SENSORY GARDENS

Above: Tom Massey’s design of a healthy landscape for The Cassel Hospital ecotherapy garden Right: sensory gardens are common in hospice settings Below: Florence Nightingale

The historical relationship between art and science is displayed as a range of professionals collaborate to design sensory gardens today. Primarily in healthcare settings, but with ideas that can be transferred to other sectors, these gardens aim to tackle our disconnect between mind and body and increase exposure to the outside world.

Long ago, Florence Nightingale recognised these aims as she placed her patients in natural landscapes with access to sunlight and fresh air, as much as possible. We seem to be coming back to the idea that health and recovery is dependent on sensory stimulation. In 1984, Roger Ulrich measured the recovery time of patients who had undergone invasive gall bladder surgery. The patients were split into two groups: one group had a view to nature, the other looked onto a brick wall. Strikingly, those with a view to nature averaged a day less recovery time and needed less pain medication. This provides a strong argument for the worthy investment into the healthy design of healthcare buildings, with an obvious financial benefit that could help today’s struggling NHS.

Users of medical buildings can experience sensory deprivation at the same time as sensory overload. Medical settings are often bleak by design, with a lack of natural lighting and an inability to control environments local to the patient. Sensory gardens, and views onto them, are a great example of how the design aspects discussed throughout this magazine can be used together in harmony. The gardens are aesthetically pleasing, provide access to fresh air, and give a view to natural light and weather. To continue engagement with nature during darker hours (especially important in winter), the garden can be subtly illuminated to avoid the ‘black mirror’ effect of windows. They can act as a space for movement, a quiet escape in a nonclinical setting or for the establishment of a community.

In healthcare settings, this is not only vital for patient recovery, but also for the wellbeing of visitors and staff, especially with the extra pressure from COVID-19 care.

A great case study is the ‘secret garden’ at Derriford Hospital, Plymouth. As part of a rehabilitation programme, Derriford have found that the garden helps to improve functional outcomes, decrease ventilator days, reduce delirium and decrease ICU (intensive care unit) and hospital length of stay. Whilst the garden can allow for longer visiting times, the weather can still get in the way. To mitigate this, Derriford are looking to build a garden room with piped oxygen, power, skylights, glass walls, benches and raised plant beds, bringing the outside in to stimulate the senses. The success story of 84-yearold Robin Hanbury-Tenison’s recovery from COVID-19 just goes to show how beneficial these design aspects are for our health. To find out more about Robin’s climb of the highest peak in Cornwall, just 5 months after leaving the ICU and finishing Derriford’s rehabilitation programme, check out Survival: To the Brink and Back on BBC iPlayer.

As with all sectors, there are specific challenges to encouraging wellbeing through building design. In healthcare and medical settings, NHS funding, infection control and the range of users (particularly with patients of different conditions and levels of severity) present can all be barriers to a design that prioritises holistic wellbeing, rather than purely the treatment of a sick body. Infection control limits the range of materials that can be used; materials must be wipeable and water features are a no-go due to Legionnaires disease. However, on a positive note, sensory gardens show how encouraging wellbeing is not limited to new build design - a common misconception. Simple changes can make a large difference in existing buildings, making refurbishment one less barrier to implementing the design aspects and benefits discussed throughout this magazine.

Above: sensory gardens are also a great addition in educational settings Below: Robin Hanbury-Tenison in Derriford Hospital’s ‘secret garden’

Adrenaline A stress hormone mostly produced by the adrenal glands (at the top of kidneys). It is part of the ‘fight or flight’ response to fear, panic or perceived threat.

Amygdala A collection of cells, with an almond-like shape, near the base of the brain (in the temporal lobe). It is associated with emotional processes, such as stress and anxiety.

Biodiversity The variety and variability of life on earth across several levels, from genes to ecosystems.

Bio-psycho-social An approach that combines the disciplines of biology, psychology and socialenvironmental factors.

Cortisol A hormone involved in the body’s stress response that is derived from an ancient poem that talks about human life being connected and flowing to the surrounding environment. It is now the practice of arranging pieces in living spaces, in order to create balance and harmony with the natural world.

made in the adrenal glands. Cortisol is essential for health, but too much can be dangerous.

Delirium An abrupt change in the brain that causes mental confusion and emotional disruption. People can also become sleepy and drowsy.

Dopamine Acts as a chemical messenger between the body and brain. It is released when your brain is expecting a reward.

Endorphins A group of hormones secreted within the brain and nervous system, having a number of effects on the body. They are produced and stored in the ‘pituitary gland’ in the brain.

Feng Shui The Chinese words translate to mean ‘wind’ and ‘water’, respectively. This concept

Histamine Often known for it’s role in allergies, it is largely involved in immune system responses. It can also act as a brain chemical (neurotransmitter).

Legionnaires Disease A lung infection you can get from inhaling droplets of water that contains certain bacteria. It is a severe form of pneumonia.

Melatonin A hormone primarily released by the ‘pineal gland’ in the brain, at night. It has long been associated with the control of the sleep-wake cycle as it acts on receptors in the body. Levels peak in the early hours of the morning and should

reduce during daylight hours.

Miasma Now defined as an unpleasant smell or vapour. In Ancient Europe and China, miasma theory suggested that diseases (such as cholera and chlamydia) were caused by ‘bad air’ that emanated from rotting organic matter. The theory was replaced by the germ theory of disease in the 19th century.

Neurons An electrically excitable cell that communicates with other cells via specialised connections (synapses) and chemicals (neurotransmitters). They are the fundamental units of the brain and nervous system. They receive sensory stimuli from the external world and send motor commands to our muscles in response.

Oxytocin A hormone and neurotransmitter released in response to the activation of sensory nerves. It is often associated with labour, breastfeeding and sexual activity (sometimes called the ‘love hormone’). However, it can also be released in response to low intensity stimulation of the skin, such as from touch and temperature. It helps to regulate our emotional responses and pro-social behaviours (trust, empathy, communication, etc.).

Qualitative Relating to, measuring, or measured by the quality of something, rather than quantity. It can be descriptive and observational to allow for an in depth analysis of ideas and experiences.

Quantitative The use of numbers and statistics to create data to analyse. An emphasis is placed on the testing of theory.

Sanitarium An establishment for the medical treatment of longterm illnesses. They are most typically associated with the treatment of tuberculosis (TB) in the late 19th century and early 20th century, before the discovery of antibiotics.

Serotonin The key hormone that stabilises our mood, wellbeing and happiness. It has impacts on the entire body, from emotions to motor skills, and is mostly found in the digestive system.

Vastu Shastra Translating to the ‘science of architecture’, it is a traditional system that originated in India. Incorporating Hindu, and sometimes Buddhist beliefs, designs aim to integrate architecture with nature, functions of structure, and ancient beliefs through geometric patterns, symmetry and alignment.

This magazine highlights how architectural design, across a range of sectors, can encourage social, mental and physical wellbeing for all building users.