HOSPICE CARE CENTRE

THESIS REPORT

Submitted by

SUHANYAA H

in partial fulfillment for the award of the degree

of

BACHELOR OF ARCHITECTURE

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 N.R SCHOOL OF ARCHITECTURE, COIMBATORE

ANNA UNIVERSITY: CHENNAI 600 025

MAY 2018

ANNA UNIVERSITY: CHENNAI 600 025

BONAFIDE CERTIFICATE

Certified that this thesis report HOSPICE CARE CENTRE is the bonafide

Work of SUHANYAA H who carried out the thesis work under my supervision.

SIGNATURE SIGNATURE

Ar. DHILIP KUMAR RAJA

DIRECTOR
NR School of Architecture
Coimbatore

Project coordinator External

Examiner

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 ACKNOWLEDGEMENT

First of all, I am thankful to the Almighty God for leading me.

I earnestly express my sincere thanks to project coordinators Ar. RAJASUNDARI

Ar. ASHISH JENO, Ar.SYED ABUTHAHIR, Ar. IDHREES for their
Inputs and valid criticism during the topic selection and course of study.

I am much obliged to express my sincere thanks and gratitude to my

Project Guide Ar. SYED ABUTHAHIR for his valuable inputs, suggest ions, and
Encouragement that has enabled to complete this project successfully.

Above all I express my heart felt gratitude to my parents and friends for
Their supports to complete this project successfully.

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 ABSTRACT

The basis of this project thesis was to introduce a new building type that serves the
terminally ill patients & their family members by creating a building that is
designed & prepared to meet their required needs.. Nowadays several chronic
diseases have appeared & the number of dying terminally ill patients is increasing,
whereas hospitals are occupied with patients who are not in need for cure, only in
need for treatment & conditions management. Hospice Care Center is becoming a
global society need to fill some of the gaps that hospitals are no longer able to.

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 LIST OF TOPICS

CHAPTER 1 – SYNOPSIS

1.1 INTRODUCTION 11
1.2 SCOPE 13
1.3 AIM 16
1.4 OBJECTIVE 16
1.5 SPECIAL STUDY 16
1.6 SITE 16
1.7 METHODOLOGY 16
1.8 REQUIREMENTS 17
1.9 NET STUDY 17
1.10 CASE STUDY 18
1.11 CONCLUSION 19
CHAPTER 2- CASE STUDY

2.1 – NET CASE STUDY 20

2.1.1URBAN HOSPICE 20
2.1.2 BEARHOUSE CHILDREN’S HOSPICE 30

2.2- LIVE CASE STUDY 41

2.2.1 KARUNASHRAYA 41
2.2.2 JEEVOTHAYA HOSPICE 57

CHAPTER 3 – LITERATURE STUDY

3.1 INTRODUCTION
3.2TERMINOLOGIES
3.3 TYPE OF USERS
3.4 SITE FEATURES
3.5 SPATIAL RELATIONSHIP
3.5.1 RESIDENTIAL ZONE
3.5.1.1 PATIENT ROOM
3.6 MEDICAL ZONE
3.6.1 SURGICAL SUIT
3.6.2 NURSE LOUNGE

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 3.6.3 CONSULTATION ROOM
3.6.4 PHARMACY
3.7 ACTIVITY ZONE
3.7.1 PHYSICAL THERAPHY
3.7.2 HYDROTHERAPHY
3.7.3 OCCUPATIONAL THERAPHY
3.7.4 DAYROOM
3.7.4 PLAYAREA
3.8 ADMIN ZONE
3.8.1 RECEPTION
3.8.2 WAITING
3.8.3 MEDICAL OFFICE
3.8.4 SECERATERY ROOM
3.8.5 RECORD ROOM
3.8 ENTRY ZONE
3.8.1 PARKING
3.8.2 BYCYCLE PARKING
3.8.3 AMBULANCE PARKING
3.9 SERVICE ZONE
3.9.1 KITCHEN
3.9.2 LAUNDRY
3.10 CIRCULATION

CHAPTER 4 – PSYCHOLOGY

4.1 DYING AS A OPPOURTUNITY FOR POSITIVE GROWTH

CHAPTER 5 – SPECIAL STUDY

BIOPHILIC DESIGN

5.1 ELEMENTS OF BIOPHILIC DESIGN

5.1.1 LIGHT AND HEALING
5.1.2 COLOURS AND HEALING
5.1.3 GRAVITY AND HEALING
5.1.4 FRACTALS AND HEALING

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 5.1.5 CURVES AND HEALING
5.1.6 DETAILS AND HEALING
5.1.7 WATER AND HEALING

5.2 PATTERNS OF HEALING

5.2.1 NATURE IN SPACE
5.2.1.1.VISUAL CONNECTION WITH NATURE..
5.2.1.2. NON-VISUAL CONNECTION WITH NATURE.
5.2.1.3. NON-RHYTHMIC SENSORY STIMULI.
5.2.1.4. THERMAL & AIRFLOW VARIABILITY.
5.2.1.5. PRESENCE OF WATER.
5.2.1.6. DYNAMIC & DIFFUSE LIGHT
5.2.1.7. CONNECTION WITH NATURAL SYSTEMS
5.2.2NATURAL ANALOGUES

5.2.2.1 BIOMORPHIC FORMS & PATTERNS.

5.2.2.2. MATERIAL CONNECTION WITH NATURE
5.2.2.3. COMPLEXITY & ORDER.

5.2.3NATURE OF THE SPACE

5.2.3.1PROSPECT
5.2.3.2. REFUGE.
5.2.3.4MYSTERY.
5.2.3.5RISK/PERIL

CHAPTER-6

6.1 COMPARITIVE ANALYSIS

6.2 AREA STATEMENT
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CHAPTER-7 SITE STUDY

7.1 INTRODUCTION
7.2 LOCATION
7.3 NEIGHBOURHOOD
7.4 ACCESS
7.5 CLIMATE
7.6 CONTOURS
7.7 SECTION
7.8 VIEW
7.9 NOISE ANALYSIS
7.10 SITE DRAIN

LIST OF IMAGES
FIG 1- CANCER STATISTCS INDIA
FIG 2- CANCER STATISTICS TAMILNADU
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FIG 3 –CANCER STATISTICS COIMBATORE
FIG 4- MORTALITY RATE
FIG 5-CONCEPT
FIG 6 –CIRCULATION
FIG 7 – SERVICE FLOOR GROUND FLOOR PLAN
FIG 8- FIRST FLOOR PLAN
FIG 9- FORM
FIG 10- TERRACE
FIG 11- FORM
FIG 12- SITE PLAN
FIG 13 – GROUND FLOOR
FIG 14 FIRST FLOOR
FIG 16- PSYCHOLOGY
FIG 17 – FORM
FIG 18 –PLANNING
FIG 19 – AIR CIRCULATION
FIG 20 -SITE PLAN
FIG 21- GROUND FLOOR PLAN
FIG 22 -FIRST FLOOR PLAN
FIG 23- FORM
FIG 24 – GROUND FLOOR PLAN
FIG 25 -FIRST FLOOR PLAN
FIG 26- CANCER IMPACT
FIG 27 USERS AND FUNCTION
FIG 28- SITE
FIG 29- SITE ZONING
FIG 30- ZONAL CONNECTIVITY
FIG 31- FLOW CHART
FIG 32 – PATIENT ROOM PLAN
FIG 33- FOUR BED ROOM
FIG 34- OTHER ROOMS
FIG 35 – ELEVATION
FIG 36 – TOILET
FIG 37- SURGICAL SUIT
FIG 38-SURGICAL SUIT PLAN
FIG 39- ITU
FIG 40- FLOW CHART
FIG 41- CONSULTATION
FIG 42- NURSE STATION
FIG 43- UTILITY
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FIG 44 –PHARMACY
FIG 45- MORGUE
FIG 46- PHYSICAL THERAPHY
FIG 47- HYDRO THERAPHY
FIG 48- OCCUPATIONAL THERAPHY
FIG 50 – ADMIN LAYOUT
FIG 51 –LOBBY
FIG 52- WAITING
FIG 53-MEDICAL OFFICE
FIG 55 –PARKING
FIG 56 – BIKE PARKING
FIG 57 – AMBULANCE PARKING
FIG 58-KITCHEN LAYOUT
FIG 60 –CORRIDORS
FIG 61 -STAIRS
FIG 62- RAMP
FIG 63- LIGHT AND GREEN
FIG 64- LOCATION
FIG 65-ACCESS
FIG 66- CLIMATE SUMMARY
FIG 67 –TEMPRATURE GRAPH
FIG 68- COUNTOURS
FIG 69 – SECTIONS
FIG 70- VIEWS
FIG 71 -SUN AND WIND
FIG 72-NOISE ANALYSIS
FIG 73 – SITE DRAIN
LIST OF TABLES

TABLE 1 – CANCER STATISTICS

TABLE 2- PATIENT ROOM STANDARD
TABLE 3- STANDARDS
TABLE 4 - AREA STATEMENT FOR 50 BEDDED HOSPITAL
TABLE 5 –PARKING STANDARDS
TABLE 6- HEALING EFFECTS

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CHAPTER 1-SYNOPSIS

1.1 INTRODUCTION

Death is one of the great certainties of life & a life changing experience. To
understand what a dying person need we have to understand & define the
experience of death & dying. There are two death situations that people face every
day, the sudden death and the expected death(slow death) death caused by a
terminal disease. In the sudden death the family members are the ones who suffer,
it is a very shocking & heartbreaking experience. Where in the near death
experience both of the patient & the family members are suffering, in this
experience the patient goes through a grief cycle.Many chronic diseases have
recently accrued. The medical science has provided the best treatments for such
diseases but still they cannot be cured. Hospitals alone are no longer satisfying
these emerging needs. Whereas new solutions of care & treatment are becoming
highly in demand for societies & communities

Hospice care
Hospice is a special type of care & philosophy that is concerned with helping
terminally ill patients & their family emotionally, spiritually & psychosocially to
scope with end stage disease.Hospice care believes that the quality of life is
important as the length of life.

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PALLIATIVE CARE

Palliative care is the process of medical therapy that focuses on minimizing the
pain & ache associated with the illness. It is basically concerned with physical state
of the patient. This care is provided by a special medical team that includes
doctors, nurses & specialists who work together to provide the best medical care
for them.

CANCER

Among various diseases, cancer has become a big threat to human beings globally.
As per Indian population census data, the rate of mortality due to cancer in India
was high and alarming with about 806000 existing cases by the end of the last
century. Cancer is the second most common disease in India responsible for
maximum mortality with about 0.3 million deaths per year.

CANCER STATICS IN INDIA

Estimated number of people living with disease around 2.5 million every year,new
cancer patients registed over 7 lakhs cancer realted deaths.5,56400.

FIG 1- CANCER STATISTICS

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DESIDERATUM OF HOSPICE CARE
Statistics report of the year convey that 67% of death in the country occur due to
cancer.

FIG -2 CANCER STATSTICS TN

Hospice are very rare in india .only 18 of india ‘s 28 state and 7 union territories
have any palliative care service at all .Many states In india have no absolute no
medical facilities that prescribe morphine.so we are in essential situation of
increasing hospice facilities in india.

LIST OF HOSPICE
Andrapradesh-1 goa-1 punjab-1
Karnataka-3 gujarath-3
Chandigarh-1 Tamilnadu-3
1.2 SCOPE
STATISTICS (NEED OF HOSPICE IN COIMBATORE)

coimbatore and its surrounding the second place were more cancer patients is seen

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TABLE 1- CANCER STATISTICS TN

`` FIG 3 CANCER STATISTICS

FIG 4-MORTALITY RATE

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Knowledge about the hospice and palliative will be created among the people.
Providing this type of professional center will lift the load from the hospital.Proper
care will be provided especially for those who need.

1.3 AIM
 Mission of giving this type of care in a professional center will left loads
from hospitals & allow them to provide medical care for those in true need.
 Vision is to play a leading major role giving an innovative type of care in the
health care field for the terminally ill patients.

1.4 OBJECTIVE
Provide good quality spaces and insure that spaces of the project will serve
terminally ill patients properly.
Provide medical health care facilities and Entertainment commercial facilities
which would to improve their social behavior.

Green spaces provided for them a healthy environment to address their mental &
emotional needs.
Emphasize on family role by providing facilities that allow them to spend time
with their loved one.
Provide public amenities that can provide financial aid for the center to make it
affordable for all social classes.

1.5 SPECIAL STUDY

Healing Architecture – Biophilic Design

1.6 SITE
Perur coimbatore( a proposed site for health care) . Presence of river siruvani
makes the space even vital.

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 `

1.7 METHODOLOGY

1.8 REQUIREMENTS
 Residential Zone: is declared to accommodate both patients & staff
members with very high standard of space quality.
A special housing shell for patients with green spaces with in and around it.

A housing shell with all comfort level for staffs.

 Major clinic & Health Care facilities Zone:

Clinic & health care center
Emergency units around the areas of the center.
 Entertainment & Amenities Zone: the project must provide a Varity &
different kind of activities

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 Theaters
Art and music events (which even serve as a theraphy to patients).
 Parks & Green spaces Zone: are highly in demand for hospice & palliative
care.
Green space theraphy pavilion for meditation.

1.9 NET STUDY

 BEAR COTTAGE CHILDREN’S HOSPICE

Received RIBA West midland regional award thelayout conveys a message of

openess and sharing experience.

 URBAN HOSPICE
Designed by NORD Architects the concept of the project is to design a
hospice care within a urban environment by providing an intimate
experiencnce.

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1.10 CASE STUDY

 Karunashraya( Hospice care centre in Banglore)

Designed by Ar Chandravarkar & Ar Thacker. The hospice is considered as
a beat architectural example of green sensiblity.The building greets you
with with a series of green pockets,water bodies aglow with colourful fish,
corridor awash in sunlight and a sense of calm.

 Jeevothaya Hospice (Hospice care centre in chennai)

Designed in a urban context in a busy part of north Chennai

CONCLUSION
The project will provide a meaningful,naturally & releving experience. It will
implement massive use of greenery and natural elements.

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CHAPTER -2 CASE STUDIES
2.1 NET CASE STUDY

2.1.1 URBAN HOSPICE

Location: CopenhageDenmark
Client: Diakonissestiftelsen
Year: 2013-2016
Typology: Hospice
Construction costs: 45 mill DKR
Surface area: 2.230 m2
architect: nord architects

FEATURES

The project is to design a hospice care within a urban environment by providing an

intimate experience which is highly needed for hospice.The project is designed to
reflect and support the notion that healing architecture has a positive effect on
palliative patients.

