Healing design: a phenomenological approach to the relation of the physical setting to positive social interaction in pediatric intensive care units in the United States and Turkey

Abstract

This study examines the impact of the physical setting in the care and healing process of hospitalized children, their families, and the caregivers in two selected pediatric intensive care units (PICUs) in the U.S. and Turkey. A holistic, cross-cultural, comparative, and naturalistic approach emphasized the importance of the total (i.e., physical, social, cultural, spiritual, organizational, political) environment and quality of life to health and healing. Information was gathered through qualitative methods such as participant observations, behavioral maps, in-depth interviews, and floor plan analysis. Despite some universal features of the PICU atmosphere, the value and place ascribed to pediatric critical care in Turkey and the U.S. present different worldviews. Field studies revealed social interaction as a universal healing function despite its cultural specificity stemming from socio-cultural, ethnic, economic, and religious differences between different groups. Crowding, parental absence, and over-stimulation, which stem from the lack of individual patient rooms, and organizational problems related with human resources and staffing shortage play against the critically ill child’s deep need to heal in the Turkish PICU. Despite spatial limitations, informal social interactions and cooperative relationships among caregivers, their devotion, and their ability to adapt to the existing physical and social environment enable care delivery. While staffing shortage continues to be a crucial problem in the U.S. model, specialization of labor and the systemic organization in general support care delivery, reducing the importance of informal social interactions and cooperation among caregivers. However, emphasizing the role of the family in the child’s care, social interaction is also identified as a healing function in this setting. Therefore, despite the significant role the physical setting may play in healing, social interaction is found to be more important for improving patient outcomes and the well-being of families and caregivers. The study focuses on six healing design interventions to increase the chances for positive social interaction and collaboration. These are programmatic (provisional, scale, locational), functional, ambient, symbolic, social and psychological interventions.