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Healing by Design: Healing Gardens and Therapeutic Landscapes

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Published on Sep 29, 2014

Healing by Design: Healing Gardens and Therapeutic Landscapes

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Healing by Design: Healing Gardens and Therapeutic Landscapes

1. 1. Implications www.informedesign.umn.edu A Newsletter by InformeDesign. A Web site for design and human behavior research. Healing by Design: Healing Gardens and Therapeutic
Landscapes “Quality of life,” “well-being,” and “heal-ing” are phrases that embody concepts being recognized with increasing impor-tance in the 21st-century. Healthcare costs are climbing. Also,
in today’s cul-ture we as individuals are having more demanded of each of us to meet expecta-tions— ours, our family’s, and our employer’s/employee’s. Stress or associ-ated illness can be an
outcome. As a result, non-traditional alternatives are being considered as possible healthful options. This issue of Implications illus-trates some not-so-new concepts that are gaining renewed
acceptance as viable options for consideration. Plant Usage in Healthcare: Past, Present, and Future Within the last 20 years there has been renewed interest in the role of designed natural
environments and health. However, the importance of natural envi-ronments to health is ancient. The use of the garden as a place for healing can be traced back to early Asian, Greek, and Roman
cultures. For example, the Chinese wrote the “Pen Ts’ao”—the oldest list of medicinal herbs known - on silk in 3000 B.C. The Greeks created healing temples for their gods. The temple for the
god Aesclepius (god of healing) was built in pastoral settings with mineral springs, bathing pools, gymnasiums, and healing gardens. Here people would come to worship, lodge, recreate, and heal.
In the 1st-century A.D., Dioscorides, a surgeon in the Roman Army, recorded the “De Materia Medica,” including 950 curative sub-stances of which 650 are herbal. The manuscripts included:
drawings, descriptions, and medicinal qualities of plants; methods of preparations; and contraindications and warnings (Gerlach-Spriggs, et al., 1998). Presently, hospitals and healthcare insti-
tutions often keep up extensive gardens and landscapes as an important part of healing. However, over the last 50 years with the rapid growth of medical technol-ogy and economic pressure, this
ancient concept has been neglected. In the United States, healthcare reform has prompted our public officials and health-care administrators to measure success by the length of time (shorter
being bet-ter) spent in the hospital and the effi-ciency of service delivery (Beal, 2004). Despite a long history in healthcare, the effects of natural environments on health have only been recently
systemat- VOL. 02 ISSUE 10 IN THIS ISSUE Healing by Design: Healing Gardens and Therapeutic Landscapes Healthcare Costs and Environmental Design Related Research Summaries
2. 2. Implications ically studied. Since the mid-1980s, an integrated approach to medicine has helped reawaken the belief that gardens can play a significant role in the heal-ing process. Perhaps the
best-documented study to date is that of surgical patients and their access to views to the outside world conducted by Roger Ulrich in 1984. This study demonstrated a relationship between the
duration of hospitalization, pain medica-tion usage, and the ability to view nature through a hospital window. Based on the findings of Ulrich’s study, patients with access to a view recovered faster
and needed less pain medication to do so—a winning outcome for both the patient and the facility. Healthcare institutions are increasingly recognizing the need for exposure to natural environments
 with-in the context of healthcare. The Joint Commission for the Accreditation of Hospitals Organization (JCAHO) has stated, “Patients and visitors should have opportunities to connect with
nature through outside spaces, plants, indoor atriums, and views from windows” (1999). Unfortunately, most of our information regarding natural environments and healthcare is anecdotal. It
remains difficult at present to make firm recommen-dations for the precise design of landscapes to pro-mote health and healing. Also, the needs of specific patient populations are unknown. Does
one design cure all, or are different designs needed by different conditions? Moreover, what features of the design might be positively influencing patient outcomes? These questions have gone
