Healthcare Landscape Pamphlet

Cal Poly Pomona Landscape Architecture

Healthcare

Pamphlet

image: Mikyoung Kim Design - Crown Sky Garden, Chicago Illinois

table of contents

+ introduction - abstract + chapter 1

the foundation of healthcare landscape design

what influenced healthcare landscape design + chapter 2

what is a therapeutic garden?

break down of therapeutic garden typologies

+ chapter 3

a deeper look into therapeutic gardens

studies and examples of therapeutic gardens + chapter 4

healthcare landscape lectures

collaboration between designers and medical professionals

+ chapter 5 wanderings

a personal exploration and how it ties back to healthcare design

This pamphlet is aiming to understand how landscape design can provide a positive influence in the world of healthcare. By understanding the different groups of patients and their needs (especially if a hospital or facility is specialized) will inform how the landscape can influence the patients, their families, and medical staff. It is not just designing for patients because their families and the medical staff are just as affected by the hospital setting as the patients themselves. The Landscape in Healthcare pamphlet is deeper personal research and understanding on how if healthcare facilities (small or big) budgets early on to provide space for landscape that it is a start for providing a healthier atmosphere for patients and staff alike. The long term affects outweigh any dollar amount. Through research, it shows how that even a simple view of a landscape or nature of some sort can provide a positively influence patients recovery time.

+ Nicole Nguyen

+Chapter 1

The Foundation of Healthcare Landscape Design What influenced healthcare landscape design

image: Brett Hendel-Paterson via The Society of Hospital Medicine Blog

Natural Scene (n) the natural features of a landscape; a view or views of natural features dictionary.com

The significance of natural scenes in healthcare landscape design, is based off of research that began with Roger S. Ulrich.

A view through a window of a “natural scene” can have a positive influence on patient’s recovery time.

Healing (adj) curing or curative; prescribed or helping to heal dictionary.com

“Healing� is a key term for healthcare landscape design. The idea for healthcare gardens are for the idea of healing their patients whether it is mentally or physically.

Healthy (adj) possessing or enjoying good health or a sound and vigorous mentality dictionary.com

Healthy pertains to the physical and mental state of the human body, but can also be implied to the overall atmosphere of the space. image: The Tampa Tribune

“View Through a Window May Influence Recovery from Surgery”

by Roger S. Ulrich

27 April 1984

One would not think that the view through a window in a hospital room will have such a big impact on the recovery time for patients. Roger S. Ulrich, a faculty fellow at the Center for Health Systems & Design Research and a Professor of Architecture at Texas A&M, began his research in hospital design in 1984 with his article “View Through a Window May Influence Recovery from Surgery.” This article became a foundation of the approach and understanding of healthcare design.

A window view of some kind of landscape or nature versus a view of buildings have a different impact on patients. Through data collection, he discovered that patients that had views of some sort of landscape had a much more positive recovery, in comparison to the patients that had views of HVAC units. Recovery time is shorter with the patients that had a view of landscapes or nature in general. These patients required

Hard lines from building blocked skyline or treeline

view empty - negative

Soft lines from tree canopy

meditative qualities

Table from University of Seville

less medication and had slightly lower any post-operation complications.

Views highly influence a person’s emotional state. Through his research, Ulrich discovered that not everyone wants a view of nature, that some would want views of the city skylines or view of the busy streets. But regardless, through his research, he concluded in the end that views through a window do have an impact on patients. But it is not just the patients that are important when it comes to window views. Their families and the medical staff are just as important. The atmosphere in any healthcare facility is not always pleasant, and everyone goes through some sort of emotional stress. Views from nursing station or from waiting rooms are just as important as the patients’ room themselves. From the University of Seville (Spain), research was done of six categories for aesthetic value, naturalness scored 25%, the highest of the six categories. People prefer some sort of naturalness to be aesthetically pleasing, which influences our emotional state. Ulrich’s research on the importance of views through a window began the movement on how designers in collaboration with medical professionals can create an environment that reduces recovery time for patients, but to also provide a place that is safe, sustainable, green, and smart.

+Chapter 2

What is a Therapeutic Garden?

