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This paper selectively reviews scientific research on the health benefits and influences of nature and gardens in hospitals and other healthcare settings.Article reference: Green Plants for Green BuildingsBy:Roger S. Ulrich, Ph.D.Center for Health Systems and DesignColleges of Architecture and MedicineBenefits of Nature and Gardens in Healthcare SettingsThe research examples described in the previous parts of this article, all based on non-patient groups, indicate that visual exposure to plants and other nature and gardens lasting only a few minutes can foster considerable restoration or recovery from stress. It is important to emphasize that broadly parallel findings have been obtained when stressed patients in healthcare settings have been visually exposed to nature in for example hospital gardens. A study by Heerwagen and Orians, for instance, found that anxious patients in a dental fears clinic were less stressed on days when a large nature mural was hung on a wall of the waiting room in contrast to days when the wall was blank (Heerwagen, 1990). The restorative benefits of the nature landscape scene were evident both in heart rate data and self-reports of emotional states. In the case of hospitals and other healthcare facilities, there is mounting evidence that the function of a nature landscape or gardens are especially effective and are beneficial settings with respect to fostering restoration for stressed patients, family members, and staff (Ulrich, 1999). Cooper-Marcus and Barnes (1995) used a combination of behavioral observation and interview methods to evaluate four hospital gardens in California. They found that restoration from stress, including improved mood, was by far the most important category of benefits derived by nearly all users of the gardens -- patients, family, and employees. Likewise, a recent study of a hospital garden in a children’s hospital identified mood improvement and restoration from stress as primary benefits for users (Whitehouse et al., 2001). This conclusion was supported by convergent results from behavioral observations, interviews, and surveys. The fact that stress is a pervasive, well documented, and very important health-related problem in hospitals implies major significance for the finding that restoration is the key benefit motivating persons to use gardens or nature landscapes in healthcare facilities (Ulrich, 1999). Well-designed hospital gardens not only provide calming and pleasant nature views, but can also reduce stress and improve clinical outcomes through other mechanisms, for instance, fostering access to social support and privacy, and providing opportunities for escape from stressful clinical settings (Ulrich, 1999; Cooper-Marcus and Barnes, 1995). Concerning the last of these, escape, Cooper-Marcus and Barnes (1995) concluded that many healthcare employees used plants and gardens as an effective means for achieving a restorative pleasant escape from work stress and aversive conditions in the hospital. They also included in their report statements by several patients, which suggested that the gardens fostered restoration in part by providing positive escape (and sense of control) with respect to stress. For example, a patient interviewed in a hospital garden commented: “It’s a good escape from what they put me through. I come out here between appointments. . I feel much calmer, less stressed” (Cooper-Marcus and Barnes, 1995, p. 27). In addition to ameliorating stress and improving mood, gardens and nature in hospitals can significantly heighten satisfaction with the healthcare provider and the overall quality of care. Evidence from studies of a number of different hospitals and diverse categories of patients (adults, children, and elderly patients; ambulatory or outpatient settings, inpatient acute care wards) strongly suggests that the presence of nature -- indoor and outdoor gardens, plants, window views of nature -- increases both patient and family satisfaction (Cooper-Marcus and Barnes, 1995; Whitehouse et al., 2001; Picker Institute and Center for Health Design, 1999).
Roger S. Ulrich, Ph.D.