JUSTIFICATION

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Hospice care a healing place for terminally ill patients. When we see in accordance
to it the location of the care will be userfriendly if it is located in a calm area were
nature can be feel and heal the peoples.But the location of hospice in a urban area
is quite challenging. All the healing ambience has to be bought inside the
structure.Takin g such a hospice care as a literature study would help me to learn
the possitive aspects of the design and overcome the negative aspect of the design
which will be implemented further.

LOCATION

Urban hospice care is located in Frederiksberg in the city of Copenhagen.

Frederiksberg is a place of garden surrounding. placing a hospice in such a planned
area will give a good spatial condition for users.

To overcome the site constraints and complement neighboring residences, the

design team, decided to give the two-story facility a residential scale.

Frederiksberg is a place of garden surrounding. placing a hospice in such a planned

area will give a good spatial condition for users.

CONCEPT

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 FIG
FIG-5 CONCEPT

The overall form and concept were heavily influenced by the complex site
conditions and the proximity of the neighbouring built context. Within these
parameters, the vision was to create a warm and protecting atmosphere. The design
incorporates both curved and rectilinear elements that allow for an optimal
functional layout, built around a private inner courtyard.

CIRCULATION

FIG 6 CIRCULATION

The main concept of circulation is to reduce the complexity of the movement to the
different zones. Moreover the designer want to broke the concept of linear
corridors which was one of the majore feature of medical care. This both inner and
outer part of the of the curvilinear act as a interaction space.

The building's overall mass is divided into a series of smaller units, which are
connected by curving corridors that optimise the flow of movement and enhance
the sense of connection between different areas.

PLANNING

On the ground level, staff quarters occupy the western side of the floor, with
patient rooms on the east, and the largest courtyard between the two. The second
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floor is devoted completely to patients, including the roof terrace. Designed to
accommodate a total of 16 residents, each room has a sofa that can convert to a bed
for visiting family: there are also two separate guest rooms in the facility. Specific
technical requirements can be met easily: electric hoists are integrated into the
rooms to help staff move around those who are immobile; soundproofing solves
acoustical needs, and even the thick doors have rubber seals. And though the
rooms have operable windows for use when appropriate, each is air-conditioned in
such a way that they can be easily refrigerated following a death by lowering the
thermostat. There is no separate morgue: the bodies remain in place for 24 hours,
so that families and friends can visit to pay their final respects.

FIG 7 SERVICE FLOOR SECOND FLOOR PLAN

PLANNING AND CIRCULATION VIEW

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FIG 8 FIRST FLOOR PLAN

On the in first floor 60% of the space is given for patients care. 25% for the
administration and staff zone. 15% for the services. The second floor is totally
devoted to the patients.

The activity zone used by patients is facing the curvilinear part of the wall which
gives a continuous dynamic and protective feel.

Patients has individual entries and the staffs have a seperate entry. Which makes
the patients to avoid the medical zone and to make them feel like home

Service zone is less in floor area and no special type of sevices provided in the
urban hospice alike services provided in hospital.

Nurse station provided inside the patients

zone is quite less.So it make difficulties is
monitoring the patients condition.

The service floor is located in the G-1 floor. The departments such as laundry
CSSD is located in the ground floor.The Services from here is carried by service
lift and stairs. The service lift is located on the rear side of the main lift. The
service staircase is located in the north west part of the building.

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The service route soul is the service lift and service stairs. The service route is not
clear. The service route cross the activity zone. Which is not
recommended.Hence the service route is not good.

FORM

FIG 9- FORM

At the outset, the volumes were derived from the surrounding villas and then
adapted to the flow of the hospice and the care-taking core function of the place.

The inner courtyard gives sufficient light to the building. It creats a warm
atmosphere to the users.

INTERACTIVE TERRACE

FIG 10 TERRACE

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The courtyard composed of both linear and curvilinear elements which act as the
heart of the building.It is landscaped with trees and the flooring is done by warm
wood accent which goes good with the landscape. A special access is given to the
courtyard from the interactive terrace.

The patients room which is oriented towards the east side has direct access to the
interactive terrace. Where the patients can interact with the family. It gives a sense
of extovated connection with the environment.

Seating areas with a variety of furniture, including couches, high-back chairs, and
tables and chairs, provide multiple settings for conversation and respite.

HEALING ARCHITECTURE

Architecture and design can promote the healing process by giving a

psychological and physical lift to the patients.Hospice care need to actively

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contribute to the healing process by relaxing and reinvigorating patiens. New
knoweledge and ideas are adding new impentus to spatial design practice.

Many materials incorporated in urban hospice care plays a important role in

patients healing process and even it supports the concept of sustainablity.

LANDSCAPE

To ensure the setting still offers natural views within its urban location, the design
team incorporated small landscaped courtyards inside semicircularcutouts around
the perimeter of the building as well as a rooftop deck with terrace, providing
palliative patients and families several places where they can step outside

WALLS

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The walls are acoustical so it cut off the sound which gives a good ambience inside
the war. White a cool colour application of this colour over the wall gives a
peaceful home like surounding to the patient.

WINDOWS

Since the micro climate of the area is very cold -16 degree average tempratue in
winter and 32 degree in summer the thermal insulation is necessary

Windows throughout the building are triple-glazed for acoustical and thermal
insulation, including the large curved ones

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Windows throughout the building are triple-glazed for acoustical and thermal
insulation, including the large curved ones

A CRITICAL VIEW

The primary reason for having a good healing impact on patients is the locaion of
the site. The location of hospice is in a planned residential zone which is naturally
green. This helps the patient to have a feel in like living in a home.

The selection of materials like triple glazed glass which serve as an acoustics,
thermal insulation, the colour of wall in interior gives a pleasent ambience to
patiens, selection of furnitures which is adjustable and user friendly to users. these
material play a good role in healing architecture.

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Rounded corners create a natural flow through the building, further distancing the
architecture from traditional hospice design and the negativity too often associated
with it.

Similarly the service of palliative was more when compare with hospice
service.Instead of dumping with 16 individual suits in hospice care little more
space can be provided for theraphy and activity area.

2.1.2 BEARHOUSE CHILDREN’S HOSPICE CARE

LOCATION: AUSTRALIA
DESGINED BY: MCCONEL SMITH & JOHNSON DARLINGHURST

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CONSTRUCTION: REINFORCED CONCRETE, STEEL, MASONRY,
STUCCO, LAMINATED WOOD BEAMS, FLOORING & FINISHES
SITE/ PARKING: 2.1 ACRES / 22
BUILT UP AREA: GROUND/FIRST: 1351 – TOTAL: 2702

FEATURE

The project has presented several interesting new trends that played a prime role in
providing suitable spaces for dying children to have the opportunity to experience
as much as possible a normal childhood.

JUSTIFICATION

While designing a hospice it is important to consider the user needs. In most of the
regular hospice the need of space for children is not given importance. Bear cottage
hospice is a children hospice located in manley. which has a pleasant environment
with greenery and sea

Bear Cottage is the first dedicated children's hospice and respite care facility in New
South Wales, a service provided by Westmead Children's Hospital. The novel
concept of a children's hospice suggests the need for a
domestic setting, but with all the functions normally provided in an institutional
environment. The meeting of these two radically different types of setting in Bear
Cottage raises important questions about how architecture, and the inhabitants,
negotiates this hybrid condition

LOCATION

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LOCATION: AUSTRALIA SYDNEY

TYPOLOGY: CHILDRENS HOSPICE

NEARBY HOSPITAL: MANLEY

The site selection of this project had played an essential role in creating a unique
environment for dying children. The site had several important qualities which
enhanced the quality of the design.

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Located in a coastal resort town: provides the users an interaction with natural
environment & water elements.
Located near to a hospital. Surrounded by beaches this will provide an interaction
with community & will offer link to nature.

Located next to Residential quite area. Located near to educational institutes: in

order to attract students as possible volunteers in the hospice.

SPECIAL FEATURES

The project has presented several interesting new trends that played a prime role in
providing suitable spaces for dying children to have the opportunity to experience.

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Children's scaled restorative Garden

Tree House
It is accessible for patients & family through the outdoor bridge terrace from the
second level. It is mainly used for meditation & counselling. The tree house gives
the children a sense of playful sanctuary where they can feel free to open up through
the process of counselling because the tree house is a fresh casual spa

A fascinating new trend located in the back of the house as a backyard which
includes multisensory equipment such as light, sound & smell-based therapy
amenities. This trend allows the children to interact with nature & be part of it.

FORM

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Circulation was the primary spine of the hospice care. The form of the building was
evolved from the circulation. More over the additive and subtractive form was
followed based on the need of users. The L shape circulation helps in both the
privacy of the zones and also an easy accessible between the zones.

FIG 11 FORM

2.2.4 ZONE CONNECTIVITY

SPATIAL PLANNING:

The building responds to this site in a variety of ways. On entering from the south-
west corner, the established grounds open up to view as a pathway meanders to the
building's entrance, which is on grade at the second and principal level of the
building. The south-eastern edge of the building steps away towards the north,
following the line of an existing ridge in the site, reducing the visible mass of the
building. The entrance scale is immediately that of the domestic. The separation of
pitched roofs (required by the existing heritage context), two apparent chimney
elements (concealing ventilation and lift machinery), screened outdoor spaces and
a small water garden further suggest a domestic condition.

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FIG 12 SITE PLAN

The spaces are arranged in a cluster manner in way to complement each other to
serve the users of the building. The entrance area is located near to the
administration offices to in order for the staff to have a direct relation to the
reception desk.
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Next to it overnight accommodations for staff & family members are located so
the staying staff can be close to their work area.

Also the administration has two parts & each part is located in an area near to the
patient room for easy supervision.

In the patient area the common facilities are scattered around the patient's rooms.
Different types of facilities such as the game room are located in between the rooms
to allow easy access for all the patients to use all the rooms & to give them the sense
of home unlike the hospital where all the patients are located in one space without
any facilities which they can access to it easily.

FIG 13 GROUND FLOOR

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A CRITICAL VIEW

FIG 14 FIRST FLOOR

This project have introduced very creative new trends that are concerned with
providing a childhood experience for dying children while taking into consideration
the involvement of their family members.

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This project presents integration between the site selection & the project design as
they are blended together in harmony. All these aspects of the project would provide
a beneficial reference for further design of the hospice care.

The building that its sense of the domestic had been taken further, by both staff and
children alike, in the ways in which the spaces had been inhabited. Like all
successful domestic inhabitation, the placement and movement of objects and
furnishings tends to push to the background and in some senses transform the
careful spatial articulation.

The line between architectural design and inhabitation, just like the line between the
domestic and the institutional, is a tricky one for all parties to negotiate.

The corridor widens at particular points to create a north-lit sunroom and a wider
movement bay adjacent to the lift (discreetly turned away from opening directly
onto the corridor), and the kitchen/dining room.

Corridor wainscoting and handrails, normally required by regulation in health

facility buildings, are not present, and what emerge in their place are careful
demarcations at the points of transition between public and private areas. The
bedrooms themselves suggest a kind of hotel/domestic hybrid.

The provision of private outdoor space and personally adjustable environmental

controls does much to de-institutionalise these spaces, along with the concealment
of medical gas outlets within the lines of a recessed shelf above each bed.

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Communal spaces, residents' bedrooms, and administration and care facilities are all
organised with more intensive palliative care offered in suites of rooms at a discreet
distance from communal areas. The level below contains other recreational
facilities on the northern edge, including substantial outdoor space, two two-
bedroom self-contained apartments to enable parents and families of children to
stay on site, and to the south, service spaces and enclosed car parking.

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Bear Cottage is not just another sort of house. The truest test of a building such as
this is the way in which it invites inhabitation; the way in which it invites a literal
remaking of its spaces, so that each inhabitant of Bear Cottage can make it into
their space, whatever that space may need to be, for the duration of their time
there.

The therapy room designed according to the psychology of the children. Use of
warm colours gives a pleasant feel in the hospice. The activity zone is used wisely,
which enhance numbers of activity.

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CHAPTER -2.2 LIVE CASE STUDY

2.2.1 KARUNASHRAYA HOSPICE CARE

LOCATION - MAHARALLI ,BANGLORE

AREA -8200 SQ.m

CLIENT -Krishna rao (Chairman of indian cancer institute )

ARCHITECT - AR Chandravarkar

INTRODUCTION

The Bangalore Hospice care trust runs a hospice care known as Karunashraya
‘ADOBE OF COMPASSION’ was formed as registered charitable trust the Indian
cancer society and Rotary club of Banglore Indranagar to provide free
professional palliative care for advanced stage of cancer patients who is beyond
cure.

LOCATION

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Nearby buildings
Shankara eye hospital

Sree devi Ayurveda pharmacy

Navmillya Apartments

Rainbow children’s hospital (3.5 kms from hospice )

ADMINISTRATIVE STRUCTURE

The hospice is run by the charitable trust .The fund for this hospice is provided by
30 % of forigen NGO’s and rest by the local NGO’s

About 157 staffs are working there .The students who have completed 10 th having
a poor financial background are trained with nursing courses for 2 years with
accomadation

SERVICES

Karunashraya is the first hospice in India to offer the flexibility of

alternating between our In-Patient facility (hospice) and their homes
(Home care service). Apart from the 50 bedded in-patient facility at
Karunashraya, they also run a Home Care Service where the nurse goes
42
to the homes of cancer patients who need dressings to be done. They
also counsel the patient and the relatives, show the relative how to
handle the patient, give medicines for controlling pain and later on when
they are immobile, they see that the patient gets admitted at
Karunashraya

CONCEPT

FIG 15 -CONCEPT

Karunashraya a adobe of compassion has a unique design features for

terminally ill patients. A comman man who enter and experience such a
ambience will never have a feel about coming out and live in the real
world. It is a of unveiled world of water and greens.Ar chandravarkar
who designed the hospice has designed from the view of patient and
their psychology what need at the moment. He used the traditional
materials in structure. the design is fexible and friendly to the users.
Healing architecture

43
play a vital role in design the use of plant and water creates a good
ambience to the users.
Water
Water a sacred thing which gives a sense of purity.
Green plants
Plants basically reduces the stree and anxious level of the human. So it is
recommended for all the users to live in a green environment.
Design philosophy
Introverted design - Basically gives a sense of protectiveness and
privacy to the users. Since water replicates purity the architect induced
water in the traditional ( courtyard design) in the middle and the green
plants around it. This green zone act as a barrier to the external
elements.It gives the sense of both protective and calm environment to
the users.
Death a Five letter word which gives the sense of fear to the patients
and family.Hospice a care centre that delete the sense fear to the
patients.So it is necessity to give the protective sense of environment to
the users. A stage is reached by the patients where there is no more fear
of death is there.In such a condition they like to feel and enjoy the
beauty of world and nature.

