When we think of hospitals, we think of medical treatment, but also of the clinical, sterile environment in which that treatment takes place. More and more often, however, surrounding a hospital or hidden at its heart, is a garden. Founded on recent research and the opinions of health care professionals from centuries ago, conventional medicine is recognizing the benefits of nature in the healing process of patients. Sometimes this involves using organically grown food as preventative medicine, strengthening patients with garden-grown meals. Most times, patients are given the opportunity to sit in a quiet garden or walk a peaceful, landscaped trail as a way to recover from the stress of various treatments. From trees visible through windows to areas for children to play and learn with their families, discover how gardens in modern hospitals are helping patients heal.
The Beginnings of Health Care Gardens
Although it has the appearance of an up-and-coming trend, records of nature and gardens as additions to health care facilities actually date back 1000 years in both European and Asian cultures. In the Middle Ages, monasteries were designed with soothing, distracting gardens for the ill. In the 19th century, Benjamin Rush, the “father of American psychiatry,” claimed that patients with mental illnesses benefitted from garden settings. Even famed nurse Florence Nightingale continually advocated for healing gardens and prominently featured their success in her writings, which included examples of their use in European and American hospitals. She found nature to be an essential part of a therapeutic regimen, saying in her 1859 book Notes on Nursing, “It is a curious thing to observe how almost all patients lie with their faces turned to the light, exactly as plants always make their way towards the light…” Nightingale knew fresh air, sunlight, and greenery were what recovering patients craved.
As Rush had observed, healing gardens weren’t exclusive to medical hospitals. In the late 1880s, artist Vincent Van Gogh preserved therapeutic gardens on canvas when he composed various paintings of the landscaping, benches, and winding pathways surrounding the asylums at which he was a patient. “Garden of the Asylum,” “The Garden of the Asylum at Saint-Rémy,” and “The Garden of the Hospital in Arles” are just a few examples. While asylums during this time did eventually deteriorate into last-resort treatment centers, they were originally built with plans that included pleasure grounds, large windows, and greenery to “soothe shattered nerves.”
Despite support from historic medical professionals, it was when medicine advanced in leaps and bounds in the early 1900s that hospitals became less focused on the restorative effects of an environment and more focused on new technology, as well as eliminating any possible risk of spreading infection. The resulting institutions, while efficient and successful, are often stark. By emphasizing hygiene and functionality over all else, hospitals across the world forgot to focus on fulfilling the emotional needs of patients who were experiencing traumatic, stressful, exhausting treatments. But by reincorporating green spaces into modern hospital design, a number of facilities have noticed positive changes in patient welfare, as well as improvement in staff and visitor satisfaction.
The Purpose of Healing Gardens
So, apart from the draw of green spaces for patients, what’s the purpose of a healing garden in a hospital setting? After all, they cost money to create, require extra maintenance, and take up space. And until now, that’s exactly why the elimination of hospital gardens was so easy to justify. But as health care and medical facilities become increasingly expensive, and hospitals face mounting pressure to become more patient-oriented, why not turn funds toward an open, relaxing space proven to elevate positive feelings in patients and staff, reduce stress and anxiety, improve clinical outcomes, and heighten satisfaction with the overall quality of care?
Perhaps one of the most impressive effects of nature settings is how quickly they promote positive feelings. A combination of psychological, emotional, and physiological changes have been recorded in those viewing vegetation or garden-like features. Elevated feelings of calm, reduced blood pressure, lessened muscle tension, and beneficial brain electrical activity have been observed within five minutes of subjects viewing nature scenes. In a study of four California hospital gardens, patients, visiting family, and staff alike reported restored mood as the most notable effect of the greenery.
Roger Ulrich, a leading researcher into healing gardens, conducted a controlled study of 120 nonpatient subjects who were experiencing high levels of stress. As subjects recuperated from their stress, they were given one of six videos to watch, each either of natural settings or of built settings with no nature. After continuously recording their blood pressure, heart rate, and muscle tension, results indicated that recovery from stress was not only faster, but more complete, in subjects exposed to nature scenery. Those subjects even reported lower levels of fear and anger. These lowered stress levels and calmer moods can have a huge impact on the pace and completion with which patients recover from their time in medical care, especially for those undergoing lengthy, invasive, or exhausting treatments. Other studies have shown that patients with views from their window overlooking trees have shorter hospital stays, fewer post-surgical complications, and fewer doses of strong pain medication than patients whose view overlooked a brick building with no nature in sight.
Results from a number of different hospitals and diverse patients suggest both patient and family satisfaction is heightened when nature is present throughout a care facility. And as careers in health care have become more demanding and high-pressure, evidence shows that staff grow more satisfied with their workplace with the addition of hospital gardens. Diane Snyder, registered nurse at Kansas City Hospice House, was asked about the courtyards at their facility. She says, “Our work as end-of-life nurses is emotionally charged and often weighs heavily on the spirit. On challenging days, I will take a walk on the garden path, recharge my ‘soular’ batteries in the sun, and return to work refreshed.”
