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Stress-Reducing Effects of Real and Artificial Nature in a Hospital Waiting Room
Abstract
This field study investigated the potential stress-reducing effects of exposure to real or artificial nature on patients in a hospital waiting room. Additionally, it was investigated whether perceived attractiveness of the room could explain these effects.
In this between-patients experimental design, patients were exposed to one of the following: real plants, posters of plants, or no nature (control). These conditions were alternately applied to two waiting rooms.
The location of this study was two waiting rooms at the Radiology Department of a Dutch hospital.
The subjects comprised 457 patients (60% female and 40% male) who were mostly scheduled for echocardiogram, dual-energy x-ray absorptiometry, magnetic resonance imaging, computed tomography scans, or nuclear research.
Patients exposed to real plants, as well as patients exposed to posters of plants, report lower levels of experienced stress compared to the control condition. Further analyses show that these small but significant effects of exposure to nature are partially mediated by the perceived attractiveness of the waiting room.
Natural elements in hospital environments have the potential to reduce patients' feelings of stress. By increasing the attractiveness of the waiting room by adding either real plants or posters of plants, hospitals can create a pleasant atmosphere that positively influences patients' well-being.
... Yin et al. (2018) confirmed that natural elements in both real and virtual indoor environments decreased negative emotions and increased positive emotions with improvement in short-term memory. In healthcare environments, natural elements can help relieve stress (Beukeboom et al., 2012;Dijkstra et al., 2008), stimulate positive moods (Berman et al., 2012;Park & Mattson, 2008), and offer positive distractions and social support (Andrade & Devlin, 2015). Berman et al. (2012) compared changes in positive moods in individuals diagnosed with major depressive disorders. ...
... Several recent studies presented the positive effects of nature contact in hospital waiting areas. Beukeboom et al. (2012) found that patients exposed to real plants or posters of plants in hospital waiting rooms showed lower stress levels than those without any natural element exposure. Bai (2015) demonstrated that access to daylight and nature views from windows was associated with less negative and more positive behaviors. ...
... Nanda et al. (2012) focused on behavioral responses to nature images in ED waiting areas and found that nature images positively influence waiting experiences by reducing people-watching behavior, increasing socializing, and reducing desk queries and out-of-seat behaviors. Beukeboom et al. (2012) found a significant mediating role of the perceived attractiveness of the waiting environment in the effect of natural elements of the waiting area on stress levels. Pruyn and Smidts (1998) studied the effects of wait time and waiting environment on satisfaction and found that the attractiveness of the environment influences satisfaction, with positive affective responses mediating this effect. ...
Visitors to emergency department waiting areas often experience high anxiety, which results in discomfort during their waits. Our findings offer empirical evidence for the positive impact of including natural elements in these waiting areas. We created four high-fidelity virtual environments that incorporated natural elements in three ways, i.e., the presence of plants, the use of nature images and natural materials, and a combination of those two, in addition to a controlled environment without natural elements. We tested how subjects responded to each environmental setting. Our findings demonstrated that the inclusion of natural elements significantly lowered patients' anxiety in hospital environments, confirming previous research, and the presence of natural elements improved perceived wait time, as well as service quality through anxiety and perceived wait time. The combination yielded higher scores in anxiety, perceived wait time, and service quality than the other conditions. Serial mediation analysis results revealed that underlying anxiety and patients' perceived wait time mediated the effect of natural elements on perceived service quality. Among the five dimensions of service quality, the mediating effects of anxiety and perceived wait time appeared stronger in reliability and responsiveness.
... Biophilic design has been shown to produce a range of positive impacts in healthcare environments (Ulrich, 2001;El Messeidy, 2019;Dijkstra et al., 2008;Park, S. H., & Mattson, R. H., 2008;Beukeboom et al., 2012). Visual connections with nature, such as the use of plant walls or nature views, have been linked to reduced stress, improved mood, and faster recovery times for patients. ...
... These effects were partially mediated by the perceived attractiveness of the waiting room. Incorporating natural elements in hospital environments has the potential to reduce patients' feelings of stress and increase the attractiveness of the waiting room, creating a pleasant atmosphere that positively influences patients' well-being (Beukeboom et al., 2012). These studies indicated the importance of biophilic applications in enhancing users' wellness in hospital environment, supporting the goal of psychologically supportive design. ...
... Under the current global situation, where the time spent indoors has greatly increased, the findings demonstrated the benefits of biophilia in a built environment in everyday life. When planning artificial indoor environments or renovating existing buildings, architects, interior designers, and developers should consider incorporating direct and indirect features of biophilic design to improve affect, cognitive performance, and wellbeing (Beukeboom et al., 2012;Sharam et al., 2023). ...
