Professional Documents
Culture Documents
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
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
4. MEGA HOSPITALS 1980s Hospitals resemble corporate office buildings Little concern for usable outdoor space
Kirklin Clinic, Birmingham, Alabama,USA
Designers look to familiar icons that may feel comfortable for patients and staff The shopping mall
5. PATIENT CENTERED CARE Designers look to regional context for more appropriate styles, forms, colors and materials
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 $$$
5.PATIENT CENTERED CARE Hospital clients commission art with nature images
5.PATIENT CENTERED CARE Product designers create features for hospitals with nature themes
Sample
User categories: 2,140 people 2,140 people observed observed 143 people 143 people interviewed interviewed
73 female 73 female 70 male 70 male
patient 26% visitors 15%
staff 59%
94% 73%
73%
50%
38%
36%
12%
0%
Relax Eat Talk Pass by Stroll Therapy Wait Visit Play
11%
Meeting
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.
Kaiser Permanente Hospital Walnut Creek, California
I work in the Intensive Care Unit which is like a hell holesitting here in the sun is like therapy for me I work underground in the Radiation Department, like one of the Mole People. If I didnt have this garden to come tosunlight, fresh air, birdsong, treesI think Id go CRAZY!
5. PATIENT CENTERED CARE Results of postoccupancy evaluations of hospital gardens, and design guidelines for future gardens, published 1999
After
Some of first healing gardens in US created by patients who saw potential of wasted space and raised money to pay for design
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
Mid 1990s: Hospital staff begin to lobby for usable outdoor spaces Horticultural therapist 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
Good Samaritan Hospital, Portland,Oregon
Before
After
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
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
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)
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 outpatient clinic
Kaiser Permanente Hospital, Vallejo, California
Labyrinths are becoming increasingly popular in U.S healing gardens Patients, staff and visitors use for contemplative walking
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
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 in shade, offers welcome choices
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 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 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 ThomasHospital, 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 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 !
Plants and trees with distinctive seasonal changes should be considered in gardens for nursing homes, assisted living, Alzheimers 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 Our connection with nature can also be cognitive Plant labels engage our attention and can stimulate conversation
Healing Garden, Good Samaritan Hospital, Portland,Oregon
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
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 ones way around a strange building
Views of still, reflective 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
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
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 from main lobby, so signage is not necessary
6.ACCESSIBILITY
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
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, Dorchester ,UK
Pregnant women feared they would trip Water/island theme of hospital interior carried to ridiculous lengths Courtyard surface waves up and down; frail patients cannot use
7.FAMILIARITY
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
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
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
Inappropriate art in a cancer clinic garden? These concrete-slab sculptures would be quite appropriate in a museum garden BUTare they appropriate at a cancer clinic where stressed patients might interpret them as gravestones?
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?
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
1. Archetypal spaces
2. 3. 4. 5. 6. 7. Metaphors Historical precedents Domestic precedents Regional attributes Statement art 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, ravine, island etc
Therapeutic Garden at the Institute For Child and Adolescent 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
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
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 Alzheimers 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 hospitalized children?
Leichtag Family Healing Garden, San Diego Childrens Hospital, 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 northeastern USA ?
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 space ?
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 recognition, reading etc
7. MEDICAL DIAGNOSIS
Before
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 ALZHEIMERS DISEASE Looped pathway to aid orientation
The Lodge at Broadmead,Victoria,BC,Canada
Tinted concrete to reduce glare Low planting for stooped posture Non-toxic plants Features to evoke earlier memories: prairie grass and garden shed
7. MEDICAL DIAGNOSIS
Garden at a childrens hospital must provide for sometimes conflicting needs of sick children, well siblings, worried or grieving parents, and stressedout staff
Prouty Terrace and Garden, Childrens 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
7. MEDICAL DIAGNOSIS Garden for children with severe HANDICAPS who live at home or in a hospital and come to facility each day
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, Legacy Emanuel Hospital, 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
GARDEN
Domestic scale Natural Evoking good memories Rich,sensory detail Varied shapes,organic Fresh air Places to be alone Conducive to positive feelings, introspection Links to wider world of nature, on-going cycle of life
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
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?
Courtyard designed by artists fulfills none of the requirements of a healing garden (Royal Devon and Exeter
Hospital, England)
Front lawn of a childrens hospital surrounded by traffic streets is not suitable for well or sick children
(Childrens Hospital, Los Angeles, California)
Designers work as team with medical personnel likely to use garden for therapy, and with potential patientusers 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.
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
Staff who work in this kind of milieu deserve a place where they can take a break that is better than
THIS
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 hospitalIf they cant keep the plants alive, how will they care for me ?!