8. Conclusion

    9. Select bibliography

    10. List of tables

    11. List of graphs

    12. List of figure

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    Introduction

    Health care are one of the most prominent and vital industry of 21 st century. Though hospital

    provides vital service to humankind, it still possesses an image of fear and false anticipation. In

    simple words, people fear hospitals and negative psychology affects them severely. There are

    many reasons for the person to be reluctant from being admitted to or even going to hospital during

    illness.

    The seminar deals with the understanding of the factors responsible for making the hospital a

    disliked building, and effective measure that shall be taken during the planning / designing stage to

    eradicate the cause. And give the building a better identity.

    This study explores how cancer patients experience the meaning of positive sensory impressions in

    the hospital environment such as architecture, decoration and the interior. Data were obtained at a

    general hospital in Denmark by interviewing six cancer patients at two different wards. The

    analysis process was guided by the hermeneutical-phenomenological theory of interpretation as

    presented by the French philosopher Paul Ricoeur. Two main themes were identified: to preserve

    identity and positive thoughts and feelings. The participants experienced that positive sensory

    impressions in the hospital environment had a significant impact on their mood, generating

    positive thoughts and feelings. A view to nature also helped them to forget their negative thoughts

    for a while. The possibility of having a view helped some cancer patients to connect with good

    memories and personal life stories that enabled them to recall some of their feelings of identity.

    This paper adds knowledge about how cancer patients experience sensory impressions in the

    hospital environment. An environment that provides homeliness and offers a view to nature seems

    to help some patients to preserve their identity. Furthermore, positive sensory impressions and the

    opportunity for recreation through environmental facilities strengthen the patient's positive

    thoughts and feelings.

    Advance objective

    The main reason behind development of the report is to better design the health care facility, which

    tends to increase the positive psychological impact on its intended user, not only the patients but

    also the staff.

    Himanshu Tripathi, 5th Year Architecture, 2008BARC033

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    Chapter 1 GENERAL PATIENTS PSYCHOLOGY

    Introduction

    The general perception of patients towards the hospital and hospitalization has always been

    reluctant and stressful. He/she prefers to stay at home rather than to be in an environment

    which has trained personnel who can cure the ailment he/she has. There are various reasons

    behind such behavior,

    1. Psychological effect of hospitalization

    a. Medical and surgical hospital patient were asked to perceive Stressfulness.

    From this results it can be seen that some of the most stressful events.

    2. Involved lack of communication

    a. Unfamiliarity of the surrounding.

    b. Loss of independence.

    c. Separation from family.

    d. Financial problem.

    e. Lack of information.

    f. Threat of severe illness.

    g. Problem with medication.

    3. Stress events

    a. Unfamiliarity of the surrounding :

    i. Having strangers sleep with you in the same room.

    ii. Having to sleep in strange bed.

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    iii. Being aware of unusual smells around you.

    iv. Being in a room that is too cold or too hot.

    v. Having to eat cold or tasteless food.

    b. Loss of independence:

    i. Having to eat at different times than you usually.

    ii. Having to wear a hospital gown.

    iii. Having to be assisted with bathing.

    iv. Not being able to get newspaper radio or TV when you want to.

    v. Having to be assisted with a bad pan.

    vi. Being fed through tubes thinking you may lose your weight.

    c. Separation from family

    d. Financial problem

    i. Losing income because of illness

    e. Isolation from society

    i. Having a seriously ill roommate, unfriendly, or cannot talk to you.

    f. Lack of information

    i. Thinking you might have pain because of test or procedures.

    ii. Not knowing when to expect the results.

    iii. Fear of medical jargon

    iv. Lack of knowledge of proper diagnosing.

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    g. Threat of serious illness

    h. Separation from family

    i. Not having family visit you

    ii. Being hospitalized far from home

    i. Problem with medication

    i. The need for attention during illness patient may use behavior pattern

    quite unconsciously such as cry , complain ,and display their suffering

    other appear to be able to tolerate great deal of discomfort without

    complaint.

