Analysis of perceptual processes of individuals using pediatric spaces by the methods of cognition and space syntax

Environment and behavior theories are a research area in which the relationships and interactions between individuals and the environment are studied through perception, behavior, cognition and cognitive schema. Individuals gather environmental stimuli through visual, audial, olfactory and tactile senses, and convert this sensual data into behavior patterns via cognitive schemata. This kind of information processing is defined as a learning mechanism that depends on physical, cognitive and sensual development reaching a multiple perception and learning level. Additionaly, this information processing is also affected by the individual's sociocultural phenomenon; people also tend to demonstrate behaviours dependent on societial norms since social habits have the potential to shape the environment from the smallest house to the largest urban scale. Briefly, individuals, in their daily routines, develop certain kinds of behaviors through interactions with stimuli from their environment. In this manner, the environment and individual behaviors have an effect on each other. However, some periods interrupt the harmonious interaction between individuals and the daily environment, forcing individuals to implement a required environmental change. Illness is one of the times that require individuals to go beyond their ordinary lives. Sickness, as an irregularity of well-being, may necessarily require the person to be treated as an in-patient and enter an unrecognized environment. Both the lack of convenience and the difference of environment that are supposed to be adapted have an impact on the individual's experience, causing environmental press originated by the environment. Considering that adults find long-term treatment periods greatly depressing, it can be stated that they are extremely upsetting for children. Since children are accustomed to spending their daily routines in such spaces like school and recreational areas nearby their homes, they feel obliged to adapt to new spaces and social factors as they pursue their treatment progress. So, it seems possible that novel information processing procedures and original types of behaviour patterns may result from the dissimilar experiences of children who are exposed to a high level of environmental pressure. For this reason, pediatric healthcare spaces, where children are taken care of, are supposed to be designed through a holistic pedagogical approach, handling children as living beings with physical, social and psychological needs. It is necessary for environments used by children to be designed in a child-centered approach. Therefore, it is crucial that close relatives attend to the children because, depending on their age, they may likely lack the ability to care for themselves. However, the accompaniment of children may also bring about some other difficulties for the accompanying person. The companion also enters into the necessary requirement to embrace a distinct routine different from daily life, adjust to a new space, and interact with diverse individuals, including other suffering children accompanied by their relatives in addition to medical professionals. So, both the children and their companions enter into different sociophysical settings, including unordinary environmental stimuli imposed on them to behave in a different manner. In addition, this study found that the environmental dynamics and physical conditions of healthcare services are not only stressful for the in-patients and their companions, but also for the medical professionals and nurses. Nurses who have a field of responsibility, including long working hours and night duties, also need the preservation of their personal space and privacy while they have a rest or their meals. They also need to socialize with their colleagues during their work shifts. Thus, within this study, as physical conditions of healthcare environments probably have an influence on the perceptual processes, experiences and behaviours of nurses, this study also examines these kinds of interactions. Accordingly, the thesis is based on the investigation of the effects of the perceptual processes of children who are mainly attached to their home environments as their primary setting but required to adapt to a pediatric healthcare service as a secondary setting to their cognitive maps. Additionally, as the scope of this thesis handles these kinds of pediatric environments as a design problem of the spaces that companions and nurses share together with children, the pediatric in-patients. As three different social groups with various physical, emotional and social needs are required to live together in the pediatric service, it is proposed that each social group is influenced differently through these social and environmental interactions. Therefore, the main aim of the thesis is to examine the sociobehavioral and perceptual processes between the physical components of a pediatric healthcare service and the social actors of the pediatric environment within the context of private space, privacy, territory, sociopedal and sociofugal spaces. Within the context of this investigation, the case study area is the Pediatric Hematology and Oncology Service of the Cerrahpasa Hospital of Istanbul University with the participation of 30 children, 30 companions of the children, and 13 nurses, which is the total number of those giving care at the service. The behavioral and cognitive data is gathered; analysed through a triple methodology of cognitive maps, behavior maps and space syntax; and evaluated statistically to find any significant outcomes through chi-square and regression analyses. Through chi-square correlations, the study searches for any significance between independent factors such as age, gender and