Center for Health Systems and Design
Colleges of Architecture and MedicineBenefits of Nature and Gardens in Healthcare SettingsThe research examples described in the previous parts of this article, all based on non-patient groups, indicate that visual exposure to plants and other nature and gardens lasting only a few minutes can foster considerable restoration or recovery from stress. It is important to emphasize that broadly parallel findings have been obtained when stressed patients in healthcare settings have been visually exposed to nature in for example hospital gardens. A study by Heerwagen and Orians, for instance, found that anxious patients in a dental fears clinic were less stressed on days when a large nature mural was hung on a wall of the waiting room in contrast to days when the wall was blank (Heerwagen, 1990). The restorative benefits of the nature landscape scene were evident both in heart rate data and self-reports of emotional states. In the case of hospitals and other healthcare facilities, there is mounting evidence that the function of a nature landscape or gardens are especially effective and are beneficial settings with respect to fostering restoration for stressed patients, family members, and staff (Ulrich, 1999). Cooper-Marcus and Barnes (1995) used a combination of behavioral observation and interview methods to evaluate four hospital gardens in California. They found that restoration from stress, including improved mood, was by far the most important category of benefits derived by nearly all users of the gardens -- patients, family, and employees. Likewise, a recent study of a hospital garden in a children’s hospital identified mood improvement and restoration from stress as primary benefits for users (Whitehouse et al., 2001). This conclusion was supported by convergent results from behavioral observations, interviews, and surveys. The fact that stress is a pervasive, well documented, and very important health-related problem in hospitals implies major significance for the finding that restoration is the key benefit motivating persons to use gardens or nature landscapes in healthcare facilities (Ulrich, 1999). Well-designed hospital gardens not only provide calming and pleasant nature views, but can also reduce stress and improve clinical outcomes through other mechanisms, for instance, fostering access to social support and privacy, and providing opportunities for escape from stressful clinical settings (Ulrich, 1999; Cooper-Marcus and Barnes, 1995). Concerning the last of these, escape, Cooper-Marcus and Barnes (1995) concluded that many healthcare employees used plants and gardens as an effective means for achieving a restorative pleasant escape from work stress and aversive conditions in the hospital. They also included in their report statements by several patients, which suggested that the gardens fostered restoration in part by providing positive escape (and sense of control) with respect to stress. For example, a patient interviewed in a hospital garden commented: “It’s a good escape from what they put me through. I come out here between appointments. . I feel much calmer, less stressed” (Cooper-Marcus and Barnes, 1995, p. 27). In addition to ameliorating stress and improving mood, gardens and nature in hospitals can significantly heighten satisfaction with the healthcare provider and the overall quality of care. Evidence from studies of a number of different hospitals and diverse categories of patients (adults, children, and elderly patients; ambulatory or outpatient settings, inpatient acute care wards) strongly suggests that the presence of nature -- indoor and outdoor gardens, plants, window views of nature -- increases both patient and family satisfaction (Cooper-Marcus and Barnes, 1995; Whitehouse et al., 2001; Picker Institute and Center for Health Design, 1999).
Benefits of Nature and Gardens in Healthcare Settings
The research examples described in the previous parts of this article, all based on non-patient groups, indicate that visual exposure to plants and other nature and gardens lasting only a few minutes can foster considerable restoration or recovery from stress.
It is important to emphasize that broadly parallel findings have been obtained when stressed patients in healthcare settings have been visually exposed to nature in for example hospital gardens. A study by Heerwagen and Orians, for instance, found that anxious patients in a dental fears clinic were less stressed on days when a large nature mural was hung on a wall of the waiting room in contrast to days when the wall was blank (Heerwagen, 1990). The restorative benefits of the nature landscape scene were evident both in heart rate data and self-reports of emotional states.
In the case of hospitals and other healthcare facilities, there is mounting evidence that the function of a nature landscape or gardens are especially effective and are beneficial settings with respect to fostering restoration for stressed patients, family members, and staff (Ulrich, 1999). Cooper-Marcus and Barnes (1995) used a combination of behavioral observation and interview methods to evaluate four hospital gardens in California. They found that restoration from stress, including improved mood, was by far the most important category of benefits derived by nearly all users of the gardens -- patients, family, and employees. Likewise, a recent study of a hospital garden in a children’s hospital identified mood improvement and restoration from stress as primary benefits for users (Whitehouse et al., 2001). This conclusion was supported by convergent results from behavioral observations, interviews, and surveys. The fact that stress is a pervasive, well documented, and very important health-related problem in hospitals implies major significance for the finding that restoration is the key benefit motivating persons to use gardens or nature landscapes in healthcare facilities (Ulrich, 1999).
Well-designed hospital gardens not only provide calming and pleasant nature views, but can also reduce stress and improve clinical outcomes through other mechanisms, for instance, fostering access to social support and privacy, and providing opportunities for escape from stressful clinical settings (Ulrich, 1999; Cooper-Marcus and Barnes, 1995). Concerning the last of these, escape, Cooper-Marcus and Barnes (1995) concluded that many healthcare employees used plants and gardens as an effective means for achieving a restorative pleasant escape from work stress and aversive conditions in the hospital. They also included in their report statements by several patients, which suggested that the gardens fostered restoration in part by providing positive escape (and sense of control) with respect to stress. For example, a patient interviewed in a hospital garden commented: “It’s a good escape from what they put me through. I come out here between appointments. . I feel much calmer, less stressed” (Cooper-Marcus and Barnes, 1995, p. 27).
In addition to ameliorating stress and improving mood, gardens and nature in hospitals can significantly heighten satisfaction with the healthcare provider and the overall quality of care. Evidence from studies of a number of different hospitals and diverse categories of patients (adults, children, and elderly patients; ambulatory or outpatient settings, inpatient acute care wards) strongly suggests that the presence of nature -- indoor and outdoor gardens, plants, window views of nature -- increases both patient and family satisfaction (Cooper-Marcus and Barnes, 1995; Whitehouse et al., 2001; Picker Institute and Center for Health Design, 1999).
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