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HEALING GARDENS IN HOSPITALS - Umcg

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					HEALING GARDENS IN
    HOSPITALS
     Clare Cooper Marcus
University of California, Berkeley

       The Architecture of Hospitals
               April 2005
     Outline of Presentation
• History of outdoor spaces in hospitals
  and why healing gardens have recently
  become of interest
• Design guidelines
• Precedents drawn upon by designers of
  contemporary healing gardens
       History and Recent
         Developments
1.MIDDLE AGES
                  • Medieval monastic
                    cloister garden

                  • Early example of
                    restorative outdoor
                    space for sick
                    patients
2. RENAISSANCE

         • 17th-18th century :
           Period of large
           municipal hospitals

         • Buildings surround
           courtyards for
           exercise and air
           circulation
       3. PAVILION-STYLE HOSPITALS


                          • Mid-19th-early 20th
                            century

                          • Pavilion hospital,
                            providing fresh air,
                            sunlight and views
                            to nature inspired by
                            work of public health
                            reformer,Florence
                            Nightingale
Johns Hopkins Hospital,
Baltimore
3.PAVILION-STYLE HOSPITALS

                • Early 20th century

                • TB sanitoria and
                  mental asylums
                  provide maximum
                  exposure to sun,
                  fresh air, and
                  gardens to assist in
                  healing
                          4. MEGA HOSPITALS

                                   • Mid-20th century
                                   • Neo-classical style
                                     thrown out in favor of
                                     International Style
                                   • High rise buildings with
                                     emphasis on efficiency
                                   • Nature succumbs to
                                     cars and parking lots


Nebraska Methodist Hospital,
Omaha,Nebraska,USA
                         4. MEGA HOSPITALS

                                          • 1980s

                                          • Hospitals resemble
                                            corporate office
                                            buildings
                                          • Little concern for
                                            usable outdoor
                                            space

Kirklin Clinic, Birmingham, Alabama,USA
                    5. PATIENT CENTERED CARE

                                  • 1990 - Present
                                  • Negative reactions to
                                    institutional
                                    environments
                                  • Competition between
                                    hospitals in US
                                  • Greater concern for
                                    patient needs
                                  • Slow shift to more
Monterey Community Hospital,
Monterey,California
                                    welcoming , familiar
                                    imagery in interiors
           5.PATIENT CENTERED CARE


                                      • Designers look to
                                        familiar icons that may
                                        feel comfortable for
                                        patients and staff

                                      • The shopping mall




Dartmouth-Hitchcock Medical Center,
Lebanon, New Hampshire,USA (1992)
                    5. PATIENT CENTERED CARE

                                            • Designers look to
                                              regional context for
                                              more appropriate
                                              styles, forms, colors
                                              and materials




San Diego Children’s Hospital, San Diego,
California( 1990-93)
         5.PATIENT CENTERED CARE

• 1984: Significant study by Roger Ulrich finds views
  to nature have positive influence on health outcomes
• Patients recovering from gall bladder surgery with
  view to trees had fewer post-surgery complications,
  required fewer doses of strong pain drugs, went
  home sooner…
        Compared to those looking out at a brick wall
• At last…credible scientific evidence that nature has
  healing properties
5.PATIENT CENTERED
       CARE                              • Important research by
                                           Roger Ulrich, Terry
                                           Hartig et al
                                         • Viewing - or being in -
                                           nature causes
                                           physiological and
                                           psychological changes
                                         • Body/mind returns to
                                           state of balance, and
                                           contributes to state of
                                           wholeness and health
                                         • Medical authorities see
                                           nature/trees in hospital
                                           setting as not just
                                           cosmetic extras--may
                                           speed recovery, save
St Michael’s Medical Center, Texarkana
Texas
                                           $$$
              5.PATIENT CENTERED CARE

                          • Hospital clients
                            commission art with
                            nature images




Scripps Mercy Hospital,
San Diego, California
5.PATIENT CENTERED CARE

            • Product designers
              create features for
              hospitals with nature
              themes
   HOSPITAL GARDEN RESEARCH


                                    • 1994 - First systematic
                                      post-occupancy study
                                      of hospital outdoor
                                      space in US
                                    • 4 hospital gardens in
                                      San Francisco Bay area
                                      studied using visual
                                      analysis, behavior
Roof garden, Alta Bates Hospital,
                                      mapping, and
Berkeley,California                   interviews

                                    (Cooper Marcus and Barnes, 1994)
                  Sample
                            User categories:
• 2,140 people                           visitors
 • 2,140 people   patient
                                           15%
   observed
   observed
                   26%

