毕业设计外文翻译

How Architectural Design Affords Experiences of

资料来源： Journal of Aging Studies

设计题目：长春市净月鹿鸣谷养老服务中心方案设计

学生姓名： 占思祺

学院名称： 建筑与设计学院

专业名称： 建筑学

班级名称： 建筑 155

学 号： 1507511110

指导教师： 赵晖

教师职称： 教授

完成时间： 2020 年 3 月 3 日

2020 年 3 月 3 日
 How Architectural Design Affords Experiences of
Freedom in Residential Care for Older People.
Text Abstract
Human values and social issues shape visions on dwelling and care for older
people, a growing number of whom live in residential care facilities. These facilities'
architectural design is considered to play an important role in realizing care visions.
This role, however, has received little attention in research.
This article presents a case study of a residential care facility for which the
architects made considerable effort to match the design with the care vision. The study
o ff ers insights into residents' and caregivers' experiences of, respectively, living and
working in this facility, and the role of architectural features therein.
A single qualitative case study design was used to provide in-depth, contextual
insights. The methods include semi-structured interviews with residents and
caregivers, and participant observation. Data concerning design intentions,
assumptions and strategies were obtained from design documents, through a
semi-structured interview with the architects, and observations on site.
Our analysis underlines the importance of freedom (and especially freedom of
movement), and the balance between experiencing freedom and being bound to a
social and physical framework. It shows the architecture features that can have a role
therein: small-scaleness in terms of number of residents per dwelling unit, size and
compactness; spatial generosity in terms of surface area, room to maneuver and
variety of places; and physical accessibility. Our study challenges the idea of
family-like group living. Since we found limited sense of group belonging amongst
residents, our findings suggest to rethink residential care facilities in terms of private
or collective living in order to address residents' social freedom of movement.
Caregivers associated ‘hominess’ with freedom of movement, action and choice,
with favorable social dynamics and with the building's residential character. Being
perceived as homey, the facility's architectural design matches caregivers' care vision
and, thus, helped them realizing this vision.
Introduction
Worldwide, the number of older people is rising (United Nations, Department of
Economic and Social A ff airs, 2015). Because health status typically declines
with advancing age, the need grows for long- term care, like provided in residential
care facilities (United Nations, Department of Economic and Social Affairs, 2015; Van
den Bosch et al., 2011). Ideally, these facilities meet contemporary care visions.
Societal discourses on dwelling and care for older people re fl ect an evolution
from a medical to a social model (Declercq, 2000; Elf, Fröst, Lindahl, & Wijk, 2015;
Mens & Wagenaar, 2009; van der Kooij, 1987). Originating in early 20th century
modernism, the former takes a rational, objective, functional and pathological
approach to care. Older people are categorized based on medical parameters or care
needs. This model is associated with patronizing, stigmatization, institutionaliza- tion,
exclusion and lack of recognition of personal characteristics, values and
perspectives. The corresponding architecture lacks places relating to residents' daily
life: “in a classical nursing home, people do not dwell” (Mens & Wagenaar, 2009,
p. 79, authors' translation). By contrast, the social model emphasizes people's
autonomy, individuality, community integration and participation, normalization, and
home (versus institution) (Declercq, 2000; Mens & Wagenaar, 2009). Increas- ing
attention goes to older people's experiences. The ongoing refutation of a purely
medical model evidences an emancipation process of older people who want to avoid
institutionalization (i.e., avoid subjection to institutional rules and routines, and to
restrictions of activities, mobility and social contacts), and instead want their voice to
be heard, continue their own daily lives, and stay involved in society as much as
possible (Mens & Wagenaar, 2009). The physical environment plays an impor- tant
role in realizing care visions (Elf et al., 2015; Kearns, 2007; Martin, Nettleton, Buse,
Prior, & Twigg, 2015; Mens & Wagenaar, 2009; Van Steenwinkel, Verstraeten, &
Heylighen, 2016).
Theoretically, environmental gerontology puts forward several models to
develop understandings of relations between people and their physical
environment. The competence-press model (Lawton & Nahemow,
1973), for example, plots the press exerted by the environment (broadly defi
ned) that older people can manage in relation to their competence level. Another
model by Parmelee and Lawton (1990) suggests that at the heart of
person-environment relations in late life lies the dialectic of autonomy and security
(following citations, see Parmelee & Lawton, 1990, p. 465 – 466). They de fi ne
autonomy as “a state in which the person is, or feels, capable of pursuing life goals
by the use of his or her own resources ”, and which implies “freedom of choice,
action, and self-regulation of one's life space – in other words, the
perception of and capacity for effective independent action”. Security is “a state in
which pursuit of life goals is linked to, limited by, and aided by dependable physical,
social, and interpersonal resources. ” Security includes physical safety, social sup-
port, and peace of mind, for example, being free “ from risk, danger, concern, or
doubt.”
Besides a focus on processes (like environmental stress, and competence),
increasing attention goes to ‘ place ’ as a “ key integrative construct in
conceptualizing both the environments occupied by older persons and older person's
interaction with these environments ” (Wahl & Weisman, 2003, p. 625). A
well-known model of place by Weisman et al. (Weisman, 1997; Weisman, Calkins, &
Sloane, 1994; Weisman, Chaudhury, & Diaz Moore, 2000) considers the people stu-
died in their physical, social, and care organizational context. Diaz Moore (2004, p.
298), following Gubrium (1978), defines place as “a milieu comprising a physical
setting within which activities occur – which can be thought to be carried out by
people of various social groups – and having inherent yet largely implicit socially
shared understandings that enable effective coaction”. In connection with the meaning
of places in late life, the concepts home, identity, and privacy are well-researched (e.g.,
Rowles & Chaudhury, 2005).
However, theories within environmental gerontology have been criticized for
being not very productive (Wahl & Weisman, 2003, p. 626). The worldviews
underlying these theories may hamper research innovation and compatibility of
knowledge with design practice (Diaz Moore & Geboy, 2010; Schwarz, 2012; Wahl &
Weisman, 2003). Indeed, Schwarz (2012, p. 6) notes, by emphasizing a positivistic