    Himanshu Tripathi, 5th Year Architecture, 2008BARC033

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    Himanshu Tripathi, 5th Year Architecture, 2008BARC033

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    Chapter 2 PHYSICAL AND NON-PHYSICAL FACTORS.

    Various factors are responsible for altering over all ambience of hospital building and heavily

    affects the psychology of the patients.

    Built environment

    1. Interior

    a. Color

    b. Texture

    c. Anthropometry

    d. Air- quality

    e. Lighting

    f. Noise / sound

    2. Exterior

    a. Color

    b. Ambience

    c. Landscape

    d. Shade and shadows

    e. Scene and scenery

    Effects of Interior Color on Healthcare Consumers: A 360 degree Photo Simulation

    The effects of the servicescape (Bitner, 1992) on consumer behavior have long been recognized.

    Especially in high-stress services, such as medical care, the physical environment can strongly

    influence customer evaluation. This experiment investigates the effect of interior color on patients

    emotional and cognitive appraisal and perceived service quality. Subjects were exposed to

    QuickTime 360 panorama photos of a first aid examination room and a private ward room. Blue

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    walls (as compared to white walls) reduce anxiety and increase cognitive and affective appraisal

    and even perceived service quality.

    Introduction

    Hospitalization can have a great psychological impact. A patients health is at stake, and (s)he is

    temporarily separated from family and friends. Under such conditions, patients display a strong

    need for information concerning their health and treatment (Engstrm, 1984). However, reliable

    information about the quality of healthcare is rather difficult or even impossible to obtain, as

    patients lack insight into the procedure and effects of the treatment. To reduce this uncertainty,

    patients will be inclined to infer their judgment of service quality from other indicators, such as the

    tangible environment. Therefore, physical aspects of the service environment play an important

    role in customers evaluation of healthcare services (Arneill & Devlin, 2002).

    A considerable amount of empirical evidence is available about the effects of environmental

    factors on a wide variety of consumer responses (Turley & Milliman, 2000). Historically, the

    atmosphere in clinical environments has been cold and sterile due to color, lighting and furniture.

    The current trend in hospital interior design is to create an attractive, relaxing atmosphere in order

    to relieve patients stress and anxiety, improve their emotions and hence encourage the healing

    process (Devlin & Arneill, 2003). Color can be used effectively for this purpose (Calkins, 2002;

    Marberry & Zagon, 1995). Blue has been found to be the most preferred color throughout colorliterature (e.g. Bellizzi, Crowley & Hasty, 1983; Guilford & Smith, 1959), and stress-reducing

    effects of short wavelength colors (blue, green) are welldocumented (e.g., Birren, 1979; Valdez &

    Mehrabian, 1994). Yet, solid empirical evidence for anxiety-reducing and affect-enhancing effects

    of interior color in healthcare settings is largely lacking. In this study we investigated the effects of

    wall color on anxiety, pleasure, evaluation of the room and perceived service quality in a

    simulation of a general hospital. We expected subjects exposed to a hospital room with blue walls

    to experience more positive emotions, and lower anxiety, to evaluate the room more positively,

    and to appraise the quality of the service higher than subjects exposed to a white hospital room.

    There's hardly a secret anymore that human behavior is highly influenced by colors. Scientific

    studies have proven that our emotions and mood are affected when surrounded by particular

    colors. Some cause us to be more aggressive, whereas others have a soothing effect on us. From

    psychologists to interior designers, everybody seems fascinated with the phenomenon.

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    No wonder then that when it comes to paints, specialists are extremely careful to make the right

    choice. As their ideas come as colors do, in a wide variety, ultimately the only thing they have to

    consider is the appropriateness of their vision. For instance, a hospital room wouldn't be painted in

    the same shades as a private residence's living room. The patients would it find difficult to cope

    with some red painted walls instead of the usual white, green or blue ones.

    We all may have in contact, one way or another, with the imposing, intimidating places which are

    hospitals. Either as patients or visitors, we are most certainly overwhelmed by their presence. But,

    once inside, hospitals have this huge power of conveying a sensation of calm and peace. How do

    they manage to do that? It's simple to find the answer by just taking a quick look at the walls and

    noticing the colors they are painted in.

