Stress reduction in the hospital room: Applying Ulrich's theory of supportive design

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Highlights

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    We tested and confirmed Ulrich's theory of supportive design.

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    Room elements affect perception of control, social support, and positive distraction.

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    A greater number of elements in the room reduce expected stress.

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    Only social support and positive distraction predict expected stress-reduction.

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    Understanding the psychological mechanism is useful to design interventions.

Abstract

Hospital rooms may exacerbate or reduce patients' stress. According to Ulrich's (1991) theory of supportive design, the hospital environment will reduce stress if it fosters perceptions of control (PC), social support (SS), and positive distraction (PD). An experimental study was conducted to test this theory. Participants were asked to imagine a hospitalization scenario and were exposed to one of 8 lists of elements that the hospital room would provide selected to facilitate PC, SS, PD, or 1 of all the possible combinations of these elements. Results confirmed Ulrich's theory. Participants expected significantly less stress in the situations where all (or only PD and SS) elements were present. Meditational analyses confirmed that the number of elements in the hospital room affects expected stress through the perceptions of how much positive distraction and social support it is perceived to provide, but not through the perception of the level of perceived control available.

Section snippets

Stress in the hospital

Stress is conceptualized as a relationship between a person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering well-being (Lazarus & Folkman, 1984). Being in a hospital as a patient is a stressful experience (e.g., Haltman et al., 2012, Tanja-Dijkstra, 2011; see Mitchell, 2003 for a review). Illness that may involve reduced physical capabilities, uncertainty, and painful medical procedures is an inevitable source of stress (e.g.,

The healing potential of the physical environment

Research has demonstrated that the quality of the physical environment of hospital rooms contributes to patients' well-being (e.g., Devlin & Arneill, 2003), but little attention has been paid to the modeling processes involved in this relationship (Andrade, Lima, Fornara, & Bonaiuto, 2012). However, interventions in the healthcare physical environment will be more effective if the intervening mediating and moderating variables that affect the success of those interventions are known. Thus, the

Hypotheses

Our hypothesis is that the as number of environmental elements – facilitating control, distraction, or social support – in a hospital room increases, the level of perceived stress will decrease. We further hypothesize that perceptions of control, positive distraction, and possibilities for social support provided by the room will explain (mediate) the link between the number of elements in the room and patients' well-being. Moreover, we expect that the room elements categorized within each

Participants and design

Participants were 217 students, split between Portugal (n = 142) and the United States (n = 75). In the total sample, there were 91 (42.1%) women and 125 (57.9%) men, and the mean age was 20.99 years (SD = 5.48 years).

In the Portuguese sample, there were 29 women (20.6%) and 112 men (79.4%), and the mean age was 22.04 years (SD = 6.54 years). In the American sample, there were 62 women (82.7%) and 13 men (17.3%), and the mean age was 19.07 years (SD = 1.08). Sixty-six (88.0%) American

Results

Two hundred and ninety-three students opened the survey online. Excluding the 76 students that did not answer any questions from the STAI or any questions at all, 217 participants were retained.

In order to detect the organization of the items created to assess the perceptions of control, social support, and positive distraction promoted by the environment in specific dimensions, we ran a factor analysis using the method of Principal Axis Factoring with Varimax Rotation. From the initial

Discussion

The main goal of the present research was to contribute to a better understanding of the ways through which the healthcare physical environment impacts patients' well-being. In the theory of supportive design, Ulrich (1991) proposed that a hospital environment will alleviate patients' stress if it provides them a sense of control, positive distraction, and possibilities of social support. However, this theoretical model has never been fully empirically tested. We proposed to do that through an

Future research and final comments

To our knowledge, this study was the first to test Ulrich's theory of supportive design. The results obtained confirmed Ulrich's theory, but need further exploration in real settings, because being ill produces physiological and psychological conditions that may have an important impact on patients' needs and perceptions. Moreover, one cannot overlook the fact that the participants in this study were students, with an average age of 21, which, in principle, means limited hospital experience. On

Acknowledgments

This research was supported by a PhD Grant (SFRH/BD/43452/2008) from the Portuguese Foundation for Science and Technology awarded to the first author.

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