approach, environmental gerontology focused on predictive, context-independent
theories that fail to o ff er insight into the role of the physical environ- ment as a
contextual element in the aging process and in older people's experiences.
In line with Schwarz (2012) we recognize the potential of studying cases that are
connected with their context, to develop in-depth understandings of how and why
older people experience and negotiate their physical environment the way they do.
Such understandings should not aim to be predictive, since people have certain
degrees of freedom in making sense of and negotiating their environment. The
environment thus has no deterministic force. The understandings developed can help
to gain insight into and anticipate similar situations and envision alternative futures
(Flyvbjerg, 2011, p. 312; Geertz, 1993,p. 26), and can in this way be relevant to
architectural design research and practice.
This article presents a case study of a newly-built residential care facility for
older people – referred to as Heather House (pseudonym) – for which the
architects made considerable effort to match the design with the care vision. We aimed
to gain insight into residents' and caregivers' experiences of, respectively, living and
working in Heather House, and the role of architectural features in these experiences.
Methods
The fi rst author collected data and analyzed them in collaboration with the
second and third author, and is henceforth referred to as “the researcher.”
Because we aim to articulate an in-depth understanding of architec- ture's role in
people's experiences, the research consists of a case narrative with a critical realist
and constructionist (Crotty, 1998) approach. Two data gathering techniques were used:
participant observation and in-depth, semi-structured interviews with residents
and caregivers. For interview preparation and for contextual informa- tion, data
concerning design intentions, assumptions and strategies were obtained from the
design brief, and architects' design contest submission, and through a semi-structured
interview with them, and observations on site.
Setting
Heather House is a residential care facility for people with physical impairments,
psychosocial problems, dementia, and psychiatric pro- blems due to old age, in use
since May 2014. It is located in a multicultural garden suburb, and includes four
dwelling units for eight residents each. During one week, four nursing assistants
individually manage one dwelling unit. Per four dwelling units there are five nurses,
one occupational therapist, and four cleaners. Additionally, help is offered by interns
(about five per year), and family members. Residents can use a paid service from a
non-profit organization, e.g., to assist in activities or transportation.
Heather House was selected for its contemporary care vision and its innovative
architectural design. Its care vision aligns with ‘small-scale, normalized living’, a
well-known concept in Flanders, Belgium, denot- ing a housing and care type where
six to 16 people, with professional guidance, form a household in a for them familiar
and homey environment, which is architecturally and/or socially integrated in the
neighborhood (Van Audenhove et al., 2003). In their care vision, directors of Heather
House emphasize normalization, integration, participation, and family-like group
living within a household. They aim to house eight people per dwelling unit in a
familiar, homey environment that offers common places and ample privacy. They aim
to offer an environment that compensates for residents' impairments, supports them in
conducting homey activities and moving indepen- dently and safely, a ff ords social
freedom of movement, and integrates residents in the neighborhood. According to the
care vision, residents' daily life is not bound by fixed care tasks, rather, much can be
chosen and decided by themselves.
The architects took as the starting point for their design dwelling (rather than
care logistics). Each dwelling unit consists of well-lit dwelling places compactly
clustered around a patio in an open plan (i.e., a continuous space without
doors) (Fig. 1b, c). Two adjoining private rooms – designed to be little houses in
themselves, with an entrance, sitting corner, bedroom and bathroom (Fig. 1d) –
give way to an entrance, living room, hobby room, or kitchen-dining area. These
common rooms are scaled to accommodate eight residents, each with a stroller and
wheelchair. Four of these dwelling units are grouped in two building blocks of two fl
oors high, connected with a bridge on the first floor. Their front doors face each other.
The basement contains a bathroom for residents, and staff's utility and storage rooms.
A garden path connects the garden gates, (front) doors and terraces (Fig. 1e). To
integrate Heather House in the residential area, the building stands along the street
(rather than drawing back from it), and its façade is articulated into smaller parts with
pitched roofs, and varying windows (Fig. 1a), like the neighboring houses.
Additionally, the site and building include residential elements like an
hedge, garden path, garden gate, and front door with a lamp.
Fig. 1. a) The east façade is articulated into smaller parts, with pitched roofs, and
varying windows; b) The ground floor includes two similar dwelling units. They are
di ff erently orientated so that their entrances (marked in grey and with arrows) face
each other; c) Basic spatial organizational principle of one dwelling unit: private
rooms clustered around a patio create space for multiple common rooms arranged in
an open plan; d) A private room with an entrance, sitting corner, bedroom and
bathroom; e) The site plan shows outdoor places, garden paths, the street and
neighboring houses.
Sample
Convenience sampling was used. Residents living in the two dwell- ing units
where participant observation took place, and nursing assistants of all four dwelling
units were included. Residents cognitively unable to participate in interviews, or not
speaking Dutch wereexcluded. Residents were chosen based on the researcher's
informal contacts with them during participant observation, and in consultation with
caregivers. Table 1 and Table 2 respectively show the diversity in interviewed
residents' and caregivers' characteristics.
Seven residents and seven caregivers were interviewed. The number of
participants was decided during the study, based on the richness of the interviews. In
combination with participant observation, the inter- views offered sufficient material to
explore the role of architectural features in residents' and caregivers' experiences.
Data collection
Data collected include notes, pictures, audio recordings and verba- tim
transcriptions.
Participant observation focused on how daily activities of residents and
caregivers took place within the physical setting of Heather House. The researchers'
participation included, e.g., talking to residents and caregivers, joining residents
