Article

Evaluating a children's hospital garden environment: Utilization and consumer satisfaction

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Abstract

The Leichtag Family Healing Garden at Children's Hospital and Health Center, San Diego was planned and built as a healing environment space for patients, families, and staff. A Post-Occupancy Evaluation (POE) was conducted to determine whether the garden was meeting the goals of reducing stress, restoring hope and energy, and increasing consumer satisfaction. Results from behavioral observations, surveys, and interviews indicated a number of benefits of the garden. The garden was perceived as a place of restoration and healing, and use was accompanied by increased consumer satisfaction. However, the garden was not utilized as often or as effectively as intended. Children, parents and many staff members recommended changes for the garden, such as the inclusion of more trees and greenery, and more interactive ‘things for kids to do’. In addition, the majority of family members surveyed throughout the hospital did not know about the garden. Based on the findings, recommendations for changes were developed to promote better use of the garden. These research findings can be used to guide the future planning, design, building, and subsequent evaluation of garden environments in children's hospitals and pediatric settings.

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... Consistent with Ulrich's (1999) Theory of Supportive Gardens recommendation that hospital environments should provide supportive design attributes including access to nature, a healing garden is a designated green space within a healthcare facility that is designed to influence visitors in a positive way (Cooper Marcus & Barnes, 1999;Marcus & Valente, 2015;Relf, 2005;Stigsdotter & Grahn, 2002). Healing gardens are intended to be places for individuals to relax, connect with nature, and ease the negative feelings that are often associated with the hospital environment (Montgomery, 2019;Pasha, 2013;Whitehouse et al., 2001). Healing gardens may be located in an indoor or outdoor setting on a hospital campus and may vary in size from a 1,000 sq. ...
... Although healing gardens have become such a visible trend in healthcare design, little academic research has examined their effectiveness, with some exceptions (Davis, 2011;Montgomery, 2019;Naderi & Shin, 2008;Pasha, 2013;Pasha & Shepley, 2013;Sherman et al., 2005;Ulrich et al., 2020;Whitehouse et al., 2001). Despite the lack of empirical studies that may be directly applicable to healthcare researchers, a few researchers (e.g., Cooper Marcus & Barnes, 1999;Davis, 2011;Sherman et al., 2005;Whitehouse et al., 2001) have begun to pave the way for providing descriptive evidence for the benefits of healing gardens. ...
... Although healing gardens have become such a visible trend in healthcare design, little academic research has examined their effectiveness, with some exceptions (Davis, 2011;Montgomery, 2019;Naderi & Shin, 2008;Pasha, 2013;Pasha & Shepley, 2013;Sherman et al., 2005;Ulrich et al., 2020;Whitehouse et al., 2001). Despite the lack of empirical studies that may be directly applicable to healthcare researchers, a few researchers (e.g., Cooper Marcus & Barnes, 1999;Davis, 2011;Sherman et al., 2005;Whitehouse et al., 2001) have begun to pave the way for providing descriptive evidence for the benefits of healing gardens. A recent study conducted by Ulrich et al. (2020) found evidence of stress score improvement among family members of intensive care unit (ICU) patients when visiting the hospital healing garden; however, as noted by Ulrich et al. (2020), "despite the growing research on healthcare gardens and nature, knowledge gaps remain, and most studies have shortcomings" (p. ...
Article
Purpose: To measure hospital visitors' satisfaction with a rooftop atrium and its resultant impact on the visitors' behavioral intentions toward the healing garden, the hospital, and overall satisfaction with the hospital. Background: There is a significant lack of empirical research that links the emotional and behavioral responses toward healing gardens and the hospitals providing them. Methods: A purposeful sample of 96 visitors to the healing garden in the rooftop atrium of a surgery building in a major hospital in the Southeastern United States completed a survey based on Roger Ulrich's Theory of Supportive Gardens and the Stimulus, Organism, Response (S-O-R) paradigm. Results: Findings of this study suggest visitors' experience with the healing garden can lead to overall satisfaction with the hospital and behavioral intentions toward the hospital. Visitors' satisfaction with the healing garden significantly predicted their satisfaction with the hospital, their intend to revisit the hospital, and their intend to recommend it. Conclusions: This study demonstrates that a small healing garden can be a powerful enough space to impact visitors' overall satisfaction with the hospital and their intentions regarding their future behavior toward the hospital, such as revisiting or recommending the hospital.
... Reeve et al. (2017) concluded that gardens in children's hospitals provide emotional respite to visitors by appreciating the views, being able to have time out, being in nature, and access to outdoor air. Similarly, the results of Whitehouse et al. (2001) on the children's hospital's garden environment showed that visiting the garden could relieve stress, restore relaxation, improve the mood of the patients and their families, and increase the satisfaction of the users. Anthopoulos and Georgi (2011) concluded that landscape design with green areas would positively affect the patients' psychological status in hospitals. ...
... In the current study, the children and their therapists did not agree on the variable of relaxation. Similar to our findings, Whitehouse et al. (2001), in a study on the garden environment of a children's hospital, found that the users felt the sound of water in the garden as a relaxing factor. Also, they found that the children's favorite aspects of the garden were first the fountain and the sound of running water, and secondly new features such as dinosaurs, windmills, and animal shapes. ...
... Also, they found that the children's favorite aspects of the garden were first the fountain and the sound of running water, and secondly new features such as dinosaurs, windmills, and animal shapes. However, our results did not support Whitehouse et al. (2001) because they found that water features were the first favorite aspects of the garden by garden users, including children and adults. However, our study results showed that only children believed that water features in green space were the first important landscaping feature in increasing relaxation. ...
Article
The environmental design of built spaces can have neuro-psychological effects on humans. The design of hospital environments, especially for children, is probably more important than the other spaces because children are mentally more vulnerable than other social groups. This research aimed to examine the children's and therapists' views and perceptions on the effect of a children's hospital's landscape design elements to improve their neuropsychological health during their treatment period. Sixty sick children and 60 hospital staff (therapists) evaluated landscape images and responded to a questionnaire. Both respondent groups believed in the positive effects of landscape elements on all children's neuropsychological indices, including the increased emotional index, increased cognitive index, and reduced non-symptoms index. Both respondent groups firstly preferred children's features and secondly, water features. These preferences positively affected many neuropsychological indices of sick children. However, children chose water features as their priority, which positively affected sick children's relaxation. However, this view was not consistent with their therapists' views. The children and their therapists were also not in agreement on the impact of other landscape elements (trees, flowers, ground cover plants, turfgrasses, and mulch) on many neuropsychological indices of sick children. Therefore, based on this research, children's therapists cannot be good representatives for their psychological perceptions about the hospital's landscape elements when a direct assessment of children's perceptions is almost impossible. This research has practical recommendations for landscape professionals around the world on the sustainable design of therapeutic landscapes.
... Dans les établissements hospitaliers, le potentiel thérapeutique des jardins revêt une place centrale puisqu'ils représentent une aide au processus de soins des personnes fragilisées par des problèmes de santé dont les effets thérapeutiques sont d'ailleurs évalués (Cooper Marcus & Barnes, 1995 ;Cooper Marcus & Sachs, 2013 ;Yzoard et al., 2017 ;Ulrich, 1984 ;Ulrich et al., 1991, Whitehouse et al., 2001. ...
... Différents travaux objectivent, chez les personnes soignées, les bénéfices du jardin sur la réduction du stress, l'amélioration de l'humeur et de la satisfaction ressentie envers l'environnement de soins, le développement du sentiment d'autonomie et de liberté et sur la restauration de l'état de santé après une intervention médicale (Cooper Marcus & Barnes, 1995 ;Cooper Marcus & Sachs, 2013 ;Ulrich, 1984 ;Ulrich et al., 1991, Whitehouse et al., 2001. Les effets bénéfiques d'une courte exposition au soleil régulière sont également mentionnés à travers l'apport de vitamine D (Rodiek & Schwarz, 2013). ...
... Les membres de l'équipe soignante qui ont la possibilité de se rendre dans un jardin pendant leur service (de jour ou de nuit) bénéficient également des atouts de cet environnement extérieur (Ridenour, 2016). Le stress lié à leurs activités professionnelles est réduit et ils expriment un sentiment de satisfaction envers leur environnement de travail (Cooper- Marcus & Barnes, 1995Ulrich et al. 1999, Ulrich, 2002Whitehouse et al., 2001). ...
Thesis
Ce travail de thèse de psychologie est issu d’une collaboration entre le Groupe de recherche sur les communications du laboratoire InterPsy de l’Université de Lorraine et le CHRU de Nancy. Il a pour objectif principal de circonscrire les vertus d'étayage psychologique de l'art chez des personnes atteintes de la maladie d’Alzheimer lors de promenades accompagnées dans un jardin thérapeutique, aménagé de références régionales naturelles et culturelles. Les conversations entre un sujet Alzheimer et une expérimentatrice lors de plusieurs promenades dans le jardin ont été soumises à une analyse pragmatico-dialogique (Batt & Trognon, 2012, 2014 ; Trognon & Batt, 2007) afin d'explorer en profondeur l'expérience vécue par le sujet et d’établir les relations scientifiques entre jardin, art, mémoires, jugements artistiques et émotions. Les investigations ont été complétées à l’aide d’une évaluation neuropsychologique standard et des outils psychométriques. Les capacités à s’inscrire dans le contexte temporo- spatial, les processus thymiques, les jugements esthétiques dans le domaine de l’art et du design et les processus cognitifs liés à la reconnaissance d’œuvres artistiques sont étudiés tout au long de leur participation. Les principaux résultats sont que l’utilisation répétée du jardin, dans une relation sociale médiatisée par la conversation, favorise un apprentissage de la reconnaissance d’œuvres de formes d’art et de design spécifiques. Les promenades dans le jardin contribuent à l’acquisition de nouveaux souvenirs personnels sans impacter les préférences artistiques qui restent stables chez les sujets Alzheimer comme chez les Témoins. Mots-clés : Vieillissement, Maladie d'Alzheimer, Art & Design, Jardin thérapeutique, Mémoires, Jugements, Apprentissage, Transfert d’acquisitions.
... There is widespread research which shows green spaces have positive effects on human health and well-being (Özgüner and Kendle, 2006;Van Meter, 2019;Deng et al., 2020;Pálsdóttir et al., 2020), including improving the mood, reducing the stress, and preventing chronic illnesses (Rugel, 2015;Buck, 2016;Vujcic et al., 2016Vujcic et al., , 2017Sugiyama et al., 2018). Since hospitals are special environments and considered as stressful places due to the inconvenient health conditions of the patients (Essa and Jabbari, 2020), green spaces of the hospitals are considered as necessary and beneficial to mitigate these difficult conditions to the patients (Ulrich, 1991;Whitehouse et al., 2001); and considered as significantly important on health factors of the patients (Shah Hosseini, 2013), for example, can reduce stresses, and improve their physical and neuropsychological health (Allahyar and Kazemi, 2020). ...
