Abstract
In 2014, the World Health Organization in Nigeria recorded 150,000 new cancer cases with an estimated mortality rate of about 80,000. Even with this frightening statistic, there are few cancer clinics and only 11 cancer registries which are located in various teaching hospitals in different parts of the country. These facilities were approached using a generic design as such the psychosocial needs of the cancer patients were not considered during the planning stage. As such, this thesis aims at developing a framework for the integration of biophilic design patterns in the design of cancer hospital, thereby creating a connection between life, nature and the built environment which evolve architecture that can positively contribute to the healing and psychological recovery of cancer patients. Based on existing literature correlating biophilic design patterns and biological responses, strategies for the integration of biophilic design patterns were developed based on three broad patterns of biophilic design namely; Nature in the space, Natural analogues and Nature of the space. These strategies provided a design guideline on how to maintain a connection with natural world into a healthcare setting. The research type is exploratory and encompasses both the qualitative and quantitative tradition in methods of data collection through case studies and interviews. In order to check how these strategies were adopted in the design of existing cancer hospitals, five cases were explored; two local and three foreign. The local cases are; Oncology Department, National Hospital Abuja, Nigeria and Oncology Department, Ahmadu Bello University Teaching Hospital, Shika, Nigeria. The foreign cases are: Frauenshuh cancer centre, United States, Windsor regional cancer centre, Canada and Helen F. Graham cancer centre, United States. The result shows that across all the cases studied, Nature in the space patterns were applied the most with the average score of 3.1 out of a total of 4, followed by Nature of the space patterns with the score of 2.6 Natural analogues patterns have the least score of 2.4. A synthesis of the knowledge gained through the review of related literature, the cases studied and site analysis conducted formed an articulated design framework to accomplish an ultimate goal of creating a biophilic cancer hospital, in Abuja, Nigeria. This architecture provides patients battling with cancer an environment that is inspiring, invigorative and places with soothing ambiance to reduce their cognitive and psychological stress
CHAPTER ONE: INTRODUCTION
1.1 Background of Study
Over the centuries, the connection between healing and nature was slowly displaced as medical technology advanced and became more specialized (Davidson, 2013). There is more consciousness of infection and the necessity for sanitary conditions. New and enhanced treatments that concentrated less on the physical and more on the medical epidemiology were given attention, and the all-inclusive method to medicine was pushed aside (White, 2011). Hospitals turn into what some consider cold, sterile institutions that take over the health care industry today. However, since the 1990s there has been resurgence in nature-based care, and professionals are once again beginning to focus on the whole person, the mind, body and spirit connection in health care settings (Davidson, 2013).
The human association with nature can be drawn back to the beginning of our species and how our ancestors survived and deeply hang on the natural environment for survival. Biophilia is the theory that humans have an innate or evolutionary-based affinity for nature. It is the belief that we have a connection and a dependence on nature that has been handed throughout evolution (Wilson, 1984).
Because of its remarkable influence on human psychology, biophilia based design plays a vibrant role in healthcare delivery. The current healthcare system contains many flaws, especially in its physical spaces. Hospitals, clinics, and offices are high-stress environments for patients, visitors and families, and healthcare professionals alike. Integrating nature into healthcare facilities has abundant benefits for many groups (Heerwagen & Orians, 2011).
Cancer is a large group of diseases (over 200) characterised by uncontrolled growth and spread of abnormal cells (American cancer society, 2005). However, treating cancer is not the same as treating the patient (Holland & Rowland, 1990). This is due to the fact that cancer is not restricted to physical effects; it also evokes emotional chaos that influences personal relationship and patient‟s ability to live and work (Smith, 2013). These additional impacts are referred to as one‟s psychosocial health. Problems resulting from untreated psychosocial needs have been shown to bring antagonistic effects within the body‟s cardiovascular, immune, and endocrine systems, contributing to the decline in health associated with cancer and its treatment (Segerstom
- Miller, 2004). Two of the most reported psychosocial effects in persons with cancer are anxiety and emotional distress (Stark, Kiely, Smith, Velikova, & Selby, 2002).
The journey a patient battling cancer takes can be both scary and difficult (Smith, 2013). Moderating the fear helps patients circumnavigate the journey easier and with more confidence. While diagnosis of cancer will always come with a set of assumptions (Krump & Nordling, 2012), environment can be designed that helps the patients see hope and fortitude during their treatment.
1.2 Statement of Research Problem
While the projection for several forms of cancer have progressed over the last decade in developed countries, mostly due to immense technological and scientific developments, the vantage point remains grim in Nigeria. According to World Health Organization (W.H.O.) report on cancer country profile, about 150,000 new cases of cancer are recorded in Nigeria in the year 2014, with an estimated mortality rate of about 80,000. Regardless of this, there are only 11 cancer registries which are located in various tertiary teaching hospitals in different parts of the country (Abdulkarim, 2015).
