Gardens and plants reduce stress in hospitals (4)

The capacity for gardens and plants to heighten satisfaction, as well as reduce stress, is attracting considerable attention from hospital administrators who are facing strong pressures to become more patient/consumer oriented and improve the consumer’s healthcare experience.

Article Reference: Green Plants for Green Buildings



By:

Roger S. Ulrich, Ph.D.

Center for Health Systems and Design

A nationally prominent hospital administrator in the United States recently evaluated the role of gardens and plants in the highly competitive marketplace of managed care, and endorsed their effectiveness for increasing care quality and patient/consumer satisfaction (Sadler, 2001). Further, the administrator advocated creating gardens and garden plants as an effective means for helping hospitals and providers to achieve more positive market identities and thereby improve economic or financial outcomes (Sadler, 2001).

Benefits of Healthcare Gardens for Staff

Healthcare staffing problems are a critical issue in most European countries and North America. It has been known for decades that healthcare occupations such as nursing are stressful because they often involve overload from work demands, lack of control or authority over decisions, and stress from rotating shifts (Ulrich, 1991). Workloads and pressures have mounted further, however, as healthcare providers everywhere have been forced to control or cut costs (Ulrich, 2002). These conditions have in many locations lowered lower job satisfaction, increased absenteeism and turnover, contributed to shortages of qualified personnel, increased providers’ operating costs, and eroded the quality of care that patients receive (Ulrich, 2002). These serious staff related problems imply major importance for the aforementioned finding that healthcare staff heavily use gardens and plants for positive escape from workplace pressures and to recuperate from and reduce stress. Additionally, it should be emphasized that evidence has begun to appear showing that hospital gardens increase staff satisfaction with the workplace, and may help hospital administrators in hiring and retaining qualified personnel (Whitehouse et al., 2001; Sadler, 2001; Cooper-Marcus and Barnes, 1995, 1999).

Effects of Nature on Clinical Outcomes

Findings from a few studies focusing on hospitals and other healthcare facilities suggest that views of nature and indoor plants can have important benefits in terms of improving patient clinical outcomes. At Uppsala University Hospital in Sweden, Outi Lundén, John Eltinge, and I (1993) investigated whether exposing heart surgery patients to simulated nature views would improve recovery outcomes. We assigned each 160 patients in intensive care to one of six visual stimulation conditions: two nature pictures (either a view of trees and water, or an enclosed forest scene); two abstract pictures; and two control conditions (either a white panel, or no picture or panel). Results suggested that patients who viewed the trees/water scene were significantly less anxious during the postoperative period than patients assigned to the other pictures and control conditions. Moreover, patients exposed to the trees/water view suffered less severe pain, as evidenced by the fact they shifted faster than other groups from strong narcotic pain drugs to moderate strength analgesics.

By contrast, a rather surprising finding was that an abstract picture dominated by rectilinear forms produced higher patient anxiety than control conditions of no picture at all. Another medical outcomes study compared the recovery records of gall bladder surgery patients who had a bedside window view of either a landscape with trees or a brick building wall with no nature (Ulrich, 1984). To keep other factors constant that could affect outcomes, the methods ensured that the tree and wall view groups were equivalent, for example, in age, weight, tobacco use, and general medical history. The outcomes data showed that those with the nature view, compared to those who looked out at the wall, had shorter hospital stays and suffered fewer minor post-surgical complications (such as persistent headache or nausea) (Ulrich, 1984). Further, patients with the view of trees more frequently received positive written comments from staff about their conditions in their medical records (“patient is in good spirits”). Those in the wall view group, however, had far more negative evaluative comments (“patient is upset,” “needs much encouragement”). Another major difference was that persons with the view of trees, compared to the wall view patients, needed far fewer doses of strong narcotic pain drugs.

The above findings not only indicated that views of nature in hospitals could enhance clinical or medical outcomes; as well, the results suggested that nature could improve economic outcomes by reducing the costs of care. The findings clearly implied that by providing nature it would be possible to achieve cost savings, for instance, because length of hospital stays might be shortened, and some patients would have reduced need for costly injections of strong pain drugs.