... Similar to our findings, Ö zgüner and Kendle (2006), in a comparative study of the preferences of people toward naturalistic versus designed landscapes in the city of Sheffield, UK, concluded that people prefer more naturalistic landscape styles. A considerable amount of research work has demonstrated that children prefer things in the garden which are related to their sensory experiences with plants, such as smelling the plants (Akoumianaki-Ioannidou et al., 2016;Eberbach, 1988;Whitehouse et al., 2001), touching them (Eberbach, 1988;Whitehouse et al., 2001), or they are attracted by the change of the leaf colors of the plants or falling the leaves in autumn (Akoumianaki-Ioannidou et al., 2016). A possible explanation for our results is that the perception of landscape aesthetics Table 6 Comparison of the means of the therapist preferences from the sick children's viewpoints on levels of the sub-factors of the hospital's landscape. ...
... Similar to our findings, Ö zgüner and Kendle (2006), in a comparative study of the preferences of people toward naturalistic versus designed landscapes in the city of Sheffield, UK, concluded that people prefer more naturalistic landscape styles. A considerable amount of research work has demonstrated that children prefer things in the garden which are related to their sensory experiences with plants, such as smelling the plants (Akoumianaki-Ioannidou et al., 2016;Eberbach, 1988;Whitehouse et al., 2001), touching them (Eberbach, 1988;Whitehouse et al., 2001), or they are attracted by the change of the leaf colors of the plants or falling the leaves in autumn (Akoumianaki-Ioannidou et al., 2016). A possible explanation for our results is that the perception of landscape aesthetics Table 6 Comparison of the means of the therapist preferences from the sick children's viewpoints on levels of the sub-factors of the hospital's landscape. ...
Article
Hospital green spaces are important for the well-being and health of patients, especially in children’ hospitals, because children are usually more sensitive than other groups of the society. Therefore, knowledge of users’ preferences about the landscape design of the hospitals is important to maximize the benefits of green spaces and achieve the desired spaces. This research aimed to examine the views and preferences of the children and therapists on the effective factors in the landscape design of a children's hospital considering the age and spirits of the children during their treatment period. To pursue this aim, 60 sick children, and 60 hospital staff (therapists) evaluated 84 simulated images and responded to the questionnaires. The results showed that there were no significant differences between children’s and therapists’ preferences on the landscape of a children’s hospital. Both respondent groups preferred warm colors. Also, among the types of topiary, design styles, and types of space design, the children preferred animal shapes and cartoon characters, combinations of flowers and turf grasses in planting beds, combinations of water fountains with flower beds instead of water fountains alone. They also preferred weeping-form trees and combined furniture forms with plants. This research showed that therapists can be good representatives for obtaining children's preferences about the landscape design factors. Also, they can be used in such children’s preference studies when a direct assessment of the children’s preferences is less possible. Therefore, these results could help architects and designers to provide better-suited hospital landscapes for children.
... • Higher anxiety patients and family members and can also be effective in reducing pain (Ulrich, 1999;Cooper-Marcus and Barnes, 1995). Research is also beginning to show that healthcare gardens are used heavily by staff for restoration and positive escape Barnes, 1995, 1999;Whitehouse et al, 2001;Sadler, 2001). Studies have also found that the presence of nature in healthcare facilities -gardens, window views of nature, atriums with vegetation -increases patient and family satisfaction with the healthcare experience (Cooper-Marcus and Barnes, 1995;Whitehouse, Varni et al, 2001; Center for Health Design and Picker Institute, 1999). ...
... Research is also beginning to show that healthcare gardens are used heavily by staff for restoration and positive escape Barnes, 1995, 1999;Whitehouse et al, 2001;Sadler, 2001). Studies have also found that the presence of nature in healthcare facilities -gardens, window views of nature, atriums with vegetation -increases patient and family satisfaction with the healthcare experience (Cooper-Marcus and Barnes, 1995;Whitehouse, Varni et al, 2001; Center for Health Design and Picker Institute, 1999). ...
... • San Diego Children's Hospital • Chelsea and Westminster Hospital, London concrete or other hardscape, intrusive machine sounds (traffic, for example), lack of security, prominent litter, cigarette smoke, and certain abstract or ambiguous sculpture that can be interpreted in multiple ways (Ulrich, 1999;Whitehouse et al, 2001). ...
Conference Paper
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This report is a record of the 'Exploring the Patient Environment' workshop organised by NHS Estates earlier this year. The workshop brought together leading researchers, healthcare professionals and people involved in the hospital design process, to explore the implications of recent studies on the effects of buildings on health outcomes and to discuss how to develop NHS Estates' strategy for improving the patient environment. The main speaker was Roger Ulrich, a Professor in the departments of Architecture and Landscape Architecture at Texas A&M University and Director of the University's Centre for Health Systems and Design. He is recognised as a world leader in the field of hospital design and his work has influenced the design of hospitals internationally. His research is the first to document scientifically the stress-reducing and health-related benefits, for hospital patients, of viewing nature. Appendix One of this report contains Professor Ulrich's detailed account of the content of his sessions. Presentations were also made by Professor Bryan Lawson, Dean of the Faculty of Architectural Studies at the University of Sheffield and another of the leaders in architectural psychology, and by Mr Maximo Martinez, Associate and Project Consultant at Space Syntax, a provider of pioneering design advice that takes account of social and operational factors. This report is part of a major project looking at the evidence base. Many of the issues raised require further debate and discussion.
... Very few rigorous HCF garden evaluations have been conducted, and only nine have been identified in publications (Cooper Marcus & Barnes, 1995;Davis, 2011;Heath & Gifford, 2001;Naderi & Shin, 2008;Pasha, 2013;Rodiek & Lee, 2009;Shepley & Wilson, 1999;Sherman, Varni, Ulrich, & Malcarne, 2005;Whitehouse et al., 2001). Five of the nine studies were based on Masters Theses or Doctoral Dissertations (Davis, 2002;Pasha, 2011;Rodiek, 2004;Sherman, 2008;Whitehouse, 1999). ...
... Kohn, Harhay, Cooney, Small, and Halpern (2013) (Carpman & Grant, 1993;Cooper Marcus & Barnes, 1999;Cooper Marcus & Sachs, 2014;Paine, Francis, Cooper Marcus, & Barnes, 1990). Whitehouse (2001) and Sherman, Varni, Ulrich, and Malcarne (2005) found that patients, visitors, and staff used the same spaces in significantly different ways. In Sherman's research, staff and parents of patients used the space for more sedentary activities (sitting, eating, reading) but parents of patients also interacted more with garden features, especially with their children. ...
... Several studies have found that staff are sometimes, if not often, the primary users of healthcare gardens (e.g., Cooper Marcus & Barnes, 1995;Naderi & Shin, 2008;Pasha, 2013;Whitehouse, 2001), and that patients often make up the smallest percentage of users, usually due to poor health. Studies have also noted conflicting needs and perceptions of the built environment in patients/visitors and staff (Cooper Marcus & Barnes, 1995;Cooper Marcus & Sachs, 2014;Davis, 2011;Naderi & Shin, 2008;Pasha, 2011;Sherman, Varni, Ulrich, & Malcarne, 2005;Whitehouse et al., 2001). ...
Thesis
Full-text available
As healthcare organizations and designers accept, and even embrace, healing gardens and other natural spaces as modalities for promoting the health and well-being of patients, visitors, and staff, the spaces provided must be designed and programmed to best optimize user health outcomes. Valid, reliable research instruments can aid in the evaluation of existing spaces. They can also be used as guides and tools for future design and research. The Healthcare Garden Evaluation Toolkit (H-GET) is a set of four standardized instruments developed for use, individually or in combination, by researchers, designers, and healthcare providers to evaluate, design, and research gardens in general acute care hospitals. Evaluation is an important component of research on the designed environment, and is a critical part of evidence-based design. The more valid and reliable the instrument, the greater the likelihood that results will be credible and generalizable. To date, despite a clear need, there are no rigorously tested, validated instruments available for the evaluation of outdoor spaces in general acute care hospitals. The H-GET fills this need. This mixed methods study involved development and testing of the four H-GET instruments: (a) the Garden Assessment Tool for Evaluators; (b) Staff and Patient/Visitor Surveys; (c) Behavior Mapping protocol ; and (d) Stakeholder Interviews. All four instruments were tested at eight Pilot Test sites across the United States. Emphasis with data collection and analysis was on establishing instrument reliability and validity. Data from each instrument were analyzed, and data from the four instruments were triangulated to examine support for validity and to explore specific hypotheses about physical and programmatic factors that promote garden use and user satisfaction. Through H-GET pilot testing, a Healthcare Garden Evaluation Method (HGEM) emerged—a methodological process that the individual instruments facilitate in a rigorous, standardized, research-based format for future studies’ design, protocol, data collection, data analysis, and dissemination of findings.
... Further, the point should be highlighted that there is growing evidence that the presence of nature-gardens, plants, window views of nature, atriums with vegetation-increases patient and family satisfaction (Cooper Marcus and Barnes 1995;Whitehouse et al. 2001; Center for Health Design and Picker Institute 1999). Accordingly, the potential for gardens and plants to heighten satisfaction, as well as improve health and economic outcomes, is attracting considerable attention from administrators facing strong pressures in a highly competitive marketplace to increase quality and differentiate their services and market identities (Sadler 2001 ;Whitehouse et al. 2001). ...
... Further, the point should be highlighted that there is growing evidence that the presence of nature-gardens, plants, window views of nature, atriums with vegetation-increases patient and family satisfaction (Cooper Marcus and Barnes 1995;Whitehouse et al. 2001; Center for Health Design and Picker Institute 1999). Accordingly, the potential for gardens and plants to heighten satisfaction, as well as improve health and economic outcomes, is attracting considerable attention from administrators facing strong pressures in a highly competitive marketplace to increase quality and differentiate their services and market identities (Sadler 2001 ;Whitehouse et al. 2001). From these comments, it follows that proponents of healthcare gardens and plant programs often should be able to build support and possibly garner resources from administrators by demonstrating that gardenlplant interventions 1 1 Communications with the Horticulture, Healthcare, and Design Communities increase patient satisfaction. ...
... The serious staff-related problems outlined above mean that most administrators will be influenced and impressed if they are presented with evidence that gardens and plants reduce employee stress, increase job satisfaction, may reduce turnover, and aid in attracting and hiring qualified personnel. In this regard, it is noteworthy that research by Cooper Marcus and Barnes and others is beginning to show that healthcare gardens are used heavily by staff for restoration and positive escape from workplace stresses Barnes 1995, 1999;Whitehouse et al. 2001;Sadler 2001). ...