having lunch, playing a round game, or going out for a walk. She took notes on a
laptop at the table in the hobby room or in an armchair, similar to how
caregivers do their administrative tasks. The observations allowed to become
acquainted with residents and caregivers, with the architecture and care organiza- tion,
and with concrete dwelling and care related activities. In that way, the observations
helped to better understand and interpret interview data within their context.
In the interviews, residents were fi rst asked to recount their knowledge and
expectations of Heather House before moving in, and their reasons for moving. They
were also asked to describe the building (their fi rst and later impressions), and
experienced similarities or differences with other buildings; how it was for them
to live in Heather House; the things they did or would have liked to do.
Caregivers were also first asked to describe the building (their first and
later impressions); whether and how their daily work matched their image of Heather
House; how it was for them to work there; their role in the dwelling unit,
whether they fully succeeded in fulfilling it; and what they find important in their
job. For each of these questions, additional questions were asked to probe into
relations with the potentials and limitations afforded by the building's architecture.
Second, residents and caregivers were explicitly asked about theirexperiences
with architectural features of the building, e.g., the scale, open plan, number of floors,
and the caregivers' desk being integrated within one of the common rooms.
Data analysis
The analysis mainly focused on interviews with residents and caregivers,
complemented by observation notes, and was conducted according to QUAGOL, a
guide for qualitative data analysis (Dierckx de Casterlé, Gastmans, Bryon, &
Denier, 2012). QUAGOL covers two parts:
(1) coding process preparation, by taking a narrative approach and identifying
and re fl ecting on themes; (2) the actual coding process consists of an interplay
between description, analysis, interpretation and developing concepts (Dierckx de
Casterlé et al., 2012, p. 369). First, printed transcripts were read, text chunks were
highlighted and annotated. Then narrative reports, preliminary
conceptual schemes,and code lists were made. Second, qualitative data analysis
software NVivo11 (QSR International, 2015) was used to take a systematic approach
to identifying empirical support. The software facilitated searching through and
organizing data, as well as retrieving data labeled with particular codes. After
having been tested against the empirical support, preliminary conceptual schemes
were adjusted and further developed, and, finally, described.
Different strategies were used to enhance the findings' trustworthi- ness.
Bracketing was used to counter bias. Methods and data were triangulated by
combining participant observation and interviews, and by including both residents'
and caregivers' perspectives. The analysis was conducted in consultation and through
discussion with the second and third author, who also read transcripts and made
narrative reports, and through peer debriefing with academic and professional experts
in architecture, care for older people, and organizational studies. Such
multidisciplinary teamwork contributes to a deeper and more nuanced understanding
of the data (Dierckx de Casterlé et al., 2012, p. 370).
Ethical issues
This study was approved by the ethical committee of [name and fi le number
omitted for blind review]. Residents, caregivers, facility directors, and architects were
informed about the study orally and in written form, with the opportunity of asking
questions.
The researcher was not affiliated with Heather House. Through her doctoral study,
she had gained experience in conducting participant observation in a residential care
facility and interviewing frail and older people. The interviews with residents were
adjusted to each resident's capacities in terms of timing and length, content and
wording of questions. Residents were free to participate in the interview alone, or to
choose a con fi dante to join. This could be a family member, friend or professional
caregiver who could help with verbal communication, o ff er emotional support, or
suggest to pause or end the interview when noticing any discomfort in the interviewee.
All interviewed residents said to feel comfortable in doing the interview alone and
gave informed consent.
In this manuscript, details that might allow identi fi cation of participants by
externals have been omitted. A pseudonym is used to refer to the residential care
facility. However, since graphics are indispensable when analyzing architecture,
people familiar with the facility may recognize it.
Discussion
In societies with aging populations, the growing need for (re)new (ed)
residential care facilities makes the study of how people experience them timely. Our
case study of the role of architectural features in how resident and caregiver
experience a newly built residential care facility contributes to a growing body of
research that is relevant to social sciences and architectural design. The themes we
derived stay close to the data. Situating them within a socio-historical context and
linking them with available theoretical concepts yields broader insights and points of
discussion.
Socio-historically, the emphasis on freedom exemplifies older and frail people's
process of emancipation visible in societal discourses on dwelling and care (see
Introduction). Our results present the experi- ences of people compelled to move to a
care facility due to health problems. They balance being free with being bound to a
social and physical framework. This framework can either support or hinder freedom.
Theoretically, this can also be understood in terms of the dialectic of autonomy and
security (as de fi ned by Parmelee and Lawton (1990, pp. 465 – 466)): residents
balanced “freedom of choice, action, and self-regulation of one's life space” with
being “ limited by, and aidedby dependable physical, social, and interpersonal
resources”. The importance of both autonomy and security may explain why residents
highly valued their private room. Indeed, a private room a ff ords both (Van
Steenwinkel, Baumers, & Heylighen, 2012, p. 202).
Freedom of movement was the most important theme in residents' experiences
relating to architecture. To date, the interventions imple- mented to prevent residents
from running away, getting lost or injured, and to prevent wandering have been
characterized by a restrictive, “antinomadic” (Tirado, Callen, & Cassian, 2009, p.
373) type of care inside the care facility. In this way, constant supervision is needed
and, thus, regulating risk and freedom of movement is a challenge shared by
caregivers and residents (Tirado et al., 2009, p. 373). Yet, our study suggests that
increasing freedom of movement by creating a safe and accessible environment is
more pleasant and easy for residents and caregivers. Yet, this regained freedom in