FIG 16 PSYCHOLOGY

44
FORM

FIG 17 FORM

The simple rectangular form is used in the building . It deals with the
psychological aspect of the patients. Rectangle or a cuboid gives a feel of stability
to the patients.The design is simple introvated with recreational space and the
water body.It helps the patient in healing. it radiates the proper air circulation into
the patients ward.

AIR CIRCULATION

FIG 19 AIR CIRCULATION

Since the design is both introvated and in presence of water. the air that comes
down get cooled and enter into the room and hot air that formed in the room
moves out by the window and doors that is presented in the external wall. The
doors and windows present have a wide opening and even the the window that
present around the water body has a low sill level.

45
PLANNING

FIG 18 PLANNING

The water act as a soul for the planning the wards are arranged in such a way it
can face both water and plants around it. The courtyards is located in the such a
place where the patients can see the greenary views.

46
Healing architecture has played a wide role in design. Building materials used in
design is the gives the patients a good ambience.Stone used in the building is a
good choice of design. since it deals with the micro climate and nature. The door
windows are made up glass and steel.More over the design is very extovated and
blend well with the environment.Wide window and door opening are provided for
good lighting and ventilation.

FIG 20 SITE PLAN

The planning concept of the hospice care is the patients must live in the ambience
of nature. So each wards are designed in such a manner that the patients can see
the outer green plants of site. The major circulation is around the water body which
is a derived format of courtyard. The patients can see both water and green around
them. similarly many spaces for relaxation is also around the water body it act as a
activity and family zone.

47
The zoning of site played a unique role in the design. The buffer zones are created
around the site. A green island is created in the middle in which patients can
access.The island has play area for children, and seating area for the visitors and
patients. Two roads has given from the entry one for service access and other for
regular use.

The planning of the building is around the central water body. A open recreational
space is in the close proximity of the wards.This improves the patients healing

48
49
FIG 21 GROUND FLOOR PLAN

50
3.6 CIRCULATION

FIG 22- FIRST FLOOR PLAN

51
The majore circulation is around the water body. One can experience the beauty of
the design in this circulation route

The major circulation is around the central water body which gives a pleasent
amdience to the users.The medical waste and service circulation is through the
corridor

52
The entire structure is made up of stone masonry, RCC and composite masonry.
Stone masonry act as a good element in building stucture even it helps in giving a
suitable environment to the patients and also the other users. It plays a important
role in microclimate of the site.

53
The stone has a character of absorbing heat in a good rate and radiates in a slow
rate so during day time the stone absorb heat and radiates in a slow manner which
keeps the room cool from the environment. But during night it radiates the heat
absorbed in the day time which keeps the room warm.

54
FIRE SAFETY

Two fire escape route is provided in the hospice care. The minimum width of the
width of the exit door is 3.5m.Fire extingusherare provided at regular
intervals.Similarly the 6 general ward act as refuge area.Smoke detectors,
sprinklers are installed along with fire alarm.The ramp and the staircase near and
near the staff accomdation in first floor is fire proofed.

3.7 A CRITICAL VIEW

Karunashraya a adobe of compassion is a blended design of hospice along with

the nature and water.the design itslf act as a good healing agent to the cancer
patients who is in the edge of thier life.The material used in the design gives a
good healing to the patents

55
But the need of spaces for the number of patients accomodated and other users is
not enough.( beds per ward is entirely a wrong concept over hospice care. 4 beds
per ward is only the maximum required number.The absence of clean and dirty
utility rooms near the ward is also a draw back.

There is no seperate space designed for the theraputical purpose (i.e physical
therapy, occupational theraphy)So the childrens ward has been converted to
theraphy units

Not even any special unit for consultation rooms has been given.Which is a
essential space in a hospice care.

Unlike in other hospice a seperate circulation has been given for the services.

56
2.2.2 JEEVOTHAYA HOSPICE

INTRODUCTION

Jevothaya hospice was founded in the year of 1990. In patients facilities was
provided in the year of 1995. It is a 54 bedded Hospice. The hospice was found by
the francise sisters and foreign NGO organisation. Currently 35 staffs are working
there

Services provided

Provide inpatients facilities for the end stage life patients.

Treat out patients with counselling and medicines

Provide accomodation for staffs working there.

LOCATION

57
Jevothaya hospice is located in manali in north chennai.Manali area is entirely in a
urban context a busy area. But the hospice is located in the residential area of
Manali.There is no nearby hospital to the site location, so it basically fails in the
context of site location.

The site area is about 7 acres and the built up area is nearly 2.2 acres.The climate is
tropical in this region.

FORM

The form is obtained from the addition of the cuboides based on their functional
needs.Initially 2 cuboides serve as the soul of the building. One For admin and
other for inpatient.

Additional cuboid was added for the patients need. Further these three basic form
was connected with trapezium. Since square is the basic stability giving shape. It
has been utilized in the form of building. The building is surrounded by green
plants and trees.

FIG 23- FORM

58
PLANNING

FIG 24 GROUND FLOOR PLAN

The different zones of the hospice care are located in the close proximity to each
other for easy access. The service zones are located near the patients ward.
Where the need of emergency things can be obtained. The service of kitchen and
laundry is located in a seperate in the rear side of the main block.

59
CIRCULATION

Vertical circulation

Ramp

The vertical circulation is achieved by a ramp a staircase and a lift. The typical
ramp ratio of 1:12 is maintained. But the ramp fails from fire protecting materials.
The handrails are made up of wood.The flooring of the ramp is covered with
carpet instead of tactile tiles. Both the materials used easily catches fire.

Stairs

60
Further two stairs help in vertical circulation. One is located near the patients zone
and other is located near the admin zone.

Lift

The lift is located in the patients zone. The location of the lift is not in a easy
accessable way. The lift is mostly used for the services. The location of the lift is
away from the service zone.

61
Horizontal circulation

Circulation of the building is linear the wards are arranged along the side of
corridor in the first block. The second block has a free circulation space. The
administrative rooms are arranged unilateral.

The corridor space act even as a place of interaction especially for nursing staffs.
Who take care of patients.

PATIENTS ROOM

Patients room the soul of hospice is oriented along north west and south west side
of the building. The ward consists of 4 beds.Which is a proper standard of a
patients room.The floor area is about 230 ft. The patients zone is located closlely
to the medicine and service area. this makes easy functionality access to the
nursing staffs.

Lighting and ventilation

62
The lighting is achieved by the window. The colour of the wall is light peach
colour which helps the room to have more brightness.The night light is achieved
by the luminance which is located in side wall.The ventilation isachived by
windows in many rooms cross ventilation is not possible.

INTERACTION ZONE

The corridor and the seating area in the frontal portion act as the place for
interaction. The interaction space is spatious and have a sufficient lighting and
ventilation.It helps the patient in healing in a gradual level.

SERVICE ZONE

The service zone is located in the rear side of the main block. The service block
consists of services such as laundry and cooking. The CSSD service is provided in
the main block. The CSSD room has a rear access.
63
Kitchen

Kitchen is located in the frontal part of the service department. A store room is
located next to it. Individual spaces for washing the utensiles are given. The dining
space for the staffs is given next to the kitchen.

Laundry

Laundry has a special access from the service block. The entry for the laundry is
from the east side.A stairs from the service block leads to the first floor.

ADMINISTRATIVE ZONE

64
The administrative depatment is located in the unilateral side of interactive
space.The director room is located in the north east corner of the building.The
rooms such as administration is located next to it. A AV room is located in the first
floor for meeting purposes.Further a library is located in the first floor for the staff
access

CSSD

The cssd is located in the middle of patients ward for the easy access of the
material. A clean utility room is located near the ward for the easy access of the
material.

ENTRY ZONE

FIG 24 FIRST FLOOR PLAN

The entry zone consist of parking and land scape all the way. the patients are
allowed to move in this zone for healing purposes.

65
Parking

Parking is designed in such a way where two ambulance can be parked together.
other parking are done in the side of building.

Landscape

Land scape isn provided in most of the places. Where the patient can access easily.

WASTE MANAGEMENT

The bio medical waste is kept in a seperate room for the discharge. The bio
medical waste is collected by bio waste department for further treatment.

A CRITICAL VIEW

Over all the planning of the design is good but few flaws are observed in the
design. The out patients zone is not designed with proper functionality.Like ways
all the theraphyrooms
are seen in first floor.

Pharmacy morgue are absent in the design.

The inpatients zone where the rooms are designed properly.The location of service
zone have a easy functionality. No special fire protection techniques is adapted in
design.

66
CHAPTER -3 LITERATURE STUDY
CANCER

The term cancer refers to a group of diseases which share similar

characteristics. Cancer can affect all living cells in the body, at all
ages and in both genders. The causation is multi factorial and the disease process
differs at different sites. Tobacco is the single most important
identified risk factor for cancer. A host of other environmental exposures, certain
infections as well as genetic predisposition play an important
role in carcinogenesis.

Diagnostic work-up, treatment methods and outcome of treatment are not

uniform for all cancers. Advanced technology is required in many situations and on-
going research initiatives might lead to better understanding of the disease and its
control. The control of cancer requires the effective implementation of knowledge
derived from more than two decades of successful research. It is now known that
over one-third of cancers are preventable, and one-third potentially curable provided
they are diagnosed early in their course. The quality of life of patients with incurable
disease can be improved with palliative care.

STAGING OF CANCER

67
 Cancer staging is the process of determining the extent to which a cancer has
developed by growing and spreading. Contemporary practice is to assign a number
from I to IV to a cancer, with I being an isolated cancer and IV being a cancer which
has spread to the limit of what the assessment measures. The stage generally takes
into account the size of a tumour, whether it has invaded adjacent organs, how many
regional (nearby) lymph nodes it has spread to (if any), and whether it has appeared
in more distant locations (metastasized).

FIG 26 CANCER IMPACT

Stage 1 - usually means that a cancer is relatively small and contained within the
organ it started in

Stage 2 - usually means that the tumour is larger than in stage 1, but the cancer has
not started to spread into the surrounding tissues. Sometimes stage 2 means that
cancer cells have spread into lymph nodes close to the tumour. This depends on the
particular type of cancer

Stage 3 - usually means the cancer is larger. It may have started to spread into
surrounding tissues and there are cancer cells in the lymph nodes in the area

68
Stage 4 - means the cancer has spread from where it started to another body organ.
This is also called secondary or metastatic cancer.

ROLE OF HOSPICE IN CANCER

People at all stages of cancer treatment typically receive some kind of

palliative care. In some cases, medical specialty professional organizations
recommend that patients and physicians respond to cancer only with palliative care.
This applies to patients who:

display low performance status, implying limited ability to care for

themselves received no benefit from prior evidence-based treatments are not
eligible to participate in any appropriate clinical trial no strong evidence
implies that treatment would be effective.

69
The concept of Hospice care is rooted in the centuries-old idea of offering a place of
shelter and rest, or "hospitality" to weary and sick
travellers on a long journey. Today, hospice provides humane and compassionate
care for the terminally ill so that their last days on this earth may be comfortable. It
concentrates on reducing the severity of disease symptoms, rather than providing a
cure. The goal is to prevent and
relieve suffering and to improve quality of life for people facing serious and complex
illness. Hospice aims to help people find some quality
time and, even though they're dying, to look at the miracles that can still happen in
the days they have left.

3.1 INTRODUCTION

Hospice focuses on caring, not curing and in most cases care is provided in the
patient's home. Hospice care also is provided in freestanding hospice centres,
hospitals, and nursing homes and other long-term care facilities. Hospice services
are available to patients of any age, religion, race, or illness. Hospice care is covered
under Medicare, Medicaid, most private insurance plans, HMOs, and other managed
care organizations. The Medicare hospice benefit mandates that a hospice offer four
levels of care. They are

 Routine home care

70
  Continuous care
 Inpatients care
 Respite care

Routine home care-one of the four levels of care mandated by the Medicare hospice
benefit; basic hospice services brought to the patient
wherever they live.

Continuous care-one of the four levels of care mandated by the Medicare hospice
benefit; up to 24 hours/day of clinical care in the home
until symptoms are under control.

Inpatient care-one of the four levels of care mandated by the Medicare hospice
benefit; around-the-clock care provided in a healthcare facility when the patient s
symptoms cannot be managed at home. The goal is to stabilize the patent so they can
return to routine home care.

Respite care-one of the four levels of care mandated by the Medicare hospice
benefits; caring for a home care hospice patient in an inpatient
facility to provide up to five days of respite to the family caregiver.

3.2TERMINOLOGIES

Terminally ill: having a disease or illness that cannot be cured, and that is expected
to result in death in a short time

Concentrated care (continuous care): A level of care initiated when a patient's

symptoms are not being controlled. During concentrated care, a nurse can be placed
at the bedside for eight-hour shifts until symptoms are under control.

Bereavement department: Grief specialists who work with the family for up to 13
months after the death.

Impending death: When death is expected within the next two to three days.
GIP: General inpatient is a level of care where the patient is hospitalized due to
symptoms that are not being controlled. Once the symptoms are under control, the
patient returns home to routine home care.
71
Holistic services: special treatments (music therapy, massage, pet visits, reiki,
acupuncture) that address the whole patient, not just the disease

Volunteers: Individuals who give their time to help hospice patients and their loved
ones by providing companionship, assisting with daily tasks, running errands and
more

Palliative care: Comfort measures only. The patient is no longer seeking aggressive
treatment.

3.3 TYPES OF USERS

1. Full time staying patients (main users) expected to die in the centre.
2. Part time staying patients (condition management) they check to manage their
condition then they leave to spend their last days at home.
3. Daily visiting patients they visit the centre daily to receive hospice care 2 support.
4. In home hospice care providing hospice care for patients at their own homes.
5. Family members.
6. Visitors.
7. Staff (doctors, nurses, workers to medical specialists)

FIG 27 USERS AND FUNCTION

FUNCTION

72
3.4 SITE FEATURES

The general philosophy should be to create a caring atmosphere for those who are
terminally ill. The general philosophy should be to create a caring atmosphere for
those who are terminally ill; institutional buildings are to be avoided. Many hospice
designs are intended to have domestic characterising traditional materials, and set in
carefully landscaped areas or gardens. All patients should have a good view of the
garden area and, preferably, have easy access to it. The location should be away from
noise, heavy traffic, smells and other pollution.

