The role of physical design and informal communication

into the topic of nature as a therapeutic feature of the built environment. Whall et al.
(1997) found that adding images of nature and audio recordings of chirping birds and
running water to a shower room reduced stress and decreased the occurrence of
aggressive behavior in patients with late-stage dementia. As a result of research on the
pain- and stress-reducing impact of nature, many hospitals have been designed or
renovated to include water features and close-up images of birds and flowers, such as
the Pebble Project’s Dublin Methodist Hospital in Dublin, Ohio (Ollanketo & Elsas,
2007).
1.2.1.2 Social Support
Another issue gaining recognition from researchers is the concept that the built
environment can foster social support that has the potential to improve medical
outcomes. In the 1990s, medical sociologists explored the intriguing possibility that
social support could have an effect on cure rates and recovery rates (Gordy, 1996).
Glass, Matchar, Belyea, and Feussner (1993) found that stroke victims with the
greatest amount of social support functioned 65% better six months later than stroke
patients who were socially-isolated. This study and others that indicated the positive
effect of social support on patient well-being (Berkman, Leo-Summers, & Horwitz,
1992; Glass & Maddox, 1992) prompted additional research to investigate ways that
the physical healthcare environment facilitates or hinders patients’ access to social
support. For example, many studies have demonstrated that single-bed rooms are
better at accommodating the presence of family and friends than multi-bed rooms, and
some evidence proposes that multi-bed rooms actually deter family presence
(Sallstrom, Sandman, & Norberg, 1987). Evidence such as this in combination with
the Institute of Medicine’s patient-centered principles prompted the American College
of Critical Care Medicine Task Force to include among its clinical practice guidelines
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