In the face of cancer, people encounter stressful situations from the moment of their diagnosis, and sometimes for the rest of their lives. Indeed, they have to deal with aggressive treatments which, depending on the clinical stage, can involve, amongst others, surgery, radiation therapy, chemotherapy, hormone therapy, and/or targeted therapy. These can potentially threaten their lives as well as their physical and psychological well-being (Ornelas et al., 2013). The physical, emotional and social effects of the disease can be stressful for these people. Those who try to control stress by adopting risky behaviors, such as smoking or drinking alcohol, or those who become more sedentary can have a worse life quality after cancer treatment. On the contrary, it is increasingly recognized that individuals who use effective strategies to manage stress, such as relaxation techniques and stress management, show lower levels of depression, anxiety, cancer-related symptoms and treatment-related symptoms, than the ones who do not use these strategies (NCI, 2012). In addition, research in environmental psychology has highlighted the relaxing and calming effects that certain natural environments can have on stress. Visits to nature relieve daily stress and are especially valuable to those who suffer acute stress and emotional tension. However, circumstances that restrict the access to such restorative environments are multiple (Berto, 2014). In these cases, environmental simulation (images, videos and virtual reality) can be beneficial, since immersion in virtual natural environments has been shown to have positive effects comparable to nature exposure (Kaplan, 1995). We propose here an experimental design to evaluate the effects of exposure to a restorative environment on psychophysiological stress. The present study will evaluate the effects of exposure to a simulated restorative environment through three modalities: static, dynamic, and virtual reality simulation, on psychophysiological stress among cancer patients. Participants will be patients who are attending their first radiotherapy session. The sample will consist of 120 patients randomly assigned to one of four experimental situations (control group, image exposure, video exposure, and virtual reality dives). For each of the patients, we will measure the level of perceived psychological and environmental stress, and the perception of psychological restoration. Additionally, a state of stress is induced by the execution of arithmetic and an emotional task to corroborate its psychophysiological response. Finally, we will measure psychophysiological activation through electrodermal activity and heart rate (during baseline, the stress tasks, and exposure to restorative environment). A pilot study with clinical population is currently being developed to test the protocol and the psychometric instrument “Perceived psychological restoration in Mexican population” (developed for this study).

In this age of urbanization many of us spend the vast majority of our time indoors – not the least when it comes to work and working life. Why is that? Some of us have to, but the reasons for not going outdoors also seems to be a question of how we regard work – what is considered legitimate – and not. There is a grand body of knowledge linking contact with nature to various positive effects upon wellbeing and health, attention restoration, recovery from stress, as well as learning and more. All these aspects are of great relevance for understanding and tackling working life challenges of today. This PhD-project is midway through exploring possible forms of bringing work outdoors as well as understanding the benefits and challenges involved. The exploration has been undertaken during two years as an interactive research project based in a Swedish municipality, financed by the European Social Fund. Hundreds of people have been involved with a core of fifty participants contributing to the active experimentation and reflective learning process. Drawing upon a thematic analysis of large parts of the transcribed material as well as app-data, which has been going on continuously in dialogue with the participants, some initial empirical results can be summarized: 1) A number of different work activities may be brought outdoors for various purposes, both individually and together with others. Some are closer at hand and more frequent, such as walk n’ talk and reading, while others are more dependent on the weather or other aspects in the environment, especially those performed sitting down for a substantial time, alone or for a meeting. 2) Depending on type of work activity infrastructure of different sorts may be required. It is evident that proximity to outdoor greenspaces is important in order for outdoor work to happen at all and moreover some physical/ergonomic and/or technical support may be needed for it to function well, such as seating arrangements, sun-/rain-/windshield and wifi. 3) Bringing work activities outdoors is experienced positively by the participants overall, as it contributes to better conversations and makes them feel energized, calm, focused, inspired, happy, empowered and free, to mention some key themes. However, another very prominent feeling is that of guilt and illegitimacy – as if skipping out of work… even when doing the same things as they would have inside their work places. Theoretically, this research aims at contributing to a deeper understanding of norms considering work and its whereabouts, especially in relation to urban outdoor spaces. When it comes to policy contribution, due to the close collaboration with practice, routines and policies are being altered and further anchored within the municipality continuously. Also, the goal is to impact the urban planning in order for it to support/enable outdoor office work in the urban commons. It would be valuable to get input on theories of relevance for understanding the findings and also to have a problematizing discussion regarding these initial results and their limits.

Research problem and its novelty: General hospitals are one of the most complicated built environments. The study is to explore the effects of design interventions of built environment on wayfinding performance and its relation to stress. Theoretical framework and literature: The research conceptual framework is generated based on the Social Cognitive Theory. Wayfinding is influenced by different physical environment factors. Evidence has indicated that complex building layout could decrease wayfinding efficiency (Arthur & Passini, 1992), frustrate inexperienced "wayfinders" (i.e., outpatients and visitors), and increase levels of stress (Vilar, Rebelo, & Noriega, 2014). In addition, wayfinding problem in hospitals raises workload of medical staff and increases healthcare cost (Zimring, 1990). Research objective: To identify physical environment factors for wayfinding in healthcare facilities and examine wayfinding performance and stress level in an unfamiliar environment. Research questions and hypotheses: 1) How do interior elements influence wayfinding performance in healthcare environments? Hypothesis I: wayfinding performance is better in a setting where they are able to use more environmental information such as a landmark or outdoor view than that in a setting where there are fewer environmental cues that subjects are able to use. 2) How does stress level change during wayfinding process? Hypothesis II: The stress level is higher in the setting where less environmental information is provided than that in a setting where subjects are able to use environmental information such as a landmark or outdoor view. Method: The empirical study will recruit approximately 150 college students from the campus of Tongji University. They will be randomly assigned into four groups. The study employs a questionnaire battery relating sense of direction, wayfinding, and stress level. Then the subject will complete two wayfinding tasks in virtual hospital settings by wearing virtual goggles. Skin conductive response (SCR) and heart rate are to record for anxiety analysis. Finally, subjects will draw a cognitive map. Data collection and analysis: Three types of data will be recorded: 1) Wayfinding questionnaire. 2) Wayfinding performance includes walking distance, time duration, etc. 3) Skin conductive response (SCR) and heart rate. The stress level is analyzed by the mean of SCR values and the mean of heart rates during the wayfinding. Results and discussion: The expecting results are 1) wayfinding performance is better in a setting where they are able to use more environmental information, 2) The stress level is higher in the setting where less environmental information is provided. The study will be discussed in terms of physical layout, environmental cues, virtual reality with associated technologies, and wayfinding ability, etc. Expected theoretical contribution: The empirical study measures and compares wayfinding performance and stress level between different settings and explores that which interior variables have a more impact. Particular issues arising from the study: Some limitations should be addressed such as virtual environments vs real environments, adult group vs aging group, limited independent variables from physical environments, etc. Keywords: Wayfinding, healthcare design, stress, intervention elements