• 143 people
 • 143 people
   interviewed
   interviewed
  – 73 female
  –73 female                           staff
  – 70 male                            59%
  –70 male
         Activities in the Gardens
100%   94%


               73%   73%
                             68%
                                      61%
                                                53%
50%
                                                         38%    36%



                                                                        12%     11%


 0%
       Relax   Eat   Talk   Pass by   Stroll   Therapy   Wait   Visit   Play   Meeting
       How do you feel after
    spending time in the garden?
•   More relaxed,calmer                 79%
•   Refreshed,stronger                  25%
•   Able to think/cope                  22%
•   Feel better, more positive          19%
•   Religious or spiritual connection    6%
•   No change of mood                    5%
    What is it about the garden
    that helps you feel better?
• Trees,plants,nature                  69%
•   Smells, sounds, fresh air          58%
•   Place to be alone or with friend   50%
•   Views,sub-areas,textures           26%
•   Practical features, benches etc    17%
•   Don’t know                          8%
                             • Typical garden-user responses:
                             “My level of stress goes way
                               down..I return to work refreshed.”
                             “I sit in the garden before my
                                appointment; it helps me deal
                                with what they will put me
                                through.”
                             “I work in the Intensive Care Unit
Kaiser Permanente Hospital
                                which is like a hell hole…sitting
 Walnut Creek, California       here in the sun is like therapy for
                                me”
                             “I work underground in the
                                Radiation Department, like one
                                of the Mole People. If I didn’t
                                have this garden to come
                                to…sunlight, fresh air, birdsong,
                                trees…I think I’d go CRAZY!”
5. PATIENT CENTERED CARE

            • Results of post-
              occupancy
              evaluations of
              hospital gardens,
              and design
              guidelines for future
              gardens, published
              1999
             5. PATIENT CENTERED CARE


Before

                                • Some of first healing
                                  gardens in US
                                  created by patients
 After                            who saw potential of
                                  wasted space and
                                  raised money to pay
                                  for design



Cancer Clinic, St Vincent’s
Hospital,Santa Fe, New Mexico
5.PATIENT CENTERED CARE


         • American Society of
           Landscape Architects
           begins to hold special
           sessions on healing
           gardens at its annual
           conference
         • 2003 - School of Chicago
           Botanic Garden initiates
           first US course on
           Healthcare Garden
           Design
                        5.PATIENT CENTERED CARE



                                      • Mid 1990s: Hospital
                                        staff begin to lobby for
                                        usable outdoor spaces
                                      • Horticultural therapist
  Before                                lead team of hospital
                                        staff, working with
                                        landscape architect, to
                                        transform dull, useless
                                        space at this hospital
                                        into vibrant garden used
                                        for physical therapy,
                                        speech therapy and
                                        horticultural therapy
After      Good Samaritan Hospital,
           Portland,Oregon
Factors contributing to emergence of interest in
     healing gardens , beginning in 1990s

 • Understanding of mind-body connection
 • Stress reduction enhances immune function
 • Interest in alternative or complementary medicine
 • Awareness that hospitals must be not only
   functionally efficient, but also patient-centered /
   psychologically supportive
 • Evidence that environmental factors(light,
   temperature, noise, music, nature) play role in
   improved patient health-outcomes
 • Recognition(in US) that attractive environment is
   good marketing tool in competitive healthcare
Alternative medicine begins to be recognized by
    government bodies and medical schools


• 1992 - Office of Alternative Medicine established
  within National Institutes of Health, Washington,DC
• 1999 - University of Minnesota offers first U.S.
  graduate level courses in alternative medicine
• 2005 - 26 medical schools in U.S. now offer such
  courses
• Nature and healing no longer viewed as a “fringe”
  idea
THE HEALING GARDEN: Essential design
  elements and environmental qualities



  Guidelines based on stress research,
   post occupancy studies of hospital
  outdoor space, and field observations
  at more than 100 hospital gardens in
      US,UK,Canada and Australia
                HEALING GARDEN

• Facilitates stress reduction, helps body reach more
  balanced state
• Helps person summon up own inner healing
  resources
• Helps patient come to terms with incurable medical
  condition
• Provides needed retreat for staff from stress of work
• Provides welcome setting for visitors
• Healing is not equivalent to cure
• Other terms used for healing garden: therapeutic,
  restorative, rehabilitative
     POTENTIAL ACTIVITIES IN A HEALING
     GARDEN RANGE FROM PASSIVE TO
                 ACTIVE

•   Viewing garden through window
•   Sitting outside
•   Dozing/napping/meditation/prayer
•   Gentle rehabilitation exercises
•   Walking to preferred spot
•   Eating/reading/doing paper work outside
•   Taking a stroll
•   Child playing in garden
•   Raised bed gardening
•   Vigorous walking
•   Sports
What happens ,psychologically, when a person
chooses to go outdoors to a garden or natural
   space to help themselves feel better?

