Executive Summary of Key Concepts

Objective: This case study examines the implementation of inpatient telemedicine in COVID-19 intensive care units (ICUs) and explores the impact of shifting forms of visibility on the management of the unit, staff collaboration, and patient care. Background: The COVID-19 crisis drove healthcare institutions to rapidly develop new models of care based on integrating digital technologies for remote care with transformations in the hospital-built environment. The Sheba Medical Center in Israel created COVID-19 ICUs in an underground structure with an open-ward layout and telemedicine control rooms to remotely supervise, communicate, and support the operations in the contaminated zones. One unit had a physical visual connection between the control room and the contaminated zone through a window, while the other had only a virtual connection with digital technologies. Methods: The findings are based on semistructured interviews with Sheba medical staff, telemedicine companies, and the architectural design team and observations at the COVID-19 units during March–August 2020. Results: The case study illustrates the implications of virtual and physical visibility on the management of the unit, staff collaboration, and patient care. It demonstrates the correlations between patterns of visibility and the users’ sense of control, orientation in space, teamwork, safety, quality of care, and well-being. Conclusions: The case study demonstrates the limitations of current telemedicine technologies that were not designed for inpatient care to account for the spatial perception of the unit and the dynamic use of the space. It presents the potential of a hybrid model that balances virtual and physical forms of visibility and suggests directions for future research and development of inpatient telemedicine.

Michael Magazine, Matt Murphy, Daniel P. Schauer, Neal Wiggermann. Failing to provide enough bariatric beds may negatively affect outcomes for patients and healthcare workers, whereas owning more bariatric beds than required to meet demand incurs unnecessary cost. This research developed a simplified model that allows practitioners to determine the number of beds that minimize equipment costs while meeting demand. One year of hospital admissions data were used to determine arrival rates and lengths of stay for patients of size (>300 pounds). Two subsequent years verified the consistency of these rates. High-fidelity simulations modeled the flow of patients of size through the hospital and the service level associated with the number of beds owned. A minimization function determined the optimal number of bariatric beds to be acquired. The simplified model produced similar results to more complex simulation. The model was robust and identified substantial opportunity for cost savings compared to moderate over-or underestimations of demand. The approximation model and cost optimization proposed in this research can be used in many situations to prevent costly errors in equipment planning. However, hospitals should be aware of the model limitations and should consider customized simulation to estimate demand for high-cost equipment or unique circumstances not fitting the assumptions of these models.
Telemedicine Implementation in Michael Barrett,Eivor Oborn,Galia Barkai,Itai M. Pessach,Eyal Zimlichman. The COVID-19 crisis drove healthcare institutions to rapidly develop new models of care based on integrating digital technologies for remote care with transformations in the hospital-built environment. The Sheba Medical Center in Israel created COVID-19 ICUs in an underground structure with an open-ward layout and telemedicine control rooms to remotely supervise, communicate, and support the operations in the contaminated zones. Some units have a physical visual connection between the control room and the contaminated zone through a window, while others have only a virtual connection with digital technologies. The case study, based on semi-structured interviews and observations during March-August 2020, illustrates the implications of the virtual and physical visibility on the management of the unit, staff collaboration, and patient care. It demonstrates the correlations between patterns of visibility and the users' sense of control, orientation in space, teamwork, quality of care, and wellbeing. The case study demonstrates the shortcoming of current telemedicine technologies that were not designed for inpatient care to account for the spatial perception of the unit and the dynamic use of the space. It presents the potential of a hybrid model that balances virtual and physical forms of visibility and suggests directions for future research and development of inpatient telemedicine. Shannon E. Ronca, Rodney X. Sturdivant, Kelli L. Barr, Debra Harris. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the causative agent of severe coronavirus disease , declared a pandemic in March 2020. As materials and methods of disinfection became scarce during the initial rise in infections, concerns for decontamination of healthcare environments remained paramount. The role of surface materials in the transmission of disease is still not completely understood. Addressing the immediate needs of healthcare administrators and future design considerations, this research focused on decay rates of the virus on a variety of indoor surface materials with differences and similarities providing important information to inform the specification of materials for healthcare facilities.