Chapter
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Considering how to communicate and convince healthcare administrators of plant and garden benefits reflects a real growth and evolution since the first national people-plant symposium 10 years ago in Washington DC. How can we communicate in an influential, convincing way with key audiences such as healthcare administrators and physicians? We have to start by keeping an open mind and try to understand the mind-set of these crucial audiences. Where are they coming from? What do they value? What drives their decisions? What are the implications of their mind-set for making an effective case for gardens and plants? This paper will begin with a review of current trends and changes in healthcare systems that provide critical background for understanding the medical community's point of view. Against this background, information will be presented regarding how to convince administrators of garden and plant benefits, persuade them of the importance of providing funding for plant programs, of perhaps supporting horticultural therapy, and of designing healthcare buildings with prominent plants.
... All four of the studies found that those with plants present had better tolerance for pain than those without plants present. Many research works have documented the benefits of nature for reducing stress, improving mood, and increasing healthcare satisfaction (Beauchemin and Hays, 1996;Cooper-Marcus and Barnes, 1999;Ulrich, 1991;Varni et al., 2004;Whitehouse et al., 2001). ...
... The extant garden studies address the indirect effect the garden can play in patient recovery, family coping, and staff well-being, or, in other words, domains encompassed by Sullivan's (2003) "new subjective medicine." To date, only one published empirical evaluation of a children's hospital garden exists, in which Whitehouse et al. (2001) investigated the effects of a pediatric healing garden on patients, visitors, and staff. Using behavioral observations and structured interviews to measure both objective usage patterns and users' subjective perceptions of the garden, they found that although most used the gardens for less than 5 minutes, perceptions were overwhelmingly positive. ...
... A majority thought it was important for hospitals to include gardens, even though patterns indicated the garden was not used as often or effectively as intended by designers. There are evidences which prove that hospital garden-users report positive mood change resulting from garden use, and that time spent in or observing nature constitutes a restorative experience (Whitehouse et al., 2001). Healing gardens can be expensive ventures, and, if care is not taken, can even cause adverse effects (Cooper-Marcus and Barnes, 1999;Ulrich, 1999). ...
Technical Report
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In India, health care sector offers massive growth potential and a chance to capitalise on its expansion, especially as the country sees a rise in the incidence of lifestyle-related diseases. A growing elderly population paired with a rise in income levels also emphasizes the need for better facilities in the country. Historically, it has been the role of architects, planners, and designers to interpret the needs, wishes, and capabilities of those who will use their buildings. Today, a need has been felt for specialized behavioral sophistication in facility design to properly determine functional and ergonomic requirements and to translate them into the language of design and ultimately into bricks, mortar, and operating practices. The researcher has selected super – specialty hospitals for conducting the study since these spaces are being used by people belonging to all age and socio – economic group. Three numbers of super – specialty hospitals which render preventive, curative and palliative services were selected. The researcher has tried to identify the components of a therapeutic environment that would present a conducive setup for rendering optimum level of curative and palliative care within hospitals in Urban Indian context. Methods have included observations, interviews, and activity or behavior mapping as tools for understanding behavior of people in a practical situation and for determining user preference or attitude. The findings of this research implies that no longer should the ethics of healthcare be viewed exclusively through the lens of physician-patient dyad but architects associated with hospital design bear equal responsibilities. It was established by earlier researchers that architecture, which heals, requires a milieu that allows harmony - with nature and components of healing architecture include adequate daylight, sound of water and aroma along with other elements of visual aesthetics like colour, nature, and artwork. However, the current findings highlight issues like psycho – physical vulnerability of patients and family stress associated with hospitalization. It focuses on the non-medical needs of family members and visitors as an important factor in deciding the merits of specific designs and policies for hospital architecture. The research concludes by highlighting importance of factors which are closely linked with generating a sense of trust and faith on the hospital set up, familiarizing the patients and their relatives with hospital working system and process of treatment. It also highlights the need for comforting them through various rejuvenating elements, helping in negating the fear of the unknown through information dissipation and counselling.
... All four of the studies found that those with plants present had better tolerance for pain than those without plants present. Many research works have documented the benefits of nature for reducing stress, improving mood, and increasing healthcare satisfaction (Beauchemin and Hays, 1996;Cooper-Marcus and Barnes, 1999;Ulrich, 1991;Varni et al., 2004;Whitehouse et al., 2001). ...
... The extant garden studies address the indirect effect the garden can play in patient recovery, family coping, and staff well-being, or, in other words, domains encompassed by Sullivan's (2003) "new subjective medicine." To date, only one published empirical evaluation of a children's hospital garden exists, in which Whitehouse et al. (2001) investigated the effects of a pediatric healing garden on patients, visitors, and staff. Using behavioral observations and structured interviews to measure both objective usage patterns and users' subjective perceptions of the garden, they found that although most used the gardens for less than 5 minutes, perceptions were overwhelmingly positive. ...
... A majority thought it was important for hospitals to include gardens, even though patterns indicated the garden was not used as often or effectively as intended by designers. There are evidences which prove that hospital garden-users report positive mood change resulting from garden use, and that time spent in or observing nature constitutes a restorative experience (Whitehouse et al., 2001). Healing gardens can be expensive ventures, and, if care is not taken, can even cause adverse effects (Cooper-Marcus and Barnes, 1999;Ulrich, 1999). ...
Technical Report
Pradhan Mantri Awas Yojna - Urban (PMAY-U) was launched by the Government of India in 2014 with the objective of "Housing For All" to eligible urban families by year 2022. The validated demand under the scheme stood at 1 crore houses across all states and union territories. A massive spurt in housing activities as resulted, and it is reported that already 15 lacs new dwelling units are built and occupied. Another 40 lacs are under construction. While speedy and affordable construction is of uppermost importance, it is also to be noted that, India is a multi-climate country. the diverse geo-climatic conditions demands tailor-made solutions for the country across the boundary. A standard prototype is bound to fail as it is essential to make housing climate balanced to reduce dependence on mechanical means of lighting and ventilation. The Ministry of Housing and Urban Affairs (MoHUA) defines affordable housing according to different income brackets as follows: (i) Economical Weaker Section (EWS) with income level less than INR 3 lac p.a. and a dwelling unit size up to 30 sq.m, (ii) Lower Income Group (LIG) with income between INR 3 lacs to 6 lacs , dwelling unit size up to 60 sq.m (iii) Middle Income Group I (MIG-I), with income range INR 6 - 12 lac, dwelling unit size 90 - 120 sqm and (iv) Middle Income Group II (MIG-II), with income range INR 12 - 18lac, dwelling unit size 110 - 150 sqm. A housing unit is considered affordable if the EMI or rent does not exceed 30 percent of gross monthly income of buyer. Under such challenging boundary conditions of (a) geo climatic diversity, (b) low affordability, (c) size constraint and with the view t o bring in variety and flexibility in unit design., the task of this housing manual was taken up for EWS and LIG households from for the eastern part of our country viz. West Bengal and Odisha. Post occupancy evaluations were conducted on already occupied housing schemes across the two states. Field measurements were taken to assess the indoor livability conditions like lighting, ventilation and sound insulation parameters at different zones within dwelling units and also at common spaces like staircase, landings. The responses on space adequacy and general satisfaction were analyzed and a prioritization of factors was done to give design inputs. It is expected that this manual will be a handy tool for producers and policy makers of housing and also serve as a guide book for students in architectural institutes.
... a necessidade de analgésicos e influenciando até o tempo de internamento (ULRICH, 1984;ULRICH et. al., 2008;KLINE, 2009;MARCUS, SACHS, 2014 Numa época em que os aspectos financeiros ditam tantas decisões nos hospitais, é essencial avaliar empiricamente as contribuições que os jardins podem oferecer para o processo de cura em ambientes hospitalares (WHITEHOUSE et. al., 2001) ...
... de interação com o espaço do que por estritamente sua aparência e, contrariamente aos adultos, que geralmente buscam um lugar para se distrair e relaxar, as crianças buscam no local oportunidades para explorar e brincar. Em razão disso, para evitar um conflito de necessidades, recomenda-se sempre que possível destinar espaços separados à pediatria (WHITEHOUSE et. al., 2001;PASHA, SHEPLEY, 2013;MARCUS, SACHS, 2014;REEVE, NIEBERLER-WALKER, DESHA, 2017). Além disso, Pasha (2013), afirma que a equipe hospitalar tende a evitar os jardins compartilhados, procurando espaços mais isolados para poderem descansar e se afastar dos pacientes e familiares durante suas folgas. Em razão disso, notase que jardins exclusiv ...
Article
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O isolamento devido à pandemia Covid-19 no Brasil a partir de março de 2020 impôs desafios inéditos ao ensino: a falta de convivência social, fundamental à troca de ideias, e o ensino remoto como única alternativa para a superação do problema, para o qual docentes e discentes, até então não preparados para operá-lo, exigiram respostas rápidas. A experiência inédita de compartilhamento de uma disciplina reunindo cursos dos programas de pós-graduação da FAU/USP, do MDU/UFPE e do PROPAR/UFRGS, a partir dos antecedentes de cada um, levantou várias questões para contribuir para a discussão do ensino, da pesquisa e para a cultura arquitetônica. No âmbito didático-pedagógico, possibilitou uma rica troca entre docentes e discentes, questionando as práticas correntes e abrindo caminho para reflexões futuras; em relação ao conteúdo ampliou o leque de referências críticas e de obras arquitetônicas, impondo uma necessária revisão da historiografia. Muitas outras propostas se desencadearam no ensino superior para o enfrentamento da pandemia. Colocar em debate as estratégias adotadas e os resultados obtidos por esse tripé acadêmico pode estimular significativas mudanças no ensino de arquitetura.
... As a matter of fact, it is known that the green color tranquilizes the patient, water blue colors take the electricity of human skin, yellow color makes the patient feel a sense of energy, and white color has a calming effect. In addition, it should be noted that the red and orange colors cause tension and restlessness in case of long-term monitoring (Bulut and Göktuğ, 2006;Whitehouse et al., 2001;Ender et al., 2016). On the other hand, it is important also to use the fragrance feature of the plants in the designs to be applied in the hospital gardens. ...
... As a matter of fact, in a survey conducted in hospital gardens,Ulrich (2002) found that showing people photographs with open green spaces, a dim forest area and water elements surrounded by trees helps them heal, reduce their fear and anxiety levels, and reduce their stress and pain. Similarly,Whitehouse et al. (2001) suggest that users prefer the green color to make them feel good; Şahin et al. (2016) stated that green, white and blue colored plants, which function like tranquilizers, should be included. Also, ...
... As a matter of fact, it is known that the green color tranquilizes the patient, water blue colors take the electricity of human skin, yellow color makes the patient feel a sense of energy, and white color has a calming effect. In addition, it should be noted that the red and orange colors cause tension and restlessness in case of long-term monitoring (Bulut and Göktuğ, 2006;Whitehouse et al., 2001;Ender et al., 2016). On the other hand, it is important also to use the fragrance feature of the plants in the designs to be applied in the hospital gardens. ...