Heather House was only partial, since diversity amongst residents entails that
supervision and safety measures needed for some residents also limit the (experienced)
freedom of movement for others. Freedom of movement remains the subject of
tensions and constant negotiation (Gilmour, Gibson, & Campbell, 2003).
Caregivers at Heather House aim to realize a contemporary vision on
dwelling and care, i.e., ‘small-scale normalized living’, which holds in its de
finition a strong emphasis on family-like group living within a household (Coomans,
De Smet, & Heylighen, 2011, p. 332). Our study challenges this idea of residents
forming a household in residential care facilities. Indeed, we found amongst residents
a limited sense of group belonging, and, even more, clear instances of‘othering’, i.e.
practices of setting a group of people apart as different (Lepianka, 2015, pp. 1098–
1099; Mountz, 2009). On top of a variety in physical and cognitive abilities,
residents had very di ff erent sociocultural back- grounds, and did not know or chose
each other before moving into Heather House. Thus, they experienced ‘ social
freedom of movement ’ , yet only within the boundary of the collective living
setting, which was too limiting for some of them.
A family-like collective living might be preferable for some. Yet, considering
diverse preferences amongst current and future residents, an environment that holds
an ambiguity between private and collective living may be more sustainable. Even
more, because we think that one perfect or correct design does not exist, a variety of
residential care facilities in terms of private and collective living would enhance
people's freedom of choosing a facility.
The emphasis on home and hominess in contemporary care discourses is a
reaction against care institutions where residents/ patients are subjected to rigid day
schemes and regulations, have little autonomy, and are patronized and separated from
society (Declercq, 2000; Elf et al., 2015; Mens & Wagenaar, 2009; van der Kooij,
1987). “While such institutions”, Hockey (1999) notes, “share the title of ‘home’,
they have few attributes, spatial and social ones, of what one could call as an ideal
home ” . Although the interviewed residents did not or hardly talked about Heather
House as their home, they did emphasize freedom and favorable social dynamics, two
aspects care- givers related to hominess. Thus, Heather House – small-scale, and
generous in terms of space– may be considered as an example of how to introduce
socio-spatial features of home.
Holiness is an important aspect of Heather House's care vision. Since
caregivers had been hired for realizing this vision, they likely had a colored view,
and the generally positive tenor in their accounts might indicate a trained and
collectively spread narrative. However, their positive appreciations were underpinned
by concrete examples. Thus, in the case of Heather House “ both the
architecture and the way the work environment is shaped by rules and expectations
of conduct contribute to the narratives evoked by buildings” (Kearns, 2007, p.
127).
For caregivers Heather House had an ambiguous character of being a place
for both dwelling and care. Our study showed that, despite some limitations, the
architecture matched caregivers' vision on dwelling and care, and, thus, helped them
realizing this vision. This tallies with the idea that a place can be de fined as “ a
milieu comprising a physical setting within which activities occur [ … ] and
having inherent yet largely implicit socially shared understandings that enable eff
ective coaction” (Diaz Moore, 2004, p. 298).
Our case study provides insight into how architectural features may play a role in
residents' and caregivers' experiences. Small-scaleness, spatial generosity and
accessibility were the themes we used to capture multiple architectural features that
appeared to have such role: spatial articulation, compactness, available room to
maneuver, variety of places (indoor and outdoor), number of floors, open plan,
etc. These features cannot be linked one-to-one with people's experiences. They need
to be considered holistically (Calkins, 2001). Heather House is an example of how a
residential care facility can be designed to foster freedom of movement, action, choice,
social movement, as well as – at least for caregivers – a sense of hominess. In
short it consists of a compact cluster of private rooms and multiple common rooms
around a patio in an open plan; dwelling units are grouped in building blocks of two
floors high, plus basement; it has articulated façades; and it is spatially integrated in
the neighborhood (Fig. 1). This case study contributes to an accumulative knowledge
base of thoroughly studied architectural design strategies for residential care facilities.
Such a knowledge base is expected to arm architects and professional care- givers
involved with design for older people with a range of design strategies for thinking
about new and improved designs.
Although residents and caregivers often contrasted Heather House with other
facilities they knew, an in-depth comparative study has not been conducted. However,
they speci fi cally indicated Heather House's improvements compared to more
“ traditional ” facilities, and its weak- nesses that should be eliminated in future
designs. Our study included a rather small and diverse sample of interviewees. Their
diverse experi- ences might inspire further research on how residents' health condition
or sociodemographic characteristics, and caregivers' education level a ff ect their
architectural preferences.
 Conclusion
We aimed to gain insight into residents' and caregivers' experiences living and
working in a residential care facility and the role of architectural features therein. Our
analysis foregrounds an urge for emancipation, reflected in experiences of freedom of
movement, action and choice, and social freedom of movement; values of high
importance to residents and caregivers. However, for most residents, these forms of
freedom were only available within the boundaries of the facility – a collective
housing setting – to which they had been assigned. Our study shows how freedom
can be enhanced by architectural features like small-scaleness, generosity and
accessibility, while continuously balan- cing freedom, on the one hand, and safety and
support on the other. Our study challenges the idea of family-like group living. Since
we found limited sense of group belonging amongst residents, our fi ndings
suggest to rethink residential care facilities in terms of private or collective living in
order to address residents' social freedom of move- ment.
‘Hominess’ in caregivers' accounts referred to freedom of movement, action
and choice, to favorable social dynamics and the building's residential character.
Being homey to caregivers, Heather House's architectural design matched their vision
on dwelling and care and, thus, helped them realizing this vision.
 建筑设计如何在老年人的院舍护理中提供自由体验