SARS-CoV-2 Viability on 16 Common Indoor Surface Finish Materials
The results indicate that there were differences in the decay rates across the materials studied. Some materials showed a sharp virus decay while, for others, virus decayed more slowly, but most of the materials sampled indicated no active virus by twelve hours, suggesting that breaking the cycle as often as possible with appropriate disinfection methods and materials will lessen the risk of transmission of infection from surface material to human.

From Fable to Reality at Parkland Hospital:
The Impact of Evidence-Based Design Strategies on Patient Safety, Healing, and Satisfaction in an Adult Inpatient Environment Renae K. Rich, Francesqca E. Jimenez, Susan E. Puumala, Sheila DePaola, Kathy Harper, Lonnie Roy, Jeri Brittin. Many common healthcare design strategies incorporated in the new Parkland Hospital design-acuity-adaptable and same-handed single patient rooms, decentralized nurse stations, on-stage off-stage unit layout, and a connection to nature-are frequently promoted to benefit patients without strong evidence to support the claims. This study evaluated the effects of the design on adult inpatient outcomes: patient healing measured through length of stay (LOS); patient safety incidents of falls, hospitalacquired infections (HAI), and medicationrelated events; and satisfaction from standard patient surveys. These outcomes are often linked to judgements of quality of care and are used to assess doctors and hospitals.
We did not find changes in healing and safety outcomes directly connected to the hospital design. An increase in falls over time in Surgical & Trauma units appeared unaffected by the move. Medication events decreased consistently over time, with events causing harm dropping after the move. There was no obvious change in patient LOS, HAI, or falls in other inpatient divisions. The new hospital improved patient satisfaction outcomes related to the environment, including comfort, noise, temperature, and aesthetics. Nearly all patient satisfaction aspects studied improved immediately after the move, indicating possible causal connections to the new facility design.

Effect of Spatial Ambiances on the Patient Satisfaction and Well-Being in Hospitals: The Case of UHC Ibn Sina Annaba and UHC Benbadis Constantine-Algeria
Soundouss I. Talantikite and Meriama Bencherif. This research puts under study the relationship between the patient and ambiance-related physical factors of space, in order to understand the effect of architectural ambiance on patient satisfaction and well-being. A practical study was conducted based on descriptive, principal component analysis and statistical tests applied on the responses from a 19-item questionnaire at the neurology department of two hospitals in Eastern Algeria. Surrounding physical variables on the relationship between architecture and health, this analysis demonstrates the sensitive relationship between the quality of architectural space ambiance and patient well-being. Indeed, the disorders inherent in neurological diseases could favor a particular relationship to space, which could either help treat or further deteriorate these disorders.

Study of the Physical Environment of Waiting Areas and Its Effects on Patient Satisfaction, Experience, Perceived Waiting Time, and Behavior in China
Xiaodong Xuan, Zongfei Li, Xixi Chen, Yuan Cao, Zihao Feng. The physical environment design of outpatient waiting areas should consider how patients' experiences are affected by the built environment in which care is provided. This study employed actual physical environmental measurements, observations, questionnaire surveys, and an analysis of plan drawings to examine the physical environmental elements in outpatient waiting areas. The main aim of this study was to determine the variable(s) that best predict patient satisfaction, experience, and perceived waiting time and to find the most frequent behaviors and whether these behaviors differ across waiting areas with different physical environments. The results showed that better design elements such as positive distraction via visual art on the wall, good acoustic environment, comfortable furniture, a clear signage system, clean and odorless restrooms, uncrowded space, and exposure to nature views and light positively impact patients' experience and behavior in the waiting area. Therefore, patient satisfaction, waiting experience, and perceived waiting time could be improved by enhancing the physical environment, which has implications for patientcentered design.