Break down of therapeutic garden typologies

image: Florida Hospital Celebration Health

Therapeutic (adj) of or relating to the treating or curing of disease; curative dictionary.com

Therapeutic gardens are the generalized “type� of garden that encompasses pieces of the other garden typology. image: Cheyenne Botanic Gardens

Restorative (adj) serving to restore; pertaining to restoration; capable of renewing health or strength dictionary.com

Restoration is measured by both self-reporting and objective physical measures. Environmental psychologists identified four components: being away, extent, fascination, and compatibility. image: Kent Hospital

Extent (n) the space or degree to which a thing extends; length, area, volume, or scope dictionary.com

A component of restorative gardens: the connections of an area to another. An extension of a place giving a wider range of pathways or spaces to take and gather. image: Kent Hospital

Meditation (n) continued or extended thought; reflection; contemplation dictionary.com

Meditation gardens are encouraged for inward focus by deepening personal knowledge and seeking peace with oneself. image: Square Space - Landscape Architects

Contemplation (n) thoughtful observation; full or deep consideration, reflection dictionary.com

Contemplation gardens provides an ambiance that allows one to examine issues that are beyond oneself. image: Mikyoung Kim Design - Contemplation Garden

“Everyday Healing Gardens”

by Lacey In “Everyday Healing Gardens,” the author introduces the types of healing gardens and begin breaking down the design principles, garden elements, design objectives, sensory experiences, and benefits. Much like any landscape design projects, a designer would tackle a healthcare garden design much the same. Analyze the site and know the people it is to serve. Just that, with healthcare garden, extra care in understanding the people the garden will serve can have a positive or a highly negative impact on the lives of the patients.

Some of the design principles Lacey mentioned range from the variety of spaces and materials, minimizing intrusions and ambiguity. Design Cognitive - Mental

Sight

Hearing

Smell

Taste

Touch

Mobility

elements help emphasize the design principles, but it also help with enhancing overall mood and feel of the garden, as well movement through the space. The design objectives Lacey listed out are key in designing a successful healthcare garden, but as with any design project, these objectives changes. The first one listed was the individual needs. Each healthcare facility have their focus group that they serve or some cater to a much more general public. For the facilities that cater to a focus group (example: children with autism, Alzheimer’s) the design of the garden needs to pinpoint to the needs of these group specifically since their health needs are significantly different. But some objectives that are similar all the way across is safety and security, heighten sensory awareness, and promote independence. The physical environment can play a significant impact to many patients. The elderly are sensitive to the sunlight, therefore a transition canopy to and from the building is needed to give a gradual transition from the inside to the outside. Last of the objectives is interaction. For children, it is best to keep them engaged and through interaction they get moving and get their senses going. Their interaction can be something that was designed or to even create an environment where they can interact with each other.

Sensory experiences are highly encouraged, but as mentioned, certain elements per sensory experience must be decided carefully. For example, some patients with certain illness or diseases have a high sensitivity to particular smells which can cause a high emotional stress.

Color can provoke different emotions, some positive, some negative.

Though again, some patients might few a particular color one way versus someone else that might few it at a complete opposite perspective.

Benefits range from physical and physiological benefits to psychological and emotional benefits. According to Lacey, patient and non-patients that have spent time looking at greenery can reduce stress, lower blood pressure, decrease muscle tension, and increase positive feelings.

The impact of nature helps patients and non-patients improve on their concentration, mental fatigue, and improving psychological health.

Facilities with access to some sort of green space will have patients and non-patients that will receive environmental stimulation, exercise, socialization, and a place for contemplation. Therefore, when designing for healthcare landscape or gardens, all these principles, objectives, benefits needs to be concerned to make for a successful space for patients, their families, and medical staff.

+Chapter 3

A Deeper Look into Therapeutic Gardens Studies and examples of therapeutic gardens

image: Veterans Center in Hanson, Kentucky

Ambiance (n) the mood, character, quality, tone, atmosphere, etc., particularly of an environment or milieu dictionary.com

For healthcare gardens creating a particular ambiance can evoke emotions and feelings. It forms an atmosphere away from all the medical treatment and stress for the patients, their families, and medical staff.

Socialization (n) a continuing process whereby an individual acquires a personal identity and learns the norms, values, behavior, and social skills appropriate to his or her social position dictionary.com

Socialization is a key aspect to keep people engaged and away from isolation. Socializing keeps a mind active, and keeps the individual engaged. Socialization doesn’t mean words needs to be exchanged, but small group activities can keep a person engaged.

