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HUMANIZATION AND QUALITY OF HOSPITAL ENVIRONMENTS

S Cedrs Bello
Architect. MSc. In Programming and Design of Health Establishments. Teacher
Associated. Researcher SPI-Conicit.

RESUMEN
En este artculo se discuten los efectos del ambiente fsico, sobre la salud y
satisfaccin de los usuarios de los ambientes hospitalarios, as como tambin la
percepcin del ambiente y sus efectos tranquilizadores y teraputicos en los
pacientes. Se sealan algunos criterios de diseo, como son seguridad y privacidad,
que contribuyen a humanizar el ambiente fsico, promover la salvaguarda y elevar la
dignidad de cada persona como usuario de un establecimiento de salud. Se
presenta la calidad de la edificacin como una respuesta a los requerimientos de los
usuarios.
Palabras Claves: Humanizacin, Arquitectura Hospitalaria, Percepcin espacial.

ABSTRACT
This paper discusses the effect of the physical hospital environments as work places
on the User health and job satisfaction, also the environment perception and its
therapeutic effects on patients, as well. It is also designed design criteria, such as
security and privacy that enhance the humanization aspect of the physical
environment that ensures the person's Dignity as a user of a health facility. The
concept of quality is presented as a response to user requirements.
Key Words: Humanization, Hospital architecture, space Perception.

INTRODUCTION
There is much debate today about the supremacy of the design, humanization and
spatial perception, of the hospital environments on the technological aspects, and
many investigations have been carried out confirming the therapeutic it is having
the physical environment in the recovery process of patients (1.2 , 3, 4). Likewise,
the health risks of hospital staff have been studied as product designs inadequate
physical infrastructure (5.6).
The word humanization, synthesizes all the actions, measures and behaviors that
are safeguard and dignity of each human being as user of a health facility. This
means that the user is in the design decision, not only as a producer of functional as
an expression of human values that must be considered.

If we assume that the user of a hospital is not only the patient, but each person that
in a way, interacts with the physical space and with the organization of the
establishment, be it the community, the visitor, the nurse, the doctor, etc., we
understand that the aspect of humanization must reach each level of the decisions,
therefore must include: urban design, building design, unit design space, interior
design and equipment.
For the design of the physical environment, organizational system, and behavioral
models, of a health establishment, it is necessary to start by establishing the cultural
context and user, in order to promote a humanized perception of the establishment
and promote a process of user identification with the symbols, messages, and
meanings that the aspect of the building can communicate.

These human reactions to the spaces, can help us in the collection of data and in the
preparation of the establishment's programming, through contributions from the
different users. But this is not everything, from the requirements of users to
specifications of the building, is a laborious task that requires of a multidisciplinary
approach to hospital design.
In this process we should not ignore the cultural history and the existential situation
of the users, nor to produce approved buildings (typical projects), moving away
from the objectives we want to achieve.
The two largest health services in the future will be the repowering of the human,
and the habitat redesign. The repowering of the human means to fulfill the spiritual
potential of people through physical, emotional and mental means, this potential is
the predisposition to give answers, but it must be driven by an environment "that
stimulate. "A well-designed human habitat activates spiritual potential and creates
multiple pathways for expression. Through design, certain behaviors can be
stimulated or inhibited; we can ignore the sociocultural factors of individuals who
come from their environment. These factors determine patterns of behavior
learned during life a person, if we want a healthy person, we should go around a
room healthy, expressed in a broad way in the concept of Primary Health Care: "The
levels of social well-being, include all that this means, that is, disposition of excreta,
light, housing, roads, food education, so that those diseases considered avoidable,
in the current state of knowledge, are reduced or disappear.

DESIGN PRINCIPLES
In the design of hospital environments, in addition, to meet the requirements space
and functional, it is important to consider some basic criteria that collaborate with
the humanization of these environments, such as security and privacy.

Security: The physical environment should try to safeguard personal sensitivity and
human dignity of patients and their families, try to lessen their anxieties and
concerns, especially in those cases where patients and their families are
experiencing difficult times, such as waiting for the results of a surgery, an
emergency, intensive care, or a crucial diagnosis. This can be done consider when
selecting finishes, taking into account that there is no need to create all aseptic
environments, giving priority to maintenance, reflective surfaces are not
desirable. How many times during a hospital visit did we are struck by the coldness
of the physical environment, all the reflective materials, the metal furniture, by
chance, or with difficulty of orientation, lack of lighting or pleasant view, with the
impression of a huge, oppressive and potentially authoritarian, in which the human
dimension feels canceled (8). Security can be to provide a warm, non-institutional
environment in order to reduce fear, and increase the confidence and self-esteem
of the users.

