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View Through a Window May Influence Recovery from Surgery

DOI:10.1126/science.6143402
Authors:
Roger S Ulrich at Chalmers University of Technology
Roger S Ulrich
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Abstract

Records on recovery after cholecystectomy of patients in a suburban Pennsylvania hospital between 1972 and 1981 were examined to determine whether assignment to a room with a window view of a natural setting might have restorative influences. Twenty-three surgical patients assigned to rooms with windows looking out on a natural scene had shorter postoperative hospital stays, received fewer negative evaluative comments in nurses' notes, and took fewer potent analgesics than 23 matched patients in similar rooms with windows facing a brick building wall.
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... These stressors further destroy psychological and mental health, especially cognitive health (Mikneviciute et al., 2022). Stress Reduction Theory suggests that contact with nature, such as watching green plants outside the window or movies of natural scenery, can reduce stress (Ulrich, 1984;Ulrich et al., 1991). As a convenient way for older people living in high-density cities to engage with nature, visiting open spaces is expected to reduce stress, which may have an impact on cognitive health in older people (see Figure 1). ...
A Preliminary Study of the Relationship Between Built Environment of Open Space and Cognitive Health of Older People
Article
Full-text available
  • Nov 2023
Many older people are facing various risks of cognitive impairment, while outdoor activities in open spaces may be helpful for their cognitive health. However, the effect of open spaces on cognitive health is unclear. This study aims to investigate the relationships between the cognitive health of older people and the built environment of open spaces. A questionnaire survey of 60 older people aged 60 and above was conducted. Results identified three major components of the built environment of open spaces, namely, planning, supporting facilities, and building services. According to the correlation and regression analysis, it is revealed that 8 BEOS items, including green ratio, a width of the pathway, maintenance of the whole garden, the color of green space, diversity of plants, location, and font of signage, artificial light of sitting area were positively related to memory, while only the size was negatively associated with memory. Only the green ratio could positively predict the concentration. The judgment was positively influenced by the green ratio, width of pathways, maintenance of the whole garden, color of green space and diversity of plants. A BEOS – cognitive health model for older people was built in this study. The results highlighted the importance of plants for cognitive health. Several recommendations, such as not-so-large sizes and diverse plants with vivid colors and signages with big fonts, etc., were proposed to improve the built environment of the open spaces and support the declining cognitive health of older people.
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... Ever since Ulrich's (1984) study pointing at how a view on green affects patients' recovery, the presence of nature has been identified as an important quality of a healing environment (e.g. Huisman et al., 2012;Ulrich et al., 2008;Zhang et al., 2019). ...
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... The most pioneering study was performed by Roger Ulrich (1984). This study found that surgery patients with a view of nature suffered fewer complications, used less pain medication, and were discharged sooner than those with a brick-wall view. ...
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... Nature exposure, especially plants and green areas, is known as one of these effective design strategies which can produce many psychological health benefits. Indeed, it has been indicated that providing nature exposure in various forms such as views to green spaces through the windows (Ulrich, 1984), having indoor plants in different areas of healthcare settings (Beukeboom, Langeveld, & Tanja-Dijkstra, 2012), installing posters of natural environments on the walls (Beukeboom et al., 2012), using motion nature in the CT scan environments (Zijlstra, Hagedoorn, Krijnen, van der Schans, & Mobach, 2017) have been capable to bring about positive influences on patients. ...
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... Ulrich found differences in healing, length of stay, complication rates and costs between the two groups. The patients with a view of the park were discharged an average of three days earlier and cost $300 less per capita (Ulrich 1984). These findings have prompted a flurry of interdisciplinary studies looking at all factors of a building or space (lighting, layout, materials sounds, odors, signaling, etc.) in a hospital as well as other buildings. ...
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... In the U.S., given the novelty of the healthcare design topic back in the 90s, the organization A has been formed to create a conversation about the role of design in improving healthcare outcomes, which at the time was formed around the seminal paper published by Roger Ulrich (Ulrich, 1984). In the early 90s, several experts got together trying to build the body of research that would support the practice in addition to just 5 of 9 providing the knowledge. ...
