To summarize briefly, key general points in this presentation include the following: To promote wellness, healthcare facilities should be designed to support patients in coping with stress. As general compass points for designers, scientific research suggests that healthcare environments will support coping with stress and promote wellness if they are designed to foster: 1. Sense of control; 2. Access to social support; 3. Access to positive distractions, and lack of exposure to negative distractions; A growing amount of scientific evidence suggests that nature elements or views can be effective as stress-reducing, positive distractions that promote wellness in healthcare environments. In considering the needs of different types of users of healthcare facilities--patients, visitors, staff--it should be kept in mind that these groups sometimes have conflicting needs or orientations with respect to control, social support, and positive distractions. It is important for designers to recognize such differing orientations as potential sources of conflict and stress in health facilities (Schumaker and Pequegnat, 1989). For instance, a receptionist in a waiting area may understandably wish to control the programs on a television that he or she is continuously exposed to; however, patients in the waiting area may experience some stress if they cannot select the programs or elect to turn off the television. Some staff may prefer bright, arousing art for corridors and patient rooms where they spend much of their time; however, for many patients, such art may increase rather than reduce stress. A difficult but important challenge for designers is to be sensitive to such group differences in orientations, and try to assess the gains or losses for one group vis-a-vis the other in attempting to achieve the goal of psychologically supportive design. Designers should also consider programs or strategies that combine or mesh different stress-reducing components. For example, it seems possible that a program enabling patients to select at least some of their wall art or pictures would foster both control and access to positive distraction. As another example, the theory outlined in this paper suggests that an "artist-in-residence" program, wherein an artist with a caring, supportive disposition would work with patients, might foster social support in addition to control and access to positive distraction. Running through this presentation is the conviction that scientific research can be useful in informing the intuition, sensitivity, and creativity of designers, and thereby can help to create psychologically supportive healthcare environments.(ABSTRACT TRUNCATED AT 400 WORDS)