Responsive architecture: Creating positive human environments, kidney dialysis center and disease learning clinic, Lubbock, Texas



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Tf-")(^- O.Tjalrry o f ]-T^'.3jfnj7 Hn -/Tronrnonte Thesis Justification The concept of creating a positive healing environment focuses on the understanding and acceptance of a distinct medical congelation between the mental state, the physical state, and the spiritual state that lies within us. This is not an entirely new concept, but one that is merely underdeveloped. The Navajo had a similar philosophy for healing based on symbolic therapy. They believed that symbols sacred to their culture acted as transformers, their function being to convert libido from a 'lower' form into a higher* fonri.^ When this transition took place, a release of energy occun-ed that then allowed the patient to recover successfully. The significance of the symbols and the ceremonial rituals merely focused the patient, preparing them for this energy transferance. Unfortunately, symbolic healing philosophies require that patients share in the similar beliefs of their culture and those those who administer treatments. If this does not exist, symbolic healing will not work. The social function of symbolic healing is unusually large, because it depends on the concensus of the community as a cultural unit to give validity to its symbols." In the 1990s, healing is generally based on scientific methods and technologies proven through extensive and costly research and development programs. These new methods and technologies are designed to increase patients chances of recovery through applied procedures and cutting-edge medications. As a result, scientific healing has extended, and even cured many patients of fatal health conditions that were once considered in^eversible. However, there are still many who die every year from chronic diseases that were believed to be under control. The fact of the matter is that scientific healing, in all its glory, cannot guarantee complete recovery. Scientific healing deals only with the physical state of being. It disregards the mental and spiritual dimension that dwell within us. The dimensions that prepare and maintain our positivity. Scientific healing does not allow for the 'release of energy' that acknowledges affliction and opens the door for reconciliation and atonement. With all this in mind, the question then becomes one of how to integrate mind, body, and spirit into a complete healing process. I believe the connection for this lies within creating positive healing architecture. Architecture provides a linkage between scientific and symbolic healing. It provides scientific healing with the means to carry out its complex functions while at the same lime providing unlimited possibilities of symbolic concensus to its users. Architecture and the built environment can be used to facilitate the comprehension of acute and chronic kidney disorders. Architecture must be designed to establish an environment that positively stimulates the mental, physical, and spiritual healing qualities that coorelate with rehabilitation and the healing process. Facility Type Dialysis centers accommodate those who have been afflicted with acute or chronic kidney disorders to the point of renal failure. These centers provide hope and life alternatives to what, just eight years ago, would have been considered a fatal condition with no reassurance of recovery. The importance of these facilities to the community rest in the fact that the increasing number of people who suffer from kidney ailments in the United States is in the millions.^ Most of these kidney diseases improve spontaneously, or can be treated with medicine or surgery. However, approximately 33,000 people develop kidney failure each year and the numbers continue to grow at a dramatic rate'^ The dialysis centers primary purpose is to provide quality treatment at a reduced cost, and by doing so pass the savings on to the patient. In order to understand completely the role of this facility and the conceptuality of the propsed facility, it is imperative to understand the functions of the kidney, relative to the body, and the diseases that prompt dialysis therapies. The Kidney The healthy balance of our body's internal chemistry is in large part due to the vyork of two organs, the kidneys. Each kidney is about the size of a clenched fist and weighs approximately one-third of a pound. These organs are located on either side of the spine at waist height, tuckeo under the bottom two ribs of each rib cage. They piay a critical role in maintaining our health. In fact our survival depends on the functioning of these vital organs' The kidneys function in four basic ways. They (1) eliminate waste products through an internal blood filtering system, (2) regulate the production of red blood cells and blood formation, (3) control blood pressure, and (4) control the body's delicate chemical and fluid balances. Blood flows into the kidneys through the renal artery where it is filtered by nephrons in much the same way that an oil filter works in a car. Nephrons are made up of glomerulus and a small tube called a tubule. This is where actual filtration takes place. As blood is filtered it is modified and absorbed. The remainder of unwanted toxins, the kidney forces to the ureter in the form of urine which travels to the bladder where it is externally released. Every two minutes the entire blood supply circulates through the kidneys and is cleansed. The kidney regulates calcium and phosphoms concentrations in tne blood and manufactures an active form of Vitamin D which promotes calcium absorption from food. The kidney also releases the honnone erythropoietin, which promotes the maturation of red blood cells. A shortage of this honnone may cause anemia. The kidney controls hypertension by monitoring levels of sodium, potassium, calcium, phosphorus, chloride and biocarbonate, thus removing excessive amounts of salts and fluids in the urine. The kidneys secrete a substance called renin which stimulates the production of a hormone which causes an elevation in blood pressure. When the kidneys do not work properiy, too much renin may be produced which causes blood pressures to elevate. The kidneys control all of these primary functions as well as maintain the proper chemical and fluid balances in the body. Kidney Disease Kidney Disease, if caught in the eariy stages can be controlled and, in some instances reversed. The important factor would then be recognizing the symptoms eariy enough to control its severity. The most common symptoms of kidney Disease are fatigue, oizziness, fluctuation in weight, nausea, and vomiting. In addition, lowerback pain, buming sensations during urination, swelling of parts of the body, paniculariy around the ankles, wrists, and eyes. High-blood pressure, bloody urine, and changes in the frequency of urination can also be symptoms. There are two types of kidney failure: acute and chronic. Acute failure is a temporary situation where as chronic is a pemnanent condition with no hopes of kidney rehabilitation. Acute failure can be caused by severe infections, extensive bums, severe diarrhea or vomiting, chemical or drug poisoning, surgery, and injury or blockage of the kidneys. In most cases normal function will resume. Chronic failure may be a result of heredity, polycystic kidney disease, or by prolonged medical conditions, such as hypertension or diabetes. People with chronic renal failure are said to be in End Stage Renal Failure. There is no known cure for chronic kidney disease. The only alternatives are dialysis or transplantation. Kidney Treatments Dialysis is the process by which the blood is cleansed artificially rather than by the kidneys.