    Hospital walls are usually covered in colors such as white, green and blue. There is an explanation

    behind these choices and it has to do with the psychological effects these colors have.

    White is the most common color to be seen on a hospital wall. And that is due to the peaceful and

    calm mood it provides. Other reason for choosing it is the fact that it denotes cleanness. It implies

    sterility, which has the effect of making patients feel reassured. This is also why doctors andnurses wear white uniforms.

    Blue and green are considered to be the most relaxing and refreshing colors, promoting peaceful

    atmosphere which encourages concentration. Designers, psychologists and feng-shui experts, they

    all tend to consider that shades of blues and greens make us fell calmer, more balanced and less

    emotional. Because green has a calming effect on our nerves, hospital waiting rooms and even

    psychiatric wards are painted in this color. And surgeons wear green scrubs for the same reason.

    As for blue, it has often been noticed that children in pain are put in hospital rooms painted in light

    blue due to its healing effect it conveys.

    When coming inside a hospital, the general atmosphere must make us feel reassured and calm.

    Before knowing anything about the staff's professionalism, our worried look will check for visible

    signs that we will be well taken for. And the hospital's walls, white, green or blue, are our first

    impression.

    Himanshu Tripathi, 5th Year Architecture, 2008BARC033

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    Chapter 3 DEPARTMENTAL COMPONENT OF HOSPITAL

    BUILDING

    In this chapter we shall discuss all the functional components o=in terms not only of efficiency

    but also their aesthetics quality, including comfort and delight. How can the car parks, entrance

    halls, canteens, mortuaries, corridors and all the other necessary functional components of any

    hospital building be designed and maintained not only to work well but also to give pleasure.

    The average hospital building will have following areas:

    1. Main roadway entrance

    2. Car park and route to the main door

    3. Large communal areas: reception foyers and waiting rooms

    4. Circulation areas: corridor and staircase

    5. Specialist examination and treatment areas: body scanner and x-rays units, anaesthetics

    and recovery rooms, operating theatre.

    6. Interview and counseling rooms

    7. Traditional rooms: management boardrooms, committee and meeting rooms.

    8. Kitchens and serving hatches

    9. General eating areas: dining rooms

    10. Patient wards, rooms for birth, rooms for death.

    11. Living and activity areas: day room

    12. Washing area: lavatory versus toilet, bathroom

    13. Public areas for private use.

    14. Staff areas: changing rooms, rest room, bedroom

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    15. Administration areas: general and personal offices

    16. Storage

    Main roadway entrance

    General layout

    Positive reassurers a large notice of the hospital name, nature and town, placed first at

    some distance from the main entrance with an indication for drivers that the main entrance

    is one hundred yards further on, and then repeated at the entrance, well lit at night.

    For people arriving on foot or by bus, small direction signs at bus stops and streets

    intersections.

    Clear directions as to what the visitor does next: main reception / information point, direct

    route to emergencies, dropping- off points for patients, disabled parking, visitors car parks.

    A well maintained entrance, neat verges, shrubs, flowers, litter free, with a well lit, safe

    route such as footpath beside a road clearly leading to the main reception / information

    points.

    Positive unreassurers small notices and small prints

    Information about name and nature of hospital not given

    Poorly lit at night

    Signs hidden by trees

    No notice for pedestrians in the streets near the hospitals

    Litter at the hospital entrance.

    A forest of signs at the hospital entrance.

    Notice too near the entrance to enable a driver to indicate and make a safe turning.

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    A large number of signs with negative messages

    Subsidiary signs

    1. Prohibition on parking, dogs and trespassers.

    2. Cautions against theft and speed

    3. Exoneration of blame should the worst occur

    4. Information about closure, resting

    5. Multiple and contradictory general directions

    Solutions

    Treat main entrance signs like an army; organise them according to rank, select wisely,

    demonstrate authority over underlining and do not keep changing your mind. The enemy muddle

    so make sure everyone understands what muddle looks and can recognise it; when they can see the

    whites of its eye, shoot to kill.