... As a matter of fact, in a survey conducted in hospital gardens,Ulrich (2002) found that showing people photographs with open green spaces, a dim forest area and water elements surrounded by trees helps them heal, reduce their fear and anxiety levels, and reduce their stress and pain. Similarly,Whitehouse et al. (2001) suggest that users prefer the green color to make them feel good; Şahin et al. (2016) stated that green, white and blue colored plants, which function like tranquilizers, should be included. Also, ...
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Hospital gardens are one of the most important connection points between health and nature. The creation of visually effective plant compositions in hospital gardens is also important in terms of relaxing users and providing socialization. In this study, observation, data collection and evaluation methods were followed. In the scope of the study, a total of 26 hospital gardens Bursa (Osmangazi, Yıldırım, and Nilüfer) including state and private hospitals in the central districts of Bursa were evaluated. The plant diversity in hospital gardens were examined and form, texture, color and odor characteristics, autumn color effects, sensory effects of the identified taxa, and how they were used in hospital gardens were evaluated. It has been determined that the hospital gardens had a rich plant diversity with 95 woody plant taxa, and 47.37% of the identified plants were natural and 52.63% were exotic species and the gardens were insufficient in terms of planting design. In the hospital gardens, green colors, which gave a sense of tranquility and confidence, were determined to be dominant (81.05%). State hospitals were found to be more successful in terms of plant diversity than private hospitals. In the design of hospital gardens, blue, pink and yellow plant species that make people feel a sense of eternity, desire of living, vitality and love should be included.
... Hospital authorities must take into account these problems, to correct, renew and improve their gardens, and to evaluate the hospital gardens as a part of the treatment. Thus, patients will be more peaceful, away from stress and happy and will respond more quickly to treatment (Paine and Francis, 1990;Theorell, 2001;Ulrich, 2001;Whitehouse et al. 2001;Söderback, Söderström, and Schalander, 2004). It should not be forgotten that hospital gardens are also open spaces in open green areas. ...
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Abstract While designing hospital gardens, aesthetic concerns should be put into the second plan, and design approaches should be included in line with the requests and needs of the users, unlike other outdoor design. The suitability of the garden of the new State Hospital in Kastamonu with the help of this study has been revealed. In the evaluation, 52 criteria, 14 sub-headings and 3 main headings were taken separately point average for each feature. For the evaluation of the garden, a survey study was conducted with 100 field users consisting of patients, visitor and staff and user satisfaction was determined. 3-point Likert scale was used in the evaluation of the questions. The Kruskal- Wallis test was used to determine whether there was a difference in scores between the user groups, and Mann-Whitney U test was used to compare the dissimilarity in the characteristics of the difference. Based on the results of the questionnaire and the design criteria of the Open Area Therapy Unit, the problems of the hospital garden were presented and solutions were offered to these problems, and a special stain design was proposed to convert the hospital garden into an open space therapy unit.
... The importance of outdoor space has long been touted in the 1 health design community, though many facilities still provide inadequate opportunities. When 2 considering how outdoor space may be implemented, it may be more nuanced than simply a 3 healing garden -in some studies, participants have indicated value for any space that allows 4 patients to spend time outside of the hospital room or ward (Whitehouse et al., 2001;Birch et al., 5 2007). In an oncology setting, this flexible definition of "outdoor space" may be necessary, as 6 immune-compromised patients may not be afforded the opportunity to access a ground-floor 7 garden, nor are patients receiving certain typical cancer medications allowed in direct sunlight. ...
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As cancer remains the leading disease-related cause of death in adolescence, designers must consider the influence of health facility design on social support and quality of life, while considering the changing psychosocial needs of adolescents and young adults (AYAs). Both the stress of treatment and the environment in which treatment occurs can influence AYAs during a time of significant social, biological, and cognitive developmental transitions. A questionnaire developed and provided to 104 AYA-aged survivors of AYA cancer revealed significant inadequacies across 22 features of the cancer treatment environment. Results of a regression analysis suggest a significant relationship between adequacy of the built environment, social support, AYA-specific resources, and health-related quality of life. Recommendations are provided for the design of an inpatient or outpatient cancer facility for young people, such that designers must create space to balance desired and achieved social interaction.
... Patients, visitors, and staff in general hospitals who use gardens report reduced stress and improved emotional well-being (Marcus & Barnes, 1995;Sherman, Varni, Ulrich, & Malcarne, 2005;Whitehouse et al., 2001). Studies in general hospitals suggest that gardens designed in informal natural styles with prominent vegetation and flowers are more effective in reducing stress than structured or geometric gardens with prominent hardscape such as concrete (Marcus & Sachs, 2014;Shukor, 2012;Twedt, Rainey, & Proffitt, 2016). ...
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Objectives The objective of this discussion paper is to deepen the discourse on the complex interrelationship between “healing architecture” and “safe architecture,” here labeled “ The healing architecture and safety architecture,” for the benefit of those who want to make informed decisions in the design of future psychiatric wards. Background Today’s psychiatric care sets the patient at the forefront. As a part of this ambition, the discussion regarding the patient’s physical environment has also advanced. At the same time, staff are exposed to increasing threats and violence in their everyday work, which can lead to severe personal psychological suffering as well as physical injuries. The requirements of patients and staff are sometimes conflicting which has ethical implications. Methods The reasoning and arguments presented here mainly derive from discussions and dialogue with psychiatric facility management and other healthcare professionals in multidisciplinary working groups during the design process. Results Offering patients and staff a healing and safe environment is the most important architectural challenge in the design of psychiatric wards. How architects, management, and staff evaluate and balance the two aspects will have a crucial impact on the building’s final design and atmosphere and thereby influence staff and patient safety as well as civil protection. Conclusions In everyday practice, it is up to the multidisciplinary design teams and management to become better informed in order to make “the right decisions to the best of their ability” as evidence is still limited when it comes to “ The healing architecture and safety architecture.”
... Historically developed in settings for the sight-impaired, more recently designers and health commissioners have recognised their potential to reduce stress in general health-related settings. As the evidence base has grown, sensory gardens are now used from children's hospitals and special needs schools to residential dementia care units (Hussein, 2010b;Uwajeh, Onosahwo, & Mukaddes, 2019;Whitehouse et al., 2001). While therapeutic and healing gardens use a programme of activities to prompt an outcome , in contrast, sensory gardens are designed to offer unprogrammed, innate sensory delight. ...
Article
Chronic stress impacts workplace wellbeing. To counter this, stress recovery and attention restoration theories assert a need for nature connection. However, the impacts of environmental design typologies are poorly understood. This research sought to explore the potential of salutogenic design as a stress-reducing health promotion tool for ‘apparently well’ people in a workplace setting. A randomised controlled trial compared ‘apparently well’ (n = 164), 18–65-year-old staff and students at a University campus in Auckland, New Zealand. Participants were recruited and randomised into two intervention groups, sensory garden (SG; n = 57), and urban plaza (UP; n = 51), and a control group (CG; n = 56). SG and UP participants had a monitored ‘appointment outdoors’ for 30 min once weekly for four weeks. All participants were tested for salivary cortisol, perceived wellbeing, productivity, perceived stress, nature relatedness pre- and post-intervention; data were analysed using generalised linear models. Significant intervention effects (SG vs control) were observed for salivary cortisol (−16.1% [95% CI: –32.0%, 0.2%]; p = 0.048), wellbeing (6.9% [95% CI: 2.7%, 11.1%]; p = 0.001) and productivity (2.8% [95% CI: 0.1%, 5.5%]; p = 0.040). Although not significant, a surprising trend towards negative effects of the Plaza on wellbeing (−4%[95% CI: −8.78%, 0.35%]; p = 0.071), productivity (−2% [95% CI: −5.38%, 1.34%]; p = 0.238), and perceived stress (19% [95% CI: −59.87, 21.49]; p = 0.355) were observed when compared to the SG group. This study suggests a sensory garden effectively reduces stress, enhances wellbeing and improves productivity of ‘apparently well’ people in the workplace. Future wellbeing initiatives should explore opportunities for nature connection in their setting.
... In addition to the general design considerations that must be fulfilled in all healing gardens, there are special considerations that distinguish a therapeutic garden from another or emphasize to achieve them in one garden without the other. In Table 3 some types of these gardens and their considerations, such as Alzheimer's [22], [2], [23], [24], the elderly [23], [2], [25], cancer [26], [27], mental [28], [22], [29], children [30], [31], [32]. ...
Article
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Outdoor natural environments are well proven to have psychological, physical, and social benefits, particularly those attached to healthcare facilities. Despite that, the Egyptian Codes devoid of data related to the design of such gardens, which hinders the design process and the inclusion of these spaces within health care facilities. Thus, this paper seeks to reach a set of considerations for the design of different types of therapeutic gardens by summarizing the findings and recommendations of some evidence-based design (EBD) research and post-occupancy evaluations (POEs). Post-occupancy evaluations lack to determining the percentage of achieving the design principles in the garden. Therefore, in addition to the behavioral and visual observations to evaluate Children's Cancer Hospital garden in Egypt (CCHE), an audit tool was integrated to combine the advantages of audit tools and POEs. With this merging, we can reach a steady form of post-occupancy evaluations of pediatric cancer hospital’s gardens to be a guide for future researches and landscape architects.
...  Reducing stress  Improving mood [10].  Improving the quality of life [11]. ...
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There were emergences trends towards achieving sustainability in landscape. But the study of the role of healing gardens in the landscape sustainability for the public gardens had not been studied previously in recent literatures. The research hypothesis is that healing gardens have a role in the landscape sustainability for public gardens. The research depends on a descriptive analytical study for public garden samples, which applied the design principles and elements of healing gardens (accessibility, Sense of control, Flexibility, etc). These gardens also relied in their designs on the basic principles of sustainability. The results showed that healing gardens effectively contribute achieving landscape sustainability for public garden through the use of natural materials, the cultivation of local plants, consistent with the local climate, and enhancing social interaction and sensory interaction with the landscape.
...  Reducing stress  Improving mood [10].  Improving the quality of life [11]. ...
Article
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There were emergences trends towards achieving sustainability in landscape. But the study of the role of healing gardens in the landscape sustainability for the public gardens had not been studied previously in recent literatures. The research hypothesis is that healing gardens have a role in the landscape sustainability for public gardens. The research depends on a descriptive analytical study for public garden samples, which applied the design principles and elements of healing gardens (accessibility, Sense of control, Flexibility, etc). These gardens also relied in their designs on the basic principles of sustainability. The results showed that healing gardens effectively contribute achieving landscape sustainability for public garden through the use of natural materials, the cultivation of local plants, consistent with the local climate, and enhancing social interaction and sensory interaction with the landscape.
... Research published in refereed journals between 1999 until 2016, which focus on children involvements in retail or shopping environments is selected and reviewed to ensure all information used are recent and may contribute to the current state of knowledge within the research area. (Whitehouse et al., 2001;Thomson and Laing, 2003). Based on the selection criteria, the researcher reviewed seventeen studies. ...
