Healing gardens: Hospital design using nature to heal and soothe

Using "bench diaries" to record user experience, researchers at the Queensland University of Technology studied the healing gardens at Brisbane's Lady Cilento Children's Hospital to analyze their value to patients.

Walking through the corridors of most medical institutions, we experience the whirr and electronic buzz of instruments. We are surrounded by an artificial symphony accompanying fluorescent lighting, featureless walls and maze-like layouts. Collectively these confound our senses, creating a sense of dis-ease that can even compound patient symptoms.

In this milieu, a quiet counter-revolution to the conventional hospital is underway around the world. Hospitals are being designed to promote healing and restoration – environments and spaces that soothe the senses, reduce stress and stimulate the parasympathetic nervous system.1, 2, 3 Drawing on several decades of research showing that people can heal more quickly and with less pain when they can see trees and nature,4 hospitals are reimagining spaces, incorporating gardens and nature in and around buildings with specific healing intentions.

In inner-city Brisbane, the new Lady Cilento Children’s Hospital is at the forefront of this new wave of design innovation, incorporating eleven healing gardens. Despite being situated between major roads, school and existing hospital infrastructure, these gardens are a living demonstration of how intentional design can deliver high-quality, restorative environments within smaller and more challenging spaces.

Bench seats in the Lady Cilento Children’s Hospital “secret garden” are surrounded by lush tropical vegetation.

Bench seats in the Lady Cilento Children’s Hospital “secret garden” are surrounded by lush tropical vegetation.

Image: Christopher Frederick Jones

Although there is rapidly growing interest in the design and use of healing gardens, evaluations of these spaces remain fragmented. We still have limited insight into how patients, their families and hospital staff actually use such spaces, and into their appreciation of and benefit from these spaces compared with the intended design. Several studies in the United States5, 6, 7 and Sweden8 have evaluated healing gardens in rehabilitation and children’s hospitals, however, much more work is needed to understand the values and benefits of these gardens, and how to design them to maximize their healing potential.

The Lady Cilento Children’s Hospital provides an ideal opportunity to enquire into gardens that are specifically designed to promote healing and restoration. Insights into the hospital and its gardens can assist designers and hospital practitioners elsewhere in demonstrating and improving the healing value of such spaces. Research is currently underway to evaluate environmental conditions and user experiences of the hospital, and results for one key aspect of the human experience are summarized here.

Grassed areas in the Lady Cilento Children’s Hospital “secret garden,” with views to the Brisbane River and CBD.

Grassed areas in the Lady Cilento Children’s Hospital “secret garden,” with views to the Brisbane River and CBD.

Image: Christopher Frederick Jones

In a novel approach to understanding user experience, a series of visitors’ books, or “bench diaries,” were left on bench seats in the gardens over several weeks when the hospital first opened. The covers invited those spending time there to “Tell me, why are you here? How are you feeling? What do you enjoy? Tell me what is on your mind…” Researchers from the Queensland University of Technology (Dr Angela Reeve, Associate Professor Jennifer Firn and Dr Cheryl Desha) worked with Conrad Gargett (Katharina Nieberler-Walker) and Children’s Health Queensland (Professor Jenny Ziviani) to transcribe, code and analyse the diary entries, which included notes, poetry, letters and drawings. This rich and personal feedback has provided powerful insights into the lives and experiences of people who came to these gardens and the value they perceived in spending time there.

The data highlights the gardens’ significant value in creating a safe and peaceful environment. While in the garden, users recorded “being away” from both the hospital and the reality of being sick, or having a sick child, or providing treatment. Furthermore, the diary entries clearly distinguished a sense of peace, calm and being restored.

The entries also highlight how the gardens helped people to be positive during difficult times, assisting them to find new perspectives and things to be grateful for.

“This garden has saved our sanity. It is a beautiful quiet place.”

“Just finding this space has made the world of difference when I want to yell or scream at the world.”