Health Literacy in Hospital Outpatient Waiting Areas: An Observational Study of What Is Available to and Accessed by Consumers
Cassie E. McDonald, Louisa J. Remedios, Catherine M. Said, Catherine L. Granger. Health literacy is a global issue. Outpatient waiting areas commonly offer health information, resources and supports for consumers to use whilst waiting for their appointments. Health information, resources and supports which are available, accessible to, and meet the needs of consumers have potential to improve health literacy. This study investigated what health information, resources and supports were available to and accessed by consumers in hospital outpatient rehabilitation waiting areas.
A researcher observed the waiting area environment in-person and via video recordings. Observations were recorded on purpose designed instruments. In part 1, the available health information, resources and supports were identified and recorded. In part 2, the number of times and for how long these were accessed was recorded. Other observed interactions and activities were also recorded.
A range of health information, resources and supports were available for consumers in the waiting areas at both sites. Only a limited number were infrequently, and very briefly accessed by consumers.
This indicates that the available health information, resources and supports may not be meeting the health literacy needs of consumers. Further research is needed to understand how waiting areas should be designed to promote and improve health literacy.

Perceptions of Psychotherapy Waiting Rooms: Design Recommendations
Lilly Noble and Ann Sloan Devlin. This study contributes design guidelines for psychotherapy waiting rooms. In this quantitative study, 225 individuals rated 20 photographs of the waiting rooms of psychotherapy offices of 12 practitioners in southern New England. The participants were asked to rate the photos on the level of comfort they would feel in the particular waiting room and the quality of care they thought would be provided by the practitioner in the setting. People were also asked to indicate what features of the waiting rooms influenced their judgments. The responses showed that waiting rooms that were spacious were favored, as were those with a variety of seating choices and those where the seating provided privacy. The low ratings for cramped and crowded spaces shows that guidelines are needed to inform the design of such waiting areas; further, many of the waiting areas had bare walls and outdated furniture. Moreover, few therapists reported any design training and none about the waiting room, suggesting the need for counselor education to consider all of the spaces involved in the experience of therapy.

Research in the Healthcare Design Practice: Design Practitioners' Perspective
Sara Bayramzadeh and Tina Patel. Healthcare design is one of the most complex sectors in the architecture industry. Healthcare systems' familiarity with the value of evidence has urged practitioners to make an effort in adopting research in the design practice. Although design practice tends to rely on best practices, literature shows research can impact healthcare outcomes, such as patient safety, patient experience, and efficiency. While research is proving to be an effective tool, its integration in the design process has been a challenge. This study explored design practitioners' level of knowledge about research and their attitude and perception of research integration into the design solution utilizing a survey method. The results indicated that healthcare practitioners recognize the value of research in improving design decisions and healthcare outcomes. However, lack of expertise, the difficulty of alignment between project and research timelines, associated high costs, clients' unwillingness to invest financially are hurdles in applying research. Research offers benefits, such as improving design decisions, credibility for the firm, helping clients determine value, and improving design outcomes. Practitioners indicated they are most likely to use research in the early phases of design and programming. Thus, facilitating research integration in this phase can be beneficial.

Hospital Architecture in Spain and Italy: Gaps Between Education and Practice
Laura Cambra-Rufino, Andrea Brambilla, José León Paniagua-Caparrós, Stefano Capolongo. This study analyses the challenges and limitations of Spanish and Italian hospital design. These two countries face contemporary challenges (such as elderly population, staff retention, and obsolete healthcare facilities) and have similar issues of life expectancy, health expenditure, hospital beds provision and decentralized tax-financed healthcare systems.
By analyzing the education offer from universities of both countries, this study depicts the existing sources of the practitioners' knowledge. Additionally, an online survey of relevant practitioners provides a detailed description of current practices of office typologies (size, years of experience), hospital architecture skills (educational background, professional certifications, conferences, and associations) project types (sector, clients, and procedures) and the design process (methods, sources of information and team composition).
The results suggest several ways to improve hospital design quality in Italy and Spain by promoting multidisciplinary teams (in practice and education), increasing the education offer and encouraging research application to national needs. These issues are particularly relevant for those countries, but general lessons can be learned to advance healthcare design research globally.

