Healthcare settings and stress

There is an aspect of medicine in recent decades that is intriguing and at the same time alarming. For centuries the foremost problem of hospitals was the very high death rate due to infections of a various nature. With the discovery of germs it became clear how important cleanliness and hygiene were, and hospitals began to be designed bare, with smooth, cold surfaces and white walls, in the systematic search for a sterile environment.

It would be legitimate to expect that, thanks to these measures, the sickness and death rates should have radically diminished, but if we look at the data published by the World Health Organization it is clear that such is not the case. Quite apart from the fact that infections continue to afflict the hospitals, in the last few decades there has been a drastic general increase in illnesses linked to exposure to prolonged stress. According to the WHO, mental and cardiovascular illnesses (both categories due to stress) will by the year 2020 be the major group of illnesses in all parts of the world, irrespective of age or sex (Grahn et al., 2011, in Ward Thompson et al.).

If prolonged stress has such an injurious effect on a healthy organism, it is self-evident that its negative role will be even greater when an illness is already present.

Healing and therapeutic gardens design rules

If to this we add the second problem caused by stress in hospitals – the “burnout” syndrome (the type of psychological response to a situation felt to be intolerable, as the resources available are considered insufficient to meet the user’s demands; it leads to the exhaustion of both physical and psychological energy and to a general worsening of professional performances) that affects the medical and nursing staff (Avallone, Paplomatas, 2005; Braibanti, Zunino, 2010; Maslach et al., 2001), the picture becomes even more alarming: turnover, absenteeism, mental exhaustion, a feeling of uselessness and inefficiency – all of which leads to a general lowering of the quality of the care and treatment for patients and, very often, to the administration of mistaken therapies. In the USA alone, between 44 and 98 thousand Americans die every year in hospitals because of medical errors – more than the number of deaths due to traffic accidents, breast cancer or AIDS (Sexton et al., 2000).

Healing gardens for hospitals

Hospital's environment can be very scary.

Stress today seems to be what infections used to be for hospitals in previous centuries, and the fight against the illnesses or the malaise caused by it is one of the foremost challenges for health centers in the twenty-first century. In this optic, a garden can become a certain, economically not very expensive and pleasant way for all to contribute toward this aim.

In various countries in North America, Europe and Asia, the theme of “healing gardens” is arousing more and more interest, but it is often addressed in a superficial manner, claiming that any green space is therapeutic, or planning without any scientific basis, which means that we find ourselves with green areas made out to be healing gardens but which have none of the features that such a garden ought to have, and which even contribute toward increasing the stress level of those frequenting them.

For a garden to have this restorative effect, it must above all be designed specifically for the patient and be in keeping with his actual needs (Cooper Marcus, Barnes, 1999; Hartig, Cooper Marcus, 2006; Ulrich, 2002). A statement that is only apparently obvious.

Healing and therapeutic gardens for hospitals

Overcrowded rooms without windows makes an already stressing situation much worse.

In the majority of cases the designer is asked for creativity and inventiveness, neglecting the aesthetic preferences of the future users (these are closely linked with the healing effect of the places as will be illustrated below). The risk is finding oneself with open spaces that are innovative and interesting but hardly functional and even less visited and loved. While this, in a context of “normal” urban life, can be admitted, granting to the open spaces the right to be at times also a work of art and not just an “object to be used”, in a particular environment such as places of health care, this is not in the least admitted. Here the necessities, needs and, consequently, the preferences of the users (patients and staff) are of primary importance and the talent or the aesthetic preferences of the planner must conform thereto.

Prime importance thus attaches to defining above all what a healing garden is. The name itself is not particularly felicitous because “healing” indicates in fact a cure, and no-one could ever claim that a garden can by itself be a cure. It is rather a space whose purpose is helping the healing process triggered by the treatment, the operations, and so on, performed by the doctors, and improving the patient’s well-being, especially his mental well-being which, as will be demonstrated below, has a direct influence on the patient’s physical well-being. The concept of “healing gardens” forms part of a holistic vision of medicine, helping to realize the concept of health as defined by the World Health Organization, ”a complete state of physical, mental and social well-being and not a mere absence of illness or infirmity” (WHO, 1948).

It must first be stated that very few research projects deal specifically with gardens inside hospitals. The majority of them come from the USA, where for a number of decades there has been a growing interest in improving the hospital environment. In a market system of privatistic type such as the American one, hospital administrations, striving to be more competitive, have turned toward planning processes that are more and more aware and “profitable”. This has given rise to a branch of architectural design known as “evidence-based design”. In this, through the survey of physiological changes and of improvements in health (the length of hospitalization, amount of painkillers taken, complications, stress level and the patient’s mood and satisfaction) it is sought to assess the benefits for patients’ health, according to the various architectural typologies, elements and features adopted. In this type of design not only architects but also environmental psychologists and neurologists are usually involved.

Healing and therapeutic gardens for hospitals

Even a simple view of nature from windows can be helpful in recovering from ilness.

My personal research of the answers (during my preparation of my degree thesis) has enabled me to work out a basic model that defines the essential characteristics that a healing garden annexed to a health center should possess. Not a strict listing of elements but rather a sort of universally applicable grammatical rules, which a planner/designer, irrespective of his sensitivity, capacity, aesthetic preferences or the place where he works, can always and in any case translate into a project in keeping with the necessities of a person who happens to be living in the hospital environment.

The aim of a considerable part of the research was a careful review of the main research projects in the field of human visual perception, in order to understand not only the mechanism that governs the collection and processing of stimuli/notions coming from the surrounding environment, but more particularly to understand how they are linked with and influence our preferences and consequently our choices. I firmly believe that properly understanding a mechanism, its “why’s” and “hows”, not only enables us to give more adequate answers (practical and theoretical ones), but also – and this is a no less important fact –enables us to convince those who regard with skepticism the phenomena which, as in this case, are difficult (for the moment) to demonstrate by a survey of physical facts.

On the basis of the results obtained with the theoretical end empirical research the design of a healing garden annexed to the Aurelia Hospital in Rome was subsequently drawn up.