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Research

Research on Nature & Healing

Nature Enhances Patient Experience and Healing
Exposure to Nature releases serotonin, reducing patient stress, boosts staff satisfaction

Based on decades of empirical research, Sereneview® products bring Nature to the hospital setting, with evidence-based designs.

Forty-years of research documents the link between viewing Nature photographs and lowering blood pressure, lowering anxiety, reduced need for pain medication, shorter hospital stays and less complications after surgery. Exposure to a Nature scene affects the autonomic nervous system and enhances the healing process.

Viewing a beautiful Nature scene can increase employee satisfaction, and the rate and quality of patient recovery.

Extensive research studies show that viewing Nature plays a key role in healing.

What is visual therapy? Brief outline of the concepts and intentions of visual therapy. (Download PDF)

Journals

Physical setting linked to patient and staff outcomes. The Role of the Physical Environment in the Hospital in the 21st Century: A Once-in-a-Lifetime Opportunity, Report to The Center for Health Design for the Designing the 21st Century Hospital Project (Robert Wood Johnson Foundation), September 2004, Roger Ulrich, Ph.D., Craig Zimring, Ph.D., et. al. Evaluation of over 600 studies showing that improved physical settings can be an important tool in making hospitals more healing, better places to work. Investigators consistently report that simply viewing nature has stress-reducing or restorative benefits, including positive emotional and physiological changes. (Download PDF)

Views of nature improve patient clinical outcomes. Health Benefits of Gardens in Hospitals, International Exhibition Floriade, Plants for People Conference, 2002. At Uppsala University Hospital in Sweden, the authors (1993) show that exposing heart surgery patients to simulated nature views improved recovery outcomes. Each of 160 patients in intensive care was assigned to one of six visual stimulation conditions: two nature pictures (a view of trees and water, or a forest scene); two abstract pictures; and two control conditions (a white panel, or no picture/panel). Results suggest that patients who viewed the trees/water scene were significantly less anxious during the postoperative period than patients assigned to the other pictures and control conditions. Patients exposed to the trees/water view suffered less severe pain, as evidenced by the fact they shifted faster than other groups from strong narcotic pain drugs to moderate strength analgesics.

Views of nature provide therapeutic benefit. Healing by Design, New England Journal of Medicine, Volume 333 (11). A retrospective study of patients who had undergone cholecystectomy showed that those assigned to rooms with a view of a natural setting had shorter postoperative stays and took fewer analgesic drugs than those whose rooms looked onto a brick wall. In a hospital study, views of nature were associated with reduced employee stress and fewer health-related complaints; students under the stress of examinations felt better after viewing nature scenes; prisoners with a view of nature were less likely to attend sick call.

The designed environment has significant effect on clinical outcomes. Investigation to Determine Whether The Built Environment Affects Patients Medical Outcomes, by Haya Rubin, MD, Adjunct Professor Johns Hopkins School of Medicine, et. al., in Integrating Complementary Medicine into Health Systems, by Nancy Faass, Aspen/Jones& Bartlett, 2001. There is suggestive evidence that aspects of the designed environment exert significant effects on clinical outcomes for patients receiving medical care.

Vibrant surroundings improve patient recovery. Art in hospitals: why is it there and what is it for? The Lancet, Volume 350(9077), August 1997, Pryle Behrman. Roger Ulrich, PhD, director and professor, Center of Health Systems and Design, College of Architecture, Texas A&M University, College Station, investigated the effects of visual stimulation on the rate of recuperation. He found that patients with vibrant surroundings (e.g., paintings, flowers, an outside view, etc.) recovered three-quarters of a day faster, and needed fewer painkillers than those with dull surroundings.

The Role of Patient Amenities in Hospital Demand - Hospitals have various dimensions along which they can differentiate themselves in order to compete against other area hospitals. One is clinical quality, as measured by patient outcomes. Another is their ability to offer the latest technology and equipment. A third is the amenities they offer to patients and their families. Previous research has established that the first two factors affect patient demand for hospitals. In Hospitals as Hotels: The Role of Patient Amenities in Hospital Demand(NBER Working Paper 14619), researchers Dana Goldman and John Romley provide the first systematic evidence on the role of amenities in hospital demand.

News

We are spending more time indoors and online. Recent studies suggest that nature can help our brains and bodies to stay healthy. The University of California Berkeley posted an entry on their Greater Good in Action blog titled How Nature Can Make You Kinder, Happier, and More Creative by Jill Suttie. She notes to five basic points: Being in nature decreases stress, Nature makes you less brooding, Nature relieves attention fatique and increases creativity, Nature may help you to be kind and generous, and Nature makes you "feel more alive".