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... Blood pressure is regulated physiologically by the autonomic nervous system [32], and it has been shown to induce changes in blood pressure under the influence of stress or relaxation [11,33]. Blood pressure increases under stressful conditions and decreases under relaxed emotional conditions [34][35][36]. In a previous study, adults were randomly divided into four groups (control group, horticultural activity group with green plants, horticultural activity group without green plants, and green exercise group), and the findings showed that in the group whose horticultural activity involved green plants, the participants' blood pressure was significantly lowered post-activity compared to beforehand and the other green exercise groups [37]. ...
Effects of Tactile Stimulation Using an Assortment of Natural Elements on the Psychophysiological Responses of Adults
Article
Full-text available
  • Nov 2023
Contact with the natural environment has positive effects on physical and mental health and well-being. This study aimed to investigate the effects of tactile stimulation on the psychophysiological responses of adults, using natural gardening elements. The participants were 30 adults (20–60 years old). The participants received tactile stimulation by touching five natural elements with their hands and feet, and tactile stimulation for each natural element was performed for 90 s. Geranium, tiny ardisia, decomposed granite soil, log hardwood, and culture soil were used as tactile stimulation factors for the hand, and moss, grass, pebble, bark, and culture soil were used as tactile stimulation factors for the foot. Oxyhemoglobin (oxy-Hb) concentrations in the prefrontal cortex during the stimulation as well as blood pressure and pulse rate after each activity were measured. Additionally, the semantic differential method was used to evaluate the psychological effects of contact with the elements on the participants. Compared to before tactile stimulation, the oxy-Hb concentration related to prefrontal lobe cortical activity significantly decreased in some sections using tiny ardisia, log hardwood, and culture soil on the hands, and using grass, moss, pebble, and bark on the feet. Blood pressure also showed a significant decrease after tactile stimulation using geranium, tiny ardisia, and log hardwood. The findings of this study suggest that tactile stimulation using natural gardening elements could be a significant intervention in inducing physiological stability and reducing stress by calming the activity of the prefrontal cortex.
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Design guidelines for healing gardens in the general hospital
Article
Full-text available
  • Dec 2023
Introduction Despite being recognized as a cost-effective method to enhance physical and mental health, Healing Gardens remain insufficiently popularized in outdoor spaces of hospitals. This paper aims to introduce a new perspective and offer guidelines for their implementation within general hospitals. Methods A methodology is proposed for formulating hospital-specific guidelines, encompassing the extraction of successful Healing Garden features from case studies, definition of key components grounded in theoretical frameworks, validation of essential features through user questionnaires, and comprehensive site analyses. Results The methodology was applied in a case study at Zhongnan Hospital in Wuhan. This research presents a novel perspective and robust methodology for implementing Healing Gardens in general hospital settings, potentially improving physical and mental health in a cost-efficient manner. Discussion This work aims to encourage the adoption of Healing Gardens as preventive medical tools in more healthcare settings. By providing a comprehensive methodology and a case study illustration, this research endeavors to stimulate broader acceptance and utilization of Healing Gardens in healthcare environments.
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Natural Versus Urban Scenes: Some Psychophysiological Effects
Article
Full-text available
  • Sep 1981
Subjects viewed sixty color slides of either (1) nature with water, (2) nature dominated by vegetation, or (3) urban environments without water or vegetation. The information rates of the three slide samples were equivalent. Measurements were taken of the effects of the slide presentations on alpha amplitude, heart rate, and emotional states. Results revealed several significant differences as a function of environment, which together indicate that the two categories of nature views had more positive influences on psychophysiological states than the urban scenes. Alpha was significantly higher during the vegetation as opposed to urban slides; similarly, alpha was higher on the average when subjects viewed water rather than urban content. There was also a consistent pattern for nature, especially water, to have more positive influences on emotional states. A salient finding was that water, and to a lesser extent vegetation views, held attention and interest more effectively than the urban scenes. Implications of the findings for theory development in environmental aesthetics are discussed.
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Anxiety and pain in surgical patients
Article
Full-text available
  • Aug 1975
Investigated the effects of surgery on state anxiety (A-state) and perceived pain in 59 white male surgical patients. The Melzack-Torgerson Pain Questionnaire, the State-Trait Anxiety Inventory (STAI), and the Fear of Surgery Scale (FSS) were given the day before the operation and again 10 days after surgery. Results indicate that surgery as a physical threat has an effect on A-state but not on anxiety as a personality disposition (trait anxiety; A-trait). The correlation of A-state and magnitude of reported pain postsurgery, but not presurgery, attributed to the existence of little pain variance before surgery, and to realistic concern over pain following surgery. (19 ref)
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Visual landscapes and psychological well-being( National Parks).
