Three months ago I visited my father in a New York City hospital as he awaited a heart transplant due to a deeply weakened chamber. He couldn’t leave the cardiac floor of the hospital because of the bluetooth-enabled heart monitor he wore, and the wait might be anywhere from a week to nine months. During my visit we kept finding ourselves in the most southeastern side of the unit, mesmerized by the garden five stories below. The tiered, trapezoidal Chapel Garden of New York-Presbyterian Hospital boasted cherry trees and a sloped lawn. Hospital staff, random New Yorkers and patients all wandered through the green space, and even just watching it from up high seemed to soothe the nervous system.
Many of us intuitively feel that gardens in hospitals have calming effects, but hospitals are increasingly using a growing body of scientific findings to create gardens that are best suited to maximize nature’s healing powers.
Turning to nature for physical and mental health benefits isn’t a modern concept. Doctors in the 1800s regularly prescribed time in the countryside for its healing power, according to Adam Anderson, critic at the Rhode Island School of Design. It wasn’t until the 1930s that human-created medical advancements like vaccines and anesthetics took precedence over nature, he explained. After years of perfecting sterile medical environments and heralding scientific discovery, Anderson mentioned that nature is “coming back in a big way. Now [scientists are] showing the actual mental and physical data that shows that it really does have a big impact.”
One much-cited study, published in 1984, demonstrated that gazing at a garden through a window in a hospital room helped patients recovering from gallbladder surgery heal a day faster, need less pain medication and have fewer postsurgical complications than patients viewing a brick wall. Nearly 10 years later Dr. Roger Ulrich, perhaps the most influential evidence-based healthcare design researcher in the world, and colleagues in Sweden found that patients who looked at large nature photos of water were less anxious and needed fewer doses of pain medicine than those who looked at abstract art or no art at all.
What’s more, a number of studies from a variety of sources have found that the presence of nature, whether indoor plants or window views of gardens, can increase both patient and family satisfaction (Cooper-Marcus and Barnes, 1995; Picker Institute and Center for Health Design, 1999). Nature has been shown to impact recovery after hospital stays, too. In one study, stroke survivors experienced a 20 percent reduction in risk of death after time in the hospital if they lived near a high concentration of green space.
“We know that patients who looked out at a nature view [have] a benefit. But imagine how taking them out to green space might help them heal faster,” said Teresia Hazen, coordinator of the Therapeutic Garden Program for Legacy Health, a Portland, Oregon-based health system that’s considered a leader in therapeutic gardens.
Terrace Garden at Legacy Emanuel Medical Center. (Photo Credit: Legacy Health)
She’s not the only hospital worker who has made that connection. Newly built or renovated hospitals across the globe are devoting their resources to incorporating nature. And, more often than not, that comes in the form of healing gardens. While there is no standard definition, healing gardens are usually plant-filled environments specifically designed to provide users with the ability to interact with the healing elements of nature. While they can be in private homes or public spaces, these gardens often are found in healthcare, rehabilitative and therapeutic settings.
“The hospital garden can look very different than the [hospital] interior,” Anderson said. This leads to an “ability to get away from that environment and be happily distracted by things growing.” Healing gardens can serve as a reward system or motivator to get patients up and out of bed to visit a spot they come to know and love during their stay. They can also provide spaces for a range of families, groups or patients wanting to have private conversations or a moment of solitude.
In order to create a space that’s most beneficial to users, some hospitals are using evidence-based design, or the process of basing decisions about the environment on research, to build healing gardens. Although there are currently no industry standards for healing gardens, researchers are compiling existing studies and data. A well-designed garden stimulates the senses, offers a variety of seating options and is comfortable in all seasons, according to a survey of the available research by Dr. Angeliki T. Paraskevopoulou of the Agricultural University of Athens.
“We usually have the tendency of designing spaces just on the basis of aesthetics, but designers are trying to simulate in a positive way the senses of the users—[for example] trying to integrate sound, like water, to create a calming effect,” Paraskevopoulou said.
When Legacy Health designed and built its terrace garden at Legacy Emanuel Medical Center, it incorporated specific elements to stimulate the senses. Native, drought-tolerant flowering plants were chosen as draws for pollinators. Education signage abounds to stimulate the brain. Audubon-approved birdhouses made of recycled, repurposed materials were picked to encourage birdsong. A ramp helps patients get to the overlook deck, with a view of the Children’s Garden, built in 1997. Patients see the treetops of juniper, magnolia, sourwood and birch trees.
Healing gardens aren’t terribly useful if visitors can’t access them due to environmental issues like wind, rain or sun. That’s why designers seek to create spaces with optimum microclimates, or regions where the weather differs from the surrounding area. “We need to consider that the patient is comfortable in that environment, that they have shelter from wind or sun or glare,” Paraskevopoulou said.
The award-winning MGH Healing Garden at Yawkey Cancer Center in Boston is one such example. A glass wall encloses the north and west sides of the garden, so users can see both in and out of the space and are protected from the elements. There are a variety of places to sit and relax so visitors can find full, partial or minimal sun exposure, to further shelter users in the space. There is also a glass centerpiece to the garden, a sun room, filled with plants and seating options that allow garden visits in the winter or on days with weather challenges.
Located on the eighth floor of the hospital, the main feature of the garden is a looping path—which offers opportunities for movement during recovery. The garden itself looks over the Charles River, a western view that allows users to take in the sunset. There is a small reflecting pool, trees, grassy areas, granite benches and teak furniture.
In addition to best practices for what to include in a healing garden, hospitals and designers must also take into consideration a variety of patient needs. Research has found that particular groups, like cancer patients, are sensitive to aromas, so designers need to carefully select plants. Sun glare is another factor to consider—elderly patients might not feel comfortable without shade and a muted walking surface. And patients with an IV or in a wheelchair need wide, smooth paths for safety.
“You can’t have the same design criteria for children and the elderly. Age groups, medical conditions of the patients need to be considered,” Paraskevopoulou said.
Evidence-based design of healing gardens is still an emerging field. “We know how to build a hospital—there are guidelines for them,” said Paraskevopoulou. “For the outdoor environments, there aren’t really statutory guidelines. Designers are working toward that direction.” Until then, designers like Anderson take what is known from the research to create beautiful, peaceful spaces for hospitals.
But, according to Hazen, nature’s healing effects don’t begin and end in healing gardens. “We want to create [healing through nature] here in the hospital but also in every neighborhood too. We want [people] to go outside and immunize themselves. We need to have outdoor activity every day of the year for good health. We have to train our children too: getting used to being in outdoor nature for good health.”
At least one patient believes her. A few weeks after my visit, my father was gifted, incredibly, a new heart. And just 10 days after that, in a seemingly impossibly short period of time, he walked through the garden we’d watched others enjoy from above, feeling the strong beat of a new heart in his chest. Life is good, he said.