unanswered. Design Principles in Therapeutic Landscapes An emerging area of research and design focus with-in landscape architecture has sought to address the relationship of designed natural
environments to health and healing. As landscape architecture increasingly addresses the interface between designed natural environments and health, confu-sion www.informedesign.umn.edu has
developed regarding various terms applied to this concept. “Healing gardens” is a term frequently applied to gar-dens designed to promote recovery from illness. “Healing,” within the context of
healthcare, is a broad term, not necessarily referring to the cure from a given illness. Rather, healing is seen as an improve-ment in overall well-being that incorporates the spir-itual as well as the
physical. “Therapeutic Landscape Design” is more specific and relates to a particular aspect of a disease or healing process. The Therapeutic Landscape is designed to produce a given effect and
measurable outcome upon a disease process within a given patient and/or group of patients. It can be thought of as similar to a medication taken for a specific disease or illness. The Therapeutic
Landscape is thus less focused on heal-ing in the spiritual context, and more akin to the dis-ease model of illness as practiced in most allopathic medical systems. Numerous healthcare institutions
within and outside the United States have begun to incorporate thera-peutic landscape design. As Clare Cooper-Marcus and Marni Barnes have noted in their book Healing Where Research
Informs Design® 2 Therapeutic landscape designed for people with vision loss, outside London, England.
3. 3. Implications Gardens: Therapeutic Benefits and Design Recommendations (1999) these gardens focus on pro-viding stress relief, alleviation of physical symptoms, and improvement in the
overall sense of wellness for both patients and healthcare staff. Successful gar-dens include the following design principles: 1. Variety of Spaces: Spaces for both group and solitary occupancy. By
providing a variety of spaces, the patient is given choices, thus provid-ing an increased sense of control-leading to lower stress levels. An area for solitary occupancy allows one to “get away”
from the sterilized envi-ronments of the hospital. Areas for small groups (e.g., family members or support staff) to congre-gate provide social support to the patient. 2. A Prevalence of Green
Material: Hardscaping is minimized and plant materials dominate the gar-den. The goal would be to minimize hardscaping to only one-third of the space being occupied. It is through the softening
of the landscape patients can feel an improvement in their overall sense of wellness. 3. Encourage Exercise: Gardens that encourage walking as a form of exercise have been correlat-ed with lower
levels of depression. 4. Provide Positive Distractions: Natural distrac-tions such as plants, flowers, and water features decrease stress levels. Other activities such as working with plants and
gardening can also pro-vide positive distractions in the garden setting. 5. Minimize Intrusions: Negative factors such as urban noise, smoke, and artificial lighting are minimized in the garden.
Natural lighting and sounds are additive to the positive effects of the garden. www.informedesign.umn.edu 6. Minimize Ambiguity: Abstract environments (i.e., those with a high sense of mystery
or complexity) can be interesting and challenging to the healthy, but to the ill they may have counter-indicated effects. Numerous studies show that abstraction in design is not well tolerated by
persons who are ill or stressed. Clearly identifiable features and garden elements should be incorporated into the design. Abstract art in the facility and garden is often inappropriate. Design
Elements in the Healing Garden Whereas the Therapeutic Landscape Design is more specific and relates to a particular aspect of a disease or healing process within a given individual and/or
group, the healing garden is a term frequently applied to gardens designed to promote improvement in overall well-being that incorporates the spiritual within the healing process. In the book The
Sanctuary Garden by C. Forrest McDowell and Tricia Clark-McDowell (1998), they say, “…the key to a (healing garden) is to honor and celebrate our broader human relationship with Where
Research Informs Design® 3 Healing garden entrance with arbor at Cortesia’s Healing Sanctuary in Oregon.