FIG 28 SITE

1. terrace;
2. lawn;
3. informal garden;
4. parking;

SITE ZONING

73
 FIG 29 SITE ZONING

Location:

The site must have the sufficient space for residential unit and hospital departments.
It should be located in a quite location, where there is intrusive development take
place in adjacent site based upon the rules. No loss of amenities must be due to fog,
wind, dust, insect etc. The land must not be contaminated and it must be planned in
such way useful for future expansion.

Orientation:

The most suitable orientation for treatment room and operating theatre is north west
and north east. For nursing ward south east and south west is favourable. Pleasant
morning and evening sun, minimum heat build-up, and little need of shading devices
are some of the benefits by keeping the room in such orientation. East and west
facing wards have deeper sun penetrations. Some special ways are needed in north
to prevent direct sun to the patient’s room.

74
It is necessary to take the location of a hospice in urban
environment. It must be located in a calm area between residential
and hospital areas. This gives a peaceful nose pollution free
environment. In other case if the location is not in a proper site
feature it is essential to create a buffer zone that reduce the
pollution.

It is necessary to note done the radius of the hospital must be of

within 5 km of the hospice for essential emergency purpose.

4.5 SPATIAL RELATIONSHIP

FIG30 ZONAL CONNECTIVITY

75
 FIG 31- FLOW CHART

3.5.1 RESIDENTIAL ZONE

FIG 32 PATIENT ROOM PLAN

3.5.1.1PATIENTS ROOM

76
The considerable variation in room sizes.
Ranges of net clear floor area from corridor door to window stool, not including
built-in wardrobes, are :
Single rooms: 117 to 172 sq ft(deluxe are larger)
Double rooms: 157 to 210 sq ft
Four-bed rooms: 306 to 401 sq ft

FIG 33- FOUR BED ROOM

In the other dimension, comments of administrators evoke no complaints

about single rooms as narrow as 10 ft-0 in. to centres of partitions-rooms up to
12 ft-0 in. on centres draw comments from "excellent" to "more than ample".
Majority of double bedrooms are 12 ft-0 in. on centres and are wall regarded
smaller ones are criticized for being too tight. Four-bed rooms range from
acceptable minimum of 20 ft-0 in. on centres to more than 24 ft-0 in.

FIG 34 –OTHER ROOMS

77
PATIENTS ROOM
Single (125 sq ft) Depends on patient Beds (usually patch type) with side rails
Multi bedded (100 sq ft per bed), population 36 by 81 in. over bed tables (usually not
Cubicle curtains required required) bed side cabinet, 18 by 20 in
chairs, straight back and arms (at least
Will serve for both sleeping one chair per bed)
and general activity. And
may also include dining, Storage Space
recreation, and therapy Vertical storage- robes. Outdoor clothing in
closets or wardrobes, 1ft 8 in wide by 1ft 10
in deep, should contain shoe rack and shelf.

Horizontal storage- cabinets or built. in

drawers,1ft 6 in deep

(Note: Ideally, vertical storage areas should

be increased or ambulatory patients and
horizontal storage increased for non-
ambulatory patients)

Optional Equipment
Small table, ideally round with a heavy
pedestal base, platform rocking chairs.
where patient conditions permit, lavatory,
cabinet for storing patient
toiletries

(Note: Where private toilet is used, lavatory

may be placed in toilet)
TABL2 PATIENT ROOM
Oxygen and Suction

FIG 35 ELEVATION

78
 Oxygen is piped in from a central source in most rooms studied. Outlets are 4
ft-0 in. to 5 ft-6 in. above floors -5 ft

Proximity
Patient room must not be 120 ft away from nurse station.

Furniture
In the two and four-bed rooms a clear distance of 14 ft-0 in. for two beds and two
bedside tables is “snug,” but it should be noted that the majority of rooms studied
measure nearer to 15 ft-0 in.

The typical bedside table measures about 16 in. x 20 in.

There is no uniformity in position of bedside table. It may be placed on near side of

bed as one enters room, or on far side, or sometimes.

Doors and Windows

Standard bedroom door width is 3 ft-10 in. or 4 ft-0 in. This can reduced by
2 in. with offset hinges. Toilet room door widths are 2 ft-0 in to 2 ft-4 in.

The wide variety of window treatment suggests that climate, orientation, aesthetics,
economics and other considerations do more to govern this architectural feature than
any predetermined optimum standard.

Lighting

There is uniformity in every plan reviewed in the way beds are set parallel to
exterior wall, so that patients can look out window without facing directly into the
bright sky.

Low window stools offer patient an opportunity to see out when his motorized bed
is in its low position.

79
A study of the rooms shows that no single, a few double, and most four-bed rooms
have ceiling fixtures for general illumination In almost all rooms there is a wall
fixture over head of bed, mounted from 5ft-2 in. to 6ft-6 in. above floor indirect
light is prescribed mostly.

Heating and power

all patient areas: 18'C minimum
day spaces: 21’C minimum

Radiators may be required to have a surface temperature of 50'C maximum or a

substantial fixed guard. Emergency heating (e.g. back-up boilers) must be provided
to ensure the above temperatures are maintained in the event of a breakdown guard.

CLOSET

FIG 36 TOILET
In almost every case individual hanging space is provided for each patient,
often in the form of built-in metal wardrobes-sometimes these are in combination
with dressers, with mirrors over. One caution was offered that mirrors should not
be so placed as to reflect light into patient's eyes.

2 ft-10 in. to 3 ft-2 in. by 3 ft-10 in. to 4 ft-10 in. are the dimensions noted for
individual toilet rooms, usually with grab-bars on one or both side walls. Locating
water closet slightly off-centre in the room allows a little more space on wider side

80
for manipulating cleanser-the letter needs only cold water and is usually on the right
as you face beck wall.

4.6 MEDICAL ZONE

4.6.1 SURCTICAL SUITE

OT must be designed in square shape as far as possible for a suitable space
6.50mx6.50m. with a clear height of 3m. and a extra
height of 0.7 m for air conditioning.

FIG 37 SURGICAL SUIT

equipment trolley (e g. for respiration, service supply, high voltage,
monitoring, suction, etc ) low voltage, gas

In the general hospice the tendency is to have all major operating rooms as nearly
identical as possible to facilitate scheduling of various surgical procedures . Free
floor space should be 18 ft by 20 ft, or approximately 350 eq ft . Many surgeons
and surgical supervisors recommend 20 ft by 20 ft free floor space.

FIG 38- SURGICAL SUIT PLAN

81
Within the surgical suite we have three basic zones predicated on three types of
activity and circulation involved, and the degree of sterility to be maintained .The
preplanning analysis of these areas is just as important as the determination of the
number and type of operating rooms.

Outer zone
Administrative elements and basic control where personnel enter the department,
patients are received and held or sent to proper holding areas of

Inner zone
Conference, classroom areas, locker spaces, any outpatient reception, etc .

Intermediate zone
Predominantly work and storage areas; outside personnel will deliver to this area
should not penetrate the innerzone.The recovery suite, if completely integrated with
the surgical suite, is a inter mediator outer zone activity.

Inner zone
The actual operating rooms, the scrub areas, the patient holding or induction areas.
All alien traffic should be eliminated .Here we want to maintain the highest level of
cleanliness and aseptic conditions.

Anaesthetic room
Anesthetic room must be approx a dimension of 3.8mx 3.8m and a electrical door of
1.04 m width. The door must be made up of glass for clear visual link. The room
must contain refrigerator, sink other anaesthetic equipment and emergency power.

Sterile goods room

The room must be close to operation room for easy access the size of the room is
flexible. It must be sufficient to hold the items with enough shelves and cupboards.
approx size recommended is 10 sq m for 1 operation theatre

Equipment room

82
Direct access is preferable but direct acees is not possible. So the room is located
near OT. The aprox room size preferred is 20 sq m.

Sub Sterilisation room

The room must have direct access to the operation theater's sterilearea. It has non
clean area for non sterile material and sterile area for sterile material. It is equiped
with sink, storage surface, work surface and steam sterilizer

3.6.2 Nurse lounge

The dimension of this room depends upon surgical department. We must
take in account eight staffs per operation. The size of the room varies
depending upon number of operation theatre.

Nurse station
Must be in centre and covered with glass where the work corridor can be
viewed easily

4.6.3 Pharmacy
A area of 20sq m is recommended inside the surgical suite. From where
anaesthesia and surgical medication are supplied.

Cleaning room
A area of 5 sq m is recommended and must be located near the theater,
after the operation the room must be cleaned from the infections.

Central sterilisation
Where the instruments for the hospital is prepared. the maximum
prepared instruments is for surgical department(40%) So it is located near the
surgical department. The size varies from 40-120sq m.

Lighting

83
In OT light must be adjustable in different angle for operation. The most
used lighting system is mobile celling pendent light. Recommended
lighting in operation theater is 1000 lux and 500lux for auxiliary surgical

FIG 39 ITU

The unit should be in close proximity to operating theatres. A large space is

required for each bed, together with extensive services that need to be located in
such a way as to allow free movement of staff around the bed and to the patient

84
FIG 40 ITU FLOW CHART

3.6.3 CONSULTATION ROOM

Consultation Room include in the furnishings for the physician's office

and consultation room an executive desk and chair, bookshelves, and film
illuminator. Allow space for two visitors’ chairs and a wheelchair. Provides
convenient coat closet. Examination Room Include in the furnishings for this room
an examination table with clearance on all sides, an examination light, a lavatory and
mirror, clinical scales, a film illuminator, an instrument and supply closet, a small
electric pressure sterilizer (if no lab-utility room is provided), and a chair. Standing
bars are optional equipment.

85
FIG 41 CONSULTATION

Each examination room will have not less than 80 net sq ft of usable floor area.
Rooms also used for treatment shall not have less than 120 net sq ft of usable floor
space.

86
Activities are arranged along the main circulation route. Since considerable traffic
is expected, this corridor is 10 ft wide and forms the spine of the scheme. Branch
corridors, each 8 ft wide, which separate other element.

FIG 42 NURSE STATION

The nurse work station must be positioned in centre and required floor space about
25 to 30 sq m. The nurse station must be situated about 120ft of radius from
patients ward, the nurse station consists of file record. The station must be easy
accessible to the utility area medicine room. The corridor wall of the nurse station
must be glazed view for the visual link at the same time it must be
free from fire. The station must be fire protected.

FIG 43- UTILITY

87
3.6.4 PHARMACY
In the hospital pharmacy, drugs are received, stored, dispensed to
out-patients and issued to wards and other departments.

1 . Pneumatic tube station

2. Desk
3. Typewriter, electric, non movable carriage
4. Chair
5. Files, intermediate height
6. Files, swinging panel, strip insert type
7. File, revolving on two levels
8. Table, movable, 2 feet by 3 feet
9. Waste receptacle
10 . Photocopier
11 . File, 2-drawer
12 . Utility pole
13 . Telephone
14 . Shelving, adjustable, 12 inches
15 . Safe

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16 . Refrigerator, with freezer
17 . Counter, with file drawer, bins
18 . Shelving, adjustable, 7 inches
19 . Counter, dispensing
20 . Bins, on top of hood
21 . Hood, laminar airflow, vertical or horizontal
22 . Counter, with open adjustable shelving beneath
23 . Cart, storage
24 . Carts, utility
25 . Desk, small
26 . Bookcase, wall-mounted
27 . File cabinet, 5-drawer
28 . Counter, with adjustable shelves beneath
29 . Shelving, wall-mounted, 9 inches
30 . Shelving, adjustable, rail-mounted

FIG 44 PHARMACY

Pharmacy activity flow

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The pharmacy is unlikely to include its own manufacturing area, prepared drugs
now being purchased from commercial sources. There is also a tendency to limit
out-patient dispensing and to refer patients to community pharmacies (' hemists')
but the dispensing counter needs to be near the OPD.

Access should be out of sight from windows of wards and other patients' areas.

The main elements are the body store, post-mortem rooms, and facilities for
visitors. The access route into the mortuary for bodies from the hospital should be
separate from that taken by visitors, although mortuary trolleys are discreet enough
that separate lifts and circulation routes through the hospital are not needed.

MORGUE

FIG 45 MORGUE

90
Reception

Reception size of the morgue is 240 sq ft.lt is the place where the
body is received and documents are checked. lt should be easy
accessible well illuminated, and have comfortable chair.

Ancillary room
Ancillary room is provided for the workers over there.

Cold room
Cold room where the dead persons bodies are transferred and kept refrigeration
The minimum door width is 1.8 m.

3.7 ACTIVITY ZONE

3.7.1 PHYSICAL THERAPY DEPARTMENT

Location
Location is closely related to function. The area selected for physical therapy should
be centrally located to minimize problems of transporting patients and to
facilitate giving bedside treatment when necessary.

FIG 46 PHYSICAL THERAPHY

1. Posture mirror

91
2. Parallel bars
3. Steps
4. Stall Bars
5. Gym Mat
6. Stationary Bicycle
7. Sayer Head Sling 7 Coiling
8. Pulley Weights
9. Shoulder Wheel
10. Gym Mat Hooks
11. Cart with Open Sl
12. Open Shelves
13. Wheel Chair
14. Shelf
15. Wall Hooks
16. Wall Cabinet
17. Lavatory, Goose
18. Water Closet
19. Hand Ran
20. Water Paper Receptacle
21. Portable Equipment
22. Adjustable chair
23. Whirlpool
24. Chair
25. Table
26. Chair, preferable with arms
27. Wheel Stretcher
28. Desk
29. Swivel Chair
30. 1ittle Cabinet
31. Bookcase
32. Bulletin Board
33. Wall Desk (counter, shelf below)
34. Lavatory, Gooseneck Spout and 1'oot Control
35. Wall Cabinet with Lack
36. Treatment Table, Storage below
37. Mirror and Glass shelf over Lavatory
38. Adjustable tool
39. Laundry Hamper

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Location of the department in a hospital. Day lighted space as close to patient areas
as possible and readily accessible to toilet facilities is recommended

Floor space required by patients. Approximately 54 to 61 sq ft per patient is

recommended for the entire department, including clinic, office and storage. For the
clinic alone, 42 to 47 sq ft per patient is suggested to allow for easy circulation and
use of equipment.