    Information about good signposting is available and an important part of the management of health

    service building is constantly checking that every effort is being made to guide people as they

    come on to the site or enter the main reception area will give a good picture of whether people

    hesitate look anxiously around and appears uncertain, or whether they move confidently and

    approach the destination or information desk readily. Staff who work in reception can tell you

    which question people ask most often and you can get expert advice on how to sign spot them in

    those directions, which avoids the situation whereby staff put up a handwritten notice. However

    handwritten notice at least indicate a well meaning attempt to make direction clearer.

    Signsposting systems are available to enable you to alter and add information easily and quickly.

    They are worth the investment. It is very easy to make people feel hesitant and uncomfortable from

    the first moment they enter a building ; signposting gives you an opportunity to achieve comfort

    and confidence.

    Car park and route to the main door

    Vehicular access

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    Most people arrive by private car and the sheer numbers that have to be accommodated have led to

    vast car parks, confusing direction s and sometimes-unpopular parking fees. The possible

    landscaping of the car park to make them as attractive and welcoming as possible. If you do charge

    parking fees it is worth thinking about how you explain them to the public. A notice on the fee

    system saying that by charging fees to cover the cost of car parking more is available for patient

    care or for site surveillance is helpful.

    Pedestrian access

    There has been such determination to accommodate the disabled in the hospital that this is now

    less of a problem than formerly. Most hospitals now realise that it is essential to involve disabled

    people in planning access and adapting facilities, and offer a critique of existence provision.

    Trying out your own facilities in a wheel chair, wearing ear plugs and fogged glasses, can give the

    able-bodied useful insight.

    Some common mistakes at the entrance

    Rubbish impermanent skips or permanently parked wheeled rubbish bins situated besides the

    main entrance ar not inviting. If there are litterbins, they must be emptied before they reach

    overflow point.

    Doors expensive, highly manufactured automatic glass doors often have shabby notices stuck all

    over them.

    Smoking Hospitals that have non-smoking policies have carpets of cigarette butts outside often

    the main entrance, and frequently a group of furtive smokers too, sometimes in dressing gowns and

    nighties, attached to drips and equipment.

    Large communal areas

    Reception foyers

    The checklists of essential furnishing continue with these items:

    1. Clarity it is clear where you go for information?

    2. Signposts are they clear, logical and organised?

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    3. Written instruction maps, leaflets etc, are they unambiguous in telling people what to do

    next.

    4. Cleanliness are the premises clean?

    5. Furniture is it clean, comfortable, well arranged?

    6. Lavatories are they well signposted, accessible and maintained.

    7. Telephone are they working and well sited?

    8. Drinking and food dispenses do these offer a variety of goods, are they clean or

    surrounded by rubbish.

    9. Refuse sacks and laundry are piles of these in views.

    10. Items for repair are old chairs and broken telephone hoods left near the door for eventual

    collection.

    An aura of helpfulness

    This is the most important requirement. On the arrival, is there someone who would notice

    people in distress and help them appropriately?

    Are reception staff ease to identify and available? In a number of reception arrangements staffs

    are given other tasks to do, such as switchboard duties or typing, and it is easy for the vivitors

    to feel they are interruption. In one hospital the most obvious information point is staffed byy

    the people in charge of security and keys ; it is hard to combine these policing tasks with being

    available for ordinary questions. Do porters, passing management staff and visiting peripatetic

    staff look approachable and pleasant?

    Waiting rooms

    The best way of reducing anxiety is to provide something of the interest to compete with the

    anxiety. Most hospitals will have lots of different areas where people wait. Sometimes they

    wait and wait, apparently unnecessarily, as in a five hour wait to have a limb plaster removed

    in ten minutes; on the other occasions their long wait is essential while life savings procedures

    are performed on their relatives, people may be accompanied by small children, or someone

    old, sick and incontinent, so what sort of diversions can be introduced.

