Using green space in health care settings

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There has been an increasing number of studies focused on green space in the health care setting in recent years. This is due to a growing appreciation for the value of nature and its therapeutic effects on patients and staff alike.

However, many questions remain. What is it about gardens that supports health? What design features facilitate use or create barriers to use? Is the restorative potential of gardens influenced by demographic characteristics? There have been a number of recent studies focused on green space in health care settings, and several new additions to The Center for Health Design’s Knowledge Repository address some of these questions. These include two new research studies, one literature review and two tool development efforts. The studies used a range of research methods, from interviews to observation and behavior mapping to physiological measures such as eye movement and heart rate variability.

A study by Elsadek, et al., found that when looking at different types of gardens, the landscape aesthetics can have significantly different effects for people depending on their culture, gender and individual biological characteristics. Specifically, parasympathetic nervous activity increased when users looked at high-manicured landscapes.

Through a narrative inquiry, a study by van der Riet, et al., found that student nurses see gardens as a nonclinical escape for their pediatric patients to play, explore and find temporary freedom to be a non-sick child. The importance of the garden as a setting for nonclinical escape was prominent in a post-occupancy evaluation conducted by Lygum, et al., as well, which applied results to design guidelines for safer, more positively distractive and more versatile gardens, in terms of available activities.

Weerasuriya, Henderson-Wilson and Townsend explored the evidence on access to green space within health care settings and found several common elements in the landscape design that either supported (e.g., views, water features and animal life) or created barriers for (e.g., related to awareness, accessibility and comfort) health facility users.

Barriers to garden use was also a prevalent finding in a study by Jiang, Staloch and Kaljevic, including issues with physical access, lack of seating and shading, and lack of bright colors in different seasons. 

As more health care facilities continue to incorporate green space into their projects, more research is needed to understand the ways in which evidence-based landscape design can make a difference for patients, families, staff and local communities. 

The following citations from The Center for Health Design's Knowledge Repository of health care design resources were used by the author when writing this column:

• M. Elsadek, et al., “Cross-Cultural Comparison of Physiological and Psychological Responses to Different Garden Styles,” Urban Forestry & Urban Greening, 38 (2019): 74–83.
• P. van der Riet, et al., “Student Nurses Experience of a ‘Fairy Garden’ Healing Haven Garden for Sick Children,” Nurse Education Today, 59 (2017): 88–93.
• V. L. Lygum, et al., “Post-Occupancy Evaluation of a Crisis Shelter Garden and Application of Findings Through the Use of a Participatory Design Process,” HERD: Health Environments Research & Design Journal, 2018, in press.
• R. Weerasuriya, C. Henderson-Wilson and M. Townsend, “Accessing Green Spaces Within a Healthcare Setting: A Mixed Studies Review of Barriers and Facilitators,” HERD: Health Environments Research & Design Journal, 2018, in press.

Melissa Piatkowski, research associate, The Center for Health Design.