                       • Research suggests
                         that unconsciously
                         they may move
                         through 3 or 4
                         stages:
                       • The journey
                       • Sensory awakening
                       • Personal centering
                       • Spiritual attunement
                       (Marni Barnes, 1994)
  EVIDENCE-GROUNDED DESIGN THEORY:
  How Gardens Improve Outcomes (Ulrich,1991, 1999)

              SENSE OF             SOCIAL             ENGAGEMENT
EXERCISE      CONTROL             SUPPORT             WITH NATURE




     STRESS RESTORATION AND BUFFERING




        IMPROVED HEALTH OUTCOMES
       (Clinical outcomes, patient satisfaction,cost of care)
1. OPPORTUNITIES FOR EXERCISE

                 • Exercise is associated
                   with a spectrum of
                   health benefits -
                   especially for those who
                   are sedentary,
                   depressed or elderly
                 • Even a few minutes of
                   mild exercise improves
                   mood, reduces stress
                 • People are more likely
                   to walk when there is an
                   attractive setting to walk
                   in; paths which
                   encourage exploration
1.OPPORTUNITIES FOR EXERCISE: Different
    people seek different kinds of exercise

                      • Opportunities for
                        exercise for patients
                        recovering from a
                        stroke will be very
                        different from…
                      • Those for staff who
                        want to walk or jog
                        for health in their
                        lunch hour
       1.OPPORTUNITIES FOR EXERCISE: Different
         people will seek different kinds of exercise

                                                        • Well siblings run off
                                                          steam in a maze
                                                          outside a pediatric out-
                                                          patient clinic

  Kaiser Permanente Hospital, Vallejo, California
                                                        • Labyrinths are
                                                          becoming increasingly
                                                          popular in U.S healing
                                                          gardens
                                                        • Patients, staff and
                                                          visitors use for
                                                          contemplative walking


(Temporary labyrinth installed for healing design conference, Liverpool,UK)
  2.OPPORTUNITIES TO MAKE CHOICES,
SEEK PRIVACY AND EXPERIENCE A SENSE
            OF CONTROL
• People have need for sense of control with respect
  to physical and social environments
• On entering hospital, many experience loss of
  control: Institution decides…
       -what you eat
       -what you wear
       -when doctor visits , etc
• Loss of control produces stress, worsens health
  outcomes
• Garden can be designed to enhance sense of control
                    2. SENSE OF CONTROL



                                       • Being able to go
                                         outdoors,visit with
                                         friends, choose where
                                         to walk, where to sit
                                         subtly reinforces a
                                         sense of autonomy




St Thomas’ Hospital, London, England
                  2. SENSE OF CONTROL

                                            • Something as simple as
                                              providing mobile
                                              furniture permits this
                                              nurse to move into the
                                              shade and place her
                                              lunch on the edge of a
                                              concrete planter
                                            • Staff working on tight
                                              schedules and perhaps
                                              under strict supervision
                                              can regain a measure
                                              of control in a garden

Alta Bates Hospital, Berkeley, California
                    2.SENSE OF CONTROL


                                       • Providing choices
                                         where people can sit -
                                         as a group or alone -
                                         can facilitate a sense of
                                         control
                                       • Locating seating with an
                                         expansive view or a
                                         close-in view, in sun or
Garden of St Thomas’ Hospital,           in shade, offers
London                                   welcome choices
St Thomas’ Hospital, London, England
3.PROVIDE SETTINGS WHICH ENCOURAGE
   PEOPLE TO GATHER TOGETHER AND
     EXPERIENCE SOCIAL SUPPORT

                                        Research indicates that
                                        people with higher levels of
                                        social support :
                                            -are less stressed
                                            -have better health
                                        than those who are more
                                        socially isolated
                                        Locate gardens close to
St George’s Hospital, London, England
                                        patient rooms and waiting
                                        areas, with sub-spaces
                                        where people can find
                                        privacy
                                            3.SOCIAL SUPPORT

                                                 • Staff also need
                                                   restorative places to
                                                   converse with
                                                   colleagues and find
                                                   social support
                                                 • Post-occupancy
                                                   study in California
                                                   found staff were
                                                   largest users of
                                                   hospital outdoor
                                                   space

Alta Bates Hospital, Berkeley, California
                                                       3.SOCIAL SUPPORT

