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Stress-Reducing Effects of Real and Artificial Nature in a Hospital Waiting Room

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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.
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... In those situations, the question becomes how to bring nature inside in order to allow older adults to enjoy nature's charms. Interestingly, several studies show that indirect contact with nature, such as exposure to pictures and videos, can have effects comparable to real nature interaction (Beukeboom et al., 2012;Keniger et al., 2013;van Rompay and Jol, 2016). For instance, even brief exposures to nature videos or awe-evoking nature images during a day can boost people's mood and emotions (Joye and Bolderdijk, 2014;Browning et al., 2020). ...
... When it comes to bringing nature inside, various types of nature representations have been used across a wide range of studies (for a review, see Keniger et al., 2013), varying from images, to posters, to videos (Beukeboom et al., 2012;van Rompay and Jol, 2016). Overall, findings show that such indirect encounters with nature can at least to some extent confer the same benefits as interactions with real nature (Keniger et al., 2013). ...
Article
Feelings of disconnectedness and social isolation among older adults are increasingly recognised as important challenges of our times. Interestingly, nature interaction can stimulate social connectedness and enhance perceived social support, indicating that nature can contribute to social wellbeing. However, nature may not always be around or accessible for older adults. In such cases, digital nature could provide an alternative means for enjoying nature's benefits. To identify limitations and restrictions that older adults experience with respect to nature interaction, and to explore preferences with respect to digital nature and their potential for influencing social wellbeing, two studies are reported: a qualitative study comprising focus groups with Dutch care centre residents (N = 26) and a subsequent quantitative study (N = 200) testing effects of digital landscapes on social wellbeing measures. Findings from the focus groups indicate that opportunities for nature interaction and preferences for digital nature vary with mobility restrictions, whereas findings from the quantitative study testify to the potential of digital nature for enhancing social wellbeing and related emotions. These findings extend research on how (digital) nature interventions can contribute to the social wellbeing of older adults and pinpoint essential nature characteristics important for doing so.
... Since people in urban societies spend most of their time indoors (WHO, 2013), integrating nature into the indoor living environment could generate a health-supportive environment (McSweeney et al., 2015;Gillis and Gatersleben, 2015). Even simulated nature like posters or pictures can have a significant relaxing effect (Beukeboom et al., 2012;McMahan and Estes, 2015). Apart from improving air quality, a growing body of literature suggests that indoor plant exposure has relaxing, restorative, and mood-improving properties, and that there can even be psychophysiological consequences, such as an activated parasympathetic nervous system (Deng and Deng, 2018;Han and Ruan, 2020). ...
... First, compared to exposure to real plants or using virtual reality, pictures might induce less immersion due to the lack of multisensory stimulation. Nonetheless, previous picture studies successfully prompted psychophysiological restorative effects by nature pictures (Brown et al., 2013;van den Berg et al., 2015), pictures sometimes outperformed virtual reality for physiological restoration (Mostajeran et al., 2021), and nature posters enabled the same experienced stress effect as real plants (Beukeboom et al., 2012). Second, the effect of color was verified by integrating greyscale plants/objects in the pictures. ...
Article
Aim Urbanized environments may stimulate unhealthy food choices and stress. Several theories explain that exposure to green nature can counter these stress effects. Since we spend most time indoors, integrating nature in the interior could be a promising health promotion tool. Hence, we tested whether the beneficial effect of nature for stress recovery is also present in indoor settings via the use of plants or green colors, and whether it is applicable on eating behavior as a new outcome. Methods The 92 participants (18-30y, 16% men) were divided into four groups. Each viewed a 6-min slideshow with room pictures containing either green plants, green objects, greyscale plants or greyscale objects to allow distinction between color- and plant-effects. Group differences were tested for the perceived restorativeness scale, psychological recovery and eating behavior. To allow psychological recovery testing, participants were exposed to a stressor before the picture slideshow via the Trier Social Stress Test. The change of self-reports (stress, positive and negative affect) and psychophysiology (heart rate and vagal-induced heart rate variability RMSSD) post-slideshow versus pre-slideshow was checked. Eating behavior outcomes included change in hunger, craving, and food choice (for fruits, vegetables and snacks). Results From the four picture sets, the green plants pictures were reported as most mentally restorative and appeared most beneficial for post-stressor recovery of positive affect, but not for negative affect or stress recovery. The green plants group also had higher preference for vegetables and lower preference or craving for (unhealthy) snacks. Those significant group differences were mainly due to the presence of plants and only occasionally due to the green color. Conclusion Indoor green plant pictures were associated with higher mental restorativeness and healthier food choices. Integrating plants in the interior seems to be a relevant health promotion approach, while applying green colors seems less relevant.
