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This paper selectively reviews scientific research on thehealth benefits and influences of plants and gardens in hospitals and other healthcare settings. Article reference: Green Plants for Green BuildingsArticle written by: Roger S. Ulrich, Ph.D.Center for Health Systems and DesignColleges of Architecture and MedicineTexas A & M UniversityCollege State, TX 77843 Importance of Health Outcomes EvidenceHealthcare administrators everywhere are under strong pressures to control or reduce costs yet increase care quality. Faced with imperative demands such as paying for costly new medical technology, administrators may often consider plants and gardens as desirable in healthcare settings, but nonessential. Convincing the medical community to assign priority and resources usually requires providing credible evidence that plants and gardens produce benefits yet are cost-effective compared to alternatives, including not providing gardens/plants. It should be emphasized here that most healthcare administrators and especially physicians consider evidence from health outcomes research to provide the most sound and persuasive basis for assessing whether a particular medical treatment or service (here providing a garden or garden plants) is medically beneficial and financially sensible. (Ulrich, 1999, 2002). Health outcomes are numerous and varied, but most refer to measures of a patient’s medical condition or to indicators of healthcare quality. These measures include (1) observable clinical signs or medical measures, (2) subjective measures such as reported satisfaction, and (2) economic measures (Ulrich, 2002).Clinical indicators that are observable signs and symptoms relating to patients’ conditions. (Examples: length of stay, blood pressure, intake of pain drugs)Patient/staff reported outcomes. (Examples: patient reports of satisfaction with healthcare services, staff reported satisfaction with working conditions)Economic outcomes. (Examples: cost of patient care, recruitment or hiring costs due to staff turnover)Clinical and economic outcomes data traditionally have carried the greatest weight in decisions, but in recent years evidence regarding effects of treatments or services on patient satisfaction has gained much importance as healthcare providers in the United States and Europe have faced mounting pressures to become more patient or consumer oriented. STRESS REDUCING EFFECTS OF VIEWING PLANTS AND NATURESeveral studies of nonpatient groups (such as university students) as well as patients have consistently shown that simply looking at environments dominated by greenery, garden plants, flowers, or water -- as compared to built scenes lacking nature (rooms, buildings, towns) -- is significantly more effective in promoting recovery or restoration from stress. (See Ulrich, 1999, for a survey of studies.) A limited amount of research suggests that viewing settings with plants or other nature for a few minutes can promote measurable restoration even in hospital patients who are acutely stressed. There is considerable evidence that restorative effects of nature scenes are manifested within only three to five minutes as a combination of psychological/emotional and physiological changes. Concerning the first, psychological/emotional, many views of vegetation or garden-like features elevate levels of positive feelings (pleasantness, calm), and reduce negatively toned emotions such as fear, anger, and sadness. Certain nature scenes effectively sustain interest and attention, and accordingly can serve as pleasant distractions that may diminish stressful thoughts. Regarding physiological manifestations of stress recovery, laboratory and clinical investigations have found that viewing nature settings can produce significant restoration within less than five minutes as indicated by positive changes, for instance, in blood pressure, heart activity, muscle tension, and brain electrical activity (Ulrich, 1981; Ulrich et al., 1991). One controlled experiment, for example, measured a battery of physiological responses in 120 stressed persons (non-patients) who were randomly assigned to a recovery period consisting of one of six different videotapes of either nature settings (vegetation or vegetation with water) or built settings lacking nature (Ulrich et al., 1991). Findings from four continuously recorded physiological measures (blood pressure, heart rate, skin conductance, muscle tension) were consistent in indicating that recuperation from stress was faster and much more complete when individuals were exposed to the nature settings rather than any of the built environments. The quickness of nature-induced restoration was manifested as significant changes in all physiological measures within about three minutes. The pattern of physiological data further supported the interpretation that nature, compared to the built settings, more effectively lowered activity in the