Man's Search for Meaning: An Introduction to Logotherapy.

Aaron Antonovsky advanced the concept of salutogenesis almost four decades ago (Antonovsky, Health, Stress and Coping. Jossey-Bass, San Francisco, CA, 1979; Unravelling the Mystery of Health. Jossey-Bass, San Francisco, CA, 1987). Salutogenesis posits that life experiences shape the sense of coherence (SOC) that helps to mobilize resources to cope with stressors and manage tension successfully (determining one’s movement on the health Ease/Dis-ease continuum). Antonovsky considered the three-dimensional SOC (i.e. comprehensibility, manageability, meaningfulness) as the key answer to his question about the origin of health. The field of health promotion has adopted the concept of salutogenesis as reflected in the international Handbook of Salutogenesis (Mittelmark et al., The Handbook of Salutogenesis. Springer, New York, 2016). However, health promotion mostly builds on the more vague, general salutogenic orientation that implies the need to foster resources and capacities to promote health and wellbeing. To strengthen the knowledge base of salutogenesis, the Global Working Group on Salutogenesis (GWG-Sal) of the International Union of Health Promotion and Education produced the Handbook of Salutogenesis. During the creation of the handbook and the regular meetings of the GWG-Sal, the working group identified four key conceptual issues to be advanced: (i) the overall salutogenic model of health; (ii) the SOC concept; (iii) the design of salutogenic interventions and change processes in complex systems; (iv) the application of salutogenesis beyond health sector. For each of these areas, we first highlight Antonovsky’s original contribution and then present suggestions for future development. These ideas will help guide GWG-Sal’s work to strengthen salutogenesis as a theory base for health promotion.

Future directions for the concept of salutogenesis: a position article.

Florence Nightingale Today: Healing, Leadership, Global Action

An investigation examined the structured scientific evidence on healthcare facilities (the healing built environment – HBE) and its impact on patients’ health outcomes under a holistic conceptual evaluative framework. The integrative review considered 127 papers (of which 59 were review papers). It found there was no adequate framework that could integrate existing research findings holistically. Such a holistic framework needs to demonstrate the cumulative and interactive effects of various HBE characteristics on patients’ health outcomes and wellbeing. An environment–occupant–health (E-O-H) framework is proposed, taking a holistic perspective to identify and evaluate different HBE characteristics. The E-O-H framework should support future research by (1) identifying the HBE characteristics that affect health outcomes; (2) defining appropriate future research designs; and (3) understanding the need for holistic analysis of the integrated effects of diverse HBE characteristics on health outcomes.

https://www.tandfonline.com/doi/pdf/10.1080/09613218.2017.1411130

Healing built-environment effects on health outcomes: environment–occupant–health framework

Evidence-based design (EBD) research has demonstrated the power of environmental design to support improved patient, family, and staff outcomes and to minimize or avoid harm in healthcare settings. While healthcare has primarily focused on fixing the body, there is a growing recognition that our healthcare system could do more by promoting overall wellness, and this requires expanding the focus to healing. This article explores how we can extend what we know from EBD about health impacts of spatial design to the more elusive goal of healing. By breaking the concept of healing into antecedent components (emotional, psychological, social, behavioral, and functional), this review of the literature presents the existing evidence to identify how healthcare spaces can foster healing. The environmental variables found to directly affect or facilitate one or more dimension of healing were organized into six groups of variables-homelike environment, access to views and nature, light, noise control, barrier-free environment, and room layout. While there is limited scientific research confirming design solutions for creating healing spaces, the literature search revealed relationships that provide a basis for a draft definition. Healing spaces evoke a sense of cohesion of the mind, body, and spirit. They support healing intention and foster healing relationships.

Exploring the Concept of Healing Spaces.