“Hallo, I am sick and staying in hospital and I came up here to have some fresh air and enjoy the view. I feel like I am in the botanical garden because it is beautiful here. The view is great and relaxing. I forgot that I am sick when I look around.”

Garden users strongly valued the view, and the sense of peacefulness and calm achieved.

“Hallo there Benchi ol mate! I am feelin’ fine, full and fantastic. Look at this view! How can you not be happy with that! Always so peaceful up here, especially at night watching the sun go down. Sitting in the morning sun with a fresh earl grey is the stuff that makes me happy. The simple pleasures in life.”

The entries also highlight the value of the greenery and beauty of the gardens, which reminded several users of their homes.

“We bring her up to this beautiful garden for fresh air and sunshine. We are 7 hrs away from home, so it’s a welcome peaceful space up here to refresh, away from PICU [Paediatric Intensive Care Unit].”

Most people who wrote in the diaries talked about sitting and relaxing, often while enjoying a meal or tea or coffee.

“I am just here sitting by the big city lights wondering about life, the universe and everything else … its quite possibly one of my favourite places to eat dinner.”

Some entries by users also suggested that the gardens provided a place for their children to play that was safe but still felt like the outdoors.

“My son […] had his appendix out, the staff here have been great, but as an active boy, […] wanted to get outside but was not allowed to leave this level for a while. This garden is just what he needed. Thanks Lady Cilento, great job.”

Some people directly commented on how they felt the gardens helped their healing process, for example.

“Fresh air is my healer for the moment.”

Incorporating gardens and nature into hospitals can enhance the healing process and provide a place where people can be relieved of some of the stress and angst that can come with hospital experiences. The bench diary experiential accounts, by patients, families and staff of the Lady Cilento Children’s Hospital, clearly highlight the value of the gardens. This includes assisting them with shifting perspectives and taking a break from the reality of their current situation.

The researchers are now preparing for a more extensive post-occupancy evaluation of the gardens, and a review of the garden design process to understand how different stakeholder needs and expectations were addressed and incorporated within healing garden design.

1. Clare Cooper Marcus ad Marni Barnes (eds), Healing Gardens: Therapeutic Benefits and Design Recommendations (New York: John Wiley & Sons, 1999).

2. Catherine Ward Thompson, “Linking Landscape and Health: The Recurring Theme,” Landscape and Urban Planning, vol 99 (3), 2011, 187–195.

3. Gregory N. Bratman, Gretchen C. Daily, Benjamin J. Levy and James J. Gross, “The Benefits of Nature Experience: Improved Affect and Cognition,” Landscape and Urban Planning, vol 138, June 2015, 41–50.

4. Roger S. Ulrich, “View through a window may influence recovery,” Science, vol 224 (4647), April 1984, 224–225.

5. Sandra A. Sherman, James W. Varni, Roger S. Ulrich, Vanessa L. Malcarne, “Post-occupancy Evaluation of Healing Gardens in a Pediatric Cancer Center,” Landscape and Urban Planning, issue 73(2), October 2005, 167–183.

6. Sandra Whitehouse, James W. Varni, Michael Seid, Clare Cooper-Marcus, Mary Jane Ensberg, Jenifer R. Jacobs and Robyn S. Mehlenbeck, “Evaluating a Children’s Hospital Garden Environment: Utilization and Consumer Satisfaction,” Journal of Environmental Psychology, vol 21 (3), September 2001, 301–314.

7. Samira Pasha and Mardelle M. Shepley, “Research Note: Physical Activity in Pediatric Healing Gardens,” Landscape and Urban Planning, vol 118, October 2013, 53–58.

8. Ingrid Söderback, Marianne Söderström and Elizabeth Schälander, “Horticultural Therapy: The ‘Healing Garden’ and Gardening in Rehabilitation Measures at Danderyd Hospital Rehabilitation Clinic, Sweden,” Developmental Neurorehabilitation, vol 7 (4), 2004, 245–260.

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