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    Circulation areas

    Corridors

    The designs treatment of corridors is a major challenge. They are the main roads which have to

    carry the traffic of many people and heavy good. Long, bleak, featureless corridors are the

    enemies of the comfort and reassurance. So what can be done?

    The problem of perspective

    There are many architectural precedent of interior and garden perspective vistas handled with

    visual eloquence which rely on three basic things

    Vista end attraction

    Intersection and interval interest

    High quality dcor.

    Vista end attraction

    The aim of a corridor is to encourage people to progress along it. you want them to reach their

    destination in a good shape , avoiding exhaustion and despair. Sometimes in the visible

    distance, that attracts the attention is an old ruse for achieving this.

    Staircase

    Corridors and staircase are like the outside street in that they are public pathways and can

    suggest menace. They can also look as though their main function is an escape in the event of

    fire and have notices telling you so., but even the most utilitarian of fire escapesstaircase have

    opportunities of design delight.

    Specialist examination and treatment areas

    In any hospitals there will be several areas where the demand demands of clinical technology

    will dominate design unless these areas are given special attention.

    Anaesthetics and recovery rooms

    There is a difference in design requirement between these two; the anaesthetics room is where

    conscious patients are wheeled for their operation pre0medication and then full anaesthetics.

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    There is no need for bacterial sterility while and anaesthetics is administered, so one such room

    was wallpapered on the ceiling and upper walls with a William Morris paper; what better way

    than to float off looking at his magical forest full of birds.

    The recovery room is where patients come round from the anaesthetics and the need for

    sterility is absolute. Post-operative bleeding and projectile vomiting mean the room has to be

    washed down with hoses; floor joint must be sealed and the curved , pre-moulded skirting

    boards is usually used for cleaning ease. No one, least of all the post-operative patient, cares

    what it looks like.

    Operating theatre

    It is surprising to those of us who regards surgeons and airline pilots as professional who are

    ipso facto swathed in glamour that boredom is a hazard of their profession. Therefore, although

    only staff see operating theatres, some Dutch hospitals have still regarded them as sufficiently

    important to decorate and appoint carefully.

    Operating theatres are traditionally green because in the colour-spectrum green is the opposite

    of red and blood is red. Blood and other fluids are shiny surfaces should be matt and never

    glossy.

    Management boardrooms, committee and meeting rooms

    It is unknown for a hospital to remove all original features, fireplaces, skirting boards, flooring

    and so on and lower the ceiling before inviting and interior designer to give it character; by this

    time the original period character is lying in the rubbish skips. We are not suggesting that

    everything old is beautiful and everything modern is not, for this is not the case , but older

    things are more difficult to replace one lost and it takes professionalism to make the two blend

    together. They are like the oldest child and the youngest, both valuable but different.

    However, it is these traditional senior-staff meeting rooms that tend to be the only interiors to

    have been allowed to retain the quality and dignity of their period because their function has

    not changed; well behaved people still meet, sir down

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    Chapter 4 LANDSCAPE, GARDEN AND SPACE BETWEEN

    BUILDINGS

    The built environment has the largest and direct psychological impact on its inhabitant. In the

    case of hospital, it is the patient who perceives it more than any other.

    Often the requirement with the good and livable built environment is its resemblance to home

    and homely features. Certain features of home like garden, living area which applies to

    hospital ward tends to make the patient more relaxed about it. Generally the departments and

    the public places like the waiting lobby and the corridors widely runs on artificial ventilation

    and lighting, this cause some of the patients to feel congested and suffocated. Prolonged

    exposure to such environment may be harmful in some cases. Design should maximize the

    exposure of public area to the natural sunlight and ventilation.

    Certain features in built environment tend to enhance its efficiency in psychological terms, like

    garden and water body at different intervals of negotiation.