image: Paws with Purpose

“The Therapeutic Garden: A Definition”

by Nancy Gerlach-Spriggs and Vince Healy

Nancy Gerlach-Spriggs and Vince Healy took the broad definition of therapeutic gardens and broke it down into four different garden typologies – healing, meditation, contemplation, and restorative. They mentioned if a landscape designer understands the foundations of a therapeutic garden and how it needs to meet the medical model than designing for the other four garden types is easier. Therapeutic gardens, according to Gerlach-Spriggs and Healy, “suggests more than healing, meditation, or contemplation, [that it should] most likely include aspects that promote restoration.” We design these particular types of gardens as if we are like a doctor prescribing medication or treatment. It is important when designing a garden of any sort for medical related settings, that the designer understands the patients being treated at the facility. The design needs and should cater to those that they serve, but to also serve their families and the medical staff. A successful design requires the designer to work close with medical professionals that can help identify the goals and make measurable outcomes. Not all the gardens

acute care facility - landscape for aesthetic and marketing image: Carlton Gardens Care Center

hospice care facilities like nursing homes create gardens for everyday use and functional

for medical facilities will be the same, but the ideas to help the people they serve is the same. The patients are not only different but the type of facility it is: acute care (short-term) versus long-term care or hospice. A garden design for an acute care facility might not need to be big in scale, and might just serve more so for aesthetics and marketing. For long-term care or hospice facilities, the garden space can become a sanctuary for the patients, family members, and medical staff. Gardens for long-term care facilities can help target the needs of the patients or residents. It not only allows for outdoor enjoyment, but gives the patients a chance to be out and not be confined to their bedrooms. Being cooped up in their hospital room can make one depressed and it really disrupts the mental state of a person, and can be even worse physically for not being able to move around. It also allows patients to be by themselves in a relaxing atmosphere, or allows them to socialize with other patients, or a place for them to enjoy their time with their visiting family members and friends.

These garden spaces are important for the families and medical staff.

The stresses are just as heavy on the family and the medical staff, and having a place for them to go to can help recuperate.

“Therapeutic Gardens and Outdoor Space Design”

by Elizabeth Brawley

In Elizabeth Brawley’s article “Therapeutic Gardens and Outdoor Space Design,” she focus in on therapeutic garden design for those with dementia. Dementia is a generalized term for the decline in mental ability severe enough to interfere with daily life. Brawley mentions the importance that outdoor space can provide for those with dementia.

Confined and enclosed places are often upsetting, and by planning and designing an outdoor environment is a valuable source for people with dementia, but also for medical staff and patients’ families. Outdoor spaces, as mentioned by Brawley, is a great outlet for socialization and a range of activities for all levels of participation. The only concern when it comes to gardens in a healthcare facility of any sizes is the “is it going to be used?” A big part of this is up to the staff to help encourage outdoor activity, even if it is to just sit outside and

wandering pathways

gathering space

get some fresh-air. A particular design element that needs to be kept in mind when designing for patients with dementia is safety and security.

Not only does the garden needs to be physically safe and secure, but to feel safe and secure. The patients, their families, and staff needs a place to escape to. The garden design needs to accommodate the needs of dementia patients. They do not have good balance, so an addition of railings along pathways will help support the residents when they are out for walks. Areas for individual or group activities are great, keeps the residents for socializing. By designing in this type of situation, known as “sheltered freedom,” designs can allow residence some freedom and dignity within the bounds of a safe and protective environment.

Since there is a varying degree of memory loss for dementia patients, pathways need to be easy to navigate and give a sense of orientation.

Elements at particular corners or areas can allow residences to find their way around. Plant material are great for fencing and bordering pathways, and to just be aesthetically pleasing. But for many in later stages of dementia tend to eat plants, therefore nontoxic plants need to be used. Sensory stimulation is also an element that should be considered when designing. Though

“Being outside is necessary for well-being and for life itself.”

- Elizabeth Brawley each stage will have different stimulation with the senses, designing different areas to trigger different experiences can target the different stages of dementia. Many of the design elements and concepts used for dementia patients will drastically vary for other types of illness or diseases. And as designers, we design to cater to the needs of the patients, their families, and medical staff.

different, clear material

+Chapter 4

Healthcare Landscape Lectures Collaboration between designers and medical professionals

image: Boston Children’s Hospital - Prouty Garden

“Healthy Hospital” Lecture at the National Building Museum

Roger S. Ulrich, Bob Eisenman, Robin Guenther

March 6, 2012 - https://youtu.be/f2Nrf26_7LE

Ulrich along with Bob Eisenman (executive director at Global Health and Safety Initiative) and Robin Guenther they discuss on how designers and medical professionals can improve the quality of life in general in a medical facility. Designing for medical facilities should be based on what they called “evidence based design.” Meaning that the design for the facility is based on data from medical staff and the needs of their patients. What prevents many facilities from budgeting for a garden is overall cost. Ulrich, Eisenman, and Gunther all agreed that the long term cost outweighs the short term cost. The benefits that a garden can provide can play a significant role for patient outcome. Yes it will cost a bit more, but shorter stays for patients’ means more patients can come in and out of the facility. People are much happier. Something that they looked into was the benefits of a single bedroom. Shared bedrooms cause stress and poor sleep qualities. With a single room, the patient not only has privacy, but their sleep is much better. With a roommate, if they are being checked on or being treated it becomes disturbing and noisy.