Evidence-Based Design points to healing approaches to hospital design. Four Levels of Evidence-Based Design, an AIA article written by D. Kirk Hamilton, FAIA, FACHA. Like evidence-based medical research, evidence-based design is based on data, interprets evidence, shares and publishes results, and establishes standards in an academic setting. These assessments help architects and designers create a hospital environment that is aesthetic, economical, and contributes to healing. (Download PDF)

Art in Healthcare, Healthcare Design Magazine, December 2011 - Art is arguably the first thing people react to when they approach or enter a facility. When the process for selecting and integrating art with healthcare design fully considers context, art adds value well beyond a visually aesthetic appeal.

Design that ignores aesthetic needs may worsen patient outcomes. What does research show about healing environments? OR Design and Construction, March 2002. Atrium’s, artwork, and hotel-type amenities are part of a design trend in hospitals and ambulatory surgery centers. Is this a fad, or does it make a difference in patient care?

Patient-focused Healing: Integrating Caring and Curing in Health Care, OR Design and Construction, March 2002, Nancy Moore and Henrietta Komras. Research shows that design that ignores basic psychological needs may lead to anxiety, elevated blood pressure and an increase in the use of pain-relieving drugs. Conversely, a warm and nurturing setting induces a relaxation response that can reduce medication levels and even decrease lengths of stay.

Stress reducing environment shows measurable outcome improvements. Healing Environments: Mitigating Patient Stress, Improving Medical Outcomes, SurgiCenter Online, by Kelly M. Pyrek. Patients exposed to stress-reducing interventions in a healing environment show measurable reductions in anxiety and increases in immunity. The medical community is more accepting of the fact that having a patient look at a white ceiling and having nothing better to do than counting the tiles is not a good thing.

Interior design can impact patient well being. Creating health and health promoting hospitals: a worthy challenge for the twenty-first century, International Journal of Health Care Quality Assurance, 12/2/99 viii-xix, Trevor Hancock. Interior design and aesthetics can have a dramatic impact on the mental and social well being of patients, their families and hospital staff. The use of color, texture and form to create pleasing environments ... are increasingly important in the health care sector.

Improving Decor and Layout Can Have Impact on Care. Healthy Hospital Designs, The Wall Street Journal, Marketplace, 11/27/02, Motoko Rich. Fewer fractures and infections. Hospitals, long a bastion of bad design and dreary décor, are finding that improving their layouts and their looks can translate into better health for their patients. (Download PDF)

Growth of therapeutic design for hospitals. Nature scenes add to holistic approach at Mad River, Eureka Times-Standard January 12, 2003. Many studies show that stress-free patients heal faster, and paying attention to such positive patient outcomes — and thus lowered costs — has led to a boom in the therapeutic design industry. Experts in the field encourage health care administrators to consider holistic approaches to patient care.

JCAHO manual welcomes healing environments. Interiors, Doctored Design, Hospitals & Health Networks, Ken Garber, February 1999. As far as JCAHO is concerned, a “supportive” environment is now just what the doctor ordered. The Joint commission published major revisions to its hospital accreditation manual, encouraging hospitals to create welcoming environments that support patient dignity. The changes followed years of work by the Center for Health Design in Martinez, CA., which promotes patient-friendly environments. “Most hospitals don’t take patients’ needs and preferences into account when it comes to design,” says CHD founder and former president Wayne Ruga. “Health care people think of environmental solutions in terms of cost. It’s much more a matter of making strategic investments.”

Research on noise in hospitals and other health care settings shows that patients and clinical staff identify noise as a major stressor. Auditory Assistance; Strategies to reduce hospital noise problems, by Benjamin Davenny, LEED AP BD+C, EDAC, in the January 2010 issue of Health Facilities Management magazine addresses a number of factors in designing acoustic solutions for health care facilities. Moreover, traditional infection control solutions often work against a healthy acoustic environment. For example, surfaces covered with hard materials for easy cleaning generally reflect rather than absorb sound. Likewise, acoustical duct linings for muffling mechanical noises are prohibited between final filters and room air devices in many hospital areas. Still, there are a number of actions a design team can take to help reduce noise levels in the environment of care.

Tools

You can raise your HCAPS scores by doing a little research measuring your patient satisfaction levels. Because there are no tools that take the curtains into consideration, we have developed a five-point Likert scale that includes room decor into the questions asked to properly measure the effect the curtains have on patients.

Five-point Scale: Very Poor, Poor, Fair, Good, Very Good.

  1. Timely response to Call Lights/requests?
  2. Friendliness/Courtesy of Nurses?
  3. Attention paid to your special needs?
  4. How well the Nurses helped you understand your treatments, tests and condition?
  5. Skill of Nurses?
  6. How did the room decor (curtains, room size, etc.) add to your comfort level?
  7. Rate your overall hospital Experience?
  8. (Optional) Signature

You can alter the questions to suit your objective or add more. But there is only so much space and asking too many questions can limit response levels.