Thesis
Shopping centres are no doubt one of the many modern-day necessities, providing everything one might need all under one roof. To encourage customer visits, prolong time spent, and potential purchases, the environment of a shopping centre is often designed in a specific way to affect customer’s shopping values, enticing both their emotional and physiological sensations. A well designed shopping centre is a combination of modern architecture, as well as the integration of the right shopping atmospheric variables such as wall decoration, lighting, sound effects, music as well as retail layout. In today’s society, parents and children visit shopping centres for multiple purposes including retail therapy, entertainment, socialising and many others. Most of the time, parents intend to complete a purchase and at the same time to enjoy the hedonic aspects of the shopping environment with their children. In the shopping journey between a parent and their accompanying child, children play a significant role in determining the family’s shopping expenses, one that is as important as an adult. However, research within this area also found that having a child companion can reduce positive shopping values due to the child’s behaviour. As a result, this will lead parents into making hasteful decisions such as shortening their shopping visit or even making a turning back home. Although numerous efforts have been made by scholars to understand the effects of shopping atmospheric variables on the customer, only a few research is conducted to understand how these variables affect small children’s emotional response and shopping behaviour during their shopping journey. Therefore, this research focuses on ‘how to improve children aged between three to seven years shopping experience through the shopping atmospheric variables when accompanying parents during shopping activities?’. The qualitative methodology using ethnography studies is employed in this research to develop an in-depth understanding of children customer shopping experience. Research data is collected using ethnography cultural probes (children shopping experience diary), digital ethnography observations and face-to-face semi-structured interviews. Results from this study are used to help the researcher develop a theoretical framework to identify atmospheric variables that are salient to young children customers, which may later provide vital insights in improving their shopping journey. Based from the findings, this research found that children emotional response, shopping behaviour and experience are influenced by four key factors. Each key factor explained how children react towards shopping atmospherics variables they engaged with, including their self-role and characteristics as a young customer, in-store decorative elements and electronic devices, categories for merchandise and snacks and other human variables while shopping with parents. The findings help to clarify children’s attitude towards each shopping atmospherics variable, and factors that might potentially influence their response towards them. To continue, the findings also highlighted important insights that will be useful for the shopping centre’s managerial team, designer and retailer who aim to improve children’s shopping experience. The improvement made based on these insights may also potentially help businesses create a more pleasant shopping environment for children as well as increase store and brand loyalty. Moreover, the findings may also benefit parents, since a positive children’s shopping behaviour may contribute towards a more positive family’s shopping vibes.
... If nature exposure can increase resilience through buffering from stress and/or increased happiness, we might just keep our essential healthcare workers from burning out. The presence of nature has been linked to higher levels of satisfaction for staff, patients, and visitors (Pasha, 2013;Sachs, 2017;Whitehouse et al., 2001). Greater satisfaction in staff keeps productivity high and turnover down; in patients and visitors, it breeds customer loyalty (Rodiek et al., 2013). ...
... After assessment of post-occupancy data evaluations of hospital gardens in the state of California, USA, researchers found that patients were not the only ones who used these gardens to promote healing; nurses, healthcare workers as well as other staff members also used these gardens as a much needed escape to recuperate from everyday stress (Cooper Marcus & Barnes, 1999). Results from other post departure research found that admitted patients and family members, who used hospital gardens, reported reduced stress levels and positive mood changes (Whitehouse, 2001), leading to heightened satisfaction with overall quality of care from both patients and family members (Ulrich et al., 2004). "Healing gardens," as they were termed, offered a way for patients and healthcare workers and personnel to step back, relax, recover, and revive. ...
Chapter
Valuing public perceptions of biophilia impact on human well-being: 2 sustainable building case studies from India and Greece| This study focusses on valuing the ‘green technologies’ of designing and building with nature to encourage a wider dimension to the current ratings and evaluations of effectiveness of ‘green buildings’, by including the perceived impact on human well-being. We believe that for buildings to offer a ‘sustainable’ way of living, they must also include the technologies and intelligence to provide what all of life needs to thrive beyond just surviving. This paper aims to give a wider understanding of ‘green buildings’ beyond reporting on energy, water and waste, to show a more sophisticated, wider evaluation of sustainable buildings by including the value of subjective perception of individuals’ experience. And, to contribute to changing existing paradigms about how ‘green buildings’ are valued. Other studies conclude that leading bodies for ‘green building’ certification have failed to provide a holistic measure of sustainable buildings. Current environmental measures of ‘green buildings’ conflict with the values of human health and there are conflicting ‘logics’ and technologies with little consensus on what makes a sustainable building. The perceived ‘value’ of the health and well-being benefits of a ‘green building’ appears to be disregarded as a measure of effectiveness. This paper challenges that view. Findings from questionnaires, testimonials and in-depth interviews from the public using 2 green buildings in different countries suggest that people do believe that they experience physical and emotional health benefits from spending time in in green buildings. This suggests that valuing the ’unmeasurable’ perceived benefits of sustainable buildings on health and well-being, equally alongside quantitative audits and environmental measures, could bring combined societal and environmental benefits. More study and evaluation with larger samples in different countries is necessary. Further study could make an important contribution to greater understanding about the positive impacts of biophilia design for healthcare institutions, community spaces, workplaces and homes.
... After assessment of post-occupancy data evaluations of hospital gardens in the state of California, USA, researchers found that patients were not the only ones who used these gardens to promote healing; nurses, healthcare workers as well as other staff members also used these gardens as a much needed escape to recuperate from everyday stress (Cooper Marcus & Barnes, 1999). Results from other post departure research found that admitted patients and family members, who used hospital gardens, reported reduced stress levels and positive mood changes (Whitehouse, 2001), leading to heightened satisfaction with overall quality of care from both patients and family members (Ulrich et al., 2004). "Healing gardens," as they were termed, offered a way for patients and healthcare workers and personnel to step back, relax, recover, and revive. ...
Chapter
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Recent studies have defined the ‘healthy neighborhood’ as the social or socio-economic unit within a healthy district or spatial unit within a human-oriented transportation system. However, those views have failed to notice both standard elements of organic and city transportation policy and other dimensions of organic transportation, excluding spatial one. In this study, the social-ecological system (SES) and human-oriented transportation system (HOTS) frameworks will be compared to each other in terms of structure, application and dynamics to draw a conclusion about the suitability of HOTS in framework to describe the complex socio-technological system such as ‘healthy neighborhood’. Additionally, the structure and the multidisciplinary process that occur within the ‘healthy neighborhood’ will be analyzed in terms of HOTS framework. Finally, the indicators of pattern and size of ‘healthy neighborhood’ in terms of HOTS framework will be suggested. Thus, a healthy interdisciplinary neighborhood will be captured. This research will be the first attempt to shift from the traditional ‘unit’ perspective to the network models capable of unfolding the internal socio-economic and technical processes, uncovering the internal organization and functions of healthy neighborhoods.
... Other studies in hospitals and workplaces have similarly found that patients, medical staff, and office employees using gardens report reduced stress and improved emotional well-being (Marcus & Barnes, 1995;Whitehouse et al., 2001;Sherman et al., 2005). Walking in nature areas, compared to built environments lacking nature, is more effective in reducing stress and improving mood for persons with negative emotional states or mental health problems (Roe & Aspinall, 2011;Berman et al., 2012). ...
... After assessment of post-occupancy data evaluations of hospital gardens in the state of California, USA, researchers found that patients were not the only ones who used these gardens to promote healing; nurses, healthcare workers as well as other staff members also used these gardens as a much needed escape to recuperate from everyday stress (Cooper Marcus & Barnes, 1999). Results from other post departure research found that admitted patients and family members, who used hospital gardens, reported reduced stress levels and positive mood changes (Whitehouse, 2001), leading to heightened satisfaction with overall quality of care from both patients and family members (Ulrich et al., 2004). "Healing gardens," as they were termed, offered a way for patients and healthcare workers and personnel to step back, relax, recover, and revive. ...
... Additionally, a considerable amount of research has demonstrated that windowless, maze-like hallways, smelly interior spaces create unpleasant feelings (Relph, 1976;in Adams et al., 2010), and thus increase the distress in patients (Boyd and Hunsberger, 1998). Whitehouse et al. (2001) usingsemi-structured interviews, provided evidence on the positive effects of restorative elements of nature on sick children in a children's hospital and health centre in San Diego. Despite the research on the psychological effects of outdoor environments, research on pediatric environments is more limited. ...
Article
Hospital is one of the areas that affect the mental and psychological conditions of the children, and the poor design of these environments may affect physical and psychological health. This study investigated the effect of a typical Dish Garden as a surrogate for green spaces in improving the physical and neuropsychological characteristics of hospitalized children. For this purpose, 54 hospitalized children were randomly divided into intervention (experimental) and control groups. The children in the experimental group were placed in a pre-designed room with a Dish Garden for 72 hours, and the control group did not receive any intervention. In this research, a pre-test and post-test design were applied. The results showed that the group exposed to the Dish Garden was significantly healthier than the control group in terms of physical and neuropsychological factors. The recorded vital signs, including systolic and diastolic blood pressures, heart, and respiration rates decreased to normal rates in the experimental group. The neuropsychological indices in the experimental group included the emotional index (lack of fear, happiness, and relaxation), the cognitive index (compatibility and attention), and the non-symptom index (no anxiety and lack of depression). The Dish Garden enhanced physical and neuropsychological health of the children through visual distraction. Therefore, using Dish Gardens can be suggested as low-budget and low-risk tools to create favourable environments in children's hospitals.
... Wilson 11 Rollins 12 Adams 13 Andrade & Devlin 14 Healing garden 15 ...
Conference Paper
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Different physical factors in a hospital setting can have qualitative and quantitative effects on the hospitalization of patients. In other words, the proper hospital is not only faced with medicinal needs, but also with the movement, social, evolutionary and emotional needs of patients, should also be considered in the architectural design. Hospitalization is a stressful experience for children that can lead to emotional isolation, various regressive behaviors, prolonged crying, disturbed sleep patterns and a variety of devastating conditions that become angry at being exposed to such attacks. Accordingly, the present study aimed to identify environmental factors affecting children’s morale in stress reduction in hospital environment besides physical and functional analysis of six different children’s hospital samples in the world. In this paper, systematic review method was used for initial recognition and also descriptive-comparative method was used to express the effective features in the design of case samples architecture. The results of the studies indicate that environmental and physical factors have a significant impact on reducing children’s stress in a hospital environment, at the same time paying attention to the attractiveness, readability and simplicity of functional spaces for them.
... 32 Surprisingly, patients and visitors are often not aware of hospital gardens, and proactive approaches to increasing patient and family use of gardens have been recommended. 34 Usually conceptualized as spaces for patients and visitors, staff are often their primary users. 32 Outdoor spaces can be restorative for hospital staff, helping to reduce stress and improve attention, which may improve patient care and staff retention. ...