In recent years, there has been a growing interest in investigating the influence of biophilic design on occupants’ psychological comfort and well-being in the built environment. Biophilic principles aim to leverage the therapeutic effects of nature to alleviate distress, depression, anxiety, and pain. The impact of biophilic design can vary depending on the outcome measures and the design context, but studies examining diverse forms of biophilic design in hospital rooms have been limited. The study investigated how the incorporation of biophilic design elements in a virtual reality (VR) hospital patient room affects emotional and brain responses. The purpose of this experiment was to measure interactive emotions in an experimental setting, using a combination of electroencephalogram (EEG) and VR methods. A machine learning approach and statistical analysis were applied to differentiate emotional changes related to biophilic design. Seventy-five participants were divided into three groups to investigate the distinct effects of three types of biophilic design. EEG recordings were taken during experimental conditions to determine how biophilic design affects brain and emotional states. The Positive and Negative Affect Scale (PANAS) and State-Trait Anxiety Inventory - state (STAI-s) were used to measure changes in emotion and anxiety state. The results of the machine learning application on EEG data showed that classification accuracy above 90% included the frontal region in all classification conditions, indicating that biophilic design causes changes in brain function in this region. For the classification of the control room and digital wall room, and the control room and both plant and digital wall room, alpha power for frontal regions was included with above 90% classification accuracy. The results of the statistical analysis of the EEG data found that low-frequency band, which is associated with a relaxed state, was increased by biophilic design, while high- frequency band, which is associated with high arousal state, was reduced. These findings suggested that bio- philic design in a hospital room can reduce tension. The results from PANAS and STAI-s showed that biophilic design can induce positive emotional changes. The results of PANAS suggested that adding plant walls can reduce negative emotions due to their calming effect on the human nervous system. Using both plant walls and digital elements in healthcare environments can have a complementary effect on emotional well-being by reducing negative emotions while enhancing positive emotions. The study can potentially contribute to building a deeper and unified knowledge base for developing evidence-based designs to improve mental health and well-being. Moreover, the study provides insights into the potential benefits of different forms of biophilic design and their impact on human well-being.
... However, for [68], the connectedness with nature is a predictor only when the individual is "emotionally attuned to nature's beauty". So, the influence of the paintings is mediated by perceptive or emotional-related variables and does not have the same psychological and physiological impact [61,73]. By following the three levels model, the mediators are represented in the interaction between the subjective and the objective levels by considering the needs and the goals of the individuals in the context of objective limitations imposed by the current conditions. ...
... The patients in two waiting areas of a radiology department were subjected to natural plants or pictures of Nature 457 patients The effect of nature (artificial/ natural) on the stress reduction in waiting areas (Beukeboom, Langeveld, & Tanja-Dijkstra, 2012) (Alimoglu & Donmez, 2005) ...
Today, the design of a healthcare facility is not just about designing a performance-based building. In contrast, it gradually shifts to a design that respects and considers human needs and shows admiration for the medical team and patients. The literature review revealed many physical and psychological environmental factors that affect the Patient's health and recovery. Since most studies have focused on the effects of a single physical or psychological environment factor, in this research, we intend to investigate the results of the previous works and categorize them to provide a list of those affecting factors. In this research, through a deep review and the scientific method, the environmental factors and processes for measuring them are provided in a table. This table could be applied as a guiding tool for environmental designers and is a checklist for controlling the utilization of all the factors in environmental designs.
... Research has suggested that both nature and companion animals can create calming environments [12,13,96], which could help students feel more at ease and willing to connect prior to an advising session. Further investigation is necessary to explore this relationship. ...
The benefits of animal-assisted interventions (AAI) involving animals in therapy are widely accepted. The presence of animals in therapy can decrease a patient’s reservation about therapy and promote a sense of comfort and rapport during the therapy process. Using survey data from college students (n = 152) attending a large public four-year institution, this study is the first to investigate the benefits of virtual animal stimuli during academic advising appointments. It posits that exposure to virtual animal stimuli can influence positive mental health and well-being in academic advising settings. Specifically, the research questions explored how different types of video content influence students’ affect and how virtual animal stimuli impact students’ perception of their advisor and university. College students were randomly assigned to watch one of four types of virtual stimuli (wild animals, companion animals, nature, and a control) prior to their advising session. Subjective measures were collected at baseline and after the advising session. Results indicated animal stimuli increase positive affect, and companion animal stimuli influence the student’s perception of the advisor. This study supports the notion that companion animal videos positively impact students’ well-being and interactions with their advisors and may have broader implications beyond the academic setting.