                                                       • “It would show that they
                                                         care about us, as staff
                                                         in a hospital, by having
                                                         a place where we can
Kaiser Permanente Hospital, Walnut Creek, California     relax..” (Nurse,London
                                                         hospital)
                                                       • “…Public spaces that
                                                         encourage interaction
                                                         and communication
                                                         influence staff
                                                         retention.”
                                                        ( Survey of Nurses, Committee
                                                         for Architecture and the Built
                                                         Environment, UK, 2004)

   St Thomas’Hospital, London, England
                          3.SOCIAL SUPPORT

                                                • For people to be
                                                  attracted to relax and
                                                  visit with friends or
                                                  family in a hospital
                                                  outdoor space it must
                                                  be green, quiet, and
                                                  offer places of
Legacy Emanuel Hospital, Portland, Oregon,USA     privacy…..

                                                • NOT THIS !
                            3.SOCIAL SUPPORT
                                             • In considering the need
                                               for social support - the
                                               comfort of people sitting
                                               and talking together -
                                               care must be taken in
                                               the selection of furniture
                                             • This….
 Alzheimer facility, Chemainus, BC,Canada


                                             • NOT THIS !




St Mary’s Hospital, Isle of Wight, England
4.ENGAGEMENT WITH NATURE
              • A healing garden must
                have a profusion of green
                nature , which has the
                effect of:
                + Awakening the senses
                + Calming the mind
                + Reducing stress
                + Assisting a person to
                   marshall their own inner
                   healing resources
              • Nature cannot mend a
                broken leg or remove a
                tumor, but can support
                and strengthen us
                before/during/after
                medical procedures
4.ENGAGEMENT WITH NATURE

             • In selecting plant
               material, designer
               should consider color,
               texture,subtleties of
               green and leaf shape,
               grasses which more
               with the slightest breeze
             • Frail patient may move
               slowly, and sit for long
               time in one place
             • Planting design should
               be intricate, detailed
               and appeal to all the
               senses
        4.ENGAGEMENT WITH NATURE




• Plants and trees with distinctive seasonal changes
  should be considered in gardens for nursing homes,
  assisted living, Alzheimer’s facilities etc, where
  patients spend a long time and may lose track of time
• Nature attracts our attention without depleting the
  body of energy
                  4.ENGAGEMENT WITH NATURE

                                                 • Trees can provide
                                                   metaphors of solidity,
                                                   strength and
                                                   permanence
                                                 • Annuals can provide
                                                   metaphors of growth,
                                                   budding,blooming,seed-
                                                   ng, decay, death, and
                                                   transformation
                                                 • Perennials can provide
                                                   metaphors of
Kaiser Permanente Hospital, Vallejo California
                                                   persistence and
                                                   renewal
              4.ENGAGEMENT WITH NATURE

                                 • Our connection with
                                   nature can also be
                                   cognitive
                                 • Plant labels engage
                                   our attention and
                                   can stimulate
                                   conversation

Healing Garden, Good Samaritan
Hospital, Portland,Oregon
4.ENGAGEMENT WITH NATURE


             • Hospital outdoor space
               with little or no
               greenery will have little
               healing value
             • No amount of clever
               paving
               design,sculpture or
               seating can make up
               for lack of nature
          4.ENGAGEMENT WITH NATURE




  Hospice, Portland, Oregon        Victoria General Hospital,
                                   Victoria,BC,Canada

• Architects and landscape architects must work
  together to ensure that there are views out to
  gardens and landscape from patient rooms, staff
  offices, and corridors for post-surgery exercise
• Views to gardens and exterior landscape can assist
  in way-finding and reduce the stress of finding one’s
  way around a strange building
4.ENGAGEMENT WITH NATURE



                          • Water is also an
                            element of nature
     Trinity              • Views of still, reflective
     Hospice,
     London
                            water; sounds and
                            views of moving water
                            are engaging and
                            soothing
                          • Water attracts wildlife,
                            reminding us in time of
                            ill-health that life goes
                            on
     West Dorset County
     Hospital, UK
                   4. ENGAGEMENT WITH NATURE



                                                     • Indoor gardens and
                                                       atria are becoming
                                                       more common in
                                                       hospitals where:
Rehabilitation Hospital ,Lake Katrine, NY, USA           -no outdoor space is
                                                          available
                                                         -climate precludes
                                                          use of outdoors for
                                                          much of year


Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
                      5.VISIBILITY

                               • Designing a healing
                                 garden to provide for
                                 exercise, sense of
                                 control, social support,
                                 and engagement with
                                 nature - though all
                                 essential - is not
                                 enough
                               • People have to know
                                 the garden is there!
                               • Ideally, garden is visible
St Mary’s Hospital,
                                 from main lobby, so
San Francisco                    signage is not
                                 necessary
               6.ACCESSIBILITY




