Dilani A
Karolinska Institute, Swedish National Institute for Psychosocial Factors and Health.
World Hosp Health Serv. 2001;37(1):20-4, 33, 35.
The major purpose of this paper is to discuss the basic ideas and criteria underlying contemporary health care design. Special attention is given to the growing shift in biomedical attitude from a largely pathogenic concept of disease to a more salutogenic perspective. This shift should not only lead to a stronger integration of building design and care philosophy but also result in an enhanced quality of medical care and strengthened health processes. Traditionally, the pathogenic perspective has tended to consider patients as objects and concentrated on individual "sick parts" of the human body, which were further and further divided into smaller parts and separately treated. Consistent with this perspective, health care facilities have been interpreted as medical-technical environments oriented toward the physical needs of the treated body part. From this perspective the main requirement placed on health care facilities has often been interpreted narrowly as the reduction of the risk of exposure to disease. Comparatively little priority has been given to calming the patients and making them feel relaxed in spite of traumatic hospital experiences and starkly institutional care environments. Other consequences of the pathogenic perspective have been that psychological, social and spiritual needs of patients have been largely disregarded in the design of Health care facilities, and often marginalized in the philosophy of delivering care. The emphasis on functional efficiency, together with the pathogenic conception of disease and health, has often produced health care facilities that are not psychosocially supportive. In recent years, however, a different perspective has emerged leading to a new paradigm. The modern disease concept is no longer narrowly pathogenic; rather, disease is seen as multifaceted and having a variety of causes or elements. The salutogenic perspective, which focuses on health promoting processes, has become much more central to the consideration of care philosophies and in the creation of new health care facilities. In this new paradigm, the focus is on the patients: along with their physical health needs the patients' psychological and social health needs are given major emphasis in the delivery of care activities and in the design of health care environments. Future research needs to develop care philosophies that focus on a broader concept of health, thus creating an awareness of the importance of psychosocially supportive design.
本文的主要目的是探讨当代医疗保健设计背后的基本理念和标准。特别关注生物医学态度从主要的致病疾病概念向更具健康促进视角的日益转变。这种转变不仅应导致建筑设计与护理理念更强的融合，还应提高医疗质量并强化健康进程。传统上，致病视角倾向于将患者视为对象，并专注于人体的各个“患病部位”，这些部位被进一步细分为更小的部分并分别进行治疗。与此视角一致，医疗保健设施被解释为面向所治疗身体部位的生理需求的医疗技术环境。从这个角度来看，对医疗保健设施的主要要求常常被狭义地解释为降低接触疾病的风险。相对而言，尽管患者有创伤性的住院经历和严峻的机构护理环境，但在使患者平静并让他们感到放松方面给予的优先级较低。致病视角的其他后果是，患者的心理、社会和精神需求在医疗保健设施设计中基本被忽视，并且在护理理念中常常被边缘化。对功能效率的强调，连同疾病和健康的致病概念，常常产生在心理社会方面缺乏支持的医疗保健设施。然而，近年来出现了一种不同的视角，导致了一种新的范式。现代疾病概念不再狭义地致病；相反，疾病被视为多方面的且有多种原因或因素。关注健康促进过程的健康促进视角在护理理念的考量以及新医疗保健设施的创建中变得更加核心。在这个新范式中，重点是患者：在提供护理活动和设计医疗保健环境时，除了患者的身体健康需求外，还特别强调患者的心理和社会健康需求。未来的研究需要发展关注更广泛健康概念的护理理念，从而提高对心理社会支持性设计重要性的认识。