And if we’re to talk about cost, what could be less expensive than fewer medications used and shorter hospital stays? And if simply viewing nature can have such a positive effect on those going through high-stress times, how much more beneficial might the experience of sitting in a garden be rather than watching it behind glass? Snyder explains, “It’s a beautiful sight to see a patient’s face light up when their bed has been wheeled outside and they’ve been able to rest in the sun. It’s one thing to enjoy a view of nature through the window, but an entirely different experience to feel the warmth of the sun, a soft breeze on the face, hear the birds sing, smell the autumn leaves or approaching spring in the air.”
What Makes a Hospital Garden?
Hospital gardens, at the end of the day, can be defined exactly as they sound: Green spaces in health care facilities that aim to provide comfort, sanctuary, and healing in patients, families, and staff. The American Horticultural Therapy Association says that a “therapeutic garden is a plant-dominated environment purposefully designed to facilitate interaction with the healing elements of nature. Interactions can be passive or active depending on the garden design and users’ needs.”
It’s generally concluded that the gardens most likely to provide calm and relaxation are those full of living, healthy foliage, abundant flowers, soothing water features, the sounds of nature, and visible wildlife. Perennials are encouraged, so that there’s color and life all year. On the other hand, stark concrete structures, abstract art, urban sounds, and overcrowded spaces in these settings can hamper recovery, or make patients even more anxious. In fact, in a similar study to that mentioned previously, Ulrich and his partners assigned 160 patients in intensive care to one of six visuals: two nature pictures, two abstract pictures, and one white panel or no panel at all. The patients who viewed scenes of trees or water were less anxious during their postoperative period. Not only that, but those who had the most anxiety during recovery looked at not the blank canvas, but the abstract art.
Adrianne Carroll, the major gifts officer at University of Maryland Baltimore Washington Medical Center, described the healing garden that just celebrated its 15th anniversary as an oasis, a retreat, and a special place. “Our Tate Cancer Center is all glass at the back, so those patients undergoing treatment are able to be a part of the garden from there.” There are tables and benches, bricks inscribed with inspirational messages, and plenty of greenery, as well as nooks where people can go and sit and relax. “It really is a destination,” Carroll says, “not somewhere where people are just walking through.”
Similarly, Kansas City Hospice House was designed to use nature to bring peace of mind and a sense of sanctuary to patients. Former CEO, Elaine McIntosh, says, “The sightlines in the building are such that a view of nature is never more than a few seconds away.” Patient beds can be wheeled from the rooms to the courtyards, there’s a stone labyrinth for meditation, and all patient windows open to bring fresh air inside. Looking back on interactions clients and visitors have had with their sprawling courtyards, Snyder recalls a particular patient who had been a rancher before arriving: “He spent his whole life outside caring for animals and the environment. His family wheeled his bed outside every day for the last three days of his life; it was where he most wanted to be. Being able to fulfill that wish for him brought the patient and the family such peace.”
The type of accessibility prominent at Kansas City Hospice House was also the main consideration at Liberty Hospital during the creation of their landscaped, wheelchair-accessible walking trail — not only for their patients, but for their community. “The Walking Trail opened in 1996 as a joint effort between the Liberty Hospital Foundation, Liberty Hospital, and area businesses that shared the same goal to integrate wellness, exercise, and preventative care into the lives of people in our community,” says Julie Simpson, director of marketing and public relations for the hospital. “Once those groups made a plan, they were able to share their vision with neighboring businesses in the community that felt this space would be beneficial for their employees and residents of the area at large.”
Other facilities have found that garden space fulfills a different health need in their community: food. While some may grow produce in a public, healing space, others simply have visible greenery not open to walk through, but whose produce feeds patients and staff. New Milford Hospital is one example. The herbs and vegetables they grow in aeroponic towers go straight to the cafeteria to supplement food brought in from local farms, and they feed not only their staff and patients, but also offer daily meals to senior citizens in their community. There, garden produce, whole foods, and nutrition are treated as the first steps in disease prevention.
Seattle Children’s Hospital transformed a helipad into a teaching garden, where patients and their parents can spend an hour each week learning how to grow, harvest, and prepare healthy vegetables. Families are invited to take extra produce to further their nutrition at home. And, among other green efforts, Boston Medical Center has created 7,000 square feet of rooftop garden space. Their vegetable harvest is split between their hospital kitchens and their Preventative Food Pantry — a service that addresses nutrition-related illnesses by providing fresh, healthy foods to low-income patients and their families. The hospital also utilizes The Teaching Kitchen on their campus, a space where patients can learn to cook meals that will help with disease prevention and overall health.
As the healing power of nature is proven over and over, gardens are once again becoming a more common addition to a hospital setting. McIntosh says, “Progressive-thinking facilities are increasingly aware of the benefits of nature and attempt to build around those ideas. There are organizations which are devoted to this concept.” One of those organizations is Nature Sacred, the founders of which were the driving force behind the healing gardens at University of Maryland Baltimore Washington Medical Center. Visit their website at Nature Sacred, where they share a step-by-step guide detailing how to advocate for a healing garden — what they call a “Sacred Place” — in your community. When armed with inarguable research and the right tools for success, anyone can champion a green space meant for wellness, sanctuary, and deep healing.
Haley Casey is an editor at Mother Earth Living. When she’s not reading or writing, she can be found optimistically plotting a spring garden or collecting new ideas for natural health and delicious recipes.