         St Thomas’ Hospital, London


• People of all ages and abilities need to be
  able to enter and move around in the garden
• Paths must be wide enough for two
  wheelchairs to pass (minimum 6 feet)
                6.ACCESSIBILITY




                                           Healing Garden,
                                           Good Samaritan Hospital,
                                           Portland, Oregon




• Paths should be smooth and wide enough for a
  patient on a bed or gurney to be wheeled into the
  garden
• Paving joints should be narrow enough so as not to
  catch a cane, the wheels of a walker or an IV-pole
                                      6.ACCESSIBILITY

                                      • WHAT NOT TO DO!
                                      • Garden paved with
                                        pebbles for maternity
                                        ward
West Dorset County Hospital,          • Pregnant women feared
Dorchester ,UK
                                        they would trip
                                      • Water/island theme of
                                        hospital interior carried
                                        to ridiculous lengths
                                      • Courtyard surface
                                        “waves” up and down;
                                        frail patients cannot use
St Mary’s Hospital , Isle of Wight,
UK
               7.FAMILIARITY




                                        St Nicholas’Hospice,
                                        W.Suffolk Hospital,
                                        England




• When people are stressed, elements that are
  familiar in that culture are comforting - this
  should include the garden, its design, plants,
  detailing, furnishing etc
8.QUIET

   • People enjoy natural
     sounds in a hospital
     garden, such as a
     fountain,
     birdsong,rustling of
     leaves
   • Study of 4 California
     hospital gardens found
     people most disturbed
     by incongruent sounds
     such as air
     conditioner,traffic,
     emergency helicopter
 9.COMFORT



 • Garden should be
   located close to patient
   areas and staff break
   room, with choice of
   seating in sun and
   shade, and semi-private
   niches where a person
   can feel secure



Homerton Hospital,London
                   9.COMFORT




                                      Garden of Trinity Hospice,
                                      London




• A garden shelter can provide a destination
  point for a walk, and offer shelter from sun,
  wind or rain, thus extending the use of the
  garden throughout the day or year
                9.COMFORT




• WHAT NOT TO DO!
• Psychological discomfort in a courtyard
  surrounded with windows, no sense of
  privacy, feeling of being in a “fishbowl”
              10.PANORAMIC VIEW




                                            San Diego Hospice,
                                            California


• Where location and topography permit, a viewpoint
  from a garden provides a significant place for
  reflection
• Research suggests that people who are stressed find
  a viewpoint soothing as it helps them to “get things
  into perspective”, and “see the big picture”
11. UNAMBIGUOUSLY POSITIVE ELEMENTS;
       Emotional Congruence Theory

• Our emotional state biases our perception of the
  environment
• A person who is fearful, and a person who is happy,
  may look at the same object and have very different
  reactions
• Ambiguous or abstract features may be interpreted
  by stressed patients as fearful or threatening
  (…even if the artist had no such intention…)
• Therefore…any feature that might be misinterpreted
  should not be located in a healing garden
Art in a Psychiatric Ward (Ulrich, 1986)

                     • STAFF comments:
                       “I think its fun..whimsical..”
                       “Funny little talking apple
                       cores…”
                     • PATIENT comments:
                       “Charred skulls…Drops of
                       blood flying..”
                       “Wounded people. They-re
                       in pain and crying out.”
Duke Medical Center, Raleigh , North Carolina:
              The Bird Garden
                           • An example of the
                             wrong kind of art being
                             placed in a hospital
                           • Cancer patients, looking
                             out onto this “garden”
                             reacted negatively:
                               “Beaks tearing my
                               flesh…”
                               “Hands coming up to
                               grab me…”
                           • The sculptures had to
                             be removed
Inappropriate art in a cancer clinic garden?


                      • These concrete-slab
                        sculptures would be
                        quite appropriate in
                        a museum garden…
                      • BUT…are they
                        appropriate at a
                        cancer clinic where
                        stressed patients
                        might interpret them
                        as gravestones?
What art IS appropriate in a hospital?