sympathetic nervous system. (Heightened sympathetic nervous system activity involves energy consuming mobilization or arousal and is central in stress responding.) Moreover, data from self-reports of feelings indicated that the nature environments likewise produced substantially more recuperation in the psychological component of stress. Persons exposed to the settings with plants and other nature, in contrast to the built environments, had lower levels of fear and anger, and reported far higher levels of positive feelings (Ulrich et al., 1991). Hartig (1991) also used both physiological and psychological measures to study restoration in non-patient subjects who were stressed because they either had driven an automobile through urban traffic or completed a series of difficult tests. His findings were broadly similar to those described above -- more specifically, blood pressure data and emotional self-reports converged to indicate that recovery was appreciably greater if persons looked at a nature setting dominated by vegetation rather than a built environment without nature (Hartig, 1991). Nakamura and Fujii have carried out two studies in Japan (1990, 1992) that measured brain wave activity as unstressed persons (non-patients) looked either at plants or human-made objects. In an intriguing first experiment, the researchers analyzed alpha rhythm activity as subjects viewed: two types of potted plants, each with and without flowers (Pelargonium and Begonia); the same pots without a plant; or a cylinder similar to the pots (Nakamura and Fujii, 1990). Results suggested that persons were most wakefully relaxed when they observed plants with flowers, and least relaxed when they looked at pots without plants. In the second study they recorded the electroencephalogram (EEG) while persons were seated in a real outdoor setting and viewed a hedge of greenery, a concrete fence with dimensions similar to the hedge, or a mixed condition consisting of part greenery and part concrete (Nakamura and Fujii, 1992). The EEG data supported the conclusion that the greenery elicited relaxation whereas the concrete had stressful influences.
Roger S. Ulrich, Ph.D.
Center for Health Systems and Design
Colleges of Architecture and Medicine
Texas A & M University
College State, TX 77843 Importance of Health Outcomes EvidenceHealthcare administrators everywhere are under strong pressures to control or reduce costs yet increase care quality. Faced with imperative demands such as paying for costly new medical technology, administrators may often consider plants and gardens as desirable in healthcare settings, but nonessential. Convincing the medical community to assign priority and resources usually requires providing credible evidence that plants and gardens produce benefits yet are cost-effective compared to alternatives, including not providing gardens/plants. It should be emphasized here that most healthcare administrators and especially physicians consider evidence from health outcomes research to provide the most sound and persuasive basis for assessing whether a particular medical treatment or service (here providing a garden or garden plants) is medically beneficial and financially sensible. (Ulrich, 1999, 2002). Health outcomes are numerous and varied, but most refer to measures of a patient’s medical condition or to indicators of healthcare quality. These measures include (1) observable clinical signs or medical measures, (2) subjective measures such as reported satisfaction, and (2) economic measures (Ulrich, 2002).Clinical indicators that are observable signs and symptoms relating to patients’ conditions. (Examples: length of stay, blood pressure, intake of pain drugs)Patient/staff reported outcomes. (Examples: patient reports of satisfaction with healthcare services, staff reported satisfaction with working conditions)Economic outcomes. (Examples: cost of patient care, recruitment or hiring costs due to staff turnover)Clinical and economic outcomes data traditionally have carried the greatest weight in decisions, but in recent years evidence regarding effects of treatments or services on patient satisfaction has gained much importance as healthcare providers in the United States and Europe have faced mounting pressures to become more patient or consumer oriented. STRESS REDUCING EFFECTS OF VIEWING PLANTS AND NATURESeveral studies of nonpatient groups (such as university students) as well as patients have consistently shown that simply looking at environments dominated by greenery, garden plants, flowers, or water -- as compared to built scenes lacking nature (rooms, buildings, towns) -- is significantly more effective in promoting recovery or restoration from stress. (See Ulrich, 1999, for a survey of studies.) A limited amount of research suggests that viewing settings with plants or other nature for a few minutes can promote measurable restoration even in hospital patients who are acutely stressed. There is