^ The procedure separates toxins from the blood, catches them in a poly-fit)er filter and recirculates the cleansed blood back into the body's blood stream. This type of dialysis is knov,/n as hemo dialysis and usually takes three, four to five hour treatments per week to maintain a functioning living standard. Another form of dialysis known as peritoneal dialysis is also an available treatment but requires a surgically implanted catheter. The catheter, hov/ever, is highly susceptible to aquiring infections. Waste products are removed from the blood through three chemical processes: diffusion, osmosis, or ultrafiltration. In the diffusion principle, liquids of different concentrations tend to equalize when placed next to each other. Osmosis is similar to diffusion, however, rather than removing waste products, excess fluid is removed. Dextrose is added to the diasylate to help pull excess fluids from the blood. Ultrafiltration is the process by which micro particles are filtered from a substance. A pump is implemented to raise trie pressure of blood flow through the dialysis machine, which forces excess fluids out of the blood. Special, surgically implanted accesses are needed to perform dialysis. These take the forms of shunts, fistulas, or grafts. These aid in dialysis by allowing larger volumes of blood to be pulled from the body, to be filtered, thus reducing the time to complete the filtration process. For most kidney disease patients the hope is to receive a kidney transplant, however, acceptance criteria is rigorous for this procedure. Irregardiess of this, the fact still remains that sometime during an End Stage Renal Diagnosed patients illness, dialysis will be a reality. Whether it be for eight months or eight years. The importance of the previous material can not be over-emphasized. The wellfare and recovery success of the patient will rest in the designers ability to be responsive to the needs of the patient and user of the building to a point of refinement that emulates the same care and concern the staff must provide to the patient. If this is not achieved the design will fail. Scope of Project The overall mission of the Kidney Dialysis Clinic and Disease Learning Center focuses on the ability of the staff to encourage the patient to take an active role in their own recovery while providing them with the treatments they need. This will be achieved by educating patients on their specific kidney disorder through the availability of the necessary resources and the facilities ability to act as a tool for treatment and learning. At a health conference held by the AIA Academy of Architecture, February 10- 12, 1994, entitled Healinq Environments: Places. Settings. Needs and Responses. Jain Malkin defines this approach as "Planetree." She said, "It focuses on options and choices that allow the patient to decide how passive or active he or she wants to be in treatment." Planetree emphasizes education and information to the patient. 'The belief is that an educated patient will be more compliant to therapy", IVIalkin said. It also emphasizes the patients need to relax by focusing on entertainment, stimulation, and diversion with emphasis on things like music, art, food, the sound of water, and light. Other considerations might encompass massage therapy. "People are moved to rooms of different colors depending on the illness they have," Malkin said, "they are moved toward stimulation as they recover." Planetree design approaches also implement patient control of the environment, the use of gardens, water elements and adequate storage of equipment to get things out of corridors. The report also identified environmental stressors including noise, air quality, poor lighting, odors, lack of privacy, lack of control over patient environments and thermal comfort. Research conducted originally link stress to the release of renin hormones that can cause or contribute to illness. Malkin said," We really need to focus on healing environments, on the multi-sensory, what do people hear, feel, touch, taste, and smell?" In another study at the conference, Roger Ulrich, Professor and Associaite Dean for research at Texas A&M University College of Architecture cites three major principles that he considers contribute to the success of positive healing environments, the first being control. Patients who have a sense of feeling as if they're in control have less stress and related health problems and seem to recover from their illness faster, he said. The second principle encompasses social support and the direct linkage between family, friends and staff who are helpful, caring and supportive. The third principle he describes as positive distraction. Positive distractions are those elements that promote positive feelings when experienced and are strong enough to block out wonrisome thoughts. These usually take the fonns of natural elements including the sound of water, gardens, and smiling human faces. Ulrich listed some alternatives to designing such as reducing glare and noise by using indirect daylighting, carpet, quieter equipment and moving noisy activities away from patients. Context Statements Contextual consideration for health care facility must target multi-sensory areas. Architects tend to focus too much on the visual, but for a health facility to tnjly achieve its purpose of contributing to the healing process, it must also stimulate the auditory, tactile, and olfactory senses. For example, an MRI facility at Sloan Cancer Center uses the smell of vanilla to elicit the memory of freshly baked cookies, to reduce patient stress levels. Because MRI tests can take anywhere from 20 minutes to 4 hours, 1 in 10 patients ask that the procedure be stopped before it is completed, which results in lost revenues for the facility.



Health facilities -- Design.