                    • A whale “diving”
                      into the ground can
                      be a whimsical
                      feature in a
                      playground, but…
                    • Might patients at this
                      psychiatric hospital
                      interpret it as a
                      whale committing
                      suicide?
Art in a hospital setting needs to be
  UNAMBIGUOUSLY POSITIVE


                   • This sculpture might not
                     win an award for
                     cutting-edge design,
                     but…
                   • It is entirely
                     appropriate in a hospital
                     setting where it may
                     evoke positive
                     associations and
                     memories, and help
                     reduce stress
    PRECEDENTS DRAWN UPON BY
DESIGNERS OF CONTEMPORARY HEALING
             GARDENS


1. Archetypal spaces
2.   Metaphors
3.   Historical precedents
4.   Domestic precedents
5.   Regional attributes
6.   Statement art
7.   Medical diagnoses
                1. ARCHETYPAL SPACES

                                      • A garden used in
                                        the psychiatric
                                        treatment of children
                                        who have
                                        experienced severe
                                        trauma
                                      • Incorporates
                                        archetypal spaces
                                        such as hill, cave,
Therapeutic Garden at the Institute
For Child and Adolescent                ravine, island etc
Development,
Wellesley,Massachusetts
                           2. METAPHORS


                                 • A water course is a
                                   major feature of this
                                   garden, symbolizing
                                   The Cycle of Life which
                                   begins with a low
                                   fountain-pool(birth),
                                   feeds a rocky stream
                                   (the passage of life),
                                   and ends in a
                                   contemplative pool (the
                                   end of life).
Good Samaritan Hospital,
Phoenix,Arizona
     3.HISTORICAL PRECEDENTS: English
               strolling garden

                              • Combination of trees,
                                flowers, lawns,winding
                                paths
                              • Suitable in many healthcare
                                settings since it provides 4
                                key elements in healing
                                garden design:
                                 - opportunities for exercise
                                 - places for privacy,sense
                                   of control
                                 - settings for social support
AIDS Memorial Grove, Golden      - engagement with nature
Gate Park, San Francisco
     3.HISTORICAL PRECEDENT: The courtyard


                                   • Provides enclosed,
                                     protected space
                                   • Is clearly hospital
                                     territory; in-patients may
                                     feel comfortable there in
                                     their hospital gowns
                                   • Privacy of adjacent
                                     rooms needs to be
                                     protected
Royal Devon and Exeter Hospital,
Devon, England
                                   • Sounds of HVAC units
                                     can be irritating
        3.HISTORICAL PRECEDENT: The cloister
                      garden

                                     • Would be an ideal model for
                                       garden in nursing home,
                                       geriatric ward etc
                                     • Smooth walking
                                       surface,sheltered
                                       seating,garden view
                                     • No contemporary examples
                                       found in N. America or UK;
12th century cloister, Santiago de     perhaps in Italy, Spain ?
Compostela, Spain
4. DOMESTIC PRECEDENTS


             • Front porch or front
               garden facing street
               activity preferred by
               elderly people in
               senior housing
             • Older people who
               are not sick are
               faced with problem
               of boredom rather
               than stress
4.DOMESTIC PRECEDENTS


             • Back garden is ideal
               model for frail
               elderly or those with
               Alzheimer’s disease
             • Enclosed space
               feels secure and is
               familiar from home
               environment
               5. REGIONAL ATTRIBUTES

                                  • A garden which
                                    “echoes” the colors
                                    and forms of a
                                    southern California
                                    beach scene
                                  • Does the familiarity
                                    create a more
                                    soothing setting for
Leichtag Family Healing Garden,     hospitalized
San Diego Children’s Hospital,      children?
San Diego, California
              5. REGIONAL ATTRIBUTES

                              • This garden “echoes”
                                the vegetation and
                                landscape of local
                                coastline
                              • Does this make it a
                                more healing
                                environment?
                              • Perhaps….Recent
                                study in Australia found
                                favorite art in hospital
                                depicted familiar,local
                                scenes
Harrison Memorial Hospital,
Bremerton, Washington
                  5.REGIONAL ATTRIBUTES

                                • Garden appropriate
                                  to regional desert
                                  context and to
                                  preferences of local
                                  Hispanic population
                                • But what about
                                  preferences of
                                  retirees from north-
Scottsdale Memorial Hospital,     eastern USA ?
Arizona
                       6. STATEMENT ART

                                           • Artist commissioned to
                                             design a hospital
                                             courtyard makes
                                             “statement” that has
                                             nothing to do with
                                             regional context and
                                             has none of the
                                             attributes of a healing
                                             space
West Dorset County Hospital, Dorchester,
England
                      6.STATEMENT ART


                                     • Garden for cancer
                                       center based on
                                       Russian
                                       constructivist
                                       painting
                                     • Do steel structures
                                       and minimal planting
                                       create a healing
Norris Cancer Center garden,
                                       space ?
University of Southern California,
Los Angeles
          7. MEDICAL DIAGNOSES