considerable evidence that restorative effects of nature scenes are manifested within only three to five minutes as a combination of psychological/emotional and physiological changes. Concerning the first, psychological/emotional, many views of vegetation or garden-like features elevate levels of positive feelings (pleasantness, calm), and reduce negatively toned emotions such as fear, anger, and sadness. Certain nature scenes effectively sustain interest and attention, and accordingly can serve as pleasant distractions that may diminish stressful thoughts. Regarding physiological manifestations of stress recovery, laboratory and clinical investigations have found that viewing nature settings can produce significant restoration within less than five minutes as indicated by positive changes, for instance, in blood pressure, heart activity, muscle tension, and brain electrical activity (Ulrich, 1981; Ulrich et al., 1991). One controlled experiment, for example, measured a battery of physiological responses in 120 stressed persons (non-patients) who were randomly assigned to a recovery period consisting of one of six different videotapes of either nature settings (vegetation or vegetation with water) or built settings lacking nature (Ulrich et al., 1991). Findings from four continuously recorded physiological measures (blood pressure, heart rate, skin conductance, muscle tension) were consistent in indicating that recuperation from stress was faster and much more complete when individuals were exposed to the nature settings rather than any of the built environments. The quickness of nature-induced restoration was manifested as significant changes in all physiological measures within about three minutes. The pattern of physiological data further supported the interpretation that nature, compared to the built settings, more effectively lowered activity in the sympathetic nervous system. (Heightened sympathetic nervous system activity involves energy consuming mobilization or arousal and is central in stress responding.) Moreover, data from self-reports of feelings indicated that the nature environments likewise produced substantially more recuperation in the psychological component of stress. Persons exposed to the settings with plants and other nature, in contrast to the built environments, had lower levels of fear and anger, and reported far higher levels of positive feelings (Ulrich et al., 1991). Hartig (1991) also used both physiological and psychological measures to study restoration in non-patient subjects who were stressed because they either had driven an automobile through urban traffic or completed a series of difficult tests. His findings were broadly similar to those described above -- more specifically, blood pressure data and emotional self-reports converged to indicate that recovery was appreciably greater if persons looked at a nature setting dominated by vegetation rather than a built environment without nature (Hartig, 1991). Nakamura and Fujii have carried out two studies in Japan (1990, 1992) that measured brain wave activity as unstressed persons (non-patients) looked either at plants or human-made objects. In an intriguing first experiment, the researchers analyzed alpha rhythm activity as subjects viewed: two types of potted plants, each with and without flowers (Pelargonium and Begonia); the same pots without a plant; or a cylinder similar to the pots (Nakamura and Fujii, 1990). Results suggested that persons were most wakefully relaxed when they observed plants with flowers, and least relaxed when they looked at pots without plants. In the second study they recorded the electroencephalogram (EEG) while persons were seated in a real outdoor setting and viewed a hedge of greenery, a concrete fence with dimensions similar to the hedge, or a mixed condition consisting of part greenery and part concrete (Nakamura and Fujii, 1992). The EEG data supported the conclusion that the greenery elicited relaxation whereas the concrete had stressful influences.
Importance of Health Outcomes Evidence
Healthcare administrators everywhere are under strong pressures to control or reduce costs yet increase care quality. Faced with imperative demands such as paying for costly new medical technology, administrators may often consider plants and gardens as desirable in healthcare settings, but nonessential. Convincing the medical community to assign priority and resources usually requires providing credible evidence that plants and gardens produce benefits yet are cost-effective compared to alternatives, including not providing gardens/plants.
It should be emphasized here that most healthcare administrators and especially physicians consider evidence from health outcomes research to provide the most sound and persuasive basis for assessing whether a particular medical treatment or service (here providing a garden or garden plants) is medically beneficial and financially sensible. (Ulrich, 1999, 2002).