Lessons Learned From Decentralization of an Elective Surgery Medical-Surgical Unit
Laurie Waggener, Debajyoti Pati, Apoorva P. Rane, Esteban Montenegro-Montenegro, Ellen Angelo. This before-after study offers further insight into the outcomes of decentralized nursing. An innovative, hybrid decentralized unit layout for a medical-surgical unit was examined. Outcomes were measured in patient falls and physical environment supportiveness. Decentralization had initially been hypothesized to address numerous challenges including efficiencies, safety, visibility, errors, and productivity. Studies have, however, produced conflicting findings in some areas. The novelty of this project site lies in the unit layout design. Clinicians and designers have traditionally considered decentralized pod designs as providing proximity to support spaces, but lacking in flexibility in response to census as well as in teamwork. The neighborhood design implemented in this project offers both the advantages of smaller patient room clusters and crossneighborhood collaboration/support. Data show some favorable and some unfavorable outcomes. Findings suggest that the success of a unit cannot be achieved without coordinated and successful interventions in the areas of operations, processes, policies, culture, and the physical design, thereby providing insight into necessary corrective measures in future projects.

Does the Laminar Airflow System Affect the Development of Perioperative Hypothermia? A Randomized Clinical Trial
Recai Dagli, Fatma Ç elik, Hüseyin Ö zden, Serdar Ş ahin. Different heating, ventilation, and airconditioning systems (HVAC) are used in the operating room, such as laminar airflow (LAS-OR) and conventional turbulent airflow systems (CAS-OR). Is laminar airflow, which directed towards the patient in LAS-OR cause the faster heat loss and higher IPH rates? We aimed to compare tympanic membrane temperature changes and the incidence of inadvertent perioperative hypothermia (IPH) in patients undergoing laparoscopic cholecystectomy under general anaesthesia in LAS-OR and CAS-OR.
In prospective, randomized our study, we divided two hundred patients with simple randomization, as group LAS and group CAS, and took the patients into the LAS-OR or CAS-OR for the operation. The tympanic membrane temperatures of patients were measured before anaesthesia induction and then every 15 minutes during surgery. We calculated changes in temperatures.
In the first 30 minutes, there was a temperature decrease of approximately 0.8 C(1.44 F) in both groups. IPH occurred in more than half of the patients in the entire surgical evaluation period in group LAS and group CAS.
IPH is seen frequently in both HVAC systems. Airflow directed towards the patient in LAS-OR causes no faster heat loss and higher IPH rates according to this study.

Understanding Older Adults' Perception and Usage of Indoor Lighting in Independent Senior Living
Daejin Kim, Carl Chang, Jennifer Margrett. The main purpose of this research is to examine the lighting condition and residents' perception of lighting in a senior retirement community in order to understand various environmental issues related to lighting. Also, this research aims to suggest a new lighting solution to compensate for older adults' vision impairment and challenges at home for a successful aging place. Via a mixed-method study design, residents were asked to describe the adequacy of light levels and specific tasks and needs related to lighting at their home. In addition to the survey and interview, indoor lighting assessments were conducted during the in-home session. Survey results show that older residents tended to report satisfaction with their lighting conditions in most places, but many residents described that there are multiple issues in the living room because of inappropriate lighting for their specific activities, such as reading a book or newspaper. Interestingly, there were significant differences of fear of falling by age and visual impairment, but this research failed to find any different perception of lighting between groups. Also, lighting assessment showed that everyday lighting condition were inadequate compared to IESNA standards even though the senior living community provides good quality lighting.
The research findings can be empirical evidence of the indispensable needs of a new lighting system. In order to address various challenges which older adults have been experiencing in their home for a long time, this research suggests new smart lighting platform which provides a proper level of illumination in older adult's homes. Such a smart platform is proactive and can dynamically adjust the smart devices or lighting fixtures in situ while older adults are performing certain tasks so that proper lighting levels can be achieved.