There is universal agreement that a healing environment is desirable for patients and for providers. What constitutes a healing environment is open to discussion and depends on individual perspectives. The Samueli Institute coined the term Optimal Healing Environment (OHE) in 2004 to describe a healthcare system that is designed to stimulate and support the inherent healing capacity of patients, families, and their care providers. An OHE consists of people in relationships, their health-creating behaviors, and the surrounding physical environment.1 The OHE framework (Figure) is a conceptual framework applicable to health professionals; patients, their families, and significant others; healthcare organizations; and healthcare systems. As an organizing framework, the 8 concepts contained in the 4 environments of the OHE framework provide direction to patients, families, care providers, and organizations to optimize the potential for healing. Each of the environments and constructs of the OHE framework work ...

Optimal Healing Environments

Patient's perception of care-referred to as patient satisfaction-is of great interest in the healthcare industry, as it becomes more directly tied to the revenue of the health system providers. The perception of care has now become important in addition to the actual health outcome of the patient. The known influencers for the patient perception of care are the patient's own characteristics as well as the quality of service received. In patient surveys, the physical environment is noted as important for being clean and quiet but is not considered a critical part of patient satisfaction or other health outcomes. Patient perception of care is currently measured as patient satisfaction, a systematic collection of perceptions of social interactions from an individual person as well as their interaction with the environment. This exploration of the literature intends to explore the rigorous, statistically tested research conducted that has a spatial predictor variable and a health or behavior outcome, with the intent to begin to further test the relationships of these variables in the future studies. This literature review uses the patient satisfaction framework of components of influence and identifies at least 10 known spatial environmental variables that have been shown to have a direct connection to the health and behavior outcome of a patient. The results show that there are certain features of the spatial layout and environmental design in hospital or work settings that influence outcomes and should be noted in the future research.

Environmental Variables That Influence Patient Satisfaction: A Review of the Literature

This retrospective, exploratory study examined 8,366 patient responses to surveys on patient satisfaction and patient room spatial layout in a large academic teaching hospital consisting of 17 nursing units and 382 patient rooms. This study included four spatial measures: average distance to the nurse station, room handedness, location of bed, and location of first encounter-and explored their statistical associations with two types of patient satisfaction surveys (Hospital Consumer Assessment of the Healthcare Provider and Systems and third party). The study had two phases: a preliminary study of 3,751 patient respondents in a limited diagnosis-related group (DRG) over 5 years and a general study of 4,615 patient respondents with a broader range of DRG's over 2 different years from the preliminary study. Findings indicated statistically significant relationships between all four spatial layout measures and specific survey questions pertaining to perception of nursing, physician, individual care, and overall room environment. Results emphasize the importance of hospital design-and spatial layout in particular-on patient satisfaction.

https://journals.sagepub.com/doi/pdf/10.1177/1937586718782163

Exploring the Relationships Between Patient Room Layout and Patient Satisfaction.

In order to understand a patient's healing experience it is essential to understand the elements that they, the patient, believes contributed to their healing. Previous research has focused on symptom reducers or contributors through environment such as stress. A person's experience of healing happens over time not instantaneous. Therefore, in this study, the interviews with patients happened after forty-eight hours of hospitalization. This mixed methods study describes the experiences of seventeen inpatients from two healthcare systems using a phenomenological approach combined with evidence based design evaluation methods to document the setting. The qualitative data was analyzed first for reoccurring themes then further explored and defined through quantitative environmental observations. The seventeen patients defined healing as "getting better/well." Seventy three statements were recorded about contributors and detractors to healing in the physical environment. Three primary themes emerged from the data as positive influencers of a healing experience: being cared for, being comfortable and experiencing something familiar or like home. These results demonstrate that patients perceive their inpatient healing experience through a supported environment.

https://journals.sagepub.com/doi/pdf/10.1177/2374373516676182

Lorissa MacAllister

Papers

Optimal Healing Environments

Exploring the Concept of Healing Spaces.

Environmental Variables That Influence Patient Satisfaction: A Review of the Literature

Exploring the Relationships Between Patient Room Layout and Patient Satisfaction.

Exploring Inpatients' Experiences of Healing and Healing Spaces: A Mixed Methods Study.