Health and Nature: The Influence of Nature on Design of the Environment of Care

By Jerry Smith, ASLA, LEED AP

A Position Paper for The Center for Health Design's Environmental Standards, Council, 2007

INTRODUCTION

Much of the recent research in the fields of therapeutic and environmental design has to do with patient stress and health outcomes, which refer to an indicator or measure of a patient’s condition or progress. Now, healthcare designers are using this research to approach healthcare facility design with a different focus than the traditional methods.

This approach, called, evidence-based design, is based on information available from both research and project evaluations. Such design approaches are engaged to create environments that are therapeutic, supportive of family involvement, efficient for staff performance, and restorative for workers under stress. If implemented accordingly, these projects should result in demonstrated improvements in the organization’s clinical outcomes, economic performance, productivity, customer satisfaction, and cultural measures (Hamilton 2003).

One major component of this process is the role nature plays in the environment of care. According to Ulrich, health outcomes research can potentially “indicate the degree to which gardens in healthcare facilities are medically beneficial and cost-effective relative to such alternatives as not having gardens” (Ulrich 1999).

In fact, research has documented that the appropriate use of nature reduces stress (Tyson, Lambert & Beattie, 2002); improves health outcomes (Parsons and Hartig, 2001; Ulrich, 1999); supports pain management (Ulrich, 1984); and promotes a sense of overall well-being among patients, visitors, and staff (Mack, 2001).

According to these researchers, probable outcomes are benefits that will more than likely be experienced in the reduction of anxiety/stress or a buffering of subsequent stressful episodes by the patients, staff, and visitors alike (Ulrich 1984). Notably with patients, the reduction of depression has been observed, especially where access to nature fosters physical exercise (Lewy, 1998).

Patients who are in direct or sensual contact with nature have demonstrated higher thresholds of pain (Ulrich 1992). And interaction with nature in chronic and terminal patients yields higher levels of quality of life. When wayfinding and landmarks are associated with nature and are clearly identified, visitor stress is reduced (Carpman 1984).

Research also indicates that attention to the environment of care yields financial benefits as well. “Places of respite is a quality-of-life issue that has proven economic benefits to its users, including shorter patient stays, reduced staff turnover, and improved staff longevity” (Waxman et. al., 1984).

Clare Cooper Marcus and Marni Barnes have provided valuable research on the physical, psychological, emotional, and behavioral responses to being in contact with nature. Their numerous case studies of healthcare facilities and user groups are ongoing and are being further documented with post occupancy evaluations (POEs) as a way to check and document their findings. POEs examine the effectiveness of designed environments after an environment is designed, completed, and occupied (Cooper Marcus, Barnes, 1999).