Privacy: is a primary consideration in the design of the conductive environments to


the practice of Medicine. This feeling is crucial for patients who receive type of
treatment, such as cancer patients (9), which manifest often feelings of depression,
anxiety, fear of being discriminated against, rejection, etc. The physical environment
as the size of the spaces must provide adequate levels of privacy. In the waiting
areas of critical areas, customized spaces are required where families can expect
together with a minimum of contact with others patients, but it is also desirable to
have spaces that insinuate a certain sociability and stimulate personal contact as
some patients and families feel considerable support to share your concerns with
others who are going through the same situation.
In the internal areas of the emergency or first aid department, it is convenient visual
and acoustic separation; pediatric areas of adult, chronic patients, in order to lessen
the can psychologically disrupt patients and their relatives, and prevent their
recovery, reassurance and progress.

QUALITY OF BUILDING AND USER REQUIREMENTS


Commonly the idea of quality is associated with words like good, excellent, bright,
expensive, but these qualifications do not guarantee quality. A hospital building
very expensive does not necessarily mean that it is of good quality, it can have many
undesirable characteristics such as the proximity between departments, very small
spaces, insufficient isolation of the sound between offices, etc.
On the other hand a more modest hospital, can have better quality if it gathers a
series of necessary, economic in its operation and effective in the use of the
spaces. It is said that "quality consists in being in conformity with the
requirements".
The Spanish legislation states: "... the designer must take into account that the are
undergoing considerable activity and that resources for their construction, and
especially for their maintenance are limited. Thus, it is necessary to use materials
appropriate to the functional demand that will be required and lasting, without
that, it is necessary to give up aesthetics. In general, simple, practical and durable
solutions should be simplicity that does not require complex adjustments or
maintenance, but always with the higher quality, not luxury ".
Knowing the requirements of the users is the basis for establishing the
requirements quality. Quality can be achieved, first, by reaching agreement on the
Requirements and needs of the users, to be translated and reflected in the
design. In order to establish these requirements, the user must be clear in what is
what you want, and what your expectations are. It is not absolutely necessary to
involve everyone users in the design process, usually the head nurse of each
department, knows very well the needs of daily routines needs of patients. Part of
the requirements of a hospital building are needs of the users, but others refer to
the requirements of the building as such as its components, materials, etc. A third
type of requirements refers to the environmental conditions, urban regulations, or
in relation to financial resources available.
The quality requirements of a hospital can be divided into three
categories (12): functional, technical and psychosocial. The functional requirements
are refer to the dimensions of spaces, the location of functions, relationships
interdepartmental, as well as furniture, equipment and facilities. The requirements
Technicians refer to parts of the building, structures, materials, internal
temperature, acoustics, lighting as well as technical installations. Psychosocial
requirements are relate to environmental image, cooperation and interaction,
privacy and recovery of the health.
Prescribing user requirements generally does not include a solution which indicates
how to comply with that requirement. For example: when prescribing the need that
the voice in a normal conversation, should not be heard from one office to another,
or from one patient's room to another, this requirement can be translated into
quality requirements if it is specified that the type of material walls separating the
spaces have an insulating capacity of 50 decibels (dB: Unit of sound volume
measurement). Up to now, the appreciation of the quality of buildings subjective
and personal. This is due inter alia to the existence of construction, merely
descriptive. Gerard Blachere (13) explains that to certify the Quality of a building
must be made according to the requirements of the users. In this spirit, a building
regulation based on objectives, not the means, which leads to the need to have
behavioral norms. All requirements must be systematically defined by the customer
before start the design process. The conformity of the requirements can be
checked in the specifications presented by the architect (the architectural program
and plans). If the architect and the builder understand and follow the requirements,
the client can expect to have a quality hospital, according to their needs (10). The
variables do not included in the program should not be subject to evaluation (14).
PERCEPTION OF THE ENVIRONMENT
The characteristics of the physical environment can directly influence the behavior
and well-being of the user. Individual psychological differences are important
modifiers of environmental perception and evaluation. They are based mainly in
individual experiences acquired from the cultural environment. Each person also
adopts sociocultural norms, attitudes and specific skills of the environment social in
which it operates which determines the environmental interrelationships (12).
Roff (14) raises the communicational attributes that own the buildings, relating
with the transmission of semantic and aesthetic information. The first allows the
knowledge of the outside world through a system of established habits and
expectations, in change aesthetic information only determines in the recipient
affective states such as pleasure or displeasure, pleasure or emotion.
An open and sensitive personality, receives more stimuli from the environment but
is also more intensely affected by unpleasant stimuli.
Continuous exposure to a particular environment gradually changes adaptation of a
person to the conditions of that environment, adapting to the time to undesirable
environments at first, once they become familiar.
Familiarity with a given environment can help the acceptance of another
environment unknown if both belong to the class of environments called
genotypes (12). Is the case of typical departments of hospitals such as operating
theaters, radiology, etc., which may have similar designs and functions in different
hospitals.
In work environments such as hospitals, where most tasks require movement
through the building, is an essential condition for functioning efficiently to be able
to adapt to the physical environment through the development of maps
cognitive. The coherence and legibility of the environment promotes this
development. The others building users should also be clearly oriented in their
movement to through it, for which it must have a good system of signaling, or
through symbols, colors, lighting, landscaping, and the building's own architecture.
Signs and graphics that provide clear and consistent messages can do more to put
people in the right direction and keep them in that direction take them by the
hand. These signs can convey the message that the institution and its staff are
concerned about meeting the needs of patients and visitors, and they
want to help (15).
PHYSICAL ENVIRONMENT AND SATISFACTION AT WORK
Some of the characteristics of the environment that should be considered at the
time of design, to adapt it to the needs of the user, are: noise, lighting,
temperature, air quality, color, equipment and furnishings, privacy, status
symbol. The unsatisfied needs cause tension, dissatisfaction and dissatisfaction. On
the other hand, tendency of workers to overestimate or ignore the importance of
the physical environment in relation to their satisfaction at work, may reflect their
habits and their values more than the true contribution of the environment.
Locke (16) defines values as "conditions acquired a person consciously or
unconsciously wants, wants or seeks to obtain. "According to him, the needs
human beings are a universal and innate condition for maintaining life, which exist
regardless of whether the organism wants them or not. True emotional reactions
and choices are determined by values. While all human beings mainly have the same
basic needs, they differ greatly in their which they value.
The contribution of the physical environment to job satisfaction or dissatisfaction
will be determined insofar as it facilitates the achievement of the user's objectives
by satisfying their basic needs and achieving physiological comfort.

