Architecture for Nurses: A Salutogenic Re-Imagining of Hospital Infrastructure

Abstract

Purpose: The purpose of this inquiry was to explore how nurses envision and benefit from restorative built environments in acute care hospitals. Background: The Covid-19 pandemic has resulted in alarming rates of occupational stress and attrition in front-line clinicians, which has made inquiry into how to promote well-being in nurses particularly timely, and salient. Much of the existing design literature is functionalist in tenor, foregrounding how to improve the efficiency and productivity of staff. Provided this, little is known about how nurses experience hospital environments and what restorative features they imagine within these spaces to attenuate stress. This insight is necessary for an improved articulation of supportive and restorative architectural affordances. Methods: Informed by interpretive description, a qualitative study using photo-elicitation was employed to solicit the experiences of 4 frontline registered nurses working in acute care hospitals in Canada. Data was triangulated from three sources; (1) Photographs; (2) Narrative notes; (3) Semi-structured interviews. Results: Iterative and thematic analysis revealed that nurses recognize the power of good design to promote staff retention and promote well-being, although participants largely regard their present work environments as pathogenic and perpetuating harm. Nurses visually and narratively envisioned enriched environments through the use of adaptable space, visual and associative references to nature, a creative atmosphere, inclusive spaces, a civic presence, and the provision of spaces to enable rituals of (self)care. Conclusions: Nurses have considerable tacit and embodied knowledge which can improve the hospital built environment, but further research is needed to capture and solicit these holistic experiences.