time elapsed in the hospital for each social group and their behavioral and cognitive frequencies. Through regression correlations, the study checks for any significance between the behavioral and cognitive frequencies of each spatial component and syntactic values of the service. Depending on these evaluations, the study analyses whether the syntactic values of the present physical conditions of the plan layout relate to behavioral frequencies of the individuals acting in the pediatric setting and the cognitive maps of children. Following the introduction section, the second section introduces such ideas as perception, behaviour, cognitive schema, and cognitive maps within the scope of environment and behaviour theories, and transitions to the topic of environmental perception of pediatric in-patient. In this manner, it is intended to uncover the contrast between two different settings; the primary setting is the home environment where children feel the greatest attachment and the secondary setting is the healthcare environment which children are getting used to within a particular time they have spent in this setting. By initiating such a debate about the contrast between the two settings, the concepts of environmental press, personal space and privacy together with the concept of social interaction are introduced, as the social actors of the setting also impact the behavior patterns in the healthcare service. The third section focuses on the design parameters of pediatric healthcare centers; it covers the change of block design of healthcare centers throughout history, the evolution of pediatric hospitals through the influence of child-centered design and the transformation of the plan layout and spatial components of pediatric units. In addition, some examples of national and international pediatric healthcare centers are presented to give the reader an opportunity to compare the physical conditions of the settings. The fourth section covers the methodology of the study, giving attention to the introduction of the plan layout together with its spatial components, the characteristics of the participants who contribute to the study, how the case study is executed step by step, how the data is collected and how the collected data is correlated. In the fifth section, the results and outcomes of the correlations resulting from chi-square and regression analyses are explained by emphasizing any significance. In the sixth section, the evaluations and results are combined with any personal observations that have been evaluated cumulatively to discuss within the framework of the scope and aim of the study. In addition, it is also intended to make some proposals and recommendations regarding the design characteristics of a pediatric healthcare setting in order to meet the physical and social needs of different social groups that have participated into this study. Regarding the results, companions are found to be as active as the nurses in the pediatric unit when considering the behavior maps, and the lowest frequency is found to belong to the group of children. Within the plan layout, some spatial components such as the nurse station and kitchen are the shared spaces of different social groups, which increases the social interaction between individuals as sociopedal spaces. The kitchen, for instance, is a space where companions carry out cooking actions together with strengthening their social bonds, which makes kitchen areas a familial space. Patient rooms are found to be sociofugal spaces and reflections of the childrens' home environments as they are observed to put a great effort to personalize their rooms with their personal belongings, hobby materials, etc. in order to increase their place attachment. Therefore, patient rooms can be evaluated as the new reference points of their lately adapted environment and daily routine. The windows establishing visual communication between the patient rooms and corridor are found to have a significant influence on children in understanding their physical environment, but also these windows are observed to be disturbing, harming their privacy, personal and territorial space. The maximum behavioral frequency of children exists in the playroom, showing that children have a high need to interact socially with others living in the same setting. Therefore, the playrooms in pediatric settings can be evaluated as sociopedal spaces that increase the social interaction between individuals. According to the implemented case study, however, it is recommended to give some free spaces within the design of recreational spaces in pediatric healthcare environments for different age groups of children so that every age group may find an appropriate activity. In addition, one corridor plan type pediatric units, about which the case study has been performed, is determined to have strong intelligibility within the cognitive maps of children as the corridor carries the maximum amount of cognitive frequency. Also, the corridor is quite an intersecting spatial component regarding behavioral frequencies of three social groups, going beyond its basic spatial function of circulation. While pediatric in-patients use the corridor as a place to walk end-to-end and socially interact with others, companions use the corridor in order to have conversations with other companions, to have phone conversations, and to welcome visitors, especially when they are not allowed to enter patient rooms to prevent the risk of infection; the nurses use the corridor mainly to reach all of the patient rooms to give care to the patients, give directions to companions, and have little chats, especially with the children. So, the corridor is a place where social interaction overflows from the thresholds of the patient rooms having a supplementary, valuable social meaning for all individuals using the pediatric setting.