No roommate means better sleep which helps with recovery. We, as designers, need to design for a smart, safe, and sustainable garden that can be beneficial for patients, their families, and the medical staff.

Robin Guenther Architect Co-Author of Sustainable Healthcare Architecture

Roger S. Ulrich Faculty fellow at the Center for Health Systems & Design Research Professor of Architecture at Texas A&M

Bob Eisenman Executive Director at Global Health and Safety Initiative

“The Healing Landscape: Therapeutic Outdoor Environments” Lecture

Joanne Westphal

TEDMED at Michigan State - July 17, 2013 - https://youtu.be/ikGL1UWMAXc There are three questions that Joanne Westphal asked the audience before beginning her lecture, which became her three topics:

Are all gardens therapeutic?

Are all therapeutic gardens equal?

How can medical practitioners improve therapeutic garden design?

image: UCSF Benioff Children’s Hospital

Joanne Westphal looks at therapeutic gardens in a broad sense before specifying into finer details how they are beneficial whether in a medical setting or not. She looked at therapeutic gardens based upon the “integrated medical models,” which consist of five dimensions of human health: anatomical, physiological, psychological, sociological, and spiritual (Herbert Benson 1994). Therapeutic gardens that are designed based on human health can go a long way. By not only giving a place for patients to go to, but give patients a chance to be independent and

image: Mikyoung Kim Design - Crown Sky Garden

have an active exercise. Not all types of therapeutic gardens are the same. Therapeutic gardens that are designed specifically for healthcare have a much more refined and designated target population. Healthcare gardens are catered to medical protocols. Cost is always an issue. For a garden costs can vary from $2,000 to $20,000 versus a hospital stay for one day is about $10,000. By having a garden designed alongside the healthcare facility, patients have shorter stay. Designers and medical professionals, like many in this design field has mentioned, that it is key to work together and design alongside medical professionals.

+Chapter 5

Wanderings A personal exploration and how it ties back to healthcare design

image: Nicole Nguyen at the Wright Organic Resource Center

Living in the Santa Monica Mountains The Wright Organic Resource Center 24680 Piuma Road Malibu, CA 90265

Walking around the under construction Wright Organic Resource Center in the Santa Monica Mountains was quite an experience. The legacy of Frank Lloyd Wright sites upon the plot of land and overlooks to the ocean along the cliff side.

Continuing his grandfather’s legacy, Eric Lloyd Wright, continues to build upon the home that is integrated into the mountain overlooking the ocean. Wandering around the site is therapeutic with the “natural” landscape surrounding you. One can lose themselves with not only the architecture, but with the landscape itself. Though the materials is rough and harsh, the finer details emphasize on the elements – earth, wind, fire, and water. Two beautiful oaks provide full shade on the deck for one to just lay out and relax. Being able to warm up in the sun, but have shelter from it is within a few steps. A man-made stream that collects in a little pond, brings a calming sound with the water trickling its way through stone and into the pond.

Being away from the city and up deep within the mountains took me away from the stresses of everyday life and allowed for body and mind to relax and absorb what the landscape has to offer.

Mural Mecca of Philadelphia Philadelphia’s Magic Gardens

1020 South St. Philadelphia, PA 19147

Though the garden is not part of a medical facility, the experience and meditative like experiences are there. It triggered the senses in a way that it became a bit overwhelming. There was a lot to take in and look at, and no matter how many times you went through the gardens, you would always find something different. The Philadelphia’s Magic Gardens filled up the space all around you, from the ground plane to the vertical planes, and the overhead plane. The artist emerges you into his work. It was meditative in a way to walk through the gardens, since majority of the colors found within the site are blue which have a calming effect. The way the garden is laid out, allows for wandering, with no set direction. The visitor creates their own experiences. Though confined with a small lot, the place seemed huge due to the scale that the artist created his mosaic work. The visual and touch of the senses are highly triggered. Though you were not supposed to touch anything within the garden itself, just by looking at the materials use you have that sense of actually feeling the textures of the materials. It was definitely a meditative experience, and one can wander around or just look for finer details for hours on end.

Nicole Nguyen 4th Year Undergrad nicole.tn@hotmail.com

LA 401 Lecture Professor Andrew Wilcox Cal Poly Pomona Dept. of Landscape Architecture