Article
  • Jan 1979
The therapeutic value of landscape in giving opportunity for 'spiritual renewal' through closer contact with nature has been the basis for much of the scenic conservation movement and lies behind a universal concept of National Parks as providing recreational resources for urban populations. This belief is tested in a series of classroom studies. -C.Laverick
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Reduction of psychological stress in surgical patients
Article
  • Dec 1975
This study assesses the effectiveness of two stress-reducing strategies in a field setting. The first strategy consists of a coping device which entails the cognitive reappraisal of anxiety-provoking events, calming self-talk, and cognitive control through selective attention. The second strategy consists of supplying information about the threatening event along with reassurances for the purpose of producing emotional inoculation. Patients about to undergo major surgery were exposed to either the coping device, the preparatory information, both strategies, or neither. The prediction that the coping device would effectively reduce both pre- and post-operative stress was confirmed. An analysis of the nurses' ratings of preoperative stress showed a significant main effect for the coping device. There was also a significant main effect for the coping device on postoperative measures (number of pain relievers requested and proportion of patients requesting sedatives). The preparatory information, however, did not produce any significant effects on these postoperative measures.
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Windows and People: A Literature Survey. Psychological Reaction to Environments with and Without Windows
Article
  • Jun 1975
The current need for energy conservation has forced some fundamental re-evaluation of building design. One aspect that has come under much review is that of building fenestration. Although windows provide daylight and ventilation, they also can allow undesirable heat gain and loss. In the past, the provision of light and fresh air were essential functions of windows. A building was uninhabitable without windows. Now however, these functions can be fulfilled by artificial lighting and mechanical ventilation. As a result, a number of people have suggested that a substantial reduction in the size of windows, or their complete elimination is desirable in order to reduce excessive energy consumption. Nevertheless, even though a windowless building might be the best solution for eliminating energy loss through windows, there is considerable evidence that this may not be very desirable for the people in the building. In an attempt to delineate some of the functions of windows, the literature on the reaction to both the presence and the absence of windows was surveyed. In the first section, the psychological reaction to windowless buildings is examined to determine if the absence of windows in a building exerts any noticeable effect upon the occupants' behavior or attitudes. In the second section, the various characteristics of windows are reviewed to define some of their functions and benefits. (123 references) (from Introduction)
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Anxiety, pain, and depression surrounding elective surgery: A multivariate comparison of abdominal surgery patients with kidney donors and recipients
Article
Anxiety, depression, and pain were psychometrically assessed in 67 abdominal surgery patients on the day before surgery, on the first postoperative day, and on the third postoperative day. Patients were divided into kidney donor, kidney recipient, and general surgery groups, and a multi-variate analysis of variance was performed in order to compare the trends of response over days across groups. There were significant group differences in the pattern of scores over the three days. Trait anxiety was related to post-surgical pain, anxiety, and depression in general surgery and renal recipient patients, but not in kidney donors. Results suggest that the meaning attached to the stress of surgery significantly affects the subjective state changes surrounding the operation.
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Active Coping Processes, Coping Dispositions, and Recovery from Surgery
Article
  • Sep 1973
: Surgical patients with similar medical problems differ greatly in their rate of postoperative recovery. This study investigated the relationship between the mode of coping with preoperative stress and recovery from surgery. Sixty-one preoperative surgical patients were interviewed and classified into three groups based on whether they showed avoidance vigilance, or both kinds of coping behavior, concerning their surgical problem. Coping dispositions referring to the same dimension, preoperative anxiety, and previous life stress were also measured. The five recovery variables included days in hospital, number of pain medications, minor medical complications, negative psychological reactions, and the sum of these. Results showed that the vigilant group had the most complicated postoperative recovery, although only two recovery variables (days in hospital and minor complications) were statistically significant. Coping dispositions, anxiety, and life stress showed no clear or consistent relationships with recovery. Ways in which mode of coping may have influenced recovery are discussed. Copyright (C) 1973 by American Psychosomatic Society
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