These essential components of the physical therapy department grow but

the fundamental requirements are the same for a small or large department.

They include
reception area,
staff space,
examining room,
treatment areas,
toilet facilities,
storage

Reception area: Accommodations for inpatients and out-patients, if possible.

Adequate space for stretcher and wheelchair patients.

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Staff space-private: Office space suitable for interviewing patients, attending to
administrative and clerical duties, housing files, etc Writing facilities for the staff
adequate for dictation, record keeping. There should be space for staff lockers and
dressing rooms separate from the patient area, either within the department or near
to it.

Treatment area: There are three types of treatment areas: cubicle (dry), underwater
exercise (wet) and exercise (open). Each is designed to meet the particular
requirements of the special equipment used for different kinds of treatment.

Cubicle: Each unit large enough for the physical therapist to work on either side of
the table without having to move equipment belonging in the cubicle. Preferably
cubicles divided by curtains for easier access for wheelchair and stretcher cases, for
expansion of usable floor area for gait analysis, group activity or teaching

Exercise area: Very flexible open space planned to accommodate patients engaged
in diverse individual or group exercise activities. Used extensively by people in
wheelchairs, on crutches or canes, or with other disabilities which limit their motion
and agility. At least one wall should be reinforced for the installation of stall bars
end similar equipment.

Toilet facilities: Separate toilet facilities for patients and staff, if possible. Patient
facilities should be designed to accommodate wheelchair patients. If the department
serves small children, seat

Storage: Designed to meet special needs in and near work areas. Should also be
storage space on the wards for equipment and supplies usually needed for bedside
treatments. For wheelchairs, stretchers, etc ., it is best to plan "carport" space, not

3.7.2HYDROTHERAPY DEPARTMENT

Organization of Space: There should be two major treatment areas, dry and
wet. The dry area includes the exercise room or gym and treatment cubicles whereas
the wet area includes all hydrotherapy treatment, tanks, pools, and related facilities.
Location and occupational therapy, as well as for activities of daily living, should be
94
in close proximity, as many patients will receive treatment and training in all three
areas

Underwater exercise area: All equipment requiring special plumbing and

water supply concentrated in one section of the department but accessible and
adjacent to other treatment areas. Should include a treatment table, especially in the
room with a tank or exercise pool. Fixed overhead lifts are absolutely essential for
the efficient use of tanks and failure to provide lifts severely limits the usefulness of
this valuable equipment. Plumbing and other installation requirements, humidity and
noise

FIG 47 HYDROTHERAPHY

DAY ROOM

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TABLE 3- STANDARDS

closets . All storage space should be accessible, simple, well lighted 4.7.2

4.7.3 OCCUPATIONAL THERAPY DEPARTMENT

The increasing recognition of occasionally therapy as an internal part of the medical

rehabilitation program has resulted in its becoming an increasingly import.

Occupational Therapy Department

Fig. 1 Floor plans for typical occupational therapy
department in hospitals up to 250-bcd capacity.
1. Shadow board cabinet
2. Electric tool grinder
3. Tool storage and work bench
4. 2-man bench
5. Electric jig saw
6. Drill press
7. Weave frame

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8. Step stool
9. Stainless steel sink
10. Chair
11. Adjustable table
12. Floor loom
13. Warping board
14. Open shelving
15. Pull-out shelf
16. Storage cabinet
17. Bench for loom
18. File cabinet
19. Book shelf and cabinet
20. Tool cabinet
21. Paint cabinet
22. Finishing bench and cabinets

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 FIG 48 – OCCUPATIONAL THERAPHY

Types of work in occupational therapy

1 Table work-leather, block printing, flytying, sewing and art work.

2 Loom work-weaving, braiding.
3 "Functional equipment" (not an active classification) -bicycle, jig saws and
other adopted equipment for treatment physical disabilities.

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 F

The following considerations were made for the three specific areas within the
department:
1. Clinic area: The first obvious requirement is space for free circulation around
the required equipment SpaceSpace for parking at least 3 wheel chairs is also
necessary. Double doors at shop entrance simplify moving equipment and
supplies. Sliding doors for upper cabinets avoid interference with patients
working at counter tops. No display case for finished articles was included as it
was felt that this emphasized the product.

2. Storage area. Space was provided for a mobile cart for servicing ward patients.
A cabinet with work top was included for preparation
and finishing work. It was assumed that only 8-ft length@ of lumber and plywood
would be stored in this basic unit, and that other closets, rooms, etc . in various
parts of the of the hospital could be used for "dead storage."

3. Office area. Space was provided for the usual office furnishings. A large glass
panel in front of the desk facilitates control and supervision of the unit.

These could be cared for by one therapist, with a possible second therapist for
word service. On the basis of 15 patients per session at 54 sq ft per patient, the
entire unit was allotted 813.75 sq ft

Location of the department in the hospital. Day lighted space as close to patient
areas as possible and readily accessible to toilet facilities are recommended.

PLAY ROOM

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 An important therapeutic area is the dayroom playroom which may be used for
dining and schoolwork as well. At least 50 percent of the
children may use this room. It is located for ready observation and control from
the nurse’s station and at the same time designed to avoid
disturbing patients in their rooms. Furnishings and equipment are selected for
multiuse in these various activities.

SPACE CONSIDERATIONS

TABLE 3 AREA STATEMENT

3.8 ADMIN ZONE

3.8.1 Reception
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The receptionist, who, in the small medical practice facility is also the doctor's
assistant, the bookkeeper, and the bill collector, is the hub around which the office
revolves. She should be so placed that she can keep an eye on all the workings of the
office. So the reception must have an easy circulation around it. More over it
becomes the second attraction place in a hospice care. So it must be good looking.

Area required for information and reception Area 5.02sq.m/staff.

FIG 50 ADMIN LAYOUT

3.8.2 Waiting

The patients receive their first impression from the waiting room.
Its appearance may indicate the type of care they can expect to receive. A wait in a
crowded, out-of-date room can depress and disgruntle even the best and steadiest of
patient. The chairs, tables, and lamps should be adequate in number and well-spaced
so as to make reading possible and to give the patients a feeling of freedom.

101
 FIG 51 LOBBY

Needless to say, some educated thought should be given to decoration: the walls,
upholstery, pictures, and drapes. Tasteful, harmonizing colours which are cheery
rather than drab are desirable. The overall effect should be homelike and restful. The
waiting room preferably should permit a view of the outside and, if possible, the
view should be a pleasing one. Flowers, trees, or distance are the best, but when this
is impossible an interesting view of people and activity is the second choice

Space needed for waiting Area 0.65/person

FIG 52 WAITING

3.8.3 Medical office room

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FIG 53 MEDICAL OFFICE

In many offices the medical room serves multiple functions, particularly in the last
few years, and the doctor is interested in increasing the number of treatment rooms
within a small overall.

Floor space required for the room-5.02 sqm/person

3.8.4 Secretary room

This is the key or control point in the management of the office. The drawing reflects
the position the receptionist assumes in relation to waiting area. Full visual control
is maintained through closed sliding glass window. Appointment and financial
arrangements are consummated at this point. All traffic and flow control is regulated
by the nurse

FIG 54 SECERATARY ROOM

3.8.5 Medical record room

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As considering for hospice the medical records of the patient who is dead must be
kept for six years. So it must have sufficient racks or shelves to keep the files.
Usually there is no any special layout for record room. A table for working and chair
must be provided for the workers over there. It is usually situated at a corner and
must have easy access to the office room. Medical Records 5.02sqm/staff

4.8 ENTRY ZONE

4.8.1 Parking

The parking must serve for the patient staffs as well as the volunteers.

Hospice CAR PARKING

Staff: one space for each doctor and surgeon, plus one space for
each three others
Outpatients and visitors: one space for each three beds

SERVICE PARKING

General minima as follows:

Gross floor space not exceeding: Minimum space required:
1000m2 200 m2
2000 300
4000 400
6000 500

Every additional
2000m2 100 m2

TABLE 5 PARKING STANDARDS

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Car Parking space needed for disables

FIG 55 PARKING

FIG 56 BIKE PARKING

3.8.2 Bike Parking

This should be located as close to destinations as possible without interfering with
pedestrian traffic; and where visual supervision, lighting and shelter from inclement
weather can be achieved. It is essential to provide facilities for securely locking the
bicycle frame and the front wheel to something immoveable.

105
FIG 57 BIKE PARKING
3.8.3 Ambulance Parking:

Ambulance parking must be easily access and must be located in frontal zone of
the hospice. One ambulance is required for every fifteen persons.

The parking is available in 90 degree, 45 degree, parallel and in 90 degree.

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3.9 Service Zone

3.9.1Kitchen

The size of the kitchen depends on the number of seats (covers) served at the peak
period of demand also vary with the type of the menu and the extent to which food
is prepared in advance.

Kitchen relative to size of dining area depending on:

Conventional kitchen: 0.3 to 0.5:1 menu choice and seat turnover.
Finishing kitchen: 0.1 to 0.3:1 storage and dishwashing.

Storage areas
Storage depends on throughput and frequency of deliveries. Cold stores are grouped
together and preferably entered through chilled holding areas to save energy.

107
Vegetable stores have direct access to their preparation area. Purpose-designed
moveable racks are used in food stores. Racks and shelves should allow about 50mm
between and above packages for easy access. The top shelf should not be higher than
1800mm and the lowest should be at least 200mm above floor. Shelves for heavy
and frequently used items are best between 700 and 1500mm high.

Preparation areas
Kitchen areas and layout are determined by:
 The sizes of equipment and benches
 Space for working access and circulation
Some typical dimensions are:
 Work top and sink rim height: 870-900mm
 Wall bench width: 600-750mm
 Island bench or table width: 900-1050mm
 Length of work area with convenient reach: 1200-1800mm

Cooking equipment

About 30% of the kitchen floor is occupied by equipment, 10 20% by benches and
trolleys and 50%for circulation and access.

Dishwashing

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Methods of collection for used dishes include self-removal with trays, trolleys or
waiter removal. This must be decided at the initial planning stage. Trolleys will
require straight aisles with minimum 1050mm width and screened trolley parks.
Manual dishwashing in a double sink is inefficient and unhygienic for public
foodservices. Spray machines may be intermittent or continuous through flow and
designed for corner (small kitchens) or in line position.

109
FIG58- KITCHEN LAYOUT

3.9.2Laundry

Collection of soiled laundry may be by trolley or chute. A standard laundry room for
a 200 room hotel takes up about 160m2, plus separate linen storage and housekeeping
areas of 80m2. Requirements include ventilation giving rates of 15 to 20 air
changes/hour, separate extracts from steam and dry cleaning equipment, high
lighting (160 lux), moisture- and fireproof electrical systems, non-slip flooring and
drainage, and storage for chemicals.

Housekeeping areas are 0.4m2/room. Separate areas may be required for sewing
work, uniforms and guest valet services.

110
Other Stores:

Separate secure storage with controlled issue required for:

 rn furniture (with repair and paint shops adjacent)

 rn cleaning materials
 rn glass, china, silver
 rn drinks - red wines (14-16’C), white wines (10-12’C), spirits, beers, etc. and
soft drinks.

Overall area: high-grade, 0.8-1.2 m2 room; budget, 0.3-0.5m2/room

FIG 59 LAUNDRY LAYOUT

Clean and Dirty utility Rooms

111
Clean utility will have equipment and appliances for the treatment. Clean utility
room for intensive care unit must be little bigger. The size of the room varies from
160 to 200 sq ft.

Disposal room is to dispose the waste materials like cotton etc. From
Disposal room Bed spread, pillow covers will move to laundry room.

4.10CIRCULATION

4.10.1Corridor

Corridor must be designed for maximum Circulation flow. General corridor must
have a minimum width of 1.5m.The corridor in which patient travel in trolley must
have a minimum width of 2.25m. The effective width of corridor must not be
constricted with projections, column or other building elements.

FIG 60 CORRIDORS
Wheelchair Passage

Width The minimum clear passage width for a single wheelchair is 900 mm
continuously. An accessible route should be 1200 mm wide to allow both a
112
wheelchair and a walking person except where extra space is required at the
doorways.

Wheelchair Turning Space

The minimum space required for a wheelchair to make a 180 degree turn is a clear
space of 1500 mm diameter or a T-shaped space 900 mm. wide.

Width for Passing Wheelchairs

The minimum passage width for two wheelchairs to pass side by side is 1500 mm.
In case of continuous stretch of corridor, the preferable width is 1800 mm.

4.10.2 Stairs

For safety reason if in case of necessity it must accommodate all vertical circulation.
Stairs must have handrail on both sides without projecting
tips. The effective width of the stairs and landing must be minimum 1.50m and must
not exceed 2.50m. Step height of 170 is permissible and a tread depth of 280 mm is
allowable. But a ratio of rise/tread of 150mm: 300mm is feasible.

4.10.3 Ramp
Any part of an accessible route with a slope greater than 1:20 shall be considered a
ramp.

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The least possible slope shall be used for any ramp. The maximum slope of a ramp
in hospice shall be 1:12.

Slope and Rise

Ramps shall have level landings at bottom and top of each ramp and each ramp run,
and at every 10 mts of run.

Landings
The landing shall be at least as wide as the ramp run leading to it. The landing length
shall be a minimum of 1500 mm clear.

Clear Width

The minimum clear width of a ramp shall be 900 mm.

Handrails
114
If a ramp run has a rise greater than 150 mm or a horizontal projection greater than
1800 mm, then it shall have handrails on both sides.

If handrails are not continuous, they shall extend at least 300 mm beyond the top and
bottom of the ramp segment and shall be parallel with the floor or ground surface.

The top of handrail gripping surfaces shall be mounted between 800 mm and 900
mm above ramp.

FIG 61 RAMP

CHAPTER 4 -PSYCHOLOGY

4.1 Dying as an Opportunity for Positive Growth

“A tremendous opportunity for growth comes out of being sick, and growth
often comes from things we don’t want to deal with.”

-Study Participant

Those facing death often struggle with psychological concerns, including loss of
autonomy, isolation, and loss of meaning in life.

Positive psychology suggests that experiencing and overcoming suffering may

facilitate positive psychological changes.

115
Confronting aging, illness, and death may present an opportunity for growth and
developing wisdom.

What Makes Life Meaningful for end care patients?