4. 4. Implications nature and spirit, not just plants.” The McDowells proposed seven design elements as a guideline for design and as a means to identify the intention of the space. That is, a marriage
between the garden keep-er and the spirit of nature. The seven design ele-ments are: —A special entrance that invites and embraces the visitor into the garden —The element of water for its
psychological, spiritu-al, and physical effects —A creative use of color and lighting (be they plant or human-designed light sources) to elicit emotion, comfort, and/or awe in the visitor —The
emphasis of natural features as grounding points-such as the use of rocks, wood, natural fences, screens, trellises, wind, sound, etc. —The integration of art to enhance the overall mood/spirit of
the garden —Garden features that attract wildlife and provide habitat to a diversity of wildlife Overall, the healing gar-den design should com-fort the soul and renew the spirit—no matter if it
consists of a bench next to a tree or an intricately designed landscape. Of greatest importance is the inten-tion of honoring the design element and its relationship to the spir-it of nature. Definitions
Allopathic Medicine: theory of treatment that is based on germs causing disease. Allopathic treat-ment is a system that seeks to cure a disease by pro-ducing a condition different from or
incompatible www.informedesign.umn.edu with the effects of the disease Psychoneuroimmunology: focuses on the correla-tion between stress and health References —Beal, H., (2004). “Natural
Healing.” Architecture Minnesota, 30, p. 48-53. —Bilchik, G. (2002, August 12). “A Better Place to Heal.” Health Forum Journal. —Coile, R., Jr. (2002, July-August). “Competing by Design:
Healing Environments Attract Patients, Reduce Costs and Help Recruit Staff.” The Physician Executive, p.12-16. —Cooper-Marcus, C., & Barnes, M. (1999). Healing Gardens: Therapeutic
Benefits and Design Recommendations. New York: John Wiley & Sons. —Gerlach-Spriggs, N., Kaufman, R., & Warner, Jr., S. (1998). Restorative Gardens: The Healing Landscape. New
Haven, CT and London: Yale University Press. —McDowell, C. F., & McDowell, T. C. (1998). The Sanctuary Garden. New York: Fireside Books. —Joint Commission for the Accreditation
of Hospitals Organization. (1999). “Management of the Environment of Care,” Comprehensive Accreditation Manual for Hospitals. www.jcaho.org. —Tieman, J. (2001). “Healing through
Nature,” Modern Healthcare, 31(2), p 34-36. —Ulrich, R. (1984). “View Through a Window May Influence Recovery from Surgery.” Science, 224, p. 420-421. Healthcare Costs and
Environmental Design Despite an increase in scientific research to support benefits of healing environmental design, few health-care facilities seem to be inclined to include thera-peutic gardens or
any other access to nature in their remodeling or new construction design. In 2002, only 20% of hospitals include healing environmental fac-tors in their construction plans (Bilchik, 2002). Where
Research Informs Design® 4 Sitting bench at Cortesia’s Healing Sanctuary in Oregon.
5. 5. Implications www.informedesign.umn.edu Where Research Informs Design® 5 However, evidence-based design supports therapeu-tic environments decreasing health care costs. For
example, Derek Parker (1992) estimated the cost sav-ings from better-built healing environments (i.e., with shorter stays, drug savings, and labor costs) at $10 million per year for a 300-bed
hospital. Parker’s $10 million estimate of the annual impact of a better-built healing environment could be upwards of $15- $20 million in today’s dollars (Coile, 2002). Also, in 1998, researchers
at the Johns Hopkins University prepared a comprehensive review of 84 studies about the impact of the health care environ-ment on patient outcomes. Results indicated that patients who were
happier with their healthcare envi-ronment used fewer strong medications, were easier to care for, returned to their homes sooner, and rec-ommended the hospital to others (Coile, 2002). In the
competitive market of healthcare the message is clear: it is to the advantage of the healthcare administrator to provide an environment that is wel-coming to patients as it improves quality of life and