    TRADITIONAL HOSPITAL LANDSCAPE

    Landscape is what you can see from one vantage point, whether stationary or moving along, and

    implies both size and scale. It may not have mountains, waterfall and cantons but it ought to have

    some elements of maturity and a horizon to qualify; otherwise, it is a mere outlook. In our

    hospital context of landscape, there will nearly always be urban features but when the buildings

    dominate the scene visually, and then it becomes the space between buildings. Garden are a

    defined area which has received at some time systematic and intensive planting for athe purpose of

    pleasure and delight.

    The nature and extent of a hospitals land will depend on its past history and current situation, as

    do its building, and similarly the quantity and imagination of its care will jdepend upon the

    management in charge.

    Many public institution have a tradition of a formal garden: railway stations used to have a good

    display, town halls sported flower clocks each summer and hospitals used to welcome all comers

    with banks of carefully tiered geraniums and an heraldic concern with formal, coloured shapes of

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    flower-planting within a border boundary. All around there would have been raked gravel, the tube

    and urns sitting like exclamation marks in the expanse, beyond which was probably of many

    gardnerrs, at first for the glory of the gentry, then the pleasure of the public and perhaps eventually

    the hospital management committee.

    Such tradition garden take many hours of greenhouse and site work and this expenditure inb not

    the sort that many modern institutions, including hospitals , can now expect to make. However, the

    average public expectation of a garden is generally stuck in this time warp whereby fine gardens

    imply labor and, to an extent, this expectation is true, Nowadays, many of the experienced,

    traditional gardens have gone, retired and taken their dibbers and twine with them. Their

    replacement is probably contract labour that gives a basic service of mowing and chopping,

    strumming and spraying and spraying, and death to the aesthetic. We believe there are viable,

    modern alternatives but first we needed to look more specifically at the average hospital and its

    land.

    ENVIRONMENTAL ISSUE

    Land has become a precious commodity. Urban sprawl and our road network have grossly reduced

    its acreage, while intensive farming and the toll of herbicides and pesticides have diminished much

    of its quality.

    Open land in towns and cities has always been valued by urban inhabitant, which is why squares.

    Parks and gardens, playing fields and cemeteries are so precious; now a days, some new area such

    as community gardens and green-lines are developing. There is an accelerating demand for

    allotment and city farms and organic farmers and environmentalist urge a restricted use of

    herbicides and pesticides, strumming and chopping. These voices should be heard and the handling

    of the hospitals land has a part to play in this.

    CURRENT NHS LAND USAGE

    There are four main reasons why so many modern hospitals do not use their land better;

    1. Land care is often the responsibilities of estates staff for whom it is a less urgent priority

    than the maintenance of the building and technical resources.

    2. The old traditions of formal gardens and estates management have been largely lost and

    have not been replaced by any new form of garden creations and land management.

    Himanshu Tripathi, 5th Year Architecture, 2008BARC033

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    3. Money is a genuinely constrained.

    4. Low value is placed on the aesthetics benefite for the patients and staff of the quality land

    usage.

    RATIONAL FORMAL PLANTING

    We are not advocating that the hospitals hand no colorful, formal planting but the means of

    adequate maintenance is not usually available these days. Garden formality has to be a manicured.

    But since such borders have such a strong traditions perhaps one good outside the main entrance

    could be justifies and it can serve as a splendid identifier of the place if it is impeccably

    maintained.

    ALTERNATIVE USE OF COLOUR PLANTING

    The love of organized colors besides the available budget could be channeled instead into hanging

    baskets. In springs, dozens of such baskets could be prepared, fully planted, padded with moss and

    be ready for a summers display.

    TREES, SHRUBS, HEDGES, CREEPERS

    These are usually inherited from thoughtful gardeners who planted those decades ago and, as

    such , they er often taken for granted. Great trees and large shrubs might be the remains of the

    asylum parks, hedges may mark the edges of land ownership or have been planted simply for their

    aesthetics.

    To neglect their replacement is to I mperil our reputation with future generations; these established

    plants, especially trees need a steady regeneration to maintain the population.

    SAFTEY ASPECTS

    Hospitals land does present the usual possibility of attack and assault on many people who use it.