关键词：建筑设计，设施，老年人，经验，自由，未来愿景

文字摘要

人的价值观和社会问题塑造了老年人居住和护理的愿景，其中老

年人居住在养老院中。这些设施的建筑设计被认为在实现护理愿景方

面发挥着重要作用。但是，该角色在研究中很少受到关注。

本文介绍了一个住宅护理设施的案例研究，建筑师为此做出了相

当大的努力，以使设计与护理愿景相匹配。该研究为居民和看护者在

该设施中的生活和工作经历以及建筑特征在其中的作用提供了见解。

一个单一的定性案例研究设计用于提供深入的上下文见解。这些

方法包括对居民和看护者的半结构化访谈，以及参与者的观察。通过

与建筑师进行半结构化访谈以及现场观察，从设计文档中获得了有关

设计意图，假设和策略的数据。

我们的分析强调了自由（尤其是行动自由）的重要性，以及体验

自由与社会和自然框架之间的平衡。它显示了可以在其中发挥作用的

建筑特征：从每个住宅单元的居民人数，规模和紧凑性来看，规模较

小；在表面积，回旋空间和各种地方方面的空间宽敞；和身体可及性。

我们的研究挑战了家庭式集体生活的观念。由于我们发现居民中的群

体归属感有限，因此我们的发现建议从私人或集体生活的角度重新考

虑住宅护理设施，以解决居民的社会迁徙自由。照顾者将“友善”与

行动，行动和选择的自由，良好的社会动力以及建筑物的居住特征联
系在一起。该设施的建筑设计被视为居家般，与护理人员的护理愿景

相符，从而帮助他们实现了这一愿景。

介绍

在世界范围内，老年人的数量正在增加（联合国经济和社会事务

部，2015 年）
。由于健康状况通常会随着年龄的增长而下降，因此对

长期护理的需求也在增长，就像在住宅护理设施中提供的一样（联合

国经济和社会事务部，2015； Van den Bosch 等，2011）。理想情况

下，这些设施符合当代护理的愿景。

关于老年人居住和照料的社会论述反映了从医学到社会模式的

演变（Declercq，2000; Elf，Fröst，Lindahl，＆Wijk，2015; Mens＆

Wagenaar，2009; van der Kooij，1987）

代主义，采用理性，客观，功能和病理的护理方法。根据医学参数或

护理需求对老年人进行分类。这种模式与光顾，污名化，制度化，排

斥和缺乏对个人特征，价值观和观点的认识有关。相应的建筑缺少与

居民日常生活相关的场所：“在古典养老院中，人们不居住”（Mens

＆Wagenaar，2009 年，第 79 页，作者翻译）。相比之下，社会模型

则强调人们的自主权，个性，社区融合与参与，规范化以及家庭（相

对于制度）（Declercq，2000； Mens＆Wagenaar，2009）。人们对老

年人的经历越来越关注。对纯医学模型的不断驳斥证明了老年人的解

放进程，他们希望避免制度化（即避免服从制度规则和惯例，以及对

活动，流动性和社会交往的限制），而是希望他们的声音能够听，继

续自己的日常生活，并尽可能多地参与社会（Mens＆Wagenaar，2009）。
物理环境在实现护理愿景方面起着重要作用（Elf 等人，2015； Kearns，

