Theoretical Integration for Designing Healing ICU Environments: An Interdisciplinary Framework

PurposeThis paper presents an integrated framework combining perspectives from nursing, environmental psychology, and critical space theory. The framework is intended to support the study of materiality in ICUs and to inform future research on stakeholders' needs and guiding design interventions for more supportive, healing care environments.BackgroundIntensive care units (ICUs) are paradoxical spaces designed to save lives yet often experienced by patients as environments of dependency, disorientation, and loss of control. Materiality of the ICU environments can exacerbate stress and compromise recovery. While interventions addressing the material environment show promise in improving care experiences, existing approaches remain limited by single-theory perspectives that fail to capture the complexity of ICU materiality.MethodsThe integrated conceptual framework was developed through theory-informed synthesis guided by relevance to ICU settings and theoretical complementarity. Three established theories were synthesized-Roy's Adaptation Model, Ulrich's Theory of Supportive Design, and Lefebvre's Critical Theory on Space Production-using conceptual mapping across ontological, interactional, and interventional levels.ResultsThe analysis revealed convergent points and complementary relationships across the three theories. The integrated framework synthesizes these perspectives across three interconnected dimensions: environmental stimuli and adaptive response, spatial production and power relations, and evidence-based supportive design.ConclusionsThe integrated framework demonstrates that healing ICU environments require interdisciplinary approaches addressing interconnected biological, psychological, social, and material dimensions simultaneously. Effective interventions must target adaptive physiological needs, reduce psychological stress through supportive design, and challenge spatial power relations that marginalize patients and families. This framework provides a foundation for research and practice that empowers all care-related stakeholders to actively shape healing ICU environments.