... Ulrich [62] examined records on recovery from surgery and found out that the assignment to a room with a window view of a natural setting has stronger restorative influences than a room with a window view of a brick building wall. Beukeboom et al. [63] showed that natural elements in hospital environments have the potential to reduce patients' feelings of stress and thereby to contribute to higher levels of well-being, but not only in hospital settings nature does play an important role. ...
Stressors are especially widespread in urban agglomerations. Common themes of built environment interventions that support health and well-being are blue and green infrastructure, indoor and outdoor air quality, thermal comfort, access to natural lighting, and acoustics. Given the current megatrends of increasing summer temperatures and the high popularity of home offices, we aimed at modeling thermal comfort changes of people working at home in three Austrian cities (Vienna, Innsbruck, and Graz) during the next decades until 2090. We present findings based on (I) an inter-disciplinary literature search and (II) indoor and outdoor climate simulations for actual and future climate scenarios. Based on the results, we discuss the potential impacts for work and human health and well-being, and we suggest a framework for the home office in “post-COVID-19 Austria” that integrates social, ecological, and economic aspects. The results of our study indicate that, in future climate scenarios, overheating of the interior can no longer be prevented without active cooling measures and nature-based solutions. Recommendations on the adjustment of behavior under climate change, including greening, adequate ventilation, and cooling techniques, are thus urgently needed for employees who are working from home in order to maintain physical and mental health and wellbeing.
... In addition, in order to make patients satisfied and attached to a healthcare establishment, managers should incorporate natural/green features in the interior areas of the healthcare setting (e.g., reception area and hospital rooms) in various ways to increase their positive influence on patients. Previous studies (Beukeboom et al., 2012) have shown that patients recovering from surgery who were exposed to plants or various posters of plants placed inside the hospital room exhibited positive physiological, psychological, and perceptual outcomes. In addition, Walch et al. (2005) indicated that patients who were exposed to increased amount of natural light reported reduced perceived stress and decreased pain during medical treatments. ...
The present study aims to evaluate a conceptual framework that explains patients' attachment to a healthcare establishment by considering the effect of a natural/green environment as nature-based solutions (NBS), mental health value, emotional wellbeing, and satisfaction. An online survey method was utilized to reach Romanian patients. Using this procedure, a total of 386 cases were used for the data analysis. Structural equation modeling was utilized as the data analysis method. Our findings reveal that natural/green environment as NBS significantly influences patients' mental health value, emotional wellbeing, and satisfaction, which contributes to an increase in their attachment to the healthcare facility. In addition, the mediating role of mental health value, emotional wellbeing, and satisfaction is uncovered. Our results can help healthcare managers and researchers develop strategies to effectively integrate natural/green features as NBS in the interior spaces of healthcare settings.
p>Narasi cerita yang disampaikan melalui teks dapat memberikan informasi secara detail mengenai perasaan yang sedang dihadapi oleh seorang karakter, sedangkan cerita melalui visual seperti film terkesan sangat sulit untuk menyampaikan informasi seperti demikian karena keterbatasan dalam berdialog dan adanya jarak antara penonton dengan layar film. Tujuan dari jurnal ini yakni untuk mencari tahu apakah color psychology , jika diterapkan pada adegan film, dapat memberikan dampak pada emosi penonton sehingga secara tidak langsung mampu membuat penonton merasakan perasaan seorang karakter pada film. Dari hasil kuesioner yang telah dijawab oleh 38 orang, dapat disimpulkan bahwa penerapan color psychology bisa mempengaruhi perasaan pengamat. Studi ini berkontribusi untuk memberikan pengetahuan penting khususnya kepada para perancang visual untuk menciptakan film yang lebih bermakna dan lebih kuat secara emosional.</p
Aim To explore the impact of dental anxiety on daily living.
A well-known research report showed that being in a hospital room with a view of trees rather than a view of a building was linked to the use of fewer pain-reducing medications by patients recovering from surgery. The experiment reported here was designed to further examine the role of plants in pain perception. We found that more subjects were willing to keep a hand submerged in ice water for 5 min if they were in a room with plants present than if they were in a room without plants. This was found to be true even when the room without plants had other colorful objects that might help the subject focus on something other than the discomfort. Results from a room assessment survey confirmed that the room with colorful, nonplant objects was as interesting and colorful as the room with plants present, but the presence of plants was perceived as making the air in the room fresher.
Aim:
To explore the impact of dental anxiety on daily living.
