Designing Health

The baby boom generation is beginning to age and consequently the US is encountering one of its largest hospital reconstruction eras in history, whether it be in the remodeling of aging hospitals or constructing new facilities altogether, it is a massive project. Consequently there are new design themes incorporated into the discussion of what constitutes holistic healthcare, and the environments which help maximize health and patient satisfaction. Within this paper, I will argue that healing gardens play a large role in holistic healthcare, and continue on to discuss various important factors when designing a healing garden. One of the main researchers in the field of healing spaces is Dr. Roger Ulrich at Texas A &M University who is a professor in both the Department of Architecture and the Department of Landscape Architecture and Urban Planning. He also serves as Director of the Center for Health Systems and Design. Ulrich has conducted a series of studies that provide evidence supporting the theory that the natural environment can influence our lives in a positive way. Topher Delaney, a landscape architect from San Francisco who survived breast cancer designed a garden for children a the San Diego Children's Hospital and Health Center. When asked about the significance of healing gardens she replied, "Nature heals the heart and soul, and those are things the doctor can't help... that's what this garden is all about-healing the parts of yourself that the doctors can't. The garden really gives hope because people see the flowers bloom and others enjoying life. It's a garden full of change and metaphor." Another successful architect involved in the design of healing gardens is Kurisu Landscape Design and Construction. Two of their projects, the Rosecrance Substance Abuse Treatment Center and the Lebanon Community Health Foundation are examples of healing gardens that incorporate many of the design features that make a garden comfortable for the patients using it. Nature has long been recognized as a source of energy, producing everything we need to sustain life. Plants produce medicines that heal our wounds, food to nourish us, and materials to shelter us, all of which are tangible. But what does nature provide that we can't sense? Nature's ability to connect with our spirit, inner self, life force, whatever one may choose to call it, is precisely what medical facilities and doctors are trying to harness in the construction of healing gardens. Historically nature has been created in many places for the purpose of enjoyment; the hanging gardens of Babylon, the cloisters of monasteries and abbeys, Buddhist temples, royal courtyards and so on. Even then gardens were valued for much more than their aesthetic value. They provide an outlet for people to sit with their thoughts, to reflect, to care for something, to congregate and most obvious to be outside.

Recent studies show that people value nature in their everyday life. They are happier, more clam, reflective and serene when nature is accessible to them. Adults have reported that natural environments, particularly trees, rocks, grass, water, flowers, birds and the sky (Olds,1989) make them feel better when they are under stress or feeling depressed (Cooper-Marcus, 1995). Whitehouse et al. performed a study in 2001 that found that the use of hospital gardens was associated with elevated mood and overall healthcare satisfaction while similar studies in the mid- 1980's showed that gardens reduced the number of complaints by patients (Ulrich,1984) and staff (Berderber, 1986). In a 1999 study by Cooper-Marcus and Barnes, gardens were shown to reduce stress and provide a place for patients to reflect and gain perspective on life and death. Access to nature, natural light, art and music has been shown to reduce a patient's stay and the amount of medication they take (Zeisel, 1999). These studies shows that when people are surrounded by a natural setting, they have more control to personalize their space, promote energy and a feeling of completeness, as well as fostering healing relationships.

Several studies have been conducted to show the connection that people feel to the natural landscape, part of which includes natural light. Ulrich was the first to record such by comparing two groups of surgical patients- one group's rooms looked out the window while the other's at a brick wall. The patients whose view was that of the natural world had shortened post-op stays, less negative comments about the nursing staff and they also took less medication for pain. Windows as influencing the way patients feel was shown in a study conducted by Keep et al. Again two groups of individuals who spent 48 hours in an intensive therapy unit, one group had translucent windows the other did not. The group that had windows slept more comfortably, had fewer delusions or hallucinations, were more oriented during their stay and more likely to remember their admission and discharge. Ulrich also found that when comparing nature to the urban world in a hospital setting, the type of environmental stimulation affected pulse rate which was lower in individuals who experienced nature as a stimuli. Their pulse rate was lower than those who were in urban conditions, those who watched television, those who did not watch television and those that experienced no stimuli at all. These mentioned studies exemplify specific health benefits that can become standard outcomes by the simple inclusion of a garden.

Certain organizations exist to help set guidelines for the design and construction of healing gardens, specific criteria that should be considered and followed when designing these spaces for therapy. Functionality is discussed because the proportion of users that are healthy and able individuals is different that the normal public. A special group of individuals needs to be accounted for. Maintainability is crucial because the condition of the garden reflects the facility and if the garden is poorly kept, then patients may lose confidence in the level of care being provided to them. The garden should be environmentally sound, meaning that the right plants are chosen for the right places to ensure health of the plants and consequently a healthier environment for visitors. Because this sort of project is still considered to be extra, and not a required medical related feature of a facility, many and most of these projects are done through fundraising and donations. Therefore it is very important to be cost effective in their design, making as little go as far as possible. Possibly the most obvious of the criteria is the aesthetic appeal, a space must be visually pleasing in order to be successful in purpose. There are principles of design that come in to play as well; simplicity, variety, balance, emphasis, sequence and scale. Many people in these gardens are

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