Article
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Healthcare facilities are among the most expensive buildings to construct, maintain, and operate. How building design can best support healthcare services, staff, and patients is important to consider. In this narrative review we outline why the healthcare environment matters and describe areas of research focus and current built environment evidence that supports health care in general and stroke care in particular. Ward configuration, corridor design, and staff station placements can all impact care provision, staff and patient behaviour. Contrary to many new ward design approaches, single bed rooms are neither uniformly favoured, nor strongly evidence-based, for people with stroke. Green spaces are important both for staff (helping to reduce stress and errors), patients and relatives, although access to, and awareness of, these and other communal spaces is often poor. Built environment research specific to stroke is limited but increasing and we highlight emerging collaborative multi-stakeholder partnerships (Living Labs) contributing to this evidence base. We believe that involving engaged and informed clinicians in design and research will help shape better hospitals of the future.
... Furthermore, (Weerasuriya et al., 2019a) pointed out that the green space enables family members to spend time playing with their ill child, or allows the child to play and interact with other children. Similarly, (Whitehouse et al., 2001) reported that participants use the green space for activities such as "celebration of life" and memorial services, which enables them to share their pain and struggles with other people in the same space who are experiencing similar tribulations, thus giving them the strength to cope and recuperate fast. ...
Article
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Staff, visitors, and patients are extremely likely to suffer from stress in healthcare environments. Through natural environments like hospital gardens, high stress levels can be significantly neutralised to improve health and boost healing. First, this study is aimed at evaluating the perceived curative features of hospital gardens for prospective visitors and patients, as well as for staff. Second, the study focuses on providing recommendations for building new restorative gardens and transforming existing hospital gardens into curative types. In an online questionnaire, 411 respondents and 28 staff members from four of Klang Valley hospitals were asked to rate four gardens from these hospitals in several workshops. With the aid of semantic differential (SD) and other psychological grading systems, the gardens were evaluated by respondents based on their restorative qualities and appearance. The restorative capacity of a hypothetical ideal hospital garden, which acted as a reference, was also assessed by the respondents. The most natural garden, with the highest score for restoration, was ranked next to the reference garden. Using SD factor analysis, sense of touch, tranquillity, mysticism, nature, well-being, and mood were found to be relevant factors for design. We made use of the findings to offer recommendations for (re)designing hospital gardens, which researchers of healthcare facilities, administrators, planners, and architects can adopt to improve the healing capability of gardens at medical centres. This paper presents a method that enables existing hospital gardens to be evaluated and compared with regard to their restorative potential and appearance, as well as facilitates the (re)construction of hospital gardens.
... Based on post occupancy evaluations of hospital gardens in California, USA, researchers concluded that nurses, healthcare workers and other staff members also used the gardens as a pleasant escape and to recuperate from stress (18). Results from other post departure studies indicate that patients and family members who used hospital gardens, reported reduced stress levels and positive mood changes (19). These reports also suggest that gardens and nature in hospitals can heighten patient and family satisfaction with overall quality of care (16). ...
Article
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Healthcare facilities are complex and complicated structures that affect their inhabitants heavily. The effects may become both physical and psychological and address patients, users and visitors. However, recent studies have shown that "coming back to nature" affects hospital stays significantly. Patients that are given access to nature and continuous connection to family, friends and specialized social workers may eventually recover faster and become dismissed earlier. With the beginning of the 21st century, the design of healthcare facilities took on a turn to include human aspects, in an attempt to, support the productivity of these institutions. The length and capacity of stay of patients became an issue that was addressed to promote better health and living and enhance the quality of life of individuals undergoing hospitalization. This research is based on an analytical overview of previous literature in relevance to promotion of health and healing in healthcare facilities which have higher access to daylight and natural views. It accentuates previous research and emphasizes the importance of these factors as well as exterior connectivity for patients and their essentiality in accelerating the healing process. The research also presents the design indicators and criteria that future hospitals should follow to enhance the productivity of these institutions and promote wellness for patients. The results of this research came out as a group of indicators that address the effect of design factors on overall building and interior design of healthcare facilities.
Article
Purpose This study aims to evaluate the quality of an on-campus medical facility at a leading university. Design/methodology/approach Published literature was consulted to review knowledge areas on the usability and quality performance requirements of healthcare facilities. Quality indicators were, thus, developed from the extant literature and verified by a walkthrough of a case study medical facility. Then, a quality assessment survey was developed and administered to obtain feedback from users of the medical facility. Additionally, a focus group meeting was conducted to obtain more qualitative feedback on the issues identified through the questionnaire survey. Findings The results show that users were generally satisfied with the identified evaluation categories, indicating moderate quality. Potential quality issues related to the exterior and interior finishes, furniture and the indoor air were noted through focus group meetings. The study proposed a number of recommendations to enhance the design quality of the medical center. Originality/value The importance of this study is evident in the fact that the quality of healthcare facilities has a direct link to the performance and overall well-being of its intended users, as well as the overall success of its host organization. The study demonstrates the value of users' feedback on the quality of a built facility. It re-emphasizes the point that buildings can only be judged to be of high quality if the users' are highly satisfied.
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Jordan suffered from a shortage in low-income housing. Jordan faces a surplus in other housing stock. Factors of imbalance included funding, land, and construction process. Despite the diagnosis of this imbalance, the government could not address the issue. Empowerment of the private sector through partnership potentially bridges housing needs for the growing segment of low income. Further challenges of the proposed study area included cultural values, living needs, and necessary services, in addition to provision of livelihood sources. This study examines the possibility of providing adequate and low-cost housing for the group of Al-Noaim tribe at Al-Mansoura town. This social group still inhabits Bayt Asha’ar housing typology so as to match their low income pressures. The study was based on field survey and interviews with of 27 families and householders. Outcomes proposed a project to be built in two stages during 15 years, 100 residential units distributed on 27 families. The suggested reduction of the total cost of the project was based on: (1) Site selection, (2) Identifying areas and patterns of housing units, and (3) Identification of multiple typologies for construction of the wall section to be used in construction with the retention of social meanings and psychological impact on such low income social groups.
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Egyptian cities have faced several challenges since the start of this new millennium; rapid population growth, urban decay at the expense of available shelter, and services, degradation of infrastructure and land, the downgrade of the environment, social structure and the economy in general, are all factors that have led to unsustainable living. The Burullus region, located in the Northern part of the Egypt delta, is an active commercial and administrative hub. It is one of the five protectorate lakes of Egypt which accommodates both a recreational summer resort and a poorer all year residence. The lake has faced, across time, several changes in respect to the surrounding cities, which in turn impacted dramatically the shore. The changes that happened to the land use and land footprint have changed the shoreline, and will, eventually, lead to many environmental and urban problems as well. Many actions should be taken when thinking about future extensions of cities that have natural edges like Lake Burullus and huge agricultural lands, the aforementioned challenges will face existing communities, as well as, extend with respect to the surrounding areas leading consequently to the change of the identity of the area at large. This paper focuses on the importance of urban development and urban solutions of the cities surrounding Lake Burullus as well as the shoreline protection and implementation policies to optimize deterioration of shoreline, taking into consideration the importance of rural regeneration and its impact on this area. It also highlights a list of actions for successful lake upgrading steps based on the experiences reviewed and concludes that the success of the development of shoreline depends on several factors and that metropolitan planning should cover problems across urban and peri-urban areas and address multijurisdictional issues.
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Abstract: This study aims to investigate the psychological effects of the epidemic outbreak and quarantine in individuals aged 18-65. 357 individual, 251 women (70.3%) and 106 men (29.7%), participated in the study. Participants were given online on the sociodemographic information form, questions about pet ownership and plant ownership, telephone use, Intolerence of Uncertainty Scale, Leisure Boredom Scale, and Impact of Events Scale. In the analysis of the data; bivariate correlation, independent samples t-test and linear regression analysis were used. Individuals who do not have pets have higher scores from Impact of Events Scale and Intolerence of Uncertainty Scale than who have pets. No difference was found between the scale scores of individuals with and without plants. According to the correlation analysis, there is a significant and positive relationship between all scales. According to the standardized regression coefficients of linear regression; the order of importance of the predictive variables on the effects of events was determined as intolerance of uncertainty, leisure boredom, home environment, time spent on the phone, socioeconomic level and use of twitter. The world is struggling with a pandemic outbreak. Results indicate that having a pet, living in a detached house, high socioeconomic level may be a protective factor and high levels of intolerance of uncertainty, leisure boredom, time spent on the phone and use of twitter may be a risk factor. It is recommended to increase the number of studies using these variables.
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Background Patient-centred ward design has recently attracted attention, and the impact of architectural environment on inpatients' psychological well-being is an important aspect thereof. However, little is known about inpatients’ perceptions of ward environments. Method Fifty-four inpatients at a Chinese general hospital participated in the study. The subjects experienced simulated patient ward environments through the use of virtual reality to test six design characteristics in various combinations. Subjects’ skin conductance (physiological measurement) and perceived restorative outcomes (psychological measurement) were tracked during and after the experiences. Results A window view of an urban landscape with natural elements led to better restorative effects than indoor plants or a digital representation of nature. Inpatients experience better restoration when surrounded by warm-coloured rather than cold-coloured or white walls. Relatively spacious patient rooms are more restorative, especially with a large width-length ratio. However, no restorative benefits were found for additional furniture, and abstract artwork does not necessarily improve mental well-being. The results of doorway position were varied, depending on measurements used. Conclusions The impacts of six built environments on inpatients' restorative outcomes were identified, and some impacts were mediated by demographics and human factors. The difference between physiological and psychological measurement results is argued to relate to the influence of people's additional information processing.
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Purpose The aim of this study is to undertake a systemic literature review (SLR) of horticultural therapy and to explore whether its inclusion in a healthcare programme can enhance hospitalised children's well-being. Design/methodology/approach An empirical study was developed using a mixed methods approach to monitor stakeholders' perceptions of horticultural therapy. Specifically, hospitalised children ( N = 31) and their families ( N = 21), as well as medical and nursing staff ( N = 3), were engaged in the empirical study. Qualitative and quantitative surveys were developed, involving two paediatric units in an Italian hospital. Findings The authors’ findings show a significant improvement of children's mood and psycho-physical well-being following horticultural therapy. The authors found positive effects of interactive horticultural therapy on hospitalised paediatric patients and their parents. Parents perceived a positive influence on their mood and found the therapy very beneficial for their children. Qualitative analyses of children's and parents' comments (and related rankings) revealed the helpful support role of horticultural therapy in dealing with the hospitalisation period. There is a very limited number of studies that have inspected co-therapy implementation in paediatric hospitals, and to the best of the authors' knowledge, no study has yet examined the effect of horticultural therapy in such a context. The practice of horticultural therapy with children in health settings has been documented in some Italian hospitals, but its effectiveness has not yet been well established in the literature. Originality/value The authors’ findings could provide useful insights to clinicians, health managers and directors in creating and sustaining a successful group co-therapy programme under the managed healthcare system.