    Psychiatric hospitals experience their fair share of attack both by and on patients and hospitals

    generally attracts voyeurs, the unstable and those with a grudge. Dense shrubberies of a height to

    offer concealment may be felt to present an avoidable hazard so lower growth and trees above the

    head are alternatives, besides the usual precautions of lit pathways and camera surveillance.

    Shrubberies also tent to attract and accumulated rubbish underneath that trunked trees do not and

    the provisions of rubbish bins is another feature of environmental care.

    Himanshu Tripathi, 5th Year Architecture, 2008BARC033

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    WATER FEATURES

    Water features are always being requested but it is firmly advised never to install a pond, fountain

    or anything to do with water for two reasons: one is that they are never, ever maintained and other

    is that they arouse frantic fears of danger amongst nurse. You cn drown in an inch of water, we are

    lugubriously warned, again and again.

    The poor capacity to actually accept and care for water features is a great pity, because water does

    prompt soothing reactions almost universally. There are good instances, award winning water

    gardens and so on but visualize them in ten years time after yet more reorganizationto the NHS

    and consider what their condition might be like them.

    HARD LANDSCAPE

    The course of path

    We described earlier the need for a good system that works and has visual quality, but the best way

    to designate paths for walking is to let peoples feet describe their course. If people are determined

    to take a short cut that is where the path will appear and for the estates department vainly to place

    no parking traffic cones on the path merely makes everyone step around them. Then the worn earth

    has a bulge in it like a snake that has swallowed a goat.

    When people have voted with their feet, it is better to accept theses determined footpaths and

    upgrade and pave them in some way. Stepping stone slabs in the mown grass are a neglected

    variant and white flowers planted along the path edges give night guidance. Native, self-

    perpetuating or cheap, flowers like snowdrops, alliums, alyssum, ransoms and so on traditionally

    lined the path to the outdoor privy to guide you in the dark and the same principles could be used

    to guide people to the car park, in spite of in addition to lights.

    Hard surfacing qualities

    Asphalts and concrete are unavoidable but they do not have to present unbroken sweeps; there is a

    great deal of landscape design expertise on the planning of minor road system and car parking; the

    NHS has only to consult wisely and in time.

    Himanshu Tripathi, 5th Year Architecture, 2008BARC033

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    Suppose you wish to create a concrete courtyard for the elderly; you will think in terms of pavings

    to allow wheel chairs, zimmer frames, unsteady walking and an easy passage, and it is usual to

    have one type of constituted stone slabs, probably light in tone and laid everyehere, as many slab

    as possible covering and controlling as much earth as possible. On the sunny day the unrelieved

    slabbing will reflect light and heat directly up into old eyes; on a dim day there will be no variation

    in its appreances.

    There is no reason why two or three colors of the same composite slab cannot be used, for variety.

    Gaps for low flowers do not impede wheelchairs if well placed, nor do small areas of gravels,

    which is cheapest to lay, and intersection in the ground of cobbles and brick make all the

    difference.

    Also, to take paving right up to a wall losses opportunity for planting climbers and softening the

    engineering harshness of the building ,materials. Many courtyard have no relief in the form of

    large trees to interrupt visually the straight, hard engineering line of the surrounding roofs, but the

    planting of large trees, even up to twenty feet high, while a specialist job, is not difficult or even

    prohibitively expensive and it makes a dramatic difference.

    Walls, curbs and steps

    Walls to sit on, curbs and steps to steps off should have two features, softness and variety. The use

    of half nosed bull bricks is a much softer edges than an ordinary squares bricks. If you have raised

    borders with inches high to two feet high. Any physiotherapist wills advice that variety is what

    humanity needs.

    LANDSCPAE BUILDING / FURNITURE / EMBELLISHMENT

    The well-dressed landscaped

    A classically well-dressed will have achieved that state by careful planning; even if they have not

    bought their whole outfit at the same time, there will be thoughtful coordination about it from the

    whole image down to the details of handkerchief and shoes.

    An alternative is gipsy variety where assorted items are thrown together and given a sort of unity

    by the glamorous if eccentric style of their combination. If we transfer this metaphor of classical

    and gipsy to the appointing landscape, we shall understand the alternatives.