• Hospital gardens for specific populations are
  now being designed to meet the medical
  needs of patients and their care-givers
• Gardens are becoming the location of, and
  means of treatment for, certain patients
• While some successful gardens in this
  category have been created, more research
  is needed
                                 7. MEDICAL DIAGNOSIS
                                  • REHABILITATION
                                    garden designed for
                                    physical therapists,
                                    speech pathologists, and
                                    horticultural therapists to
                                    work with patients who
                                    have had strokes,or
                                    suffered brain damage
                                  • Varied surfaces and
                                    slopes for learning to
                                    walk again
                                  • Varied planter edge
                                    heights for sitting, leaning
                                  • Variety of labeled plants
                                    for color and shape
Healing Garden, Good Samaritan      recognition, reading etc
Hospital,Portland,Oregon
                    7. MEDICAL DIAGNOSIS
Before




                             • Before and after views
                               of a rooftop garden for
                               HIV/AIDS patients

After

                             • Special attention to
                               levels of shade because
                               patients on certain
                               medications must not
                               be in sun
  Joel Schapner Memorial
  Garden,Cardinal Cook
  Hospital,New York City
                     7. MEDICAL DIAGNOSIS

                                     • Courtyard garden at a
                                       CANCER clinic with
                                       soothing sound of
                                       water, engaging plant
                                       material, and varied
                                       degrees of shade
                                       because patients on
                                       chemotherapy drugs
                                       must stay out of sun
                                     • Cancer patients and
                                       relatives at workshop to
                                       inscribe their stories on
                                       tiles to decorate corridor
                                       beside garden
Cancer Clinic Garden, Mount Zion
Hospital, San Francisco,California
                                            7.MEDICAL DIAGNOSIS
                                             • Garden-courtyards for
                                               patients with
                                               ALZHEIMER’S
                                               DISEASE
                                             • Looped pathway to aid
                                               orientation
                                             • Tinted concrete to
The Lodge at Broadmead,Victoria,BC,Canada      reduce glare
                                             • Low planting for
                                               stooped posture
                                             • Non-toxic plants
                                             • Features to evoke
                                               earlier memories:
                                               prairie grass and
 Chemainus Health Care Center,Chemainus,
                       Center,Chemainus,       garden shed
 BC, Canada
                  7. MEDICAL DIAGNOSIS



                                • Garden at a children’s
                                  hospital must provide
                                  for sometimes
                                  conflicting needs of sick
                                  children, well siblings,
                                  worried or grieving
                                  parents, and stressed-
                                  out staff
Prouty Terrace and Garden,
Children’s Hospital, Boston,
Massachusetts
                  7. MEDICAL DIAGNOSIS

                                   • Garden/playground for
                                     children with BRAIN
                                     INJURIES/mobility
                                     problems designed to
                                     encourage physical
                                     activity and re-use of
                                     limbs
                                   • Range of topography,
                                     surfaces,features to
                                     manipulate
                                   • Encourages interaction
                                     with natural world, and
                                     taking risks
Rusk Institute of Rehabilitative
Medicine, New York
               7. MEDICAL DIAGNOSIS

                                 • Garden for children
                                   with severe
                                   HANDICAPS who
                                   live at home or in a
                                   hospital and come
                                   to facility each day



Sensory Garden , Lucas Gardens
School, Canada Bay, Sydney,
Australia
                7. MEDICAL DIAGNOSIS

                             • Garden for BURN
                               PATIENTS and families
                             • Paths wide enough for
                               beds
                             • Shade is essential
                             • Grade changes to
                               practice walking
                             • Different textures for
                               touch

Legacy Burn Center Garden,   • Separate,private staff
Legacy Emanuel Hospital,       area
Portland,Oregon
                7. MEDICAL DIAGNOSIS

                                    • Garden for patients in
                                      DRUG AND ALCOHOL
                                      rehabilitation unit based
                                      on 12-Step Alcoholics
                                      Anonymous program
                                    • Each step a different
                                      sub-space in garden with
                                      inspiring words inscribed
                                      on paving stone

Serenity Garden, Drug and Alcohol
Rehabilitation Center, Scripps
Memorial Hospital, San Diego,
California
    SUMMARY OF HEALING GARDEN DESIGN
            CONSIDERATIONS
Supportive of stress reduction and healing:
• Convenient way-finding to garden
• Accessibility
• Places of privacy
• Seating encouraging interaction
• Contact with nature (green vegetation,nature
  sounds,wildlife)
Hindering stress reduction and healing:
• Predominance of hardscape          • Crowding
• Ambiguous, abstract art            • Cigarette smoke
• Intrusive mechanical sounds
• Lack of privacy, places to sit
• Lack of choice
• Lack of shade
• Feeling of insecurity or risk
    GARDEN OFFERS COMPLETE CONTRAST
          TO HOSPITAL INTERIOR