Challenges at the End of Life

•Physical Challenges (Typical)

•Legacy Concerns (Typical)

•Family Challenges (Typical)

•Inability to do important things (Typical)

•Variant findings: Fear and uncertainty, aftermath concerns, loss of autonomy,

dying with dignity, isolation, difficulty accepting death, learning to accept help.

Coping with Illness and Dying

•Developing an accepting attitude (Typical)

•Receiving support from others (Typical)

•Religious/spiritual comfort (Typical)

•Variant findings: finding meaning in illness, sense of humour.

Dying as an opportunity for positive growth

116
Enhanced appreciation of life in the present moment (Typical)

Change in priorities (Typical)

Leads to self-improvement (Variant)

Greater sense of purpose (Variant)

Strengthened relationships (Variant)

Provided opportunity to reflect (Variant)

Fosters wisdom (Variant)

A PATIENTS VIEW ABOUT HER DEATH

“It gave me time to think.”

“…the illness, it has given me a sense that I have taken so much for granted.”

“[Illness] definitely makes you wiser, smarter if you let it.”

“Then I got cancer and then it opens up your eyes to the possibilities of life can be
cut short and I don’t think people get that perspective very often… I treat it so
much better as a beautiful journey and gift and you don’t take it lightly.”

“I want to live until I die. I don’t want to die until I die.”

“It has made me stronger. It has made me capable of things I never thought I was
capable of. A lot of treatments. A lot of pulling until you think you can’t be pulled
anymore and then you find more strength and you move forward more which I
think has taught me so much about myself.”

“Death doesn’t have to be a bad thing. It can be a thing where you just look at it
and accept it for what it is.”

“[my relationship with my husband] has gotten so much stronger… getting sick
and going through what we’ve gone through together just heightened that even
more.”

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118
CHAPTER-5
HEALING ARCHITECTURE – BIOPHILIC DESIGN

Introduction

The role of the natural environment in human growth and development has been a
critical factor that is often underutilized and unappreciated in our modern urban
society. Biophilic Design, or biophilia is the inherent human inclination to affiliate
with natural systems and processes. This affinity became biologically encoded in
enhancing human physical, emotional and intellectual fitness during the course of
human evolution due to the surrounding natural context the human mind and body
developed in.

Nature effects on human health

It is believed that nature posses the ability to make the human body feel more at ease
and comfortable in a particular setting, which in turn can improve our stress levels,
reduce the amount of pain felt after an instance such as surgery and it also has the
power to distract and sooth the mind and body simultaneously. One study conducted
in a hospital setting used patients recovering from abdominal surgery and analysed
the amount of strong narcotic pain medications required by patients located in two
identical rooms with differing views. Room 1 had a view of a brick wall and rooftop
several feet away. Whereas room 2 had a view to nature and the surrounding
landscape. Results showed that patients with the window view out to nature felt
significantly less pain after surgery and required less medication that those with the
view of the building, implying a faster healing rate.

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Dimensions of Biophilc Design

Biophilic Design is broken down into two main categories that can result in different
design solutions, each demonstrating a relationship with the natural environment.
Vernacular or place based design, refers to buildings and landscapes that create an
attachment to place by connecting culture, history, ecology within a geographic
context. Organic design or a naturalistic approach uses forms and shapes in both the
building and the landscape that directly, indirectly or symbolically represent those
found in the natural environment.

FIG 62 FLOW CHART

120
Biophilia effect

But aside from bringing live beings into our living spaces, there are also aspects to
the design of buildings that make them attractive and life-enhancing. These factors
arise no less surely from biophilia — the word literally means love of life — than
does having plants and animals around. While other factors play a role, key elements
of successful buildings (from the user’s point of view, not the architect’s) can be
ascribed to biophilia.

Two parallel strands of conjecture help to explain the biophilic effect. One source of
the biophilic instinct is thought to come from inherited memory, from our evolution
and development in the environment of the savannah long ago. Our ancestors relied
on information gleaned from those characteristics to hone their capacity for survival,
to learn to intuit the presence of a tiger. We first became human in that setting,
genetically encoding its geometrical qualities .

The second source of biophilia comes from biological structure itself: the
geometrical rules of biological forms with which we share a template. This structure
is believed to elicit a general response in humans of recognizable “kinship” that cuts
across the divide between living and inanimate form

FCarved ornamental doorframe. Whle inspired by natural forms

Elements biophilia effect

121
Here are the major factors that contribute to the biophilic effect experienced by
human beings. Strictly speaking, our craving for natural light is properly termed
“photophilia”, and that for natural environments “topophilia”.

5.1 EIGHT ELEMENTS OF THE BIOPHILIC EFFECT

1. LIGHT

2. COLOR

3. GRAVITY

4. FRACTALS

5. CURVES

6. DETAIL

7. WATER

8. LIFE

5.1.1Light and healing

We seek natural light, preferably from different angles so that shadows do not
diminish our stereoscopic vision, necessary to form three-dimensional imagery and
depth perception. Natural light is not merely essential to perceive and then to
evaluate our surroundings: our skin requires sunlight in order to manufacture vitamin
D, crucial to our metabolism. We possess two organs that require sunlight: our eyes
and our skin. Our circadian rhythms (our instinctual perception of time, our “internal
clocks”) are regulated by sunlight on the eye and skin, which controls our sleep cycle
via melatonin secretion. Whenever our circadian rhythms are disturbed (as in jet lag),
our bodies are chronically fatigued and cannot function properly. We require
sunlight to re-set them

122
FIG 63 LIGHT AND GREEN

Beyond simple exposure, natural light can assume aesthetically appealing shapes
and forms through the creative interplay of light and shadow, diffuse and variable
light, and the integration of light with spatial properties.

Natural light can be brought deep into interior spaces by such means as glass walls
and clerestories, the use of reflecting colours and materials, and other design
strategies. The experience of light in motion can be achieved through the contrast of
lighter and darker areas and changes of daylight over time.

5.1.2Colour and healing

123
Pigmentation of partial intensity but overall harmony generates a healthy effect.
Color perception is one of our senses (including receptors in our eyes and processing
pathways in our brain) that links directly with our emotions.

Humans evolved in natural light that ranges in coloration from red to orange to blue,
depending upon the time of day. This describes the hue of incident light

The effective use of color in the built environment can be challenging, given the
modern ability to generate artificial, especially bright colors

We experience color both in the transmitted quality of light and as reflected from
pigmented surfaces. The psychological effects of color run deep, and they are used
(and abused) extensively by the advertising industry. Interior designers employ
colors and color harmonies to affect people’s psychological mood

124
The effective biophilic application of color should generally favor muted “earth”
tones characteristic of soil, rock, and plants. The use of bright colors should be
cautiously applied, and emphasize such appealing environmental forms as flowers,
sunsets and sunup, rainbows, and certain plants and animals

5.1.3Gravity and healing

We feel and relate to balance through gravity. Plants and animals grow in gravity,
thus their forms show an exquisite vertical balance. In natural structures, the heavier
parts are on the bottom and the lighter parts are on top. Our brain automatically
computes the gravitational balance of forms that surround us. All objects in nature
exist in gravitational equilibrium, and this informs our mental reverence for stable
structures.

Left: Balanced form reinforces tectonic stability, Woolworth Building, New York
City, 1913, 792 feet or 241 meters. Right: Cantilevered form generates anxiety,
Giant Underpants Building, Beijing, 2008, 768 feet or 234 meters.

125
Forced perspective — where scale is deliberately shrunk as your gaze rises — is
used in traditional architecture and stage sets. This exaggerated perspective
“reassures” our body of the gravitational balance around us, reducing stress.
Conversely, its imbalance causes anxiety and even nausea. Our balance mechanism
is centred in our inner ear. For this reason, nausea is triggered exactly the same way
in the case of imbalance (perceived loss of equilibrium) as in the case of the body
poisoned by an ingestion of toxins

5.1.4Fractals and healing

A fractal encodes geometrical structure on many different linked levels: it has no

preferred scale, hence any structure is scale-free. Fern leaves and cauliflowers are
examples. Many scales are present in a fractal, with complex structure showing at
any magnification. A fractal contains well-defined subdivisions of structure in an
ordered hierarchy of scales, from the large size down to the size of its details. Much
of living organic tissue is fractal — for example, the nervous system, the circulatory
system, and the lung’s system of branching air passages

We recognize and respond positively to fractal structures because our own bodies
have these in common with other animals and plants. This similarity links us
cognitively to structures that follow the same geometrical principles, such as
landscapes, trees, bushes, and animals. On the other hand, we react poorly to
structures that are not fractal: smooth or shiny objects or surroundings create
alarm. This discomfort occurs because their minimalism contradicts the fractal
structures and patterns we are used to experiencing in natural environments

126
 Complex details are vital for meaningful information exchange

5.1.5Curves and healing

Curved forms are found everywhere in nature, where it is in fact difficult to find a
straight line. Again, curves arise from the biological structure of animals and plants,
and also from natural inanimate environments where matter is shaped by tectonic
forces. Smooth curves are mathematically at odds with angled (“broken”) types of
fractal such as are found in trees and in the weathered patterns of natural materials.

The natural environment exhibits fractal or curved forms, or a combination. We do

not expect straight lines or right angles in nature. Since our neurological-response
mechanisms are hard-wired, we obtain emotional pleasure from curves that possess
a natural balance through symmetry. Curves in the environment that are
gravitationally unbalanced however can be unsettling

Fractals show structure at every successive magnification. The more perfect

fractals are self-similar

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5.1.6Detail and healing

On the most intimate scale — at arm’s length and closer — highly organized
complex detail is visible and touchable throughout nature. Our sense of touch
requires that we be near a surface or structure so as to recover information from the
most detailed levels of scale. We focus on the smallest detail, sharply defined natural
structures and textures such as veins in stone (fossilized animals and plants), wooden
grain, branches and leaves in trees, etc. We expect to find the same sort of complex
structural detail in an artificial environment, since our perceptual mechanisms are
finely tuned to process such signals. In fact, look at the underside of a leaf and you
see its veins display, at the smallest visible level, a fractal network resembling an
irregular urban street grid. Natural materials emerge as fractals, and provide
interesting organic information at increasingly minute distance, heightened by our
ability to touch them. To communicate with animals (including humans), we focus
on their eyes, pupils, lips, and nostrils (and the ears of cats and dogs). “Subliminal
communication” when face-to-face with another human depends upon subtle
anatomical cues we receive from such details. Meaningful response to other life
occurs through tiny details, predisposing us to focus on those. We transfer to the
built environment our inclination to grant importance to small details. We feel cut
off from this mechanism when we experience architectural styles that largely lack
detail or have detail that exists in randomly textured form, chaotic, and intuitively
indecipherable

5.1.7Water and healing

The presence of water can be healing. Human beings love to see water, and even
better, hear it and feel it. Perhaps the need to be close to water is a reassurance that
we have enough water to drink, because without water we cannot survive. It could
be a vestige of the streams and lakes in our ancestral environment. Strict necessity
does not, however, explain the joy of visiting the salty sea. People the world over go
to the beach, and enjoy a promenade along the waterfront. A vast worldwide tourist
industry is driven by vacations on the coastline, and the obvious pleasure of voyages
in water-going vessels, from sailboats to cruise ships. (While not biophilia in the
direct sense of attraction to living forms, the effect is included in this group by
strength of parallel.)

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Water is essential to life and its positive experience in the built environment can
relieve stress, promote satisfaction, and enhance health and performance. The
attraction to water can be especially pronounced when associated with the multiple
senses of sight, sound, touch, taste, and movement. Varying design strategies can
satisfy the desire for contact with water including views of prominent water bodies,
fountains, aquaria, constructed wetlands, and others. Water in the built environment
is often most pleasing when perceived as clean, in motion, and experienced through
multiple senses

Life the “Healing”

Actual and intimate contact with living forms nourishes us. This is the most obvious
meaning of biophilia. We crave the companionship of plants, animals, and other
humans. This is not among the features of a building per se, but serves to encourage
the building user to interact with the natural environment. For example, enclosing a
courtyard garden, or surrounding a building with intimately interwoven trees and
shrubs, provides immediate access to nature

It is not merely decorative. The biophilic effect nurtures and is nurtured by such
simple acts as bringing a potted plant indoors. This has nothing to do with a
building’s structure or design itself — except that buildings that shut off fresh air

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and light inhibit the survival of plants. (Humans thus entrapped might well also be
wary.)

These eight descriptions show how the biophilic effect can be applied to help design
buildings conducive to health. Biophilia reflects natural intuitive response in humans
to their environment

5.2 PATTERNS OF BIOPHILIC DESIGN

Biophilic design can reduce stress, enhance creativity and clarity of thought,
improve our well-being and expedite healing

Theorists, research scientists, and design practitioners have been working for
decades to define aspects of nature that most impact our satisfaction with the built
environment. “14 Patterns of Biophilic Design” articulates the relationships between
nature, human biology and the design of the built environment so that we may
experience the human benefits of biophilia in our design applications

The Patterns lays out a series of tools for understanding design opportunities,
including the roots of the science behind each pattern, then metrics, strategies and
considerations for how to use each pattern. This paper moves from research on
biophilic responses to design application as a way to effectively enhance health and
well-being for individuals and society.

Nature-Design Relationships
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Biophilic design can be organized into three categories – Nature in the Space,
Natural Analogues, and Nature of the Space – providing a framework for
understanding and enabling thoughtful incorporation of a rich diversity of strategies
into the built environment

5.2.1Nature in the Space

Nature in the Space addresses the direct, physical and ephemeral presence of nature
in a space or place. This includes plant life, water and animals, as well as breezes,
sounds, scents and other natural elements. Common examples

include potted plants, flowerbeds, bird feeders, butterfly gardens, water features,
fountains, aquariums, courtyard gardens and green walls or vegetated roofs. Nature
in the Space encompasses seven biophilic design patterns:

6.2.2Natural Analogues

Natural Analogues addresses organic, non-living and indirect evocations of nature.

Objects, materials, colors, shapes, sequences and patterns found in nature, manifest
as artwork

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Mimicry of shells and leaves, furniture with organic shapes, and natural materials
that have been processed or extensively altered (e.g., wood planks, granite table
tops), each provide an indirect connection with nature

The strongest Natural Analogue experiences are achieved by providing information

richness in an organized and sometimes evolving manner.