HARMFUL EFFECTS AND RISKS CAUSED BY THE PHYSICAL ENVIRONMENT


The direct harmful effects on staff are manifested psychological changes, fatigue or
accidents. The physical environment must insinuate certain patterns of behavior
and prevent others, in order to delimit the possibilities of action. Environmental
conditions such as extreme temperatures, contaminated air, noises annoying or bad
lighting, that are outside the limits psychologically acceptable, can make work
intolerable. Certain dangerous aspects in the physical environment can be detected
only when they cause serious accidents, such as falling on a floor slippery, or on an
imperceptible step. Hazards such as toxic chemicals, radiation ionizing agents or
microbiological hazards include long-term effects that may even be impossible to be
perceived.
The humanization of the environment must also be reflected in the concern to
reduce risks to staff members working in hospitals are numerous cases that have
been reported on damage to the worker's health produced by poor design,
construction or maintenance, of the habitat where it works. HE have reported cases
such as the Hospital of Maracaibo (6) which have been observed damage in the
physical conditions of anesthesiologists because the surgical area of the mentioned
hospital is under the floor of X-rays, being exposed radiation sources that are not
regularly calibrated, and there are also no gas extraction equipment in the surgical
area.
Continuously subjected to the inhalation of toxic gases such as ethylene oxide.
Similarly, in the Surgical Unit of the Hospital Baquero Gonzlez (5) they were
detected ailments and conditions of the spine in the nurses who work there, due to
the long routes with stairs in the middle, which must be submitted during the time
of work, caused by a design not suitable to the operation of the Unit.
Today we possess the cognitive instrument to project the environment of man, not
in abstract terms, but based on their own need, their values, and their existential
situation This requires a systematic analysis and priorities and forms of
operation. Infrastructure is an aspect that must be programmed to achieve an end,
that of improving the quality of patient care and improve the quality of the spaces
where the providers of such care operate.

Bibliographic references
1. Del Nord Romano. Human Centered approach to hospital design. In:
<Http://www.healthdesign.org/en20.htm> (see: 10-11-1998).
2. Shepley M. / s good healthcare design more dependent upon art or science? In:
<Http://www.healthdesign.org/forum> (see: 10-11-1998).
3. Fiset, Martn. Architecture and the Art of Healing. The Canadian Architec
Villalobos C, et al. Chromosomal Alterations in Anesthetists of the University
Hospital Of Maracaibo. Rev. of the Faculty of Medicine, UCV. 1998; 21 (2): 108-114. 7.
Kaiser L. Need for a Paradigm Design. In: <http://www.healthdesign.org/forum>
(See: 10-11-1998)