Built Environment and Self-Rated Health: Comparing Young, Middle-Aged, and Older People in Chengdu, China
Yingying Lyu, Ann Forsyth, Steven Worthington. This study explored how environmental and other factors could influence health in different age groups. Using a mixed method logistic regression model, we analyzed survey data from 1,019 residents aged 18-70 recruited with a clustered random sampling approach in Chengdu, China, in 2016. We found that in the older group, on average, the probability of reporting better health among those living in the multi-floor buildings of up to six floors was 0.42 times of that among those living in one-floor or high-rise elevator buildings of seven floors and more. Further, older people who had a household smoker and fewer exercise hours per week had significantly lower probability of reporting better health. These relationships were not found in middle-aged and younger groups. The low-rise multi-floor buildings in Chengdu usually do not have elevators. Difficulty in using stairs can curtail older people's outdoor activities. We recommend that, to build a healthy living environment for all ages, it is necessary to upgrade multi-floor walkup apartments with elevators, especially in communities where older people may concentrate. New designs of multi-floor apartments should have elevators. This is especially meaningful for promoting health in cities in developing countries like Chengdu, China.

Walking in Your Culture: A Study of Culturally Sensitive Outdoor Walking Space for Chinese Elderly Immigrants
Pai Liu, Matthew Powers, Cheryl Dye, Ellen Vincent, Mary Padua. This is a study examining the relationship between visual preference and walking desire. How does the design of outdoor spaces of culturally sensitive care facilities affect the desire of elderly Chinese to use the space, especially for walking? A visual preference survey was used to assess preferences of Chinese elderly immigrants attending a care facility setting who had an average time of 26 years living in the United States for either Chinese classical walking spaces or American modern walking spaces. Survey results revealed that respondents had a high preference for Chinese classical walking spaces. The cultural features in the outdoor spaces enhanced their willingness of using the outdoor spaces. These results support the significance of culturally sensitive care environments in promoting outdoor walking for elderly Chinese immigrants.

Exploring the Relationship Between Perceived Visual Access to Nature and Nurse Burnout
Sahar Mihandoust, Debajyoti Pati, Jaehoon Lee, Jamie Roney. When designing a hospital, it is important to consider health outcomes for care providers and care takers as well as the patients. Nurse burnout is a severe problem among nurses and impacts many nurse and patient related outcomes in the hospital. Literature suggests that visual access to nature affects many burnout related outcomes, therefore, this study examined the relationship between the perceived visual access to nature and nurse burnout in nurse work and break environments.
Study results suggested that nurses who reported perceiving higher percentage of nature views in their 12-hour shifts, also reported lower levels of emotional exhaustion and depersonalization. Percentage of perceived nature views were found to be among the top predictors correlating with two subscales of MBI: emotional exhaustion and depersonalization. The results of this study suggest that the unit and breakroom design, accommodating access to nature views, could work as a consistent preventive intervention for nurse burnout.

Small Garden, Big Impact: Emotional and Behavioral Responses of Visitors to a Rooftop Atrium in a Major Hospital Kelly Martin, Luana Nanu, Wi-Suk Kwon, David
Martin. Despite the growing interest in healing gardens in hospitals, there has been a significant lack of a generalized measure to assess perceptions of specific design elements in healing gardens. This study addresses the process by which consumers experience emotional and behavioral responses to the healing garden and the hospital as a whole. The findings of this study provide further support for the Theory of Supportive Gardens and highlight the importance of the inclusion of healing gardens in hospitals.