Natural Analogues encompasses three patterns of biophilic design

6.2.3Nature of the Space

Nature of the Space addresses spatial configurations in nature. This includes our
innate and learned desire to be able to see beyond our immediate surroundings, our
fascination with the slightly dangerous or unknown; obscured views and revelatory
moments; and sometimes even phobia-inducing properties when they include a
trusted element of safety. The strongest Nature of the Space experiences are
achieved through the creation of deliberate and engaging spatial configurations
commingled with patterns of Nature in the Space and Natural Analogues.

PATTERNS AND ITS HEALING BENEFITS

TABLE 6 HEALING EFFECTS

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Nature in the Space

encompasses seven biophilic design patterns

1.Visual Connection with Nature..

2. Non-Visual Connection with Nature.

3. Non-Rhythmic Sensory Stimuli.

4. Thermal & Airflow Variability.

5. Presence of Water.

6. Dynamic & Diffuse Light

7. Connection with Natural Systems

Natural Analogues

encompasses 3 patterns of biophilic design

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8. Biomorphic Forms & Patterns.

9. Material Connection with Nature

10. Complexity & Order.

Nature of the Space

encompasses four biophilic design patterns:

11. Prospect

12. Refuge.

13. Mystery.

14. Risk/Peril

5.2.1.1VISUAL CONNECTION WITH NATURE

The Experience

A space with a good Visual Connection with Nature feels whole, it grabs one’s
attention and can be stimulating or calming. It can convey a sense of time, weather
and other living things

Roots of the Pattern

The Visual Connection with Nature pattern has evolved from research on visual
preference and responses to views to nature showing reduced stress, more positive
emotional functioning, and improved concentration and recovery rates. Stress
recovery from visual connections with nature have reportedly been realized through
lowered blood pressure and heart rate; reduced attentional fatigue, sadness, anger,

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and aggression; improved mental engagement/attentiveness, attitude and overall
happiness.

Working with the Pattern

Design considerations for establishing a strong visual connection with nature:

• Prioritize real nature over simulated nature; and simulated nature over no nature.

• Prioritize biodiversity over acreage, area or quantity.

• Prioritize or enable exercise opportunities that are in proximity to green space.

• Design to support a visual connection that can be experienced for at least 5-20
minutes per day.

• Design spatial layouts and furnishings to uphold desired view lines and avoid
impeding the visual access when in a seated position.

• Visual connections to even small instances of nature can be

restorative, and particularly relevant for temporary interventions, or spaces where

real estate (floor/ground area, wall space) is limited.

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Example

An example of a designed environment with an excellent Visual Connection with

Nature is the birch tree and moss garden in the New York Times Building in New
York City – a carved out space in the middle of the building by which everyone
passes as they enter or leave the building.

5.2.1.2 NON-VISUAL CONNECTION WITH NATURE

The Experience

A space with a good Non-Visual Connection with Nature feels fresh and well
balanced; the ambient conditions are perceived as complex and variable but at the
same time familiar and comfortable, whereby sounds, aromas, and textures are
reminiscent of being outdoors in nature.

Roots of the Pattern

The Non-Visual Connection with Nature pattern has evolved from research on
reductions in systolic blood pressure and stress hormones; impact of sound and
vibration on cognitive performance; and perceived improvements in mental health
and tranquillity as a result of non-visual sensory interactions with non-threatening
Nature..

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Working with the Pattern

The objective of the Non-Visual Connection with Nature pattern is to provide an

environment that uses sound, scent, touch and possibly even taste to engage the
individual in a manner that helps reduce stress and improve perceived physical and
mental health

Design considerations for establishing a strong non-visual connection with nature:

• Prioritize nature sounds over urban sounds.

• Design for non-visual connections that can be easily accessed from one or multiple
locations, and in such a way that allows daily engagement for 5 to 20 minutes at a
time.

• Integrate non-visual connections with other aspects of the design program.

• A single intervention that can be experienced in multiple ways can enhance the
impacts.

• Design for visual and non-visual connections to be experienced simultaneously to

maximize potential positive health responses. Example

Calat Alhambra in Granada, Spain, is an exquisite example of the, Non-Visual

Connections with Nature are experienced throughout. The integration of water and

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natural ventilation with the architecture is central to the non-visual experience,
supporting a seamless connection between indoor and outdoor spaces, and between
the building and the surrounding natural landscape Solar heat penetrates at distinct
locations, the whispering gallery resonates sounds of nature and people, and gardens
of rosemary, myrtles, and other fragrant plants surround the premises..

5.2.1.3 NON-RHYTHMIC SENSORY STIMULI

The Experience

A space with good Non-Rhythmic Sensory Stimuli feels as if one is momentarily

privy to something special, something fresh, interesting, stimulating and energizing.
It is a brief but welcome distraction

Roots of the Pattern

The Non-Rhythmic Sensory Stimuli pattern has evolved from research on looking
behaviour (particularly periphery vision movement reflexes); eye lens focal
relaxation patterns; heart rate, systolic blood pressure and sympathetic nervous
system activity; and observed and quantified behavioural measures of attention and
exploration

Working with the Pattern

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The objective of the Non-Rhythmic Sensory Stimuli pattern is to encourage the use
of natural sensory stimuli that unobtrusively attract attention, allowing individuals’
capacity for focused tasks to be replenished from mental fatigue and physiological
stressors. This can be achieved by designing for momentary exposure to the
stochastic or unpredictable movement, particularly for periphery vision or the
periodic experience of scents or sounds

Design considerations for establishing accessible and effective non-rhythmic

stimuli:

• As a general guideline, non-rhythmic sensory experiences should occur

approximately every 20 minutes for about 20 seconds and, for visual stimuli, from a
distance of more than 20 feet away.

• Many stimuli in nature are seasonal, so a strategy that is effective year-round,

such as with multiple interventions that overlap with seasons, will help ensure
that non-rhythmic sensory experiences can occur at any given time of the year.
• An intervention that leverages simulation of (rather than naturally occurring)
natural stimuli will likely necessitate early collaboration with the mechanical
engineer or facilities team.
• A non-rhythmic stimuli strategy can be interwoven with almost any
landscape or horticulture plan. For instance, selecting plant species for
window boxes that will attract bees, butterflies and other pollinators may be
a more practical application for some projects than maintaining a honeybee
apiary or butterfly sanctuary.
• In some cases, the intervention may be similar to that of [P1] Visual or [P2]
Non-Visual Connection with Nature; what’s important here is the ephemeral
and stochastic quality of the intervention

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 Example

The Dockside Green community on Vancouver Island, Victoria, BC Canada,

is a great example of non-rhythmic stimuli. The implementation of habitat
restoration and rainwater management has led to ephemeral experiences of
swaying grasses, falling water and the buzz of passing insects and animals that
are visible from walkways, porches, and windows around the community

5.2.1.4 THERMAL & AIRFLOW VARIABILITY

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The Experience

A space with good Thermal & Airflow Variability feels refreshing, active, alive,
invigorating and comfortable. The space provides a feeling of both flexibility and
a sense of control.

Roots of the Pattern

The Thermal & Airflow Variability pattern has evolved from research measuring
the effects of natural ventilation, its resulting thermal variability, and worker
comfort, well-being and productivity; physiology and perception of temporal and
spatial pleasure (alliesthesia); the impact of nature in motion on concentration;
and, generally speaking, a growing discontent with the conventional approach to
thermal design, which focuses on achieving a narrow target area of temperature,
humidity and air flow while minimizing variability

Working with the Pattern

The objective of the Thermal & Airflow Variability pattern is to provide an

environment that allows users to experience the sensory elements of airflow
variability and thermal variability. The intent is also for the user to be able to
control thermal conditions, either by using individual controls, or allowing
occupants access to variable ambient conditions within a space.

Design considerations:

• Incorporation of airflow and thermal conditions into materials, daylighting,

mechanical ventilation and/or fenestration will help distribute variability over
space and time.

• Thermal comfort is a vital bridging component between biophilic design and

sustainable design, especially in the face of climate change and rising energy
costs. When Thermal & Airflow Variability is implemented in a way that
broadens people’s perception of thermal comfort, it may also help reduce energy
demands for air conditioning and heating.

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• Designing in features that allow users to easily adapt and modify their perceived
thermal conditions of their environment will increase the range of acceptable
temperatures by two degrees Celsius above and below the conventional
parameters for thermal comfort

• Coordination of design strategies among a project team as early as the schematic

design process will be particularly important for achieving design intent.

Example

Singapore’s Khoo Teck Puat Hospital by RMJM Architects is an excellent

example thermal & Airflow Variability. The passive design of the hospital draws
fresh air in from the exterior courtyards; the cool air helps maintain thermal
comfort, while patients also have operable windows in their rooms, allowing for
greater personal control. The facade and internal layouts are designed to enhance
daylight and light/shade variability while reducing glare. Connecting, elevated
exterior walkways also provide access to breezes, shade and solar heat.

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5.2.1.5 PRESENCE OF WATER

The Experience

A space with a good Presence of Water condition feels compelling and

captivating. Fluidity, sound, lighting, proximity and accessibility each contribute
to whether a space is stimulating, calming, or both.

Roots of the Pattern

The Presence of Water pattern has evolved from research on visual preference
for and positive emotional responses to environments containing water elements;
reduced stress, increased feelings of tranquillity, and lower heart rate and blood
pressure from exposure to water features; improved concentration and memory
restoration induced by complex, naturally fluctuating visual stimuli; and
enhanced perception and psychological and physiological responsiveness when
multiple senses are stimulated simultaneously

Working with the Pattern

The objective of the Presence of Water pattern is to capitalize on the multisensory

attributes of water to enhance the experience of a place in a manner that is
soothing, prompts contemplation, enhances mood, and provides restoration from
cognitive fatigue

Design considerations for optimizing the impacts of a presence of water:

• Prioritize a multi-sensory water experience to achieve the most beneficial

outcome.

• Prioritize naturally fluctuating water movement over predictable movement or

stagnancy.

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• High volume, high turbulence water features could create discomfort, impact
humidity levels or decrease acoustic quality, so proximity may influence
appropriateness.

• Water features can be water and energy intensive and as such should be used
sparingly, particularly in climates with little access to water. Shading the water,
using high albedo surfaces, and minimizing the exposed water surface area will
minimize water loss through evaporation, and possibly contribute to the biophilic
experience

Example

The Robert and Arlene Kogod Courtyard at the Smithsonian American Art
Museum

in Washington, D.C. is a great example of Presence of Water with its physically

expansive water feature. The former outdoor space has been enclosed with an
undulating canopy design by Foster + Partners, bearing resemblance to water or
clouds. On several portions of the gently sloping floors are slits from which a
sheet of water emerges, it flows across the textured stone and then disappears into
a series of slots toward the center of the courtyard

Simulated or Constructed
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• Water wall

• Constructed water fall

• Aquarium

• Fountain

• Constructed stream

5.2.1.6 DYNAMIC & DIFFUSE LIGHT

The Experience

A space with a good Dynamic & Diffuse Light condition conveys expressions of
time and movement to evoke feelings of drama and intrigue, buffered with a sense
of calm.

Roots of the Pattern

Lighting design has long been used to set the mood for a space, and different
lighting conditions elicit differing psychological responses. The impact of
daylight on performance, mood and well-being has been studied for many years,
in a variety of environments, and as a complex field of science and design, light
has been extensively studied and written about.

Working with the Pattern

The objective of the Dynamic & Diffuse Light pattern is twofold: to provide users
with lighting options that stimulate the eye and hold attention in a manner that
engenders a positive psychological or physiological response, and to help
maintain circadian system functioning. The goal should not be to create uniform
distribution of light through a (boring) space, nor should there be extreme
differences

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Design considerations for establishing a balance between dynamic and diffused
lighting conditions:

• Dynamic lighting conditions can help transition between indoor and outdoor
spaces.

• Drastically dynamic lighting conditions, such as with sustained movement,

changing colors, direct sunlight penetration and high contrasts, may not be
appropriate for spaces where directed attention activities are performed.

• Circadian lighting will be especially important in spaces the people occupy for
extended periods of time.

Example

A prime example of a Dynamic & Diffuse Light condition is at the Yale Center
for British Art, designed by Louis Kahn. Despite the building’s stark exterior, the
diversity of interior spaces and differing orientations of windows, clerestories,
skylights and a large central atrium allows for light to penetrate at variable levels
of diffusion to create an enhanced visitor experience, while upholding indoor
environmental conditions necessary for displaying fine art.

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5.2.1.7 CONNECTION WITH NATURAL SYSTEMS

The Experience

A space with a good Connection with Natural Systems evokes a relationship to a

greater whole, making one aware of seasonality and the cycles of life. The
experience is often relaxing, nostalgic, profound or enlightening, and frequently
anticipated

Roots of the Pattern

There is limited scientific documentation of the health impacts associated with

access to natural systems; however, much like Presence of Water, this pattern is
suspected to enhance positive health responses

Working with the Pattern

The objective of the Connection with Natural Systems pattern is to heighten both
awareness of natural properties and hopefully environmental stewardship of the
ecosystems within which those properties prevail. The strategy for working with the
pattern may be as simple as identifying key content in a view to nature

Design considerations and opportunities that may help create quality connections
with natural systems:

• Integration of rainwater capture and treatment into the landscape design that
responds to rain events.

• In some cases, providing visual access to existing natural systems will be the easiest
and most cost effective approach. In other cases, the incorporation of responsive
design tactics (e.g., use of materials that change form or expand function with
exposure to solar heat gain, wind, rain/moisture, or shading)

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• Design interactive opportunities, especially for children, patients, and the elderly
(e.g., integrative educational curriculum; horticulture programs, community
gardens; seasonal cooking/diet).

Example

Outside the New York penthouse office of COOKFOX Architects, sits a 3,000
square foot extensive green roof that changes color and vibrancy from season to
season. Witnessing a hawk killing a small bird shifted employee perception of their
green roof as an ecosystem and not just a decorative garden. This perception was
reinforced when employees noticed changes in bee colony behavior during times of

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extreme heat and humidity, when the honeybee apiary was invaded by robber bees,
and again when the summer honey harvest looked and tasted different than the
autumn harvest

5.2.2.1 BIOMORPHIC FORMS & PATTERNS

The Experience

A space with good Biomorphic Forms & Patterns feels interesting and comfortable,
possibly captivating, contemplative or even absorptive

Roots of the Pattern

Biomorphic Forms & Patterns has evolved from research on view preferences (Joye,
2007), reduced stress due to induced shift in focus, and enhanced concentration. We
have a visual preference for organic and biomorphic forms but the science behind
why this is the case is not yet formulated. While our brain knows that biomorphic
forms and patterns are not living things, we may describe them as symbolic
representations of life

Working with the Pattern

The objective of Biomorphic Forms & Patterns is to provide representational design

elements within the built environment that allow users to make connections to nature

Design considerations that may help create a quality biomorphic condition:

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• Apply on 2 or 3 planes or dimensions (e.g., floor plane and wall; furniture windows
and soffits) for greater diversity and frequency of exposure.