supports families and employees, or else, suffer the economic consequences (Tieman, 2001). “Healing by Design” Lecture Series The Center for Spirituality and Healing (CSH; est. 1995), is
charged with integrating complementary, cross-cultural and spiritual aspects of care into the education, research and clinical care programs of the University of Minnesota’s Academic Health
Center. This is accomplished by teaching healthcare profes-sionals, students, and the greater community about the interconnectedness of body-mind-spirit and the vital role that world culture and
spirituality play in achieving optimal health and well-being. In February, 2005, the University of Minnesota will begin hosting a lecture series entitled Healing by Design: Therapeutic Health Benefits
through Landscape, Garden, and Interior Design. Leading professionals will share their knowledge and insight generated from the fields of environmental psychol-ogy, neurosciences, medicine,
therapeutic horticul-ture, clinical psychology, evolutionary biology, and psychoneuroimmunology. Presenters are Clare Cooper Marcus (2/17/05), Forrest McDowell and Tricia Clark-McDowell
(5/11/05), and Jain Malkin (9/21/05). For more information on this lecture series go to: http://www.informedesign.umn.edu/Calendar.aspx Additional Resources —www.healinglandscapes.org —
www.ahta.org —www.alexstark.com —www.arboretum.umn.edu —www.csh.umn.edu —Kaplan, R., Kaplan, S., & Ryan, R. (1998). With People in Mind: Design and Management of
Everyday Nature. Washington, DC: Island Press. —Lewis, C. (1996). Green Nature/Human Nature: The Meaning of Plants in Our Lives. Urbana: University of Illinois Press. —Tyson, M.
(1998). The Healing Landscape: Therapeutic Outdoor Environment. New York: McGraw-Hill. About the Authors: At the Minnesota Landscape Arboretum, Jean Larson, M.A., H.T.R.,
C.T.R.S., serves as the coordina-tor of Therapeutic Horticulture Services. She oversees training of professional staff in the principles of therapeutic horticulture, the imple-mentation of therapeutic
horticulture programs, and community outreach. Ms. Larson is a faculty mem-ber at the CSH and serves as the center’s healing
6. 6. Implications www.informedesign.umn.edu The Mission The Mission of InformeDesign is to facilitate interior designers’ use of current, research-based information as a decision-making tool in
the design process, thereby integrating research and practice. Created by: Sponsored by: 6 garden consultant. She earned her M.A. in Therapeutic Recreation and Outdoor Education at the
University of Minnesota in 1990 and is a certified therapeutic recreation specialist and registered in horticultural therapy. As founder and director of the Center for Spirituality and Healing (CSH)
at the University of Minnesota, Mary Jo Kreitzer, Ph.D., RN, brings more than 15 years of leadership and expertise to the field of complementary thera-pies and healing prac-tices. Currently, she
is the principal investigator (PI) of a $1.6 million National Institutes of Health (NCCAM) education grant; the co-PI of a five year $2.1 million NIH (NINR) clinical trial of mindfulness meditation
with solid organ transplant patients; and the PI on a Fetzer Institute funded evaluation of the Inner Life of Healers Program. Dr. Kreitzer is also a tenured associate professor in the School of
Nursing. Related Research Summaries InformeDesign has many Research Summaries about healing, well-being, and related, pertinent topics. This knowledge will be valuable to you as you
consid-er your next design solution and worth sharing with your clients and collaborators. “Benefits of Restorative Environments” —Journal of Environmental Psychology “Influences of Favorite
Places” —Environment and Behavior “Health Benefits of Including Nature Within Hospitals” —Journal of Environmental Psychology “Influence of Meaningful Landscapes” —Landscape Journal
“Creating Beneficial Urban and Natural Settings” —Journal of Environmental Psychology “Individuals Experience Landscapes Differently” —Journal of Environmental Psychology “Physical
Features Facilitate Place Attachment” —Environment and Behavior “Natural Environmental and Transcendent Experiences” —Journal of Environmental Psychology Photos Courtesy of: Jean
Larson, Minnesota Landscape Arboretum (p. 1 & 2) Mary Jo Kreitzer, University of Minnesota (p. 3 & 4)

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