Clinical practices in these cancer registries focus mainly on “cure over care” phenomena while often neglecting the patients‟ psychological and spiritual needs. And since their design is not cancer specific, they lack the required provision of natural elements fused in their design, which aids in connecting the patients with natural environments and for the purpose of meeting their psychosocial needs. As such this research seeks to study the healing attributes of biophilic architecture and its positive effects particularly on cancer patients, and how it will aid in enhancing their physical and psychological recovery.
1.3 Justification
Due to fast progress of new cancer cases every year in the country, it is necessary for the request of effective health care delivery to tackle cancer explicitly. The health facilities present can neither cope with such demand nor where they designed to.
- Nigeria ranks among top 25 countries in the world (Sam, 2012) with highest cancer morbidity rate and no equivalent health care centres to tackle the demand. Moreover, an estimated figure of 80,000 deaths occurs in Nigeria in 2014, with 10 deaths recorded every 1 hour (W.H.O., 2014).
- The release of stress hormones tends to make cancer cells more resistant to treatment, and even enhance their metastasis. As such, there is need to connect the recovering patients with natural world to enable them harness the healing attributes of nature.
- It must be understood that health promotion is most effective by means of a holistic approach, with supportive environments proving to have the greatest impact. Thus, studying biophilia will provide an in-depth analysis on how to incorporate nature into healthcare settings thereby aiding in holistic recovery.
1.4 Aim and Objectives
The research aims at developing a framework for the integration of biophilic design patterns in the design of cancer hospital, thereby creating architecture that can positively contribute to the healing and psychological recovery of cancer patients.
The objectives are:
- To relate explore the connection between biophilia and holistic treatment of cancer patients.
- To explore ways in which biophilic design patterns have been integrated in the design & construction of existing cancer centres through case study approach.
- To develop a framework for the integration of biophilic design patterns on cancer hospital.
- To demonstrate, through design, the integration of these patterns in designing national cancer hospital, in Abuja, Nigeria.
1.5 Research Question
The research intends to answer the following questions;
- What aspect of biophilic design are in existence Nigerian cancer facilities?
- How relevant are patterns of biophilic design in creating naturalistic spaces within a hospital design, thereby stimulating the healing process and psychological recovery of cancer patients?
1.6 Scope of the study
The research hinges mostly on three broad categories of biophilic design. Namely; Nature in space, Natural analogues and Nature of space.
From a well analysis of these patterns, a detailed architectural design will be prepared through a conceptual design process in which these patterns will be applied in various degrees in cancer hospital. And since the design is set to become the core of all related cancer cases in the country, it will be located in Federal Capital Territory, Abuja, North-central of Nigeria.
1.7 Thesis Outline
The thesis is organised into seven chapters as shown in Table 0.1 and discussed below.
Table 0.1: Thesis Organization
| Problem | Chapter one: „Introduction‟ | |
| Theoretical | Chapter two: „Literature Review‟ | |
| Framework | ||
| Chapter three: | Chapter four: | |
| Methodology | „Methodology‟ | „Case Studies‟ |
| Chapter five: | Chapter Six: | |
| Results | „Study Area‟ | „Design Report‟ |
| Chapter Seven: | ||
| Conclusion | „Conclusion and Recommendation‟ | |
Source: (Researcher, 2015) Chapter one highlights the research problem and presents the aims, objectives, research
question & justify the need of the research. Chapter two reviews the literature that explores different areas of influence that nature has had in benefiting human health and well-being with a particular focus on cancer patients. The review examines the biophilia hypothesis, dimensions, elements and attributes, and focuses on the found benefits of access to nature, particularly for cancer patients,
Chapter three presents the approach adopted for the study based on a conceptual/theoretical framework comprising three major components of biophilic design patterns garnered from the review of related literature. The chapter also presents criteria employed in choosing the sample population for the survey subsequently conducted as well as ways for interpreting results.
Chapter four reports the ways in which biophilic design principles have been integrated in the design & construction of existing cancer centres through case study approach. It also presents and discussed the findings of the case studies conducted.
Chapter five titled „Study Area‟ reports the conceptual/analytical ways employed through design process for choosing site and subsequently analysing it to suite the need of the design.
Chapter six titled “Design Report” brings all data previously studied into a pronounced design framework which will form the basis for the devising of design concept. All design solutions, theory and findings of the case study conducted shall be ascribed to the designing a proposed biophilic cancer hospital, in Abuja, Nigeria.
Chapter seven concludes the research work by stating its findings and recommendations. It also mentioned the contribution of the research to knowledge and projected areas of further study.