Method:
Twenty people attending a dental sedation clinic completed the Modified Dental Anxiety Scale, and were interviewed privately using a reflexive, in-depth technique. All interviews were audio-tape recorded and transcribed. The transcripts were analysed to identify the impact of dental anxiety upon the participants' daily lives. Twenty-five per cent of the qualitative data was reviewed by an independent researcher to ensure the reliability of the analysis.
Results:
The mean age of participants was 41 years (range 23 to 60). The mean MDAS score was 21.5 (range 14 to 25). Five main impacts of dental anxiety were identified: physiological; cognitive; behavioural; health; and social. Subsumed under these broad categories were: the fright response; a vast array of negative thoughts, feelings and fears; avoidance behaviour and behaviours related to eating, oral hygiene, and self-medication; and other manifestations of anxiety in the dental environment including muscular tension, crying and aggression were all identified. Dental anxiety was also found to disturb sleep and to have a profound affect socially, interfering with work and personal relationships.
Conclusion:
The impact that dental anxiety can have on people's lives is wide-ranging and dynamic.
For all the debate and philosophizing and frequently polemical argument concerning nature and its relationship to man,1 the concept of nature does not seem to have proved a very natural one for psychologists. As noted in the introduction to this volume, the individual’s response to the natural environment has not been at the forefront of problems chosen for psychological investigation—not even among environmental psychologists. A perusal of the index of Psychological Abstracts reveals that Nature serves as an indexing term only in its adjectival form, and then only in reference to two very limited topics: Natural Childbirth (i.e., a process unaided by external intervention) and Natural Disasters. The prominent place of the latter as a subject of behavioral science research (though better represented within geography than psychology) may hark back to the historical fear of nature as a dangerous and potentially evil force in the affairs of man. But it is apparent from any discussion of environmental problems and treatments of the relationship between human activity and the physical environment that nature is a much more salient concept, for the lay person and the scientist alike, than one would suppose from the classification schemes of psychologists or from the subject matter of their research.
Scenes of the outdoor physical environment vary substantially in the extent to which they are preferred. Variables empirically found to predict preference can be analyzed both in terms of their information-processing implications and in terms of their evolutionary significance. Some of these predictors appear to require fairly extensive information processing, thus supporting the hypothesis that a rapid, unconscious type of cognition may precede certain affective judgments. Such ties between cognition and affect are understandable in the context of the proposed theoretical framework for environmental preference. This framework not only provides a coherent guide to research but also points to the pervasiveness and significance of aesthetics as a factor in human behavior and human experience.
This article evaluates the intuitively informed interior design changes made to a United Kingdom neurology outpatient waiting area following relocation to an alternative building. This nouveau environment is compared with the more traditional waiting area used before the relocation. The two waiting areas are compared in terms of their effects on the environmental appraisals, self-reported stress and arousal, satisfaction ratings, and pulse readings of 145 outpatients. The equivalence of the outpatient samples attending each clinic is demonstrated in terms of their common demographic characteristics and their similar health profiles. The results provide convergent evidence that the nouveau waiting area is associated with more positive environmental appraisals, improved mood, altered physiological state, and greater reported satisfaction. These findings provide support for the concept of a therapeutic hospital environment.
This review of the literature on health care environments and patient outcomes considers three research themes: patient involvement with health care (e.g., the role of patient control), the impact of the ambient environment (e.g., sound, light, art), and the emergence of specialized building types for defined populations (e.g., Alzheimer's patients). The article also describes the challenges presented in doing high-quality research focused on health care environments and contrasts the contributions made by two different traditions: architecture and behavioral science. The implications of managed care and opportunities for research are considered.
Understanding communication processes is the goal of most communication researchers. Rarely are we satisfied merely ascertaining whether messages have an effect on some outcome of focus in a specific context. Instead, we seek to understand how such effects come to be. What kinds of causal sequences does exposure to a message initiate? What are the causal pathways through which a message exerts its effect? And what role does communication play in the transmission of the effects of other variables over time and space? Numerous communication models attempt to describe the mechanism through which messages or other communication-related variables transmit their effects or intervene between two other variables in a causal model. The communication literature is replete with tests of such models. Over the years, methods used to test such process models have grown in sophistication. An example includes the rise of structural equation modeling (SEM), which allows investigators to examine how well a process model that links some focal variable X to some outcome Y through one or more intervening pathways fits the observed data. Yet frequently, the analytical choices communication researchers make when testing intervening variables models are out of step with advances made in the statistical methods literature. My goal here is to update the field on some of these new advances. While at it, I challenge some conventional wisdom and nudge the field toward a more modern way of thinking about the analysis of intervening variable effects.