2007；Martin，Nettleton，
Buse，
Prior 和 Twigg，
2015；Mens＆Wagenaar，

2009； Van Steenwinkel，Verstraeten，＆ Heylighen，2016 年）。

从理论上讲，环境老年医学提出了几种模型，以加深对人与自然

环境之间关系的理解。例如，能力压力模型（Lawton＆Nahemow，

1973）绘制了老年人可以管理的环境（广泛定义）所施加的压力与能

力水平的关系图。 Parmelee 和 Lawton（1990）的另一种模型表明，

晚年人与环境关系的核心在于自治与安全的辩证法（以下引文，参见

Parmelee＆Lawton，1990，第 465-466 页）
。他们将自主权定义为“一

个人能够或感觉到能够通过使用自己的资源来追求生活目标的状态”，

这意味着“选择自由，行动自由和对生活空间的自我调节” –换句

话说，是对有效独立行动的认识和能力。安全是“一种将追求生活目

标与可靠的物质，社会和人际关系联系在一起，加以限制和辅助的状

态。
”安全包括人身安全，社会支持和安心，例如，没有“免受风险，

危险，关注或怀疑”。

除了关注过程（如环境压力和能力）外，“地方”作为“概念化

老年人占据的环境以及老年人与这些环境的交互的关键集成结构”，

也越来越受到关注（Wahl＆Weisman，2003 年），第 625 页）。Weisman

等人的著名场所模型。（Weisman，1997；Weisman，Calkins 和 Sloane，

1994； Weisman，Chaudhury 和 Diaz Moore，2000）认为人们是在他

们的身体，社会和护理组织环境中学习的。 Diaz Moore（2004，第

298 页）
，紧随 Gubrium（1978）之后，定义为“一个环境，其中包括
活动发生的物理环境–可以认为是由各个社会群体的人们进行的–

并且具有固有的在很大程度上是隐含的，在社会上共享的，能够实现

有效合作的理解”。关于晚年生活地点的含义，对住所，身份和隐私

等概念进行了深入研究（例如，Rowles 和 Chaudhury，2005 年）。

但是，环境老年病学中的理论因效率不高而受到批评（Wahl＆

Weisman，2003，p.626）。这些理论所依据的世界观可能会阻碍研究

创新以及知识与设计实践之间的兼容性（Diaz Moore＆Geboy，2010；

Schwarz，2012； Wahl＆Weisman，2003）
。实际上，施瓦茨（Schwarz，

2012 年，第 6 页）指出，通过强调实证主义方法，环境老年病学侧

重于与环境无关的预测性理论，这些理论未能深入了解物理环境作为

衰老过程中环境因素的作用和老年人的经验。

与 Schwarz（2012）一致，我们认识到研究与案例相关的案例的

潜力，可以深入理解老年人如何以及为何体验和如何以他们的方式协

商自己的自然环境。这种理解不应旨在具有预测性，因为人们在理解

和谈判环境方面具有一定程度的自由。因此，环境没有确定力。形成

的理解可以帮助获得对类似情况的洞察力和预期，并预见替代的未来

（Flyvbjerg，2011 年，第 312 页； Geertz，1993 年，第 26 页），并

因此可以与建筑设计研究和实践相关。

本文介绍了一个针对老年人的新建住宅护理设施的案例研究-称

为 Heather House（化名）-建筑师为此付出了相当大的努力，以使设

计与护理愿景相匹配。我们旨在深入了解居民和看护者在希瑟大厦的

生活和工作经历，以及建筑特征在这些经历中的作用。
 方法

第一作者收集数据并与第二和第三作者合作对它们进行分析，此

后称为“研究者”
。

因为我们的目的是要表达对建筑在人们经验中的作用的深入理

解，所以本研究包括案例叙事，其中包括批判的现实主义者和建构主

义者（Crotty，1998）。 使用了两种数据收集技术：参与者观察以及

与居民和看护者的深入，半结构化访谈。 为了准备面试和获取背景

信息，从设计简介，建筑师提交的设计竞赛，通过与他们的半结构化

访谈以及现场观察中获得了有关设计意图，假设和策略的数据设置。

希瑟之家（Heather House）是一所住宅护理设施，用于因年老而

导致身体残障，心理社会问题，痴呆和精神病患者，自 2014 年 5 月

起投入使用。它位于一个多元文化的花园郊区，包括四个住宅单元，

可容纳 8 个人每个居民。在一个星期内，四名护理助理分别管理一个

住所。每四个住宅单元就有五名护士，一名职业治疗师和四名清洁工。

此外，实习生（每年约五名）和家庭成员获得帮助。居民可以使用非

营利组织提供的有偿服务，例如协助活动或运输。

Heather House 因其当代护理理念和创新的建筑设计而入选。它

的护理愿景与“小规模，规范化的生活”相符，这是比利时佛兰德斯

的一个著名概念，表示一种住房和护理类型，其中六到十六个人在专

业指导下组成了一个熟悉的家庭和家庭环境，在建筑上和/或社会上

都融入了社区（Van Audenhove 等，2003）。在他们的照护愿景中，

Heather House 的董事强调规范化，融合，参与和居住在家庭中的类

个住宅单元容纳八个人，该环境具有公共场所和充足的隐私。他们的

目的是提供一个补偿居民损害的环境，支持他们开展家庭活动和独立

安全地生活，提供社会迁徙自由，并使居民融入社区。根据护理愿景，

居民的日常生活不受固定护理任务的束缚，而是可以自己选择和决定

的。

建筑师以他们的设计住宅（而不是后勤）为起点。每个居住单元

由光线充足的居住场所组成，这些居住场所紧凑地聚集在一个开放式

（图 1b，c）
平面中的露台周围（即一个没有门的连续空间） 。两个相

邻的私人房间–本身就是小房子，带有入口，坐角，卧室和浴室（图

1d）–让位于入口，起居室，娱乐室或厨房用餐区。这些公共休息室

的大小可容纳 8 位居民，每位居民都配有推车和轮椅。这些居住单元

中的四个居住在两个高两层的建筑块中，并与一楼的一座桥相连。他

们的前门彼此面对。地下室包含一个供居民使用的浴室以及 sta ff的

（前）门和露台（图 1e）。
杂物间和储藏室。花园小径连接了花园大门，

为了将 Heather House 集成到住宅区中，该建筑沿街道站立（而不是