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The purpose of this article is to examine inclusive access criteria and explore the significance of post-occupancy evaluation (POE) for establishing and sustaining social inclusion in urban centres. Since the post-occupancy evaluation research framework was drawn on for appraising urban open space's accessibility and usability for people with and without physical disabilities, the POE methodology could be adapted for similar urban contexts and was tested on the upgrade projects in Kyrenia Town Centre (KTC) for use by both disabled and non-disabled people. A survey and structured observations with behavioural mapping were used to test urban space user's preferences, needs and satisfaction levels regarding desirable qualities of urban centres: adaptability, safety, comfort, dignity, density, legibility and autonomy. Using representative samples, a survey (sample size = 383) was initially conducted and then systematic observations (sample size = 1620) were performed to obtain data necessary to complete behavioural maps. The survey findings showed that the KTC possesses physical and social barriers, which represent challenges for both disabled and non-disabled users. Therefore, post-occupancy evaluation could be beneficial for the development of inclusive design policy and should be a necessary component of design process in order for determining what is needed to create the most inclusive environment by including disabled segments of the community.
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Purpose Hospital landscape is not a useless space within hospital buildings anymore. It is considered as a supportive area providing mental and physical peace. However, the planting design of the hospital landscape and the way it should be in order to not disrupt wayfinding performance is neglected. This paper, which is a case study, aims at investigating the effects of planting design in Kerman hospitals’ landscapes on the users’ wayfinding using space syntax techniques. Design/methodology/approach This research focuses on the effects of planting design on the users’ wayfinding in hospitals. In so doing, library research, computer simulation and analysis with the University College London (UCL) Depthmap software, and comparison techniques are used. Based on axial maps, the measures of integration, connectivity and intelligibility are considered for analysing the wayfinding process of individuals. Findings The findings show that planting configurations in the hospital landscape can affect individuals’ wayfinding. Integrated and regular planting design in addition to combining planted areas with the hospital buildings can pave the way for intelligible space and easier wayfinding. Originality/value According to the authors’ knowledge, the current study is the first to use the space syntax techniques in the health-care landscape architecture in terms of planting design and wayfinding. As wayfinding is an important issue in health-care spaces, the study findings can greatly help the health-care building designers and the related organizations to pay attention to the hospital landscape as much as hospital indoors.
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Inpatients’ mental well-being is linked to the restorative quality of patient ward environments, which are mostly determined by design characteristics. However, past research has predominantly separated these characteristics and seldom provides insights into inpatients’ perceptions of their ward environment in an integrated way. Therefore, this research was conducted to comprehensively determine the fundamental design characteristics and dimensions that affect the restorative quality of ward environments. A 27-item questionnaire and a Hospital Indoor Restoration Scale was used to collect the perspectives of 150 inpatients from five types of general wards in a Chinese hospital. Correlation analysis, principal component analysis, and statistical weight calculation were applied to the responses to investigate the restorative quality of design characteristics within a framework. The results demonstrate that 19 design characteristics significantly correlate with the overall restorativeness of ward environments, and nature, artwork, doorway position, furniture layout, room size, and wall colour are the most dominant characteristics. Four principal components were identified, namely object, connection, spatiality, and ambience, and seven sub-dimensions were determined, including ornamentation, furniture, interaction, component, scale, decoration, and ambience. The weight calculation demonstrates that object and connection are the most significant dimensions that influence the restorative quality of the ward environment. The findings indicate that these influential environment characteristics and key dimensions should be the primary considerations in patient ward design and management to foster inpatients’ mental well-being.
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Horticulture Therapy is an integrated approach to human development using horticulture techniques with behavioral science. This paper attempts to present the results of the study to evaluate the impact of horticulture therapy in developing self-esteem and motor skills in physically challenged children. Fifty physically challenged children in the age group of 12-18 years were selected using purposive sampling. Motor skills of the children were studied using an observation schedule by inter observer agreement method. Assessment of self-esteem of the sample was done using a rating scale. The tools were constructed and standardized. Horticulture therapy included goal specific activities along with raising a vegetable garden. The data collected before and after horticulture therapy was analyzed using paired sample 't' test. The results revealed that there is significant impact on the development of self-esteem and motor skills in challenged children after attending the horticultural therapy programme.
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Dudkiewicz M., Pudelska K., Parzymies M., Durlak W. 2018. Rola hortiterapii i bukieciarstwa w leczeniu dzieci i dorosłych. Kosmos 4: 813-821 Hortiterapia i bukieciarstwo skierowane są do wszystkich grup pacjentów: dzieci, osób starszych, osób z zaburzeniami psychofizycznymi i umysłowymi, ludzi z dysfunkcjami fizycznymi i sensorycznymi, a także osób uzależnionych od narkotyków, alkoholu itp. Hortiterapia może odbywać się w ogrodach przy szpitalach, domach opieki społecznej, domach spokojnej starości, ośrodkach dla osób uzależnionych, a także w terapeutycznych gospodarstwach o pr0ofilu rolnym i ogrodniczym. Celem pracy jest przedstawienie wyników licznych badań nad pozytywnym oddziaływaniem roślin na człowieka oraz opisanie przykładów zastosowania ogrodu jako elementu pomocniczego w rehabilitacji. Od lat 30. XX w. wspomniana forma terapii alternatywnej popularna jest w Stanach Zjednoczonych, Australii, Kanadzie, Japonii, Wielkiej Brytanii, Niemczech, Holandii, Belgii i krajach skandynawskich. W Polsce pionierem w stosowaniu ogrodu, jako środka wspomagającego leczenie jest Szpital im. św. Ludwika w Krakowie. Kolor, kształt, zapach, faktura roślin i obiektów małej architektury, dźwięk wody w fontannie, szum wiatru, śpiew ptaków oraz rozmowa z innymi osobami przebywającymi w ogrodzie stymulują narządy zmysłów i uatrakcyjniają rehabilitację. Dotykanie roślin, wdychanie pięknego zapachu oraz wykonywanie czynności ogrodniczych prowadzi do redukcji napięcia psychicznego i stresu. Poprzez wzmocnienie siły mięśni, poprawę koordynacji, równowagi i wytrzymałości fizycznej terapia ogrodowa wspomaga rehabilitację zdrowotną.
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Dudkiewicz M., Szot P., Pogroszewska E., Durlak W. 2016. Przystosowanie ogrodu przydomowego do potrzeb osoby niepełnosprawnej ruchowo. Niepełnosprawność i rehabilitacja 2: 189-198 Streszczenie. Podstawą kompozycji ogrodu przydomowego spełniającego funkcję terapeutyczną powinna być wieloaspektowa wiedza o niepełnosprawności użytkownika, jego predyspozycjach fizycznych i psychicznych oraz o dostępnych rozwiązaniach technicznych ułatwiających poruszanie się osób niepełnosprawnych ruchowo. Architekt krajobrazu powinien tak zaprojektować ogród by stworzyć możliwość realizacji potrzeb i celów osoby niepełnosprawnej, przy zachowaniu estetyki i różnorodności przestrzeni dla wszystkich korzystających z ogrodu. W pracy zaprezentowano koncepcję zagospodarowania przydomowej przestrzeni ogrodowej dostosowanej dla użytkownika poruszającego się na wózku. Słowa kluczowe: ogród przydomowy, ogród terapeutyczny, hortiterapia Summary. The basis of the composition backyard garden that meets the therapeutic function should be multi-faceted knowledge of the user's disability , his physical and mental abilities and the available technical solutions to facilitate the movement of persons with reduced mobility. The landscape architect should design the garden to create the opportunity to meet the needs and goals of a disabled person , while maintaining the aesthetics and diversity space for all the users of the garden. The paper presents a concept of development backyard garden space customized for the user who uses a wheelchair.
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Background Recent epidemiologic analyses have considered impacts of multiple spatially correlated urban exposures, but this literature has not been systematically evaluated. Objectives To characterize the long-term impacts of four distinct spatially correlated urban environmental exposures – traffic-related air pollution (TRAP), noise, natural spaces, and neighborhood walkability – by evaluating studies including measures of at least two such exposures in relationship to mortality, cardiovascular disease, chronic respiratory disease, allergy, type 2 diabetes, or reproductive outcomes. Methods Following the Navigation Guide framework, the literature was searched for studies published since 2003 and meeting predefined inclusion criteria. Identified studies were scored individually for risk of bias and all studies related to an exposure-group set were appraised for overall quality and strength of evidence. Results A total of 51 individual studies (TRAP and noise: n = 29; TRAP and natural spaces: n = 10; noise and natural spaces: n = 2; TRAP, noise, and natural spaces: n = 7; TRAP, noise, natural spaces, and walkability: n = 3) were included. When TRAP and noise were considered jointly, evidence was sufficient for increased cardiovascular morbidity with higher noise exposures; sufficient for no effect of TRAP on CVD morbidity; sufficient for increased mortality with higher TRAP exposures, but limited for noise; and limited for increased adverse reproductive outcomes with higher TRAP exposures and no effect of noise. Looking at natural spaces and TRAP, there was limited evidence for lower risk of chronic respiratory disease and small increases in birthweight with greater natural space; this relationship with birthweight persisted after adjustment for noise as well. Evidence was inadequate for all other exposure groups and outcomes. Discussion Studies that properly account for the complexity of relationships between urban form and physical health are limited but suggest that even highly correlated exposures may have distinct effects. Review registration PROSPERO 2018 CRD42018106050.
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Human visual preferences for slides of five natural landscapes or biomes-tropical rain forest, temperate deciduous forest, coniferous forest, savanna, and desert-were examined. Subjects were third graders, sixth graders, ninth graders, college students, adults, senior citizens, and a group of professional foresters. A series of 20 slides, 4 examples of each biome, was shown twice to each group of subjects. On one pass through the slides, subjects judged how much they would like to live in an area similar to the one represented; on the other pass, subjects rated the slides for how much they would like to visit an area similar to the one shown. Judgments were made on a 6-point Likert scale. Elementary schoolchildren showed a significant preference for savanna over all other biomes. From midadolescence and through adulthood, more familiar natural environments were equally preferred to savanna. Results were interpreted as providing limited support for the hypothesis that humans have an innate preference for savanna-like settings that arises from their long evolutionary history on the savannas of East Africa.