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    The best thing to do is accept the varied and various existing items and combine them in a

    powerful design scheme, your gipsy solution. This should involve a fresh approach to planting and

    paving and painting abut, above all organizing. These are a few suggestion of what can be done.

    Organizing and painting

    Temporary rubbish skips are difficult to hide but they can be placed sensitively. Semi- permanent

    wheeled bins can be parked behind trellis screens, in the way caravans are hidden in a garden, and

    the screens stained greens covered with creepers. Several Russian vines and multiple other

    creepers can make a huge difference to a hospital site. There are likely to be different designs of

    railings, bollards, seats, lampposts in a typically muddled site and some unity can be achieved by

    painting them in relating colors but in different ways to emphasize their designs, whatever it may

    be; the traditional items can be painted traditionally, the modern one in hi-tech way and trashy

    ones in gaudy manner.

    Colors washes on disparate buildings an unify them, doors can be painted to a scheme and nothing

    softens unsympathetic architecture like creepers. The lining of window curtains can be used as

    color opportunity since they are what outside sees. In a modern movement block the entire outside

    facing curtain colors can be handled like a huge abstract painting of colored; it takes dedicated

    organization but this could transform a bleak building.

    Pavilion, sheds and huts are often interesting and reflect the hospital history.

    Community and specialist use of land

    Psychiatric hospitals have been working to take patient into the community, but the community

    can also be encouraged to come into the psychiatric or any other hospital site and use its land. It

    can be reasonably feared that thicker and lass obviously manicured vegetation may increase

    vandalism and likelihood of attack on the vulnerable. However, these things are controlled when

    there are a lot of people around; it is the desolate car park with a few unsupervised cars that spells

    trouble, but a well-used open track, for dog walkers, horse riders, cyclist, and other land uses,

    brings in people and they can be regarded as unpaid supervision.

    WILDLIFE GARDENS

    This is a more of an element than a specific place. Its features are to encourage self-seeding, non-

    cultivated plants and so attract insects, birds and wild mammals. ;large areas are needed, not tiny

    Himanshu Tripathi, 5th Year Architecture, 2008BARC033

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    courtyard, as it is no use encouraging insects in one small patch when they are blitzed pesticides

    throughout the surrounding acres. There will also need to be agreement that estates or contract

    staff will not suddenly mow all the seeding flowers heads and remove them to a rubbish tip a mile

    away in order of someone who thinks anything wildlife is untidy.

    PROVISION FOR CHILDERN

    There is a plenty of material available regarding playing fields for adolescents and adults, and

    playgrounds for children. The problem always arise whether such facilities should be available to

    the community generally or just the hospitalized and the staff. This will depend upon space

    expediency.

    Himanshu Tripathi, 5th Year Architecture, 2008BARC033

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    References

    1. www.mskcc.org/research/psychiatry-behavioral/research-activity

    2.www.christianacare.org/cancerpsychology

    3. www.tmc.gov.in/medical/departments/as/psychiatric.htm

    4. www.cancer.ucsf.edu/psycho-oncology

    Bibliography

    1. Healing the hospital design Sarah Hosking, Liz Haggard

    Himanshu Tripathi, 5th Year Architecture, 2008BARC033

    http://www.christianacare.org/cancerpsychologyhttp://www.christianacare.org/cancerpsychologyhttp://www.christianacare.org/cancerpsychologyhttp://www.christianacare.org/cancerpsychologyhttp://www.cancer.ucsf.edu/psycho-oncologyhttp://www.cancer.ucsf.edu/psycho-oncologyhttp://www.cancer.ucsf.edu/psycho-oncologyhttp://www.cancer.ucsf.edu/psycho-oncologyhttp://www.cancer.ucsf.edu/psycho-oncologyhttp://www.cancer.ucsf.edu/psycho-oncologyhttp://www.christianacare.org/cancerpsychologyhttp://www.cancer.ucsf.edu/psycho-oncology
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