从街道上撤退），其立面与相邻房屋一样，被铰接成具有斜屋顶和变

化的窗户的较小部分（图 1a）
。此外，场地和建筑物还包括住宅元素，

例如绿篱，花园小径，花园大门和带灯的前门。

图 1. a）东立面铰接成较小的部分，具有倾斜的屋顶和变化的窗

户； b）地面包括两个类似的居住单元。 它们的方向不同，因此它

们的入口（用灰色标记并带有箭头）彼此面对。 c）一个住宅单元的
基本空间组织原则：围绕露台聚集的私人房间为开放式布置的多个公

共房间创造了空间； d）带有入口，坐角，卧室和浴室的私人房间；

e）场地平面图显示室外场所，花园小径，街道和附近的房屋。

案例

使用便利取样。 包括参加观察的两个住所的居民，以及所有四

个住所的护理助手。 认知上无法参加采访或不讲荷兰语的居民排除

在外。 根据研究人员在参与者观察过程中与研究人员的非正式接触

并与看护者协商，选择了居民。 表 1 和表 2 分别显示了受访者和照

顾者特征的多样性。

采访了七名居民和七名保姆。 根据访谈的丰富程度，在研究期

间确定参与者的数量。 结合参与者的观察，访谈提供了足够的材料，

以探讨建筑特征在居民和看护者体验中的作用。

数据采集

收集的数据包括笔记，图片，录音和原声录音。

参与者的观察集中在希瑟之家的实际环境中居民和看护者的日

常活动。研究人员的参与包括例如与居民和看护者交谈，与居民共进

午餐，玩圆形游戏或外出散步。她在自助餐厅桌子或扶手椅上的笔记

本电脑上记笔记，类似于看护人如何执行其管理任务。这些观察使居

民和护理人员，建筑和护理组织以及与混凝土住宅和护理有关的活动

变得熟悉。这样，观察结果有助于更好地理解和解释其背景下的采访

数据。

在采访中，首先要求居民在搬进来之前叙述他们对希瑟·豪斯的
了解和期望，以及搬迁的原因。他们还被要求描述建筑物（他们的第

一和以后的印象），并经历与其他建筑物的相似或不同之处。他们住

在希瑟楼的感觉如何；他们曾经做过或本来想做的事情。还首先要求

看护者描述建筑物（他们的第一印象和以后的印象）。他们的日常工

作是否以及如何与他们对 Heather House 的形象相符；他们在那里工

作如何？他们在住宅部门中的角色，是否完全成功完成了该任务；以

及他们在工作中发现的重要内容。对于这些问题中的每一个，都询问

了其他问题，以探究与建筑物结构所具有的潜力和局限性之间的关系。

其次，明确询问居民和护理人员体验建筑物的建筑特征，例如比

例尺，开放式平面图，楼层数以及将护理人员的办公桌集成在一个公

共房间中。

数据分析

该分析主要集中于对居民和看护者的访谈，并辅以观察说明，并

根据定性数据分析指南 QUAGOL 进行（Dierckx deCasterlé，Gastmans，

Bryon 和＆Denier，2012 年）
。 QUAGOL 涵盖两个部分：

（1）通过叙述方式并确定和反映主题来进行编码过程的准备；

（2）实际的编码过程包括描述，分析，解释和发展概念之间的相互

作用（Dierckx deCasterlé等，2012，第 369 页）。首先，阅读打印的

笔录，突出显示并注释文本块。然后是叙述性报告，初步概念方案，

使用定性数据分析软件 NVivo11
和代码清单。其次， （QSR International，

2015）采取系统的方法来确定经验支持。该软件有助于搜索和组织数

据，以及检索标有特定代码的数据。在根据经验支持进行测试之后，
对初步的概念方案进行了调整和进一步发展，最后进行了描述。

采用了不同的策略来增强调查结果的可信度。 包围用于抵消偏

见。 通过将参与者的观察和访谈相结合，并纳入居民和看护者的观

点，对方法和数据进行了三角测量。 分析是在与第二和第三作者进

行协商和讨论之后进行的，第二和第三作者也阅读了成绩单并作了叙

述性报告，并与建筑，护理老年人和组织研究领域的学术和专业专家

进行了同伴交流。 这种跨学科的团队合作有助于更深入，更细致地

理解数据（Dierckx deCasterlé等人，2012，第 370 页）

伦理道德问题

这项研究得到了伦理委员会的批准，[姓名和文件号省略了以供

盲目审查]。通过口头和书面形式向居民，护理人员，设施负责人和

建筑师通报了这项研究，并有机会提出问题。

研究人员与希瑟·豪斯没有关系。通过她的博士研究，她获得了

在居民护理机构进行参与者观察以及采访虚弱和老年人的经验。根据

时间和时间长短，问题的内容和措辞，对居民的访谈进行了调整，以

适应每个居民的能力。居民可以自由参加单独的面试，也可以自由选

择参加采访。这可能是家庭成员，朋友或专业照料者，可以帮助他们

进行口头交流，提供更多的情感支持，或者在注意到被访者的任何不

适时建议暂停或结束访谈。所有受访居民表示，对单独进行采访感到

自在，并给予了知情同意。

讨论内容

在人口老龄化的社会中，对（更新）（居住）住所护理设施的需
求不断增长，这使得人们需要及时研究他们的生活方式。我们对建筑

特征在居民和看护者体验新建住宅护理设施中的作用的案例研究促

进了与社会科学和建筑设计相关的越来越多的研究。我们得出的主题

与数据保持紧密联系。将它们置于社会历史环境中并将它们与可用的

理论概念联系起来，可以产生更广泛的见解和讨论要点。

从社会历史上讲，对自由的强调体现了老年人和体弱的人们在住

房和护理方面的社会论述中可见的解放进程（请参阅“简介”
）。我们

的结果显示了由于健康问题而不得不搬到护理机构的人们的经历。他

们在自由与约束于社会和自然框架之间取得平衡。这个框架可以支持

或阻碍自由。从理论上讲，这也可以用自治与安全的辩证法来理解（由

Parmelee 和 Lawton（1990，第 465-466 页）定义）：居民平衡了“选

择自由，行动自由和生活自我调节”空间”
，“受到可靠的物质，社会

和人际关系资源的限制和辅助”。自治和安全的重要性可以解释为什

么居民高度重视自己的私人房间。确实，这两个房间都是私密的（Van

Steenwinkel，Baumers 和 Heylighen，2012 年，第 202 页）

行动自由是居民与建筑相关的体验中最重要的主题。迄今为止，

为防止居民逃跑，迷路或受伤以及防止流浪而实施的干预措施具有限