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Evolution has given human beings strong perceptual and informational biases that affect aesthetic preferences for landscapes. A model of visual landscape preference developed largely from these biases forecasts high preference for scenes (a) that have various attributes facilitating perception and comprehension, or (b) that convey to the observer an explicit anticipation that additional information can be gained by changing the vantage point. These information properties are conceived as independent dimensions underlying preference and are represented in the model as several component variables: complexity, focality, ground surface texture, depth, and mystery. The performance of the model is tested by its application to preference data obtained from groups of Americans and Swedish Ss. Results support the model's accuracy and strongly suggest that the formulation identifies major determinants of preference. One implication is that much previous work on aesthetic preference for landscapes has overstated the importance of culture and neglected the role of informational determinants. (52 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Different conceptual perspectives converge to predict that if individuals are stressed, an encounter with most unthreatening natural environments will have a stress reducing or restorative influence, whereas many urban environments will hamper recuperation. Hypotheses regarding emotional, attentional and physiological aspects of stress reducing influences of nature are derived from a psycho-evolutionary theory. To investigate these hypotheses, 120 subjects first viewed a stressful movie, and then were exposed to color/sound videotapes of one of six different natural and urban settings. Data concerning stress recovery during the environmental presentations were obtained from self-ratings of affective states and a battery of physiological measures: heart period, muscle tension, skin conductance and pulse transit time, a non-invasive measure that correlates with systolic blood pressure. Findings from the physiological and verbal measures converged to indicate that recovery was faster and more complete when subjects were exposed to natural rather than urban environments. The pattern of physiological findings raised the possibility that responses to nature had a salient parasympathetic nervous system component; however, there was no evidence of pronounced parasympathetic involvement in responses to the urban settings. There were directional differences in cardiac responses to the natural vs urban settings, suggesting that attention/intake was higher during the natural exposures. However, both the stressor film and the nature settings elicited high levels of involuntary or automatic attention, which contradicts the notion that restorative influences of nature stem from involuntary attention or fascination. Findings were consistent with the predictions of the psycho-evolutionary theory that restorative influences of nature involve a shift towards a more positively-toned emotional state, positive changes in physiological activity levels, and that these changes are accompanied by sustained attention/intake. Content differences in terms of natural vs human-made properties appeared decisive in accounting for the differences in recuperation and perceptual intake.
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This paper provides a historical context for the Probe studies reported in this special issue by describing the stalled development of post-occupancy evaluation (POE) in Britain since the 1960s. It charts 40 years of continuing academic, professional and commercial neglect of POE as a mainstream activity in the procurement of buildings in Britain. It notes the current resurgence of interest in the "customer care" focus of the Egan Report. And it closes by identifying a re-emerging research agenda for POE in Britain. This could include its use for benchmarking progress in the transition towards more sustainable production and consumption of the built environment.
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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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... And analysis of this body of research is at least suggestive that a cause-ef- fect relationship exists between some health - care environmental factors and therapeutic ... xx An Investigation to Determine Whether the Built Healthcare Environment Affects Patients' Medical Outcomes ...
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In order to get an idea of special places for children, it is important not only to learn more about the places children like, but also about the places children dislike or even fear. As part of a longitudinal research project about children and their outdoor environment in The Netherlands, data on these issues were collected by means of interviews and mapping techniques. The whole project consisted of a pilot study involving 36 children ages 6 to 12 years and a main study involving 140 children of the same ages. These children were asked which places in their direct neighborhood they liked, disliked, or feared and what reasons they had for their preferences. This article reports on the results of the study, giving the main categories and figures of the responses and discussing the qualitative information from the reasons the children gave for their preferences.
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The utility of different theoretical models of restorative experience was explored in a quasi-experimental field study and a true experiment. The former included wilderness backpacking and nonwilderness vacation conditions, as well as a control condition in which participants continued with their daily routines. The latter had urban environment, natural environment, and passive relaxation conditions. Multimethod assessments of restoration consisted of self-reports of affective states, cognitive performance, and, in the latter study, physiological measures. Convergent self-report and performance results obtained in both studies offer evidence of greater restorative effects arising from experiences in nature. Implications for theory, methodology, and design are discussed.
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An empirical investigation focused on person-window transactions in the physical medicine and rehabilitation environment. Attributes of windows, view, daylight, and spaces perceived as insufficient in these respects were studied in six hospitals. Preference, environmental documentation, and behaviorsassociated with windows and windowless rooms were the subject of a two-part interview and questionnaire. The respondent group numbered 250 persons. Nonmetric multidimensional scaling (MDS) was utilized, yielding an array of 21 cognitive dimensions. From evaluations of 56 photographs that sampled a broad spectrum of spaces ranging from highly windowed to windowless, 8 visual dimensions were identified; and 13 nonvisual dimensions distilled from 89 written response items were identified that addressed degree of satisfaction and associated behaviors. Among the findings, ideal window and view conditions frequently contrasted the actual conditions in one's hospital setting; informative views of urban life and nature beyond the hospital, accessible from one's typical viewing angle and position within the room, were desired; minimally windowed rooms wereequated with architecturally windowless spaces, and window-view substitutes in windowless rooms were distinguished from similar rooms without such compensatory measures. Implications for hospital planning and design are discussed.
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In an attempt to move beyond traditional design guidelines to develop and design healing gardensfor Alzheimers disease facilities, the author presents his theory of remembrance therapy. Using Sedgewood Commons, a). Alzheimer'sfacility designed by the!.Mthor and located in Falmouth, Maine, as a prototype, this paper examines the design of built gardens that support the theory of remembrn nce therapy. Simply stated, remembrance therapy is based on the theory lriat each stage of Alzheimer s diseast--mild, moderate, and severe-ixs associated with a correspondib-g emotional stage of normal human development-adult, child, and infant. Thus, the author describes built ga rden types that are designed to respond to the emotional equivalent of each corresponding stage of normal human development. This paper concludes with a brief discussion and inquiry into the role of post-occupancy evaluation, research, and data gathering. This is done in an attempt to validate or refine remembrance therapy as a landscape planning awd design method for Alzheimer's Facilities.
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Contrasts the naturalistic research paradigm with the scientific model, noting that the naturalistic paradigm assumes multiple reality, subject-object interrelatedness, and contextuality. Skills required for the pursuit of naturalistic inquiry are described. (JEG)
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Explored the relationship of well-being to physical settings in workshop visualizations and artwork by adults asked to depict settings where healing occurs. Characteristics of natural spaces such as motion, control, light, privacy, and beauty are discussed for their healing properties. Adults' strong images of the healing capacity of natural spaces argues for increasing children's contact with nature as a critical resource for healthy growth and development. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The dearth of theoretically driven research on the predictors of pediatric chronic pain may unwittingly contribute to needless suffering in children and adolescents by underinvestigating a potentially treatable condition. The objective of the present study was to investigate the hypothesized predictive effects of perceived stress on pediatric chronic pain intensity in 148 children and adolescents. Consistent with thea priori Biobehavioral Model of Pediatric Pain, higher perceived stress was predictive of greater pediatric pain intensity. The results are discussed with regard to the implications for cognitive-behavioral pediatric pain treatment.
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A group of members and volunteers at the Morton Arboretum near Chicago rated their preferences for photographs of landscapes in the arboretum, wrote open-ended descriptions of their favorite arboretum settings, and described the thoughts, feelings, and memories they associated with those settings. Most participants rated densely forested, natural landscapes highest in preference, but some also liked either open, natural fields or maintained, formal landscapes. The open-ended descriptions revealed a variety of significant meanings and experiences, some of which appeared to be associated with specific kinds of environments. The combination of quantitative and qualitative research methods yields a more complete understanding of how people experience arboretum landscapes, than would either method used by itself.
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Environmental design research and participation can enable groups with different environmental values to negotiate critical design decisions. This article presents findings and techniques from two open space projects—one a neighbourhood playground, the other an elementary schoolyard—found to be useful in clarifying differences in open space values and preferences. Specific differences between child and adult views of these places are reviewed. How participation and research was utilized to help resolve basic open space differences is discussed. The article concludes with a brief review of future issues facing research and design participation.
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nand urbanization: the dirt, dilapidation, overcrowding, and unsanitary conditions of industrial cities. It is our view that the uncritical continuation and extension of these policies as priorities for twentieth century problems is inappropriate be­ cause these policies do not take into account new information. First, sani­ tary programs in the nineteenth century were primarily directed toward, and had a major impact on, the infectious diseases that decimated popula­ tions at that time. These diseases are no longer the main causes of morbidity and mortality in industrialized nations of the world. The main causes of disease today include conditions not related directly to sanitation, such as coronary heart disease, stroke, cancer, mental illness, accidents, and sui­ cide. Second, the development of modern industrialized communities has generated a range of new disease-producin g agents also not related directly to sanitation, such as toxic chemicals and waste, increased levels of ionizing radiation, vehicle exhaust and other new synthetic products that pollute air, water and food. Third, as will be seen, new evidence indicates that disease occurs more frequently (a) among those with fewer meaningful social rela­ tionships, (b) among those in lower hierarchical positions, and (c) among those disconnected from their biological and cultural heritage.
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The role of the health care physical or tangible environment, including the facility, is essentially an unstudied area. This article identifies and defines components of "atmospherics" concerning health care (Healthscapes), to assess their strengths and predictiveness in the relationship between patient and other customer outcomes, satisfaction, quality assessments, intention to return, and willingness to recommend a health care provider to others and to propose much needed research in the area.
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Medical care cannot be separated from the buildings in which it is delivered. The quality of space in such buildings affects the outcome of medical care, and architectural design is thus an important part of the healing process. This article explores the relation between spatial design and healing by focusing on recent developments in the design of hospitals in the United States. The number of U.S. hospitals grew steadily from 6125 in 1945 to 7174 in 1974, an increase of 17 percent.1 Since 1975, however, there has been a continuous decline in numbers, to 6467 in 1993, while the average . . .
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Conceptually-driven investigations on the potentially modifiable predictors of individual differences among children with newly-diagnosed cancer may facilitate the identification of pediatric cancer patients at risk for maladjustment during the profound adversity associated with this life-threatening disease and aversive biomedical treatment. Within a risk and resistance theoretical framework, perceived stress and social support were investigated concurrently and prospectively within an exploratory design as predictors of negative affectivity (anxiety and depressive symptoms composite construct) in newly-diagnosed pediatric cancer patients at Time 1 (within one month after diagnosis), Time 2 (6 months postdiagnosis), and Time 3 (9 months postdiagnosis). Hierarchical multiple regression analysis findings indicate that perceived stress and social support have direct and independent effects on negative affectivity principally at the 9-month time interval. These findings are discussed in terms of the cognitive-behavioral treatment implications for enhancing child adjustment during the transition from the initial cancer diagnosis and aversive biomedical treatment to subsequent school and social reintegration.
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Greater fear or distress prior to surgery is associated with a slower and more complicated postoperative recovery. Although anxiety presumably interferes with recuperation through both behavioral and physiological mechanisms, the pathways have been unclear. Recent work in psychoneuroimmunology (PNI) has demonstrated that stress delays wound healing. In addition, a second line of research has illustrated the adverse effects of pain on endocrine and immune function. A biobehavioral model is described that is based on these and other data; it suggests a number of routes through which psychological and behavioral responses can influence surgery and post-surgical outcomes. Clinical and research implications are highlighted.
Cognition and Environ-ment: Functioning in an Uncertain World Psychological in-£uences on surgical recovery: Perspectives from psy-choneuroimmunology
  • R Kaplan
  • S Kaplan
  • J K Kiecolt-Glaser
  • G G Page
  • P T Marucha
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