• Avoid the overuse of forms and patterns that may lead to visual toxicity.

• More comprehensive interventions will be more cost effective when they are
introduced early in the design process.

Example

The Art Nouveau Hotel Tassel in Brussels (Victor Horta, architect, 1893) is a
favorite example of Biomorphic Forms & Patterns. The interior space in particular
is rife with natural analogues, with graphic vine-like tendrils painted on the wall and
designed into the banisters and railings, floor mosaics, window details, furniture, and
columns.

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5.2.2.1 MATERIAL CONNECTION WITH NATURE

The Experience

A space with a good Material Connection with Nature feels rich, warm and authentic,
and sometimes stimulating to the touch.

Roots of the Pattern

While scientific documentation on the health impact of natural materials is limited,

available research is beginning to shed light on opportunities for informed design.
As such, the Material Connection with Nature pattern has evolved from a limited
body of scientific research on physiological responses to variable quantities of
natural materials, and the impact of natural color palette, particularly the color green,
has on cognitive performance.

Working with the Pattern

The objective of the Material Connection with Nature pattern is to explore the
characteristics and quantities of natural materials optimal for engendering positive
cognitive or physiological responses. In some cases, there may be several layers of
information in materials that enhance the connection, such as learned knowledge
about the material, familiar textures, or nested fractals that occur within a stone or
wood grain pattern

Design considerations that may help create a quality material connection:

• Quantities of a (natural) material and color should be specified based on

intended function of the space (e.g., to restore versus stimulate). In the same
vein, a degree of variability of materials and applications is recommended
over high ratios of any one material or color.

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 • Real materials are preferred over synthetic variations because human
receptors can tell the difference between real and synthetic, so minimally
processed materials from real nature are preferred whenever possible.

• Incorporating instances of the color green may help enhance creative

environments; however, scientific studies on the impact of the color green have
mostly been conducted in controlled lab environments, so dependence on color to
engender creativity should be considered experimental

Example

The lobby of the Bank of America Tower at One Bryant Park in New York
(COOKFOX Architects, 2009) is a good example of a diverse application of
Material Connections with Nature. One enters the glass skyscraper by grasping a
thin wooden door handle. The interior lobby walls are clad with Jerusalem Stone –
the tiles with the highest fossil content were intentionally placed at the corner where
they would be most encountered and even touched by passers-by. Leather panelling
in the elevator lobby is warm in color, providing a sense of calm for people as they
wait for their ride, and soft to the touch, from which the patina has begun to show

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5.2.2.3 COMPLEXITY & ORDER

The Experience

A space with good Complexity & Order feels engaging and information-rich, as an
intriguing balance between boring and overwhelming

Roots of the Pattern

The Complexity & Order pattern has evolved from research on fractal geometries
and preferred views; the perceptual and physiological responses to the complexity
of fractals in nature, art and architecture; and the predictability of the occurrence of
design flows and patterns in nature

Working with the Pattern

The objective of the Complexity & Order pattern is to provide symmetries and fractal
geometries, configured with a coherent spatial hierarchy, to create a visually
nourishing environment that engenders a positive psychological or cognitive
response Fractals can exist at any scale, from desktop trinkets or textile patterns, to
facade design, to a city grid or regional transport infrastructure.

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Design considerations that may help create a quality Complexity & Order
condition:

• Prioritize artwork and material selection, architectural expressions, and landscape

and master planning schemes that reveal fractal geometries and hierarchies.

• Fractal structures with iterations of three will be more impactful than a design
limited to two iterations.

• Computer technology using the algorithms of mathematical and geometric

functions can produce fractal designs for architectural, design and planning
applications with ease. If a fractal design is being created, consider using geometries
with a mid-range dimensional ratio (broadly speaking, D=1.3-1.75).

• Over-use of and/or extended exposure to high-fractal dimensions could in still

discomfort or even fear, countering the intended response: to nourish and reduce
stress. Avoidance or under-utilization of fractals in design could result in complete
predictability and disinterest.

• A new building or landscape design should take into account its impact on the
fractal quality of the existing urban skyline.

Example

Tucked in between buildings of downtown Toronto, Ontario, is the Allen Lambert

Galleria and Atrium at Brookfield Place. The cathedral-like structure designed by
Santiago Calatrava (1992) is information rich, yet protecting, with its orderly

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columns that rise up into a canopy of complex tree-like forms, showers diffuse
light and shadow onto the courtyard, and keeps visitors awestruck and engaged

5.2.3.1 PROSPECT

The Experience

A space with a good Prospect condition feels open and freeing, yet imparts a sense
of safety and control, particularly when alone or in unfamiliar environments

Roots of the Pattern

The Prospect pattern has evolved from research on visual preference and spatial
habitat responses, as well as cultural anthropology, evolutionary psychology and
architectural analysis. Health benefits are suggested to include reductions in stress,
boredom, irritation, fatigue and perceived vulnerability, as well as improved comfort

Working with the Pattern

The objective of the Prospect pattern is to provide users with a condition suitable for
visually surveying and contemplating the surrounding environment for both
opportunity and hazard. In landscapes, Prospect is characterized as the view from an

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elevated position or across an expanse. While an elevated position can enhance
(indoor and outdoor) prospect, it is not essential to creating a quality Prospect
experience.

Design considerations that may help create a quality Prospect condition:

• Orienting building, fenestration, corridors and workstations will help optimize

visual access to indoor or outdoor vistas, activity hubs or destinations.

• Designing with or around an existing or planned savannah-like ecosystem, body of

water, and evidence of human activity or habitation will help the information-
richness of the prospect view.

• Locating stairwells at building perimeter with glass facade and interior glass
stairwell walls can form a dual Prospect condition.

• When high ceilings are present, perimeter or interior spaces elevated 12-18” will
enhance the Prospect condition.

• Often the view quality and the balance between Prospect and Refuge will be more
important than the size or frequency of the experience.

• Refer to Visual Connection with Nature to optimize the Prospect experience with
a quality view.

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The central courtyard of the Salk Institute for Biological Studies in California,
designed by Louis Kahn, is a popular example of a nearly pure Prospect condition.
This elevated space is bounded by the angled fins of the adjacent researcher
offices, and has a rill flowing through the center out towards the view of the
Pacific Ocean. There are some small trees in planters at the entry of the courtyard,
but once in the space one’s gaze is drawn outward through the space.

5.2.3.2 REFUGE

The Experience

A space with a good Refuge condition feels safe, providing a sense of retreat and
withdrawal – for work, protection, rest or healing – whether alone or in small
groups. A good Refuge space feels separate or unique from its surrounding
environment; its spatial characteristics can feel contemplative, embracing and
protective, without unnecessarily disengaging.

Roots of the Pattern

The Refuge pattern has evolved from research on visual preference research and
spatial habitat responses, and its relationship to Prospect conditions. Refuge
conditions are important for restoration experiences and stress reduction, which
can be realized through lowered blood pressure and heart rate. Other benefits of
Refuge are suggested to include reduced irritation, fatigue and perceived
vulnerability, as well as improved concentration, attention and perception of safety

Working with the Pattern

The primary objective of the Refuge pattern is to provide users with an easily
accessible and protective environment – a smaller portion of a larger space – that
supports restoration

Design considerations:

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• Indoor refuge spaces are usually characterized by lowered ceiling conditions. For
spaces with standard ceiling heights, this may equate to approximately 18-24
inches below the main ceiling, and is often achieved through treatments like a
soffit, a drop-ceiling or acoustical panelling, or suspended fabric.

• For outdoor or indoor spaces with particularly high ceilings (>14 feet), a more
drastic differential may be necessary to achieve the desired outcome; freestanding
or vegetative alcoves and mezzanine-like structures are often effective.

• Light levels in refuge spaces should differ from adjacent spaces and user lighting
controls will broaden functionality as a refuge space.

Example

Sitting with one’s back against the trunk of a big shade tree is a classic refuge space,
as is high backed booth seating in a restaurant, a reading nook in a library or school,
a covered bus stop, or a wraparound porch. Treehouses are a timeless

example of Refuge; and Cliff Palace in Mesa Verde, Colorado (constructed pre-
A.D.1200s) is one of the best historic examples. While the settlement provides a
feeling of containment and protection from the arid climate and potential

predators or enemies, the refuge experience is enhanced with characteristics of

Prospect through its elevated position and views over the canyon.

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5.2.3.3 MYSTERY

The Experience

A space with a good Mystery condition has a palpable sense of anticipation, or of

being teased, offering the senses a kind of denial and reward that compels one to
further investigate the space.

Roots of the Pattern

The Mystery pattern is largely based on the idea that people have two basic needs in
environments: to understand and to explore and that these ‘basic needs’ should occur
“from one’s current position” in order to engender a sense of mystery

Working with the Pattern

Mystery characterizes a place where an individual feels compelled to move forward

to see what is around the corner; it is the partially revealed view ahead. The objective
of the Mystery pattern is to provide a functional environment that encourages
exploration in a manner that supports stress reduction and cognitive restoration

Design considerations that will help create a quality Mystery condition:

• Curving edges that slowly reveal are more effective than sharp corners in drawing
people through a space.

• Dramatic shade and shadows can enhance the mystery experience.

• Strategies that provide dark shadows or shallow depth of field could in still
unappreciated surprise or fear

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Example

Prospect Park, in Brooklyn, New York, is an excellent example of Mystery. In

classic Olmsted style, many views throughout the park are obscured through the
use of topography and vegetation. Key focal points in the landscape are revealed
from stationary prospect points within the park. The focal points within the park
(trees, buildings, lake and meadows) give the space a degree of legibility, but
obscured views entice occupants to explore the space further, in order to
understand it, which cannot be achieved in a single visit.

5.2.3.4 RISK

The Experience

A space with a good Risk/Peril condition feels exhilarating, and with an implied
threat, maybe even a little mischievous or perverse. One feels that it might be
dangerous, but intriguing, worth exploring and possibly even irresistible.

Roots of the Pattern

Risk can be generated by a learned or biophobic response triggered by a near and

present danger. This danger, however, is inert and unable to cause harm due to a
trusted element of safety. The defining difference between Risk/Peril and fear is
the level of perceived threat and perceived control

Working with the PatternThe objective of the Risk/Peril pattern is to arouse

attention and curiosity, and refresh memory and problem solving skills. There are
different degrees of risk that can be incorporated into a design depending on the
intended user or the space available; a cantilevered walkway over a sheer cliff is an
extreme case

Design considerations that will help create a quality Risk/Peril condition:

• Risk/Peril design interventions are usually quite deliberate and as

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such will not be appropriate for all user groups or places.

• Design strategies that rely on spatial conditions will be easier to

implement when incorporated as early as concept design and

schematic phases of the design process.

• The element of safety must protect the user from harm while still

permitting the experience of risk.

Example

At Frank Lloyd Wright’s home, Taliesin, in Spring Green, Wisconsin, The Bird
walk is a thrilling narrow balcony that cantilevers out over the hillside. Artist
Michael Heizer’s Levitated Mass (pictured below) at Los Angeles County Museum
of Art is an enormous boulder that spans over a pedestrian ramp, and under which
visitors pass. The balancing act is seems improbable, but the bracing provides
some reassurance of safety, and visitors flock en masse to be photographed below
the rock Lower-level risk, like getting one’s feet wet, may be a more appropriate
strategy for some settings. A great example would the stepping stone path through
the water feature designed by Herbert Dreiseitl at Potsdamer Platz in Berlin,
Germany

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CHAPTER -7 SITE

HOSPICE CARE SITE

The site selection of hospice care plays a vital role in the design of hospice care.
Healing plays a vital role in hoapice care. So I concluded the location of hospice
care must be in such a place where the richness of nature must be experience a
delightful space at their each visit.

On interrogating with the view of a norms. A hospice site must be located in a

clam area even in the urban contex.An other important point that must be noted
down is the location of health care institutions At the minimum distance of 5 km. It
is even suggested that the site location must be away from institutional zone

SITE

7.1 INTRODUCTION

The area in which site is located is perur, coimbatore.The distance from here to
hot of the city ukkadam is around 7 km. The perur is vital because of perur lake
which is there.

7.2 LOCATION

The site is located near chettipalayam lake. A good lake is seen from the site.The
area of the site is about 6.74 acres.

The site is located about a distance of 1.2km meter.The area in which site is set
is calm and easy accessable to the facilities required like hospital, temple, main bus
stand of perur.

More over the main access from the site leads to many leisur distination like Esha
yoga centre, Siruvani water falls, Kovai kondatam.etc.

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So the placement of recreational area in the site will bring the public into the site.

Perur chettipalayam lake has a proposal of having a bird sanctury which has many
numbers of acacia trees which attract 77 species of birds.This helps the site to
serve for healing the terminally ill patients in a great way.

FIG 64 -LOCATION

7.3 NEIGHBOURHOOD

The site is located near perur chettipalayam lake since the around it are mostly
farm land there are some neighbourhood residences.More over the site is located in
main road

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7.4 ACCESS

Ukkadam bustand -7.3 km

Near by bus stop- 300m( postal colony stop)
Railway station-8 km

FIG 65 -ACCESS

7.5 CLIMATE

Climate – tropical

FIG 66 –CLIMATE SUMMARY

Wind

Wind- The wind speed rate was above 0.9.The wind flows from north east to south
west.

Temperature

The driest month is January, with 8 mm of rain. In October, the precipitation

reaches its peak, with an average of 155 mm.

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 FIG 67 – TEMPRATURE GRAPH

Vegetation

The vegetation seen in the site are coconut tree and neam tree

7.6 COUNTOURS

The height varies from -1 to +1 which is a gradual slope

FIG 68- CONTOURS

7.7 SECTION

FIG 69 SECTIONS

7.8 VIEW

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FIG 70 VIEWS

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FIG 71 SUN AND WIND

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7.9 NOISE ANALYSIS

FIG 72 NOISE ANALYSIS

7.10 SITE DRAIN

FIG 73 SITE DRAIN

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