Effects of Biophilic Nature Imagery on Indexes of Satisfaction in Medically Complex Physical Rehabilitation Patients: An Exploratory Study
Matthew J. Wichrowski, John R. Corcoran, Francois Haas, Greg Sweeney, Arlene Mcgee. There is significant interest in the benefits of nature exposure and its applications in healthcare. Many areas within healthcare settings preclude exposure to real nature due to medical acuity, concerns regarding infection control, and space limitations due to room design and presence of medical equipment. Nature imagery has shown potential to convey a range of benefits in these situations. This project assessed the effects of biophilic nature imagery in hospital rooms for medically complex/cardiac rehabilitation patients as compared to similar rooms with décor as usual utilizing an environmental assessment scale (EAS) and open ended inquiry. Analysis of the EAS scale results showed significant differences in evaluations between enhanced rooms and décor as usual rooms. Qualitative responses supported the EAS results. Information gathered can serve to inform design processes and bring an added range of benefits for medical settings patients.

A National Look at Hospital Bed Tower Design
Michael J. Pingel. This study is a retrospective analysis of the built environment and design solutions developed during the past decade (2008-2018) of healthcare design. It focuses on acute patient unit measurables, including the Floor-BGSF/Bed, patient care area and key planning units. The data examined 157 design solutions from þ25 healthcare architects. The diversified sampling of design teams, user groups, and healthcare delivery models represent a broad spectrum of design solutions. The results should represent the current state of healthcare design for new facilities, horizontal expansions, and vertical expansions. Design solutions from 171 facilities were collected for review and measurement. Designs falling outside of the selection and validation criteria were excluded.
The findings were compared against three benchmarks from 2006-2008. The individual and composite comparisons would indicate that the average patient care area, 305 DGSF, 95% CI [299,311], has decreased 5%-10%. The study then analyzed how the total number of beds/unit may impact the required Floor-BGSF/Bed. The findings would indicated that facilities with 32-36 beds/unit can utilize <þ20%> less Floor-BGSF/bed than facilities with 24 beds/unit. These solutions ultimately represent balance points for internal and external constraints among program, budget, and numerous other factors.

Architecture and Mental Disorders: A Systematic Study of Peer-Reviewed Literature
Mais M. Aljunaidy and Mohamad Nadim Adi. Studies propose that physical environment design can trigger or reduce mental disorder symptoms. However, there is a lack of the knowledge about to what extent architectural design is contributing to mental disorder prevention or intervention. This systematic study builds upon previous peer-reviewed manuscripts about the effect of architectural design on mental disorders. A team of cross-disciplinary researchers were gathered information from peer-reviewed manuscripts that assessed the effect of architectural design on enhancing or reducing mental disorder symptoms. Our data showed that architectural studies focused mainly on some mental disorders. For example, there were 28 studies about dementia and 11 studies about Autism versus 3 studies about depressive disorders and no studies about personality disorders. Furthermore, we noticed that light was the main architectural theme assessed by those architectural studies when compared to other themes such as space, visual and auditory support. That could be due to the role of light/dark cycle in the nervous system well-being. As all mental disorders can have a significant impact on the society, we conclude that architectural studies should focus more on improving or preventing the symptoms of all types of mental disorders through the design of physical environments.

Mental Health Outcome Measures in Environmental Design Research: A Critical Review
Jung-hye Shin, Samuel Dennis Jr., Hassnaa Mohammed. During the last several decades, researchers have produced abundant evidence of the environmental impacts on stress, attention, and physical activity. More recently, scholars have turned their focus to the influence environments have on mental wellness. In this paper, we report on a systematic review of these studies. We categorized the research studies into six groups based on mental health outcomes: emotions, moods, vitality, executive function, stress, and general wellbeing.
Almost all of the environments studied were some form of "green space" from urban parks to forest preserves. Only a very few examined indoor environments. Participants experienced these green spaces in a wide variety of ways including, full emersion (e.g., walking in the forest), frequent visual contact (e.g., during daily commute), view from a window, and an office with an abundance of indoor plants. Others used visual images or guided visualization in lieu of direct environmental experience. Several studies used proximity to parks as proxies for actual experience of green spaces.
This review provides an introduction for environmental planners and designers to the way environments produce particular mental wellbeing outcomes. This literature supports evidencebased environmental design focused on improving these outcomes.

