Roger Ulrich, professor and director of the Center for Health Systems & Design at Texas A&M's College of Architecture, says a growing body of research is giving credibility to the widely held belief that nature can improve health.
"Knowledge and research into fields such as health psychology and behavioral medicine have demonstrated that there need not be anything magical about the processes through which gardens in healthcare facilities should be capable of reducing stress and improving patients' health," Ulrich says.
Ulrich's research focuses on the effects of built and natural environments on people's psychological well-being, stress and health, and he says more and more healthcare facilities are incorporating "healing gardens" into their designs as part of an international movement seeking to improve the quality of healthcare.
Healing gardens, he explains, refer to a variety of garden features that have in common a tendency to foster restoration from stress and have other positive influences on patients, visitors, staff and caregivers. They feature prominent amounts of real nature content, such as green vegetation, flowers and water and can be outdoor or indoor spaces, varying in size.
"Supportive gardens in healthcare facilities potentially can be an important adjunct to the healing effects of drugs and other modern medical technology, and help improve the overall quality of care," Ulrich says.
What's more, research has linked poor design - or psychologically inappropriate physical surroundings - to detrimental health effects such as higher anxiety, delirium, increased need for pain medication, elevated blood pressure and sleeplessness, Ulrich notes.
Probable advantages associated with healing gardens include reduced stress and anxiety in patients, visitors and staff, reduction in depression, higher reported quality of life for chronic and terminal patients, improved way-finding in facilities and reduced pain in patients, he notes. Gardenlike scenes can apparently reduce pain, he explains, as indicated by patient ratings of perceived pain and observed intake of pain-relieving medications.
Other potential advantages, he says, include reduced provider costs because some patients need fewer doses of costly strong pain medication and the length of stay is shorter for some patients. Increased patient mobility and independence, higher patient satisfaction with facility and increased staff job satisfaction are also potential advantages.
The belief that nature is beneficial for people with illness dates back centuries and is consistent across cultures, Ulrich notes. There are several theories, he says, that attempt to explain people's affinity for nature.
Learning theories hypothesize that people associate relaxation with nature, for example during vacations. They acquire stressful associations with urban environments because of aspects like traffic, work and crime. Other scientists argue that built environments are overly taxing to people's senses because of high levels of noise and visual complexity. Nature settings are not as arousing and therefore less stressful.
Proponents of an evolutionary theory believe that humans may have a genetic readiness to respond positively to nature such as vegetation and water because these things were favorable to survival during some two to three million years of evolution.
Whatever the case may be, the capability of gardens to improve health arises mainly from their effectiveness as stress reducing and buffering resources, Ulrich notes.
Stress is a widespread problem for patients, he explains. The vast majority of patients with illness suffer from stress and many suffer from acute stress. Many aspects of hospitalization are stressful to patients, such as impending surgery, pain and unknown diagnostic procedures, depersonalization, disruption of social relationships and job activities. Stress is also a problem for families of patients and healthcare staff.
And while gardens have the potential to help patients and staff cope with stressful scenarios, not any garden will do, Ulrich emphasizes. To be effective in reducing stress, Ulrich has found that gardens must address four main areas: promoting a sense of control, encouraging social support, offering opportunities for physical movement and providing access to natural distractions.
"If a researcher had seriously proposed two decades ago that gardens could improve medical outcomes in healthcare facilities, the position would have met with skepticism by most behavioral scientists and probably with derision by many physicians," Ulrich notes.