... While urban environments have negative effects on individuals, natural environmental stimuli that do not cause a threat have stress-reducing and regenerative effects [13]. Today, visual and audial interventions are commonly used in the hospital environment due to their positive effects [14,15]. However, the influence of visual and audial designs of waiting rooms has not been sufficiently investigated in breast cancer patients who are to receive adjuvant or neoadjuvant chemotherapy for the first time. ...
... Using still art by covering a frame in waiting rooms has positive effects on anxiety and stress through a "window-like" effect [40]. Beukeboom et al. obtained a similar effect through artificial nature in a heterogeneous patient population in the radiology department [15]. In our study, in order to create such a "window-like effect," real nature scenic views such as natural coasts and meadows which do not include restrictive elements were used. ...
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... We think that the preferred use of metaphors for mood tracking and regulation can be applied to designing built environments and shared experiences in social spaces. For example, nature-inspired sounds and lighting might be used to regulate the moods in waiting rooms (Beukeboom, Langeveld, & Tanja-Dijkstra, 2012;Fenko & Loock, 2014). ...
Conference Paper
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Many studies have demonstrated the positive impact of self-tracking technology on people’s health and wellbeing. Research on the effects of the tools for tracking moods to create awareness of people’s affective health is also gaining attention. In addition, studies show that people are open to using tools that contribute to sharing their moods and reflecting on them. In this paper, we aim to contribute to this emerging field. We carried out a three-phase study (i.e., exploratory survey, cocreation, and testing) with a total of 46 participants to explore preferred ways of mood tracking and the ways design can support these ways. By presenting the results of each phase, we show how design studies can contribute to mood tracking and sharing studies.
... Exercising outside and being in nature were shown to be the two most effective ways of reducing stress, outperforming ten other leisure activities (e.g., dining out, social relations, and cultural activities). Beukeboom, Langeveld, and Tanja-Dijkstra (2012) looked at whether plants in a radiology waiting area may reduce patient anxiety. When compared to the control group, the results revealed that exposure to either actual plants or photographs of plants resulted in reduced levels of stress. ...
Book
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Promotion of Responsible environmental Behavior
... In relation to vulnerable subpopulations, nature-based interventions have a good evidence base for positive mental health outcomes [32] and have the potential for a much wider impact across a range of population groups [33]. Within clinical settings, exposure to nature has been shown to reduce stress, anxiety, and pain through distraction [34][35][36], diverting patient's attention to a pleasant environment, and in turn increasing positive affect and reducing negative affect [37]. ...
Article
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The importance of natural environments in supporting health and wellbeing has been well evidenced in supporting positive mental and physical health outcomes, including during periods of crisis and stress. Given the disproportionate impacts of the COVID-19 pandemic have been greatest for those who are most vulnerable, understanding the role of natural environment and alternative forms of nature engagement in supporting health and wellbeing for vulnerable groups is important. This study explored how nature engagement supported health and wellbeing in those with a pre-existing health condition during the first UK lockdown. Semi-structured interviews were conducted with 17 adults with a pre-existing health condition and analysed using Interpretative Phenomenological Analysis (IPA). Four themes were identified: COVID-19 versus nature; Nature as an extension and replacement; Nature connectedness; and Therapeutic nature. The findings show the importance of nature in supporting health and wellbeing in those with a pre-existing health condition through engagement with private and public natural environments, micro-restorative opportunities, nature connection as an important pathway, and the therapeutic benefits of nature engagement. The present research extends the evidence-base beyond patterns of nature engagement to a deeper understanding of how those with existing health conditions perceived and interacted with nature in relation to their health and wellbeing during the first UK lockdown. Findings are discussed in relation to health supporting environments, micro-restorative opportunities, and policy implications
... For example, offices with a view of natural features are known to improve job satisfaction and well-being, reduce stress and low mood, and also reduce sick leave compared to offices without natural features (Heerwagen and Orians 1986;Leather et al. 1998;Shibata and Suzuki 2004;Bringslimark et al. 2007;Kweon et al. 2008). Even hospitals with a view of natural landscapes induce in their patients better recovery, less stress and lower pain perception (Ulrich 1984;Lechtzin et al. 2010;Beukeboom et al. 2012). ...
... Exercising outside and being in nature were shown to be the two most effective ways of reducing stress, outperforming ten other leisure activities (e.g., dining out, social relations, and cultural activities). Beukeboom, Langeveld, and Tanja-Dijkstra (2012) looked at whether plants in a radiology waiting area may reduce patient anxiety. When compared to the control group, the results revealed that exposure to either actual plants or photographs of plants resulted in reduced levels of stress. ...
Chapter
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Chapter
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