Health outcomes are numerous and varied, but most refer to measures of a patient’s medical condition or to indicators of healthcare quality. These measures include (1) observable clinical signs or medical measures, (2) subjective measures such as reported satisfaction, and (2) economic measures (Ulrich, 2002).
STRESS REDUCING EFFECTS OF VIEWING PLANTS AND NATURE
Several studies of nonpatient groups (such as university students) as well as patients have consistently shown that simply looking at environments dominated by greenery, garden plants, flowers, or water -- as compared to built scenes lacking nature (rooms, buildings, towns) -- is significantly more effective in promoting recovery or restoration from stress. (See Ulrich, 1999, for a survey of studies.) A limited amount of research suggests that viewing settings with plants or other nature for a few minutes can promote measurable restoration even in hospital patients who are acutely stressed.
There is considerable evidence that restorative effects of nature scenes are manifested within only three to five minutes as a combination of psychological/emotional and physiological changes. Concerning the first, psychological/emotional, many views of vegetation or garden-like features elevate levels of positive feelings (pleasantness, calm), and reduce negatively toned emotions such as fear, anger, and sadness. Certain nature scenes effectively sustain interest and attention, and accordingly can serve as pleasant distractions that may diminish stressful thoughts. Regarding physiological manifestations of stress recovery, laboratory and clinical investigations have found that viewing nature settings can produce significant restoration within less than five minutes as indicated by positive changes, for instance, in blood pressure, heart activity, muscle tension, and brain electrical activity (Ulrich, 1981; Ulrich et al., 1991).
One controlled experiment, for example, measured a battery of physiological responses in 120 stressed persons (non-patients) who were randomly assigned to a recovery period consisting of one of six different videotapes of either nature settings (vegetation or vegetation with water) or built settings lacking nature (Ulrich et al., 1991). Findings from four continuously recorded physiological measures (blood pressure, heart rate, skin conductance, muscle tension) were consistent in indicating that recuperation from stress was faster and much more complete when individuals were exposed to the nature settings rather than any of the built environments. The quickness of nature-induced restoration was manifested as significant changes in all physiological measures within about three minutes. The pattern of physiological data further supported the interpretation that nature, compared to the built settings, more effectively lowered activity in the sympathetic nervous system. (Heightened sympathetic nervous system activity involves energy consuming mobilization or arousal and is central in stress responding.) Moreover, data from self-reports of feelings indicated that the nature environments likewise produced substantially more recuperation in the psychological component of stress.
Persons exposed to the settings with plants and other nature, in contrast to the built environments, had lower levels of fear and anger, and reported far higher levels of positive feelings (Ulrich et al., 1991).
Hartig (1991) also used both physiological and psychological measures to study restoration in non-patient subjects who were stressed because they either had driven an automobile through urban traffic or completed a series of difficult tests. His findings were broadly similar to those described above -- more specifically, blood pressure data and emotional self-reports converged to indicate that recovery was appreciably greater if persons looked at a nature setting dominated by vegetation rather than a built environment without nature (Hartig, 1991).
Nakamura and Fujii have carried out two studies in Japan (1990, 1992) that measured brain wave activity as unstressed persons (non-patients) looked either at plants or human-made objects. In an intriguing first experiment, the researchers analyzed alpha rhythm activity as subjects viewed: two types of potted plants, each with and without flowers (Pelargonium and Begonia); the same pots without a plant; or a cylinder similar to the pots (Nakamura and Fujii, 1990). Results suggested that persons were most wakefully relaxed when they observed plants with flowers, and least relaxed when they looked at pots without plants. In the second study they recorded the electroencephalogram (EEG) while persons were seated in a real outdoor setting and viewed a hedge of greenery, a concrete fence with dimensions similar to the hedge, or a mixed condition consisting of part greenery and part concrete (Nakamura and Fujii, 1992). The EEG data supported the conclusion that the greenery elicited relaxation whereas the concrete had stressful influences.
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