制性的“反种族主义”特征（Tirado，Callen 和＆Cassian，2009 年，

第 373 页）
。护理机构内部的护理。这样，就需要持续的监督，因此，

调节风险和行动自由是护理人员和居民共同面临的挑战（Tirado 等，

2009，第 373 页）。然而，我们的研究表明，通过创建一个安全且可

及的环境来增加行动自由对于居民和看护者而言更加愉快和容易。然
而，在希瑟庄园获得的这种自由只是部分的，因为居民之间的差异意

味着对某些居民所需要的监督和安全措施也限制了其他人的（有经验

的）行动自由。迁徙自由仍然是紧张局势和不断进行谈判的主题（吉

尔默，吉布森和坎贝尔，2003 年）。

在本手稿中，省略了可能允许外部人员识别参与者的细节。笔名

用于指代住宅护理设施。但是，由于图形在分析体系结构时必不可少，

因此熟悉此功能的人可能会认识到它。

健康护理中心的护理人员旨在实现当代的住宅和护理愿景，即

“小规模规范化生活”，在其定义中着重强调了住在家庭中的类似家

庭的群体（Coomans，De Smet 和 Heylighen ，2011，第 332 页）。我

们的研究挑战了居民在养老院中建立家庭的想法。确实，我们在居民

中发现了有限的群体归属感，甚至还有明显的“其他”实例，即将一

群人区分开来的做法（Lepianka，2015 年，第 1098-1099 页； Mountz，

2009 年） ）。除了各种各样的身体和认知能力外，居民拥有非常不

同的社会文化背景，并且在搬进希瑟庄园之前并不认识或彼此选择。

因此，他们经历了“迁徙的社会自由”，但仅在集体生活环境的边界

内，这对他们中的某些人来说太过局限了。

对于某些人来说，家庭式的集体生活可能更可取。但是，考虑到

当前和未来居民的不同偏好，在私人生活和集体生活之间存在歧义的

环境可能更可持续。甚至，由于我们认为不存在一种完美或正确的设

计，因此就私人和集体生活而言，各种住宅护理设施将增强人们选择

设施的自由。
 当代护理话语中对家和友善的强调是对护理机构的一种反应，在

该机构中，居民/患者要遵守严格的日间计划和规定，几乎没有自治

权，受到光顾和与社会隔离（Declercq，2000； Elf 等， 2015; Mens

＆Wagenaar，2009; van der Kooij，1987）。 Hockey（1999）指出：

管有这样的机构，但它们拥有'房屋'的称号，但它们在空间和社会属

性上几乎没有所谓的理想住所”。尽管受访者没有或几乎没有谈论希

瑟之家作为他们的住所，但他们确实强调了自由和良好的社会动力，

这两个方面与照顾者有关。因此，希瑟之家（小面积，宽敞的空间）

可以被视为如何引入房屋的社会空间特征的示例。

忠诚是希瑟·豪斯（Heather House）护理愿景的重要方面。由于

已聘请看护者来实现此构想，因此他们可能会有不同的看法，并且其

账目中总体上积极的男高音可能表示经过训练且集体传播的叙述。但

是，他们的积极赞赏得到了具体例子的支持。因此，在希瑟·豪斯

（Heather House）的案例中，“建筑和工作环境都受到规则和行为期

望的影响，都对建筑物引起的叙事产生了影响”（Kearns，2007 年，

第 127 页）
。

对于看护人而言，希瑟·豪斯（Heather House）具有一个模棱两

可的特征，既是住所又是护理场所。我们的研究表明，尽管存在一些

局限性，但该体系结构与护理人员的住所和照护愿景相匹配，因此帮

助他们实现了这一愿景。这与一个地方可以定义为“一个环境包括活

动发生的物理环境[…]，并具有能够实现有效合作的内在但很大程度

上隐含的，在社会上共有的理解”的想法相吻合（Diaz Moore，2004
年，第 298 页）
。 。

我们的案例研究提供了有关建筑特征如何在居民和护理人员的

体验中发挥作用的见解。小规模，空间大方和可及性是我们用来捕捉

似乎具有这种作用的多个建筑特征的主题：空间清晰度，紧凑性，可

操纵的空间，各种场所（室内和室外），楼层数量，开放式等等。这

些功能无法与人们的体验一对一地关联。必须从整体上考虑它们

（Calkins，2001）。希瑟之家就是一个例子，说明如何设计住宅护理

设施以促进行动自由，行动自由，选择自由，社交活动，以及（至少

对于看护者而言）一种友善感。简而言之，它由紧凑的私人房间集群

和围绕开放式露台的多个公共房间组成；住宅单元分为两层，外加地

下室。它具有清晰的立面；并且它在空间上整合在附近（图 1）。本

案例研究为积累的知识基础做出了贡献，该知识基础已深入研究了住

宅护理设施的建筑设计策略。这样的知识库有望为涉及老年人设计的

建筑师和专业护理人员提供一系列设计策略，供他们思考新的和改进

的设计。

尽管居民和看护人经常将希瑟之家与他们知道的其他设施进行

对比，但尚未进行深入的比较研究。但是，他们具体指出了希瑟·豪

斯（Heather House）与更多“传统”设施相比的改进，以及其弱点应

在以后的设计中消除。我们的研究包括一个相当小的且多样化的受访

者样本。他们的丰富经验可能会激发人们进一步研究居民的健康状况

或社会人口统计学特征以及看护者的教育水平如何影响他们的建筑

偏好。
 结论

我们旨在深入了解居民和护理人员在住宅护理设施中的生活和

工作经验，以及其中的建筑特色。我们的分析着眼于解放的渴望，体

现在行动自由，行动和选择自由以及社会行动自由的经验中；对居民

和照顾者高度重视的价值观。但是，对于大多数居民而言，这些自由

形式仅在他们被分配到的设施范围内（集体住房环境）内可用。我们

的研究表明，如何通过小型，慷慨和可及性等建筑特征来增强自由，

同时一方面不断平衡自由，另一方面又保证安全和支持。我们的研究

挑战了家庭式集体生活的观念。由于我们发现居民中的群体归属感有

限，我们的发现建议从私人或集体生活的角度重新考虑住宅护理设施，

以解决居民的社会迁徙自由。

照料者中的“诚实”指的是行动，行动和选择的自由，良好的社

会动力和建筑物的居住特征。作为照顾者的家，希瑟·豪斯（Heather

House）的建筑设计与他们对住所和照料的愿景相符，从而帮助他们

实现了这一愿景。

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