HOSPITAL INTERIOR            GARDEN
• Institutional scale        • Domestic scale
• Man-made                   • Natural
• Evoking anxiety            • Evoking good memories
• Limited sensory detail     • Rich,sensory detail
• Straight lines,ordered     • Varied shapes,organic
• Controlled air             • Fresh air
• Few places to be alone     • Places to be alone
• Not conducive to calming   • Conducive to positive
  the mind                     feelings, introspection
• Evoking thoughts of        • Links to wider world of
  illness,death                nature, on-going cycle
                               of life
   ADVANTAGES TO HEALTHCARE FACILITIES
                         ( Roger Ulrich, 1999)

PROBABLE ADVANTAGES
• Reduction of stress in patients,staff and visitors (very likely)
• Reduced pain in patients(likely)
• Reduction in depression (likely, especially if garden fosters
  exercise)
• Higher reported quality of life for chronic and terminally-ill
  patients(likely, especially if garden fosters exercise)
• Improved way-finding( very likely, especially if garden in
  prominent location)
POTENTIAL ADVANTAGES
• Reduced costs : Length of stay shorter for certain patient
  categories; fewer strong pain medication doses
• Increased patient mobility and independence
• Higher patient satisfaction
• Increased staff job satisfaction
    MANY UNANSWERED QUESTIONS…




• Do people seeking calmness and peace in a
  hospital garden prefer a winding path,
  encouraging exploration? Or a straight path
  where they can see their destination?
• Does it depend on the type of facility?
• Does it depend on culture?
      MANY UNANSWERED QUESTIONS…


                                                       • Does this Native
                                                         American family find
                                                         comfort in the fact that
                                                         all the plants in this
                                                         garden are used in
                                    Good Samaritan       traditional healing?
                                    Hospital,Phoenix
                                    Arizona
                                                       • Are patients at this
                                                         heart hospital troubled
                                                         by a fountain-sculpture
                                                         shaped like the human
                                                         heart sliced in half, and
                                                         pulsing at the rate of a
                                                         normal heart-beat?

Royal Brompton Heart and Lung Hospital,
London
MANY UNANSWERED QUESTIONS

            • Do people find solace and
              peace in a zen garden,
              even when they don’t
              understand its symbolism?
            • Do the residents of this
              London nursing home
              spend time in this
              courtyard based on a
              Persian paradise motif, or
              would they have preferred
              an English cottage garden
              like the one they left at
              home?
      TOO MANY WASTED OPPORTUNITIES




• Courtyard designed by artists fulfills none of the
  requirements of a healing garden (Royal Devon and Exeter
    Hospital, England)

• “Front lawn” of a children’s hospital surrounded by
  traffic streets is not suitable for well or sick children
•   (Children’s Hospital, Los Angeles, California)
DO ARCHITECTS HAVE TOO MUCH
         CONTROL ?
               • Architects often“think”
                 via big, computer-drawn
                 models
               • Outdoor space
                 sometimes perceived
                 as “…what separates
                 buildings…”
               • Architect may design
                 outdoor space; does not
                 have appropriate
                 training
               • Landscape architect
                 brought into design
                 process too late
               • Minimal budget to
                 create gardens
      IDEALLY, THIS SHOULD HAPPEN:


• Designers work as team with medical personnel likely
  to use garden for therapy, and with potential patient-
  users
• Lead professional on team is landscape architect
• Team annotates plans with presumed health benefits
• Post occupancy evaluation conducted after garden in
  use
• Research results disseminated to peers
• Information on garden benefits disseminated to
  hospital staff
Clearly more research is
needed but we cannot wait
until such studies are
completed. The evidence
we DO have warrants our
continuing efforts to
establish healing gardens so
that users may benefit, and
researchers have more
possibilities of evaluating
their success.
               WE MUST DO BETTER THAN THIS !
Royal Alexandra Children’s Hospital, Sydney   St Rose Hospital, Las Vegas, Nevada
Australia




   • Fads and fashions in design lead to hospital outdoor
     space that fulfills none of the needs of a healing
     garden
   • “Stripes” of granite and gravel, lawn and
     gravel….anything striped = current fashion in
     landscape architecture
         WE MUST DO BETTER THAN THIS




• Staff who work in this
  kind of milieu deserve       THIS
  a place where they can
  take a break that is
  better than…
               WE MUST DO BETTER THAN THIS !




Mental Health Clinic, Miami,Florida   Mt. Sinai Hospital, Toronto, Canada



  • A path that runs through a bench and terminates in a
    wall: What sort of message is that for a patient with a
    mental illness?
  • Dying plants at the entrance to a hospital…”If they can’t
    keep the plants alive, how will they care for me ?!…”

				
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