Specialty Space: Breast Care Centers
Diane Guevara. Breast care centers around the world vary in patient area interior design based on geographical location and trends in healthcare interior design. However, on the forefront of healthcare interior design is Evidence Based Design (EBD) and Universal Design (UD), which are derived from research on the effect that interior design has on patient well-being. This study supports future breast care center interior design, with guidelines stemming from this research. This study incorporated a thorough review of the literature, examples of eight breast care centers around the world, observations, an interview, and staff surveys of the interior design of a local breast care center. The results revealed that the interior design of the eight breast care centers, and of the local center, lacked design features that are supported by the research on patient wellbeing. This study concluded with guidelines based on EBD and UD: robes (versus hospital gowns), spa-like atmosphere with monochromatic color scheme, use of natural elements such as wood, stone and live plants or views of nature, private check-in areas, wayfinding, seating comfort and seating style choices including bariatric, personal items storage, access to natural light and indirect artificial lighting, comfort features such room temperature, flooring comfort and finally, wheelchair accessibility.

Can Physical Design Help Reduce Loneliness in the Elderly? A Theoretical Exploration
Eman Nasrallah and Debajyoti Pati. This paper explores whether the physical design of lived environments, in conjunction with social programs, could address loneliness in the elderly population. That the elderly population is dying more from loneliness and related factors than from lack of medical care has been reported lately in popular press. The problem is so pervasive that it is being described as an epidemic, affecting 17% of elderly Americans. However, loneliness is a less examined concept, and although social programs have focused on social connection/ interaction as a way to address the problem, a lesser understanding of the causal pathways renders comprehension of the potential role of the physical environment difficult. This paper examined a wide range of theories to identify a causal pathway between intergenerational interactions and loneliness, and used three theories-Symbolic Interactionism, Proxemics, and Affordance-to meaningfully situate and articulate the role of the physical design within the explanatory model. The causal pathway presented in this paper posits that sets of physical environment attributes (associated with Symbolic Interactionism, Proxemics and Affordance theories) have a direct and moderating effect in the association between physical design and intergenerational interaction, with the latter influencing loneliness through generativity, purposefulness, and hopefulness.

Opinion
In the Moment: Fostering Mindfulness and Reducing Stressors in the Healthcare Workplace Shabboo Valipoor and Sheila J. Bosch. While healthcare design research has primarily focused on patient outcomes, there is a growing recognition that environmental interventions could do more by promoting the overall quality of care, and this requires expanding the focus to the health and well-being of those who deliver care to patients. Healthcare professionals are under high levels of stress, which leads to burnout, job dissatisfaction, and poor patient care. Among other tools, mindfulness is recommended as a tool to decrease stress and help workers function at higher levels. This paper aims to identify potential environmental strategies for reducing work-related stressors and facilitating mindfulness in healthcare settings. Using the existing evidence on workplace mindfulness and stress-reducing design strategies, we highlight the power of the physical environment in not only alleviating stressful conditions, but intentionally encouraging a mindful perspective. Strategies like minimizing distractions or avoiding overstimulation in the healthcare environment can be more effective if implemented along with provision of special spaces for mindfulness-based programs. Future research may explore optimal methods and hospital workers' preferences for environments that support mindfulness and stress management. The long-term goal of all these efforts is to enhance healthcare professionals' wellbeing, re-ignite their professional enthusiasm, and help them be resilient in times of stress.