Theoretical and Conceptual Frameworks in Research and Practice

The mission of HERD is to enhance the knowledge and practice of evidencebased healthcare design by disseminating research findings, discussing issues and trends, and translating research into practice. So one might ask, "Why emphasize theory? " Why have we chosen to address it in issue 1, number 4, as we complete our first exciting year of publication at HERD? What does theory have to do with evidence-based design, design research, or even design decisions? Isn't this "theory stuff " only for academicians and researchers? Of course, we must quickly admit our possible biases on the subject, because your editors are both academicians and researchers, but we were once a practicing architect and a nurse consultant leading the design of healthcare facilities.Merriam-Webster Online (www.merriamwebster. com) says theory is "a plausible or scientifically acceptable general principle or body of principles offered to explain phenomena" or "a hypothesis assumed for the sake of argument or investigation. " Theories help us make sense of issues in healthcare design because they help explain certain ideas, concepts, values, beliefs, and intentions, and can give meaning to the connections among all of these concepts. Theory building arises from day-to-day observations, experiential learning, interactions with others, and the actual work of designing healthcare facilities. One develops hypotheses to try to confirm a theory. What if we designed it this way; what would be the outcome? How would it affect patient care, nurse staffing, or physician interventions? These questions-based on theory-and an unlimited number of others are tested every day with simulation modeling, mock-ups, or other methods as we try to translate abstract notions into concrete visualizations of what could or should be built.In a classic study of experiential learning, Kolb (1984) indicated that the concrete experiences of our day-to-day work and our observations and reflections as we consider various options and their effect on outcomes lead to the development of theory. However, in the real world of practice, we call it expert advice, strong opinion, our best guess, or even examples of best practice. Kolb stated that our concrete experiences and reflective observations lead to abstract thinking about the concepts or notions of interest, and they result in conceptualizations, which then must be tested by research to determine whether our notions and assumptions about things are "true" enough to be replicated or used as a guide in future decisions. We have many such notions, much expert advice, and many strong opinions in healthcare and design that need to be tested hypothetically. The results of these exercises should be reported in journals such as HERD so they can be replicated as examples of best practice or abandoned because they didn't work as well as we had hypothesized.Conceptual frameworks provide models for theory and hypothesis. The way that stress exacerbates clinical conditions and the way the physical environment relates to stress point to a conceptual framework suggesting that reducing environmental stress may result in more effective healthcare settings. Working within this conceptual framework, Roger Ulrich (1997) developed a theory of supportive design. Other researchers can now develop and test their own hypotheses related to that theory, as in the case of noise, lighting, artwork, or views of nature, among many other possibilities. …